Hoe Your Own Row

Nearly Half of All Russians Have Switched to Subsistence Farming
Natalya Novopashina
RBC
October 21, 2016

The percentage of Russians who grow food in their gardens has increased to 46%. At the same, food sales in stores have decreased, according to GfK Russia.

In two years, the percentage of Russians growing vegetables and fruits in their own gardens has increased from 39% to 46%. Moreover, production of their own vegetables is the main source of nutrition for the 15% of “active” gardeners, GfK Russia CEO Alexander Demidov told RBC.

“We have noticed a fairly big burst. People have been switching to growing their own produce. It is definitely a crisis,” he said, adding that the percentage of Russians engaged in subsistence farm not as a hobby, but to feed themselves, will only grow.

Irina Koziy, general director of industry news website FruitNews, confirms the trend, noting that it is most visible in medium-sized towns for now.

“Besides, there are a number of programs in the regions under which needy and large families are supplied with seed potatoes for planting in the spring. Such programs operate in Buryatia, Kuzbass, and a number of other regions,” said Koziy.

“The consumer moods of Russians have improved slightly, but they still remain in the negative zone,” notes GfK Russia’s report “The Russian Consumer 2016: Adapting to the Crisis.”

In April 2016, 53% of respondents reported the crisis had had a direct impact on their lives. In July 2016, this figure was 46%.

And yet, in reality, the actual financial circumstances of Russians have not improved. They have simply adapted to the crisis and regard the current economic reality more calmly.

“The effect of adjusting to the situation has kicked in, because people don’t believe the crisis will be resolved soon,” said Demidov. “So crisis consumerist strategies are still in effect.”

According to GfK, the vast majority of respondents (75%) said they were willing to give up purchasing certain goods. In particular, according to the company, the greatness number of Russians (17% of respondents) have been saving money by cutting out trips to beauty salons. Other expenditures that had been cut included purchases of household appliances (16%) and cosmetics (15%).

The sales of most foods have also decreased. According to GfK, during the year beginning July 2015 and ending July 2016, sales of dairy products and meat decreased in physical terms by 0.5% and 0.8%, respectively. Most of all, consumers scrimped on sweets and snacks (a 3% decrease), bread products (a 7% decrease), and fish and seafood (a 7.4% decrease). A slight increase occurred in sales of frozen products (1.1%), eggs (1.4%), fresh fruits and vegetables (1.5%), and baby food (2.2%).

During the same period, the volume in terms of price of goods purchased through promotions grew by 45%. And the share of promotions throughout the fast-moving consumer goods sector increased from 12.2% to 14.1%, according to GfK’s calculations.

Translated by the Russian Reader. Photo courtesy of russiannotes.com

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The Decline Has Gone Uphill

Silhouette figures trying to keep a ten-ruble in the air next to an inscription that reads, "Not everything is in our hands." Petersburg, May 23, 2016. Photo by the Russian Reader
Silhouette figures trying to keep a ten-ruble coin in the air next to a stenciled inscription (left) that reads, “Not everything is in our hands.” Petersburg, May 23, 2016. Photo by the Russian Reader

Russia Level with Kazakhstan in Wages
Maria Leiva
RBC
May 24, 2016

In 2015, the average Russian salary, in terms of US dollars, was equal to the level of wages in Kazahkstan, according to data from the Higher School of Economics (HSE). Compared to 2014, the salaries of Russians dropped by almost a third last year.

The observed decline in wages in Russia has led to their drawing level, late last year, with average wages in Belarus and Kazakhstan in previous years, experts at the HSE have calculated in their May monitoring of the populace’s socio-economic status and social well-being. Computed on the basis of exchange rates, the average wage in Russia last year was $558 a month, which is lower than the 2014 level by 34% or more than a third. By way of comparison, in Kazakhstan and Belarus, the average monthly wage, calculated using the same method, was $549 and $415, respectively.

From 2011 to 2015, Russia had the highest level of wages in the CIS, but in 2014, compared with 2013, it dropped by nearly 10%, from $936 to $847. The experts at the HSE note that the gap in economic performance indicators between Russia and certain CIS countries has been constantly contracting. For example, the average salary in Armenia in 2008 was around 52% of the 2015 Russian wage, but by the end of the period in question, it had grown to 60%. During the same period, Belarus has gone from 61% to 75%, and Tajikistan, from 17% to 26%. However, over the same period, the relative positions of Azerbaijan, Moldova, Ukraine, and Kazakhstan have declined.

If we compare the average wage in Russia and Central and Eastern Europe, the wage in those countries has exceeded the average in Russia for the past five years. Thus, last year, the average Russian wage came to 60% of the average wage in Hungary, and 50% of the average wage in the Czech Republic. However, in 2015, Russia came close to the level of wages in Bulgaria during 2013–2014.

Trends in the average monthly wage in Russia, Brazil, and China over the past five years show that wages in Brazil were higher than in Russia last year. Despite the fact that data on wages in China for 2015 have not yet been published, the figures for Russia in 2015 were lower than for China in 2012, 2013, and 2014, indicating the gradual reduction of the gap between the two countries in terms of this indicator.

Last week, Sberbank also reported a fall in the average monthly Russian wage below China’s average wage. The bank’s principal analyst, Mikhail Matovnikov, cited data that the average monthly wage of Russians had fallen below $450 a month, lower than that in China, Poland, Serbia, and Romania.

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

Ilya Budraitskis: Putrefaction as the Laboratory of Life (The 2016 Elections)

Nikolai Yaroshenko, Life Is Everywhere, 1888. Image courtesy of Wikipedia
Nikolai Yaroshenko, Life Is Everywhere, 1888. Image courtesy of Wikipedia

The 2016 Elections: Putrefaction as the Laboratory of Life
Ilya Budraitskis
OpenLeft
April 29, 2016

How do the upcoming Duma elections threaten the regime?

Today, it would seem that the upcoming September elections to the State Duma are a cause of growing concern only in the Kremlin. While polls continue to record a low level of public interest in the event, and the tiny number of parties allowed to run in the election wanly prepares to fulfill their usual roles, the president and his entourage are increasingly talking about possible threats.

The rationale of radicalization
At a recent meeting with activists of the Russian People’s Front, Putin noted that external enemies would preparing ever more provocations to coincide “with elections to the State Duma, and then with the presidential election. It’s a one hundred percent certainty, a safe bet, as they say.”

Regardless of their real value, the upcoming elections have been turning right before our eyes into a point of tension on which the state’s repressive apparatus has focused. Beginning with the establishment of the National Guard, the process has been mounting. Each security agency has now inaugurated its own advertising season, designed not only to remind the president and public of its existence but also to show off its unique capabilities, inaccessible to other competing agencies, for combating potential threats.

Prosecutor General Yuri Chaika has uncovered a plot by the Ukrainian nationalist group Right Sector, while in his programmatic article, Investigative Committee head Alexander Bastrykin essentially suggested canceling the elections since holding them could prove too dangerous. He made a direct appeal to stop “playing at pseudo-democracy” and provide a “tough, appropriate, and balanced response” to the country’s enemies “in light of the upcoming elections and the possible risks presented by the stepping up of efforts by destabilizing political forces.” With the appointment of Tatyana Moskalkova, even the previously neutral office of the human rights ombudsman has, apparently, been turned into yet another bastion of the fight against conspiracies.

