St. Petersburg, 5 May 1997 (RFE/RL) - Russia's ailing medical care system can hardly meet the needs of its citizens who have a roof over their heads. But what about those who are homeless?
In theory, the situation of the homeless doesn't look so bad. A doctor's refusal to give medical attention to anyone in need is punishable by law. Also, the state-run City Insurance Medical Committee (GSMK) allows the homeless to be treated free-of-charge in any state hospital and poliklinika.
But, when one canvasses the city's homeless about free access to state medical care, many react with exasperation and some with tears. They have heart-rending stories about the humiliation and callousness experienced, when appealing to state hospitals and clinics for help.
The homeless are sometimes refused treatment on the grounds that they're "dirty and lice-ridden," and that accepting them would put other patients at risk. Since the homeless lack a residency permit and any social status, they're hardly in a position to start demanding their rights.
A doctor at a St. Petersburg hospital (who requested anonymity) told our correspondent that, "such refusals are not endemic to the city's medical care system, but rather, arbitrary decisions reflecting a poor understanding of procedures, as well as an ethical problem." Whether or not a homeless person is accepted usually depends on the whim of the doctor on duty, and just how seriously he or she takes the Hippocratic oath.
Whatever the cause, based on the accounts of the homeless themselves, it seems many of them needlessly suffer and die due to wounds and illnesses that can be easily treated.
When Luba, who has been homeless since her release from prison in 1993, fell and tore open her leg puncturing a vein, medics did arrive to save her from bleeding to death. Living in unsanitary conditions, however, it wasn't long before the wound became infected and required urgent medical care. Still, no clinic would accept her, since she lacked a residency permit and had no money.
Down and out, with no one to turn to, Luba was threatened with gangrene setting in and eventual amputation -- if the doctors would perform even that procedure.
There are many like Luba who have - over the years - lived and died under such circumstances. This crueler side of life on the Neva has long been known to Medicines Sans Frontieres (MSF), or Doctors Without Borders, who have been providing free medical attention to Moscow's homeless since 1991. But, according to St. Petersburg MSF director, Jean Pierre Jacquet, two years of planning and fundraising was necessary to open a small medical center for the homeless that began operations in February.
Luba turned to MSF for help, and the infection in her leg was treated in time.
The MSF center operates as any district poliklinka. Records are kept, patients are stitched up, diagnosed and given medicine for a range of ailments. To combat pests, such as lice and scabies, which are the biggest problem, MSF has an agreement with a city disinfection clinic to do the job.
For serious ailments such as tuberculosis, which Nochlezhka (Shelter) St. Petersburg's leading charity helping the homeless, believes infects at least 60 percent of the city's homeless, MSF doctors arrange free treatment in the city tuberculosis clinic Number 8, with which they also have a working relationship.
Because of deteriorating social conditions, the number of TB
deaths nationwide has nearly doubled since 1989. And experts believe officials statistics underestimate the scope of the problem, because autopsies are not always performed on the homeless.
MSF's work is commendable and the staff capable, but it's a drop in the bucket. Only several medical personnel work each shift, treating about 40 patients each day. A wait in line is the rule because, according to Nochlezhka, city-wide there are at least 55,000 homeless adults many of whom have critical medical needs.
To meet this demand, Roberto Mauri, director of MSF's clinic, says he hopes someday to have a mobile medical unit that will frequent places where the homeless gather and live.
Though MSF's mission is solely medical, in the end their work is not just about bandages and stitches. Galina, a doctor at MSF's clinic, says "The fact that we accept the homeless makes a big emotional and psychological difference, because they are used to being pushed on, refused help, and beaten." This unqualified acceptance and respect might be MSF's most potent medicine. On the street, in front of the clinic, one homeless man said, "These guys (the doctors) remind us that we're human beings and not cattle, as many consider us to be."