Underfunding, corruption allegations, internal feuding, facilities in disrepair — flaws revealed at a Moscow paediatric cancer ward have shone a harsh spotlight on the afflictions plaguing Russia’s public healthcare system.
The Blokhin cancer centre, housed in a brutalist 1970s-era compound in the south of the capital, is so notorious that some have taken to calling it “Blokhinwald” after the Nazi-era Buchenwald concentration camp.“Children with cancer are being treated in atrocious conditions, with a lack of ventilation, mould on the walls and overcrowded rooms,” the hospital’s former deputy director of paediatrics, Maxim Rykov, told AFP.
Along with 20 of his colleagues, Rykov quit the hospital, which describes itself as Russia’s biggest oncological clinic, in September, accusing its new chief of mismanagement.
A health ministry investigation cleared the hospital, but the accusations were hardly a surprise to the parents of children treated there.
“The air vents had to be blocked up because the ventilation ducts hadn’t been cleaned for years,” said Tamara Tsvetkova, whose five-year-old daughter Veronika spent a year at the centre for leukaemia treatment and is now in remission.
“In the rooms there were no lockers to put things, we had to buy them ourselves, as well as camp beds so that we could sleep next to our children,” Tsvetkova said.
An AFP request to visit the Blokhin clinic was refused.The oncologists who resigned accused the new management, which took over in June, of cutting their salaries by 35 percent, as well as changing treatment regimes to save money.
– Lack of transplant funding –
Following media reports, the health ministry opened an investigation that instead accused doctors of enriching themselves through opaque schemes to fund bone marrow transplants.
Contacted by AFP, hospital management refused to comment, saying the conflict was “closed”.
The medics denied any corruption, saying they arranged for private foundations to pay for transplants because of a lack of public financing.
“We do 50 or 60 transplants per year and the state pays for around 30. For the rest, either we abandon the patients or we look for a funding source,” said surgeon Igor Dolgopolov, who resigned in November after a 20-year career.
Parents of child patients say they see the doctors who quit as victims of the system.
“They’ve saved so many children. I can’t condemn them,” said Nailiya Tugusheva, whose five-year-old daughter Amira also has leukaemia.
– Growing dissent –
What causes the greatest alarm among parents of young Blokhin patients are changes in some treatment protocols.
Foreign-made medicines are being replaced with Russian equivalents, partly because they are cheaper but also due to a government requirement in place since 2015 to support the national pharmaceuticals industry.
About 30 parents have written to President Vladimir Putin asking him to reconsider the policy but “nothing came of our message,” Tsvetkova said.
The deaths in early December of two girls, aged 14 and 17, at the cancer centre after bone marrow transplants have only increased concerns, though no link has been established with the new drugs regime.
Russian doctors have generally avoided public disputes, despite very low pay by Western standards, but those at the Blokhin clinic are not the only ones speaking out and posting videos online.
In October, neonatologists — treating newborns — threatened to resign from a hospital in the city of Perm in the Urals mountains over low pay and long hours.
In the Kurgan region of Siberia, the closure of a tuberculosis centre led to protests.
And in Moscow in November, two renowned specialists in children’s kidney transplants condemned the veto on foreign medicines, saying no Russian equivalents existed.
– ‘Very little’ spent on health –
The government stresses the need to overhaul an inefficient health system, inherited from the Soviet era and hit hard by the economic turmoil of the 1990s.
Its so-called optimisation drive over the last two decades to better allocate resources has led to the closure of smaller rural hospitals and a concentration of doctors in large multifunctional hospitals in major cities.
But in some areas “people have to travel 200 kilometres” (125 miles) for medical help, said Ivan Konovalov, of the Alliance of Doctors trade union.
And parts of the countryside often have no more than just first-aid drop-in centres.
From 2000 to 2018, the number of hospitals fell from 10,700 to 4,390, according to official figures, while the number of beds per 10,000 Russians dropped from 115 to 71.
“Hospitals are short of medicines and patients have to buy them themselves,” Konovalov said.
“In our country, a lot of money gets spent on the security forces, army and police and very little on health,” he added.
Russia’s health expenditure was 3.7 percent of GDP last year. That’s much less than the 9.5 percent in France or Germany, according to Organisation for Economic Cooperation and Development data.
Putin has acknowledged certain problems, notably a lack of facilities, equipment and staff, and announced an extra 150 billion rubles ($2.3 billion/2.1 billion euros) funding in total for a three-year period beginning this year.
Yet, medical student Darya Sosedova, who recently protested outside the health ministry, says she is not convinced by Putin’s promises.
“People being fired, the low pay — when you see all that, you wonder if it’s worth continuing your studies and staying in Russia,” she said.