Xenophobia and Corruption Making Russia Less Attractive to Central Asian Migrant Workers

DSCN3525To give only one of a thousand examples, without Central Asian migrant workers, there would be almost no one left to do the heavy and, sometimes, dangerous work of clearing freshly fallen snow from rooftops and pavements during the winter. February 5, 2018, Petersburg. Photo by the Russian Reader

Fists and Epaulettes: Xenophobia and Corruption Making Russia Less Attractive to Central Asian Migrant Workers
Vyacheslav Polovinko and Yulia Reprintseva, with Madina Kuanova
Novaya Gazeta
February 5, 2018

Novaya Gazeta continues to investigate the lives of migrant laborers in Russia. In our last issue, we discussed the magnitude of the corruption faced by immigrants when they apply for resident permits and work permits (“Luck and Labor,” February 2, 2018). However, even when migrant workers finally obtain these papers, their lives in Russia are not made any easier.

Police, Open Up!
In the run-up to New Year’s 2018, detectives from the Perovo and Kuntsevo police precincts in Moscow detained 520 migrant workers. All of them were taken to a police station, where they were forced to stand outside in the cold from six in the evening to two in the morning. According to Valentina Chupik, head of the human rights organization Tong Jahoni (Morning of the World), only those who gave the police 10,000 rubles [approx. 140 euros] each were released. The police said they were collecting money “for celebrating the holiday.”

The police regularly hold such “celebrations” for migrant workers. In a ranking of offenses against immigrants, the police take first place with a large margin (86% of all complaints). Most often, the police extort money during groundless document checks.

“In Russia, the attitude is he is an Asian, so he’ll give us money,” claims Chupik.

In police stations, up to twelve migrant workers are held in seven-meter-square cells for forty-eight hours and not allowed to go to the toilet. Police sometimes assault them. In October 2017, according to human rights activists, the officers at Perovo and Novogireevo precincts in Moscow beat up 39 people.  It was a tough month, apparently.

“Volunteer work days” are another police practice. According to human rights activists, migrant workers were forced to repair a police station in the Moscow suburb of Mytishchi on April 21, 2017.

The migrant workers complain, but to little effect. In 2016, Valentina Chupik filed 6,232 complaints with various police internal affairs departments in Moscow and Moscow Region, but only four of them were passed up the command chain for further review. Meanwhile, the system for expelling migrants on the basis of police complaints operates without fail. In 2016 (there is no data for 2017), Moscow courts expelled over 14,000 migrant workers from Russia for living somewhere other than their registered domicile. They expelled almost 12,000 migrant workers for being in public without their papers on them.

“The main problem is the right the police have accorded themselves to check the papers of migrant workers for any reason,” says Chupik.

“Yes, they do have this obligation, but only when a migrant worker is involved in a criminal case,” she says.

According the Interior Ministry’s latest orders, even a neighborhood police inspector can check someone’s immigration status. He can write the person up for a nonexistent violation, which is immediately entered into a special data base. Two violations are sufficient cause for deportation from hospitable Russia, explains Chupik.

Curiously, at the same time, migrant workers are far from the most dangerous social group in Russia, formally speaking. Moreover, the number of crimes committed by migrant workers has been steadily declining, which has been noted even by the Russian Prosecutor General’s Office. As reported by Kommersant, according to the Prosecutor General, foreign nationals and stateless persons committed 41,047 crimes in Russia in 2017, which was 6.6% fewer than in 2016. In November of last year, Interior Minister Vladimir Kolokoltsev mentioned an even earlier nine-percent drop in crimes committed by migrant workers when presenting the new immigration policy. But what the top brass has said is not digested fully and immediately by rank-and-file police officers.

Commentary
Valentina Chupik, head of Tong Jahoni
State agencies and the police do not hate migrant workers because they are so despicable. The authorities pretend to hate them so it is less shameful when they rob them for their own profit. When you talk to on-duty cops, they claim eighty percent of crimes are committed by migrant workers. When you ask them to go to the Interior Ministry’s own website and take a gander at the stats, they switch to saying most crimes are committed by North Caucasians. Then they say, “Well, it’s just our policy.” When you tell them they should not implement a criminal policy because they are law enforcement officers, they get it. But they complain they have arrest quotas to fill. 

