Developing a Moral Immunity to HIV The Education and Science Ministry doesn’t want young people to talk about condoms
Anna Makeyeva and Valeriya Mishina Kommersant
November 3, 2017
As Kommersant has learned, a scandal has erupted in the Education and Science Ministry over an online HIV prevention lesson for high school and university students. The people responsible for the internet project have refused to fulfill demands by officials to vet answers to users’ questions in advance, as well as their recommendations to “talk about morality in order to get away from slippery topics” and avoid such words as “condom.” It is still unclear how the lesson, scheduled for December 1, will be taught.
The Nationwide Internet HIV Prevention Lesson, timed to coincide with World AIDS Day on December 1, has been held by order of the Education and Science Ministry since 2015. On the eve of the lesson in 2016, Education and Science Minister Olga Vasilyeva noted that the issue of countering the spread of the HIV infection among children and adolescents, given the complicated epidemiological circumstances, had long been a focus of the Education and Science Ministry, and occupied a vital place in a set of measures for preserving and strengthening the health of children and young people.
“The use of such innovative methods as open internet lessons at preventive events in educational institutions will help us cope more effectively with the existing problem,” Izvestiaquoted the ministry’s stated position in 2015.
On November 2, a working meeting in preparation for the upcoming internet lesson was chaired by Larisa Falkovskaya, deputy director of the department for state policy on children’s rights at the Education and Science Ministry.
“For the first time in my life, a meeting at the Education and Science Ministry ended in scandal because of my fault. I refused to write the answers for those taking part in the online HIV prevention lesson,” said Sergei Bulanov, who is in charge of organizing the online lesson and heads the Center for Modern Education Technologies, a group of non-profit organizations engaged in educational and related projects.
According to Bulanov, the officials at the meeting deemed use of the word “condom” “unacceptable,” and consequently the meeting was adjourned.
Project organizers suggested to officials they give up the practice of using prepared answers in the video lesson and discuss issues of prevention in a playful way, for example, by arranging a rap battle between student teams from two regions.
“But we were told to talk about morality in order to get away from slippery topics,” complained Bulanov, adding, “The topic is ratherly widely represented in the school curriculum, but currently the Education Ministry has adopted a surprising stance, based on substituting HIV prevention, which is mostly a matter of personal hygiene, with lessons in moral values.”
Besides, Bulanov argues it is incorrect to equate the risk of infection only with antisocial behavior.
“Thirty percent of HIV-infected women were infected by the only sexual partner they ever had. Can we reproach them for antisocial behavior? HIV-positive teenagers who have been infected from birth did not lead an antisocial lifestyle.”
Vadim Pokrovsky, head of the Federal AIDS Center, argues the view it is better not talk to children about sex currently prevails in Russia.
“It is one of the reasons HIV has spread so widely in Russia,” he said.
According to Pokrovsky, twenty percent of young women are already having sex by the age of fifteen. He added that in Germany, for example, sex education is an obligatory subject in schools. Last year, only 3,500 cases of infection were registered there, while over 100,000 cases of infection were registered in the Russian Federation.
“We see two fundamentally [different] approaches and two different outcomes,” Pokrovsky concluded.
The Education and Science Ministry declined to comment on the situation when approached by Kommersant. The Russian Federal Health Ministry learned about the conflict from Kommersant. The ministry said the online HIV prevention lesson was an undertaking of the Education and Science Ministry.
“They did not come to us with this or consult with us,” our sources at the Health Ministry said.
Sergei Bulanov assured Kommersant preparations for the open HIV prevention lesson for young people would be continued.
“We will keep on working, focusing more on recommendations from specialists at the Health Ministry and Rospotrebnadzor [the Russian federal consumer watchdog] than on the client [i.e., the Education and Science Ministry].
The internet lesson will take place on December 1, 2017.
Translated by the Russian Reader. Photo courtesy of Pravda.ru
“I Only Want to Take a Bath, Nothing More”
Alexander Kalinin Rosbalt
May 15, 2017
Anna Yegorova is ninety-eight years old. She defended Leningrad all nine hundred days of the Nazi siege of the city during the Second World War. On the seventy-second anniversary of Victory Day, the combatant did not even get postcards from the government. But there was a time when she wrote to Brezhnev—and got a reply.
Anna Yegorova was born in 1918 in the Kholm-Zhirkovsky District of Smolensk Region. When she was ten, her parents decided to set out in search of a better life and moved to Leningrad with their daughter. They settled in a wooden house near the Narva Gates on New Sivkov Street, now known as Ivan Chernykh Street. Yegorova finished a seven-year primary school and enrolled in the Factory Apprenticeship School, where she graduated as a men’s barber.
“Oh, what beards didn’t I trim in my time,” the Siege survivor recalls.
After acquiring a vocation, the 19-year-old woman married Alexander Vesyolov, a worker at the Kirov Factory. As soon as the war broke out, her husband volunteered for the first division of the people’s militia. Nearly the entire division fell in battle during July–September 1941 on the southern approaches to Leningrad. Vesyolov is still officially listed as missing in action.
