Russia’s Healthcare System Faced Cuts for Years. Now Medical Students Are on the Coronavirus Frontlines.

In between studying for exams coming up next week, Tatiana, a 22-year-old sixth-year medical student at First Moscow State Medical University, is working as a nurse at Kommunarka, Moscow’s main coronavirus hospital. 

For someone who has eight weeks of clinical experience from previous summer internships, working in the middle of a pandemic is a step up. During a shift on Monday, for instance, the student supported a single professional nurse tending to 17 patients.

Tatiana, who asked that her last name be withheld, is one of hundreds of students on the frontlines of the battle against the coronavirus in Moscow, the epicenter of Russia’s outbreak. 

Alexei, a 20-year-old third-year student, helped process 60 suspected coronavirus patients from Tuesday to Wednesday over the course of a 24-hour shift at the university’s Clinical Hospital no. 3. The hospital began taking in suspected coronavirus patients Tuesday morning.

Over the weekend, Maria, a 22-year-old fifth-year student — medical students in Russia start as young as 16 and study for six years — had 60 suspected coronavirus patients under her watch along with just one professional nurse during a 24-hour shift at the university’s Clinical Hospital no. 2. 

“I set up 100 IVs during that shift,” Maria said. “At the end you don't feel your hands and your back is gone.”

Over recent days, The Moscow Times kept in regular contact with 11 medical students at Moscow’s leading universities who are working directly with suspected coronavirus patients as nurses or orderlies. They painted a picture of a medical system teetering in its battle against the pandemic as hospitals become increasingly inundated. 

All but one of the students asked that their family names be withheld to avoid repercussions from their universities and employers.

That these students are playing such a key role in the battle also highlights a dearth of resources in Russia’s healthcare system — a state of affairs critics say is of the Russian government’s own making. 

And not just critics. 

At a forum late last month, Andrei Klepach, chief economist of VEB.RF, a state development corporation, questioned a policy made a priority by President Vladimir Putin after his return to the presidency in May 2012: optimizing the country’s healthcare system, or trimming and modernizing a bloated and decrepit system inherited from the Soviet Union. 

In practice, however, critics say the policy was driven by corrupt practices and has seen hundreds of hospitals closed and thousands of medical jobs axed nationwide in the years since with not much gained. 

“Our healthcare system, possibly as a result of many optimization measures — reductions in the number of beds and doctors, including infectious diseases specialists, which have been taking place since 2012 — is very vulnerable to such a sharp increase in workload,” Klepach said. 

‘A few beds left’

When The Moscow Times began interviewing Moscow’s student medical workers, some felt that they had a handle on the situation. 

“The work is grueling, but overall everything at Kommunarka is more or less organized,” Nikita, a 23-year-old fifth-year-student working at the main hospital, said Monday. 

At that point, though, cases were only beginning to spike. 

As of Thursday, six days after Moscow Mayor Sergei Sobyanin said that the country was only in the “foothills” of its coronavirus peak, the Russian capital has officially reported 16,146 coronavirus cases — or 58% of Russia’s total cases. 

The severity of the situation prompted Putin on Monday to tell governors: “We have a lot of problems, and we don’t have much to brag about, nor reason to, and we certainly can’t relax.”

On Tuesday, as photos began to surface on social media of long ambulance lines at hospitals waiting hours to drop off patients, Moscow’s Health Department warned that the city could run out of intensive care beds within two weeks. It said it is rushing to re-profile 24 more hospitals for coronavirus patients, adding 21,000 beds.

“We have a few beds left but you can count them on your fingers,” Lilia, a 23-year-old sixth-year student working at the Federal Scientific-Clinical Center of Otorhinolaryngology, said late Tuesday evening.

Moscow almost certainly has many more cases than have been officially reported.

Health officials have admitted that Russia’s testing procedures are not sensitive enough to pick up all cases and that the country’s labs have been overwhelmed by the sheer numbers. 

