Mid 1980s. Image courtesy of Life magazine.

Whenever there is a heated argument whether things were better during the USSR times, this statement invariably pops up as a mighty ace: At least they had free medical care in the Soviet Union! This is supposed to bring the opponent to the knees and make them beg mercy and forgiveness for betraying the Great October achievements.

Well well well. Let’s have a close look at what really was free then.

After the events of October 1917, the Bolsheviks chose to nationalise all hospitals and medical practices previously founded by various state and charitable organisations. This would have been a feasible plan, had they not chosen to class all doctors as “rotten bourgeois” which meant that they had to emigrate from the “Red Terror” or face death.

Even Vladimir Lenin in a letter dated of Nov 1918 wrote to an acquaintance: Please go abroad to see a doctor – they have wonderful specialists in Switzerland and Vienna… Our so-called doctors are fools.

In early 1920s various medical experiments became popular and acquired great support of the state: without much of a theoretical base or substantial research, a lot of time and money was poured into genetical experiments to breed a new type of person – of a Socialist kind.

Al in all, the years in which the Bolsheviks were starting off were very tough: the country was in a run-down state after the WWI; there was a severe famine; pandemics of cholera, typhoid, malaria; as well rising numbers of people dying of various infections and malnutrition. From a health perspective, the state of many medical practices and hospitals was borderline catastrophic. The buildings were getting old without any hopes for repair; central heating often failed; medical supplies were insufficient and irregular. The food supplies were often short, and the burial of the dead was an issue as well.

The state spending on medicine was low to start with, and it was gradually declining: it was 3.9% of the total budget in 1927; 3.6% in 1928; 3.5% in 1929 and 3% only in 1930. The severe skill shortages in the health industry were imminent, and there was a strong urban focus in health providers’ locations – given that the supply was already short, the villages were even worse off.

In the late 1920s industrialisation, as per Stalin’s orders, aimed at developing the heavier industrial machinery production – so the times which what was already bad was turning even more foul. Bureaucracy was starting to settle in, while the budget cuts continued (2.5% of the total budget in 1932, 2.7% in 1933). On paper, as often in the USSR, things looked if not rosy but at least decent: the attention was drawn to preventative measures and the importance of the population’s health; whereas in reality it was very ugly.In our old post about the life in the 1920s, the images of those time were indeed scary, if you remember.

During the Second World War, the main beneficiary of medical help was, understandably, the army – the rest of the population, fair to say, was abandoned. Various types of typhoid, TB, dysentery, malaria, cholera and even plague were not uncommon– the diseases were spreading very rapidly due to the poor supply of drugs and increasing numbers of migrants.

When the war was over, the main efforts (as well as financial means) were generated towards rebuilding the towns and getting the economy back up – and as always, there was no room for medicine research and development. The health industry salary bands were among the lowest in the country. In 1940 the doctors were earning 255 roubles per month, as compared with 399 roubles average. In 1955 it was 521 roubles against 711 average. In August 1945 a group of doctors sent an open letter to Stalin describing the abhorrent situation in the health industry. It mentioned the factory workers with high-school qualifications were earning 1300–1400 roubles per month, whereas the hospital manager, a doctor with 8 years of education and years of experience would be fortunate enough to earn 800 roubles.

A paramedic on call.

The change was brought upon by Nikita Khrushchev, who was slowly setting new goals and getting his government to redevelop many facets of Soviet life. But the late fifties were also the times when the famous free Soviet medical care system stopped being free. The doctors became less covert in taking cash from patients in exchange for medical services, for medical supplies, for drugs. The less-qualified medical staff (nurses and caregivers) were making some extra cash by providing extra-nice services to patients – for 10 roubles per night you could have a nurse by your bed taking care of you – obviously, all other patients would have been neglected. Midwives in birthcare institutions were bribing the fathers – one would pay a one off 25 roubles for the girl and twice as much for the boy as to “take them home”.

Among the key problems were:

• Alcoholism and drug use – extremely widespread.
• Bad ecology – due to heavily exploited plants and factories, many towns were below par – the Southern republics, Moldavia, some parts of Ukraine, industrial central Russia and Siberia.
• Food shortages – especially in the rural areas and small towns with the population of less than 100,000 people; as well as the appalling quality of food.
• Extremely high rates of abortions (100 for every 1000 women in the age of 15–49; or 200 abortions for every 100 of births). Also, the actual procedure was a very primitive one which lead to the death of a woman in almost 25–30% of cases.
• Health and Safety in employment – extremely high industrial accident rates
• Road death tolls

Also, in early 1980s the widespread of sexually transmitted diseases started to take its toll. In 1970 more than 12% of women of reproductive age were diagnosed and treated from STD, many of whom suffered from syphilis. In 1987 the first case of HIV was registered, after which the disease had escalated to the point of people panicking.

