Medicine: Mustard Plasters to Heart Surgery

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A revolution in health care that is still being fought

Towering, superbly equipped research institutes contrast with hospitals that are bleak, antiquated and poorly staffed. Some Soviet physicians are equal to the best in the West in such fields as orthopedics and ophthalmology; yet doctors still use such primitive therapies as mustard plasters and cupping and even leeches. Treatment is administered free and drugs are inexpensive, yet patients often must bribe doctors and nurses for medication, operations, even to have linen changed and bedpans emptied.

Such is the paradoxical state of Soviet medicine. Even so, the Soviets have made great strides in health care since 1917. Says Washington, D.C., Internist William Knaus, who lived in the U.S.S.R. for 18 months and is the author of a forthcoming book, Inside Russian Medicine: "They took a country that was 200 years behind the rest of the world and provided the basics at a fraction of what we charge. They eliminated epidemics. Life expectancy is up and infant mortality is down. That has to be judged a success."

Just before the revolution, the average life expectancy was about 30 years. By the 1960s men were living on average to 66, women to 74 (about the life expectancy of U.S. citizens). In 1950, 84 children out of every 1,000 died before the age of one. By 1971 infant mortality had dropped to 23 deaths per thousand. Lately, though, these gains seem to be eroding. Life expectancy for men has been dropping, in part because of rampant alcoholism, and observers say that the U.S.S.R. is losing 30 of every 1,000 new citizens (double the U.S. figure).

Spearheading the medical care effort are the nation's 900,000 physicians, twice as many as in the U.S., and a fourth of all the world's doctors. About 70% of them are women. Backing them up are 2.7 million nurses and feldshers, or paramedics. Notes Knaus: "Theirs is a people-intensive system, ours is machine-intensive."

Nevertheless, the Soviets have gleaming facilities that are equal to anything in the U.S. TIME Moscow Bureau Chief Bruce Nelan recently toured three such centers in or near the Soviet capital. His report: "The Bakulev Institute of Cardiovascular Surgery, run by internationally recognized heart surgeon Vladimir Burakovsky, has performed at least 20,000 heart operations since it was established in 1956, 2,000 of them on children under age two. There are now 40 operations a week in its nine operating theaters.

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