A call to the 5th City Polyclinic:

- The 5th City Polyclinic, paid services.

- Hello. I'd like to make an appointment for a heart echo.

- What echo?

- The heart.

- We don't do heart echo, we don't have a specialist for it.

- Is it that there’s no specialist at the moment? Seems like there’s no one at all.

- We have been waiting for four years, we don't have one. Thirty-second polyclinic, try there.

According to media reports, early June last year in Belarus there was a shortage of almost 6,500 medics. To find out how the situation has changed today, we analyzed the vacancies in the public employment service. And here's what we noticed: while at the beginning of the summer 2021 there were vacancies for 2,300 specialist doctors, the number of vacancies has now increased by more than one and a half. And for nurses — by a third. A doctor from one of Minsk emergency hospitals, cites emigration of his colleagues as one of the reasons for the shortage of medics in Belarus.

"Well, let's say we have one department from which a chief of medicine left for Poland in the summer. And naturally everyone thinks it happened for political reasons, as no one talks in person, no one talks about these relations, you know. The department more or less fell apart because of it. And they still can't form it. There was an acute shortage at some point. It's now, a year later, that they've somehow found people. From our ward, the surgical ward, two persons have already left since the war started."

As of June 1, 2021, there were 335 doctors from our country working in Poland alone. In other words, if they had not left, they would have filled almost 10% of vacancies in Belarus. At the end of 2020, during the second wave of coronavirus, Poland made it easier for foreign medics to get employed - they no longer have to legalise their diploma straight away. Foreign doctors, including those from Belarus, have 5 years to close the achievement gap, take the state medical exam and to get an internship. Diana moved to Poland a year ago, prior to which she worked as an ophthalmologist in a Belarusian district clinic. 

"I worked in a curious polyclinic, let’s say it was a smaller version of Lukashenka’s regime. The chief of medicine there was a bit of a dictator. And in general, there was a loyalty system, nepotism. I tried to do something, I stood up for changes, said something, bucked the system, but they just cut you off. Patients always complained about everything. They take their anger out on you out of their, so to speak, not exactly wonderful life. All my colleagues, with whom I graduated, said that at first they even cried. So I got a little bit down and realised that I wouldn’t break it and had to do something about it. I made a decision to leave."

Today, the minimum salary of a doctor practitioner in Poland is over $1,400. Nurses, physiotherapists and pharmacists earn $1,200.

In Belarus, the average salary in the whole field of health care is now just over $500. Medics tell us that during the coronavirus pandemic their salaries increased significantly thanks to so-called covid allowances. The following was told by a doctor at the emergency hospital:

"Well, I can speak purely for myself. As a doctor with the first category, I have 1300 BYN net - that's my rate salary. And the same allowance for coronavirus patients when I cure them every shift".

In fact, these allowances have not been abolished. But, on condition of anonymity, another doctor working at a district hospital told us that their hospital had received orders "from above" to do everything possible to reduce these payments.

"They started limiting PCR and antigen smears to simply not diagnose covid. There was a case when a patient came in and was seen by several doctors, and the chief medical officer said not to take a PCR today, as the patient had been seen by many doctors, so as not to pay them. Or another case: a patient was in the ward for three days and they found out he was tested positive for covid, but the patient was discharged home and the case report was cleared to make it as if the patient was not in the hospital so as not to pay the nursing staff".

But even without that the number of covid patients has decreased - there are fewer people getting sick with coronavirus. To the order of the regional authorities, the medic says, covid patients were manipulated in the opposite direction as well.

"We were getting good money, so everyone rushed in, and everyone found as many patients as possible to get that money paid out. So you contacted, signed up a patient, that's it, you get paid for it. And there have been cases where, let's say, people have come and asked to write down that a person has bilateral polysegmental pneumonia so that the doctor gets, let’s say, some money".

After the start of the coronavirus pandemic, the National Statistics Committee stopped publishing mortality data. As a result, Belarus is now the only country in Europe that has not released figures on deaths for 2020. But cyber partisans have hacked into the system where passport data is stored. Thanks to this we learned that 145,000 people died in the country two years ago - one of the highest death tolls in the post-war history of Belarus. Excessive mortality - 25 thousand, presumably that's how many actually died from the coronavirus. That is 17 times more than the Belarusian authorities say. Volha Ravinskaya, a pathologist, gave her opinion on what diseases will spread in Belarus.

