RURAL MEDICINE

Except for those with the highest grade average, the law required new doctors to work for two years in the countryside or smaller towns. But most medical school graduates did not want to work in rural areas even temporarily, and often found ways to avoid the boot camp of village hospitals and clinics. Consequently, the doctor-patient ratio was much higher in cities than in rural areas. During the Stalin era it was not unusual for medical care in Siberia and Central Asia to be in the hands of doctors and nurses serving out sentences as "enemies of the people." If they survived they practiced medicine where they found themselves, whether in prison camps or in forced residence near the camp in which they had served their time. Within the gulag, women were recruited as nurses from the female prison population without regard to previous training or experience. For prisoners a job in the camp hospital was a treasure because it meant indoor work and enough food to sustain life. Eugenia Ginzburg, a prisoner in Siberian camps and former Kazan University lecturer in literature, was saved from freezing and starvation by the happy accident of meeting a prisoner-doctor who had been friendly with a relative of hers in Leningrad. The doctor got her a job as nurse in a home for prisoners' children and she "jojnce again... [gave] death the slip." Her beloved husband, Anton Walter, arrested because of his German descent, was a devoted doctor-prisoner who ministered to his patients in and out of camps during his Siberian imprisonment. In 1952 Aleksandr Solzhenitsyn

Was a prisoner in a camp in Ekibastuz, northern Kazakhstan, and was about to be operated on in the prison hospital (where all the doctors were prisoners) for a fast-growing tumor in his groin. The day before the writer's operation the camp surgeon was sent to a different camp, and Solzhenitsyn had to wait almost two weeks for the arrival of another prisoner-surgeon, who removed a cancerous lymph node. Because the prison hospital had no laboratory, sections of Solzhenitsyn's tumor were sent to Omsk (some 250 miles north) for analysis. Solzhenitsyn was not informed about the results of the lab tests, nor was he offered any followup or further treatment while he was a camp inmate. He finally was treated for a recurrence of the cancer but only because he battled an indifferent bureaucracy for the right to travel to a Tashkent hospital. Where no doctors could be found (or forced) to practice, a district was served by a feldsher.

In 1980 a logging village of 30 small log cabins, wooden sidewalks, and dirt roads, about 150 miles north of Irkutsk, boasted a restaurant, grocery store, and small hospital. This hospital, a little wooden building with 20 beds and two doctors, was the only medical care for the district's 2,000 people. In winter it could be reached only by a small aircraft the doctors used for emergencies. Unless there was something like a flu epidemic, the hospital usually had three or four of its beds occupied at any given time. Heavily cultivated areas of the USSR had bigger hospitals built for collective farms.