Coronavirus Crisis Strains Russia’s Soviet-Era Regional Health System – The Wall Street Journal

By | June 28, 2020

KARABANOVO, Russia—In mid-April, when the hospital in this hardscrabble rural town saw its first confirmed coronavirus infections, the district’s chief doctor ordered 16 nurses and doctors to quarantine at the facility, together with 40 patients, many suspected of having the virus.

The health workers cared for the sick without any protection such as masks, said Nina Rogova, 46 years old, a nurse at Karabanovo hospital, in the Vladimir region some 130 miles northeast of Moscow. The hospital’s management threatened them with criminal charges if they left. Medical personnel slept in their offices or in wards next to the sick.

“There we were, all together in this broth,” Ms. Rogova said.

By the time they left six days later, Ms. Rogova had contracted the virus. She later recovered and returned to work.

Nurse Nina Rogova, who contracted the new coronavirus, said health workers at the hospital in Karabanovo initially had no protective gear.

But Mikhail Savichev, 61, the head doctor at the hospital, who was quarantined with Ms. Rogova, died on June 9 of adult respiratory distress syndrome and Covid-19, the disease caused by the coronavirus, his daughter wrote in a message on social media platform Vkontakte, Russia’s version of Facebook.

Emmanuil Zdanovsky, the chief district doctor who ordered the medical personnel to stay in the hospital, resigned on June 10. He and regional health officials didn’t respond to a request to comment on the conditions at the hospital or the account given by Ms. Rogova.

The episode at Karabanovo hospital offers a glimpse into the dysfunction and inefficiency that plagues Russia’s health-care system as the country fights the new coronavirus, which as of Sunday had recorded 634,437 coronavirus infection cases nationwide, according to official Russian government data—the world’s third-highest caseload after the U.S. and Brazil.

Dr. Mikhail Savichev, who was among those quarantined in Karabanovo hospital, died on June 9 of Covid-19 and another ailment, his daughter said.

Many front-line medical workers in Russia say their safety has been neglected and they feel overworked, underpaid and undervalued. Nowhere is the strain felt more than in the country’s rural regions, which contrast with the quality of health care available in Moscow and St. Petersburg.

Rural areas had already been hemorrhaging medical professionals before the pandemic and have suffered the most from health-care overhauls introduced by President Vladimir Putin. This restructuring was intended to upgrade the decaying system inherited from the Soviet Union, but it has instead largely failed, say medical professionals, health activists and opposition politicians.

“All these optimizations that have been carried out in our country, unfortunately, led to the fact that the situation in medicine sharply worsened,” said Dmitry Kushpita, chairman of the Vladimir branch of the opposition party Yabloko.

The number of hospital beds in Russia was halved between 2000, when Mr. Putin came to power, and 2015, according to official data. Many health facilities haven’t been renovated since they were built during Soviet times.

A February report by a parliamentary financial body said that as of 2018 nearly a third of all Russia’s medical facilities had no running water and more than half lacked hot water. Around 40% lacked central heating and in 35% the sewage didn’t work, the report said.

The Vladimir region, with 1.3 million people, has recorded more than 4,000 coronavirus cases.

A market in Vladimir’s administrative center, also called Vladimir. The region has little more than half the emergency physicians it needs, its governor said.

Alexander Kudrin, head of the parliamentary financial body and a former finance minister, has blamed the problems in the country’s medical system on a lack of government funding in health care.

Mr. Putin has acknowledged that regions outside of Moscow are deficient in medical facilities, beds and personnel. Last month, he ordered additional doctors be dispatched to certain areas particularly hard hit by the coronavirus and said monthly bonuses ranging from about $ 300 to $ 1,000 should be paid to health professionals on the front lines of the crisis. He recently ordered the payments be extended through August. Nurses in regional areas earn around $ 432 a month on average and doctor’s salaries start at around $ 720.

Mr. Putin recently told state television that the nation had generally handled the pandemic well, suffering “minimal losses,” and that Russia handled the pandemic better than did the U.S., where it had been politicized.