"Given the covid situation, there will now be a growing cancer neglect. Because people didn’t go for treatment and diagnosis. That is why, so to speak, the mortality rate will increase in the short term precisely from cancer, I believe".

But let us get back to the problems with medical staff in Belarus. Here's what another medic, who lives in the region, says about it.

"You know, the first problem is probably a lack of specialists. We have about 20 thousand people in the city, plus about the same number of people in the district. Our central district hospital sometimes lacks narrow specialists. For example, we may not have an otolaryngologist, an ophthalmologist, a neurologist and so on for years. It is a good thing that surgeons are still around, because the surgeon is always there for himself and for that guy. If there were no surgeons, I don't know who would be seeing people".

There is a shortage of nursing and paramedical staff in Belarus. The main reason is low salaries. The Public Employment Service is now offering vacancies for nurses with a salary of about 750 rubles, hospital attendants are willing to pay about 600 rubles. According to the emergency hospital doctor, they have staffing problems in the cardiology, surgery and emergency departments.

"Well, our hospital has always had problems with the nursing staff in the emergency department. After all, the work is very hard and poorly paid, and it always has been. And it is a problem indeed. There is an acute problem with hospital attendants. The problem with nurses is not as big, but more than with doctors. After all, nurses have low salaries for Minsk and it is profitable for all of them to work at the same "Euroopt" as a shop assistant and not be responsible for people’s lives. But it has always been such a problem. It is all because of the salaries".

It should be noted that when we did our experiment trying to make appointments at various health facilities, we did not feel a critical shortage of medics. We were rejected more often because the equipment was not working.

A call to a regional hospital:

- Regional.

- Hello.

- Hello.

- I'd like to make an appointment for a head CT scan.

- The appointments have been suspended at the moment. Our machine is broken. And we don't take paid ones on the old machine - there's a very large dose.

- How long is the wait?

- I don't know. I can't say.

- Well, a week...

- Try the oncologic centre, try the RSPC - they have two machines each and there will be paid services.

- Or maybe you'll have it in a week? Or are we talking months? Years?

- No, we are not talking about years or months. If the details come from Russia, it could probably be within a month. If not, I can't say anything about how long it will be.

Medics also tell us about problems with equipment.

Diana, an ophthalmologist: "There was no equipment to work with, it was horrorible to go on a call with a simple school lamp and an old grandfather's ophthalmoscope. It’s a little scary, if you know what equipment and instruments you should have had".

A doctor at a district hospital: "Allegedly there are enough ultrasound machines and ventilators, oxygen is also supplied in sufficient quantities. But our X-ray machine is the most long-suffering. Our CT machine was supposed to be replaced in 2021, but the Ministry gave us a new X-ray machine, which, according to the documents, should have been put into operation back in December. But, naturally, it has been delayed, now promising to start work in late May to install it. But almost all our equipment is old, 10-15 years old. This is why there are breakdowns, and the repairs are going slowly. At the moment the X-ray machine needs an expensive foreign-made part, we have been waiting for it since autumn. They are also promising to deliver it by the end of May. There’s no X-ray tape - and we do not know when there will be one. The supply of X-ray contrast agents and medication is also intermittent.”

Why do medics in Belarus work with old equipment? The cause may be the persistent problem with corruption in this field. Experts say that the state saves on healthcare quite often, and low salaries are one of the reasons why doctors commit crimes. In 2013, for example, the trial against Vitebsk doctor Leanid Shylka was quite high-profile. He sentenced to six years in prison for thefts by abuse of power. The law enforcers estimated that the doctor, who made Kastsyukovichy hospital one of the best in the country, stole about three thousand US dollars. But a number of investigations of the program "Davaite razbiratsia", which like "Shchyra Kazhuchy", is produced by the Belarusian Investigative Center, has found that businessmen and officials associated with the authorities and directly with Alyaksandar Lukashenka's family have embezzled not thousands, but millions and tens of millions of dollars from the medical budget.