This nervousness is certainly due to the fact that the growing economic and social crisis has had no visible political fallout for the time being. There have been no mass spontaneous revolts or sectoral strikes, although there has been an overall uptick in isolated labor disputes.  The political realm has long ago been securely purged of any uncontrollable opposition, while the president’s personal rating has remained phenomenally high. Nothing, it would seem, portends serious grounds for political destabilization this autumn. The absence, however, of real threats itself has become a threat to the internal stability of the state apparatus.

Where does the threat lie? In recent times, it has become obvious that decision-making at all levels and whatever the occasion has been subjected to a rationale of radicalization. Its principle can be described roughly as follows: no new decision can be less radical than the previous decision. Bureaucratic loyalty is measured only by the level of severity. MPs must propose more sweeping laws against latent traitors. Law enforcement agencies must expose more and more conspiracies, while the courts must hand down rulings that are harsher than the harshest proposals made by the security officials and MPs. Permanently mounting radicalism enables officials to increase budgets, expand powers, and prove their reliability, while any manifestation of moderation or leniency can cost them their careers. This radicalization, whose causes are rooted in the political psychology of the Russian elite (which suffers from an almost animal fear of uncontrollability), has set off an extremely dangerous bureaucratic momentum. Its main problem is the inability to stop. It is not only unclear where the bottom is, but who is ultimately interested in reaching that bottom and leaving it at that.

All this generates a strange situation vis-à-vis the elections, which have generally functioned primarily as a political balancing mechanism for the Putinist system, and even now function in this way. Elections have always been a reminder—not to voters, but to the elite itself—that varying opinions within a clearly defined framework have not only been possible but have also been encouraged. This reminder has been important not out of faithfulness to an abstract principle, but as confirmation that political bodies (first of all, the presidential administration) have had the monopoly on deciding domestic policy, not a military or police junta.

Fixing the broken mechanism?
For the Kremlin, the upcoming elections are overshadowed by the political trauma of 2011, when the smoothly functioning system of managed democracy suffered a serious breakdown. The current chief political strategist Vyacheslav Volodin has more or less consistently focused on making sure the failure of five years ago is not repeated. Volodin’s mission is to fix the broken mechanism with political methods, not by force.

It is worth remembering that, for the greater part of the Putin era, parliamentary and presidential elections were parts of a single political cycle, in which the same scenario was played out. The triumphal success of the ruling United Russia party was supposed to precede and ensure the even more resounding success of Vladimir Putin. In December 2011, however, the cycle’s unity backfired against the Kremlin’s plans. The interval between elections enabled the protest movement to maintain its grassroots energy for several months.

The political rationale of Putin’s third term is now aimed not only at technically but also at conceptually disrupting this cycle. Amidst a sharp drop in confidence in the government, the Kremlin decided last summer to move parliamentary elections up from December 2017 to September 2016, and, on the contrary, postpone the presidential election from March 2017 to March 2018. The point of the maneuver is obvious. The presidential and parliamentary elections must now represent not two parts of the same script but two completely different scripts. In the first script, a limited number of parties, which make up the symphony of the Crimean consensus, will criticize the government and each other, thus competing for the sympathies of the dissatisfied populace. In the second script, the natural patriotic instinct of voters should leave no doubt as to the need to support Putin unconditionally.

The new ideological content was embodied by Volodin’s famous statement: “There is no Russia today if there is no Putin.” This personification virtually means that, as a symbolic father, Putin transcends everyday politics. You can be a liberal or a nationalist, a proponent of greater intervention in the economy or a fan of the free market. You can choose not to like the government or government officials. But the nexus Putin-Crimea-Russia is beyond any doubt. Those who fundamentally disagree with it are simply removed from the Russian political spectrum and branded “national traitors.”

In keeping with this rationale, responsibility for the sharp drop in living standards and the consequences of the neoliberal “anti-crisis” measures has been borne by ministers, MPs, and governors, by anyone except the president. Even now, when the propaganda effect of the “reunification” of Crimea has obviously begun to fade, the president’s personal rating remains high. Thus, according to the latest opinion polls, 81% of respondents trust Putin, while 41% do not trust Prime Minister Dmitry Medvedev, and 47% do not trust his government overall.

Within the new-model Crimean consensus, United Russia will no longer play the role of the backbone it played in the noughties. Untethered from the non-partisan figure of the president, it will take on the burden of unpopularity borne by its formal leader, Dmitry Medvedev, and his government. The mixed electoral system will enable candidates from local “parties of power” in single-member districts to dissociate themselves from United Russia, presenting themselves as “non-partisan Putinists” criticizing the soulless federal authorities. Volodin’s scheme involves loosening United Russia’s grip on power and slightly increasing the value of the pseudo-opposition as represented by the Communist Party and A Just Russia.

It is worth noting that the very existence of a bureaucratic mega-party previously played a stabilizing role by dampening intra-elite conflicts. Now they will inevitably come out into the open, including in the shape of inter-party struggles. Of course, the presidential administration counts on being able to effectively ensure compliance with the clear rules of this competition, but there are no guarantees. The managed multi-party system with the “father of the nation” towering over it consummates the new architecture of the Putin regime as a personalistic regime, and becomes more and more vulnerable.

In the new reality of the crisis, Putin’s depoliticization also facilitates a more intensive “natural selection” among bureaucrats at all levels by culling those who have not mastered the art of maintaining the conservative sympathies of the populace while simultaneously implementing what amount to aggressively anti-social policies. The September campaign is supposed to go off without a hitch, culminating in a predictable outcome. Having given a human face to the Central Elections Commission, which was seriously discredited by the previous leadership, Ella Pamfilova is meant to increase this manageability and predictability. It turns out that the upcoming elections are the primary pressure test of the new, post-Bolotnaya Square design of managed democracy. The future of Vyacheslav Volodin and his team, as well as Putin’s willingness to trust them with the extremely important 2018 presidential campaign, probably depends on how smoothly they come off.

From the foregoing it is clear that the objective of reestablishing the rules of managed democracy is directly at odds with the above-mentioned rationale of radicalization, whose standard-bearers are the competing law enforcement agencies. Their individual success in the internal struggle is vouchsafed by the failure of the political scenario, which would give rise to the need for a vigorous intervention by force. After all, the National Guard’s value would be incomparably increased if it put down real riots instead of sham riots, and Bastrykin’s loyalty would all the dearer if, instead of the endless absurdity of the Bolotnaya Square Case, he would uncover real extremists. To scare someone seriously, the ghosts have to take on flesh and blood.

