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Formation of a sovetstky health care system in Vitebshchina (1917-1941)



 © M.E. Abramenko, 2005

FORMATION of the SOVIET HEALTH CARE SYSTEM IN VITEBSHCHINA (1917-1941)

M.E. Abramenko.

UO "Gomel State Medical University"

Summary. In article the creation of a new health care system in the region on the basis of the organizational principles of the Soviet medicine is investigated. The problems the most characteristic of formation of lechebnosanitarny business both in Vitebsk, and in counties are considered, the problem of overcoming financial crisis is reflected in the early twenties upon transition to the new economic policy, difficulties of filling of treatment and prevention facilities with medical shots are shown. In general the author consistently and scientifically stated on the example of bodies of health care of Vitebshchina realization of new approaches in development and activity of the industry.

Abstract. The article investigates the development of a new system of health care in the region on the basis of organizational principles of Soviet medicine. The article dwells upon the problems most typical for the development of medical-sanitary activity both in the city and in the region, presents the problem of financial crisis solution, and shows the difficulties connected with medical staff deficiency in the region. On the example of health care system of Vitebsk region the author consistently and scientifically outlined the realization of new approaches in the development and activity of medicine.

The medical section, then the medical and sanitary department of the Vitebsk provincial Council formed on December 20

became a basis of the Vitebsk provincial public health department
1917 instead of the abolished medical management of the Vitebsk provincial management. According to the resolution of the congress of representatives of medical departments of Councils which took place on June 16-19, 1918 in Moscow, medical and sanitary departments at provincial and district Councils were transformed to departments of national health care. Due to the threat of the Polish occupation and transformation of the Vitebsk gubsovet in gubrevky on October 6, 1919 the department of national health care began to submit to it. In December, 1920 in connection with elimination of a gubrevkom and resumption of work of a gu-bispolkom the department was included into its maintaining (1).

The address for correspondence: 246000, Gomel, Lange St., 5, Gomel State Medical University, M.E. Abramenko.

Due to the introduction of the new economic policy, transfer of the enterprises and institutions on self-financing the board of the Vitebsk gubzd-rav in November, 1921 approved new structure of departments. Entered organizational and administrative section with offices it: the general and medical staff; medical section with offices: dental, judicial examination and medical supply; sanitary and epidemiologic section with offices: health education, hygienic and sanitary, sanitary statistics; section of health protection of children; section of protection of motherhood and infancy; section of supply; military and sanitary section; budget and cash. In total in provincial public health department 85 employees worked (2).

Undergoing numerous organizational changes in the history, the department followed a way of consecutive implementation of the new principles of construction and activity of the Soviet medicine. As a result of the first steps of the power the system with the centralized management, public financing and planning of medical programs was created.

Be in the decree of the government of RSFSR of February 18, 1919. "About transition of all medical medicine of the former health insurance funds to NKZ" (3) appeared that a medical part of all medical institutions with all equipment and personnel passes to NKZ and its departments on places. Instructions about an order of transfer of medical parts of insurance companies were sent on places with the requirement of immediate execution. It should be noted that with creation of NKZ the departmental approach and dispersion of medicine did not disappear at once. Narkomzdrava it was necessary to work much on explanation of the position of rather material resources and the methodical management of the industry. Gradually these questions found permission. Still in

1918 turned property of community of the Red Cross of nurses, out-patient clinics and hospitals, institutions dealing with issues of refugees into maintaining the Vitebsk provincial medical and sanitary department. After the publication of the decree the department of social security and labor protection transferred to the Vitebsk district public health department property and medical personnel of the insurance working cash desks to submission. To an uzdrav the dental surgery, cash desks, out-patient clinics at Dvina factory, the Novki plant, factory of "Skin" in the town Yanovichi, medical centers at the Trud plant in the town of Obol departed. At the same time the department of social security transferring objects to bodies of health care asked physicians to keep and increase the being available equipment and to organize high-quality service of workers. In total in 1919. 35 hospitals on 1500 beds were subordinated to the Vitebsk gubzdrav (4).

Many problems were connected with overcoming disagreements in financing of the industry. In 1918 in the country there were two medicine: the subordinate Narkomzdrava uniting urban and territorial medicine and insurance working medicine. After the solution of SNK RSFSR in February, 1919 about transfer of all medical part of the former health insurance funds to Narkom-zdravu the working insurance medicine practically ceased to exist. However the new economic policy led to return of elements of insurance medicine. On November 15, 1921 the decree of SNK RSFSR entered social insurance of persons of wage labor instead of the social security of all workers established in days of military communism again. In December, 1921 the decree about social insurance in case of a disease is issued. A part of the means coming to social insurance fund was given to bodies of health care to a covering of expenses on medical care insured (5).

