In Novosibirsk, Andrei Shevela performing an operation using minimally invasive medical technology.
When Pavel Syomochkin underwent surgery to breathe better through his nose, little did he imagine that he’d end up breathing too well.
Soon after the 22-year-old had an operation on his nasal septum in the Siberian city of Ulan-Ude in 2005, his throat began to dry out because of the “large torrent of air” streaming in, he said.
Three weeks later, an X-ray revealed that the surgery had enlarged the passage too much. Although Syomochkin had an examination for corrective surgery when he moved to Moscow in 2006, he said he couldn’t afford the operation.
Syomochkin blamed outdated, poor-quality equipment in the hospital in Ulan-Ude for the surgical misfortune, although he also said inexperienced medical staff may have played a role.
“The level of quality [of medical care] is not very good in Siberia and the Far East,” he said.
“In Moscow, there’s an entirely different level of medical care,” he added. “Health care specialists are more competent here.”
Syomochkin’s story illustrates how widely health care can vary across Russia’s vast expanse. Nowhere is this range more apparent than in Siberia, which, according to its broadest geographical definition, encompasses more than three-fourths of the country’s territory but is home to only about one-fourth of its population.
Both President Dmitry Medvedev and Prime Minister Vladimir Putin have begun sweeping initiatives to reform health care. Putin has pledged to devote $15.6 billion to the modernization of medical care, beginning in 2011. But doctors and analysts agree that health care modernization will require measures such as educational reform, investment in high-tech equipment and the development of electronic information systems, all of which remain daunting, especially in the regions.
In Russian, the phrase “Siberian health” is typically used to describe vigorous health: It means that if you can tolerate Siberian weather and living conditions, you have the fortitude to survive almost anything. In actuality, however, the region faces a plethora of health problems.
As the destination for prisoners and exiles for more than 300 years, Siberia has a long history of tuberculosis. Because of especially harsh living conditions and climate, tuberculosis has continued to affect the region. In the past decade, the Siberian Federal District suffered the highest death rate for tuberculosis and had the highest incidence of new cases until it was overtaken by the Far East Federal District in 2008, according to the United Nations Development Program’s 2010 National Human Development Report.
Since the collapse of the Soviet Union, HIV/AIDS has emerged alongside tuberculosis as a menace to the health of Siberia’s residents.
In 2009, the Irkutsk region had the highest number of officially registered cases of HIV/AIDS in the country after the Samara region, about three times more than in the city of Moscow. Three other Siberian regions round out the top 10.
Meanwhile, infant mortality remains high in southern Siberia, notably in the Tuva and Altai republics.
Lifestyle choices further compound the health problems of Siberia’s population. According to research by the Novosibirsk Therapeutic Research Institute cited in a Russian Academy of Sciences publication in 2008, between 75 percent and 80 percent of the population of Siberia and the Far East smokes, whereas a World Health Organization poll found in 2010 that overall, about 40 percent of Russians are smokers.
The article also estimated that roughly 20 percent of the men in Siberia and the Far East suffer from alcoholism, and that a similar percentage use drugs.
Even in Siberia’s most developed areas, the ability of local medical care to address such public health problems has been called into question. In a suburb of Russia’s third-largest city, Novosibirsk, an 8-month-old boy died in 2010 after the family’s chosen hospital didn’t have the right equipment to treat him and other local hospitals refused him care. His mother has since started a campaign to reform health care in Novosibirsk, flagging poor organization and a lack of quality medical care for children.
At the same time, Siberia has managed to combat some of its problems. For instance, maternal mortality in the Siberian Federal District decreased by more than half between 2003 and 2008, dropping from 43 deaths to 21 deaths per 100,000 live births, although “more funding and more focused management efforts are needed” to sustain this reduction, according to the 2010 UNDP report.
The possibility that further improvements will be made in Siberian welfare now seems stronger than ever, as the country’s officials have increasingly emphasized health care reform, as well as promised a flush of federal funding to accompany it.
As part of the National Health Project begun in 2005 by then-President Vladimir Putin, 15 high-tech federal centers are slated to be built around the country, including in the Siberian regions of Krasnoyarsk and Tyumen.
In 2011, the government will start an extensive program to modernize health care in various regions, putting 460 billion rubles ($15.6 billion) toward these reforms over the next two years, Putin announced in April.
Solutions and Spending
Putin’s spokesman, Dmitry Peskov, said in a telephone interview in late January that the federal government will consider modernization programs proposed by individual regions in deciding how much to allocate to each region. The amounts haven’t been finalized, he said.
The Center for New Medical Technologies is a nonprofit organization that has researched, developed and used cutting-edge medical technologies in the treatment of patients since it opened in 2003. Part of an institute in the Siberian Branch of the Russian Academy of Sciences, the center is located in Novosibirsk’s Akademgorodok, a scientific center that is also home to Novosibirsk State University and several other institutes of the Academy of Sciences. Vitaly Morozov, a doctor at the center, listed five medical firsts for Siberia that have emerged from the facility.
