FORT LAUDERDALE, Fla--Imagine a country where a cancer diagnosis
is never revealed to a patient, where few have ever heard of screening
mammography or breast self-examination, and where most men do
not live long enough to get clinically evident prostate cancer.
"This is a portrait of the United States in the early decades
of this century and also a portrait of Russia today," said
Barrie Cassileth, PhD, in her talk at the second annual Industries'
Coalition Against Cancer conference.
Dr. Cassileth has traveled in Russia and actively encouraged modern
breast cancer education among Russian physicians. She noted that
decades of neglect have left the Russian health-care system disjointed
and inadequate, while pollution, alcoholism, smoking, and poor
nutrition have led to a major public health crisis. Russia, for
example, has the lowest life expectancies of any industrialized
country--59 years for men.
Universal access to free medical care was achieved in Russia by
sacrificing quality of care for quantity, she said, and the ideal
of equal access was subverted by a three-tiered system: At the
top, "show hospitals" created for the government elite;
for the masses, poorly equipped regional hospitals; and for rural
areas, physician assistants called feldshers.
In her talk, Dr. Cassileth, adjunct profession of medicine (oncology),
University of North Carolina, cited some dismaying statistics
about the primitive regional hospitals where the vast majority
of patients in Russia receive care: 24% lack plumbing; 19% lack
central heat; 45% lack bathrooms or showers; 49% lack hot water;
and 15% have no water.
She said that the government began reform efforts in 1992 with
a goal of reducing the number of physicians while increasing the
quality of hospitals and training. Entrance requirements for medical
school have been tightened, but continuing education and quality
assurance programs are still lacking or inadequate.
"Developing quality assurance is a crucial step," she
said, "to help counteract the widespread mistrust and lack
of respect in Russia for medical care and physicians." Part
of the mistrust stems from the oath taken by physicians in the
old Soviet Union to defend the interest not of the patient but
of the state, and of the tradition of protecting patients from
knowledge of any potentially fatal illness.