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Cholera Epidemic Strains Shaky Medical System

August 25, 1994

MOSCOW (AP) _ A cholera epidemic in southern Russia is straining a health-care system already at the breaking point.

Nearly 700 people have caught the highly infectious water-borne disease in recent weeks. All but a handful are in Dagestan, where indoor plumbing and clean drinking water are scarce. Seventeen people have died.

The government has dispatched medical teams to examine thousands of people, has quarantined infected areas, and has tested water in lakes, rivers and reservoirs.

The epidemic couldn’t have come at a worse time. The 1991 Soviet collapse hit the medical system like a wrecking ball. Health spending has plummeted, and the sudden demise of central control has left local health officials floundering.

″It’s much harder now to fight an epidemic than it would have been before,″ Irina Yeramova, deputy medical director of the International Federation of Red Cross and Red Crescent Societies office in Moscow said Wednesday.

The Soviet system was never all it was cracked up to be. It ″succeeded in only one thing - creating the myth that it was the best,″ pathologist Vladimir Pchelin wrote in an article headlined ″View from the Morgue″ published Wednesday in the newspaper Novaya Yezhednevnaya Gazeta.

″Yes, we were ahead of the rest of the planet in the number of doctors and hospital beds. Quality of treatment didn’t count,″ he wrote.

Now things are even worse. ″Now they have no money,″ Yeramova said.

Illnesses such as tuberculosis, syphilis, diphtheria and typhoid fever are coming back. And disease is conspiring with poverty, stress, alcohol, violence and pollution to rob Russians of their lives.

In a single year, from 1992 to 1993, the life expectancy for Russian men dropped from 62 to 59 years. American men, on average, live 72 years.

Women and children are also faring worse. Russia’s infant mortality is twice as high as Western Europe’s, Yeramova said, and the maternal death rate is four to seven times higher.

Against this dreary background, cholera struck at the end of July.

Yevgeny Belyaev, head of the state epidemiological service, told reporters Wednesday that 686 people in Dagestan have the disease and another 669 are carriers.

Fifteen people in Moscow, including 11 Russians who fled Rwanda’s ethnic fighting and disease, are sick, he said. Another 28 unconfirmed cases - including four deaths - are reported in Chechnya, a breakaway region of southern Russia.

The government is pouring resources into fighting the epidemic. It has also promised to invest money in clean water - purification plants, pipelines and filtering systems in Dagestan.

″By this winter,″ Belyaev said, ″we should have located all the sources of cholera.″

But the cold months will bring only temporary respite. There were outbreaks of cholera and diphtheria last summer. Health officials can only brace themselves for what next year might bring.

″Everything,″ Yeramova said, ″is falling apart.″

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