Life is everywhere
Marx said that putrefaction is the laboratory of life. Now we see how Putinist capitalism has embarked on a process of gradual self-destruction. The upcoming elections provide a clear picture of how this has been facilitated by two opposing rationales, the political rationale (Volodin and the presidential administration) and the law enforcement rationale. Thus, the first rationale, in order to generate the necessary momentum and expand the range of opinions, must respond to social discontent by providing United Russia’s managed opponents with greater freedom to criticize. Restoring the internal political balance will inevitably lead to the fact that topics related to the crisis and the government’s anti-social policies will become the centerpiece of the entire election campaign. On the other hand, the security forces will destabilize the situation outside parliament. Together, they will do much more to undermine an already-flawed system than the long-term, deliberate efforts of any western intelligence agency.

Of course, Russian leftists should in no way count on events following an automatic course. But it is absolutely necessary to take into account the conflicts of interest within the elite and understand their decisive influence on the shape of the upcoming elections. These elections have nothing to do with the real struggle for power or traditional parliamentarianism in any shape or form. But they are directly related to the internal decomposition of an authoritarian, anti-labor, and anti-social regime. So our policy vis-à-vis these elections should be flexible and remote from all general conclusions. That means we can and should support certain leftist candidates in single-member districts. We must use all the opportunities provided by the leftist, socialist critique of the Medvedev government’s so-called anti-crisis policies. We must be ready to go to the polls. Or we must be ready to reject them, taking to the streets when the time comes.

Ilya Budraitskis is a writer, researcher, and editor at OpenLeft. Translated by the Russian Reader

 

Art Clusterfuck

What would a big city and its citizens want when they already have absolutely everything a twenty-first-century city and its citizens could want, including free and fair elections, grassroots democratic governance, economic parity, high incomes, affordable housing, good schools, free, high-quality health care, incorruptible officials, a clean, safe environment, state-of-the-art public transportation, hundreds of kilometers of dedicated bike lanes, ethnic harmony, just courts, and friendly police? That’s right: they would want a new “art cluster,” and they would want it to look like this:

2-soviet-4_ver_11_0007

RBI plans to invest 3.4 billion rubles [approximately 45 million euros] in two developments in [Petersburg’s] historic center. An art cluster with spaces for temporary exhibitions and art studios is planned for 2nd Sovetskaya Street, 4, while Poltavskaya, 7, will get a residential complex. The company has spent three years obtaining permits for the projects. Due to strict legislation, investors virtually have no opportunity to reconstruct residential buildings.* All they can do is develop the remaining gaps.

The developer acquired both sites in 2013. The art cluster is planned for the site of the former labs of the Northwest Scientific Hygiene Center on 2nd Sovetskaya Street. The company Vek has drawn up plans for a nine-story, 23,000-square-meter building. Halls and special spaces for temporary exhibitions are planned for the first floor. The upper floors will feature workshops and studios for sale, 244 spaces ranging in size from 22 to 129 square meters. The company says they are not meant to serve as dwellings.

RBI received a construction permit for the building in late March of this year. It has already hired a subcontractor, Allure, to dismantle the existing one- and two-story buildings on the site. According to RBI, the former labs were built after 1917 and have no historic value.

A commercial project like this is a new thing for Petersburg. But RBI argues that research shows Petersburgers are ready to purchase several types of real estate: an apartment, a country home, and a space for self-realization or a small office to boot.**

Source: Fontanka.ru, April 25, 2016. Image courtesy of Fontanka.ru. Translated by the Russian Reader

* That is, demolish listed gloriously beautiful eighteenth-, nineteenth-, and early twentieth-century buildings and build crap like the “art cluster,” pictured above, in their place. Despite the supposedly “strict” legislation, local developers have been doing plenty of slash-and-burn-style development of this sort in the historic center over the past ten years, as readers of this blog will know.

** According to Petrostat, the average per capita monthly income in Petersburg in February 2014 was 34,129 rubles, when the Russian ruble was still trading at a rate of approximately 35 rubles to the dollar. Today, the ruble was trading at 66 rubles to the dollar, and there is no evidence, in the midst of a severe, prolonged economic crisis, that the average monthly incomes of Petersburgers have risen since February 2014. So who is going to buy those 244 “spaces for self-realization”? Or is some kind of economic miracle planned for the near future?

Ten Fun Figures about the Ex-Capital of All the Russias

Ten Telling Statistics about the Petersburg Economy
Mikhail Karelov
November 3, 2015
The Village

1–2%
According to city hall’s forecasts, the city’s gross regional product will grow this much by the end of 2016.

Facade of Galeriya shopping center, downtown Petrograd
Facade of Galeriya shopping center, downtown Petrograd

50,600,000,000 rubles [approx. 71 million euros]
Petersburg’s budget deficit in 2016.

"Crushing food in a city that survived a siege is shameful!" "I don't get it?"
“Crushing food in a city that survived a siege is shameful!” “What do you mean?”

8.9%
Decrease in Petersburg’s industrial production index year to date.

"Water level on November 7, 1824."
“Water level on November 7, 1824.”

19.3%
Decrease in production at Petersburg’s automotive production cluster year to date.

Greenlandia New Estate in Devyatkino
Facade of building in Greenlandia residential complex, Devyatkino, Lenoblast

13.8%
According to forecasts, Petersburg’s inflation rate as of January.

Advertisement in top-floor window at Kirov Palace of Culture, Vasilyevsky Island
Advertisement in top-floor window at Kirov Palace of Culture, Vasilyevsky Island

9.3%
Decrease in the average monthly wage in Petersburg year to date. 

Cat in a courtyard off Suvorov Prospect, Central Petrograd
Photogenic cat in courtyard off Suvorov Prospect, downtown Petrograd

42,656 rubles [approx. 600 euros]
Current monthly average wage in Petersburg.

"Simbirtseva, Apt. 29. Pay your debt, rat!"
“Simbirtseva, Apt. 29. Pay your debt, rat!”

28,700,000,000 rubles [approx. 40 million euros]
Amount banks lent to Petersburg residents in the third quarter of 2015.

Statue of Lenin, Detskoye Selo State Farm
Monument to Vladimir Lenin, Detskoye Selo State Farm, Pushkin

6.5%
Increase in the amount of utilities tariffs in Petersburg, according to the “index of changes in the average amounts to be paid by citizens for municipal services in various parts of the Russian Federation in 2016.”

"Building for sale"
“Building for sale”

11%
Increase in electricity costs for individual consumers in Petersburg in 2016.

Adapted and translated by the Russian Reader. Photos by the Russian Reader

Tatyana Maleva: People and Oil Don’t Mix

Demolishing the Population’s Income Is a Big Mistake by the Authorities
Yevgeny Andreyev
Special to Novaya Gazeta
October 17, 2015
Novaya Gazeta

Why the government prefers oil to people, why poverty could touch half the population, and why social services are losing out to defense spending

Tatyana Maleva. Photo: TASS
Tatyana Maleva. Photo: TASS

In previous years, when it submitted the latest draft budget to the Duma for consideration, the government repeatedly emphasized its social focus: it was all about people, they would say. Now, as the 2016 budget is being worked out, the authorities prefer not to think about this. Spending on the most people-focused items—education and health care—will be significantly reduced. Despite annual inflation’s soaring to nearly 16%, public sector wages will not be indexed at all, while old-age pensions will be indexed only by 4%. Tatyana Maleva, director of the Institute of Social Analysis and Forecasting at the Russian Academy of National Economy and Public Administration (RANEPA) told us how the social sector would cope with all these blows.

