CSEW: October 1993

Focus on Health Care

Since the breakup of the USSR in 1991, health care conditions, which were already bad, have worsened considerably across the region as a whole. National health care budgets have declined in real terms, as have wages in relation to the prices of medicine. People aren't eating as well as before and severe environmental health hazards remain unremedied.

The problem has been compounded by the breakup of a medical system that was designed to be specialized across the entire Soviet Union and Eastern Europe and integrated through the COMECON. Now the independent states find themselves with some special medical facilities that their smaller populations cannot support and without others that provide more basic medical services. Another dimension of this problem: pharmaceuticals once manufactured only in a certain Eastern bloc country, e.g. Hungary, are no longer sold for roubles or for barter. Russia and other nations of the old USSR now must pay in relatively scarce hard currency.

To gauge the deterioration in public health consider the following:

In Russia, the number of reported cases of diphtheria was 3 times higher in the first half of 1993 than in 1991, tuberculosis 34% higher, syphilis four times higher.
Cholera outbreaks have been reported in Tajikistan, Uzbekistan, Georgia, and southern cities of Russia and Ukraine.
Cancer and cardiovascular illness are increasing. Alcohol poisoning, attempted suicides, motor vehicle accidents, and crime injuries are up significantly.

According to Christopher Davis, a lecturer at Oxford University and long-term observer of health care in the NIS, it is "unlikely that the negative trends in the health sector can be reversed in the near future." In the short term, Davis identifies improvements in sanitation, diet, and environmental conditions, plus a reduction of alcohol and tobacco consumption, as strategies that would offer the greatest overall health gains. More long-term improvement in health care conditions, it is generally agreed, will depend on economic reforms succeeding in raising national in come levels substantially. Leaving alone the costs of improving medical education and training, the capital investment required just to install basic modern medical equipment in hospitals is enormous.

The American Response

Americans have responded to the health care crisis in the NIS in three ways:

as private citizens--for example, working at the grassroots level to support medical services in a sister city's hospital
as corporations, which have donated millions of dollars worth of medicines and medical supplies
as health care professionals providing technical assistance and training

For fiscal year 1993, USAID budgeted $16.4 million for projects to improve the health care system in the NIS. It helped to fund Project HOPE, which distributed medicines and medical supplies worth more than $114 million. USAID also purchased more than $ 8 million worth of emergency medicines and funded vaccination programs for more than one million children in Ukraine, Armenia, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan. (The U.S. Food and Drug Administration provided technical assistance in t he regulation of vaccine quality control.)

It is difficult to calculate the total amount of medicines and supplies donated to the NIS by private American individuals, organizations, and companies, but it is large. We estimate that dozens of ethnic organizations in this country have collected and distributed literally hundreds of millions of dollars worth of medicines and supplies in the NIS over the last three years. There are scores, if not hundreds, of sister city organizations, exchange groups, and hospitals that have made similar shipments through contacts they have developed over the last decade.

Two firms, Merck and Lederle, are providing technical assistance in the area of pharmaceutical production. The Children of Chornobyl Relief Fund, described later in this issue, has helped equip a 160-bed hospital in Lviv and secured the donation by Siemens of a $2 million MRI machine. The Dental Assistance Foundation to Lithuania, an all volunteer group, is e stablishing a dental clinic in Kaunas equipped with American donations.

Most shipments are made only after on-site visits by Americans who determine the specific needs of hospitals and clinics and identify, through personal contacts, the individuals through whom deliveries will be made. By personally accompanying the distribution of supplies or making follow-up visits, many projects ensure that the supplies reach their intended grantees and are not siphoned off by "mafia" or corrupt bureaucracies.

Americans are also making a significant contribution by sharing their expertise with professionals in the NIS. For decades health care professionals in the NIS have been isolated from the advances made in Western medical techniques and technologies. Physicians coordinating programs in the NIS reported that the health care professionals they come in contact with a re often eager and quick students. They also report that, in some procedures which do not require unavailable Western technology, the skills and experience of NIS physicians can be formidable.

Recent world events have triggered another wave of concern about whether Americans are becoming isolationist. Such debates may have their place on TV or radio talk shows. However, the work of Americans engaged in scores of projects in the NIS in the fields of public health and medicine reveals no contraction, but rather an expansion of interest an d activity that bespeaks American concern and empathy for the people of other nations.

Editors

This article is from the October 1993 issue of
Civil Society ... East and West

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Last updated: December 1993

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