Undercover at a Russian Hospital

The dingy facade of one of the biggest children's hospitals in Moscow. (Eradzh Nidoev)                                                                                                                                            
It's 10 a.m. on a Sunday. A thin layer of fog hangs in the air, but I can clearly see the dilapidated concrete building in front of me. It is one of the biggest children's hospitals in Moscow.

I am here to work as an unpaid volunteer.

"Do you love children?" Alexandra, a nurse, asked as we climbed the stairs to her ward on the second floor.

"I hope so," I said.

"You'll have to play with them," she cautioned.

We entered the ward. In contrast to the dingy facade outside, the hall and rooms are bright and clean with beautiful beige walls. Mothers sat on a hall bench, talking to each other. Children played with toys at their feet. Most of the children are bald.

Yes, this is a cancer ward.

Monetary 'Gifts'

Alexandra led me to the nurses' office, where I peeled off my winter wraps and boots and slid into a white coat. Alexandra agreed to help me enlist as a volunteer for a day and to show me around her workplace on condition that her surname and the name of the hospital not be published. She expressed worry about angering her superiors and perhaps getting fired.

My goal as a volunteer was to catch a glimpse of what it is like to work in a Russian hospital, a place where doctors and nurses are notoriously underpaid and prone to bribe-taking, according to numerous independent reports from human rights and anti-corruption organizations.

I found that hospital staff do receive relatively low wages and are offered monetary "gifts" from grateful parents from time to time. But the staff also love their jobs and their young patients. What the state cannot offer in the latest toys and video games are delivered in the arms of generous domestic and foreign donors.

The children at the ward often receive toys from foreign donors and visitors. (Eradzh Nidoev)

After I changed my clothes, Alexandra introduced me to Yelena, who everyone calls Big Mama and is the kindly mother of an ill boy. She looks out for the other mothers and assists the nurses and doctors. Yelena gave me a volunteer application form to fill out.

Then I headed into the ward's playroom. En route, a mother asked me to take her daughter, an 8-year-old girl named Irina who was pushing her feet against a wall in an effort to move her wheelchair toward the playroom. I introduced myself, the girl smiled broadly, and we went to the playroom together.

This is Irina's second stint in the cancer ward. She has brain cancer, and she was re-hospitalized following a relapse.

Looking around the playroom, my eyes were drawn to some reading cards. I showed them to Irina. She could not read well and did not know the letter "Ж." We started drawing a picture of a sun.

"Why are you in a wheelchair?" I asked.

"I can't walk," she answered calmly.

Her physical disability is a consequence of the cancer. She showed me her homework. She is smart, she draws and writes nicely, and she has many top marks.

Even though medical staff are notoriously underpaid, they love their job and their patients. (Eradzh Nidoev)      

The hospital where I volunteered is one of three federal government-controlled hospitals with children's cancer wards in Moscow. The city also has three municipal-controlled hospitals. The place where I worked specializes in caring for children who cannot receive proper treatment in their native Russian provinces. The children are admitted under a quota system where the federal government hands out certificates offering free treatment. To qualify for the certificate, parents must clear a complicated bureaucratic process to prove that their child is ill.

'Probably Our Money Went to Sochi Games'

11 a.m. After a while, I left the playroom to see what Alexandra was doing in a treatment room.

Alexandra has worked part-time at the hospital for two years as she finishes her studies at a Moscow medical institute. She works seven days and nights a month, earning 25,000 rubles ($765). In October, however, she received only 20,000 rubles. Everyone at the hospital, which is funded by the federal government, got less pay. Nobody knows why. It just happened.

"Probably our money went to the Sochi Olympic Games," Alexandra said with a laugh.

A nurse's salary consists of several parts. Alexandra's base salary amounts to 6,300 rubles. She receives additional compensation for working in dangerous conditions, working nights, working on holidays and for her experience. This is how her salary grows to 25,000 rubles a month. She does not complain about the wages, but she thinks a nurse with her workload should qualify for at least 40,000 to 50,000 rubles a month.

"I am still a student, which is why I am working less than the others," she said.

The average nurse's salary is 30,000 to 35,000 rubles per month, while doctors make 40,000 to 50,000 rubles.

Alexandra loves her work because she loves children. But she does not want to stay here for her entire career. Her aim is to become an endocrinologist.

The hospital workload can be tough. Twenty children have died in the cancer ward over the past two years, including three on Alexandra's watch. Children die rarely in the hospital. When doctors tell parents that their child's case is untreatable, the child usually is sent home to die.

"I do not cry at all," Alexandra said. "I can get really upset, and this is much worse."

Hospital staff and the children's relatives often find consolation in their religious beliefs. (Eradzh Nidoev)

Once Alexandra watched a baby die after the emergency room on the first floor refused to admit him. The doctor who was on duty at the time did not insist that the emergency room accept him, and the baby died in her arms. Alexandra said she blamed herself for the death. The baby was about seven months old.

