University Daily Kansan / Tuesday, September 8, 1987
5
Tuesday Forum Soviet health care
Bribes, infection and waiting lists plague medical industry
Editor's Note: Howard Solomon is an Overland Park graduate student who traveled to the Soviet Union with other members of the KU Slavic languages department. The trip was part of the Council on International Education Exchange program.
This summer I had the unique opportunity to spend two months in the Soviet Union as a student. I was a participant in an intensive Russian language program at Leningrad State University for six weeks and a tourist for the remaining period of time. I traveled through cities such as Moscow, Novgorod, Baku, Krasnodar and Riga.
To be honest, I had more than just Russian language on my mind. In May I completed the master's degree program in Soviet and Eastern European Studies at the University of Kansas. During the course of this program I did a great deal of research on the Soviet health-care system.
Throughout my stay in the Soviet Union, I kept my eyes open for any sort of tubits of information related to Soviet health care. By fortune coincidence, I became acquainted with various Soviet citizens who were connected to the health-care system at different levels.
To the best of my ability, I have tried to recall my conversations with these people and give some description of what they had to say. The names that I have used are fictitious.
A student
A most interesting and intelligent person with whom I became acquainted was Sasha. Sasha was an extraordinarily resourceful and charismatic individual. When I met him, he was studying in his third year at a medical institute in Leningrad. He had in some way managed to avoid being drafted into the military by receiving a certificate that stated he had a heart condition.
When I asked him how it was possible for a healthy young man to receive such a certificate, he smiled and answered elusively that he had made some sort of agreement with a doctor.
Sasha provided some interesting insights into the system of medical institutes where future Soviet doctors are trained. The institute where Sasha studied has an excellent reputation. Students from all over the Soviet Union apply to the institute, with only a small percentage actually being accepted.
Sasha described the system of selection in terms of two possible ways for a student to be accepted by the institute. The first is to perform brilliantly on the entrance exams and have excellent recommendations. The second way is through "that." This is a Russian word that has many connotations. It can range from having an important or highly placed relative, who can exercise influence on the institute's administration, to an outright bribe. Sasha had utilized the latter. He paid the head of the institute 2,000 rubles (approximately $3,125) in order to enter into the academic program. Sasha went on to explain that this phenomenon was not only limited to the selection process but was also found in the grading system of the institute. A high grade can be earned with a well-paid gift to the instructor, as well as by traditional methods such as hard work.
A physician
Another fascinating person with whom I spent many hours discussing the Soviet health-care system was Kolya. Kolya was a physician of general practice who had a great compassion for his fellow man. He was immediately evident from our discussions that Kolya took his work seriously and considered his profession to be a distinguished one. The day we met, he was very concerned about an epidemic among young teenagers of sniffing glue to get high. He commented that he was seeing more and more of this type of phenomenon.
Despite this pride and seriousness, Kolya was a deeply frustrated individual. He informed me that even though he was married and had one child, his monthly salary was only 130 rubles (approximately $200). By official Soviet standards, this is a little below the average salary of
Howard Solomon
Soviet citizens. But taking into account the actual cost of living in the USSR, it is virtually nothing.
A pair of men's trousers might cost 60 to 100 rubles, while a woman's dress would cost about 100 rubles. Food can run about 50 rubles a month, although that means eating a very limited diet without a lot of fruits and vegetables. One bottle of vodka can run up to 20 rubles in a state store. Since Kolya's wife could not work, the family lived in virtual poverty.
Kolya's apartment was sparsely furnished. A kitchen table provided the central attraction. A piece of foam thrown on the floor and covered by a blanket served as the couch. The bedroom was furnished with a bed designed much like the couch, and a homemade crib. Kolya asked me to excuse the condition in which he lived. He explained that he was an honest doctor, and refused to accept bribs and "gifts" as most of his colleagues regularly did to earn extra income.
This bribe-taking and gift-giving in the healthcare system was a topic that I often came across while in the Soviet Union. In a system that is more modern, it is no longer a source of irritation for many Soviet citizens.
Health care recipients
Rena and Volodya, a married couple living in Moscow, told me of the case of their aunt who recently was in need of an operation. The aunt was admitted into the hospital after waiting for some period until she received her turn. There is a waiting list for certain types of operations that are not life-threatening. A doctor soon came to see her and told her he would perform the operation for a fee of 200 rubles (approximately $130). The aunt reluctantly complied with the doctor and paid him his fee for an operation that should not have cost her a single ruble.
When I asked Rena and Volodya why their aunt did not simply refuse to pay the doctor and report him to the authorities, they gave me a funny smile. They explained that two things could have happened if their aunt had not paid. The first would have been that the hospital immediately discharged her on the doctor's orders, and she would have lost her turn to have the operation. It would have taken a long time before her turn came up again. If she complained to the authorities, the doctor would have been reprimanded and been forced to do the operation free of charge. In that case, the patient would have been at the mercy of an angry doctor.
