Episode 46: The Miracles of Socialist Healthcare

 Audio Link

Welcome to Stories of Communism, the podcast where we discuss what life is really like for those unfortunate enough to live under communist or socialist governments.    Recording from the suburbs of Wichita, Kansas, this is Erik Seligman, your host, along with co-host Manuel Castaneda in Oregon.

Today we’re going to be discussing a darkly hilarious memoir by a former Soviet doctor, Vladimir Tsesis, who practiced medicine in a small Moldovan town in the 1960s.   The memoir is titled “Communist Daze”, and describes his experiences in his first job after graduating from medical school, as a pediatrician at a hospital in a small farming town called Gradieshti.   It begins with a discussion of his days in medical school.   It’s great that his schooling is completely free, aside from the mandatory summers spent at forced labor harvesting crops in the country.   But he is a bit bothered when he notices that certain of his classmates aren’t quite held up to the same standard as he is.

… I crossed paths again with… the Komsomol leader, Sarakutza.  It seems the army veteran was struggling in chemistry, and so the professor asked me to tutor him.   One day well into the course, I was explaining the concept of valence…  Looking very puzzled, my pupil lit a cigarette… and casually inquired through a cloud of smoke, “But what is… an ‘atom’?”   Petra Sarakutza later went on to become an instructor in the Department of Biochemistry there, another bright Communist future guaranteed.

…I remember my classmate Vitale Istrati, a nice-looking fellow with a childish face, who simply could not remember the cornucopia of terms in the course on anatomy…   Due to his high level connections, he was not expelled…  Of course— you guessed it— after graduation, Vitale became a teacher in the Department of Anatomy and later even went on to chair the department at another medical school….

Vitale’s story is not unique; I would come to discover that such shameless nepotism in the medical profession was typical of the entire country, undermining the professional capabilities of generations of Soviet doctors.   Privileged students with minimal education and training invariably were permitted to finish medical school and become physicians, to whom patients entrusted their lives.

Tsesis is sent to the small farming town of Gradieshti, where he is granted the amazing privilege of a small apartment to himself.   Electric service is unreliable, and he has to use an outhouse in the yard due to the apartment’s lack of a sewer system, but it’s still a pretty nice arrangement by local standards.  He also comments on how he had to save up newspapers, since toilet paper there (and in most of the Soviet Union for non-Party-elites) is an unheard-of luxury.   This, however, creates another potential hazard, as someone caught wiping oneself with the wrong newspaper page, say one that contained a picture of a Communist Party leader, could find themselves denounced and arrested.    Tsesis comments on the wide-ranging effects of these issues:

Gradieshti’s challenges with sanitation were a microcosm of a widespread, unending Soviet problem…  a high level of gastrointestinal infections in town and country.   Like millions of my compatriots, I grew up in a medium-sized city, in a little house with a backyard outhouse and without a sewer line, shower, bath, or hot water.   With all that, my family was very lucky in comparison to people in rural areas, many of whom confronted worse sanitary conditions.   Even in the large cities, finding a toilet— even the most primitive and foul-smelling- was a difficult task.

Tsesis settles into his job at the hospital, happy to see that his boss is a somewhat competent physician, and begins treating the local population.  The staff do their best to keep the hospital running, but certain nationwide problems are hopeless to fight against.   One is the constant theft of hospital supplies by the local workers.

The theft of public property is very simple to perform.  Before the hospital stamps each new piece of bedding with its blurred, rusty hospital seal, the bedding somehow quietly slips away— for a modest fee, mind you— to employees and their acquaintances.  On paper, the “old items” miraculously become the “new items”.  One consequence of such ubiquitous stealing is that all of the hospital’s bedding is universally dirty gray, a fine match for the colorless village…   bedding is only really and truly discarded after countless washes in the hospital laundry, once it completes a long, thinning, and fragmenting journey into shapeless rags.

The level of skills of the other doctors varies, of course.   Tsesis is shocked when he sees a fellow doctor bragging that his patient is getting better because he has ordered nearly every available antibiotic for him.   The colleague gets offended when Tsesis tries to bring up the fact that there may be dangers to this strategy.   Overall, he has some harsh words for the overall system, which he calls a “grandiose global show for all those who preferred wishful thinking to reality.”

