- NEW YORK - These days, Boris Yeltsin is by no means the only Russian in
failing health.
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- 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.
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- * 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.
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- 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
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- 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.
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- * 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."
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- * 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.
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- 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.
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- AP/Wide World - Sergey Podolsky, like
many other Russians, uses ice swimming to strengthen his health
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- 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."
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- * 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.
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- "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."
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- 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.
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- 'Infectious diseases such as tuberculosis
do not stop at national borders'
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- 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."
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- 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.
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- 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
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- 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.
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- 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.
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- 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.
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- '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
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- 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.
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- Another obstacle: Russians are often
unwilling to seek help.
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- 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.
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- "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.
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- A cultural tendency to avoid doctors
in itself may also contribute to the problem.
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- "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."
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- 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.
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- "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.
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- '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'
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- 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.
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- "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."
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- However, as the TB epidemic further erodes
Russia's health care capabilities, there may be signs that this stubbornness
is eroding too.
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- 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.
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- "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."
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- 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?
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- "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."
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