Sorry, We Have No Medicine

Unlike life-saving prescription drugs, hashish and other narcotics are easy to come by in Russia. Photo by the Russian Reader
Unlike life-saving prescription drugs, hashish and other narcotics are easy to come by in Russia. Photo by the Russian Reader

Sorry, We Have No Medicine
Alfia Maksutova
Takie Dela
November 24, 2016

What doctors and officials do to avoid giving patients the free drugs they have coming to them

“You’re not ill.”

“You don’t have that.”

“You don’t need that drug.”

“You need that drug, but a cheaper substitute will also do.”

“You need the drug, but we’re out of it, so you’ll have to wait.”

This is how doctors and officials respond to thousands of people who, by law, are supposed to receive subsidized medicines. They trick them. They know these people are ill, and they know what drugs they need. According to rough estimates, however, the state now lacks 45 billion rubles for providing drugs to the populace. In certain regions, only 10% of applicants can be supplied with subsidized medicines. Officials and doctors turn down patients in such a way that it is as difficult as possible to prove they have broken the law. The Health Ministry and the health care regulator Rosdravnadzor regularly report that things are stable when it comes to preferential drug provision in Russia. The figures underpinning the reports bear no relation to reality. The true scale and brutality of the war between patients and the state is striking.

***

“Every time, they say, ‘Sorry, we have no medicine. There is nothing we can do about it.’ But by law I am supposed to get them. If they are out of them today, the state should purchase them tomorrow. Isn’t that right?”

Veronika has repeated the question over and over, but her voice still sounds surprised. When she speaks, her hands, with their long, elegant fingers, tremble slightly, as if they too are incapable of coping with the surprise. She has used hormonal inhalers for fifteen years. Without them, she cannot breathe. She has asthma, a host of related ailments, and official status as a disabled person. She is entitled to get the necessary dose at the pharmacy for free, but the medicine has not been issued for a year and a half now.

“It was always given out intermittently,” says Veronika. “You had to find out ahead of time the day when the drug would show up and run to the clinic when it opened to be in time to get it. If you were late, they would tell you they had run out, and it was your problem. But it was only last year I had to deal with the medicine not being available for months at a time.”

Then, after waiting six months, Veronika first turned to the Moscow Health Department for help. It was enough to file an application and the inhaler, which the pharmacy did not have in stock in the morning, turned up in the evening. But the magical effect of phoning the health department did not last long. A couple of months later, the drug was once again no longer available. When Veronika called the health department this time, she was told the situation was complicated. She could file an application, but no one knew when the drugs would arrive. The same day, the pharmacy called her and said her request was pointless: the drugs would not be available. Currently, relatives have been paying for her inhalers to the tune of several thousand rubles a month. According to Veronika, many of the people queued up to see the pulmonologist could not afford to pay this amount. The phrase “we are out of drugs” is tantamount a death sentence to them.

Veronika’s case is one of thousands. It suffices to peruse the regional press for the past month to read a dozen such stories. In Mordovia, the pharmacies not only have no prednisolone for patients entitled to the free drugs benefits, but no iodine or bandages, either. In Oryol Region, a woman suffering from lymphoma managed to get medicine only after local media wrote about her case. In Khakassia, the Audit Chamber will be investigating the problems with subsidized medicines due to the large numbers of complaints by patients. Organizations involved in protecting patients’ rights talk constantly about the growing number of pleas for help. The Movement against Cancer, for example, has noted an uptick. In September of this year, there had been so many cases of cancer patients turned down for subsidized drugs that the Prosecutor General’s Office investigated legal violations in a number of regions. According to online monitoring data for September 2016, done by Alexander Saversky, head of the League of Patients, over 80% of those surveyed had trouble obtaining subsidized drugs. Only 35% of those people had managed to get a prescription for the drugs in question without problems. Similar figures were adduced in a survey done last year by the Russian People’s Front: half of the patients surveyed were not issued the medicines they requested on time.

