Writing for Transitions Online, Galina Stolyarova of the St. Petersburg Times reports on the horror of getting sick in Vladimir Putin's wealthy, resurgent Russia:

The old man standing in front of me in the line seemed on the verge of fainting, his eyes scanning the walls without seeming to focus. Several times I thought he would fall over. Finally he reached the front of the line and the pharmacy clerk inspected his prescription. Then she handed it back to the old man, saying his medicine was no longer in stock. The old man closed his eyes. He barely seemed able to move his lips, but eventually I heard the words, "Then why didn’t you tell people? So painful to stand." He stood there in the pharmacy in the Kirovsky district of St. Petersburg, not knowing what to do, as a short elderly lady came up to me. She, too, had been unable to get the medicine she urgently needed. "My blood pressure is so high, I really should be lying in bed," she said. "It has been pretty bad recently, and I don't know how I'm going to get home. There are probably too many ill people in Russia. The authorities can't just pick up a gun and shoot us, so they're killing us like this, leaving us with without help. This is killing! Killing!" she repeated. “Why did you move the cancer patients here?” a pale middle-aged woman hollered, as she waited, almost doubled up in pain. Apparently those needing cancer drugs had been getting them until recently from another pharmacy nearer her home. She was at the back of line of about 30 people clutching their prescription forms. After a while, no longer able to stand, she slumped to the floor.

I stood with them for three hours, holding insulin prescriptions for my diabetic relative. Throughout that time the elderly and sick people groaned and cried out in pain and desperation. One woman burst into tears when she was told the pharmacy had only half the pills she needed. At one point a group of the less frail patients seemed close to storming the counter and breaking the windows. “Shut up, or we will close the window right now!” a pharmacy employee shouted at the crowd. There was a sudden shocked silence. I could sense the almost physical panic and fear as those people faced the prospect of walking home empty-handed.

The reason why so many sick and infirm people were jammed into that one pharmacy was simple. It was the only one in three adjacent districts of St. Petersburg that supposedly had those precious medicines in stock. Every day in Russia, an army of severely ill people ­ suffering from cancer, diabetes, heart problems, and other diseases strugglees and jostles for the chance to get medicines. In theory, drugs for certain illnesses are free with a prescription. According to government estimates, about 5 million people can technically benefit from the free drug system at the moment. But the government has failed to provide enough funds for the program. This year’s budget for free drugs, 34.9 billion rubles ($1.4 billion), is less than half the 74.5 billion rubles spent last year, Dmitry Reikhart, head of the Federal Fund for Obligatory Medical Insurance, told reporters at a Moscow press conference earlier this month. To complicate matters further, the government has been slow to pay drug providers, resulting in diminished supplies. The state debt amounts to about 20 billion rubles, down from about 36 billion rubles in January, according to Tatyana Golikova, the country’s new minister for health and social development. As a result, those who have no other way to buy their medicine are effectively forced to compete for survival.

SICK AND TIRED

My relative undergoes this ordeal every two months. And, as in a triathlon event, she has to complete every stage correctly to get to the end.

• Step 1 is to secure an appointment with a doctor and get the prescription written. Because of the shortage of doctors she may wait up to half a day in a clinic even after getting the appointment.

• Step 2 is more hit-or-miss. She has to phone around to find the nearest pharmacy with her medicines in stock. Many of the calls are fruitless, and this quest can take days or weeks.

• Step 3: Get to the pharmacy and spend hours in line, hoping that supplies will last until you reach the counter.

A prescription is valid for only a month, and if that time runs out you must go back to stage one and get a new one. I know diabetes patients who have to beg and borrow insulin shots from fellow sufferers just to stay alive for the next few weeks, due to the scandalous chaos of Russia’s drug supply system. Of course if you can pay full price for the drugs, there is no delay. But a monthly supply of insulin costs more than a monthly disability pension of, say, 3,000 rubles, or about $120. For cancer sufferers the market price of drugs can be far greater and well beyond the reach of all but the wealthy. A course of the anti-cancer drug Avastin might be around $10,000.

Russian writer Igor Alexeyev, a resident of the southwestern city of Saratov who suffers from advanced intestinal cancer, chronicles the experience in a weekly blog. He describes the insomnia by night and the torture to his body by day as he endures endless journeys along rutted provincial roads trying to get treatment and medicines. Readers of his blog have responded by sending donations, which he uses to pay for his Avastin. On one occasion Alexeyev reported his amazement at actually being able to get the medicine from his local pharmacy. But in this deadly game the rules can change without warning. The regulations about what details to put on the prescription form may be altered. And if a stamp or signature is missing, or if there is a typing error, the pharmacy may reject it, and the triathlon starts all over again. And while a new prescription is being obtained supplies of the medicine may run out again.

With the Duma election campaign in full swing, political parties are making wild promises, including re-nationalizing natural resources. However, despite Russia’s vast oil and gas wealth and the country’s massive $141 billion stabilization fund, no party has yet promised to provide enough medicines to end the nightmarish ordeal of millions of cancer, diabetes, and heart patients. Health care is one of Russia’s four declared national priorities, along with education, housing, and agriculture. First Deputy Prime Minister Dmitry Medvedev constantly tours the country to check on progress in these areas. Lengthy TV reports show him visiting new clinics and smiling at the happy faces of the patients. But never have we seen the minister set foot in a pharmacy being besieged by patients sick and desperate for medicine.

The advertised goal of these policy projects is to raise the quality of life. But to do that, the existing reality first needs to properly assessed. It's a bit like raising a ship that has foundered. To ensure success the salvage team needs to know just how far down the vessel has sunk. If Medvedev were to spend just an hour in such a prescription line he might get some useful ideas out of it, if only to fork out more cash for anti-cancer drugs. He would be forced to confront the hollow and false glossy image of Russia’s public health system that he and the government routinely promote on TV. If Medvedev wants the truth, that is.