Typical hospital rooms housed between eight and sixteen patients.  In rural Gradieshti Hospital, only four inside toilets served patients in fifty beds.  Lacking hot water, showers, or baths in the main building, our patients were unable to take appropriate care of their personal hygiene and resorted to wiping themselves with wet towels.  One of the biggest difficulties for me… was enduring the smelly and stale odors from dozens of unwashed bodies…

The needles were reused, and were never sharp or small enough.  All syringes were made from glass and were reused until they broke.  Though it was common knowledge how blood-borne infections were transmitted, none of our medical instruments were disposable… The first time I encountered the word “disposable”, I didn’t know what it meant, even after consulting an English-to-Russian dictionary.  When a coworker told me that syringes and needles, so precious in my understanding, were intended only for one-time use, I thought he was joking.   I simply had no idea that disposable medical instruments had been a mandatory norm in the West for over a quarter-century…

Another factor that continually affected our ability to treat patients was poor lighting, due to the electrical grid’s low voltage…   When the electric lights dimmed or went out, we treated and operated by kerosene lamps and sometimes even by hand-held flashlights.

To compensate for these issues, Tsesis’s superiors make sure that any formal reports to their higher-ups contain manufactured data indicating widespread success and a healthy community, regardless of the actual reality.   He doesn’t believe anyone on the Central Party Committee knows what the actual truth is most of the time, as anyone who revealed it to them would be sacrificing their careers or worse.   Tsesis attempts to fill out some forms accurately, and gets reprimanded by his boss.

He is also surprised to see how reluctant the local farmers are to bring their sick children to the hospital.   As he investigates, he learns that the real reason is that the peasants in the area are kept in a state of virtual slavery:  

The kolkhoz was run essentially like a feudal fiefdom.   The peasant farmers… were all hardworking representatives of the socialist system who could not leave because their IDs (internal passports) were kept under lock and key by the village council…  Only a small number of peasants— those drafted into military service, or going away for professional or higher educations, or marrying nonresidents— were able to get their hands on an internal passport…

The “workdays” of these peasants were carefully tracked, and given that they were barely paid at a subsistence level, they could rarely afford to sacrifice a day to bring a sick family member to the hospital, or to sit with an ailing child, for any issue that didn’t seem life-threatening.   A missed workday meant a loss of food and a danger to the family’s survival.   As a result, he would see many children with major hearing loss, horrible dental disease, and dangerous respiratory infections.

I have never, ever seen such catastrophically dehydrated children as I did in Gradieshti and the surrounding villages.  In textbooks, it is written that in cases of severe dehydration— more than ten percent loss of body fluid— a child presents with symptoms such as lethargy, sunken eyes, fast and deep respiration…  But the severely dehydrated children I encountered at least once a month in Gradieshti looked like small skeletons tightly covered with skin…  It was so damn painful and traumatic to see the last sparks of life glimmering in these children…  And some parents’ struggle for daily survival was so extreme that they were forced to leave their critically ill child alone in the hospital.


One of Tsesis’s most shocking discoveries, and another factor in the childrens’ low general health,  is the fact that in this area, citizens actually need a doctor’s prescription to get milk from the store.   Milk is available in very limited supply from a rather dirty and unsanitary kitchen.   He discovers that this came about through a typical Communist policy:

Before the District Party Committee’s enlightened plan of action, every kolkozhnik family… had been allowed to own one or two cows, which supplied them with milk and other dairy products.  The chairman of the kolkhoz… announced at a general meeting that all individual cows would become part of a common herd.  The socialist bovines would be managed at a livestock farm, where they would benefit from the latest scientific discoveries, as well as a specially educated and trained staff, led by a veterinarian. 

In this “win-win” situation, the owners would supposedly benefit even more by receiving a modest sum for their share of the calculated income of the collectivized cattle.   Each family in Gradieshti would also receive two liters of collective herd milk each day from a special mobile milk cistern…

After two months, unfortunately, the milk cistern simply did not show up one morning…  The next day, they waited in vain again and returned home with empty jugs.  Eventually a group of villagers went to the village council…   “We know how important it is for you to get milk.  But we are behind in state milk deliveries, and nobody can deny that this is the number one priority.”  At this point, their cows and now their milk taken forever from them, the incredulous villagers still kept silent.  Each standing there knew well from long years of experience that protesting was not only futile but could be counterproductive and dangerous.

  And that’s how— ta-da!— forming a collective made a nonsensical shortage of one of the most common food items in Gradieshti.