A 2016 government report stated the subsidized drugs provision program was suffering a shortfall of 45 billion rubles [approx. 660 million euros]. This was no surprise. The standard cost per person receiving free drugs has dropped from 849 rubles a month, in 2011, to 758 rubles, in 2016. According to Rosstat, however, the price of drugs has increased this year by 24%. In 2015, the government allocated an additional 16 billion rubles to alleviate the situation, but, unexpectedly, they were not used. The Health Ministry has said that all necessary drugs have been purchased. Roszdravnadzor regularly monitors the supply of drugs nationwide and has remained satisfied with its results. According to the reports issued by these agencies, around 98% of beneficiaries in Moscow Region, for example, receive their drugs, and the situation in other regions is stable. The Health Ministry’s ability to force public health officials to bend reality for reporting purposes has amazed even the president. Continue reading “Sorry, We Have No Medicine”

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They Jump on Anything That Moves

podgorkov-queue-for-beer-1970s
Sergei Podgorkov, Queue for Beer, 1970s. Courtesy of oldsp.ru

Government Proposes Banning Individual Entrepreneurs from Selling Beer 
Anton Obrezchikov
RBC
November 22, 2016

Rosalkogolregulirovanie (Russian Federal Service for Regulating the Alcohol Market) plans to prohibit the sale of beer and cider at outlets registered to individual entrepreneurs. Producers argue the decision will be a blow to small business.

Several sources in the alcohol business have told RBC that Rosalkogolregulirovanie plans to ban the sale of alcohol at outlets registered to individual entrepreneurs. According to one of our interlocutors, the law “On State Regulation of the Production and Sales of Ethyl Alcohol, Alcohol, and Alcohol Products, and On the Limitation of Consumption (Drinking) of Alcohol Products” will be amended to reflect the move.

Rosalkogolregulirovanie did not respond to RBC’s request for comments.

Kommersant’s sources reported on the draft bill on Tuesday, November 22. According to the draft document, which the newspaper had seen, restrictions would be introduced nationwide on July 1, 2017, with the exception of Crimea and Sevastopol. The ban would be postponed in these regions until January 1, 2018.

Currently, individual entrepreneurs can engage in retail sales of beer, beer drinks, and various sorts of cider and mead. In addition, a separate category of entrepreneurs, those who have the status of agricultural producers, can sell wine. So far, however, such entrepreneurs do not officially exist in Russia. At the moment, only three applications for the relevant commerical license have been filed, and none of them has been approved yet.

As Kirill Bolmatov, corporate affairs director for Heineken, told RBC, Rosalkoregulirovanie’s main beef with individual entrepreneurs is that they are “insufficiently disciplined when filling out the mandatory paper financial  reporting statements.”

“Yet EGAIS [Unified State Automated Information System] completely tracks the movement of all alcoholic beverages in real time, and there is no point in filling out the statements,” said Bolmatov.

He called the pressure on businessmen “harmful,” since “beer is a large share of the turnover for small shops.” Adoption of the amendments would entail closing a large number of small shops.

“It’s a blow to small business,” he told RBC.

Individual entrepreneurs account for at least 37% of all retail outlets selling SAN InBev’s products, Oraz Durdyyev, the beer company’s legal and corporate relations director, told RBC.

“Prohibiting individual entrepreneurs from selling beer would deal a serious blow to legal small businesses, because beer is one of the high-margin products they have in stock, which helps keep prices down on goods purchased by the underprivileged,” argued Durdyyev. “Given the current economic realities, a ban like this is out of place and harmful, and could lead to increased social tensions.”

Entrepreneurs and beer companies have already faced significant restrictions on sales venues. As a spokeperson for Baltica brewing company reminded us, restrictions on beer sales at kiosks were introduced on January 1, 2013. According to the company, kiosks accounted for 20% of all beer sold. Since then, the number of retail outlets selling beer has decreased by 50,000. Over 30,000 of these outlets were kiosks and pavilions. During the period, the number of kiosks has fallen by 75%, from 30,000 to 8,600, and the number of pavilions by 24%, from 45,00 to 35,000. Baltica beer is sold at approximately 100,000 outlets registered to individual entrepreneurs, the company told us.

Translated by the Russian Reader

________

The Soft Boys, “Leppo And The Jooves”

Crabwise
Over the Andalusian extensions of the life and loves of Noddy
Through the windows of disgust
The teeth of Leppo and his managers awry
No time to cry

Sunrise
A lamp of no position in the loss of all existence
To the vultures without bibles and
The preachers without leaves that pass it by
No time to sigh

All them pretty women
Planted in a row
You see them in the newspapers
But you can’t have ’em – no!
No no no no no no no no! Oh ho ho!

