KALININGRAD, Russia – Earlier this month, a woman in the town of Mamonovo, about 50 kilometers southwest of the Russian Baltic Sea port city of Kaliningrad, fell ill with COVID-like symptoms, including a fever that reached 39.7 degrees Celsius.
“She called an ambulance,” Yelena Maslova, a friend of the stricken woman, told RFE/RL. “And it arrived after nearly 48 hours. The whole time, she was told: ‘Be patient. We have many calls.’
“If she hadn’t treated herself based on the advice of acquaintances who had been sick earlier, I don’t know how it would have ended,” Maslova said.
President Vladimir Putin has decreed a week of “nonworking days” for the first week of November, a measure aimed at containing a sharp spike in COVID-19 cases that has put the country among the worst in Europe in terms of per capita deaths and hospitalizations. As was the case in the earlier waves of the pandemic, the country’s ambulance corps has found itself sorely tested, perhaps nowhere as badly as in the exclave of Kaliningrad, a sliver of Russia nestled between Lithuania and Poland.
“We are facing a catastrophic shortage of staff,” said Anna Slotvitskaya, an ambulance medic and chairwoman of the Working Brigades professional association of regional ambulance personnel. “Every day, as many as 10 ambulances don’t leave the garage -- either there are no medics or no drivers or both. Since the beginning of the year, 15 paramedics, 13 doctors, and nearly 20 drivers have quit. And I know of 10 people who are planning to quit immediately after their next scheduled vacation.”
At the same time, Slotvitskaya added, the number of calls per 24-hour shift has doubled from 10 to 20. Ambulances now travel 600-700 kilometers per shift, with 1,000 kilometers becoming increasingly common.
“And this while two-thirds of the crews are working shorthanded -- one medic instead of two,” she said.
On October 5, one local resident posted on a Kaliningrad chat group on the VK social-media site that on the previous day her father had fallen ill with a suspected stroke.
The ambulance dispatcher told her that she would have to wait “for days.” She was given an emergency telephone number she could call and was told that a doctor would advise her what to do while she waited.
“I called, but no one answered,” the woman wrote. “I called a commercial emergency service, but they also did not answer. Finally, I was able to reach a doctor -- an endocrinologist -- who is an acquaintance and who picked up his phone in the middle of the night. He told me what emergency measures to take and where I could turn for help.”
The woman finally used a private vehicle to get her father to a regional hospital where emergency-room workers were able to stabilize him.
“And then we waited five more hours before he was seen by a cardiologist, a man who’d already been torn to shreds by the relatives of other patients in critical condition,” she wrote.
'No One Cares About Us'
A representative of the regional Health Ministry posted a comment to the post saying that ambulance calls had risen from 800 to 1,400 per day.
“We are seeing an enormous number of unnecessary calls -- people with temperatures just over 38 degrees or with a slight cough or a stuffy nose,” the representative wrote. "So I would once again take this opportunity to ask residents to evaluate their condition realistically and to turn to their local clinic for help with respiratory problems.”
A local resident posted another comment that summarized the mood: “Learn first aid yourselves. No one cares about us.”
Slotvitskaya said Kaliningrad’s ambulance problem -- and other issues throughout the health-care system -- does not just stem from the massive increase in work caused by the pandemic, but from budget cuts and restructuring of the health-care system that began long before the world had ever heard of the coronavirus.
“Ambulance stations are completely underfunded,” she said. “The Health Ministry tries to reduce costs by cutting salaries. Every time we get a raise in base pay, they cut some of the supplementary pay and we end up getting less than before. And that was before COVID. Now the situation has become critical because of the increase in work, and people are just quitting.”
The need to purchase personal protective equipment, disinfectants, and additional medications because of the pandemic strained budgets even further.
The regional Health Ministry did not respond to RFE/RL’s requests for comment.
Drastic Cuts
Slotvitskaya said she earns 56,000 rubles ($805) a month as an experienced ambulance medic. But she earns that amount working 12 24-hour shifts -- about 300 working hours.
“That’s 12 24-hour shifts with only one day between,” she said. “It is rare to get two days off. You are thankful when you get a chance to sleep properly between shifts. Sometimes it happens that as soon as you close your eyes, you have to go back to work.”
The maximum an ambulance driver can earn -- after reaching three years on the job -- is 30,000 rubles ($430) a month. Nonetheless, she notes, an ambulance driver must be a qualified professional who not only can drive under high-pressure situations but must also know the equipment, be ready to assist in various situations, and participate in moving critically ill patients.
“So drivers are leaving,” she added. “They can make 50,000 to 60,000 ($720-$865) driving a dump truck and sleep peacefully in their own beds.”
Ironically, many staff are leaving the ambulance corps to take higher-paying jobs with better working conditions in the region’s COVID hospitals. Bonus payments for working with high-risk infectious patients are more regularly paid at hospitals, since in many cases ambulance patients are only confirmed with COVID long after the ambulance has dropped them off.
Kaliningrad’s problems are mirrored in other regions around Russia, many of which are reporting shortages of medical staff and ambulances. Anastasia Manzya, a lawyer for the Action labor union for health-care workers, said the Ural Mountains city of Magnitogorsk has reduced its ambulance service from 45 brigades to 22 to 28 because of staff shortfalls. Novosibirsk has cut its service from 187 brigades to about 100, while Voronezh has reduced its service from 110 teams to 70, Manzya said.
Manzya recalled a recent case in the southern city of Volgograd where a doctor arrived for his hospital shift and discovered there was only one emergency nurse instead of the mandated two.
“In an emergency, the consequences could be very bad for the patient and terrifying for the doctor -- including even possible criminal liability,” she told RFE/RL.
The doctor wrote a complaint to management about the staff shortage and received a reprimand. Later, Manzya said, a court canceled the reprimand for procedural reasons.
“But only very strong people with years of experience are going to stand up for themselves like that -- people who love their work,” Manzya said. “Young people take one look at such situations, lose heart, and walk away.”