I wandered around the various rooms in the ward, and I saw religious icons and pictures of Jesus everywhere.

"All of the mothers in our ward believe in God. They really believe," Alexandra said.

She told of a mother who had only halfheartedly supported her son's medical treatment. The mother believed that if God had allowed the boy to be stricken with cancer, the boy was meant to die, and no one could do anything about it.

The mothers and hospital staff also are superstitious. For example, it is considered bad luck if a family forgets a belonging when they leave. It means that the cancer will return to the child.

An American Visit

12 p.m. A group of visitors from Praxair, a U.S. industrial gases company, arrived to play with the children. The Americans brought toys and balloons.

Big Mama Yelena gathered everyone in the playroom, and the Americans handed the presents to the children. The children's eyes lit up with joy. Among the gifts was a brand-new "Grand Theft Auto V" video game for the Sony PlayStation 3.

The ward has its own enormous television, PlayStation, Xbox and even Xbox Kinect.

Visitors are welcome to play with the children on any day of the week. Many of those who visit are wealthy, and they lavish the children with gifts, hospital staff said. Sometimes well-known personalities drop by. Once the ward was visited by Mitya Fomin, a pop singer and dancer perhaps best known for his work with the pop group Hi-Fi.

"Last week we had a group of hairdressers. They cut hair," Alexandra said.

"The children's hair?" I asked.

"No, the mothers' hair. They are sick, too. They feel much more pain than their children. They are stressed out all the time, especially the mothers of new arrivals."

The youngest child in the ward is 6 months, while the oldest is 17 years. Childhood cancer is worse than any other because a child's body grows daily, allowing the cancer to grow quickly. Cancerous cells and tumors grow faster in children than in adults.

Watching television is a favorite pastime for many of the ward's residents. (Eradzh Nidoev)

Alexandra returned to work in the medical treatment room and barked down a hall, "Zinbayev! Please come to the medical treatment room!"

Deni Zinbayev is a 2-year-old Chechen boy who was admitted to the hospital about a year ago. He has a Wilms' tumor, a cancer of the kidneys. On this Sunday, his nose is bleeding and he has a high temperature. Alexandra does not understand the reason. As his mother watches, Alexandra gives the boy an injection.

"Don't cry, you are a man!" she said reassuringly.

Many children view Alexandra as a scary monster. The mothers constantly warn their children that if they do not behave well, she will give them an injection.

A few minutes later, I sat down on the hall bench to collect my thoughts.

Big Mama Yelena walked up to me. "Nobody wants to play with you?"

Yelena is a real administrator. She has to be. The hospital does not have a large staff. The few housekeepers hired by the hospital work only on weekdays, and they tackle only some of the rooms, including the nurses' office. The mothers clean everything else.

Yelena plans the schedule for cleaning, negotiates with volunteers, and assists mothers with paperwork. She inherited the role when the previous Big Mama left, and she said she accepted the responsibility because she knew that she would stay at the hospital for a while.

Her son is one year, nine months old and suffers a form of cancer that weakens the bones. He is in the fourth stage of cancer, the final one. His chances of survival are low, from 5 to 20 percent, but his mother hopes for the best. The boy recently finished a third round of chemotherapy and handled it well. Several more rounds of chemotherapy and a few operations lie ahead. Yelena expects to stay at the hospital for at least another year.

"He is a baby. He does not understand that he is sick," Yelena said. "He likes this place. He plays with the other kids."

She remembered that she found his tumor incidentally when she felt a bulge on his stomach. The doctor in their native Kaluga region could not help him, so she brought the boy to Moscow. Her husband has joined them at the hospital. Neither parent works, and they live on state benefits and handouts from relatives. Both want to stay with their son as long as possible.

A Thankless Job

1 p.m. It is time for lunch, and the children and their parents head to the dining hall.

"I would not say that they feed us well," Yelena said. "But it is free, and we have what we have."

I sat down for a meal of shchi soup and cutlets with buckwheat.

"Now you'll see what it's like to eat in a Russian hospital," Alexandra warned me.

To my surprise, the food is delicious. It may not be restaurant quality, but it is tasty.

"Do you ever feel sad?" I asked Alexandra.

"No, I adjust to life. I feel like I have a real wall and am closed off to all these problems," she said. "Otherwise I could not work."

Nurses work various schedules. There are day nurses and those who work both day and night shifts like Alexandra. A total of 13 nurses and six doctors run the cancer ward under the steady eye of a chief administrator. The ward consists of 30 beds in about a dozen rooms. Although meals are free, everyone shares a large kitchen. Each room has its own bathroom and toilet. Parents usually sleep in the same room as the child.

Alexandra said she sometimes wonders whether she made the right decision to enter medicine.

"This is a very thankless job, especially in our country," she said. "And it is not about the money."