They get Lep-Lep-Leppo and the J-J-J-J-J-Jooves
They jump on anything that m-m-m-m-m-moves
On taxis, coffin-lids, Americans, piano-heads and roofs
Leppo…

Likewise
A farmer and his diary might conspire to freeze a widow
So I went to rob the lizard
Of his skin, his coat, his money and his earth
All that he’s worth

Someday
You realize that everything you do or see or think of
If it interferes with nothing
Might as well dissolve in arrows or in tears
Nobody hears

All them famous people
Washed off in the rain
Leave not even a puddle, baby
All you leave is your name
Huh-ha-ha-ha-ha-ha!Your name!

I got a name, baby
It’s Lep-Lep-Leppo and the J-J-J-J-J-Jooves
Oh ho ho!
They jump on anything that m-m-m-m-m-moves
Ah ha ha! Ah ha ha.
On taxis, coffin-lids, Americans, piano-heads and roofs
Leppo…

Listen
And you can hear the dripping of the clocks, the reaping of the sun
The vengeance of the hammer and
The squeamish tight explosion of the liar
Burn in the fire

Gazing
With unforeseeing eyes into the smoke, the lungs of war
And all the endless formulations of unusable beginnings that
Have grown from hungry rivers into trees
Nobody sees

All them hungry people
They don’t look so good
But I don’t let it bother you
I don’t see why it should
No no no no no no!
Oh oh ho!
Oh ho ho!

Lep-Lep-Leppo and the J-J-J-J-J-Jooves
They jump on anything that m-m-m-m-m-moves
On taxis, coffin-lids, Americans, piano-heads and roofs
Leppo…

Source: Oldie Lyrics

Rospotrebnadzor Axes “Public Refrigerator” in Petersburg

“A Project like This Is Impossible in Russia”: Why the Public Refrigerator Has Closed Forever
The organizer of the first public refrigerator in Russia explains why European know-how did not catch on here
Julia Galkina
The Village
November 16, 2016

Public Refrigerator on Vasilyevsky Island. Photo courtesy of The Village and Svetlana Kholyavchuk/TASS

The first public refrigerator opened on Sunday, November 13, in Petersburg, outside the Thank You! charity shop on Vasilyevsky Island. The organizers had hoped that all comers would put unwanted food in the refrigerator and freely taked it. The refrigerator operated for exactly one day. (Read Greenpeace’s report about what that looked like.) On Monday, November 14, state consumer watchdog Rospotrebnadzor sealed the refrigerator, explaining, “We welcome charity, but the present case concerns not items for the poor, but food products. With all due respect to the organizers, if food poisoning happens and someone gets hurts, Petersburgers will blame us.” On Tuesday, November 15, the organizers abandoned the idea and removed the refrigerator, remarking that “the project is not compatible with Russian legislation.” Now they “are looking for other forms of foodsharing offline.”

Such public refrigerators exist in Czech Republic, Spain, Germany, Poland, and other countries. Why can Europeans manage it, but we cannot? We talked about this with Alexandra Lyogkaya, founder of the project Foodsharing: I Give Away Food for Free.

“As far as I know, the public refrigerators in European countries also work on the person-to-person system, the same way we wanted to organize it. The authorities there do not interfere with the work of such projects. In Russia, on the contrary, it didn’t take off, unfortunately.

“Thank You! was the only team in the city who agreed to try out the public refrigerator project with us. They made their porch available. We did all the prep work together, printing stickers and distributing adverts. It was a completely joint project. We did not vet anything with officials. We thought about it, but probably we counted on the good experience in western countries.

Queue at the public refrigerator on Vasilyevsky Island. Photo courtesy of Greenpeace
Queue at the public refrigerator on Vasilyevsky Island. Photo courtesy of Greenpeace

“People brought a lot of products—sweets, fruits, and so on—right at opening time. The refrigerator opened at twelve noon on Sunday, and Rospotrebnadzor sealed it on Monday around one-thirty in the afternoon. Even afterwards people came to pick up and bring food. As far as I know, they keep coming even now. They just leave it outside, and someone has picked it up a few minutes later.