Based on your analysis of the projections for the 2016 budget now being submitted to the Duma, which of the social sector issues do you see as most acute?

Those caused by the insufficient indexation of old-age pensions. The government has chosen the most economical solution to this problem.

A 4% indexation does not correlate at all with the expected outlook for inflation. Thus, the budget risks reducing the real value of pensions.

The acuteness of the problem is amplified by the fact that, if we look at the history of incomes in post-reform Russia over the past twenty-five years, we see that pensions have fallen lower than all other sources of income such as wages and benefits. Only in 2010, thanks to the valorization of pension rights [a one-time increase in the monetary value of the pension rights of citizens with time in employment before 2002Y.A.] and pulling the minimum pension up to the subsistence level, we pushed the real value of pensions to where it had been at the outset of reforms in the nineties. It had taken twenty years to restore the purchasing power of pensions. But now, during a crisis, they are being demolished again by the budget under consideration. This is a big mistake by the authorities.

But why? After all, budget cuts are not the government’s whim, but hard necessity dictated by the economic crisis.

As events of the last two years have shown, there are basically only two kinds of resources in this country, oil and people. The price of oil has collapsed, but the people are still here.

It is people who are, in fact, the most reliable of all resources. Sooner or later, investment in people produces economic growth. Oil, on the contrary, is impacted by circumstances unconnected with the Russian economy; we cannot influence the market price of oil. It turns out that one key resource makes us hostage to the situation, while we are voluntarily refusing to support the other resource. So I would argue that during the crisis we should look for ways to support people and even risk a larger budget deficit if necessary. Most economists, including me, are forecasting a long crisis. It is only beginning, and demolishing people’s real incomes right at the outset of the crisis is fundamentally wrong.

How painful will the decision to partially index pensions be?

The government thinks that indexing pensions by 4% will affect only the 38 million pensioners. This is misleading. Models of consumption and survival are based not on individual strategies, but on the strategies of households, meaning families. Around 40– 45% of Russian families include pensioners. The experience of the nineties tells us that even miserly pensions, when they were paid, served as a safety cushion against poverty in families when their younger member lost their jobs or faced nonpayment of wages. Because, in this case, pensions support the household’s minimum consumer budget and act as social insurance. Consequently, the forthcoming partial indexation of pensions will reduce the budgets of 40–45% of Russian households. Meaning that the real impact of this decision will be the growing risk of poverty not among pensioners but among nearly half the country’s population.

The government contends that real incomes have fallen by 2–3%, and real wages by 9–10%. Do you agree with these figures?

At one time, incomes showed a more moderate decline, but now they are rushing [downwards] hot on the heels of wages. Because the factors that were propping up incomes, including pensions, have ceased functioning, and incomes are going to fall, maybe even lower than wages. Over the last year, we have experienced a huge reduction in incomes. Basically, the entire growth they had achieved over the previous three or four years has imploded. And there is no reason to expect the growth will be restored. The decline might simply slow down due to arithmetic: the base for comparison will decrease from month to month, and therefore the rate of decline in real wages may turn out to be 7–8%, not 9–10%. But this does not alter the fact the population’s income is likely to be reduced.

How hard is inflation hitting people’s wallets?

Apparently, by year’s end we will be seeing 13–15% inflation. It is inflation that has a total effect on all incomes by devaluing them, regardless of social classes and age groups. But the risks that emerge among different social group because of high inflation are different. For examples, employees face the risk of job losses and cuts in nominal wages. This is already happening. We see cuts in benefits, reductions in allowances, and the axing of bonuses around the country. Moreover, while individuals are capable of combating other causes of income reduction such as job loss or reduction in wages by looking for a new job or retraining, they can do nothing to withstand inflation.

The number of poor people in Russia increased sharply over the past year—by three million people. Are the authorities capable of dealing with this scourge, or does everyone just have to wait for a rise in oil prices?

It is appropriate to recall how poverty has evolved in Russia. In the nineties, over 30% of the population was poor, but this was shallow poverty. When economic growth began in the nineties, poverty was significantly reduced. Many poor Russians moved into the so-called sub-middle class, rather than sinking into outright poverty. Economic growth reduced poverty levels relatively easily all by itself, without a restructuring of social benefits, without support for various social groups. But as soon as the country shifted from growth to recession, this seemingly happy trajectory turned into a disaster for us. Since, during the “fat” years, a reasonable system of targeted social support for the poor was not established, we are now reaping the consequences of its lack. Very many types of social support were eliminated in 2015, and certain “visionary” regions gutted many social benefits as far back as late 2014. Therefore, poverty will grow, and in this sense, indeed, the only hope is a hypothetical rise in the price of oil.

If the price goes up, there will be more money in the budget, and maybe benefits will return. But I am not so certain of this. It is absolutely not a fact that federal revenues are converted into institutions of social support. I think that in this case there will be a serious struggle with a high probability of the social sector’s losing to the military-industrial complex.

The country made this choice long ago, and it is clearly not going to be revisited.

The official unemployment rate in Russia has not exceeded 6%, which is quite a favorable figure by international standards. At the same time, there is lot of evidence that hidden unemployment has grown. What is your overall assessment of the employment sector?

Indeed, 6% is not a high figure at all. Actually, a low unemployment rate has been traditional in Russia in all phases of the economic cycle, whether the economy has been in growth, crisis, boom or recession. Over the quarter century that Russia has been living in the market economy, it has not really experienced unemployment. But economic laws still apply, and during crises, pressure on the market increases. Ultimately, the market extends possibilities for part-time employment, and this can be interpreted as hidden unemployment. People are willing to work a full workweek, but employers offer them part-time work, either half a day or two or three days a week.

The labor market has formed a kind of social contract under which employers save on costs by not dismissing employees, because the Labor Code forces them to bear exorbitant costs when letting employees go. Employees remain employed, which gives them the chance to earn seniority. And the state pretends not to notice any of this, because it also has a stake in the situation. It saves on unemployment benefits and thereby reduces its financial obligations.

Overall, how has the current economic crisis aggravated social problems in the country? Are there factors capable of causing society to protest and take political action?

It is not just the matter of the crisis. Long-term factors are also capable of impacting the social sector. Even during phases of economic growth, many social processes in Russia were not entirely favorable. Take demographics: the long-term trend has been determined by previous generations, and it cannot be changed. Nothing can be done about the fact that each successive generation in Russia will be smaller than the previous generation.

Furthermore, if we look at a longer trend, we have to admit that wages and other types of income have fallen undeservedly much lower than GDP has sunk. This has predetermined very many processes in the economy. Low-wage labor and a low-income population cannot be effective. We have repeatedly been taught this lesson over the last twenty-five years. Coming to terms now with a drop in incomes and wages means recognizing the inefficiency of our human resources. Yes, of course, no one gets rich during a crisis. But it is not a worsening of social tensions in the country due to a sharp collapse in incomes that we should be afraid of. We should be afraid of social apathy, of the population’s withdrawing into itself and washing its hands of the situation. From the socioeconomic viewpoint, this is a step backwards. This apathy can hold us back for many decades. And even if drivers of economic growth do emerge in Russia, and we expect that people will respond quickly, this might not happen.

