The Chicago Tribune, showing itself to be a world leader on Russia coverage, continues its series exposing the sick underbelly of Russia:

Health care is supposed to be free in Russia, but Russians know that every hospital has its under-the-table price list.

That's why the family of Khazerya Ziyayetdinova, a 70-year-old woman suffering from severe bedsores, brought cash every time they visited her at Hospital 67 in Moscow. To have Ziyayetdinova recover in a room instead of the hallway, relatives slipped an orderly $300. They paid nurses $20 to give injections, change bedpans and unclog catheters. Every chat with Ziyayetdinova's doctor cost $40.

"Our health-care system is still in the Middle Ages," said Vera Pavlova, Ziyayetdinova's daughter-in-law, sitting in her home in this small town 54 miles southwest of Moscow. "There's low professionalism, corruption -- it makes me very worried about finding myself in a situation where I might need medical treatment."
Russia is an unhealthy nation, and its health-care system is just as sick. Its hospitals are understaffed, poorly equipped and rife with corruption.

The biggest reason Russia's population plummets at a rate of more than 700,000 people each year is not that its birthrate is so low, but that its death rate is so high. The average life expectancy for Russian men is 59. In the U.S. it's 75; in Japan it's 79.

Alcohol and smoking are major culprits. Both are linked to heart disease, and in Russia, the rate of men ages 30 to 59 dying from heart disease is five times that of the United States, according to researchers at Columbia University.

Prevention and better health care can help reverse that trend. The Russian government is pumping $6.4 billion into revamping health care; much of that money is paying for the construction of eight high-tech medical centers across the country, new X-ray machines, electrocardiograms and ambulances at hospitals, and raises for family doctors.

But doctors and nurses in the Russian Far East city of Amursk are still waiting for the overhaul to reach their hospital. In January 2007, the hospital ran out of syringes and asked patients to bring their own, said Olga Cherevko, a nurse at the hospital. Even something as fundamental as keeping pharmacies stocked can prove problematic for Russia's beleaguered health-care system. A bureaucratic breakdown in late 2006 led to a severe shortage in government-supplied prescription drugs.

Russians with enough money were able to buy medicine privately. But hundreds of thousands of Russians with high blood pressure, diabetes, asthma and other diseases had to do without the drugs for weeks.

Russian officials have promised that the errors that led to the drug shortage won't happen again. They can't be as reassuring when it comes to corruption that demands bribes for everything from surgery to clean sheets.

Researchers at the Russian Academy of Sciences' Open Health Institute estimate that corruption siphons off as much as 35 percent of money spent on health care. Low wages perpetuate the problem; yearly doctor salaries in Russia average $5,160 to $6,120. Nurses make an average of $2,760 to $3,780 annually.

Pavlova estimates that Ziyayetdinova's family shelled out nearly $5,000 in bribes during the time Ziyayetdinova was hospitalized.

At a skin clinic in Moscow, nurses charged $20 each time they applied ointment to Ziyayetdinova's bedsores. One of her sons began sweeping up her ward during visits because a nurse said room cleanup was the responsibility of patients or their families -- not hospital staff.

The money never really helped. Ziyayetdinova died. Doctors said she died of a heart deficiency, but Pavlova and Ziyayetdinova's sons are convinced the indifference and neglect Ziyayetdinova endured during her hospitalization contributed to her death.

"It was as if their goal wasn't to save someone's life," Pavlova said, "as if they thought their role was to be a last stage before death. To be a place that prepares a person to die."