MOSCOW -- When the number of coronavirus cases in Russia began growing in early March, Vladimir Shelkovy set about preparing for an influx of patients to his hospital in Noviy, a village in the southern Krasnodar region.
The facility's management, he concluded, was doing too little to help, and on April 8 he bared his frustration to journalists. His bosses were saving money on vital equipment, he complained in a TV interview, and in the process were endangering the lives of their staff.
"We buy our overalls ourselves and wash them ourselves at home," he said. "They should wash our overalls at the hospital. But there's nothing to wash, because we're not given anything."
Two days later, Shelkovy was fired. He was told he had shirked his official duties, but he had long been at odds with management and suspects the interview was the final straw.
"I've worked faultlessly for over 40 years," said the fourth-generation doctor, who is 64. "But they don't need a specialist. They need someone who'll follow orders."
'Front Line Of The Country's Defense'
Russian state TV has hailed medics as national heroes, airing reports from well-equipped hospitals manned by upbeat staff. Billboards on roadsides pay tribute to their efforts. And in April, President Vladimir Putin pledged bonuses to all doctors treating the virus, to bolster "the front line of the country's defense."
But the reality off-screen and beyond the achievements peddled by officials looks very different.
Less than half the allocated bonuses had been paid by May 11, and medics who complain have at times been prosecuted for going public. Across Russia, front-line workers are decrying chronic shortages of personal protective equipment (PPE). And some are thought to have committed suicide under the pressure.
An analysis of official statements and media reports in more than 70 Russian regions shows that at least 9,479 medical workers have been infected with the virus in the past month, and more than 70 have died. That's a small fraction of Russia's reported death toll from the coronavirus, which stood at more than 3,800 as of May 26, with over 362,000 infections.
Doctors lacking trust in official figures are compiling their own list of colleagues they've lost to the virus. It now has 300 names. According to an investigation by independent outlet Mediazona, that makes Russian medical workers 16 times more likely to die from coronavirus than their counterparts in other hard-hit countries.
A nurse tends to a man at home in Moscow on May 25 amid the coronavirus outbreak.
"The rate of deaths among medical workers in Russia is huge," said Aleksei Erlikh, a cardiologist who is part of the group that launched the rolling tally. "A lack of organization, inadequate testing, PPE shortages -- all these things have played a part."
In a survey this month of 509 Russian doctors treating coronavirus patients, 39 percent said PPE was supplied irregularly or in inadequate quantities to their hospital and 48.5 percent said they had to reuse whatever PPE they had. Four out of five medics admitted feeling physically and/or psychologically exhausted.
Controversial reforms to Russian health care have compounded the problems. Over the past 20 years, as many as half of Russia's hospitals have closed as part of a campaign to merge small, rural facilities with larger, higher-tech clinics. Critics say it's a cost-saving measure that has led to chronic underfunding and an exodus of trained doctors from the health sector.
Many say they're battling a pervasive climate of hostility and secrecy. In the Buryatia region, authorities strengthened security around hospitals on May 18 after two doctors were attacked by patients. One in three respondents to the recent survey admitted to doctoring figures on deaths and infections from COVID-19 on orders from their superiors.
"This problem wasn't born yesterday; it didn't come with these hazard-pay arrears and this pandemic," said Erlikh. "It's always been there. It's a question of mentality, and the system itself."
'No Choice But To Quit'
Even before the pandemic, doctors were warning that a punitive system was driving them away from the profession. But with medics across the country now facing legal consequences for speaking out, the issue has been brought into stark relief.
Half the cardiologists from a St. Petersburg hospital resigned early this month, and in Novocherkassk, the infectious-disease clinic stopped taking patients after its entire staff left. In the Baltic exclave of Kaliningrad, 350 medical workers refused to treat coronavirus patients last month and quit. "I guess there are good reasons for this," regional Health Minister Aleksandr Kravchenko said on May 4, according to state news agency RIA Novosti.
In the town of Reutov outside Moscow, a senior doctor quit following what she said were repeated threats and insults from bosses after she complained about working conditions at her hospital, where some 50 workers have tested positive for the coronavirus.
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Russian Med Students Feel Pressured To Fill Gaps In COVID-19 Battle
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On May 19, the opposition-backed Doctors' Alliance trade union launched an initiative to track all these developments. An interactive map on its website highlights areas of the country that are short of PPE, hospitals still waiting for promised hazard pay, and facilities where inadequate testing has been done. It also allows doctors to submit anonymous complaints.
"Medical workers will see the growing number of complaints on our map, and the lack of moves to remedy them, and they'll have no choice but to quit," Doctors' Alliance head Anastasia Vasilyeva said in a video promoting the initiative, which she said is aimed at preventing such a scenario. In an interview with RFE/RL, she said the trade union had received almost 800 complaints from doctors since the initiative was launched on May 19.
Punished For Speaking Out
Many of the complaints concern the payouts that Putin promised to nurses, paramedics, ambulance drivers, and doctors. Health-care workers across Russia have complained that the bonuses have not been paid, and some have posted video addresses to the president asking him to stay true to his word. Putin, in turn, has blamed regional officials and demanded the payouts reach their destination.
"I gave specific figures for these payments to doctors, to nursing staff, to all medical staff, to ambulance crews and so on," he told officials in a recent video conference from his residence outside Moscow. Instead, he said, his subordinates "made a bureaucratic mess, counting the number of hours worked on some kind of clock. Did I instruct that you count with a watch or something? No!"
Yet even as Putin scolded officials and demanded the bonuses be paid, medical workers were facing repercussions for issuing their own appeals. After a group of paramedics in the Krasnodar region recorded a video address on May 18 complaining that they'd not received their payouts, they were called in for questioning and warned against engaging in "extremist activity."
In the Ivanovo region, two paramedics who appeared in a video requesting donations from the public to buy PPE were charged under a new law banning the spread of "fake news." The head of one Moscow clinic accused doctors who complain publicly of "treason."
"It's horrific, this attitude toward medics," said Dmitry Kolenov, an ambulance driver in the far eastern city of Khabarovsk who says he's not received any payouts from the state.
For those who have received bonuses, the sum has often fallen far short of that promised by the state.
Nurses in Chita, in Russia's Far East, had been promised 25,000 rubles ($343) each. Instead, they told RFE/RL's Russian Service, they received 200 rubles -- less than $3.
"We got this because we work with the coronavirus. Some [of our colleagues] received nothing," said Valentina Solodukhina, one of the nurses. "That's how highly they value our work."