Medicine, clinics
The difficulty in obtaining good quality medicine in the Soviet Union was a topic that frequently came up in all my conversations. One of my acquaintances, Ivan, who worked in a pharmaceutical enterprise, described how the system worked.
Ivan explained that most Soviet-made medicines were of extremely poor quality. Many educated people are simply afraid to take Soviet-made medicines. Most prefer those that are foreign-made. These foreign medicines are often in short supply and difficult to find. It should be noted that many Soviet pharmaceutical products are also in short supply. These deficits allow those, such as workers in medical institutes, laboratories and pharmacies, who have access to various pharmaceutical products to become unofficial businessmen.
In Leningrad and Moscow, a large black market of Soviet manufactured and foreign manufactured medicines is in operation. Soviet citizens who need special medicines often have to go through a chain of acquaintances that leads to one of these privileged persons who have access
to pharmaceutical products. I remember a conversation with one of our hotel maids about how she had managed to obtain medicine for her son's illness by going through a friend of a friend of a friend who had an acquaintance who worked in a medical institute.
A well-placed bribe or gift is often necessary in order to obtain certain medicines from a drug store. During the course of our stay in Leningrad, several Americans in our group became sick with some sort of virus. In order to obtain the necessary medicine, our American group leader was forced to pay a bribe to a clerk who worked in a drug store. One of the Soviet hotel employees also used her connections to find medicine for the sick Americans.
Many problems in the Soviet health-care system have no connection to the quality or honesty of personnel. The allocation of financial support depends on the shortage of facilities to a shortage of personnel.
Ira, a very intelligent and educated woman, told me about a visit she made to a friend who was in a state home for the disabled. She described filthy corridors with unused medicines, food scraps and human waste products strewn about the floor. The sound of human cries rang throughout the building, as patients waited for hours to be fed by a small, overworked staff.
Ira explained that there was only one doctor assigned to the home. He was a caring and capable man who could not be faulted for the environment he was working in. In a discussion with Ira, the doctor explained that he did his best to treat the patients in the institution, but there were many times that he just did not have the knowledge to treat illnesses that were not his specialty. There were not enough specialists to go around, and the institution was understaffed due to a lack of money.
Sanitation
The high rate of infection in Soviet health-care facilities was another topic that frequently came up in my discussions. This occurrence in Soviet health-care is due to a variety of factors. The poor training and practices of health-care personnel one factor. While in Leningrad, one of our group leaders who was sick went to a polyclinic, a type of out-patient hospital, for an examination. During the course of the examination, the doctor used a metal tongue depressor. When the exam was completed, the doctor's son the depressor at the examination, another doctor came into use with another patient and proceeded to use the same depressor without any sort of cleansing or sterilization.
voooya told me he came down with hepatitis after a trip to a dentist who didn't wash his hands or dental instruments. Health-care personnel are not the only ones to blame. Health-care facilities are presently lacking sterile disposable items, such as plastic syringes, catheters and intravenous tubing. Sterilizers using boiling water operate around the clock in hospitals.
Throughout the course of my stay in the Soviet Union, I met countless people who were frustrated with the quality of health care that they received. I also met many health-care professionals who were dedicated to improving the system they worked within. Despite much attention by the Soviet media on the various problems of the health-care system, little has changed over the last few years.
On the day before I left the Soviet Union, Prava, the official newspaper of the Communist Party of the Soviet Union, announced a special project undertaken by the Central Committee and the USSR Ministries to improve the state of Soviet health care. There was nothing extraordinary about this appearing in the Soviet press except for the word "perestroika" or reconstruction was used. Whether the health-care system will in fact be improved is dependent on the Soviet leadership. More resources must be allocated to this sector of the economy before this process can take place.
Andrew Pavich/KANSAN
Vladimir Lenin
THE FAR SIDE
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841-DELI
GREEK WEEK SCHEDULE Tuesday, September 8th
I Banner Contest Judging
Theme: "What a Week to be Greek"
Time: 12:00 noon at Houses
II Walk to the Campanile
Time: 4:00 p.m.
Speaker: Bob Fredrick, Athletic Director
Note: Wear Greek Letters and Bring Banner
III Leadership Dinner
Time: 6:30 p.m.
Where: Adams Alumni Center
(invitation only)
IV Class Parties
Time: 8:00 p.m
Freshman - ATΩ House Theme: Luau
Sophomore - ΔTΔ House Theme: Camp
Junior - ΣN House Theme: Country Club
Senior - AKA House Theme: Surpressed Desires
GREEK WEEK PAIRINGS
(not previously mentioned) YO $ \phi A O\quad\Delta E D $
AOΠ - ATΩ - ZBT
NOTICE: D.J.. Snacks. and Refreshments will be provided, no alcohol will be provided