Circumstance has forced the inhabitants of Kurganka, a village in Russia’s Omsk Region, to become their own medical service. They have worked out how to give one another injections, avoiding the need for a doctor’s’ prescription. For a prescription you have to go to Muromtsevo, the district centre, 50km away – an expensive exercise and risky as well; it never rains here but it pours, literally, and even if you get though the deluge there’s no guarantee a doctor will see you. The queue starts forming at 8am, and if you’re a bit late, tough! And the bus from the outlying villages only arrives after 9am.
For a prescription you have to go the district centre, 50km away.
‘There have been so many times when I’ve arrived too late to get an appointment’, says pensioner Lyudmila Afinogenova, ‘and then you lose the whole day: the bus doesn’t go back until the evening. I gave up going there ages ago. I went just once last year with my granddaughters; the older one was starting school and the school health worker said all the children needed to have various jabs first. So off we went, taking her little two-month-old sister along as well. A friend agreed to drive us there and back, for 1,600 roubles [the average monthly pension is 10,000 roubles]. But when we got to the hospital they said we weren’t on their lists; according to their information, we’d moved out of the area. So we had to go home without the jabs.’
This February, medics from the Central District Hospital deigned to come to Kurganka to do the immunisations. The baby was then 15 months old, and it was the first time anyone from the medical profession had shown any interest in her.
Lyudmila herself has diabetes, for which she needs regular insulin injections. ‘If your blood pressure goes up to 220, you need insulin or you’ll die’, she says. ‘Mind you, if you do die that’s not so bad, but you might have a stroke instead and that’s such a pain for your family.’
Life without medics
Sometimes Lyudmila does her own injections, sometimes, family members do it for her. Many people in Kurganka and the other settlements in the area have learned this skill; after the First Aid station that served four villages closed down, medical services have turned into a cross between volunteering and small business. There’s no other way to earn any money here: back in the 80s the prize-winning local collective farm was never out of the newspapers, but by the mid-2000s agricultural activity was reduced to a cooperative with 200 head of cattle that is now in receivership. And even while it was running, employees were mostly paid in hay and firewood – cash only appeared on special occasions.
Medical services have turned into a cross between volunteering and small business.
The Kurganka First Aid Station effectively closed down at the start of the 2000s, but it was still officially listed as a medical facility until 2009, when the Novaya Gazeta daily published an article exposing this anomaly. The mythical facility was resurrected soon afterwards, but not for long: the nurse practitioner appointed to run it went back home after a year and a half, without waiting for the 500,000 roubles he had been promised under the ‘Governor’s Medical Programme.’
‘It was such a pity’, says pensioner Lyubov Znayeva. ‘Our Aleksandr was such a good nurse. He was kind and sensitive; you could turn to him any time – evenings, Sundays, he would always be ready to help.’
The Kurganka First Aid Station, which was listed as 'operational' for 10 years. (c) Author
Lyubov is 77 and is registered disabled: she had a stroke 19 years ago and now she says she relies on injections to keep her heart and brain going. ‘We give them to each other – not for free, of course, but for a lot less than you’d pay if you went into Muromstsevo. I have an arrangement with a neighbour who used to work as a nursing assistant: she gives me 20 injections for 200 roubles.’
‘I have an arrangement with a neighbour: she gives me 20 injections for 200 roubles.’
The residents of Kurganka can’t survive entirely on their own efforts, of course; they still need qualified medical help from time to time, not to mention emergency treatment. They tell me about how, three years ago, Maria Kuklina, a young woman of 36, had a heart attack. They phoned for an ambulance but were told there was none available: they would have to get her to the hospital in Muromtsevo themselves.
It took them two hours to find a car in the village, and they had gone only six kilometres when Maria’s heart stopped.
The rationalisation of rural life
In 2001 the Znamya Truda (Banner of Labour) newspaper wrote that the Muromtsevo district (with 24,000 inhabitants) contained four hospitals, six polyclinics and more than 40 village First Aid stations.
That was in the turbulent, poverty-stricken 90s. In the following period, when Russia was getting up off its knees, big changes took place in local healthcare; and, as I have now learned from Dmitry Shchekotov, a member of the district council who has a visual impairment himself, there are now only three hospitals, one polyclinic and ten village First Aid stations.