“We had no restrictions. Anyone at all could bring and pick up food. Of course, many old women and old men came to get food. By the way, originally, the idea had been that the refrigerator would be used by people who could not get food through our group page on Vkontakte. Yet many old ladies said they were also willing to bring food themselves.

“I was ready for anything. That the refrigerator would be stolen, that it would break down, that the police and regulatory authorities would come. Rosprotrebnadzor’s visit upset me, of course, but I cannot say I was in shock or didn’t expect it. I tried to be mentally prepared for any outcome.

“Rospotrebnadzor told us that a public refrigerator was impossible in Russia. We could organize a cart to feed all comers or a public cafeteria, but not something in which anyone can donate products. So each volunteer would have to have the relevant papers. If you put pasties or jam in the refrigerator, show us your certificates listing the ingredients and how it was made, stored, and transported.

“Because our project is purely nonprofit (no money is involved), we would not be able to organize something big-scale like a cafeteria. For now, unfortunately, we have nopt come up with a way of doing an offline foodsharing project that would be legal and just as simple as the public refrigerator.

“I really liked the way people reacted well to the refrigerator. I think that matters more than what happened later. If the authorities had allowed us to put it there, but people had not understood the idea and been against it, it would have been much worse.  So we just need to find the right form. People both young and old are ready for such a project.”

Translated by the Russian Reader

The Hit-and-Miss Approach to HIV Prevention in Russia

“#testforthefuture. HIV-infection risk group. A topic that affects everyone. Take an HIV test free and anonymously. Humanitarian Action Foundation.” Public service ad in central Petersburg, October 29, 2016. Photo by the Russian Reader. Typically, the ad is plastered with flyers offering the services of prostitutes.

Health Ministry Did Not Include HIV Test in Compulsory Medical Exam
Polina Zvezdina
RBC
November 21, 2016

Optional and Anonymous

The Health Ministry has changed its annual medical exam program for adults, judging by the amendments posted on the Federal Website for Draft Regulations. Free HIV testing was not included in the document. In September 2016, Health Minister Veronika Skvortsova had promised testing would be included in the annual wellness examination program beginning in 2017.

If the amendments are adopted, beginning next year, general practitioners will be obliged to inform everyone between the ages of 21 and 49 who is undergoing a physical exam that they can take an anonymous HIV test at specialized medical clinics. Physicians should provide patients with a list of the clinics where the test is performed.

The Health Ministry had planned to receive funds to expand the program by eliminating ineffective research. Our sources at the ministry did not explain to us why the HIV test had been turned down for inclusion in the compulsory program.

MPs Fedot Tumusov and Alexandrev Petrov, who sit on the State Duma’s Healthcare Committee, believe the ministry rejected the HIV test as part of its physical exam program due to a lack of funds. Andrei Skvortsov, coordinator of the Patient Monitoring movement, agrees with them.

This is not the first time the government has been unable to find funds in the federal budget to fight HIV. Thus, on November 15, due to a lack of financing, a special interdepartmental commission decided not to add new drugs for suppressing HIV to the list of essential drugs. Elena Maximkina, director of the Health Ministry’s Department for Drug Provision, said that 20.8 billion rubles had been spent in 2016 on purchasing anti-HIV drugs. Yet in the three-year federal draft budget, 17.8 billion rubles have been slated for prevention and treatment of HIV and hepatitis B and C in 2017, 17.5 billion rubles in 2018, and 17.1 billion rubles in 2019.


Mandatory and Unethical

Another reason the free test could not be included in the medical exam program is legal. At present, the test is only administered voluntarily, explained Tumusov. Testing as part of the standard medical examination should be obligatory, believes Tumusov, A Just Russia party MP, but first you must explain to the public why it is necessary. We can already observe positive outcomes in Yekaterinburg, where reports of an unofficial [sic] HIV epidemic sparked widespread testing for the infection, said Tumusov.

Skvortsov argues that testing could be included in the medical check-up program if doctors in district clinics and non-specialized hospitals were better informed about the specifics of HIV and the means of its dissemination.

“Medical personnel often refuse to give HIV-infected patients necessary medical treatment, and such patients face other forms of discrimination,” he noted.

Doctors at ordinary clinics are also often not able to carry out the pre-test and post-test consultations that would be required if obligatory testing were included in the medical examination program, said Skvortsov.

