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As economy suffers, so do patients in Russia Doctors, pharmacists struggle for medicines

KLIN, RUSSIA — KLIN, Russia -- Last week at the Klin City Hospital there was no plaster available for casts, so surgeons used splints on patients with broken bones instead. Now the plaster is back, but drugs to treat circulatory ailments have run out.

"We have to warn the chief every time we are going to have an operation so that he can make sure we have all the anesthetics and medicines we need," said Dr. Stanislav Samokhin, chief of surgery. There's rarely enough of any one anesthetic, he said, so doctors mix and match what they have.

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The economic chaos and frozen bank accounts that have shut down so much trade in Russia have brought about a near-total halt in the flow of medicine as well. Spot shortages are hitting hospitals and clinics across the country. The remaining supplies are making it to market only sporadically, and there's little prospect of replacing them once they're used up.

This is a country that imports 82 percent of its medicines, and barely anything is coming across the border.

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Throughout Russia, pharmacy shelves are going bare, hospitals are scrounging for whatever they can get and appealing to patients to bring their own. Insulin for diabetics is about to run out; those drugs that are available are becoming so expensive that few can afford them. Newspapers are printing recipes for home remedies.

The overall picture is catastrophic. Yet here, as in towns across Russia, people are dealing with the shortages. Nothing is satisfactory, but disaster hasn't hit. Like a rider on a wobbly bicycle, the system -- as of this moment -- has managed to keep going.

Hospital's 'scared' doctor

The Klin City Hospital is a collection of stained yellow stucco buildings on a weedy rise above the Sister River about 40 miles northwest of Moscow. It has had to contend with shortages ever since what Samokhin calls the "avalanche" hit Aug. 17.

"We are surviving, but it takes all our effort," he said. "As to the future -- well, I'm scared."

The hospital has appealed to local clinics for surplus drugs, asked patients to bring their own syringes, dispensed with X-rays when film was short.

Samokhin, a mild man in a starched blue cap, has worked at the hospital since 1976. It is the only hospital in the region, serving not just Klin, a city of 100,000, but nearby villages as well, places with names like Spoons, Black Dirt, Teacups and Pawns.

He has never seen a time like the present.

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Suppliers fear nonpayment

Until 1990, Russia produced most of its own medicine. A lot of it was nearly worthless. Now the quality is far better, but domestic manufacturers produce just 18 percent, and even they must depend on imports for raw materials.

The government says there are stockpiles of drugs that should last at least until winter. Suppliers here acknowledge they have some of the needed medicines in stock, but they are reluctant to sell them because they can't be sure of getting paid, and they don't know what it will cost to replenish them. And, with the payments system still frozen, it's not clear how they could buy supplies from abroad even if they had the money.

Klin City Hospital has not yet cut back on its weekly average of 40 or 50 operations, Samokhin said, but everyone assumes it may have to. So far it has not had to ask patients to try to buy their own medicine elsewhere. But some patients' families raise the possibility themselves, Samokhin said, and their offers are not turned down.

In years past the hospital was inundated with directives from the Ministry of Health, so many that it had to ignore a good deal of them. Since the current crisis began in August, no directives have arrived. Prime Minister Yevgeny Primakov is still trying to form a Cabinet; for now, Moscow is letting the country fend for itself.

"Of course it's strange," said Samokhin. "Wouldn't you think someone would be trying to find a way out of this?"

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Yet the routine of Russian hospital life has changed little for the patients. The nurses here act like construction-crew bosses. The seven-bed wards are heated so well that patients hang out in the stairwells just to cool off and get a change of view. Relatives of the sick and injured don white coats and minister to their relatives during visiting hours.

Viktor Buzinkin, 53, cheerfully held up a large bag of groceries his family had brought him -- Russian patients have always relied on their families for food.

Buzinkin has blood clots in his left leg. He has no idea what he's being treated with. "They give me some shots, but they never tell me what they are," he said. "The doctor said I had to stay here another week, and then probably have an operation so it doesn't happen again. I don't know. The doctors are pressuring me."

At 6 p.m. all visitors leave. They wait at the bus stop across the street from the house where the composer Peter Ilich Tchaikovsky lived. Trucks from the new brewery and the new ZTC sausage plant rumble by, passing the McDonald's before turning left into town.

Klin seemed to have turned a corner in the past year or so. Prosperity beckoned. Then came the crash that's hit all of Russia.

"It was all going so well," said Lyudmila Yarotskaya, manager of a city-owned pharmacy, as she straightened a stack of prescriptions she is unable to fill.

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"The customers are nervous and worried," she said. The pharmacy's prices are strictly controlled by the city; unfortunately, that means that the few suppliers who are willing to do business have turned to independent commercial outlets instead.

Officials called 'thieves'

Many of Yarotskaya's customers are elderly or veterans or diabetics -- among the 22 million Russians who are entitled to free medicines and now aren't getting them. "That's a system that doesn't correspond to financial reality," she said.

A young man came in with prescription orders for his elderly father. She filled one, took his telephone number, and put the other six on her stack.

Across town, at a commercial pharmacy, the shelves were well-stocked. A clerk said there had been shortages at first, but her boss had found a way to do business and things seemed to be getting back to normal.

"Normal?" exploded Yulia Pankova, 62, looking for affordable medicine to treat a circulatory problem. "Three times higher? Five times higher? You call that normal? It was 34 rubles and now it's 104. They don't have any at the city pharmacy. Can I buy it? You tell me how. My pension is 300 rubles a month. This whole crisis is playing into the hands of business crooks. They used to be Communist Party secretaries, and now they're nothing but thieves."

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In a rage, she put the $7 bottle of medicine back on the shelf. Tears sprang to her eyes and her face turned red.

The clerk had had enough, and told her to get out.

Pub Date: 10/03/98


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