RFE/RL
March 1, 2008
Russia: A Robust State Fails To Resuscitate Health Care
By Claire Bigg
Copyright (c) 2008. RFE/RL, Inc. Reprinted with the permission of Radio Free Europe/Radio Liberty, 1201 Connecticut Ave., N.W. Washington DC 20036. www.rferl.org
When Svetlana Shtarkova became pregnant two years ago, she and her husband Andrei were over the moon. The young couple renovated their Moscow flat and eagerly waited for the arrival of their first child.
But their dreams were dashed when the baby was born with multiple defects, including severe brain damage, heart and lung deficiencies, and a rare form of epilepsy. Ivan, now 1, will never be able to go to school or enjoy a normal, active childhood. He will require specialized medical help all his life.
"When I went to give birth, together with my husband, we weren't suspecting anything bad at all," says Svetlana. "The doctors didn't suspect anything either because my medical card said everything was fine. So it was a shock for everyone when the baby was born with multiple congenital defects."
Nothing had prepared Svetlana for this. An initial prenatal test showed signs of trouble. But doctors had told her the baby was in good health and more comprehensive tests were not necessary.
In reality, the fetus had genetic defects and was suffering a critical lack of oxygen throughout the entire pregnancy. The condition, which caused most of Ivan's irreversible ailments, could have been detected and treated -- but weren't.
Crumbling Health Care
With comfortable incomes as marketing and publicity managers, Svetlana and Andrei had opted for one of Moscow's top-range maternity clinics. They shelled out some $2,500 for prenatal care -- a fee that excluded the actual birth.
Such fees are still considered astronomical in Russia, where many residents still remember the era of state-funded medicine. But even such high prices don't guarantee good care.
"I went for regular examinations, everyone always smiled at me, everyone was very polite," says Svetlana. "Later I understood that all I got for my money was smiles. I was not thoroughly monitored, the results were not carefully examined. It was all quite superficial."
After their son's birth, Svetlana and Andrei desperately scoured Moscow for specialists. They soon found out that few doctors were willing, let alone qualified, to take a child as sick as Ivan into their care. Svetlana was turned away from many medical centers and was eventually advised to give up her son:
"The doctor said that he would be a vegetable, that he would never recognize anyone, that all he would do was lie there and groan," she says. "She told me that my husband would leave me, that I'd end up alone with this child, and that I didn't need that kind of life."
Thoughts about suing the clinic where she received her pregnancy care have crossed Svetlana's mind. But she knows it's a lost battle -- after telling her she did not require exhaustive prenatal tests, the clinic made her sign a declaration in which she formally agreed not to undergo these examinations.
Some Russians choose to take their chances and seek legal redress for poor health care. But Lada Orlova, a lawyer specializing in medicine, says the bulk of medical errors go unreported.
"People complain mostly about public health care -- a belated diagnosis, lack of required equipment, etc," Orlova explains. "But as a rule, such people don't turn to lawyers, because those who have money for a lawyer have money for private health care."
Priced Out
The Soviet Union's public health system -- once held up as a progressive model of universally available care -- quickly fell into disrepair after the Soviet collapse. A 2000 study by the World Health Organization ranked Russia's health system 130th out of a list of 191 countries, on a par with Honduras and Peru.
Outgoing President Vladimir Putin has doubled health care spending over the past two years, but so far this has failed to bring radical improvement. Health researchers say little will change until rampant corruption is tackled.
By law, Russians are still entitled to free medical care. But patients are routinely asked to reach into their pockets for bribes and other under-the-table fees.
As a result, millions of Russians are simply unable to afford health care.
According to a report published this month by a nongovernmental medical group, the Russian Society of Evidence-Based Medicine Specialists between 50 and 70 percent of the population are not getting the help they need.
"A significant part of medical care in Russia is, de facto, for a fee -- there are many informal payments, particularly for specialized care," says Kirill Danishevsky, who chairs the group. Even homeless people can receive free emergency care. But we live in an era of noninfectious, chronic, progressive diseases that require prolonged treatment. More than half of Russian citizens have no adequate access to this kind of treatment."
According to Russia's respected Levada polling center, as few as 14 percent of Russians last year were satisfied with their country's health care system. Only 24 percent of respondents said they had access to proper medical care.
Shift in Mentality
The situation is compounding the country's steep demographic decline -- official forecasts predict the Russian population will have plummeted from today's 143 million to between 80 and 100 million by 2050.
Russia is one of the few industrialized nations where life expectancy has dropped sharply in the past 15 years. Today, Russian men live an average of 59 years, down from 64 in the late 1980s. Alcohol and tobacco are taking a heavy toll, maternal mortality is almost three time higher than in Europe, and Russia has one of the world's highest HIV-infection rates.
Dmitry Medvedev, Putin's protege and the man widely expected to win the March 2 presidential election, has been in charge of Russia's "national projects" to improve housing, education, and heath care as first deputy prime minister. He has now made welfare issues a cornerstone of his election platform.
Russians are keen to see much-needed reforms in all these spheres, which have been left in dire straits since the Soviet demise. But Russia's social recovery, says Svetlana, goes hand in hand with a mentality shift.
"Our government's attitude is that if you are gravely ill, you'd do a favor to everyone by dying," she says. "When society starts treasuring life, even if this life lasts just one day, everything will change, including health care. But life has no value whatsoever in our country."