Insured just were also that exclusive class which estimated benefits klassovo the predetermined medical care. Medical care was free, according to the first requirement of the worker had to place in a hospital, the bulletin, etc. smoothly was given. Influx of patients became so big that doctors were not able to accept all. During the public discussion about free medicine the accent began to be done on treatment prevention as in practice expensive medical treatment as it was noted at the Vitebsk provincial insurance conference in 1926, caused existence of the increasing number of cases of "irresponsible tightening of diseases".

Widely declared principle of free of charge played a long time a propaganda role, showing care of the state of health of the population.

From the economic point of view no free services exist. All free funds and social security including medical, depend on economic opportunities of the state.

The new moments in organizational structure of health care of the republic were connected with territorial and administrative integration of BSSR. In 1924 to BSSR three counties of the Vitebsk province departed according to old administrative division. On July 17, 1924 the II session of the CEC of BSSR abolished counties and volosts and created districts and areas (6). At the time of accession of the territory transformed to the district gubzdrav and managers of district public health departments received the instruction that now NKZ of Belarus is the only authorized body in permission of all questions concerning health protection of people, all managers of district departments became Narkomat's representatives.

The followed permanent administrative reform in the republic on integration, disaggregation, redivision into districts for a long time paralyzed, as a matter of fact creative function of local authorities, took away many forces and energy from the local device. In health care in each several years it was necessary to change contours of medical network, to find a taxonomy order, to constantly resolve the arising issues of organizational character, to keep continuity in work. Even sanitary statistical reporting was withdrawn from maintaining bodies of a statupravleniye of Plank beds Healthcare Committee and CSU is transferred.

During search of an optimal variant of administrative division in the republic the decision to return to a regional link was made. At a meeting of the Organizing committee of the CEC of BSSR on the Vitebsk region in December, 1938 the structure of an oblzdravotdel and the Provision on it were approved (7). After elections to regional council at the end of 1939 the executive committee was elected and at it, among others, the regional public health department is formed.

Thus, only before war the system of local bodies of health care through which social, medical, economic strategy Narkomzdrava of the republic initially was implemented was finally created.

Carrying out difficult tasks of realization of the fundamental principles of the organization of new medicine, health workers of the Vitebsk province at the same time took the most urgent measures for elimination of negative sanitary consequences of war. In the Vitebsk province in 1920 it was registered a typhus of 40.5 cases, returnable - 13.8 thousand, belly - 6.5 thousand, dysentery - 27.8 cases, smallpox natural - 617, cholera - 27 (8).

Exclusively difficult epidemiological situation developed in a front-line strip where the material resources of health care were almost destroyed. The manager of Drissensky uzdravy informed Vitebsk gubzdrav that the population has no place to address because from total absence of medicine in the county (9).

Due to the hunger and mass typhus diseases of fall of 1921 there was a wave of refugees from the southern regions of Russia going to the Baltics to seaports. Practically all medical institutions of Vitebsk were blocked by sick refugees. Vitebsk gubzdrav specified in a note of the commission on assistance to starving that in city infectious hospital from 300 patients who were on treatment 206 were refugees. In Orsha they engaged all being available beds. In percentage terms the number of sick refugees in relation to patients from local community said so: on the city of 70% and on counties of 40-60%. Gubzdrav demanded allocation of additional resources for keeping of medical staff (10).

During fight against infectious diseases the new organizations and institutions were created, disinfection groups, bureau of cleaning and disinfection, sanitary inspection, sanitarier checkpoints at stations and piers were formed. The big role in fight against epidemics was played by sanitary and educational work. Epidemics of dangerous infectious diseases were in the early twenties suppressed, however problems with a sanitary condition of settlements were found further. In the mid-thirties epidemics of typhus and malaria continued to take place. The next outbreak of disease of typhus in Vitebsk became confirmation of need of the most close attention to questions of improvement and a sanitary state. Epidemics in the city arose repeatedly: in 1930 86 cases of typhus, in 1931 already 1663, in 1932 - 1431, in 1933 - 1249 were noted. Such emergency epidemiological situation in the city was considered in November, 1933 in the Central Committee of RC (b) of B. Prichina of epidemic the pollution of a water supply system, lack of chlorination and "harmful" activity of group of workers of a gorzdravotdel was. The group of 20 doctors headed by the deputy commissioner was hastily sent to Vitebsk, 12 groups on vaccination are organized. 950 people were hospitalized, more than 100 patients because of the shortage of hospital beds underwent treatment in house conditions (11). After the taken measures the situation in the city improved.