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Muhiddin, a janitor. Photo by Vlad Dokshin. See Muhiddin’s story in Novaya Gazeta′s special project Muscovites

Xenophobia Has Momentum
On January 12, the body of 41-year-old Tahirjan Hamrayev was found in Noginsk, Moscow Region. Hamrayev had been stabbed over twenty times. Hamrayev left Kyrgyzstan as a migrant worker in May 2017 and got a job on the construction site of a multi-storey residential building. As reported by Kyrgyzstani media, the dead man’s mother, Hairins Hamrayeva, said her son was supposed to have come home for the New Year’s holidays, but decided to stay in Noginsk since his employers, impressed by his work, had offered him extra jobs. On the fateful day, Hamrayev went into a shop and fell into the hands of at least ten neo-Nazis, local law enforcement official claim, citing an eyewitness’s testimony.

In the various ultra-right groups on social media where the incident is discussed, commentators occasionally write languidly that Hamrayev got what was coming to him. Generally, after the security services were pressured by the Kremlin into mopping up the sector, nationalism and neo-Nazism have died out as phenomena [sic], and nowadays assaults on migrant workers have gradually become something out of the ordinary,although in Petersburg on January 31, for example, a Tajikistani national was attacked with a knife in the subway.

No one, however, has abolished xenophobia, which, although it has displayed a downward trend [sic], is still firmly entrenched in the minds of Russians.

In early 2017, Tong Jahoni published the findings of a study on nearly 50,000 housing rental ads in Russian media. Only one out of every twelve ads was free of xenophobic  insinuations. Most of the people who placed the ads wanted to rent their flats or rooms to “Russian citizens” (50%), “Slavs” (28%), and “ethnic Russians” (7%). The picture presented by help wanted ads was even more distressing. Only one in twenty ads among the 20,000 vacancies examined did not contain xenophobic allusions. Fifty-six percent of employers were seeking “Slavs” to fill the jobs, while 35% were eager to see “Russian citizens” in the positions.

Human rights activists say the situation is typical, and no one wants to change it for the most part. In turn, the media fuel the fire. In 2016, there were approximately 120,000 news reports involving migrant workers. News search websites focused mostly on crime reports, which constituted nearly 98,000 of the news reports filed.

However, the attitude to migrant workers on the part of the rank-and-file population is often quite neutral when they encounter each other face to face. Moreover, human rights activists can cite instances in which the police have helped migrant workers. But in terms of society at large, although xenophobia decreased by 10% last year, according to the official estimates produced by the Russian Federal Public Chamber, it still remains a serious problem. According to pollsters VTsIOM [sic], two thirds of the people they surveyed believed migrant workers took jobs away from Russian citizens.

Commentary
Alexander Verkhovsky, director, Sova Center for Information and Analysis 
There is xenophobia as a mass phenomenon: people’s attitudes and emotions. In this case, we can track changes through public opinon polls [sic]. I am quite glad that there is a growing number of people who, when asked about the feelings they have towards migrant workers (e.g., fear, apprehension, hatred, love), respond that they feel nothing, that they could not care less. The perfect relationship is precisely this, when people do not see a group as something that provokes emotions. They are just other people.

There is xenophobia as discrimination, when seeking employment, for example. Unfortunately, practical discrimination has been underresearched. What matters most is that people do not even perceive some forms of it as discrimination. For example, people are not ashamed to write in an ad that they will rent a flat only to a Slavic family. It is useless to fight this. It is a matter of the social atmosphere [sic].

Finally, the most aggressive form of xenophobia is physical violence. In recent years, the figures have been steadily declining. Just the other day, Sova Center published a new report based on the figures for last year. I would note there is not necessarily a meaningful connection with the decline of popular xenophobia, because assaults are not committed by the masses, but by ideologically motivated young people, who might have completely different opinions from the masses. This is more likely the consequence of a depression amongst radically minded young people. They are scared. They don’t really want to commit assaults [sic]. In the previous decade, they did not know the fear of God at all, as the saying goes, but then Center “E” [Russia’s “anti-extremism” police, established from disbanded anti-organized crime squads during Dmitry Medvedev’s presidency] went after them. Many street fighters went to prison, and this changed the situation.

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Shirinsho “Handsome” Vohidov, from Tajikistan. Photo by Anna Artemieva. See Shirinsho’s story in Novaya Gazeta′s special project Muscovites

Medical Disenfranchisement
When migrant workers take ill in Russia, it is no simple matter for them to recover.

