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Even for Elite, Russian Medicine Barely Makes Ends Meet

September 24, 1996

MOSCOW (AP) _ The elite heart clinic that will oversee Boris Yeltsin’s heart bypass operation is a portrait of neglect, from the gloomy, unheated lobby to the stray dogs that beg for food at the back door.

``Good medicine requires big money, and we don’t have it,″ says a young emergency room doctor walking a reporter through the maze of long halls at the Russian Scientific Cardiological Complex in far western Moscow.

``The state of Soviet and now Russian medicine is very bad _ all branches, from medical education on up _ and if anyone says otherwise he’s lying,″ he adds.

The cardiology clinic is only a small part of this enormous complex of adjoining buildings, constructed in the 1970s in that monumental Soviet style in which everything _ doors, corridors, entrances _ seems too big.

Today, steam radiators struggle to take the chill off 15-foot-high hallways with floors of stone and walls of drafty windows, and untended courtyards are overgrown with grass and weeds.

The cavernous main lobby where visitors leave their coats and wait in line for passes is dark, its fluorescent lights flickering or dead, and cloudy with cigarette smoke.

Some buildings stand empty, unneeded, their plumbing shut off and everything basically left to crumble. Even in the vital research wing, entire floors are deserted, the scientists gone elsewhere for better pay.

Yeltsin, as president, is a special case, of course, and will get the best treatment Russian and foreign specialists can offer. But his decision to have surgery in Moscow has thrown a spotlight on Russia’s impoverished medical system, where expensive surgeries like his are rare and doctors and patients alike look abroad for quality. Only a few thousand bypass operations are performed in Russia each year, compared to half a million in the United States.

Yeltsin, 65, will likely be operated on within the next two months, either at the clinic, run by the dean of Soviet cardiology, Dr. Yevgeny Chazov, or at nearby Central Clinical Hospital, also called the Kremlin hospital, where Yeltsin is now being evaluated.

In Soviet times, health care was free but shoddy. Since the 1991 collapse of the Soviet Union, even the elite clinics that cater to VIPs have been gasping for funds.

``The biggest problem is non-payment,″ says Dr. Leo Bokeria, who heads another leading Moscow clinic, the Research Center for Cardiovascular Surgery.

``Since we’re a state hospital, we’re paid 95 or 96 percent by the state, and we’ve been very badly paid,″ Bokeria says.

Russia is gripped by a chronic cycle of debt and unpaid wages. The government can’t collect taxes and doesn’t pay its bills, and most state workers, from miners to defense workers to teachers, regularly go months without paychecks.

The ER physician, who spoke on condition of anonymity, graduated with honors and considers his posting at the Chazov clinic a prize. Still, he makes only $100 a month, less than the national average. He sells German pharmaceuticals on the side, but he has a wife and young child and worries he may have to quit medicine to make a living.

Top physicians at state hospitals are known to supplement their meager incomes by demanding kickbacks from patients.

The young doctor gestures toward a Mercedes parked near the crumbling curb outside the clinic. ``That belongs to one of our surgeons,″ he says.

For a state clinic, Chazov’s 400-bed facility gets relatively good treatment. Chazov once headed the Kremlin health service and is credited with keeping ailing Soviet leader Leonid Brezhnev alive for years.

While much of the complex is falling part, the patients’ wards are well-lighted and warm, with marble and metal giving way to carpeting and woodwork. Patients are housed just one or two to a room and do not have to wait for openings; many rooms appeared vacant on the weekend walk-through.

The clinic’s physicians are among Russia’s most experienced. Chief surgeon Renat Akchurin, who will head Yeltsin’s surgical team, studied with renowned American heart surgeon Michael DeBakey at Houston’s Baylor College of Medicine.

DeBakey, 88, is now in Moscow to confer with Akchurin and other surgeons about Yeltsin’s precarious health.

The president’s heart problems have also brought attention to the need for better preventive care in Russia. The Russian diet is fatty, heavy on red meat, sausage and fried potatoes, and alcohol consumption is high. Those factors have helped reduce male life expectancy to 57, a drop of six years since 1991.

The clinic says its kitchen avoids meat and fried foods _ Monday’s dinner menu listed fish, mashed potatoes and yogurt _ but the young doctor calls the bland, institutional offerings ``ugly″ and patients’ families commonly bring meals in for loved ones. Often, they are expected to bring the necessary drugs, too.

``The level of our institute is down,″ the doctor says grimly, adding that he himself would probably look for treatment abroad.

``In my group (at medical school) we began with about 20 people. I would send my relatives to only one or two of them.″

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