Russia's Railway Medics Give Speedy Service

The Age

Saturday October 27, 2007

Marina Kamenev

A special train has become a lifeline for remote villages, writes Marina Kamenev.

AT EIGHT o'clock last Saturday morning, there was an unusual hustle around the main railway station of the remote Russian village of Obozersk. A group of scarved babushkas, a mother and child and some middle-aged men waited patiently for the doors of a train to open.

These were not passengers preparing for a journey but patients unable to get proper treatment from their local clinic. They were waiting to board the pride and joy of the Russian Railways: a medical train named after a famous Russian surgeon, Matvei Mudrov.

With the combination of an ageing population and rapid urbanisation, rural Russian hospitals are on the decline. But the Russian Railways (RZD) company looks after current and former staff and provides a modern medical train that services areas where the population is below 1000.

There are three such trains circulating for fortnightly periods. One travels from the Golden Ring city of Yaroslav to the north, one circulates in western Siberia and another travels between Khabarovsk and South Yakutia in the far east.

The eight cabins house 10 specialists - among them a dentist, gynaecologist, ophthalmologist and a psychiatrist - as well as a chemist, X-ray machine and blood-testing laboratory. It also has a satellite that can hook up to any rail hospital in Russia for emergency procedures. All the services are free for workers and pensioners of the RZD and affordable for those who are not. Doctors say they give free treatment to those with no money.

"This train is a godsend! Last time it was here I arrived in the morning and saw four different types of doctors," says Ekaterina Posekova, 77, a former train stewardess. Ms Posekova, who lives in a hamlet with 1500 people, says: "We don't have anything here but a nurse that's qualified to give injections. If we need urgent medical help, you have to travel by car to the next village - that costs 300 roubles ($A13) and takes half an hour, but a proper hospital is...much further even."

The manager of the Matvei Mudrov train, pediatrician Evgeny Pyatsokov, 27, has worked on the train since its first journey two years ago.

"It's just not financially sustainable to have hospitals," she says. "The combination of wages for doctors and maintenance - a small hospital would hang like a dead weight on any government. A mobile clinic is much more efficient."

It took the RZD millions to convert eight train cabins into a medical centre. Former cosmonaut Oleg Atkov, now vice-president of RZD, helped design the medical trains.

"(Russia has) performed surgeries on trains since the Second World War," he says.

Mr Atkov emphasises that no work takes place when the train is moving. He says most of the equipment is vibration-proof and everything that is sensitive, such as endoscope equipment, is carefully wrapped for journeys between stations.

The RZD has a reputation for being a state within a state. The railway covers 85,000 kilometres, 11 time zones and has a staff of almost 1.5 million. It has its own schools, hospitals and clinics, all free to staff.

On the Matvei Mudrov train in Obozersk, ophthalmologist Svetlana Shatskaya, 36, dazzles patients with her silver high heels and office full of gadgets.

"You can see the heart of Russia is not rich in clinics or hospitals," she says. "People here are old and neglected...they aren't spoiled by medicine like they are in larger cities, so you really feel the gratitude. I remember putting glasses on an elderly lady and she exploded, 'I can see you, is it really possible?"'

Medical staff work 12-hour shifts - two weeks on, two weeks off. On an average tour, a train visits eight villages, with 80 patients walking through the doors every day.

As at any hospital, there are happy and sad moments.

Dr Pyatsokov says: "You come across pensioners that are so removed from medicine, they have no idea what the names of the specialists mean.

"I'll never forget the woman who sat down on the dentist's chair and peeled her stockings off to complain about the sore veins on her legs."

© 2007 The Age

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