But what is the source of this apathy?

In the nineties, the population really lent a helping hand to economic reforms by a creating a strong platform for the informal economy. Everyone predicted that society would explode, but it did not happen. The population thus gave an advance to the government that was carrying out reforms. The country managed to make this incredibly difficult transition from one type of economy to another. The people’s patience was rewarded. We are seemingly now in the same situation. However, our vector is pointing down, not up. The current patience of Russians might pull the country down. The population has not been integrated into this economy; it has not become its subject. It has elaborated its own behavioral trajectories, tactics, and strategies, which do not correspond in any way to state policy. The state and the populace lead separate lives.

Are you not idealizing the nineties? After all, even now, during a crisis, people’s living standards and incomes are much higher than they were then.

What saved people from hunger and many people from death in the nineties? First, grassroots unorganized trading, whose symbol was the famous shuttle traders. A huge informal trading sector was formed, flea markets emerged, and so on. But this sector ultimately disappeared, losing out to powerful commercial chains. Second, a powerful sector of private household plots formed in small towns and villages in the nineties. Even if they provided no cash income, people lived off the land. During the years of economic growth, this sector has turned into dacha villages with lawns, and has also ceased to exist as a source of subsistence for households. Third, a small business sector took shape in some form, albeit a specific form with many negative traits. Nevertheless, there was entrepreneurial freedom. Now, all attempts to get small business on its feet have led to nothing. The administrative obstacles erected in recent years have shut the door to the big economy for small business. Fourth, by the early noughties, a small but noticeable nonprofit and NGO sector had been established in Russia. Now, many of these organizations have been labeled “foreign agents.” Formally, [many of] the NGOs continue to operate, but they do not have the ability to act freely as they see fit.

These are the four legs that have been sawed off the Russian market economy stool, and it will not be able to stand up without them. The set of factors that prevented social catastrophe in the nineties is no longer functioning.

Maybe other mechanisms will be developed, but so far I do not see them. So everything is going to depend on the speed, depth, and duration of the crisis. But if we proceed from the most probable assumption, that the crisis will shift into a protracted, sticky recession, the quality of services will fall, despite the fact that, purely superficially, universities, schools, and clinics will continue to function. We do not know yet how the population will respond economically to these challenges. It has very few options. In fact, its only option is to wait for mercy from the state. People have been prevented from taking care of themselves.

Translated by the Russian Reader. Thanks to Ilya Matveev for the suggestion.

Open Left: Moscow Doctors Talk about Their Work-to-Rule Strike

“Two of us covered eight precincts for a week”: Moscow doctors talk about the work-to-rule strike
Alexander Grigoriev
April 22, 2015
Open Left presents a unique set of interviews with the doctors involved in the first protest in the Moscow medical care system since 1993
openleft.ru

italian 1Medical workers in Moscow have been on a work-to-rule strike since March 24. The work action has been sparsely supported: around twenty people in seven of the city’s medical centers have been involved. They oppose the downsizing of staff, regular unpaid overtime, and workplace management that is detrimental to standards of good medical care.

The current work-to-rule strike is the first in Moscow since 1993, when ambulance staff protested. Although it cannot be said that there had been no problems in the Moscow and Russian healthcare systems all this time, the situation has deteriorated markedly in recent years, and this is due primarily to ongoing reforms by the government.

Since Soviet times, clinics and hospitals have been funded by the state. This meant that all costs for medical care were covered. In addition, since the 1990s, compulsory health insurance (OMS) funds have been operation in Russia. They are financed by contributions from employers. Currently, the size of each contribution is 5.1 percent of a person’s salary, with the maximum salary capped at 624,000 rubles a year. Higher salaries thus contribute the same amount of money to the OMS funds as salaries of 624,000 rubles. The idea is that the OMS funds allocate money to cover costs incurred by medical facilities in providing care to patients. However, rates for services have been set disproportionately low. For example, a chest X-ray is estimated to cost 275 rubles whereas the real cost is around one thousand rubles. Costs have not been covered by OMS funds, so the entire system has continued to be financed by the state.

2010 saw the passage of the basic law governing compulsory health insurance. The idea was that the money from the funds would “follow” the patient, and medical care facilities would be financed from OMS funds every time they provided care to patients. At the same time, rates for services were not changed, so clinics continued to cover the shortfalls that arose with money from the state budget.

When Putin signed the so-called May decrees on May 7, 2012, it became clear that major changes were coming to the existing system. According to one of the decrees, by 2018, salaries of doctors had to be increased to a level twice the amount of the average salary in each region, but there was no question of correspondingly sharp increases in budgetary allocations. On the contrary, spending on health care has been falling with each passing year. In 2014, the economic crisis further exacerbated the shortage of funds.

The Moscow city government continued to finance municipal medical facilities under the old scheme for quite a long time, but gradually reduced its budgetary allocations. Beginning in late 2013, Moscow authorities researched the municipal health care system in order to identify possible options for redistributing costs. Several options were suggested: casualizing some employees, combining several positions into one and thus preserving the old system of positions and salaries, and increasing the specialization of hospitals.

italian 2Queue at a Moscow clinic

Officials settled on the option of reducing the number of facilities in two stages: merging facilities and turning some clinics and hospitals into affiliates of other clinics and hospitals, and subsequently eliminating some of them altogether. Conversion of a clinic or hospital to an affiliate implied the dismissal of specialists who were already officially on staff at the main facility or other affiliates. It was announced that a total of twenty-eight facilities would be closed, including fifteen hospitals.

All this took place amidst protests in the regions, where the situation has been even worse. For example, in 2014, ambulance staff in Ufa twice went on hunger strike. Their demands were generally similar to those being made now by the work-to-rule strikers in Moscow: increased staffing and additional pay for additional shifts. The government of Bashkortostan has repeatedly claimed that it fulfilled all the protesters’ demands, but in March of this year, the hunger strike in Ufa kicked off again and has continued for over a month.

In November and December 2014, there was a series of rallies against healthcare reform in its current form, staff downsizing, and hospital closures. According to organizers, up to ten thousand people attended the largest of these rallies in Moscow. Not only health professionals came to the rallies but also members of various political and grassroots organizations. However, the Moscow authorities chose not to enter into negotiations, claiming it was not medical workers who organized the rallies but outside forces. The demands of the protesters were not met.

The healthcare workers union Action (Deistvie), which originally formed in Izhevsk but is now a nationwide organization with three and a half thousand members in twenty regions, was actively involved in organizing the rallies. It is Action that has now organized the work-to-rule strike by doctors in Moscow.

Open Left has tried to get to the bottom of the situation by speaking with the principal figures in the strike.

 italian 3

Andrei Konoval

Andrei Konoval is managing secretary of the trade union Action. Under his leadership, the organization has carried out a number of protest actions. Konoval talked to Open Left about the reasons Moscow doctors went on strike, why this form of strike was chosen, and the goals the protesters are pursuing.

Andrei, what is the state of the trade union Action at the moment?

