Mustard Plasters to Heart Surgery

A revolution in health care that is still being fought

Towering, superbly equipped research institutes contrast with hospitals that are bleak, antiquated and poorly staffed. Some Soviet physicians are equal to the best in the West in such fields as orthopedics and ophthalmology; yet doctors still use such primitive therapies as mustard plasters and cupping and even leeches. Treatment is administered free and drugs are inexpensive, yet patients often must bribe doctors and nurses for medication, operations, even to have linen changed and bedpans emptied.

Such is the paradoxical state of Soviet medicine. Even so, the Soviets have made great strides in health care since 1917. Says Washington, D.C., Internist William Knaus, who lived in the U.S.S.R. for 18 months and is the author of a forthcoming book, Inside Russian Medicine: "They took a country that was 200 years behind the rest of the world and provided the basics at a fraction of what we charge. They eliminated epidemics. Life expectancy is up and infant mortality is down. That has to be judged a success."

Just before the revolution, the average life expectancy was about 30 years. By the 1960s men were living on average to 66, women to 74 (about the life expectancy of U.S. citizens). In 1950, 84 children out of every 1,000 died before the age of one. By 1971 infant mortality had dropped to 23 deaths per thousand. Lately, though, these gains seem to be eroding. Life expectancy for men has been dropping, in part because of rampant alcoholism, and observers say that the U.S.S.R. is losing 30 of every 1,000 new citizens (double the U.S. figure).

Spearheading the medical care effort are the nation's 900,000 physicians, twice as many as in the U.S., and a fourth of all the world's doctors. About 70% of them are women. Backing them up are 2.7 million nurses and feldshers, or paramedics. Notes Knaus: "Theirs is a people-intensive system, ours is machine-intensive."

Nevertheless, the Soviets have gleaming facilities that are equal to anything in the U.S. TIME Moscow Bureau Chief Bruce Nelan recently toured three such centers in or near the Soviet capital. His report: "The Bakulev Institute of Cardiovascular Surgery, run by internationally recognized heart surgeon Vladimir Burakovsky, has performed at least 20,000 heart operations since it was established in 1956, 2,000 of them on children under age two. There are now 40 operations a week in its nine operating theaters.

"Eight miles away, on the city's southeastern outskirts, is the Soviet Union's most imposing medical institution: the Cancer Research Center of the Academy of Medical Sciences. Back in 1969 proceeds from the Soviet Union's annual day of voluntary work, called the subbotnik, were turned over to the academy for a new cancer center. About $128 million was contributed to help build a huge complex covering three city blocks, with 1,000 beds for patients. A staff of 4,000 works with the best equipment, purchased from all over the world. In the radiation therapy department, the doctors are particularly proud of their high-energy electron and proton accelerator from France. Professor Nikolai Trapeznikov, the center's deputy director-general, stresses that the work here is mostly experimental: 'For routine treatment there are 250 other specialized cancer hospitals in the Soviet Union, almost one in every large city.'

"In a wooded area in northern Moscow stands the Research Institute of Transplantation and Artificial Organs. Though its present quarters are two decades old and cramped, the scientific equipment is the newest and best, from the U.S., West Germany, Italy and the Soviet Union. Jokes its director, famed Surgeon Valeri Shumakov: 'Our equipment is an international team.' The institute does most of the kidney transplants in the Soviet Union (sometimes exchanging the organs with European and American hospitals), and will soon begin doing liver transplants and resume attempts at pancreas transplants as well."

Yet outside showplace institutions, medical care is surprisingly primitive for a developed country. Most Soviet physicians are unaware of current medical developments outside their country, largely because of limited access to foreign professional publications. Boston Endocrinologist Aron Lurie, who has been tutoring emigre doctors, reports that a standard teaching tool in the U.S.S.R. is the 1950 edition of Harrison's Principles of Internal Medicine. When asked why Soviet doctors did not use more up-to-date editions, Lurie's exile students replied that translations are costly, and besides, said one, "not much new has happened in medicine since 1950."

Apart from the leading institutes, Soviet hospitals are mostly old, dilapidated and sometimes incredibly filthy. Drugs, equipment and techniques that Americans take for granted are rare or lacking in the U.S.S.R. Most blood tests are done manually rather than by automated equipment, and doctors must sometimes wait three or four days for the results. Disposable syringes and needles are virtually nonexistent. There are few kidney dialysis machines, and most physicians have not seen a CAT scanner, the computerized X-ray machine that is the rage among doctors in the West. Medications frequently run out.

Birth control is another area where the Soviets are lagging. The government's ideal family has three children, but couples are forced to use the unreliable rhythm method or coitus interruptus, with abortion as a backup. According to Dr. Knaus, Soviet men do not like condoms, diaphragms come in only one size, and the pill (which is just beginning to be manufactured within the U.S.S.R.) is regarded with skepticism and fear. Intrauterine devices are popular but in short supply. The result: in 1980 Soviet doctors performed an estimated 16 million abortions. Says Dr. Knaus: "The average woman has six abortions during her lifetime. A woman in Odessa told me, without hesitation, that her mother had had 24."

While better equipment and treatments are available for the political elite, they also have problems. Dr. Warren Zapol, an anesthesiologist at Boston's Massachusetts General Hospital, tells of being asked to tend the daughter of Heart Surgeon Burakovsky. The patient, herself a doctor, had entered a general hospital in Moscow with abdominal pain, but then, as can happen in hospitals anywhere, "she got into trouble," says Zapol. She apparently had an infected fallopian tube and then a "misadventure" with anesthesia, followed by cardiac arrest and blood infection. When Zapol arrived in Moscow, she was having difficulty breathing and her chances of survival seemed slim.

In the end, she survived--with the aid of equipment and drugs from the U.S. and the care of dedicated doctors from both countries.

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