A working First Aid Station in the Sargatskoye District. (c) Author
The district is no better, and no worse, off than the rest of the Omsk Region. In the neighbouring Sargatskoye district, for example, many villages have not only no First Aid station or school, but no water fit for washing and other household needs, let alone for drinking. The locals use water from a lake, at some risk to their health. Pyotr Plesovskikh, a farmer and social activist, told me that many villagers had had enough and that ‘it could all get out of control.’
Last October, 40 people from Novotroitskoye, where he lives, and the neighbouring village of Despozinovka blocked the local highway in protest, demanding repairs to the road along which their children have to travel to school. Some of the potholes, says Plesovskikh, are half a metre deep, and it takes the bus over two hours, and longer in bad weather, to cover 40km. So the children spend five to six hours a day shaking about in the bus, while their parents wait for them at home with their hearts in their mouths.
The school bus takes over two hours, and longer in bad weather, to cover 40km.
The protest could be described as successful: the regional highways department found one million roubles for repairs to the road, a small sum considering it had had no repairs for 20 years, but something at least – the most dangerous potholes were filled in with clay.
This is, however, the farmer points out, a temporary measure: ‘Come spring, we’ll be up to our ears in mud.’ However, he and three other organisers of the blockade were fined 30,000 roubles and given 50 hours of community service, but considered it was worth it.
A road in Sargat Region. (c) Author
Last year the Omsk Region website announced that in-patient facilities were to be closed at two rural hospitals in the Cherlaksky district. The nearest hospital beds would now be in the district centre, 57km away from one of the villages served.
Medical facilities are also being ‘rationalised’ in the area around Omsk, with in-patient services closed at a hospital serving seven residential areas, and also in Omsk itself; in February, the city’s Hospital No.2 closed its in-patient department, losing 200 beds.
None of this is the fault of the regional authorities: neighbouring regions, and those further afield, are facing the same cuts. In the Sverdlovsk Region, for example, the number of village First Aid stations has fallen from 248 to 177 in the space of four years, and in the Orenburg Region, 54 have closed down over two years.
The cost of survival
All health, education, social services, and benefits in the Omsk region have been ‘rationalised’ since the beginning of the year. Free school meals, for example, are now available only to children in low-income families, those earning under 1.5 times the living wage; in some other regions it is only families with an income lower than the living wage whose children are entitled to a free school meal.
All health, education, social services, and benefits in the Omsk region have been rationalised since the beginning of the year.
Meanwhile the ‘Social Assistance Standards’ for the elderly and disabled, also introduced on 1 January, have effectively reduced this assistance to nil. Previously, home care workers visited four clients a day; now their workload has doubled and they need to get round eight people in the same eight-hour shift. ‘There’s usually a 15-20 minute walk between clients’ houses in the villages’, says Dmitry Shchekotov, ‘and if you take that out of the hour, there’s not much time left for actual care. And the fees the old people now have to pay for the service are often beyond their means.’
The rise in social service charges over the last decade (until 2006 all these services were free) is a good indicator of the humanitarian concerns of the state. Even ignoring inflation, they have increased by several times and are now exorbitant; and now disabled people and war veterans have even lost their 50% discount on service charges. Here are just a few of the new rates:
Wood cutting: 165 roubles per m3
Snow clearing: 82.5 roubles per m3
Bringing fuel (wood or coal) into the house from the yard: 13 roubles 76 kopecks
Starting a fire in the stove: 12 roubles14 kopecks
Clearing out ashes: 8 roubles 26 kopecks
Fetching 13 litres of water from the well: 26 roubles 14 kopecks
Bringing bread from the shop: 23 roubles 39 kopecks a loaf (on top of the 37 roubles for the bread itself).
Lyubov Znayeva has reason to be cheerful: ‘It’s a good thing that, although I’m registered disabled, I can still do a lot for myself. But if someone is frail and living on a miserly pension of 8000 - 9000 roubles a month, how are they supposed to manage? I ask the social service workers, “What kind of service is this? You’re fleecing helpless old people”. And they say, “We have to live as well – if we don’t fulfil our quotas we don’t get a bonus.”’
Varvara Klyuchkina, another elderly resident of Kurganka, also tried to do everything for herself. She was 85. One day she was trying to light a fire in her stove when some sparks fell on her clothes. She burned to death and her house burned down.
Dmitry Shchekotov believes that the new legislation on ‘The social welfare of the elderly and disabled’ is unconstitutional, since the Constitution states that laws may not be passed, which worsen the conditions in which people live.
He is taking the matter to court, and is prepared to go all the way to Strasbourg with it.