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]]]]]]] SOVIET HEALTH CARE'S CRITICAL CONDITION [[[[[[[[[[[
By Kenneth M. Prager [, M.D.] (9/29/88)
[Dr. Prager is on the faculty at Columbia College of Physicians
and Surgeons in New York and is a specialist in pulmonary
medicine.]
From The Wall Street Journal, 29 January 1987, p. 28:3
[Uploaded by Freeman 10602PANC]
As a physician on a private visit to Moscow and Leningrad last
spring, I had a unique opportunity to learn about the current
[1987] state of Soviet medical care. As soon as my Soviet
acquaintances learned that I was an American doctor, they
organized makeshift clinics in various apartment houses so that I
could examine patients and dispense medical advice. Even though
I expected Soviet medicine to be below American standards, I was
appalled by what I saw.
The Soviet medical-care system is decades behind the West in
technology and stresses little more than keeping the mass of
Soviet workers happy and on the job. It is a system that can
adequately care for simple and self-limited health problems of
its ordinary citizens, and it offers the privileged among them
such amenities as resortlike sanitariums where they can bathe in
mineral waters and rest. But the level of sophistication
necessary to properly attend to such chronic and complex ailments
of modern society as cancer and cardiovascular disease is what
one would expect of a developing nation and not one of the
world's great powers.
Waiting Lists for Wheelchairs
My impressions of Soviet medicine were reinforced by my care
of refusenik David Goldfarb, who arrived in the U.S. aboard
Armand Hammer's jet last October [1986]. After languishing for
four months in several Soviet hospitals, Prof. Goldfarb finally
received definitive treatment for his multiple medical and
surgical problems in New York. He is currently learning to walk
on a modern prosthesis. The fact that he did not use his heavy
and crudely made Soviet prosthesis since losing his leg at
Stalingrad in 1942 speaks volumes about Soviet care for the
disabled. Long waiting lists for wheelchairs further testify to
Soviet disregard for the needs of the handicapped.
One of my first patients on my visit was an 80-year-old man in
severe pain because he was unable to urinate. His bladder was
remarkably distended and he obviously needed to be catheterized
immediately. The urologist who had been summoned to his home
complied with my request for a rubber glove to examine the
patient's prostate gland. After examining him, I was startled
when the physician requested that I wash the glove so that it
could be reused. She then relieved the patient of his distress
by passing her only, reusable catheter into his bladder after
lubricating it with butter. She had sterilized the catheter by
boiling it in a pot of water in the patient's kitchen.
There is a virtual absence of such disposable items as
syringes, needles, catheters and intravenous tubing in hospitals
and clinics. Patients pay a considerable price: Reused items
increase rates of infection, while intravenous needles and
scalpels that have become dull as a result of wear and tear
increase pain and discomfort.
That this elderly man adamantly refused hospitalization
pointed to another feature of Soviet medicine: The aged are
afraid of being hospitalized. In a medical system that is
chronically short of the most basic supplies, the elderly are
considered expendable and will be the first to feel the brunt of
such shortages.
Another patient I met was a 28-year-old man with a
well-documented heart attack two years earlier who was still
experiencing chest pain when he exerted himself. His entire
evaluation by Soviet physicians consisted of an ECG stress test,
and his only medication was nitroglycerin to be taken as needed
for chest pain. A coronary angiogram, which might have disclosed
a surgically correctable reason for his premature heart attack
and persisting angina, was never suggested, and he was not
treated with any of the potent cardiac medications that might
lessen his pain, and possibly increase his longevity.
The case of this unfortunate young man discloses the
unavailability of coronary angiography and surgery to all but a
select few in the U.S.S.R. On a much more fundamental level,
however, it reveals how few modern medicines are available to
patients with serious problems. The tremendous strides made in
the past two decades in development of potent and effective
medications in all areas of internal medicine seem to have made
little impact in the U.S.S.R. New medications are either totally
unavailable from pharmacies or are in such short supply as to
make them ineffective in treating chronic illness.
Such staples of modern medical treatment as Tagamet [brand of
cimetidine] for ulcer disease, Sinemet [brand of a combination of
carbidopa and levodopa] for Parkinsonism, beta blockers and
calcium channel blockers for angina and hypertension, and
antihistamine-decongestant preparations for the relief of common
cold symptoms are extremely hard to come by. Other useful
medications, such as anti-asthma drugs and multivitamins, are of
such poor utility as to discourage their use. Liquid antacids
are completely unpalatable. While I was in Moscow, I was told
that a drug such as Tagamet could sell for a small fortune on the
black market.
A major health problem facing Soviet women is the absence of
reliable measures for birth control. Birth-control pills are
impure and produce intolerable side effects, and diaphragms are
poorly fitting and of low quality; condoms are crudely made. The
result is that abortion in the major method of birth control used
by non-Moslem Soviet women. A conservative estimate based on
Soviet statistics is that the average Soviet woman undergoes six
abortions in her lifetime. It is not uncommon to meet women who
have had 10 or even 15 abortions.
And this primitive health system is far from free.
Hospitalized Soviet patients frequently bring a roll of rubles
with them if they want to make sure that they obtain such basic
nursing care as linen changes and reliable delivery of
medications. Their families must bring them meals from home.
Payments to physicians in the form of cash, goods or services are
often necessary to ensure proper treatment or a skilled surgeon.
Even more money is needed to obtain scarce medications.
Faced with a medical system that is too often ineffective in
treating disease, Soviet citizens turn with desperation to a
variety of quack medical practitioners. Starvation diets are
commonly resorted to in treating chronic illness, with the
unintended result of weakening an already debilitated patient.
Psychic healers with a variety of potions abound, and amulets and
other magical devices are frequently used.
Not everyone in the U.S.S.R. must put up with these gross
deficiencies of the medical system. The "classless" Communist
utopia has a very rigid hierarchy of medical-care facilities.
The Fourth Department of the Ministry of Health consists of
hospitals, sanitariums and clinics that are available only to the
Communist Party elite and other notables. These hospitals are
stocked with the most advanced medical technology -- all of it
made abroad. It is to these flagships of the Soviet hospital
fleet that groups of visiting foreign physicians are taken when
the occasion arises. The unsuspecting doctors leave the country
with a totally distorted impression of the true state of Soviet
medicine.
A Matter of Priorities
Why does one of the world's two great superpowers tolerate
such primitive conditions in so much of its health-care sector?
The answer is that modern medicine is very expensive. The
Soviets have chosen to spend their limited resources on missiles,
heavy industry and space technology rather than on disposable
medical equipment, modern drugs and costly life-saving devices.
Excellence in medical care is simply not a high priority in the
Soviet system. The best estimates available indicate that the
Soviets allocated 9.8% of the gross national product to medical
care in 1955, but only 7.5% in 1977. The trend is clear.
Whether Mikhail Gorbachev's attempts to modernize Soviet
society will include an overhaul of the medical-care system
remains to be seen. Unremitting Western publicity about
human-rights abuses in the U.S.S.R. has sensitized the Soviets to
this issue, and there seems to be some movement on Mr.
Gorbachev's part to try to mollify his Western detractors with
conciliatory moves, however few. If the sorry state of Soviet
medicine becomes a focus of concern in the West, perhaps the
Soviets will be similarly instigated into carrying out some badly
needed reforms to bring their medical system into the second half
of the 20th century.
* * *
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