The State of Soviet Medicine

Western visitors have brought back conflicting reports about the quality of Russian medicine. Some have praised it; others have been appalled, often after traumatic personal experiences. Jerrold Schecter, chief of TIME'S Moscow Bureau, has observed the system more closely than most. At various times, his wife and five children have all been patients in Soviet hospitals or polyclinics. Schecter offers this appraisal:

EVEN before the comprehensive health code that went into effect last July, every Soviet citizen was entitled to "free and highly qualified medical assistance"--including compulsory treatment for mental illness, venereal disease, chronic alcoholism and drug addiction. The new code, however, goes far beyond individual illness. Some of its provisions deal at length with environmental controls to protect health by combatting the country's growing pollution; others bar the construction of factories in population centers and promote the development of health resorts.

All this may impress Westerners--until they happen to get sick in Russia. By U.S. standards, many Soviet hospitals are as crowded and shabby as the New York City subway. The typical building is a grim fortress with old equipment in poor repair. The food is plentiful but dull; instead of tissues and toilet paper, the patient makes do with yesterday's Pravda. The institutions are well described by Alexander Solzhenitsyn in his novel, The Cancer Ward. To some patients, though, such hospitals look like paradise. Among them are alcoholics, a major Soviet problem, who can wind up in "corrective-labor detention centers."

Still, the Russians are proud of their free medical system, and with good reason. In czarist Russia, the average life expectancy was 32 years; one-fourth of all babies failed to reach their first birthdays. Few of the country's major medical facilities survived World War II. Today, medical care has raised life expectancy for Soviet men to 65 years, for women to 73. Infant mortality has been reduced to 2.6%. The U.S.S.R. now has 104 hospital beds per 10,000 people.

Soviet medical care is wide ranging and well organized. The system revolves around polyclinics that serve neighborhoods, factories or professional groups; 80% of all treatment is handled on an outpatient basis. A key service: free annual checkups for about 100 million Soviet citizens, most of them children, students, pregnant women and workers in vital jobs. Health officials hope to expand the checkups to cover all 242 million citizens of the U.S.S.R.

Distance v. Treatment. "In the U.S.," says Soviet Health Minister Boris Petrovsky, "a patient usually goes to see his doctor only in case of great need. In the Soviet Union, we welcome a patient when he comes to his polyclinic with the earliest possible signs of illness." The welcome can be warmer than the treatment. Patients complain that polyclinic doctors are too rushed to spend enough time with them. Doctors complain about the volumes of paperwork required by the state. But both agree that the service is as personal as volume permits.

Even in the U.S.S.R.'s ostensibly classless society, special groups receive special treatment. Ballet dancers and athletes have a wing of their own in the Moscow Central Institute of Traumatology; the Central Committee of the Communist Party and top government officials have their own hospital and polyclinic. Medical treatment tends to be best in Moscow and Leningrad; it deteriorates in proportion to the distance from the major cities.

Since there is no marketplace for medicine in Russia, patients are recommended to a hospital through their polyclinics, then treated in the hospitals by doctors specializing in their illnesses. Individuals are free to consult recognized specialists or to pay a one-ruble ($1.11) fee and go to special centers for consultation if they are dissatisfied with polyclinic or hospital diagnoses.

Different Priorities. Russian medicine differs greatly from American in emphasis and approach, especially in regard to anesthesia. Russian doctors prefer local anesthetics, particularly in appendectomies and uncomplicated deliveries. Says Polina Kachalova, senior physician at Leningrad's No. 2 Hospital: "We believe general anesthetics are more harmful and that recovery is quicker with local anesthetics." Though surgery is often more traumatic as a result, few Russians seem to complain.

Russian doctors are generally wary of heart transplants. Only one such operation has been attempted in the Soviet Union. The operation was unsuccessful and Petrovsky frankly questions its value. "We are doing experimental work on heart transplantation," he says. "But we do not believe that this problem is as important as kidney transplantation. In the latter case we operate when the kidneys cease to function, and the patient cannot live any longer with these kidneys." Soviet medical men have no such reservations about bone transplants, which are now being done regularly at Moscow's Institute of Traumatology. In Soviet practice, bones that may be useful in transplants may be removed during routine autopsies unless the relatives of the deceased object. Once removed, the bones are deepfrozen or sealed in plastic for later use in transplants. More than 3,000 bone-transplant operations have been performed, 70% of them without complications.

Emergency Stations. Perhaps the most impressive aspect of Soviet medicine is its system for emergency care. Each city has a central station (reached by dialing 03) that dispatches ambulances from local substations. Leningrad, which handles as many as 1,800 calls on a winter day, has 120 ambulances at 16 stations spotted about the city. Officials boast that an ambulance can be on the scene from seven to nine minutes after a call is received. Ambulances carry equipment for emergency surgery, care of cardiac patients and "reanimation" in cases of near death. They also carry a medical doctor and a feldsher, or medical assistant, a combination that makes treatment more readily available than it is in most U.S. emergency rooms.

To staff its thousands of hospitals, polyclinics, research facilities and ambulances, the Soviet Union maintains the world's largest army of men in white--though most of its soldiers are women. According to Petrovsky, the Soviet Union has almost 620,000 medical (including dental) practitioners, about 450,000 of whom are women. Petrovsky claims that the U.S.S.R. has more doctors than the U.S., Britain and France combined; one-fourth of all the doctors in the world are Soviets. In addition, Russia has well over 500,000 feldshers, who perform the same duties as a trained nurse in Western countries, plus many of the minor tasks normally handled by physicians.

Biggest Problem. Despite all this, the Russians are worried about a relative decline in both the quality and quantity of the country's health workers. One problem is money: an ambulance doctor with six years' schooling earns only $100 a month; a feldsher with four years' training is paid $90.

But Soviet medicine's problems are hardly confined to personnel. Bureaucracy has overstandardized treatment and inhibited research. Lab equipment, drugs and anesthetics are in short supply; heart-lung machines are scarce. Psychiatric care is well below American and European standards. Health Minister Petrovsky admits that the biggest problem facing the country's medical system is "improvement of the material and technological base." Until the problem is solved, Soviet medicine, though free and highly accessible, will remain abreast of the West in knowledge, but years behind in the ability to put it to use.

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