COLUMN ONE : Every Day a Sick Day for Russia : In the cities and in the countryside, medical costs are soaring and ailments that were once conquered are staging a fierce comeback.

Valentina Garmash knows that she feels shaky and her head spins because she has subsisted on nothing but bread, potatoes and tea for more than two years. Her nights in this Black Sea port town are racked by horrific arthritis pains that an anesthetic cream could ease, but it is too expensive to use freely.

Igor Pakus is frightened--”very frightened.” In the southern Russian city of Rostov-on-Don, where he is chief doctor to 1 million residents, deaths have begun to outnumber births for the first time since World War II.

Parents in Moscow who have weathered onslaughts of lice and powerful flu have a new worry for their children. Diphtheria, once nearly eradicated across Russia, is back in such proportions that the United Nations considers it an epidemic.

Across Russia, signs are mounting of a decline in health that demographers say is unprecedented for a nation in peacetime. Pensioners like Garmash suffer unheard and die before their time. The medical system is disintegrating, and the economic crisis is so frightening that women are having fewer children. Old infectious diseases are back, and a legacy of unparalleled environmental poisoning is taking its toll.

In clinics and on Russian streets, the signs of worsening health are subtle. Perhaps a few more faces with the yellow tint of hepatitis or the puffiness of kidney disease, a few more pale, wobbly children standing on the sidelines at playgrounds.

But the numbers are striking.

For the first time since the 1940s, Russia’s death rate began to exceed its birthrate last year. The average life expectancy for a Russian man has dropped from 66.1 years in 1966 to 63.8 now, part of a steady slide that experts see only worsening. One-third of Russian men never live to see age 60.

Only one-third of Russian children are born fully normal and healthy these days, according to officials, who previously had kept such data secret. Babies die at about double the rate they do in the United States, and seven times as many birthing mothers die here as in the United States.

Children face mounting danger from infectious diseases that formerly had been nearly wiped out by vaccination.

Along with the diphtheria epidemic, polio and tuberculosis are on the rise. And they are attacking already weakened victims: The weekly Arguments and Facts estimates that nine out of 10 Russian children suffer from vitamin deficiencies.

“It’s undeniable that Russia’s state of health is getting worse,” former Soviet Health Minister Yevgeny Chazov said. “In all times, in all countries, periods of cataclysm were accompanied by a decline in health and a drop in the birthrate.”

The sense that their nation, as an entity, is physically ill plays prominently in the ideology of rising Russian nationalists, who warn that if current birth and death rates continue, the Russian people will be reduced by half in the next 50 years.

Professional demographers scoff at such dire pronouncements. But after watching health figures worsen over the sunset years of Soviet communism, they do worry that the current economic trauma of shifting to capitalism is dragging Russians even further down, even faster.

Vitaly Dmitriev, chief of the Russian Academy of Sciences’ research team on medical statistics, predicted that life expectancy will probably decline by another year or two by 1995 if current trends continue.

“To talk these days about a healthy way of life--not to drink alcohol, to eat well and exercise--is just funny in our situation,” Dmitriev said dryly. “People are thinking about where to get food and work; they can’t worry about a good lifestyle. And people take up the bottle to remove the stress.”

Although liquor-related problems have been a historic bane of Russia, the nation’s intensified “alcoholization” is sending life expectancy spiraling downward, particularly among men, Dmitriev said.

Russians drank an average of nearly a gallon and a half of hard liquor per person--including women and children--in 1991, up 36% from 1987. And that figure only includes state alcohol sales, leaving out widespread home-brew operations. More alcohol abuse means more deaths from cirrhosis of the liver and other drink-induced diseases, more suicides, more murders and more mental disease.

The other main reason for rising deaths, Dmitriev said, “is the ecological situation--and it’s getting worse and worse. Because of financial problems, fewer and fewer measures are being taken to clean up the environment.”

Prof. Murray Feshbach of Georgetown University, who documented the criminally poisoned ecology resulting from decades of heavy Soviet industrialization in his recent book “Ecocide in the U.S.S.R.,” lays out frightening statistics on pollution’s effects on citizens’ health.

About 70 million citizens of the former Soviet republics live in cities with air unfit to breathe, he found, and children living in Perm, one of the most polluted Russian cities, are 3.4 times more likely to be afflicted by blood disease than their counterparts in other cities.

At Children’s Hospital No. 2 in Rostov-on-Don, pollution translates directly into sick youngsters, chief doctor Mikhail Nezhirenko said.

“We have very bad pregnancies among our women; that’s problem No. 1. The children are born and they’re already sick,” he said. “And the ecology works on the immune system and weakens the child further.”

Food allergies, in particular, seem to be on the rise as pollutants increasingly taint produce and packaged goods; parents worry about high nitrate concentrations in fruits and vegetables, minimally processed milk products and contaminated meats. “If you have bad food, you have bad health; everybody knows that,” Nezhirenko said.

