Soviet Medicine: Culture, Practice, and Science

Chapter 12—White Coats and Tea with Raspberry Jam

Chapter 12 WHITE COATS AND TEA WITH RASPBERRY JAM Caring for Sick Children in Late Soviet Russia C AT R I O N A K E L LY Soviet medical care for children was, like other aspects of welfare provision for the young, the focus of much propaganda attention. In 1934, Pioneer Pravda claimed, “Enormous strides have been made during recent yearsinthefieldofchildren’shealthcare.Eventwoorthreeyearsago,children were getting medical care in the same out-patients’ departments as adults. But now there are 20 specialist out-patients departments for children, as well as polyclinics and centers of prophylactic medicine.”1 This item was typical. Until the late 1980s, when the onset of press freedom generated a stream of unmoderated criticism, press coverage was more or less uniformly positive. Official histories contrasted the skeletal nature of medical care before 1917 and the rapid expansion of pediatric study and of the infrastructure after the October Revolution; facilities and key indexes of health status, such as infant mortality rates, were compared favorably with those obtaining elsewhere in the world, including the prosperous West. Published statistics followed a comparable narrative of “onward and upward,” as with the table of Leningrad clinics and hospitals published in 1974 (see Table 12.1).2 Getting at “the truth” here is extraordinarily difficult, particularly with reference to the late Soviet period. Problems of evidence are acute. Material covering the mid-1960s onwards is still subject to confidentiality rules, assuming that it has been archived to begin with, which is often not the case. Some recent material is held in individual clinics and hospitals, but collec- W H I T E C O A T S A N D T E A W I T H R A S P B E R R Y J A M 2 5 9 tions are on the whole comprised of special jubilee albums, illustrated by “onwards and upwards” graphs, and collections of specially posed, decorous photographs showing staff in pristine uniforms and children in well-ironed pajamas. Oral history, the source for much of the discussion in what follows, provides some basic information about how the system functioned on the ground, but here too caution is needed. The collapse of Soviet power, bringing with it the privatization of medical care and worsening indexes of child health, has understandably generated acute nostalgia for lost achievements. In the words of a man from Perm’ oblast’, born in 1962, whose comments on Soviet life were otherwise fairly detached, “The Communists, they got some things right. Free holidays, free medicine, free education, you got that then.”3 Regret for the past is sharp among medical staff themselves also: there is resentment at having to process the many papers associated with the introduction of private medical insurance, and a sense of lost commitment and professional pride as well. The following comments from medical workers interviewed recently in St. Petersburg are typical: Back then we relied on ourselves, on our own ears and knowledge. But now you have all this support, so you can’t really talk about [comparing one with the other]. […] But now everyone abroad is saying there just weren’t any TA B L E 1 2 . 1 — L E N I N G R A D C L I N I C S A N D H O S P I TA L S 1913 1928 1940 1950 1960 1965 1970 1973 No. of pediatricians 557 891 1,808 2,062 2,877 2,890 2,884 3,110 No. of hospital beds for children 1,396 NA 8,662 7,967 8,193 7,948 9,175 9,425 No. of sanatoria 4 7 15 17 23 NA 27 NA No. of beds therein 120 539 1,906 2,185 3,045 NA 4,330 NA Places in kindergartens and crèche-kindergartens (1,000s) 0,2 6,7 45,7 51,0 88,8 141,4 145,2 158,1 In crèches (1,000s) 0,5 2,8 25,8 21,3 34,8 43,0 30,1 30,9 Source: Leningrad i Leningradskaia oblast’ v tsifrakh: statisticheskii sbornik (Leningrad: Lenizdat, 1974), 182 (figures for hospitals and crèches), 185 (sanatoria). C A T R I O N A K E L L Y 2 6 0 [medical] brains anywhere else like the Soviet ones. Because they think with their heads, whereas they [Western doctors] just think with their machines...