Paul
Goble
Staunton, March 9 – Vladimir Putin’s
destruction of the health care system in rural Russia, his failure to invest in
roads outside the largest cities, and the elimination of bus routes that
carried those without cars to medical treatment is leading to the disappearance
of over 1,000 cities a year.
But this is not some natural death
of rural Russia; it is the direct result of Putin’s optimization program and
represents what can only be called the murder of Russian villages and thus of
an entire way of life and national culture, moves that Soviet intellectuals
protested against 50 years ago but are largely silent about now.
According to Rosstat, the number of
hospitals in Russia fell from 10,700 in 2000 when Putin came to power to 5400
in 2015; and if the current rate continues, with a loss of 353 mostly rural
hospitals a year, in three to four years, Russia will have the same number of
hospitals the Russian Empire had in 1913, according to the Center for Economic
and Political Reforms.
Its 26-page report on the way in which
Putin’s “optimization” of health care is working to drive some Russians from
the villages and to drive others to an early grave is devastating (cepr.su/wp-content/uploads/2017/04/ЗдравоЗахоронение.-Оптимизация-российской-системы-здравоохранения-в-действии.pdf).
Putin in his message to the Federal
Assembly promised to throw money at the problem sometime in the future; but he
has made similar promises in the past without changing the destructive vectors
of his own policies – and so there is no reason to believe he will change
course and begin to save the Russian village.
But the combination of the Kremlin
leader’s promises however empty they most certainly are and the tendency of
people to fail to link even the most dire statistics with very real human costs
probably will be enough to keep this issue from attracting the attention it
should to the fate of millions of Russians still living in the villages.
That makes a new report by Radio
Liberty’s Russian Service so valuable.
It describes the pre-1991 rise of medical care in a single district in
Kirov Oblast and the post-2000 collapse of that care through the eyes of Sergey Vetoshkin, a Moscow doctor who was
born and grew up in that district (svoboda.org/a/29082492.html).
In tsarist times,
he says, the number of hospital beds rose gradually to 50 by 1910, before
declining to 30 in the wake of the Bolshevik revolution. Then it recovered, and by 1956, there were 250
hospital beds in the central district hospital, 90 more in three branch
hospitals and 36 medical points. The district had 38 doctors and 252 other
medical personnel.
While conditions in these hospitals
were not always the best, they were better than residents had known before or
know now. In 1991, the doctor says, the regional
hospital opened a new three-story wing with 70 beds. But with this, Vetoshkin says, “one can stop
talking about the development of the regional health care system.”
There were problems in the 1990s and
the early 2000s, but the situation became desire beginning in 2009 when Putin
announced his optimization program, a euphemism for closure. Between 2009 and
2011, 47 medical facilities with approximately 7500 beds were shut down. Some 125 secondary medical facilities in the
villages were then shut down.
As a result, the doctor continues, “residents
from distant settlements where the nearest hospital was now dozens of
kilometers away were deprived of accessible medical service.” Only 45 percent of the roads in the district
are paved and most are impassible part of the year; and more than 70 percent of
the people are now forced to rely on nurses in rural medical points.
Adding to the disaster, Vetoshkin
says, Moscow closed the district medical training college which over the 70
years of its existence had prepared some 7500 specialists. All branch hospitals
were closed, and “practically all feldsher-midwife points were liquidated.” And the central regional hospital lost most
of its departments, with those remaining suffering serious reductions.
The number of hospital beds fell
from 340 to 30, and outpatient services were severely curtailed. Patients of all kinds from the most
infectious to newborns were thrown into the same wards because the doctors had
no other choice. And doctors have been
forced to limit hospital stays to “no more than 10 days” regardless of
prognosis.
Emblematic of how Putin’s reforms
are working is the fact that the regional hospital had to close its own kitchen
and purchase food from the neighboring district one 60 kilometers away. Those
suffering strokes or heart attacks can count on only severely limited ambulance
services to take them to that alternative district hospital. Few of these
people survive the trip.
Specialists are no longer available either
locally or in neighboring areas which means that those who can’t travel long
distances simply aren’t treated. And
most people can’t go: they don’t own cars, there aren’t any buses anymore, and
a taxi ride costs 400 to 500 rubles (7 to 8 US dollars) each way, an enormous
burden for the many unemployed.
Medical care in the district, Vetoshkin
says, has been thrown back to what it was a century ago by Putin’s optimization
program. And he thus fully agrees with the conclusion of the Center for
Economic and Political Reforms that “the state has intentionally carried out a
policy of depopulating rural areas by taking away from the villages their ‘last
hope for the future.’”
Under Putin’s rule, the population
of rural Russia has fallen consistently, with many people fleeing and others
dying prematurely, both of which are not some natural and inevitable force but
rather of Kremlin policies that even Putin is now being forced to at least say
are indefensible.
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