During the 1990s and early 2000s, I managed two medical exchange projects in Russia. It's been a while since I was there, but I follow the news closely and sympathize with my educated and dedicated health care worker friends who are struggling to provide services to the people at a time when the Russian economy is in a tailspin because of sanctions applied in response to President Putin's provocative actions in Ukraine. The declining price of oil worsens this situation because the Russian economy is so dependent on energy exports.
Since the 1940s, the health care system has been a seemingly low priority for Russian central planners, and this situation has not changed. So, my Russian colleagues are in the classic "Do more with less" bind.
My impression is that the Russian people have found ways to adapt to centuries of living under authoritarian regimes and being invaded by Tatars, Mongols, Lithuanians, Poles and Nazis. One way is telling subversive jokes. Another is the vodka culture.
During the time I managed these two exchange projects, my U.S. volunteers were surprised at the low state of investment in the health system. Hospitals were run down and poorly equipped. They were even more surprised at the vodka culture. We met the CEO of a large referral hospital one morning to discuss our upcoming activities in his hospital. He greeted us warmly and proposed a toast to our joint activities. "But it's 9 AM, Sergei," I said. "It's customary that we have a welcoming toast," he replied. So we took our shot glasses and he filled them with vodka. "This is a bottoms-up toast," he said and made a flowery toast and we downed our shots.
Then he looked at me, clearly indicating that I needed to follow suit. So, I did my best to give a long toast and said "This will be a sipping toast." Sergei interrupted and said, "There are no sipping toasts." So we downed our second shot.
He pulled another bottle out of his desk with a ruby colored liquid inside. "This is something I made myself. It includes strawberries." We cried off saying that we were tired and needed to rest before beginning our work. He grudgingly accepted this breach of hospitality, but poured himself a shot, drank it and smiled, letting us know what we were missing.
"What will your day be like, Sergei?" one of the physicians in the U.S. delegation asked. "Nothing unusual," he replied. "I will see some patients and write some reports. No surgery today." The U.S. delegation looked at each other and smiled in relief. Three shots before 9:30 AM, but at least no surgery.
This scene was repeated countless times during our visits. We met with cardiovascular surgeons, obstetricians, pediatricians, administrators and nurse executives and it was always the same -- excessive drinking in both professional and social situations and the expectation that we join them.
On a drive into town at sunset, I saw the customary gathering of men after work. They met with their two best friends in a public park for some conversation and socializing. One carried some black bread, another some sausage and the third a liter of vodka. My interpreter said, "They meet, they talk, eat the bread and sausage and drink the vodka before they go home." I replied, "This seems like a lot of vodka, Irina. What happens if a fourth person shows up?" "Simple", she says. "They just buy more vodka."
This widespread acceptance of drunkenness and alcoholism by men results in serious ongoing problems with absenteeism, inadequate productivity and general declines in health and lifespan. Increasingly women are also adopting these attitudes towards alcohol which raises the frequency of Fetal Alcohol Syndrome and all the other problems that men have.
My hope is the new generation of Russians will find a way to reverse this self-destructive behavior. If not, all these other factors will continue the decline until Russia becomes a second class power, but one with nuclear warheads.