“To enroll at a district outpatient clinic, you need to have a temporary residence permit or residence permit, permanent registration,” says Daniil Kashnitsky, a junior researcher at the Higher School of Economics. “However, a poor command of information and the Russian language, as well as a lack of legal knowledge, means that when migrant workers are yelled at by employees at the intake desk, they leave and do not come back. There are many such instances.”

There is the option of going to a private clinic, but sometimes only a state clinic can help, for example, when tuberculosis is diagnosed. It can help, but it is not obliged.

“Tuberculosis has a dangerous phase when it is communicable through airborne droplets. Patients must be hospitalized during this phase. They should stay in hospital until the tuberculosis bacterium goes away, and they are no longer a danger to others. This usually takes two or three months,” explains Kashnitsky.

If migrant workers are hospitalized due to an accident, the treatment is free, of course, but the attitude towards them will be correspondingly shabby. Last year, when a busload of migrant workers was hit by a train near Vladimir, killing seventeen people, the local hospitals treated several severely injured people.

“I asked that an injured child be sent to Moscow. Two days later, he died in our regional hospital. I remember the child. He was a year and a half old, from an Uzbek family. I said, ‘Why did you send him to our hospital? Call a helicopter and take him to Moscow: he’ll get better help there.’ I was told the decision had been made by the health department,” recounts Alla Boyarova, director of an employment agency for migrant workers. On the morning of the tragedy, her husband had rushed to help the affected immigrants.

Zoyir Karimov, Boyarova’s husband, is deputy chair of the Tajik diaspora in Vladimir. He recalls that the adult victims had huge problems.

“Two of them did not make full recoveries in hospital. They were not operated on and were sent back in this shape to Uzbekistan. They were told they could buy special plates, but they had no money. One broke his shoulder, the other, his leg,” says Karimov.

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Infographic No. 1: Sources of corruption in the migrant labor sector, 2017, per information gathered by the human rights organization Tong Jahoni. Police — 1,814 incidents (86.3%); immigration centers — 196 incidents (9.3%); migration service — 53 incidents (2.5%); other state agencies — 29 incidents (1.4%); other organizations — 11 incidents (0.5%). Infographic No. 2: Forms of corruption in the migrant labor sector, 2017, according to the human rights organization Tong Jahoni. “Verification” of registration status — 5,304 incidents (78.3%); arbitrary interpretation of the law — 896 incidents (13.1%); threats by police to file trumped-up administrative charges — 340 incidents (5.0%); high-pressure selling of unnecessary “services” — 196 incidents (3.0%); forcing migrant workers to use a particular middleman when filing papers — 41 incidents (0.6%). Infographics courtesy of Veronika Tsotsko and Novaya Gazeta

Blockchain to the Rescue
It is tempting to dub what is happening in the Russian migrant labor sector a mess. In fact, however, it is more likely a restructuring of the system after the Federal Migration Service (FMS) was incorporated into the Interior Ministry in 2016. The relationship with migrant workers has changed because what the Interior Ministry does most of all is punish people. Many of the organizations that dealt with drawing up papers for migrant workers have been turned into limited liability companies, meaning it has become nearly impossible to monitor their policies, and human rights activists have huge gripes with the new state-run immigration centers. New law bills that have been tabled will only aggravate the circumstances, reducing migrant workers to semi-slave status in Russia.

The question is simple: what to do? At a January 29 meeting of human rights activists to discuss the issue of immigration (a meeting not attended by diaspora leaders) various proposals were voiced. Vladimir Khomyakov, co-chair of the grassroots movement People’s Assembly (Narodnyi Sobor), made the most radical and regressive proposal at the round table.

“We need the strictest possible oversight of each person’s stay in Russia, not just this buying a work permit and hanging out wherever you want,” said Khomyakov. “We need a system of mutual obligations. We need a single government agency that would deal with immigration and use a single database.”

People who intend to travel to Russia should obtain all the papers they need at Russian consulates in their own countries, and each migrant worker should be assigned an ID number under which all information about him or her would stored, argued Khomyakov.

Totalitarian oversight in return for peace and quiet.