“It’s hard to say how many [Covid-19] patients we actually have because we don’t test any of the patients,” said Alexei Veselkov, 23, a student working in First Moscow State Medical University’s Clinical Hospital no. 3. 

In the red zone

Officials did recognize the coming storm early on — if not its full extent. 

On March 10 — eight days after Russia reported its first coronavirus case — Moscow started building a 500-bed hospital for coronavirus patients, which is now open. 

Then, on March 15, Russia began mobilizing medical students to work in hospitals earmarked for coronavirus patients, said Darya Belimova, Moscow regional coordinator of the Health Ministry’s “Medical Volunteers” program. 

Since, she said, the government program has drawn 600 student “volunteers” from the Russian capital’s four main medical schools. 

Most of the students — those who already have licenses to practice as medical workers — are working in the so-called “red zone,” which brings them into direct contact with the coronavirus, Belimova said. 

To work in the red zone under her program, Belimova explained, volunteers receive a “meager salary” as a technicality. If they get infected at work, the students are owed compensation in the form of medicine and treatment, and so the Health Ministry “stresses” that students must be officially employed for bureaucratic procedure.

The rest of the volunteers work in so-called “green zones” — manning call centers, sorting patients, filling out forms. 

“Really, though, they’re all volunteers,” Belimova said. “It’s clear that they understand: “If not us then who?’”

“This is in our country’s nature,” she added.

Belimova’s figures, however, do not account for all of the students who have joined the fight. 

Other organizations have also rallied volunteers, and three of the 11 students who spoke with The Moscow Times explained that they signed contracts with hospitals directly without going through other channels. They are also working at hospitals not listed by Belimova as relying on student volunteers.

Some are thus likely escaping the Health Ministry’s watch. Two students, for instance, said they were working in the “red zone” without getting paid. 

‘Couldn’t turn our backs’

According to the Vedomosti newspaper, between the beginning of 2013 and the end of 2019, Russia’s healthcare reform more than halved medical staff including junior nurses and orderlies, and cut fully fledged nursing staff by 9.3%.

“It is clear they are using students because there aren’t enough staff,” said Alisa, a 21-year-old fourth-year student working at the Federal Scientific-Clinical Center of Otorhinolaryngology. 

“But we understood the gravity of the situation and couldn’t turn our backs.” 

Since 2011, Moscow has also cut nearly 2,200 infectious disease treatment beds, Vedomosti reported.

Over the years, medical workers have protested the reforms.

In October, the Russian Medical Association addressed a letter to Putin demanding the policy be rolled back. 

“Further destructive policies in relation to public health and healthcare, and to the legal and socioeconomic status of medical workers, can lead to a catastrophe,” the organization wrote.

While Russia isn’t the only country to rally human resources in the world’s worst pandemic in over a century, its students appear to be more firmly entrenched at the frontlines of the battle. 

In Germany, while students have been volunteering at hospitals, Deutsche Welle reported earlier this month that they have been tasked with less hands-on work — recording symptoms, collecting samples and determining which people patients were in contact with. 

Belimova said that while everyone leaving their home during the outbreak risks infection, the risk increases “a little more” in the hospital.

“The students know what they signed up for,” she said.

The risks at hand

In reality, though, medical workers are much more at risk than others, exposed over and over again to significantly higher viral loads, medical experts say.

In Italy, the European epicenter of the pandemic, more than 100 doctors have been killed by the coronavirus and healthcare workers account for 10% of the country’s total reported infections.

Those risks might soon hit Moscow’s student medical workers. 

On Wednesday morning, Alisa at the Federal Scientific-Clinical Center of Otorhinolaryngology told The Moscow Times they had run out of personal protective equipment (PPE). 

In New York, where at least six nurses have been killed so far, their deaths are being blamed on a lack of PPE. 

Meanwhile, at Kommunarka the same morning, Nikita was seeing supply shortages of certain medicines, including intravenous paracetamol to lower patients’ fevers. He was also coming to terms with the difficulties that lie ahead. 

“People are begging for more oxygen and you just don’t know who to help first,” he said. “Today was the hardest day so far.”