Soviet Health-Care Faults May Swell Quake Toll

Antiquated hospitals, chronic shortages of medications and a host of other grave weaknesses in the Soviet Union’s undernourished system of medical care will probably add to the already enormous loss of life in the Armenian earthquake, analysts familiar with Soviet medicine fear.

Soviet President Mikhail S. Gorbachev is expected to fly to Armenia to take personal command of a relief effort bringing thousands of tons of medical supplies, food, tents and blankets to the Caucasus Mountain region, where estimates of the death toll are approaching 100,000.

Western experts noted that the country’s highly centralized government and economy lends itself to marshaling nationwide resources in major disasters. But they said that a backward system of public health care, deprived for decades of adequate funding, is likely to handicap the Armenian relief effort.

“It’s not a very hopeful situation--they lack so much,” said Dr. Mark G. Field, an authority on Soviet health care at Harvard University’s School of Public Health.

Once Boasted of System

Until recently, Soviet officials boasted of a superior health-care system equipped with more hospital beds than any other nation and 1 million doctors serving 280 million people free of charge.

But the advent of greater openness in the Soviet press over the last two years has revealed a far different and bleaker picture of a creaking and neglected system of socialized medicine as poorly equipped and trained as many in the Third World.

After years of suppressing health statistics as state secrets, Soviet officials now acknowledge that the quality of medical care has deteriorated since the 1960s, male life expectancy has fallen and infant mortality has soared--dropping the Soviet Union to 51st place in world rankings, behind Barbados.

While the Soviet Union may have more hospital beds than any other nation, “there is very little in Soviet hospitals besides beds,” Field notes. “Medical equipment is scarce and often of the 1940s or ‘50s vintage.”

Soviet Press Critical

Soviet newspapers now write critically of dilapidated hospitals, corrupt and underpaid doctors who earn less than the average blue-collar worker and nationwide shortages of antibiotics and other pharmaceuticals often more readily found in a thriving black market than in hospitals or drugstores.

These shortages are reflected in the government’s appeal to the International Red Cross in Geneva for blood transfusing kits and other sterile equipment. The Soviet Red Cross said Friday that its most pressing needs are antibiotics, syringes and needles, blood collection containers, blood substitutes, surgical thread and food concentrates.

Even in Moscow’s better-equipped general hospitals, nurses report being called upon sometimes to buy bandage material at neighborhood pharmacies when hospital supplies run out.

Disposable hypodermic syringes and a multitude of other sterile, throwaway equipment that Western doctors take for granted are virtually nonexistent in the Soviet Union, where hospitals are accustomed to sharpening and resharpening needles until they break or wear out.

“Quite a few complications, difficulties and negative trends have been piling up in the development of health care,” Soviet Health Minister Yevgeny I. Chazov acknowledged in a television interview in June, 1987. “We need to create the health-care service afresh.”

While the quality of medical care in Moscow and a handful of other major cities varies from sophisticated to poor, it is worse in provincial areas such as Armenia.

“It is not difficult . . . to generalize about the rural health-care system,” observes Dr. Murray Feshbach, an authority on Soviet health care at Washington’s Georgetown University.

“It is very poor, frequently located far from population points . . . and also frequently much less well equipped than the urban polyclinics and hospitals.”

Lack Modern Equipment

In rural areas like the devastated mountain region of Armenia, local hospitals and polyclinics not only lack modern diagnostic and surgical equipment, but half of the hospitals are not equipped with hot running water or sewage systems, according to recent Soviet press reports. Some rural clinics lack telephones.

“With glasnost (Gorbachev’s campaign of openness), we’ve had a great deal more information about all the problems--the shortages, the corruption,” Field said in a telephone conversation. “They’re going to face outbreaks of infectious disease--typhus, for instance--and I’m not optimistic about how they’ll handle it.”

Epidemics are a risk in any disaster, but poor public sanitation in the Caucasus region is likely to magnify the threat of infectious disease in Armenia. Thousands of communities have never been equipped with modern water filtration and sewage systems.

Soviet medical journals report that, in recent years, water-borne infectious diseases like hepatitis, typhoid, amoebic dysentery and salmonella have become rampant in the southern Soviet republics.

While the number of typhoid cases in the United States varies annually from 100 to 500, the Soviets now record 16,000 to 18,000. Hepatitis in all its forms has reached 1.4 million cases a year in the Soviet Union, compared to 65,000 in the United States.

Worse, Feshbach estimates, 30% to 50% of Soviet infants fail to receive routine inoculations against such common childhood diseases as diphtheria and polio. The potency and purity of the vaccines is often unreliable, and many mothers--often on the advice of doctors--avoid having their children inoculated for fear of adverse reactions.

Some analysts note that the prevailing problems of public sanitation are likely to have been compounded in Armenia in the weeks preceding Wednesday’s earthquake by the influx of refugees fleeing communal violence in neighboring Azerbaijan.

The myriad problems plaguing Soviet health care--the shortages, ill-equipped hospitals, substandard training and pay of doctors and nurses--reflect what Soviet authorities now acknowledge to have been a failure by the leadership of Leonid I. Brezhnev during the 1960s and ‘70s to invest in a modern system of public health.

Between 1965 and 1982--the Brezhnev years--the share of the state budget devoted to health in a nation totally dependent on government-funded care fell by nearly one-third, from 6.6% to 4.7%.

Although health funding has now begun to rise, expenditures now total only about 21 billion rubles (the equivalent of $34 billion) or about $121 per person each year. Total U.S. health-care expenses, by comparison, now average more than $1,500 per person.

The decline in Soviet health funding and the deterioration of the medical system coincided during the Brezhnev years with a massive buildup of conventional and nuclear weapons by which Moscow achieved its status as a military superpower.

“We can think of this resource allocation,” Feshbach noted in a 1985 study of Soviet health care, “as being a reflection of the ethics of the state in choosing between medicine and, say, defense.”

One of the major features of Gorbachev’s economic reform program, analysts note, appears to be an effort to shift some resources from the military to consumer needs. It is in this context, as well as in pursuit of foreign policy goals, that Gorbachev announced a 10% unilateral reduction in Soviet armed forces on Wednesday in the U.N. General Assembly, immediately before rushing home to lead the Armenian relief effort.