Another factor is that patients are now often reluctant to be tested under the voluntary health insurance program, argues Igor Pchelin, chair of the Steps Regional Public Charity Foundation to Fight AIDs. This is due to the fact that physicians may not comply with medical confidentiality and reveal test results to colleagues, neighbors, and friends of infected patients.

Provided there is sufficient financing in 2020, the government plans to test 35% of the public for HIV annually, according to the strategic plan for combating the spread of the infection. From the draft of the plan, which RBC has seen, it follows that financing should amount to an additional 3.2 billion rubles per year. This amount is needed to test an additional 20 million people at a cost of 150 rubles per test. It is currently not known whether the funds will be allocated or not. In 2015, HIV testing covered around 30 million people or 19.3% of the population.

Translated by the Russian Reader. If you found this article fascinating and depressing, you should definitely read Daria Litvinova, “Russia Wishes Away Its HIV Epidemic,” The Moscow Times, November 18, 2018.

Downhill

"Lose weight with us. LPG from 890 rubles. You'll feel thinner after the first procedure." Photo by the Russian Reader
“Lose weight with us! LPG from 890 rubles. You’ll feel thinner after the first procedure.” Photo by the Russian Reader

Raw Materials, Grain, and Transport
The Russian economy has been shrinking and devolving
Pavel Aptekar
Vedomosti
November 9, 2016

As many experts had predicted, the inertia of economic policy has led to an ever-increasing shrinkage of the economy and devolution of its structure. In the last two years, the role of primary industries and the cargo haulage they generate has grown even more.

In the latest issue of Commentaries on the State and Business, Nikolay Kondrashov of the Higher School of Economics has calculated that, in the third quarter of 2016, agricultural output grew in comparison with the annual averages for 2014 by 6.6%, mining by 3.6%, and cargo haulage by 3.4%. During the same period, the volume of retail trade has decreased by 14.7%, construction by 12.8%, and manufacturing by 7.2%. According to Rosstat, real wages decreased by 13% from the third quarter of 2014 to the third quarter of 2016. This has reduced domestic demand, purchasing power and, consequently, the production of a number of consumer goods and the tempo of new construction. Sales of domestic products have increased relative to banned or seriously inflated imported goods, but overall food consumption has fallen. The contribution of manufacturing, construction, and trade to GDP has decreased, while, on the contrary, the role of extractive industries, agriculture, and the cargo turnover they generate has grown.

It is extremely difficult to break away from a resource economy and get on the path of growth. It is impossible to radically restructure the economy without major investments. They are currently at a low level and, according Vladimir Nazarov, director of the Finance Ministry’s Finance Research Institute, they are unlikely to increase. Stronger guarantees of property rights are needed,  at least, for investments to start flowing.

We can take satisfaction in the growth of agriculture, which has received a good deal of government subsidies and import-substitution preferences, but it is unlikely to provide a robust multiplier effect: the agricultural sector is heavily monopolized, and it requires less and less manpower. Agricultural equipment manufacturers may still profit, but they face serious competition from the Belarusians. Given low economic growth, the best we can look forward towithin the current framework is a slight downtick in the primary industries due to an increase in retail sales and construction, notes Nazarov.

Some growth in the manufacturing sector can be attained through defense contrats, whose impact on demand and economic growth is generally quite small. Russia can produce a limited number of products that are popular not only in the domestic market but also foreign markets, but we should not expect them to be the source of structural improvements.

The Russia economy’s structural focus on extractive industries was also typical during the fat years, but then it was mixed with windfall profits from oil sales. Nowadays, there is no hope that oil will generate growth. During a crisis, we need freedom of entrepreneurship and the development of new sectors from the bottom up, thus increasing the demand for human capital, more than ever. Otherwise, human capital degrades as well. It does not take a lot of smarts to maintain pipelines and a small number of latifundia.

Translated by Death of a Salesman. Thanks to Gabriel Levy for the heads-up

MP Oleg Shein: Astrakhan Region Headed for Social Catastrophe

Russian MP Oleg Shein. Photo courtesy of Wikipedia
Russian MP Oleg Shein in 2009. Photo courtesy of Wikipedia

MP: Astrakhan Region Headed for Deep Social Catastrophe
Rosbalt
November 18, 2016

Astrakhan is among the regions undergoing a social catastrophe, argues MP Oleg Shein, who sits on the State Duma’s Committee for Labor, Social Policy, and Veterans Affairs. As the MP told our correspondent, both federal and regional authorities are to blame for the situation.