The Soviet doctors had all the pressure to catch up with their Western counterparts, and they did their best, given the circumstances. The first successful heart transplant attempt did not happen until March 1987, which was almost 20 years after the American debut. Such a significant delay was not just due to the budget cuts and low financing – the appropriate legislative framework was missing, and so was the concept of organ donors.

This is how the free Soviet medicine had met the death of the Soviet state. It almost seems like the 70 years of the 20^th century did not provide any move forward – despite the antibiotics, vaccination and hundreds of thousands of graduate doctors, the overall state of the health industry was just ever so slightly better than at the end of the Tsar times. And then, of course, the typically Soviet traits of doing things: bureaucracy, corruption, the notoriously abhorrent levels of customer service and the low priority that the state would give the health industry.

This does not deny the Soviet doctors their achievements – over the course of 70 years, there would have been plenty – but nothing was easy and nothing was certainly free.

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One night — it was in June 1889 — there came a ring to my bell. … We heard the door open, a few hurried words, and then quick steps upon the linoleum. Our door flew open, and a lady, clad in some dark-coloured stuff, with a black veil, entered the room.

The Soviet movie illustration of this book. 1979. Vasily Livanov as Sherlock Holmes and Vitaly Solomin as Dr Watson.

Really. In June 1881, just like that, Sherlock had linoleum, which was nothing extraordinary at the time — given he was presumed to somewhat struggle financially, and thus his need to share a flat. In the USSR — and this is the point I am making now — linoleum was one of the highest sought-after products until at least early 1980. I wouldn’t believe it myself, but I remember how excited my Mum was when in 199o we managed to “secure” some of this precious material to floor the kitchen in our apartment.

What was the price of those space exploration programmes if linoleum was a scarce commodity at least for a century after it became widespread in the rotten, capitalistic West? You feel my pain?

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Remember our post about  Slava Kurilov, the guy who jumped off the cruise ship near the Philip­pines islands — and swam to freedom for three consecutive days, completely alone at sea? Our today’s post tells a story just as remarkable — a young Russian surgeon Leonid Rogozov, stranded in  Antarctica with the Sixth Soviet Antarctic Expedition, in 1961 performs a self-operation: under local anesthesia, surrounded by a bunch of guys whose only experience with medicine was sitting in a dentist’s chair, the 27th years old doctor removes his own appendix.

rogozovappendectomy2

Dr Rogozov had a very promising start, but had left for the expedition shortly before having to present his thesis on new methods of operating cancer. He was the only medical person in the expedition, and in the downtime he also performed driver’s and meteorologist’s duties. Six weeks after the arrival to the base, he started feeling ill: weakness came, then nausea, then abdominal pain along with body  temperature rising. The diagnosis was easy: it was clearly a case of acute appendicitis — but the closest medical help was about 800 km away. Dr Rogozov wrote in his diary:

I did not sleep at all last night.  It hurts like the devil!  A snowstorm whipping through my soul, wailing like a hundred jackals.  Still no obvious symptoms that perforation is imminent, but an oppressive feeling of foreboding hangs over me… This is it… I have to think through the only possible way out:  to operate on myself… It’s almost impossible… but I can’t just fold my arms and give up.

Soviet Antarctic Expedition site four years prior to Dr Rogozov’s events

All the available conservative treatment was applied (antibiotics, local cooling), but the general condition was getting worse.And so the preparations for the surgery began. In his diary  he describes these events in  plain, almost emotionless language: how the guys found out, how he told them what was about to happen, what they were to do. Following Dr Rogozov’z instructions, the team members assembled an improvised operating theatre. They moved everything out of the room, leaving only the bed, two tables, and a table lamp. The aerologists Fedor Kabot and Robert Pyzhov flooded the room thoroughly with ultraviolet lighting and sterilised the bed linen and instruments.

In the event that Rogozov lost consciousness, he instructed his team how to inject him with drugs using the syringes he had prepared. Then he gave the main helpers a surgical wash himself, disinfected their hands, and put on their rubber gloves for them. And so it began: with the team’s meteorologist holding the retractors, a driver to hold the mirror and other scientists passing surgical implements, he sat in a reclined position and cut out his own appendix under local anesthetic.

The operation went on for two hours.

One of his assistants, the station director Vladislav Gerbovich, later recalled in his diary:

When Leonid had made the incision and was manipulating his own innards as he removed the appendix, his intestine gurgled, which was highly unpleasant for us; it made one want to turn away, flee, not look—but I kept my head and stayed. He himself was calm and focused on his work, but sweat was running down his face and he frequently asked us to wipe his forehead … By the end of the surgery he was very pale and obviously tired, but he finished everything off.