Developing of these diseases was also connected by

with insufficiently high qualification of health workers in general on the republic. Cases when the paramedics working at sites instead of doctors were not able to reveal cases of typhus took place and passed them under the diagnosis "flu". Sometimes the disease extended even through treatment and prevention facilities. Disinfection cameras on the republic in most cases stayed idle. Was enough confusions of organizational character when activity of the epidotryad assigned to NKZ, their completeness were not controlled properly. These problems were discussed in 1939 at the Vsebelorussky anti-epidemic meeting. SNK BSSR adopted the special resolution on streamlining of water supply and the sewerage in the territory of the republic. The taken measures in combination with broad sanitary work allowed to stabilize a situation on infectious incidence.

Along with elimination of epidemics of infectious diseases the Vitebsk organizers of health care had to solve a problem of survival of health care in general as after the end of war the budget was not, and it was not necessary to count on full state support. The end of 1921 and all 1922 passed under the slogan of staff reduction and their best use, partial transition to cost accounting of pharmaceutical business, ensuring fuller functioning of medical network. It was necessary to keep and provide activity of bodies of health care to go on resolute staff reduction and medical network. According to the decision of the all-Russian congress of zdravotdel the Vitebsk province on an allotment left

2200 beds, from them 400 epidemic and 1300 medical. The Vitebsk County respectively left instead of 220 beds - 150. In the county with the 209-thousand population 1306 people became the share of one bed. And it as organizers of health care of the county noted, is still good because at a difficult moment it is possible to count on the help of provincial center (12).

The weakest institutions in the material plan were reduced, decreased where it is possible, the quantity of beds, some objects united. Where local health workers enjoyed confidence, the population through self-taxation helped means under repair of institutions, supply with fuel, compensation. Also local authorities gave feasible support in this case. Vitebsk a gubispolok in October, 1921 adopted the resolution obliging all institutions and the enterprises, state, cooperative and private to provide the employees and workers with medical care through 4% of assignment from profit at the expense of enterprise assets in favor of bodies of health care as it was specified, before settlement of this question in nation-wide scale (13).

Considerable reorganization was undergone also by pharmaceutical business. The former pharmaceutical section of the Vitebsk gubzdrav was transformed to management of pharmaceutical business. In its department there was the central pharmaceutical warehouse, chemical and pharmaceutical laboratories, pharmacies. Delivery of pharmacies for rent began to practice widely.

The measures taken on reduction of medical network and actually health workers led to unemployment in the industry. Across Vitebsk and the Vitebsk County had no work of 30 doctors, 27 zubvrachy, 45 lekpom, 47 pharmacists and 40 obstetricians. All of them stayed on the registry in medical section at labor exchange (14).

The unemployed in rural areas were not registered as, most likely, the surplus of doctors was not observed here that it was connected with the worst conditions of working and life, a low wage which in 1922 in rural local network was lower, than in the provincial center. And in city institutions the average salary medical

workers averaged no more than 11.4% of pre-war level of 1914 (15).

In the standard of living of medics business did not reach high-quality shifts what it was repeatedly indicated at the held congresses of managers of a zdravotdelama, trade-union meetings and other meetings of this sort. The rate of the district health officer was 70 rubles, the manager of a tubdispanser - 80-100 rubles, the doctor of district hospital of-60-70 rubles, the district rural doctor - 50 rubles. The salary of the worker, depending on qualification, was from 22 to 75 rubles. The salary question sometimes developed into political. At the 4th Vitebsk district conference of labor unions which was taking place in 1926 it was noted that the salary of medics in 13 months grew by 8%, and goods prices and products - for 15%. The demand of establishment to employees of the industry of a living wage was made. Acting coordinated situation with salary to the fact that thus the authorities push away the intellectuals from work for the fact that she did not understand and did not accept October. It was offered to find mutual understanding and to build further relationship on community of political and economic views (16).

The forced rates of development of the industry, creation of the new defense industries took away the lion's share of means from the country, and this one-sided development not in the best way affected the social sphere.

However gradually, with introduction of the New Economic Policy, stabilization of a financial system the condition of network of treatment and prevention facilities of the industry began to change for the better. Allocating funds for the most necessary, gubzdrav in 1921 created provincial sanitary and bacteriological institute, in May of the same year the Vitebsk town house of health education of N.A. Semashko opened. The number of outpatient appointments in Vitebsk increased from 50 thousand in 1914 up to 355 thousand in 1923 (17). There were new types of medical care, holiday house, clinics, day nursery, consultations. The health care of the province managed to stand in crisis of 1921-1922

The most difficult problem before health care of the republic, without which solution

advance was impossible, there was a preparation of medical shots because it was not necessary to count on their receiving from the outside.