But Khomyakov’s idea was not met with unanimous approval by round table participants, just like the proposal, made Vyacheslav Postavnin, former deputy head of the FMS and president of the 21st Century Immigration Foundation [sic], to move immigration registration online or, at least, make it obligatory for immigrants to check in with the migration service by telephone. Some human rights activists were outraged by the fact this would make it easier for terrorists to hide [sic].

“Terrorists never violate immigration laws. Terrorist acts are complicated operations. What, they are going to put themselves at risk of being stopped by police for failing to reregister on time?” Postavnin countered crossly.

He was told that hackers could erase or damage the entiere online database, to which the former deputy head of the FMS showed off his knowledge of the word “blockchain.”

“Even if you wanted to, you couldn’t erase it,” he said.

Tatyana Dmitrieva, deputy head of the Department for Coordinating Local Immigration Offices and Accountable Forms in the Immigration Directorate of the Russian Interior Ministry’s Moscow Office, did not like any of these proposals. She only remarked that the ministry wholly supported a new law bill that would punish legal entities for providing fictitious registration, and that a consensua had to be reached with regard to thorny issues.

The discussion’s moderator, Fyodor Dragoi, chair of the Committee for Safety, Public Diplomacy and Public Oversight at the Council for Ethnic Affairs in the Moscow City Govermnent, suggested drawing up a list of proposals after the discusssion, since “this tumor [could] burst any minute,” and the problem had to be solved.

Another, autonomous proposal has been made by the Center for Strategic Research (CSR), which has published its report on immigration. Recognizing a decline in migration flows from the CIS countries in recent years—2017 saw an increase the numbers of migrant workers from many countries, but the numbers have not returned to pre-crisis levels—the report’s authors propose their own measures for maintaining a migration flow of 250,000 people to 300,000 people annually, which they claim is a necessary number for modern Russia. In particular, they propose introducing something like a green card for highly qualified immigrants in order to stimulate the influx, as well as work cards that would make it easier to obtain a residence permit.

Something has to be done, since Russia will have lost thirteen million able-bodied people by 2030, but internal resources for population growth have been exhausted.

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Viorel, a Moldovan, on a lunchbreak with his workmates. Photo by Viktoria Odissonova. See Viorel’s story in Novaya Gazeta′s special project Muscovites

The problem is that there are not unlimited numbers of highly qualified immigrants, and the ones there are drift in other directions. To take one example, the number of migrant workers from Moldova has decreased over the last two years by more than one and a half times, from 250,000 to 157,000. They have begun looking towards the European Union.  The number of migrant workers from the Eurasian Union has been growing, but their numbers are also limited, especially because Kazakhstani workers, for example, are needed in Kazakhstan itself, a country that, due to geographical proximity, grabs Kyrgyzstani workers away from Russia. The number of immigrants from Tajikistan have been growing steadily. On the other hand, while the number of Uzbekistanis coming to Moscow has grown over the past year, to a million and a half registered nationals, it would seem the numbers will eventually decline, since more convenient job markets have opened up to them.

“Turkey and the Emirates are currently very interesting and attractive to migrant workers from Asia,” says attorney Yulduz Ataniyazova. “The economy there is civilized, and there is a niche in the economy for unskilled workers. At the same time, the workers are provided with normal working conditions. For example, I know that in the Emirates migrant workers who clean houses and work in restaurants note that the cleaning liquids there are less harsh [sic]. This has now become important to them.”

However, the wages there are less than in Moscow, generally, but it depends on how you look at it.

“Uzbeks start doing the maths, and it turns out that here they will pay out more in bribes, whereas in Turkey a policeman would never approach them for no reason at all,” explains Chupik.

Workers from the CIS will keep coming to Russia for some time, of course. But if Russia toughens the rules for migrant workers, even the most desperate adventurers from the CIS countries will prefer, in time, to go somewhere else, to a place where they can work without risking their lives, health, and human dignity, not to mention their wallets.

Translated by the Russian Reader

NB. Perhaps I should have a three [sic]s and you’re out rule on this website, but despite the number of dubious or simply odd claims made by the article’s authors and the experts they quote, I thought there was enough important information and nontrivial viewpoints in the article to make it worth my while to translate and your while to read.

However, on one point—the claim that nationalists and neo-Nazis have come to naught in Russia, and hence the number of assaults on migrant workers has precipitously decreased—I was so bothered I turned to my friend W., a person who has been involved with immigrant rights in Russia both professionally and personally for many years. Here is their response.