Yegorova was drafted into the air defense brigades at the war’s outset. The young woman served in a basement, equipped with seven cots, in one wing of the Kirov Factory. It was the headquarters of the local air defense brigade.
Yegorova still remembers the war’s outbreak, her military service in the besieged Leningrad, and victory in May 1945.
“How did the war begin? We were going to the cinema, but my mother told me I should go to the factory instead. Then I got a notice stating I had been drafted to serve in the headquarters of the local air defense brigade at the Kirov Factory. I spent all nine hundred days there. I was able to come home only once a month. My parents starved to death. Dad passed away on February 3, 1942. He was a first-class carpenter. His comrades made him a wooden coffin: they could not bury a carpenter without a coffin. Mom died a month later. They just carried her off to the Volodarsky Hospital in a blanket. I don’t even know where she is buried. Maybe at the Piskaryovskoye Memorial Cemetery, maybe in Moskovsky Victory Park,” says Yegorova.
Her duties included running to other parts of the city to deliver dispatches, carrying the wounded, and standing on guard at the factory, armed with a rifle. The young woman would look into the sky and watch what planes were flying overhead: planes emblazoned with red stars or planes bearing black crosses. Once, during a heavy bombardment, she was shell-shocked.
“I still remember how we chopped up houses in the Kirov District. Once, a girlfriend and I were dismantling a house near a railroad bridge, and a woman called out to us, ‘Girls, girl, come here, come.’ We didn’t go: we were scared. There were all kinds of people back then, you know. Once, this girl stole my food ration cards, and my mom’s earrings were also stolen,” recalls Yegorova.
The Siege survivor recounts how she would travel to the Krasnoarmeysky Market to buy linseed cakes and oilseed meal.
“The oilseed meal was like sawdust. Oh, how I gagged on that oilseed meal! But we had nothing to sell. We were poor.”
When Victory Day arrived, her house was nearly totally destroyed. Only an ottoman was rescued from the ruins.
Yegorova remarried after the war. Her new husband was a military officer, Nikolai Yegorov, who had fought not only in the Great Patriotic War (Second World War) but also the Finnish War (Winter War). In peacetime, Yevgorov became a first-class instrumentation specialist. In 1946, the Yegorovs gave birth to a daughter, Lydia. Yegorova worked as a secretary at the Kirov Factory, latter becoming head of a bread and confectionery department at a store.
In the late 1960s, Anna Yegorova wrote a letter to Leonid Brezhnev, secretary of the Central Committee of the Soviet Communist Party. The essence of the message was as follows.
“Leonid Ilyich, no one is forgotten, nothing is forgotten. But it has so happened that I, a survivor of the Siege of Leningrad, awarded the medal For the Defense of Leningrad, and my husband, a veteran of the Great Patriotic War, have to huddle with our daughter in a sixteen-square-meter room on Lublin Alley.”
Yegorova does not believe her letter reached Brezhnev personally, but she does think it wound up in the hands of a “kindly” secretary who helped the family move into a one-room flat in the far southern district of Ulyanka. She lived in the neighborhood for around thirty years. She was civically engaged, working with Great Patriotic War veterans. She says she even worked as an aide to Sergei Nikeshin, currently an MP in the St. Petersburg Legislative Assembly, who was then quite young. Nikeshin and she inspected the fields then surrounding Ulyanka.
In 1996, Yegorova took seriously ill. She was struck down by deep vein thrombosis. Her left leg “was like a wooden peg.” Her husband Nikolai died in 1999.
“After that, Mom stayed at home. I took care of her. This is my cross. We would take her to the dacha only in the summer. Otherwise, she would move about only in the apartment. She would get up in the morning and make her bed, come into the kitchen and sit down on the couch. She would turn on and call the station to request a song. She loved Boris Shtokolov’s “Dove.” Or she would request “A White Birch Weeps,” or something by Nikolai Baskov. But a month ago she took to her bed. Now all she does is lie in bed,” recounts her daughter Lydia Kolpashnikova.
Boris Shtolokov, “Dove” (a Russian adaptation of “La Paloma”)
Kolpashnikova is herself a pensioner. She has a third-degree disability. According to her, Petersburg authorities have practically forgotten her mother. True, three years ago, the Moscow District Administration called and said she could get a wheelchair. The women’s joy was short-lived. It transpired that the wheelchairs were used: they had been brought to Petersburg from Holland. To make use of the chair, they would have had to pay to have it repaired. The women decided to turn the gift down the gift.
Yegorova has received no substantial help from the local Siege survivors society. The organization can only offer trips to museums and theater tickets. This is not an option for Anna Yegorova, who is in no condition to leave her apartment. On memorial days—the Day of the Lifting of the Siege and Victory Day—however, cakes used to be brought to her. But this time around, however, she was completely neglected. According to the pensioner, the city did not even congratulate her.
Yegorova’s daughter Lydia decided to remind the authorities of her mother’s existence after hearing President Putin’s speech on TV. The president demanded that the heads of the country’s regions do a better job of caring for Great Patriotic War veterans.