Tsesis makes an attempt at least to improve the standards of the milk kitchen, through carrying out the formal inspection himself, but is unaware that the attendants are well-connected in the local Party.   He creates a crisis for his boss when he sends a report of the kitchen’s actual condition, including photos of the dirty rags used to clean the bowls and the dead flies floating in the milk, to the district party committee.    He damages his and his boss’s relationship with the local officials, which likely ends up as an influencing factor behind many of his later problems, but does manage to get the kitchen cleaned up a bit.

Perhaps the most absurd moment in the book comes when a delegation of foreign professors and students arrives to observe life in the village.   Naturally, the group is led by a leftist professor, who helps add legitimacy to the scripted and carefully managed tour they are provided.   When the visitors can’t help but observe the primitive conditions, the town officials simply remark that they are looking at old facilities, since new modern ones are currently under construction.    When one of the visitors attempts to follow up with a hard question, the friendly professor stops him and threatens to get him banned from any future trips to the USSR if he continues.     It is clear that nobody on either side is fooled.    

To deal with all these contradictions, Tsesis shares one of his main coping mechanisms, a commonality we see in many of our stories:

Despite the incessant grind of the Soviet propaganda machines, despite the terror and huge numbers of informers seemingly everywhere, the people of our Soviet paradise always fought back through humor.  Gradieshti was no different from any other place I lived.  In the face of shortages, the heel of totalitarian rule, extreme poverty, and bureaucratic ineptitude, all we could do was mockingly make fun of the utter absurdity of the Communist system.   Often the first thing loyal friends did when they met was to tell new political jokes they had just heard.  There was even a joke about the danger of telling a joke:

Two men are placed in the same prison cell.  One asks the other why he is in jail.  “For being too lazy, my friend!” “Lazy, why?”  “My next door neighbor told me an anti-Soviet joke.  It was late in the evening, so I decided to denounce him to the KGB first thing in the morning.  But he reported me the same night.”

Here are some of my other favorite jokes from the book:

A man explains to the Soviet authorities that he has to go to the United States to take care of his sick uncle.  The representative of the authorities replies, “Why would not your uncle come to the Soviet Union?  You can take better care of him here.”  The man answers, “I said that he is sick, not stupid.”

An ordinary woman walks into a Russian food store.  “Do you have any meat?” she asks the grocer.   “No, we don’t.”  “What about milk?”  “Comrade, we deal only with meat here.  Across the street there is a store where they have no milk.”

In a soviet school, a teacher asks a student, “Who is your father?”  “Stalin!” the child eagerly replies.  “Who is your mother?”  “The Soviet Union.”  “And who do you want to become?”  “An orphan.”

A man came home and found his wife in bed with a stranger.   Furious, the man shouted, “You good-for-nothing, look at what you’re spending your time for, while at the corner store they’re selling eggs and they have only three boxes left!”

A KGB officer is walking in the park and he sees an old Jewish man reading a book…  “I am learning Hebrew so that when I die and get to Heaven I will be able to speak to Abraham and Moses.  Hebrew is the language they speak in Heaven.”…  “But what if … when you die you go to hell?” …”Russian, I already know.”

Though perhaps the biggest joke, if unintentional, comes when one of the local Communist doctors tries to give a lecture on why the Soviet medical system is so superior to the West.

“As you know, last year with a delegation of leading rural physicians, I went for a week to Paris…  Comrades, French hospitals are not better than our city hospitals and their medicine is incredibly wasteful.  They have a lot of technology but it is too expensive.  Waste, waste, waste!  Their medical laboratories are unnecessarily large and stuffed with equipment for tests you never heard of…  The cost for medial imaging is astronomical.  And guess who pays for it?  People like you and me…   

“In France, they know nothing about our usual procedures, such as leeches… they consulted their smart books and had the nerve to tell me that these procedures were long outdated and replaced with more effective methods!…   Those French physicians are so infatuated with their technology that they use hundreds of antibiotics, while we need only ten!     Our hospital room hold six or eight patients, sometimes more, while theirs often have one or two sick people in a room.   Patients in these separate rooms are isolated, without a friend in the world, while the poor nurses are forced to run from one room to another…  Many hospital rooms have individual washrooms!   We have one washroom on each floor and nobody complains!…

“Soviet medicine is the most advanced in the entire world!”

<closing conversation with Manuel>

Anyway, there are many more moments of colorful village life, hilarious silliness, and medical horror for you to read in Tsesis’s memoir.   Check out “Communist Daze” through the link in our show notes at storiesofcommunism.com .

And this has been your Story of Communism for today.