- High-tech, minimally invasive surgical methods. The NOTES method — Natural Orifice Transluminal Endoscopic Surgery, in which instruments are inserted through bodily openings — and the SILS method — Single Incision Laparoscopic Surgery, in which one small incision is made in the navel — use optical technology alongside surgical equipment to reduce and, in the case of NOTES, eliminate incisions in the abdominal wall. That in turn decreases recovery time, risk of complications and scarring. The center was the first to use these two methods in Siberia.
- Safer radiology. The center devised a safe, nontoxic contrast medium for use in ultrasound diagnosis of hollow organs such as the appendix and fallopian tubes.
- Conservative types of joint therapy. A treatment regimen for joint conditions such as osteoarthritis patented by the center includes injections into affected ligaments and manual therapy of joints to increase their range of motion. Later on, doctors inject a substance similar to the fluid naturally found in many joints, using ultrasound technology to increase the precision and safety of the injections.
- A genetic map of personal health. The center also conducts examinations of variations in genes related to socially significant diseases such as hemostasis, cardiovascular diseases and cancer. In light of the findings, doctors can advise a patient on his or her lifestyle and prescribe medicine to reduce the risk of developing these ailments.
- Virtual palpitation of blood clots. Doctors at the center use sonoelastography, a technique in ultrasound imaging, to diagnose the risk posed by blood clots within veins of the lower extremities. This can help avoid life-threatening complications from cardiovascular diseases.
The health care system faces several fundamental challenges, not the least of which is the parallel existence of private and state-run medical facilities. Private clinics are better equipped, their proponents maintain, but many people can only afford the free local health care guaranteed by the state.
In areas such as Siberia, equipping and staffing state clinics are perhaps the most pressing issues. However, health care reform will require innovation not only in equipping medical facilities, but also in organizing and integrating clinics, said experts and practitioners.
“My opinion is that first of all, it is essential to strengthen and enlarge hospitals providing emergency care, to fill them with the latest equipment and increase their bed capacity,” Sergei Bogidayev, chief physician at the Aperto Diagnostic Tomography Center in Novosibirsk, said in an e-mail interview about health care reform in Siberia.
Bogidayev also recommended rerouting funding from ineffective medical facilities, as well as increasing the salaries of the health care specialists at effective facilities. In a fall 2010 rating of 30 professions by salary, the Moscow auditing firm FBK placed health care workers in 23rd place with an average monthly pay of 15,824 rubles ($540).
As part of Putin’s regional health care modernization program, the Health and Social Development Ministry wants to increase the average doctor’s salary to at least 23,000 rubles ($780), ministry head Tatyana Golikova said last year.
That is just part of the picture. Putin’s program also allocates 300 billion rubles ($10 billion) for renovating and outfitting public medical facilities, a third of which require major renovations.
In addition, it sets out 24 billion rubles ($820 million) for electronic systems to facilitate medical record-keeping and universal health insurance, Golikova said.
Improved use of information systems will allow health care providers to better serve patients’ needs and more fully integrate the health care system across Russia’s expansive territory, according to Konstantin Chebotayev, international project manager at the Medical Center for Information and Analysis of the Russian Academy of Medical Sciences.
“National standards for the exchange of medical information between the country’s health care facilities are currently taking shape,” Chebotayev said. “Modern health care is being organized around the patient; his [medical] information should follow him. The mobility of the population is growing, and this trend will only strengthen.”
In addition, the integration of medical information systems will allow the health ministry to gather more transparent statistical and medical information and distribute funds in a better way, he said.
As of 2006, only one state hospital out of 10 had an information system that went beyond pure billing and administrative capabilities, Chebotayev said.
The main obstacle for reform in this sphere is isolation, he added. Although there are many institutions with exemplary information systems, these systems are developed separately and have no way to exchange basic information such as medical records. According to Chebotayev, this problem is especially pronounced in wide-flung Siberia.
The federal government has begun instituting measures to reform health care information systems, starting with the formation of the Department of Information Systems Development within the health ministry in 2008.
More recently, the government is planning to create a repository of information systems, from which medical facilities will eventually be able to select and install a system free of charge, Chebotayev said.
“This is a very serious step that is destined to influence the status quo,” Chebotayev explained. “In Siberia and other regions of the Russian Federation today, there are functioning systems, brilliant specialists and a high level of successful results, but they don’t make a difference at the national level.”
Despite the recent activity in developing medical information systems, comprehensive reform of the Russian health care system remains a long-term process, especially in Siberia and other isolated areas. Patients hoping for higher-quality care face an extensive wait.
Syomochkin, the 22-year-old, isn’t one of these, however. He isn’t planning to get corrective surgery on his nose anytime soon, he said.
“Now I don’t particularly feel [the stream of air],” he said.
“Time passed, and I got used to it.”