“They are engaging in wishful thinking. Nationalism and neo-Nazism have not gone away. It has become very difficult to keep track of attacks. Officially, such reports are not welcome and are rarely discussed in the media. This is the current trend. None of this exists anymore in Russia, allegedly, while in Ukraine, for example, there has been a serious increase in anti-Semitism. According to the official interpretation, there is almost no anti-Semitism in Russia, although there were several egregious incidents in January. Basically, nobody cares about this business, and Jewish organizations mainly smooth over the potentially negative consequences of vociferous discussions.” 

I should also point out the folly of relying on public opinion polling data in an authoritarian country like Russia, where respondents can be expected to give what they think is the “right” answer out of a fear bred into the society in Soviet times.

Nevertheless, in the absence of free elections and other real political freedoms, the Putin years have been a boom time for the country’s main pollsters, VTsIOM (mentioned in this article), FOM, and the supposedly independent Levada Center. They have polled away with merry abandon, and Russian and international journalists, many of them too lazy or lacking the time to do real reporting, have become increasingly dependent on the utterly falsified portrait of “average Russians” the country’s troika of loyalist pollsters has been painting over the last eighteen years. I have dubbed the phenomenon “pollocracy” and discussed it many times on this website. TRR

Sixty Percent of Russian Doctors Make Less than 360 Euros a Month

IMG-20161117-WA0025It’s hard to say why these alleged Russian doctors are so happy, since sixty percent of them make less than 360 euros a month. Maybe they’re not real doctors, but paid actors.

Survey: Sixty Percent of Doctors Make Less than 25,000 Rubles a Month
Takie Dela
December 11, 2017

Over half of Russian doctors earn less than 25,000 rubles [approx. 360 euros] a month. Only 8.4% of them earn the nationwide average monthly salary of over 50,000 rubles a month.

RBC reports on a survey conducted by the Russian People’s Front and Zrodovye, a health services monitoring foundation, according to which 59.4% of doctors earned less than 25,000 rubles a month. 21.4% of respondents noted that their income from one salary [Russian doctors often work at more than one clinic or hospital to make ends meet—TRR] was less than 15,000 rubles a month. 21.7% of them reported they made between 15,000 and 20,000 rubles a month, while 16.3% reported a monthly income between 20,000 and 25,000 rubles.

13% of doctors reported that their salary varied between 35,000 and 50,000 rubles a month; 11%, between 25,000 and 30,000 rubles a month; and 8.5%, between 30,000 and 35,000 rubles a month. Only 8.4% made more than 50,000 rubles [approx. 720 euros] a month.

According to Rosstat, the current average salary for doctors is 53,100 rubles a month. Eduard Gavrilov, staff member at the Russian People’s Front and director of the Zdorovye Foundation, argues that the difference between reality and statistics has to do with the high amount of moonlighting among physicians. Due to low salaries, doctors are forced to work two jobs or a part-time job in addition to their full-time job.

Among medical support staff—nurses, midwives, paramedics, and others—nearly 80% of employees earn 25,000 rubles a month. Only two percent earn more 50,000 rubles a month.

According to President Putin’s May 2012 decrees, doctors would be receiving double the average monthly salary in their regions by 2018. Achieving this goal would require spending 266 billion rubles [approx. 3.85 billion euros], but officials do not know where to find the money.

In March, analysts at the Academy of Labor and Social Relations found that, as of the end of 2016, the average monthly salary of doctors at their main jobs was 21,700 rubles a month. When part-time jobs were figured in, doctors made 28,500 rubles a month on average.

Over the last four years, less than a third of medical workers have experienced pay growth, and only four percent have seen significant pay rises. A third of respondents said they had felt a drop in incomes, while a fifth of them reported a significant drop in wages.

Translated by the Russian Reader. Photo courtesy of Smolensk State Medical University

P.S. When you read an article like the one above, you naturally imagine the incumbent president would have a hard time persuading voters to re-elect him to what amounts to a fifth term, given his pathetic record when it comes to improving people’s lives, including the incomes of highly educated professionals such as doctors.

But if you imagined that, you’d be forgetting a few things.

First of all, the fix is in, so Putin will be “re-elected” in March 2018 no matter how many promises he has broken during his first four terms or “decrees” he has failed to implement.