“I clung to Putin’s words that veterans needed help, for example, if they needed help with home repairs. I called the district administration and asked them to repair our bathroom,” says Kolpashnikova. “Mom is completely ill. She is almost completely out of it. She has gallstones, heart failure, and atrial fibrillation. She is classified as a first-class disabled person. She survives only on sheer willpower. But now she cannot make it to the bathroom. I wipe her off in bed. She talks to me about the bathroom all the time, however. She wants to take a bath, but wants the bathroom repaired. The tile has crumbled in there. I called the Moscow District Administration and asked them to repair the bathroom, but I was told that ‘sponsors’ deal with these issues. Now, however, there is a crisis, and there are no sponsors. What sponsors were they talking about? Mom also needs medicines and diapers. There are social workers willing to run from one office to the next to get hold of diapers for free, but they also need to be paid to run around. The local Siege survivors organizations cannot do anything: they are the weakest link. I have no complaints against them.”
Anna Yegorova gets gifts from the authorities only on round dates. When she turned ninety, they gave her a towel, and they presented her with bed linens when she turned ninety-five.
“I called them in the autumn. I said that Mom would be turning ninety-eight on November 25. I suggested they come and congratulate her. They said to me, ‘We don’t have the right. When she turns one hundred, we’ll congratulate her,” recounts the Siege survivor’s daughter.
Anna Yegorova does not want to ask the authorities for anything.
“I have no strength. What should I do? I cannot stand up straight. I fall. I just want them to fix the bathroom. I want to take a bath. That’s it.”
All photos courtesy of Alexander Kalinin and Rosbalt. Translated by the Russian Reader. Thanks to Comrade Koganzon for the heads-up
Experts Predict Reduction in Number of Hospitals to 1913 Levels
Polina Zvezdina RBC
April 7, 2017
The optimization of healthcare has led to massive hospital closures and a decrease in the quality of medicine in Russia, experts say. By 2021–2022, the number of hospitals in the country might drop to the level of the Russian Empire.
Hospitals of the Russian Empire
Between 2000 and 2015, the number of hospitals in Russia halved, dropping from 10,700 to 5,400, according to calculations made by analysts from the Center for Economic and Political Reform (CEPR), based on data from Rosstat. In a report entitled “Burying Healthcare: Optimization of the Russian Healthcare System in Action,” CEPR analysts note that if the authorities continue to shutter hospitals at the current pace (353 a year), the number of hospitals nationwide will have dropped to 3,000 by 2021–2022, which was the number of hospitals in the Russian Empire in 1913. (RBC has obtained a copy of the report.)
Healthcare reform kicked off in 2010, when the law on compulsory health insurance was adopted, David Melik-Guseinov, director of the Moscow Health Department’s Healthcare Organization Research Institute reminded our correspondent. It consisted in optimizing costs by closing inefficient hospitals and expanding the use of high-tech health facilities. The authors of the CEPR’s report explained that they examined a fifteen-year period when Vladimir Putin was in power, including his tenure as prime minister. In addition, the vigorous reform and optimization of healthcare kicked off between 2003 and 2005, as is evident from the statistics on the numbers of hospitals and outpatient clinics.
Hot on the heels of the hospitals, the number of hospital beds also decreased during the fifteen-year period: on average by 27.5%, down to 1.2 million, according to the CEPR’s calculations. In the countryside, the reduction of hospital beds has been more blatant: the numbers there have been reduced by nearly 40%. These data have been confirmed by Eduard Gavrilov, director of the Health Independent Monitoring Foundation. According to Gavrilov, the number of hospital beds has been reduced by 100,000 since 2013 alone.
Melik-Guseinov agrees the numbers of hospitals and beds have been decreasing, but argues these figures cannot be correlated with the quality of medical service and patient care. The primary indicator is the number of hospitalizations, and that number has been growing, he claims. For example, 96,000 more people were discharged in Moscow in 2016 than in 2015. This means that, although hospital bed numbers have gone done, hospital beds have been used more efficiently. Each hospital bed should be occupied 85–90% of the time, Melik-Guseinov stresses. If beds stand empty, they need to removed.
Outmaneuvering Outpatient Clinics
As the CEPR’s report indicates, the trend towards a decrease in hospitals and hospital beds could be justified were resources redistributed to outpatient clinics, but they too are being closed in Russia. During the period from 2000 to 2015, their numbers decreased by 12.7%, down to 18,600 facilities, while their workload increased from 166 patients a day to 208 patients.
“The planned maneuver for shifting the workload and resources from hospitals to outpatient clinics did not actually take place. The situation became more complex both in the fields of inpatient and outpatient care,” conclude the authors of the report.
In its report, CEPR also cites the outcome of an audit of healthcare optimization performed by the Federal Audit Chamber. The audit led the analysts to conclude that the reforms had reduced the availability of services. As the CEPR notes, the incidence of disease increased among the population by 39.1% during the period 2000–2015. Detected neoplasms increased by 35.7%, and circulatory diseases, by 82.5%. The analysts personally checked the accessibility of medical care in the regions. The report’s authors tried to get an appointment with a GP in a small Russian city, for example, Rybinsk, in Yaroslavl Region. If they had been real patients, they would have waited 21 days to see a doctor. In addition, write the analysts, hospitals do not have a number of drugs, such as dipyrone, phenazepam, and ascorbic acid.