In a televised address to the nation last week, he acknowledged that “the situation remains difficult in a number of Russian regions,” but said that “no one will ever be left in trouble. All of Russia will certainly come to the rescue. If necessary, we will pool all resources.”

Data from some regional leaders speak to the challenges facing the rural areas.

A market in the city of Vladimir.

Vladimir Sipyagin, Vladimir’s governor, told Mr. Putin at a televised videoconference with other officials in April that his region had only about a quarter of the required infectious disease specialists or pulmonologists and little more than half the needed emergency physicians specializing in critical care and resuscitation.

The region also had insufficient personal protective equipment for doctors and had difficulties purchasing respirators and medical equipment, Mr. Sipyagin said.

By Sunday, the Vladimir region, with a population of 1.3 million, had recorded 4,263 coronavirus cases, according to official data.

Other problems in Vladimir predate the current crisis. A regional prosecutor filed seven lawsuits against Vladimir authorities this month accusing them of violating the rights of citizens to receive basic health care in a timely manner in rural areas that rely on small clinics and nursing stations for medical services, the prosecutor’s office said.

Vladimir authorities neglected to complete, start or even commission the construction and equipping of facilities that provide general health care and midwife services in several districts, the prosecutor said.

Mr. Sipyagin declined a request for comment.

Meanwhile, hospitals in many regions of Russia have quickly developed as transmission hot spots for the coronavirus.

In May, Mikhail Murashko,  Russia’s health minister, told the lower house of parliament that there were 400 Covid-19 outbreaks associated with hospitals and thousands of medical personnel had been infected. This month, Alla Samoilova, head of Russia’s health watchdog, reported that nearly 500 medical workers in Russia had died of Covid-19. Health-care advocates who are tracking the plight of medics during the crisis believe the tally could be higher.

Some medical workers have succumbed to the strain, activists said. In recent months, three doctors fell from the windows of different hospitals, amid growing complaints from health workers about long hours on duty and lack of protective equipment. Two of the doctors died, in cases that remain under investigation.

Activist Maria Antonova, right, with one of her daughters, said some medical personnel at high risk of Covid-19 complications say they are being forced to work 12-hour shifts.

Officials at Russia’s health ministry and at the state health-care regulator didn’t respond to a request for comment about the overall conditions at Russia’s public hospitals and the complaints raised by medical staff during the pandemic.

Maria Antonova, an activist in the Vladimir region who belongs to a social-welfare group that has been monitoring complaints from medical personnel, said nurses in their 60s—who by law should have been self-isolating due to their age—and many with medical conditions, such as diabetes or asthma, said they are being forced to work 12-hour shifts. Others said they were still waiting to receive the bonus Mr. Putin promised in April.

Ms. Rogova, the nurse at Karabanovo hospital, said she has been receiving the additional money, around $ 725 a month, and hospital personnel now have personal protective equipment.

Simon Galperin, head of the Doctors Defense League rights group, said cadres from all medical fields, including eye doctors and physical therapists, have been called to treat coronavirus patients—and they “are simply not prepared enough for this work.”

“The problem is we don’t have enough professionals who could work with infectious diseases,” Mr. Galperin said. Also, “a lot of health care workers are older and we don’t have others to replace them.”

In the Vladimir region town of Strunino, 40 health staff, including six doctors, chose to quit rather than be temporarily transferred to Karabanovo hospital, according to Vladimir health department officials.

The personnel were guaranteed pay, free meals, transportation to work, or if necessary, hotel accommodation. Instead, they resigned, “citing fear of illness and difficult working conditions,” the authorities said.

The Karabanovo cemetery where Dr. Mikhail Savichev is buried.

Write to Ann M. Simmons at ann.simmons@wsj.com

Copyright ©2020 Dow Jones & Company, Inc. All Rights Reserved. 87990cbe856818d5eddac44c7b1cdeb8

"Health|HealthCare" – Google News