For instance, the investigation reveals that the state bought a number of anti-cancer drugs from one firm "NatiVita", owned by Vitebsk businessman Aliaksey Sychou. They were passed off as local, but in fact "NatiVita" imported them from Russia and sold them to the state in bulk for seven times higher than their actual value. Even Health Minister Dzmitry Pinevich was outraged by this finding.

Our colleagues found out that the Nativita’s owner was linked to former Health Minister Vasil Zharko, who is said to be a protégé of Alyaksandar Lukashenka's former civil mother-in-law, the grandmother of his youngest son Mikalay. In 2011, Sychou’s wife paid at least tens of thousands of dollars to Zharko's daughter for one of the ministerial family's flats in Minsk. As a result, even in spite of Minister Pinevich's reaction, the law enforcement officers were not interested either in the schemes of theft of tens of millions of dollars (they’re still going on) or in the individuals involved in the scheme. This spring, however, the authorities detained 35 traumatologists, who were accused of receiving payments from foreign manufacturing companies for installing imported prostheses.

A doctor from an emergency hospital: "Such a large number of people have been taken away from medicine together. There are people who were waiting for some planned operations in traumatology, they could not have them, because these operations were postponed due to coronavirus, and now they cannot have them because there are no specialists. In my hospital, two heads of traumatology departments have left. The consequences of these actions are such that there are not enough traumatologists everywhere now, at least in Minsk".

Interestingly, after this, the authorities banned all imported prosthetic surgeries at all state clinics across Belarus. For example, in the RSPC for Traumatology and Orthopaedics, surgery can only be done using domestic materials. However, as our colleagues from the Belarusian investigation centre (a team from the "Davaite razbiratsia" programme) found out, it is still possible to make imported prostheses in Belarus. But in one private clinic called “Merci” and for prices much higher than those done in public hospitals. We called the Merci clinic.

A CALL TO "MERCI":

- Knee replacement, how much will it cost?

- Hang on a minute.

- OK.

- Thank you for waiting. Knee arthroscopy costs 2800-2900 rubles.

- 2,900 Belarusian rubles?

- Arthroscopy... Yes. Knee arthroscopy, stay suture of the inner and side elm is 7,600 rubles.

- Could you tell me, please, who the manufacturers are?

- Switzerland and the USA.

- Switzerland and the USA. Yeah. What’s better?

- You have to talk to a doctor about this.

- Are there any queues? Or can it be done soon?

- You have to make an appointment to see a doctor and he will then schedule the operation. There's something else I found: total knee replacement, cost of operation is 17 300 BYR.

As our colleagues from the Belarusian Investigative Centre managed to find out that the Merci Clinic has four owners and all of them are in one way or another connected with businessmen Alyaksey Aleksin and Alyaksandar Zayats, who have been sanctioned by the European Union as Alyaksandar Lukashenka’s "wallets".

In 2018, about 50 people were convicted in the so-called medical corruption case, including the former Deputy Health Minister and the head of the RSPC for Traumatology and Orthopaedics. They were sentenced to 6-7 years in prison, but the penalty was removed  after two years. Businessman Alyaksandar Knyrovich was then held in the same colony as the pardoned doctors. He says it’s rare for anyone there to be released.

"During my time in the colony, there were two other people who were released before. One was some kind of non-ranking airborne paratrooper. And the other one was a Deputy Chairman of the "Belarusbank"".

At that time, the medics were also accused of taking bribes for allowing medicines and medical equipment to enter the Belarusian market. However, the prices have not changed much after that case. Former Minister of Health Igar Zelyankevich considers these cases echoes of the system and says that those who created the conditions for power abuse should be punished.

"It was somebody who created the conditions for this to happen. Who is responsible for this? Those culprits are known. But I won’t name them because only a court can name a person guilty. It's all echoes of the system now, I’d like to emphasize. Do you understand? The system. As for the same traumatologists and orthopaedists, we need to develop our own and keep track. We should set goals for production and not fill our own pockets."

Meanwhile, the rating of the Belarusian medicine in the world is falling. According to the International Organization "Numbeo," our country is currently ranked 90th. Five years ago Belarus was 23 positions higher in the same rating.