The trade union has around forty-five locals in twenty-five localities, cities, and regional centers, about three and a half thousand members in total.

Let’s move on to the work-to-rule strike. What caused you to declare it, and why was this form of protest chosen?

Because other ways of highlighting the systemic contradictions in the management of outpatient clinics would have been ineffective. We had to attract public attention. So we chose a form of protest with a flashy name—an “Italian strike” [the usual name for work-to-rule strikes in Russian]. Although the gist of it is simply that, on the spur of the moment, physicians start working in strict accordance with the Labor Code and the standards of medical care.

What are the reasons for the strike?

The reason is that now a medical clinic employee’s actual workday is ten to twelve hours long, sometimes even longer. This overtime is not taken into account and not remunerated properly, as per the Labor Code. Doctors are put into circumstances where they have to speed up the time spent examining patients, which objectively cannot help but affect the quality of care. Less than ten minutes are allotted for receiving and examining patients, which increases the risk of medical error and reduces the quality of work. Under these circumstances, people who work in health care facilities are deprived not only of the possibility of spending time with their families, raising their children, and relaxing after the workday but also of feeling that what they do is important and useful, because when the pace of work is such that is, their ability to perform their professional duties is discredited. Real professionals with a sense of duty cannot put up with this situation and they are opposed to it. So now we are trying to show that the Moscow healthcare system is totally underfunded, there is a real shortage of doctors, and something urgently needs to be changed.

Do you agree with the argument that the strike has failed?

The authorities are no longer saying this. They are silent on this score. This was said during the first week: it was just a PR attack. As we stated from the very beginning, at the press conference, we have around twenty strikers in six medical centers (seven, even). Others had wanted to join the strike, but they abandoned the idea under pressure. This is normal; there is nothing new here. Taking on the system is something that only people with a certain stamina and courage, and who are also well versed in the legal aspects of the issue, can do.

I want to emphasize that the strike’s success depends less on the numbers and more on the fact that we have provided an example of working the right way. Even if only one person in Moscow said that he or she were ready to undertake a work-to-rule strike—and survived the pressure—even then we would consider the protest a success.

But have you managed to achieve anything by striking?

Yes, at specific institutions. On the eve of the protest and especially in the early days, first they promised and then later they really began making changes to the work schedule in keeping with our wishes: to reduce the intake time, increase the time for house calls to patients, and change the standard exam time for a single patient from ten to twelve minutes, for example. Several strikers set individual appointment schedules in keeping with federal requirements and the real time demands for working with each patient. At Diagnostic Center No. 5, they managed to get the head doctor, who was planning to sack five hundred people, fired. And there are the little things, like the provision of stationery supplies, which previously one doctor had to buy at her own expense. In some clinics, they have stopped putting unpaid Sunday shifts on the schedule. Certain processes have been set in motion, but this is only at the local level, while our objective is to bring about changes to the way the medical system is managed. Our main achievement is that we have attracted the attention of the public and certain authorities to the problem.

Are you going to strike in other regions?

Our trade union operates from the grassroots, not from the top down. If our locals are ready to pose this question, then the central leadership supports them. A strike like this took place in April 2013 in Izhevsk and ended successfully: ninety percent of our demands were met. The know-how we are now amassing in Moscow will be summarized and used in teaching materials. In fact, it does not necessarily have to be used in a work-to-rule strike, because, strictly speaking, what is happening now in Moscow is not a strike at all. The goal of the work action is not to cause economic harm to the employer and, much less, to the patients. On the contrary, when our strikers see them, patients receive objectively better medical care. So we might not call it a work-to-rule strike, but simply introduce this know-how as a recommendation for protecting the rights of medical workers, resorting to the term “strike” only when we need to draw the public’s attention.

How do you see the future of the trade union Action?

Unions have to be massive. This allows them to have a serious impact on social and labor relations with employers. This is not an easy task, but there is no other way.

Open Left also contacted the strikers themselves and asked them about the reasons, goals, and outcomes of the protest.

 italian 4Yekaterina Chatskaya

Yekaterina Chatskaya is an OG/GYN at Branch Clinic No. 4 of City Clinic No. 180. She had struggled on her own to improve her working conditions, but had failed to change anything. After her little son tearfully begged her not to go to work, because he never saw her at home, she realized it was time for decisive action.

Tell us about the conditions in which doctors are now forced to work in the clinics.

Our situation is like this. Our workload had already been quite large. I work in Mitino, a young, growing district, at a women’s health clinic. We have a lot of pregnant women and, accordingly, women who have given birth, and female cancer patients.

We had always had a shortage of doctors, and yet management periodically took on new doctors, and the staff gradually expanded. This, of course, provided some relief. But when this optimization kicked in, the number of doctors at our clinic was dramatically reduced, and the service precincts were disbanded, but no one really counted how many women there were in the service precinct. The residential buildings were simply divvied up (it is not clear on what basis) and the patient load, of course, has increased significantly.

Even before this, UMIAS2 (Unified Medical Information Analysis System 2) had been installed. This was in 2013. By order of the Ministry of Health, an initial consultation with a pregnant woman should last thirty minutes, and a follow-up visit, twenty minutes, but UMIAS set the new time it should take to see one patient—fifteen minutes. That is, they deliberately reduced the time we have to see patients and made it impossible to really help a woman during this time. However, the numbers of high-tech care techniques, such as in vitro fertilization, grows, and so I end up in a situation where a woman comes to see me and, say, she has been infertile for many years or has suffered many miscarriages (some women have ten miscarriages, twelve miscarriages), and now she has finally become pregnant, as she wanted. How can I consult her in fifteen minutes? It turns out that doctors should just engage in a sham, roughly speaking. It is all just for show, for ticking off a box on a form: the patient came in, showed her face, and left. Everything else is outside the time limit. Or the second option is that the doctor does real clinical work, the whole appointment grid shifts, and the doctor does not have time to do anything during the time allotted for seeing other patients, and she starts seeing the remaining patients on her own time.

I cannot deal with a woman like this in only fifteen minutes. In the end, my working day lasts ten to twelve hours, sometimes even longer. Because I have to do paperwork for all the patients I see, and there are also a lot of reports, whose numbers grow constantly. And it turned out that no one had been taking this time into account, it was of no interest to anyone, and basically everyone got paid the standard salary.

The situation was already critical, and I had repeatedly appealed to management to clear up and resolve this situation somehow. They told me that we had to try and make do somehow, everything had been decided, they were powerless to do anything, and we had to meet the norms. Then we were set a norm of twelve minutes per person, which was even shorter, and were told there would also be layoffs. The time for seeing patients was increased, that is, the number of people we had to see increased. However, this standard is not written down anywhere: it is all a matter of verbal instructions.

So things have deteriorated even further since the reforms to the healthcare system began?

The situation has deteriorated dramatically.

I see. And you got no response at all from management?

Absolutely none. They tried to smother “in house” all our attempts to change anything so they would not go any further. I myself personally repeatedly offered to management to write about this to the higher authorities. I even drew up a document, but I got no support from management.

What was your point of no return? What finally convinced you of the need to protest?