Melik-Guseinov is certain that one cannot rely on data on the incidence of disease among the population as an indicator of deteriorating healthcare in Russia. He points out that what is at stake is not the incidence of disease per se, but diagnosis. The fact that the more illnesses are detected is a good thing.
The CEPR’s analysts write that the lack of medicines in hospitals reflects another problems in Russian healthcare: its underfunding. The government constantly claims expenditures on healthcare have been increasing, but, taking inflation into account, on the contrary, they have been falling. The CEPR refers to an analysis of the Federal Mandatory Medical Insurance Fund. Their analysts calculated that its actual expenditures would fall by 6% in 2017 terms of 2015 prices.
The report’s authors also drew attention to medical personel’s salaries. Taking into account all overtime pay, physicians make 140 rubles [approx. 2.30 euros] an hour, while mid-level and lower-level medical staff make 82 and 72 rubles [approx. 1.36 euros and 1.18 euros] an hour, respectively.
“A physician’s hourly salary is comparable, for example, to the hourly pay of a rank-and-file worker at the McDonald’s fastfood chain (approx. 138 rubles an hour). A store manager in the chain makes around 160 rubles an hour, meaning more than a credentialed, highly educated doctor,” note the analysts in the CEPR’s report.
According to a survey of 7,500 physicians in 84 regions of Russia, done in February 2017 by the Health Independent Monitoring Foundation, around half of the doctors earn less than 20,000 rubles [approx. 330 euros] a month per position, the Foundation’s Eduard Gavrilov told RBC.
Compulsory medical insurance rates do not cover actual medical care costs, argue the CEPR’s analysts. For example, a basic blood test costs around 300 rubles, whereas outpatient clinics are paid 70 to 100 rubles on average for the tests under compulsory medical insurance. Hence the growing number of paid services. Thus, the amount paid for such services grew between 2005 and 2014 from 109.8 billion rubles to 474.4 billion rubles.
The authors of the report conclude that insurance-based medicine is ineffective in Russia. Given the country’s vast, underpopulated territory, one should not correlate money with the number of patients. This leads to underfunding and the “inevitable deterioration of medical care in small towns and rural areas.”
“It is necessary to raise the issue of reforming insurance-based medicine and partly returning to the principles of organizing and financing the medical network that existed in the Soviet Union,” the analysts conclude.
RBC expects a response from the Health Ministry.
Translated by the Russian Reader. Thanks to Comrade AT for the heads-up
Petersburg Municipal Hospital and Clinic Construction Program on the Skids
Svetlana Zobova Delovoi Peterburg
February 3, 2017
Petersburg Governor Georgy Poltavchenko has botched ex-Governor Valentina Matviyenko’s ambitious program of building 32 healthcare facilities at a cost of upwards of 30 billion rubles. The city lacks a force that could consolidate physicians and builders to campaign against construction delays.
DP has audited all the municipal healthcare facilities that have been built, are under currently construction or are in the planning stages. The circumstances surrounding them are far from ideal. In each specific case, we can speak of certain objective causes as to why a particular clinic has not been completed or is not yet treating patients. But if we look at the issue as a whole, it becomes clear our city has no system for overseeing and managing the sector. Accountability is split between two committees whose specialists, to put it mildly, are not very happy with each other.
Both doctors and builders tell obscene jokes about each other behind each other’s backs and complain of their opponents’ extreme incompetence and their unwillingness to compromise. They cannot work together to finish nearly any of the projects. But no one is ready for a showdown that could reverse the situation and establish new, functioning rules of the game.
The few examples when new hospitals and clinics have been successfully opened either conceal sad stories of protracted construction delays or were overseen by federal officials, and the degree of oversight and accountability were thus on a completely different level. Aside from federal facilities, this study did not take into account facilities that merely underwent renovations, only those that were slated for complete makeovers or new facilities.
DP received quite detailed replies from the city’s Construction Committee and Healthcare Committee about the causes of the delays at dozens of facilities and the complications with bringing operating facilities online. However, there was no answer as to why these processes have been implemented so poorly, with so much anguish and pain.
To equip the city with the three dozen modern medical facilities it so badly needed, the Matviyenko administration allocated around 30 billion rubles. However, under the current administration, construction companies have been paid less than 10 billion rubles from the budget, completing only a few facilities in fits and starts. Our sources in the Health Committee say the sector’s underfunding has been due to delays in construction.
In some cases, the quality of their work has caught the eye of the prosecutor’s office, while in other cases, expensive medical equipment has been ruined due to mistakes and miscalculations. Deadline overruns have been ubiquitous. It would be wrong to say that the only cause has been poor work on the part of builders and designers. The city authorities have kept on awarding new contracts even to those contractors who have attempted to turn over blatantly shoddy facilities to doctors and brazenly lied.