Second, despite the new school of unthought that argues Putin is not omnipotent, and we (whoever “we” are) should not be so afraid of him, attributing powers to him that he does not have even on the homefront, the problem here has nothing to do with the old “good tsar vs. bad boyars” paradigm.

It’s much simpler than that. Putin and his cronies are gangsters, concerned only with enrichening themselves and increasing what they regard as political power. For them, political power has nothing to do with making good things happen for as many people as possible or addressing more specific, urgent. They see political power as a means of disempowering ordinary people and all possible constituencies other than their own clique so they have a free hand to do with the country what they will.

To that end, Putin’s so-called May (2012) decrees were so much sand kicked in the face of Russians to blind them to the basic facts of life in their country, of which they could hardly be unaware.

At nearly the exact same time, the so-called Bolotnaya Square Case was launched to show the whole country what the Putin mob did to people who did not like having sand kicked in their face all the time.

As luck would have it, a week ago, I had to have an emergency eye exam at a fairly swishy private medical clinic on the Nevsky. Since I know quite a few Russian doctors personally and have blogged a lot on this website about the rotten state of healthcare in Russia, including pay and working conditions for Russian doctors, and nascent attempts by doctors in Moscow and elsewhere to organize militant trade unions and stop rampant hospital closures and mergers, I dared to ask my new (terrific) ophtalmologist how she liked the swishy clinic and whether she was well paid.

She avoided the second question entirely, confessing only that she liked the good working relationships at the private clinic, where she had worked three years.

The takeaway message is that Vladimir Putin is a very powerful man indeed, perhaps the most powerful man in the world. But that will remain the case only until Russians decide they have had enough of the degradation to which Putin and his mob have subjected them and their country for seventeen years and do something about putting an end to it collectively. TRR

There Are No Condoms in Russia

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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,” Izvestia quoted 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

Surviving the Siege

“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. Photo courtesy of Alexander Kalinin and Rosbalt

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.

Фото ИА «Росбалт», Александр Калинин
Anna Yegorova as a young woman. Photo courtesy of Alexander Kalinin and Rosbalt

“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.

Фото ИА «Росбалт», Александр Калинин
Yegorova’s collection of war medals. Photo courtesy of Alexander Kalinin and Rosbalt

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.”

Image courtesy of slideshare.net

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.

The certificate accompanying Anna Yegorova’s medal For the Defense of Leningrad. Photo courtesy of Alexander Kalinin and Rosbalt

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.

Фото ИА «Росбалт», Александр Калинин
Congratulatory cards and other memorabilia sent to Anna Yegorova over the years as a Siege survivor. Photo courtesy of Alexander Kalinin and Rosbalt

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.

Фото ИА «Росбалт», Александр Калинин

“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.”

Фото ИА «Росбалт», Александр Калинин

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

“Optimizing” Russian Healthcare to Death

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Given the dismal state of Russian healthcare, many people practice folk medicine. Photo by TRR

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.

Fastfood Wages
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

Has Petersburg City Hall Made a Shambles of New Hospital Construction?

Part of the old facilities at the Botkin Infectious Diseases Hospital in Petersburg. Photo courtesy of Dima Tsyrencshikov/The Village
Part of the old facilities at the Botkin Infectious Diseases Hospital in Petersburg. Photo courtesy of Dima Tsyrencshikov/The Village

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.

Good Intentions

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.

Petersburg’s Hospitals

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.

No Accountability

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.

A view of the new campus of the Botkin Infectious Diseases Hospital in Petersburg. Photo courtesy of Dima Tsyrencshikov/The Village
A view of the new campus of the Botkin Infectious Diseases Hospital in Petersburg. Photo courtesy of Dima Tsyrencshikov/The Village

Sabotage

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

Russian Government Refuses to Allocate 70 Billion Rubles to Combat HIV

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.

"Percentages of HIV infected people in Russia. The percentage of people infected nationwide is 0.72%." In the original article, this map is interactive by region.
Percentages of HIV infected people in Russia by region. The percentage of people under the age of 60 infected nationwide is 0.72%. In the original article (go to the link at the top of the page), this map is interactive by region. The figures for Crimea and Sebastopol reflect the percentage of infected residents among all age groups. Infographic courtesy of RBC

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.

Translated by the Russian Reader