For me personally, as a mother, it was when I would go to work in the morning, and my son would still be asleep, and when I would come home from work, he would already be asleep again. I simply did not see him. At some point, he woke up when I was heading off to work yet again. He grabbed my arm and started crying, “Mom, don’t go!” I just realized that was it, I had to change something. When I got home that day, he was already asleep, naturally, and I was very tired. I had had a very rough day. I came home and sat down. I was crying my eyes out. I simply did not know what to do. I plucked up my courage and wrote it all down. I described the whole situation, as it had come to be at our clinic, and sent it to the labor inspectorate. So far, there has been no response, though it has been almost two months.

In the end, I waited a couple of weeks, and then I realized that the matter would remain there, it would go no further. I started looking for like-minded people, because fighting alone, of course, is quite difficult. And so I found colleagues who also wanted to change something. I met with them and talked, and we came up with the idea of a work-to-rule strike.

Why do you think this strike has not yet evoked such a response within the medical community? Why have other doctors decided not to join you?

It’s all a mess. Doctors probably have a well-developed sense of passivity. Very many of my colleagues support me; I would say that almost all of them do. And no one has ever told me that I was wrong. On the contrary, everyone says more power to you, they are on my side, but very many of them are afraid of taking active steps. In our clinic, however, several colleagues have supported me; I am not the only one involved in this. And yet many people fear activism. We have a lot of retirees who just want to make it to retirement. We have a lot of people who have sized up this whole situation and begun to seek work elsewhere. They are planning to leave. When they leave, it is unclear what will happen.

At our clinic, for example, an ultrasound doctor was laid off. The load on the other doctors dramatically increased, and one doctor left: she could not stand the stress. We were left with one doctor who could do ultrasound tests on pregnant women in a huge district. In my opinion, it is simply absurd that, in the twenty-first century, a pregnant patient of mine should wait two or three weeks for an ultrasound. And it turns out that either I should “gently” hint that it would be nice if she paid to have it done (because it is urgent) or she has to wait, and I worry we will let something slip.

Twenty-four appointments for a pelvic ultrasound were issued for next week at our clinic. Only twenty-four appointments for an ultrasound and gynecology exam! This is an outrage. Ideally, every woman should have an ultrasound at least once a year, and those who have had problems, sometimes once a quarter, sometimes once a month. But we have no such possibility.

I have another question for you. These are not just your problems, after all, but the problems of your patients, of the populace. Does management not react to this in any way, either?

Absolutely not. We have instructions from the health department to increase the availability of appointments. Not the availability of health care, but the availability of appointments. In our clinic, it turns out that the overall time each doctor should receive patients has increased, while the time each patient can be seen has decreased. In addition, all repeat appointments have been abolished at our clinic, meaning that as a doctor I cannot make an appointment for someone to see me again; the woman has to make the appointment herself. But the earliest appointment is generally within two weeks. For example, a woman has come to see me to get a signed sick leave form. I give her five days of sick leave, but I cannot take her off sick leave in five days, because I have no room on my schedule. And I am forced to see her on a first-come-first-served basis, as it were, over and above my scheduled appointments.

In order to further increase the availability of appointments, so that they light up in green on the computer monitor at the health department, they do another really interesting thing. Registrars are given verbal instructions to randomly cancel three or four appointments for receiving physicians. While we are given orders, again verbally, to see both those patients who had appointments and those who had to get new appointments.

This increases your workload even more?

Of course. We are also required to see emergency patients, but that is not even up for debate. Rendering emergency aid is a doctor’s direct duty, and if a woman comes in with pain or bleeding, she has to be seen, too. The patient load is truly enormous.

Our service precincts had not been calculated, and when we began our protest, they finally counted the number of people attached to our clinic. By order of the Ministry of Health, the gynecological norm is 2,200 women per doctor. But after the calculations were done in Moscow, it turned out that there were service precincts with 2,900 women per doctor, and precincts with 7,000 women per doctor. So they just divided all the service precincts in half, and now we all have 5,500 women per doctor in each precinct. But each doctor gets only the standard salary.

And the last question. How do you see the future of your movement and the trade union Action in general?

Our trade union is gaining momentum. More and more people are joining it, because they see the real outcomes of our fight. I think the scenario looks positive.

As for our protest, I am still hoping for dialogue with the authorities. We have already had one meeting at the Ministry of Health’s Public Chamber. They took the proposals that we drew up for them, in which all the problems had been laid out. They took all this and promised to get in touch with us. So far, however, they have been silent, but they promised they would call, so we are waiting.

So there have been no breakthroughs so far?

Sundays had also been made working days at our clinic, though officially we have a five-day workweek. This was done without additional agreements or even oral instructions. They would just make appointments for a doctor on Sundays, and that was that. It was assumed the doctor was obliged to go in to work that day. After my written request to management (I asked them to clarify on what basis appointments had been made for me), such shifts were abolished at our clinic and declared illegal. This is one of our victories

 italian 5Elena Konte

During the course of a week, Elena Konte had to cover eight service precincts along with another doctor, after which she decided to start fighting for her rights. So far, Konte has seen no major positive changes, but she remains optimistic.

Could you tell us about the conditions in which doctors are now working in the clinics.

Well, there is a lack of personnel. In our department, four doctors are covering eight service precincts.

This was a major problem for you?

Yes, and the instability of wages. A lot depends in this instance on incentive payments, but now they are here, then they are gone, and it is unclear what percentage of extra pay they will give you, and so on.

What impact have the recent reforms had on the situation?

The most direct impact.

It was right after them that the firings began?

Yes. Our GPs were not dismissed, but our specialists were. The physiotherapist, the opticians, and some others were dismissed. Lab technicians.

I see. And how did management behave?

You mean—

The clinic’s management. You probably complained to them about the shortage of specialists. Did they react somehow?

Of course. But these were not written complaints. They were oral complaints at the general clinical conference that is held once a week. They said the same thing in response to all our recommendations: it was a done deal, no one is going to change anything, so that is why we switched to this scheme of working, work as you like, but be patient and keep working, because nothing is going to change, everything was decided long ago. It is standard practice.

I see. But when exactly was your point of no return, the point at which you decided you needed to go on a work-to-rule strike?

Ha! It was after another doctor and I covered eight care precincts alone for a week!

Why do you think many doctors are hesitant to join your movement?

I think it is this “great Russian patience,” passivity.

Last question. How do you see the future of the trade union Action and the strike itself?

That is a great question. I think the trade union Action has a bright future. More and more people are beginning to understand that it is a trade union that is worth joining and that can really solve our problems. For example, many of our doctors are now quitting the state-sponsored trade union.

As for the work-to-rule strike, to be honest, I have the sense that for now we are looking at an indefinite action, because it still has not solved anything at all.

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Anna Zemlyanukhina

Anna Zemlyanukhina is one of the strike’s coordinators. She presented a broader picture of what is happening now at the leadership level. She made the decision to strike after facing the total incomprehension of her clinic’s management. She is confident in the trade union’s successful future.

Could you say a few words about the conditions in which doctors work today.

The main difficulty is that there are not enough doctors. They are laying off not so much pediatricians as narrow specialists. So the flow of patients to the remaining doctors is quite large, and often it is a problem getting an appointment to see a particular doctor.