DP discussed the problem with a dozen head physicians and their deputies, as well as well as contractors and city officials. We got the impression Petersburg has not become Russia’s northern healthcare capital less because of the economic crisis and a lack of financing, and more because of bureaucracy and the complete absence of a genuinely efficient system for managing municipal construction projects. In several instances, it is obvious that if city officials had done nothing at all, it would have been much better, as was the case, for example, with the closure of the maternity hospital on Vavilovykh Street.
When she departed from Petersburg, Valentina Matviyenko left a legacy of numerous ambitious construction projects, including healthcare facilities. She had planned for the construction or reconstruction of 32 medical facilities by 2016, including new hospital wings, outpatient clinics for children and adults, dentistry clinics, ambulance stations, and specialized early treatment and prevention centers (as per Petersburg Government Decree No. 149, dated 10 February 2011).
As of late 2016, city authorities had built and opened only six facilities on the list. Another four facilities have been built, but their directors, the Construction Committee, and contractors have been bogged down in fierce arguments as to the quality of the construction. The other projected facilities have either been frozen or not assigned a contractor, and their designs are now outdated.
Initially, Governor Poltavchenko seemed inclined to keep improving healthcare in Petersburg. In 2012, he added several dozen future facilities to Matviyenko’s list. Design and construction work on the facilities was to have been completed in 2013–2014.
For example, the new governor promised to rebuild the morgue at the Bureau of Forensic Medicine, design a hospice, build several antenatal clinics, design new wings for the Kashchenko Mental Hospital, and build a TB prevention and treatment clinic in Kolpino.
A little later, Matviyenko and Poltavchenko’s plans were drafted as a program for the healthcare sector. The document originally promised that city officials would arrange for the construction or reconstruction of 29 ambulance stations and medical facilities capable of taking in 36,000 patients a day by 2015.
In reality, the healthcare facilities construction program has been the most disastrous line item in the city’s targeted investment program for several years running. In 2016, none of the medical facilities under construction used 100% of the funds allocated to them in the budget. Certain facilities did not touch literally any of the funds allocated to them.
The prosecutor’s office and the Audit Chamber have highlighted construction delays. The city’s vice-governors for construction policy and Construction Committee chairs have come and gone, but federal officials are still asking the same questions.
At our request, the Construction Committee listed all the medical facilities that have been either built or constructed in the last ten years. According to the officials there, from 2009 to 2011, the three years before Poltavchenko took office, eleven major facilities were brought online. After he arrived in the governor’s office, from 2012 to 2016, another eleven facilities were completed, according to officials, although two are still closed, and the others opened considerably later than they were completed.
The city’s Health Committee provided us with different information. Officials there calculated that 28 facilities had been completed between 2006 and 2016, although Poltavchenko’s program had stipulated either renovating or building 63 facilities from scratch. The difference in figures is due to the fact that officials from the two committees used different timespans. In reality, both lists show outright that the city has got worse at building medical facilities since Poltavchenko’s team came on board.
As health professionals who were well versed in the issues told us, city officials would always ask contractors the same questions during regular on-site debriefings. Why is the facility not under construction? You’ve been working here for five years, but you’re still at stage one. How much of your advance have you gone through? Who produced such a bad design?
Subordinates would be reprimanded, and contractors would be fined and have their contracts torn up, but nothing would change. Construction completion dates would be postponed, and cost estimates would be increased.
By 2016, the list of construction projects had been greatly reduced. Currently, the target invested program lists 14 medical facilities, almost all of them projects from the Matviyenko period that have been subjected to protracted delays.
The construction sector professionals we surveyed estimated that, on average, one and half years are needed to design a large medical facility, while it would take another three years to build the facility. A small ambulance station could be built in a year. In Petersburg, however, actual times to completion are many times longer. It takes five to 15 years to build many facilities.
The Causes Are Plain to See
The Smolny believes that the virtual breakdown of its grand social policy plans has been due to insufficient funding. Thus, in 2017, Petersburg’s most renowned delay-plagued construction project, the Zenit Arena, gobbled up nearly a billion rubles. But this is fibbing, for, in reality, line items for financing the building of facilities that have obviously been abandoned were simply stricken from the budget, because no one was spending any money on them.
In addition, according to the city hall officials we talked to, careless contractors are to blame for construction delays and poorly designed projects, and for not calculating their risks. As you might guess, in this way of seeing the world, officials bear no blame for the fact they are surrounded by bunglers and swindlers.
But there is a more complex view of the issue. A source at one of the city’s largest hospitals told us that the ceremonial communiques and press releases issued by city officials belie the serious friction between the Construction Committee and the Healthcare Committee, as well as between the relevant vice-governors. For while hospitals and clinics are still under construction, the Construction Committee’s budget is replenished. They even purchase medical equipment. But when hospitals start treating patients, the money for that is allocated via the Healthcare Committee. This does not mean, of course, that the Construction Committee deliberately delays building projects. Of course, they want to get delay-plagued facilities off their hands as quickly as possible. But Construction Committee staffers bear no personal accountability for missed deadlines and the poor quality of construction.