Alexandra studied under a scholarship in Japan for a while, and she said doctors there are treated differently.

"A Suzuki was the worst car that I saw. They drive Mercedes sedans, Audis and convertibles. They earn a lot. A doctor wearing Prada glasses can complain that he does not earn enough money."

Alexandra admitted that parents have offered her money — once 500 rubles and the other time 300 rubles. She refused to call it a bribe, saying the parents wanted to show that they appreciated her help. But she said she did not take the money. Alexandra is certain that offering gifts to doctors is a common practice in Russia.

"It is nice to get candy, but money is preferable to candy," she said.

Anyone, including non-Russians, can become a hospital volunteer, but the application process is complicated. To become a volunteer, you need fill out an application on the federal website deti-life.ru. Then you must be interviewed by a volunteer who checks whether you have what it takes to work in a hospital. After that, you undergo medical tests. You do not get paid for your work, and you can come and go whenever you like. But the hospital asks that you volunteer on a regular basis and not just for one day. To work as a volunteer is never physically exhausting. You do not help nurses or work in hazardous conditions. Your job is to make the children happy by playing and talking with them.

Although it is one of the best-financed hospitals in the country, the hospital that I visited still lacks some equipment. Filling in the gap is a federal fund called Deti-Life (deti-life.ru), which grants money and equipment to various hospitals. Drips are expensive, and the fund purchased them for this hospital. The fund, incidentally, also finances treatment abroad.

The emergency room is below the stairs on the first floor. If something goes wrong, Alexandra grabs the child and rushes him down. Alexandra has earned a nickname in the emergency room — "Morning Trouble" — because it is in the morning that she has run down screaming: "He isn't breathing! Help!"

Mothers Play Major Role

2 p.m. After lunch we returned to work. I overheard someone tell Alexandra that the little Zinbayev boy was weeping tears of blood.

"It's OK," Alexandra said to me soothingly. "His condition causes him to bleed frequently. He just caught a cold, and that is why he has a high temperature."

I returned to the hall bench and listened to the mothers chatting and offering each other advice. Everybody was polite. But I saw that the mothers were emotionally exhausted. There was no life in their eyes. They were like robots. They merely exist — wake up, dress their children, feed them, work with them, and stay with them during chemotherapy and other treatment. But it is clear that they share a single emotion, an enormous love for their children. They kiss them, play with them, and smile. A few mothers are happy because their children are in remission and will be released soon.

Being stuck in a hospital is boring, especially for teenagers. You wake up, pass medical checks, take pills, eat, walk with a drip, eat again, play on the Xbox, watch television and go to bed. The next day is the same.

Mothers play a central role in taking care of the children and often stay throughout the night. (Eradzh Nidoev)

6 p.m. The ward is a mess. Children are playing and running in the hall, shouting and laughing. Mothers are still talking to each other on the bench.

"Who's beeping?" Alexandra and two mothers cried out simultaneously.

Someone's drip was beeping, it needed charging. Alexandra pinpointed the source, and a boy brought over a charger. I got acquainted with Maxim, an impudent boy from the Kursk region who told me he was 13 years old. He is actually 10. Maxim wanted to monopolize the Xbox, grabbing the joystick from other children's hands, and he swore nonstop.

Maxim has lived at the hospital for about a year and responded well to chemotherapy. He will go home soon, but this does not mean he has a clean bill of health. He has to return for a checkup annually for the next five years. If no cancerous growths are found after five years, he will be declared cured.

"Were you afraid that you might die?" I asked.

"Are you crazy?" he retorted with a laugh. "I am not going to die!"

Maxim is lucky. He did not need any operations. But his mother said the past year had been difficult for her and she worried that her son would have to repeat a year in school after falling behind at a school run in the hospital.As the evening wore on, a family returned to the ward after an all-day outing. Sometimes doctors authorize parents to take their child out for a day or even a weekend.

Avoiding Bad Luck

11 p.m. With the exception of the babies, everyone remains wide awake. Alexandra said the children and mothers will snuggle in their beds at about 1 a.m. But the hall is finally empty of screaming children, replaced with mothers who are washing everything, even the walls. They call it "the big cleaning," and it takes place every night.

Alexandra will go to bed in a couple of hours after she finishes her shift. She is supposed to stay awake all night, but she does catch some sleep. Everybody sleeps in the hospital, even the guards on the first floor. Except for the rare emergency, nothing happens during the night. So I decided to leave.

I followed Alexandra through the whole hospital. Only one exit remains open at this hour. Alexandra warned me that I might have to pay a 50-ruble bribe to get out because I was leaving so late. But the guards waved me through without any questions. As I left, the smiles and laughter of the children echoed in my ears. Several children asked whether I would return. It is a good question. I hope I can. I did not wish Alexandra good night or compliment her on her work. Thank goodness.

It turns out that hospital staff believes that a simple "good night" or a kind word will bring bad luck.