Like Its Leader, Russia Is
In Failing Health
NEW YORK - These days, Boris Yeltsin is by no means the only Russian in failing health.
As the country's president struggles to convince his constituents he is not too ill to lead them, his sprawling nation of 147 million has been awash in shocking epidemics and health crises.
* Last week, Russia asked the World Bank for a $150 million loan to fight a tuberculosis epidemic that has been raging out of control, propelled by thousands of cases of deadly drug-resistant strains.
AP/Wide World - Officials claim that 700,000 Muscovites have gotten the flu, forcing the closure of many schools, and sending them to pharmacies like this one
Although 100,000 new cases of TB were registered in the last 10 months of 1998, the real number is easily twice that, said Dr. Murray Feshbach, a professor at at Georgetown University's Center for Eurasian, Russian and East European studies. Other experts estimate that stopping the epidemic would require a $500 million allocation of resources.
* Rates of syphilis and other sexually transmitted diseases are exploding. "The case number seems to triple every year," said Dr. Tunde-Agnes Madaras of the World Health Organization,s Europe office. "It,s amazing."
* Heroin addiction is on the rapid rise, according to Vladimir Kharetdinov, head of Moscow's antidrug unit. * Experts fear the increase in use of heroin and other injectable drugs will lead to an exponential increase in the number of HIV cases, since 90 percent of the HIV-infected people in Russia are IV drug users, and HIV is easily transmitted through shared IV needles.
There are only 10,000 reported cases of HIV in Russia, but Russian health experts fear that the real figure closer to 220,000 cases and predict there will be 1.2 million cases of HIV in Russia by the years 2002-2005.
AP/Wide World - Sergey Podolsky, like many other Russians, uses ice swimming to strengthen his health
These infections could cost the country $7.5 billion to treat, said Feshbach. "The Russians don't have this money. Nobody has this kind of money [to treat HIV]. So the people with HIV in Russia are just going to die."
* Alcohol poisoning has killed an average of 40,000 Russians per year since 1994, compared to about 300 to 400 cases per year among the 270 million U.S. residents. Many believe this problem and a culture of alcoholism " in which men guzzle an average of 15 liters of alcohol per year " contribute to the overall decline in life expectancy, especially for men: In the past year alone, average male life expectancy dropped from 62 to 58; in some regions, it is at 50.
"Russia has had a stunning decline in the health status of its citizens in the 1990s," said Peter Berman, an associate professor of international health economics at the Harvard School of Public Health."It has been rarely seen before that a country as advanced as Russia could have as significant a decline in health care and life expectancy as it has."
Aside from the alcohol problem, these health crises are not Russia's alone; they affect its neighbors " and ultimately the whole world. "Infectious diseases such as tuberculosis do not stop at national borders," said Madaras, who directs the tuberculosis unit at WHO-Europe.
'Infectious diseases such as tuberculosis do not stop at national borders'
Increased plane travel and increased migration to Western countries such as the United States contribute to the greater mobility of these diseases. "We are constantly trying to remind Western countries " especially Finland, Austria and Hungary, which border Russia " that their people are certainly at risk and that if they don,t react, the epidemic won,t be contained."
While the WHO, the U.S. Agency for International Development and several European aid organizations and private foundations have all been lending their monetary and humanitarian assistance, many of these measures have only been temporary stopgaps for a health care system that has been greatly disrupted by the enormous economic, political, and social upheavals that have come to Russia since the fall of the Soviet Union in 1991.
AP/Wide World - Russia's Health Ministry says that the country's alcohol poisonings - drinking a lethal amount at one sitting - have reached an extraordinary 50,000 deaths a year
Under the Soviet system, health care was far from ideal, according to Dr. Sushma Palmer of the Center for Communications, Health and the Environment, a public health organization that has sponsored programs in Russia and other developing countries. But at least, Palmer added, there used to be a system in place for preventing and containing epidemics and other health problems.
Since 1992, private health care services have become available for those who can afford them, but there has been a severe deterioration of health care services to ordinary people. "This is partly a financial problem created by the transition to the market economy, but is also due to the overall disorganization of the country and the [demise] of the old Soviet health care system," Palmer said.
As a result of the financial problems, the water supply and the food supply have both been affected and people don,t have the means to take additional health precautions such as seeing a doctor.
'While the old system provided Russians with a sense of entitlement to an endless supply of health care - there are still more doctors per capita in Russia than in America - the erosion of the system has led people to become cynical about seeking help
In some cases, Western aid is providing some relief, but the political chaos in Russia prevents money and supplies from being used effectively. Sometimes medicine shortages are caused when antibiotics and other drugs sit in warehouses due to disagreements between the customs officials, pharmaceutical agents and the Ministry of Health, said Feshbach, who authored the Environmental and Health Atlas of Russia. Or sometimes, he added, corrupt officials pocket the aid money.
Another obstacle: Russians are often unwilling to seek help.
While the old system provided them with a sense of entitlement to an endless supply of doctors, hospitals and medicines - there are still more per capita in Russia than there are in America - the erosion of the system has led people to become cynical about seeking medical care.
"Russian people's experience with hospitals is that they will [catch an infection] while being treated in the hospital," and they are skeptical that there will even be medical supplies to diagnose and treat their condition, said Feshbach.
A cultural tendency to avoid doctors in itself may also contribute to the problem.
"In Russia, there is a great tradition of self-treatment," Feshbach said. "You treat yourself with [herbal medicines] and folkloric treatment, and you only go to the doctor when you are about to die."
Many of these factors, from disorganization and corruption to Russian stubbornness and pride, may also prevent Mother Russia from getting desperately needed help for its children's health.
"I believe the U.S. is tired of giving money to a bunch of corrupt people," Feshbach said. And when the United States insists that its aid be tied to certain programs, it often meets with resistance because Russians want to solve problems their way.
'In Russia, there is a great tradition of self-treatment. You treat yourself with [herbal medicines] and folkloric treatment, and you only go to the doctor when you are about to die'
In the case of tuberculosis, WHO officials have been trying to implement a system in which patients are diagnosed with microbiology lab tests and given a course of treatment with four different drugs over six months, said Madaras.
"But Russians use methods that are 50 years old, such as surgery and screening with X-rays. Russian experts are constantly fighting against or for these protocols."
However, as the TB epidemic further erodes Russia's health care capabilities, there may be signs that this stubbornness is eroding too.
Dr. Barry Kreiswirth, director of the tuberculosis center at the New York-based Public Health Research Institute, said he saw increased cooperation when he visited the Tomsk region recently to see a tuberculosis program that this non-profit organization has founded there. The program uses WHO's recommended treatment approach, not the traditional Russian methods.
"The Russian doctors are seeing their population dying. And they are starting to embrace our approaches, because they see they can't do it the old way."
The question is, will the rest of the world continue to lend its resources to the fight or will it stubbornly refuse to address Russia's desperate plight?
"There is no historical information that says an epidemic like this one will go away by itself," noted Kreiswirth. "We can stick our heads in the sand all day, but we have to deal with this sooner or later."