A senior official, who has worked in the Healthcare Committee since the Matviyenko administration, says during the past four or five years he and Vice-Governor Olga Kazanskaya have had to wage a “quite serious fight” with the construction bloc in the Smolny. Describing the state of affairs in the Construction Committee, the official spoke of confusion and complained about the frequent change of leadership.
A telling example occurred when we asked Igor Albin, vice-governor for construction, to explain why the Botkin Infectious Diseases Hospital, whichas far back as 2015 he had publicly promised would soon reopen, was still not treating patients. However, he gave us no explanation, shifting the blame for the situation on Healthcare Committee staffers. In turn, they said it was the Construction Committee who was responsible for construction at the Botkin. Off the record [sic], they told us about a long list of defects and unfinished work to which contractors wanted doctors to turn a blind eye, making them sign off on the facility even though it was unfinished. Of course, a dispute like this could go on indefinitely until someone takes responsibility for the entire project.
Our source in the medical community, who spoke out about the construction community in a somewhat biased way, argued that no one except medical professionals had any interest in bringing facilities online. As a consequence, officials failed to make purchase requests for equipment, did not calculate the costs of logistics, and fined the medical facilities.
“There is way too much politicking and money at each stage. Everything is bureaucratized and corrupt in the extreme. What matters is that everything looks right on paper,” said our source.
He was surprised that, under Poltavchenko, the Construction Committee did not “tremble” for failing to execute the annual budget. Under Matviyenko, he claimed, failing to spend funds allocated under the yearly budget was considered an extremely grave offense for officials to commit.
Another senior medical administrator sees the root of the trouble not in corruption per se, but, rather, in the overall “muddle” and the fact that “the system doesn’t function.”
“Every staffer needs to know his function and the consequences that await him in case of failure. Step left, step right, and you can step on a land mine and blow up. Now, though, there is basically no accountability for mistakes, and no one feels personally to blame.”
The Construction Committee has no specific department or expert responsible for medical facilities. A personal curator is usually appointed to oversee each of them. A considerable part of the work is overseen by the Fund for Capital Construction and Reconstruction, which is controlled by the committee. Its longtime head was Andrei Molotkov. It was Molotkov who was criticized by Igor Albin for the numerous missed deadlines and unscrupulous contractors. Ultimately, in April 2016, Molotkov resigned his post, a job that is still vacant.
The Healthcare Committee employs one senior professional builder, Igor Gonchar, head of the Office for Medical Facilities Development. However, he deals with repairing and rebuilding the facilities his committee oversees. Since 2014, the Healthcare Committee has also been tasked with designing healthcare facilities. It was a seemingly reasonable step, meant to reduce the risk of drafting projects that were not suitable for physicians and had to be redone on the fly. In the last three years, however, the Healthcare Committee has not spent nearly 40% of the money allocated to it for design, i.e., 158 million of the 250 million rubles allocated in its budget for survey and design work.
Gonchar gave detailed answers to our questions, explaining that, out of eight planned facilities, the design work had been completed for six of them. Problems had arisen around a large project, estimated to cost 100 million rubles: new wings for Children’s Hospital No. 1. Due to the fact that, last year, changes were made to the law on historic preservation, the specs for facilities adjacent to historic Pozhelayev Park had to be redrafted. Similar difficulties have arisen with another problematic facility, the Dunes Children’s Rehabilitation Center. However, the difficulties having to do with historic preservation were in that case aggravated by the bankruptcy of the design subcontractor, Oboronmedstroy.
One of the most unpleasant consequences of delaying when medical facilities are brought on line is the premature purchase of expensive medical equipment. For when a senior official says a hospital or clinic is about to open, his underlings will willy-nilly have to purchase CT scanners and MRI machines. But then no one is responsible for the fact they have to spend several years in a warehouse, where they are not only of no use to patients but also run through their warranties and sometimes even are damaged due to improper storage conditions.
According to medical professionals, premature equipment purchases are also part of a cynical calculation by officials. They can report the city has already purchased everything a hospital in the midst of construction needs and demand its administrators move into a poorly constructed building.
“In my opinion, the people running the city are not very interested in healthcare, because it involves more political questions,” says Lev Averbakh, executive director of CORIS Assistance LLC (Saint Petersburg) [a private ambulance company]. “I think there no political will for it. No one says, ‘Let’s finish them!’ as with the stadium, for example. Besides, they have begun reducing the number of hospital beds available while changing the regulations. Under the new rules, not as many beds are needed in Petersburg as were required under the old rules.”
Another professional from the field of private medicine argues that Olga Kazanskaya, now the ex-vice-governor for social policy, and Healthcare Committee Chair Valery Kolabutin lack medical training.
Sergei Furmanchuk, co-founder of Hosser [a Petersburg-based company specializing in the design and construction of medical facilities], argues that problems arise when design work is done by people who have never done design work, and they do the construction work as well. He believes that each case has to be examined individually. However, it has to be acknowledged that having a lot of experience and even medical training, unfortunately, is no guarantee of impeccable work, as, for example, in the case of Rosstroyinvest and the Botkin Hospital, Petrokom or Oboronmedstroy, which is currently undergoing bankruptcy proceedings, abandoning several large healthcare facilities unfinished.
