Re-reading Bulgakov leads health researcher and guest contributor Erica Richardson to some sharp realisations about primary healthcare in the former Soviet Union

Photo: Vladmir Menkov via Wikicommons

I have now reached an age when I can go back to novels I read twenty years ago, reread them with fresh eyes and experience the joy of new discoveries.  Most recently, this has involved revisiting A Country Doctor’s Notebook by Mikhail Bulgakov, a collection of short stories based on his experience as a newly qualified doctor sent to a remote region for his first job practicing medicine.  I sincerely believe it is essential reading for all new doctors and cannot recommend it highly enough.  In the 1990s, I was struck by how little had changed in the rural Russian landscape despite the electrification and mechanisation drives under Stalin.  In 2012, I was struck by the way in which different members of the clinical team were presented.

Maybe this is because I’ve recently returned from Minsk, Belarus where I was representing the European Observatory on Health Systems and Policies at a sub-regional policy dialogue on human resources in countries of the former Soviet Union.  As an aside to discussions about skill-mix and task shifting, a fascinating discussion developed around the concept of a ‘nurse’ and in the post-Soviet context, and where ‘feldshers’ fit into the picture. Nurses have their distinct heritage and philosophy which is focused on ‘care’, while the doctors are more focused on providing ‘treatment’.  So what’s a feldsher? (more…)

The authoritarian regime of Aliasandr Lukashenka in Belarus has historical roots but little future, explains Andrew Wilson in his new book

Belarus hit the headlines for all the wrong reasons in December 2010. After another rigged election, Aliaksandr Lukashenka, whom Condoleezza Rice once dubbed the ‘last dictator in Europe’, jailed scores of protestors, including three of the candidates who had had the cheek to stand against him. A still unexplained bomb on the Minsk metro in April killed fourteen. Demonstrations began again in the summer, inspired by the Arab Spring and ignited by a post-election economic collapse, with activists experimenting with social networks and ’silent protests’ to try and avoid arrest, not always successfully.

My book tries to explain how Belarus got into this mess, which I can at least claim was predicted by the last two chapters entitled ‘The Edifice Crumbles’ and ‘The Myth of the Belarusian Economic Miracle’.

The story goes back a long way – as many people argue that, paradoxically, Belarus has no real history. But the weakness of national identity in the present is not because Belarus lacks a past, but because the lands that are now Belarus have long been part of other states and projects. I therefore avoided using the term ‘Belarus’ until chapter five (‘Belarus Begins’). (more…)