Owing to the policy of health care pursued by the government of the USSR the active growth of its material resources began that demanded the new prepared shots everywhere. A significant role in Belarus, disregarding of course, BGU played the second medical school created in 1934 in the solution of a personnel problem - the Vitebsk state medical institute. The same year taking into account the so-called production institute existing here (hospital higher education institution) the first release of 85 doctors, in 1939 - 89 took place, in 1940 the release made 104 persons. During the pre-war period at this institute 1001 persons studied. Educational process was conducted by 14 professors, 21 associate professors, 67 assistants, 17 teachers, 7 graduate students and 20 senior laboratory assistants. For these years the institute let out 570 doctors, according to other data - only 304. The staff of institute defended 11 doctor's and 25 master's theses (18).

However, despite the undertaken measures for preparation of own shots, the problem was solved with incredible work. By 1940 the health care of area approached with the developed network of treatment and prevention facilities. At the same time 40 rural medical sites of the area from 106 had no doctors. In Osveysky district there were 2 doctors in the regional center at all one local hospital and 4 medical sites had no doctors. Only 1 doctor was available in Lepel-sky district. And business not always consisted in physical absence of experts. Mainly sites were closed because of unwillingness of young specialists to go to rural areas, to use the level of living conditions which is available there, to receive a low wage. In the area about 600 doctors, 100 dentists, 80 paramedics were not enough everything (19). Despite huge, complex work on the organization of preparation of medical shots, this problem before war was not solved.

Development of health care in the Vitebsk region did not come out from the general course of formation of new medicine to the republic, though had some features. Its main economic and political contents

the solution of the problem of free of charge and general availability of medical care for the population of the country was. On a number of important activities of bodies of health care impressive results were achieved: in creation of material resources, the organization of the higher school, development of medical care, etc. However it should be noted that everything was reached by a resource-intensive extensive way of development. Life expectancy of people increased slightly, flashes of epidemics took place, there were problems with children's incidence and mortality. But the main problem was not in activity of bodies of health care, and that for a number of reasons social and internal political character during the pre-war period it was not succeeded to achieve visible, significant shifts in improvement of living standards of people.

Literature

1. State archive of the Vitebsk region. Further GAVO. F.64. op.1, 15, l.3-12.
2. GAVO, op.1, 168, l.92.
3. Lenin decrees on health care. - M. Medi-tsina, 1970, page 115.
4. GAVO, op.1, 120, l.31: 104, l.7.
5. Health care in the years of restoration and socialist reconstruction of the national economy of the USSR (1925-1940). Sb. documents and materials. - M. Medi-tsina, 1973, page 397.
6. Arch of establishments of BSSR. - 1924 - No. 13 - page 117.
7. GAVO, op.12, 2, l.375.
8. S.I. Belov. Formation of the Soviet health care in Belarus//Health care of Belarus - 1990 - No. 1 - page 32.
9. GAVO. Op.1, 183, l.2.
10. GAVO, op.1, 295, l.371.
11. National archive of Republic of Belarus. F.4, op.3, 125, l.372, 375.
12. GAVO, F.64, op.1, 333, l.208.
13. GAVO, F.64, op.1, 243, l.13.
14. GAVO, F.376, 5, l.56.
15. To the union medsanprayets і Iago of a stanov_shch yes 10-goddzya _snavannya BSSR//Is white Kamenshteyn S. D. Razv_zze. medical - a thought. - 1929 - No. 1 - page 18-33.
16. GAVO F.376, op.1, 22, l.103.
17. E.Yu. Zelikson. The short review of health care of Belarus and its immediate tasks (1912-1923)//Is white - medical a thought - 1924 - No. 1-2 - page 3.
18. I.I. Bogdanovich. The history of the Vitebsk medical institute and its role in preparation of medical shots and development of medical science (Questions an east. medical and health care of BSSR. - Minsk: Belarus, 1968, page 23-25; GAVO, F.1971, op. 1, 13, l.14, 84, l.70.

Arrived 18.02.2005. Accepted in the press of 29.03.2005

Publishing house of the Vitebsk state medical university

A.L. Tserkovsky. Medical ethics: course of lectures. - Vitebsk: VGMU publishing house, 2004. - 260 pages L.G. Gidranovich "Vyuo^ashs sIeshk1: gu".-Vitebsk: VGMU publishing house, 2005. - 282 pages

John John Cornelius
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