Translated by the Russian Reader
P.S. This article, its author, and Delovoy Peterburg obviously have a heavy axe to grind more against one faction of Petersburg city hall (still referred to as “the Smolny,” the headquarters of the Bolsheviks during the 1917 October Revolution). Normally, I would not translate and post this kind of potential journalistic hit job, although it does describe an urgent problem—the collapse of Russia’s post-socialist free healthcare system—more or less objectively, a problem I have touched on elsewhere in my translations of less dodgy printed matter.
But the author does signally fail to point out the role of Putin’s infamous “power vertical” in encouraging the lack of accountability among local officials, whether in Petersburg or Vladivostok.
Petersburg’s current governor, Georgy Poltavchenko, was first appointed outright by President Putin after the latter “upmoted” the city’s previous governor, Valentina Matviyenko, to the Federation Council, which she now chairs, after she had become deeply unpopular for, among other things, trying to ram Gazprom’s infamous Okhta Center skyscraper down the throat of Petersburgers, and flagrantly failing to clean snow from streets and rooftops during one particularly snowy winter, leading to massive residential property damage and a cityscape described by many locals as resembling what the city looked like during the 900-day WWII Nazi Siege.
Poltavchenko was later “freely” “re-elected” to the governorship in an election marked, as usual, by irregularities, running against a field of sock puppets that had been preemptively purged of any real competition.
From the get-go he has seemed more concerned with the matters spiritual and ecclesiastical than really running the city, which has looked especially dingy this winter, when it has become apparent that the previous street maintenance and cleaning system has collapsed altogether, possibly for a lack of poorly paid Central Asian migrant workers to keep it “affordable.”
Is is fair, though, to blame all local failings on the almighty power vertical? Probably not, and that is why I devote so much of this blog to Russians doing it for themselves at the grassroots, often against daunting odds and in the face of outright police repression. But their efforts won’t make a dent in all the issues they are tackling until the country becomes a real federation and power is devolved maximally to the regions, cities, towns, and neighorhoods.
In this light, it amounts to cynical mockery to repeatedly refer to President Putin as a “strong leader,” as the new Fascist Pig in the Poke did during his campaign and now after he has occupied the White Pride House in Washington, DC. Putin is not a strong leader in any sense, but his weakness has been especially apparent in the myriad ways his regime has disempowered Russians at all levels, making it increasingly difficult for them not only to solve but also even discuss the problems that concern them most.
Finally, I should point out that the original article in Russian features a map of the city marked with all the hospitals and other medical facilities built, currently under construction or abandoned under the municipal program described, above, as well as a table with more detailed information about each of these real, abandoned or planned facilities. I was not able to include the map or table in this translation. TRR
Government Refuses to Allocate 70 Billion Rubles to Combat HIV
Polina Zvezdina RBC
January 26, 2017
The Health Ministry has sent the government a plan for implementing the national strategy for preventing the human immunodeficiency virus (HIV) until 2020. RBC has a copy of the document, whose authenticity has been confirmed by a source close to the government, in its possession. The plan does not stipulate allocating additional funds for combating the infection. In the financial feasibility study appended to the draft plan, officials noted the agencies responsible for its implementation, as well as the regions, would have to finance the plan’s implementation.
Additional financing of the plan was stipulated in a earlier draft, also examined by RBC. In the draft, the Health Ministry had indicated additional monies from the budget, 17.5 billion rubles per annum, would be required to meet the strategy’s targets. There were plans to spend 13.2 billion rubles of this money on treatment, 3.2 billion rubles on diagnosis, and 1.1 billion rubles on treatment oversight. This funding should have made it possible for all HIV patients currently registered at AIDS centers to undergo special treatment and increase to 35% the share of the population tested annually for HIV. In 2015, 19.3% of the population was tested for HIV, while 37.3% of infected patients were provided with medical treatment.
It was the Finance Ministry that did not approve allocating the 70 billion rubles, judging by a ministry review sent to the Health Ministry on December 22, 2016. First Deputy Finance Minister Tatyana Nesterenko did not support the additional allocation, because these funds were not included in the approved federal budget for 2017–2019. In the review, the Finance Ministry argued that budgetary allocations for new spending could be contemplated only at the beginning of the fiscal year and provided that the government had additional revenues.
The government will continue its discussion of the draft plan for HIV prevention, said Denis Godlevsky, an expert at the HIV Assistance Foundation. There is a chance the Health Ministry will succeed in obtaining the full funding, he said.
Testing 35% of the population annually for HIV and providing 100% treatment for all registered patients were goals the Health Ministry hoped to achieve only if it received the “requisite” financing, as outlined in the HIV prevention strategy adopted by the government. If this money is not provided, the ministry proposes focusing on a different set of figures. Under the current healthcare budget, the number of people undergoing testing would increase to only 24%, while 56% of infected patients would receive treatment.
The Health Ministry has not responded to RBC’s questions as to which set of targets the ministry would follow when implementing the strategy.
If government agencies would use the funds already available effectively and rationally, the situation would begin to change for the better anyway, said Alexei Lakhov, deputy director for public relations at E.V.A., a noncommercial partnership.