“Astrakhan Region is currently undergoing a fiscal disaster due to the fact the regional budget has collapsed. This year, it has been slashed by 15%, from 38 to 33 billion rubles. Next year, the regional authorities have proposed cutting the budget by another eight billion rubles. Accordingly, the budget will have shrunk by about 40% in two years. Already this year, financial aid to the poor has been completely eliminated, and subsidies for parents paying fees to kindergartens have been canceled, causing kindergarten fees to increase by one and half times. The upper grades have been eliminated in a number of schools. Schools have gone from eleven grades to nine grades, and this has caused overcrowded classes in the remaining schools. Payroll has been reduced by 7% for public sector employees: doctors, teachers, and cultural workers. Actually, 7% is the average figure; large numbers of people have had their salaries cut much more considerably. So the region really is headed downhill, and the regional government sees no ways of heading off the disaster,” said Shein.

 […]

“The regional authorities—and there is some truth to this—explain what is happening by referring to the loss of tax revenues from the oil industry. Several years ago, the State Duma—or rather, the United Russia party—freed Lukoil from paying taxes on its oil rigs in the Caspian Sea. This year as well, United Russia has voted to transfer the profits from oil production in the Caspian, the income tax revenue, from the regional budget to the federal budget. The regional authorities were really counting on the money, but they have ended up with nothing.  But there is a second reason: their completely devil-may-care approach to drafting the regional budget and the loss of the local tax base. Sometimes, the regional government has literally abetted hostile takeovers of local companies, as, for example, happened to the local company Bassol, which supplies 60% of the salt to the Russian market and now pays taxes outside of Astrakhan Region. Paradoxically, the regional government welcomed this,” said Shein.

The MP said that despite its socio-economic difficulties, Astrakhan Region was also marked by high levels of corruption and the waste of money on mega projects like a musical theater and so on.

According to a rating compiled by the sociology department at the Russian Federation Government Financial University, Astrakhan was among the Russian cities with populations of 500,000 or more where the lowest indices for quality of life had been recorded. According to Astrakhanstat, during the period from January 2016 to August 2016, the real disposable income of Astrakhan Region residents was 89.4% of what it had been during the same period last year.

Translated by the Russian Reader. Thanks to Valentin Urusov for the heads-up

Johnny Depp and Oleg Sentsov

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“Oleg Sentsov is a Ukrainian filmmaker. When Crimea was annexed by Russia, he became a prime target to make an example of it in order to stifle dissent. He’s been tortured and sentenced to 20 years in prison, but Oleg is not backing down.” Image and text courtesy of Represent and The Voice Project.

Hanukkah, Christmas, Kwanzaa, and New Year’s are just around the corner. This year, think about giving your friends and loved ones t-shirts, produced by The Voice Project, featuring the mug shots of Johnny Depp, Nadya Tolokonnikova, Peter Gabriel, Tom Morello, Ana Tijoux, and Alex Ebert.

This is their way of bringing attention to the plights of political prisoners around the world, including Ukrainian filmmaker Oleg Sentsov, now serving a twenty-year sentence in Siberia on trumped-up charges of “terrorism.”

I’ll definitely be buying the Johnny Depp t-shirt. Not only has Mr. Depp been one of my favorite actors ever since the days of 21 Jump Street, he has chosen to draw attention to Mr. Sentsov’s imprisonment.

artists-800x520
Image courtesy of The Voice Project and The Kyiv Post

The Voice Project speaks up for those who speak out, for those imprisoned around the globe for having raised their voice in dissent. We have to support each other, no matter the distance, no matter the borders. You never know when you’ll need the same in return.

For singers Trần Vũ Anh Bình and Nûdem Durek, filmmaker Oleg Sentsov, writer Dawit Isaak and poet Ashraf Fayadh, these individuals have fought for change, used their voices to speak out, and are paying with their freedom and their lives. We owe it to them to speak up now on their behalf.

Source: Represent