Half way through the operation Dr Rogozov passed out, but was able to continue.

halfway through the surgery the assistants asked for a photo camera to be brought in

Once  operation was complete, he took sleeping tablets and lay down for a rest. The next day his temperature was 38.1°C; he described his condition as “moderately poor” but overall he felt better.  He continued taking antibiotics. After five days his temperature was normal; after a week he removed the stitches. Within two weeks he was able to return to his normal duties and to his diary.

Those very instruments — on a museum display nowadays

A remarkable extract from Doctor’s diary:

I worked without gloves. It was hard to see. The mirror helps, but it also hinders—after all, it’s showing things backwards. I work mainly by touch. The bleeding is quite heavy, but I take my time—I try to work surely. Opening the peritoneum, I injured the blind gut and had to sew it up. Suddenly it flashed through my mind: there are more injuries here and I didn’t notice them … I grow weaker and weaker, my head starts to spin. Every 4–5 minutes I rest for 20–25 seconds. Finally, here it is, the cursed appendage! With horror I notice the dark stain at its base. That means just a day longer and it would have burst and …

At the worst moment of removing the appendix I flagged: my heart seized up and noticeably slowed; my hands felt like rubber. Well, I thought, it’s going to end badly. And all that was left was removing the appendix …

And then I realised that, basically, I was already saved.

Dr Leonid Rogozov

About a year later he left Antarctica for home: 29 May 1962 the ship docked at Leningrad harbour. The next day Dr Rogozov returned to his work at the clinic — and shortly after he successfully defended his dissertation. He worked and taught in the Department of General Surgery of the First Leningrad Medical Institute. He never returned to the Antarctic and died in St Petersburg, as Leningrad had by then become, on 21 September 2000.

“A job like any other, a life like any other”

This self operation was probably the first such successful act undertaken out of hospital settings, with no possibility of outside help, and without any other medical professional around. It remains an example of determination and the human will for life. In later years Rogozov himself rejected glorification of his deed. When thoughts like these were put to him, he usually answered with a smile and the words: “A job like any other, a life like any other”.

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Be Vigilant! Disclose an Enemy Under any Mask!

1953 was the last year of long and terrifying governing of Stalin. In January the huge country although accustomed to repressions shuddered from the new horror – this time the enemies-saboteurs were Kremlin doctors of a Jewish origin. The commenced persecution also applied to ordinary doctors.  Soviet people who believed to the politically edited stories broadcast in the media were scared to be patients of Jewish doctors. On March, 5 of 1953 Stalin passed away and the case of Kremlin doctors was dismissed. Humiliated, maimed doctors were released. However this was only the beginning of the political repressions of the Jewish specialists and today we would like to introduce you to a striking example — the story of my family.

1951. Soviet doctors with the patient and recovered sight

My grandfather graduated from the Marine Military School in 1945, the last year of the Second World War. The training for the young officers was accelerated as the country was preparing to start the war with Japan. Soon my grandfather chose the profession of the submariner. He was a sailor on the most little submarines – so called ‘baby-submarines’ where the conditions were especially harsh. When the war with Japan ended he had a 5 year service contract in Port-Arthur in China.

By 1953 my grandfather was already a successful military officer who was preparing  to get the position of the submarine commander two months later. My grandmother was a doctor, but in winter of 1953 she did not work as  she gave a birth to her daughter, my mother. That February,  just within a day all the officers of Jewish origin were dismissed fromtheir work. No, they were not imprisoned, nor withdrawn from work completely. They were simply sent to work for the Training Troop Base in Vladivostok, the camp traditionally used as a punishment camp for alcohol-addicted or misbehaving officers. With no explanation, a huge group of people  — from navigators to mechanics, including highly qualified staff  from the Leningrad Military Engineering Academy were sent to the Training Troops Base.

In March 1953 my grandfather, offended by unfairness to the innermost of his heart, wrote to Nikita Khrushchev. He satated that he had graduated from the Marine Military School with merits, had 5 year of experience of military service on submarines with permission to control and that he wanted to continue his career there. Surprisingly he received a reply, albeit not from Khrushchev personally.  The Commander-in-Chief of the Soviet Marine Army replied that the order for transfer would not be reversed and that was the end of story. He did not provide any explanation or apology.

With time, the doctors were rehabilitated but the innocent officers were not. The years after that were full of career obstacles, like a total ban on further study, should one enter the Military Academy. At the same time my grandfather’s colleagues of non-Jewish origin were aquiring the experience on the most contemporary nuclear submarines. None of them are alive at present as those first nuclear submarines were too dangerous for the health!

Surfacing Soviet Submarine

The overt discrimination of the Jews in different forms continued till the very end of the Soviet Union. Being accused of anti-Semitism was not something the Soviet officials liked: so there usually were formal examples of successful careers of Jewish specialists. For instance, the General of the Red Army Comrade Dragunskiy, who held a high ranking  post despite his origin. However, that was exceptionally rare and was nicknamed as ‘museum rarity’.

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