Dmitriev predicted that digestive-tract diseases will soon jump upward on the charts as the Russian diet gets even poorer amid ever-rising prices. Obesity is also on the rise.

“People are getting less protein, and protein is the body’s building blocks,” he said. “They’re getting more carbohydrates--potatoes and bread. All this tells on people’s health.”

Once they get sick, Russians also have more to fear from their medical system these days as their doctors struggle with shortages so severe that needles are used again and again despite the danger of AIDS, and surgeons have been known to resort to razor blades when scalpels wear out.

One Russian study found that 15% to 17% of deaths are caused or contributed to by improper medical treatment.

In Rostov’s Red Cross clinic, where volunteer doctors provide free health care mainly to the elderly, almost all prescriptions are for herbal cures, virtual home remedies.

“The old people like them,” Dr. Olga Barsukova said. And the old people know that at least herbs are available and cheap, compared with most drugs, which are either hard to get or astronomically expensive or both.

Russian medicine is caught in a transition period, moving away from the free health care so touted by the Communists and searching for new systems. Some regions are experimenting with medical insurance, others with pay incentives for doctors; all are looking for ways to finance the collapsing system.

As more medical services become for-pay operations, doctors say that patient loads are actually dropping, despite the increase in sick people. That is because the ill hold off coming in for treatment. Patients fear the cost of care and the danger of being branded malingerers and losing their jobs, especially as massive unemployment, brought on by economic reforms, looms.

“That there are fewer patients now doesn’t mean that the situation is better,” said Albert Vardanian, chief doctor of Moscow’s Polyclinic No. 13. “It’s just that people are sure that their complaints won’t be heard and taken care of” now that the old Communist medical system is falling apart.

The delay of treatment means more and more acute illnesses will turn into chronic problems, Dmitriev said.

And ultimately, doctors say, the effects of this rocky post-Soviet period will be felt for decades to come. “We’ll only really see the results of what’s happening now in eight or 10 years,” said Barsukova of the Red Cross clinic.

But one physical response to these hard times has been immediate: In the last five years, Rostov women have started having far fewer children.

“The birthrate is falling catastrophically,” said Igor Pakus, head of the city’s Health Department. “It frightens us a lot.”

In 1985, the Rostov birthrate was 15 births for every thousand people. In 1991, it was 10.2 births, compared with 12.1 deaths.

“Women don’t want to give birth now,” Dmitriev said. “It’s like animals--when there’s less feed, they have fewer offspring.”

Pakus and other doctors also worry that with vaccines in short supply and many people afraid of contracting AIDS from infected needles, Russians are more vulnerable to diseases that vaccines once prevented.

“We’re terribly afraid that in the next two or three years there will be a flare-up of infectious diseases,” Vardanian said. “Diphtheria, lice, even cholera, anthrax. . . . If, God forbid, these diseases spread, many children will be defenseless.”

On a broad scale, declining health shows up in medical statistics; on a small scale, it is being felt in the increase in simple misery among those unlucky enough to be ill.

Valentina Garmash in Taganrog once could afford therapeutic massages for her knobby, swollen joints. No more. She pointed with twisted hands toward the boxes of medicine that most of her pension goes toward, the painkillers and anti-inflammatory agents that, in the right combinations, allow her to get up and hobble around.

“There’s no money for it all,” she said, eyes tearing. “There’s no medicine, nothing. . . . Everything has gotten so expensive. You can’t buy anything for your money, only bread and tea.”

Not far away from Garmash in central Taganrog lives Liliana Panchenko, a former teacher whose muddy, almost greenish complexion bespeaks the kidney failure that almost killed her several years ago. She retains so much fluid that it looks as if she is carrying a near-term child low on her belly.

In past years, Panchenko said, she could go to a therapeutic spa at Truskovets near the Polish border, a visit that, if nothing else, made her feel better for months. But this year, with train tickets costing more than her monthly pension, “there is not a whiff of Truskovets. Now, it’s a luxury. If I had the money, I’d go in a day.”

In another humble bungalow nearby lies Klava Voskanian, a middle-aged mother of a teen-age son. A stroke two years ago left her paralyzed from the neck down, and she has been slow to recover. Her disabled husband occasionally splurges on soup bones, but meat is out of the question on their budget and produce is rare. “If I ate more, maybe I’d be stronger, but you limit yourself, and probably it tells on your health.”

The Red Cross nurses who visit Garmash, Panchenko and Voskanian say there are more like them every month, sick people brought to the very limit of their resources and slowly, uncomplainingly, getting worse and dying.

“The Russian people won’t die out,” Barsukova said staunchly. “We lived through the Mongol occupation (of the 13th-15th centuries), and the Russian people didn’t die out but became stronger. The Russian people won’t die.”

But for the next few years, Dmitriev said, the nation’s prognosis is painful. Doctors can dream about new funding, new drug supplies, anti-alcohol education and environmental cleanups, but “lots of things are just not realistic,” he said. “To improve health you have to improve the general economy.”