Window on Eurasia: Russia No Longer to Provide Free Treatment for Victims of TB and VD

Paul Goble

Staunton, February 19 – Apparently in order to save money, Moscow has decided to end government-paid-for treatment of tuberculosis and venereal diseases, a decision that, given the large number of cases in the Russian Federation, will contribute to that country’s continuing demographic decline.

In a comment on the “Svobodnaya pressa” portal today, Oleg Koen and Aleksandra Koen note that the Russian government has just released a list of diseases for which Russian citizens can receive free treatment. Gone from this year’s list, they point out, are sexually transmitted diseases and tuberculosis (svpressa.ru/blogs/article/39242/).

What drove officials to take this step, the authors say, “is not clear,” given that both of these categories of disease represent a far greater public health threat than do many of the diseases that Russians can still obtain government-supplied treatment without making any payment.

From now on, they note, Russians will have to pay for treatment of gonorrhea and syphilis, both of which are widespread in that country. In the past, they could get “free treatment at dispensaries at their place of residence.” Now, if they are diagnosed with one or the other of these, they will either have to pay or not get cured.

“In the capital and major cities, more or less well-off citizens will turn both to government institutions and private clinics,” the Koens say, even though the costs can range up to 17,000 rubles (580 US dollars), a price that will put treatment beyond the reach of many ordinary Russians.

Moreover, they point out, “the quality of treatment will correspond to the distance of the region from civilization, that is from cities with at least a million residents.” But the requirement that Russians pay for such treatment will exacerbate another obstacle to seeking medical attention for such problems.

As in the past, “the main obstacle for cures will be not money and not the time it takes ot travel to an oblast center but the banal lack of desire to receive such treatment.” As the Koens note, “it is no secret many Russians from childhood relate to doctors with care and view people in white coasts approximately the way they do Judeo-masons, witches and NKVD executioners.”

Trusting such people was unthinkable in Soviet times, and “for certain Russians hardly anything has changed. The introduction of paid services will become another reason not to visit the doctor’s offices,” with some trying to make use of often ineffective folk remedies and others choosing not to be treated at all.

The situation with regard to tuberculosis may be even worse, the two write. TB is “a social disease,” one that is “most widespread” among “the least well-off and least defended strata of the population,” including those in prisons and those in the military. To that has been added Gastarbeiter communities where infections are rife.

According to the Russian health ministry, the Koens report, there were about 82 tuberculosis cases for every 100,000 Russian Federation citizens, with 117,227 new cases registered in that year, the fewest in the Central Federal District and the most in the Far Eastern FD.

Mortality from tuberculosis in 2007, they say, was 18.1 per 100,000 residents. That means that every year approximately 25,000 Russians die from this disease, “three times more” than the rate in Europe. In fact, 85 percent of Russian deaths from infectious and parasite disease are now from tuberculosis, a disease which can be treated effectively.

“If an individual suffers from venereal diseases and is not cured,” the Koens say, “that individual in essence brings harm exclusively to his own health and – potentially – to his possible sexual partners. But if one is speaking about tuberculosis, then the social danger that someone ill with that presents is high.”

Curing tuberculosis varies in cost. The World Health Organization suggests that most ambulatory TB cases can be treated for about 3,000 to 5,000 rubles (100 to 180 US dollars), but in the case of antibiotic resistance tuberculosis, the cost can rise to “several thousand or even tens of thousands of dollars.”

Other countries recognize this threat and provide public health support for cures. The Koens survey the cases of the US, the UK, Singapore, China, Australia, Canada and even Belarus. In every case, they say, the government provides more assistance for tuberculosis victims than Russia now proposes to do.

Indeed, “even in the very poorest countries, the situation is better than in Russia,” they note, reporting that in Afghanistan and even in The Gambia, the governments continue to assume responsibility for combating this public health scourge. And now, despite all the words from the top leaders about taking care of the population, Moscow is making the situation worse.

“These changes,” the Koens point out, “directly affect approximately one in every 1,000 residents of the Russian Federation and indirectly all those with whom this one tenth of one percent who are infected comes into contact.” If one reflects that this is an airborne disease, “that is practically any person” at all, something that should give Russians pause.