In addition, the Moscow City Health Department has announced a campaign for improving access to healthcare, but given the shortage of doctors this is implemented by lengthening a doctor’s workday and reducing the time an individual patient can be seen. But since it is impossible to examine a patient humanely in that amount of time, we have to go beyond the time limits, and in fact the physician’s workday is increased.

How have the recent reforms in the health sector affected this situation?

Frankly, until January of this year, things were more or less normal. Of course, they were hard, but they have gotten worse. Most importantly, the reforms have led to the closure of inpatient facilities, and now it is much harder for a patient to be admitted to an inpatient facility. There are verbal orders from above not to admit patients to hospital, and when a doctor refers a person to an inpatient facility, the ambulance service refuses to hospitalize him or her. A patient might be refused admission three or four times. Patients are admitted only when they are already quite ill.

What role is played in all this by clinic management? What is their stance?

They are subject to their superiors, who send them their orders.

Meaning that they do not try and meet you halfway?

It depends a lot on the individual. Some try. Typically, the lower-level bosses—the department heads—are mostly competent people, and try and meet you halfway, but at the higher levels… No, there are competent people there, too, but they are hamstrung. They get these orders from the top brass and are forced to follow them.

What was your point of no return, when you realized that protest was the only solution?

My point of no return was the increase in mortality rates among patients. And the top brass’s reaction to our protests. At a meeting with them, we raised all these questions—that it was impossible to see a patient in that amount time, that it was impossible to do our work—and the response was the same: “The decision has been made.” People are trying to get across that this is wrong, and they are told it was decided at the top and nothing can be done about it.

That is clear. Why, in your opinion, has your movement not yet engendered a broad response among other doctors? Why have they not joined?

In fact, some have decided to join. Why is this not happening en masse? Because our system “works” well. In many institutions, as soon as doctors show the desire to join up, the top brass immediately gets involved. They coerce them. They promise to get them put in jail, I don’t know, or fired or something else. And god forbid there should be any leafleting. After that, as a rule, the desire to join up diminishes.

And the last question. How do you see the future of your trade union and your protest action?

I see the future of the union as something quite positive. Many doctors are now exiting the official trade union as they no longer trust it, while our organization is gaining in popularity.

Have there been any concessions on the part of the authorities and top management?

For now, the main and only concession is that they have increased the time for seeing each patient. It is fifteen minutes again. Previously, it had been twelve minutes, and they were thinking about reducing it even more.

italian 7

Maria Gubareva

The last person with whom we were able to speak was Maria Gubareva. Before the strike, she had had to see thirty-six patients in seven hours or so, which is quite a lot for a gynecologist. She tried to appeal to the Ministry of Health, but received no reply. In her opinion, the protesters have managed to achieve some success, but they have not yet achieved any major changes in the healthcare system.

Could you tell us about the conditions in which doctors are forced to work today in clinics.

Specifically, in our clinic, the length of time we see patients and the number of patients we see during this time have increased. In other words, the grid interval in UMIAS has been reduced. In particular, after all these changes, the daily intake for gynecologists (I am a gynecologist) is seven hours and twelve minutes, and thirty-six patients. This exceeds all conceivable norms. It is physically impossible, agonizing both for patients and doctors. Plus, it is impossible to refer patients for tests (at our clinic, these are usually ultrasounds, blood tests, and such) because some ultrasound doctors have also been sacked, the workload has increased, and when it went critical, they started quitting, because it is also impossible to work in this way. Well, as for tests, you have to sign up for a blood test ten days in advance. Many other tests are just not done at all anymore, quotas on blood clotting test were introduced, and so on.

In addition, some of our midwives were fired. (We work with midwives, not with nurses.) The doctors work alone: there are one or two midwives for several doctors. The midwife is planted in a separate room and “services” patients there. In other words, the women first go see the doctor. He or she makes recommendations. Then the women sit in the queue to the midwife for another hour or two, go berserk, and go ballistic on each other and the midwives. The midwives are supposed to assign them tests and write out prescriptions, make appointments for them to see specialists through UMIAS, and so on. Basically, it is torture for everybody, for doctors and patients.

All these changes occurred as part of the reforms to the healthcare system? The reforms have had such an impact on the situation?

Yes, the changes have been very serious.

And how does clinic management act given the shortage of specialists and the increased load on doctors? Have you appealed to the authorities about this?

Before the start of the work-to-rule strike, we tried, but no one listened to us. When it was first announced, three months ago, that the workload would increase, I personally asked the deputy chief physician, “How is this possible? It is a violation of labor laws and basically just cannot be done.” To which I was told, “Anyone who does not like it can quit. The country is in a crisis: everyone has to tighten their belts.” It is like. “Everyone off to work. Work, while the sun is still high!”

I see. And what exactly made your cup of patience run over and forced you to go on strike?

It was when I was seeing patients in this crazy way for a week. Even before all the layoffs. I had written about all of it to the Ministry of Health and the labor inspectorate, but had gotten no replies from them. Then a week passed, the week when we had this crazy intake, and it became clear that working this way was just impossible. Either I had to do something or I had to leave.

Why have others not dared to follow your example? Why has the strike not taken on a broader scope?

Because people do not believe you can change anything in this country. The general opinion is that fighting the system is useless. Because the changes are implemented from the top down, they are government policy, Ministry of Health policy, everyone thinks the system cannot be moved. It will just crush its tiny functionaries—that is, those of us who do not agree with it. Plus, those who at first had almost decided to go on strike with me (they, as I have said, were in a really difficult situation) immediately came under pressure with the aim of putting the whole thing to a stop. Management acted against us with all possible means, mainly verbal. They accused us of sabotage and treason. They told us that the state had given us a job, and now we had gone against the state. And so on. Many people simply abandoned the idea. They decided to spare themselves the trouble.

How do you see the future of the union and the work-to-rule strike?

I haven’t especially thought about the future of the union. I guess if its membership grows, it will gain strength and might be able to start solving some of our workplace management issues, to do what a trade union is supposed to do: protect the legal rights of its members.

As for the strike, I cannot give you a clear answer, because the statement by the authorities that the strike failed is ambiguous. When viewed from the perspective of the twenty people who have taken part in the strike, all of our demands have been satisfied, because they were legitimate. It turned out that management has had nothing to counter us with: everything had been done strictly according to the law, in keeping with all the norms. And we have observed all the requirements, so now I see a humane number of patients, I have a humane amount of time to see them. Basically, everything is as it should be.

But this does not solve the overarching problem of healthcare, which would have happened had a significant number of people joined the strike. In our department now, where I am the only one on strike, the patients who do not get in to see me are simply fobbed off onto the other doctors. So they are seeing their own patients and that other guy’s patients, and that other guy is me. But if we had all said we would see patients as they should be seen, then half the patients would have been unable to make an appointment to see a doctor. They would have attacked the head physician and the health department, and ultimately management would have had to hire staff, which, in fact, would have solved the problem.

Alexander Grigoriev is a student in the history faculty at Moscow State University.

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Photos courtesy of Open Left. Translated by The Russian Reader