“And when the situation changes for the better, a financial feasibility study can be done requesting additional appropriations,” Lakhov suggested.
The HIV prevention strategy was approved on October 20, 2016. It contained no information about funding.
Chelaybinsk Resident Alexei Moroshkin’s Stay in Mental Hospital Extended Six Months OVD Info
January 11, 2017
On January 10, the Soviet District Court in Chelyabinsk extended Alexei Moroshkin’s forced confinement in a psychiatric hospital for another six months, according to his mother Tatyana Moroshkina. Moroshkin had been sentenced to compulsory psychiatric treatment after having been accused of calling for violation of the Russian Federation’s territorial integrity.
According to Moroshkina, the court paid no attention to any of the arguments made by the defense, neither that her son’s actions and statements did not pose a threat to others, nor that, according to his medical record and the opinion of his physician, he was not dangerous and there was no need to hospitalize him. In making its ruling, the court was guided by the unsubstantiated opinion of court-appointed experts that Alexei Moroshkin could be dangerous, said his mother.
Moroshkin was committed to Regional Clinical Mental Hospital No. 1 in Chelyabinsk in December 2015. Prior to this, a court had considered the charges of calls for separatism made against him in connection with texts, posted on the VKontakte social network, about the need to establish a Ural People’s Republic. In November 2015, a court absolved Moroshkin of criminal liability, declaring him mentally incompetent on the basis of opinions submitted by medical forensic examiners, who during the police investigation had diagnosed him with paranoid schizophrenia, adding that he suffered from the “delirium of religious reformism.” This diagnosis was occasioned, apparently, by Moroshkin’s online publications and interviews dealing with the virtual Church of the Chelyabinsk Meteorite, which he had invented. At present, acccording to his mother, the medical experts do not mention delirium, but nevertheless consider her son mentally ill and a danger to others.
Before criminal charges were filed against him, Moroshkin had never been under a psychiatrist’s care.
According to his mother, Moroshkin’s physical condition has deteriorated: he suffers from a heart disease. The court also failed to take this circumstance into account.
In October 2016, Moroshkin was suddenly transferred to a wing with worse living conditions than before. Shortly before this, the hospital’s head physician was fined for refusing to provide information about Moroshkin to his defense attorney.
Currently, another case involving Moroshkin is under investigation. He has been accused of painting a bust of Lenin in Chelyabinsk in the colors of the Ukrainian flag and charged under Article 214.2 of the Criminal Code (vandalism).
Anna Karetnikova: “The worse things are in Russia and the less money there is, the worse things are in the system” OVD Info
October 27, 2016
As promised, OVD Info has published the full version of our interview with Anna Karetnikova, civil rights activist and member of the last three Moscow Commissions for Public Monitoring of Detention Facilities. The term in office of the third Moscow Public Monitoring Commission (PMC) is coming to an end, and by law anyone who has sat on the same commission for three consecutive terms cannot apply to serve on it again. Karetnikova had applied to serve on the Moscow Region PMC, but was not included in the new commission’s lineup. Similar things happened to a large number of civil rights activists who tried to get appointments to PMCs in other parts of Russia.
The interview was conducted shortly before the new lineups of the oversight commissions were made public. In conversation with OVD Info, Karetnikova summed up the work of the Moscow PMC and talked about the Russian penitentiary system’s numerous problems.
What is a PMC?
A PMC is a public monitoring commission of detention facilities. On the basis of Federal Law No. 76, its members are admitted into institutions that have such facilities, from police stations to remand prisons, including temporary detention centers, military prisons, and so on. They see the conditions of detention and can make recommendations on enforcing the law, eliminating violations, and otherwise furthering the legal interests of the persons imprisoned there.
How would you assess the work of the current commission? During your term have you been able to effect changes in the system, in the treatment of inmates, and the way the system interacts with civil rights activists?
I would rate it quite highly. I can speak only about the Moscow PMC. We succeeded in implementing serious reforms in meal services, accountability, and expanding the range of products that can be delivered to inmates in remand prisons. We made definite improvements to the Kaluga Federal Unitary State Enterprise, the [online] prison store or shop where inmates’ relatives can order things for them. We definitely improved the conditions in Women’s Remand Prison No. 6. Unfortunately, among the things that have remained beyond our control and are getting worse, in my opinion, is medical care. The more we try and get on top of it, the worse it gets.
Medical care has remained a fallow field despite the huge effort we made to improve it just a bit. It was like running up the down escalator.
Nothing can be done. I understand the situation with healthcare is the same nationwide, but it is particularly horrible in our remand prisons.
What do you mean by accountability?
Registering complaints. If we are not around, say, the only way an incarcerated inmate can get something is by filing a complaint or petition. We expended a great deal of effort making sure these complaints and petitions were registered normally, because basically they save lives. It can happen that someone asks to see a doctor for six months and submits petitions to this effect, but none of them is registered. Then he dies, and we are sent an official reply that he never requested medical treatment. Continue reading “Anna Karetnikova: Monitoring Moscow’s Prisons”→