MELISSA BLOCK, host:
From NPR News, this is All Things Considered. I'm Melissa Block.
ROBERT SIEGEL, host:
And I'm Robert Siegel. This week, NPR's Anne Garrels is reporting on changes in Russia through the lens of a city called Chelyabinsk. Today, a look at health care. Russia is in a health crisis. The average life expectancy for Russian men is just 59 years. Add to that anemic fertility levels, and you get a drop in population. According to the U.N., Russia's population could fall by 30 percent by the middle of the century. President Dmitry Medvedev is determined to reverse that trend. His government is investing more in public health and even offering bonuses worth about $9,500 for mothers who have a second child. Here's Anne Garrels' latest story.
ANNE GARRELS: Chelyabinsk is experiencing a baby boom, a result of recent economic improvements here. And Dr. Eduard Reebin, chairman of the Regional Legislatures Medical Commission, says health care is much better than when I met him in the 1990s.
Dr. EDUARD REEBIN (Chairman, Regional Legislatures Medical Commission, Chelyabinsk): (Through Translator) There's no comparison. Of course, we still don't have what we want. No country does. But under Prime Minister Putin, there is at least a stable health program.
GARRELS: Ten years ago, I met Dr. Reebin on an airplane from Moscow. He was returning from his first visit to the United States and had a strange thing snaked around his neck. It was a piece of equipment for colonoscopies. He wouldn't put it in his luggage, lest this precious gift from an American colleague be lost or stolen. He recalls those desperate times when he had to barter and scrounge for basic medicines.
Dr. REEBIN: (Thorough Translator) The factories could not pay their share of the health insurance, so they would give me pipes. I would go to another region and trade them for rice, bring the rice back here and sell it - all this just to keep my hospital open.
GARRELS: Those frightening times are over. But there's still a shortage of specialists. And diagnostic tools like CAT scans and MRIs are still rare. The wait for a test can be more than two months.
Dr. MIKHAIL VERBITKSY: (Russian spoken)
GARRELS: After a meeting with regional officials, the head of Hospital No. 8 complains about a tangled and unresponsive bureaucracy. Dr. Mikhail Verbitksy is a generally jovial fellow, but he's struggling to pay his staff a decent wage so they'll stay in the profession. He skimps on physical improvements to pay his staff a little extra. The hospital, built 60 years ago, is in terrible shape. There are still no proper hospital beds. There's a shortage of operating rooms. The hospital is overcrowded, with twice as many patients as originally planned.
(Soundbite of a baby crying)
GARRELS: The number of babies born at Hospital 8 has jumped in the past year from 1,200 to 2,000. Good news for Russia, but a real strain on the system. Tanya Kelleher and her American husband, Mark, produced twins at another hospital where conditions were just as bad.
Mr. MARK KELLEHER (English Teacher): You have to go to a pharmacy. You have to buy everything that they're going to need. I mean, every IV tube, the stitches, the needles, everything that they're going to use during that birth, you have to buy and supply it.
Ms. TANYA KELLEHER: Yeah. The hospitals are just memories, nightmares, you know. You couldn't get in the shower there. It was like one shower for a hundred patients or something.
Mr. KELLEHER: You better have some friends on the outside that will bring you food, because the food that you get is not even gruel.
GARRELS: In theory, medical care is free, but medicines are not, except for certain groups like invalids and pensioners. And repeated complaints in the press indicate these groups are not getting the medicines they need and have been promised. Dr. Eduard Reebin acknowledges this is an ongoing problem.
Dr. REEBIN: (Through Translator) No one will be turned away, but there will always be medicines which are not available at the hospital and the patient will have to purchase them at a pharmacy.
GARRELS: What has dramatically changed in the past ten years, though, is the emergence of private clinics. This one is run by Elena Konaeva, a much-respected doctor. She specializes in infertility. She now has 3,000 patients.
Dr. ELENA KONAEVA (Russian Fertility Specialist): (Through Translator) We have some good doctors here, but they are spread out over various hospitals. You can get a good diagnosis at one hospital, good surgery at another. We try to link all that together, and we try to make the process comfortable.
GARRELS: Given the system of under-the-table payments in state hospitals for expedited care and the provision of certain treatment, this private clinic is really not that much more expensive than so-called free care.
Dr. KONAEVA: (Through Translator) Take in vitro, you usually have to pay for this even in the state system. And until this year, there was no state hospital here in Chelyabinsk that could do in vitro. The doctors still have little experience, so we work with a hospital in another city which has the best specialists in the country.
GARRELS: Her clinic, spotlessly clean with a rare air of efficiency, is comparable to any Western doctor's office. Many of her physicians, like urologist Grigory Bogdashov, are specialists in the state system who work here one day a week.
Dr. GRIGORY BOGDASHOV (Urologist): (Through Translator) At the state hospital, I earn $200 a month, 400 with overtime. Here I can make $200 in three hours of work, without the mess, the pressure, and the horrible conditions.
GARRELS: Dr. Konaeva offers her patients preventative care, which she says the state system can no longer afford. Mammograms, for instance, are not routine, and done only when a problem arises. She sees too many underweight babies because of smoking, alcohol, and inadequate prenatal care. She worries that too many Russian women still use abortion as a means of birth control. There are still more abortions than live births, with the consequent impact on fertility rates.
Dr. KONAEVA: (Through Translator) It's a sad statistic, but a true one.
GARRELS: Behind her, lining the wall, are snapshots of Chelyabinsk's next generation, the babies she has helped bring into the world. In five years, Dr. Konaeva has made back her initial investment of $200,000. She has plans to expand, though those are now on hold because of the financial crisis. Anne Garrels, NPR News.
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