author: Elena Trifonova
photographer: Anton klimov
(irkutsk city)


Chief doctor of a hospital in a small settlement which is called Balagansk wants to build a new one, but the deputies of the local government have another point of view — they wish to fire him, because of the lack of doctors in the hospital.
On the desk at the Gombo Tsydenov's office — the chief doctor of a hospital in Balagansk — there are two big monitors. Facebook is opened on one of the screens. There, on his feed, he posted kind of demotivator on the 7th of May: «If a policeman gets a bullet during the operation — he is a hero. If a fireman gets a burn during the putting the fire out — he is a hero. If a doctor got infected while being on duty, it means that he himself is the reason to blame, because he did not work according to the requirements of Sanitary Rules and Norms».

His father in his age also dreamed of building a hospital in his native village of Nizhniy Torey in Buryatia. Almost built — there was a brick box, a roof, a substation, a boiler room. Then the 90s came and everything died out. Now the box has already been dismantled into bricks. His father was worried. His brother became the chief doctor of one of the districts in Buryatia. He also began building of a hospital, but failed to finish it. Hadn't worked well with the locals, spat and left.

— I am an adrenaline addict, — says 48-year-old Tsydenov about himself. — Probably, that's why I became a resuscitator. I love the operating room, difficult cases. The desire to build a hospital has the same reason.
From Irkutsk to Balagansk — 279 kilometers. It is five hours to drive along the road by «GAZelle» Ambulance, provided that the trip takes place on the road which is very similar to a grater. There are 8,800 people living in the Balagansk region. The local hospital has 54 beds, one is an intensive care unit. There are 8 beds in the infectious diseases department, however, there is no infectologist. There are only three ventilators in the hospital.

In the office of the chief doctor there are double-glazed windows, in the corridor there are double wooden frames, as in the old houses of the Angara people. The door is opened, and the wind from the street smells like river water. Electrical wiring runs along the walls of corridor. Wires are attached to door frames, wall clocks. You can see the inscription «paid services» above the wall which is not attached to anything and hangs freely from the ceiling. Some years ago the linoleum on the expanded floor was brown, but now the shade is indistinguishable. In some places it is rubbed through, and wooden floorboards appear there, 40 centimetres wide.
Balagansk has been waiting for the new hospital for the last 20 years. Three years ago, they finally began to develop design and estimate documentation. The project costs 770 million rubles. In April, the deputies were supposed to amend the regional budget and allocate money. But due to the coronavirus, that issue was postponed.

— I was stopped by COVID on-the-go, — said Tsydenov. — I am afraid that our project will be suspended for a large period of time.
37 doctors

Have to be
17 doctors

According to the documents
12 doctors

Real number
Last summer Gombo took a leave of absence, got into his Mark II and with his brother set off on the most extreme journey in his life — to look for health workers in Zabaykalsky Krai. Brothers felt as they are head hunters. Actually, it was a desperate move, as a shortage of workers is an urgent problem in the regional hospital.

There is a severe lack of doctors in Balagansk. The list of doctors is given on the hospital website — there are 17 surnames. But paramedic Tatiana Philimonovna said that, in fact, only 12 doctors work in the hospital. For the last three years had been resigned the same amount. For the village — it's a catastrophe.

Recently ENT doctor sold her house and also is going to leave the hospital. Some other workers just quitted their houses to work in the major cities in the region. According to Tatiana, there must be 37 doctors in the hospital. Indeed, there is only a third of the norm. To tell the truth, the shortage of health workers is anywhere. In a neighboring Novonucutskoy doctors coverage is only 50%. Irina Zambilova, who is a surgeon in this hospital, said that it's the best score among neighbouring districts.
«I was told by the minister, that I should look for health workers in the places, where people live much worse than we do. I made the list: Nerchinsk, Zabaykal'sk, Borzya. Went there».
— How did it go?
— I not only broke into people' reality, I was intended to lure away health workers. But there is no place to go, I came a thousand kilometers. I had made a strategy: put on a lab coat and a smile at the entrance, and pass by emergency room confidently. Definitely, you will be stopped and asked: «Whom do you come to?». At this moment you start getting out of the situation. Every case is different, depends on how it goes on. Sometimes you say – to the patient, sometimes – to a doctor you know. If you reach the doctor's lounge and find anybody, you'll begin to describe in colors how beautiful our hospital in Balagansk is, how huge our salary is. Then you stuff flyers in their pockets and run as soon as possible.
— But if you came across a head doctor?
— It happened in Aginskiy district. I went there to my familiar surgeon. I was fairly certain, that I would poach him. Sat down with him. I put all information and he said: «I have been promoted as a head doctor for two weeks. Stay away from this place». It was a real flop. I had to screw a bottle.
Gombo didn't managed to appeal any specialist during this trip. Last year he found a paramedic at the job fair in the neighbouring regional center.

Someone to lure away workers even prepare performances. Last spring a head doctor put on Russian traditional costume and song to students the soundtrack. No one was eager to go to his hospital — seven people decided to join a head doctor from Sakhalin. He did not sing — just showed the sum of future salary.

This Summer Tsydenov is going to head hunting again. There is another Siberian region in his mind. Which one exactly — he doesn't reveal yet.
Lama said to me: «When you are standing at the feet of the dying person, his soul is hanging on the right from his body, in the upper corner. There you should address». Indeed, it helped me many times. When you do not know, what to do — you're persuading it: «Come back. What do you need from me? I've done my best». From the side it may look quite hilarious.
Maybe there will be no need for Tsydenov to drive for doctors. The head of the local Duma Yuri Lagerev says: if the Minister doesn't consider the complaint,we will go to the Governor.

— People have flooded us with complaints on lack of doctors. They demand: «Well, do something. What for are you here otherwise?»

All the while these has been no single therapist in the district. Now only one pediatrist is working at the hospital. People reserve their place in a queue from 6 am. Tsidenov introduced a take-a-number system, but no one is actually using it. The citizen of Balagansk Larisa Klypina says, that it's impossible to make an appointment with a pediatristanyway.

The paramedic explains: doctors quit their job because if the low wage. For example, an ultrasound doctor working at 1.5 rates gets 32 thousand rubles and is going to sue. According to the Presidential Decree, the average salary of a doctor in the Irkutsk region is 77 thousand rubles, a nurse or paramedic — 36 thousand. Relying on the official report of the Balagansk hospital, these indications are maintained here.
According to Filimonova, Tsydenov's wife works as a financier in the district hospital. Doctors have questions about this. According to the law «On fighting corruption», the head cannot take close relatives to the positions of their deputies, chief accountant and his deputies, cashier. Immediately there occurs a conflict of interest.

Tsydenov answers all this shortly: I'd started putting things right and many people did not like it. Who wants to earn — earns, and the rest will not be forced. Filimonova says some doctors get a hundred thousand or more. But why there is such a difference in salaries, she does not understand.
— Sometimes people die very hard. You see it all the time. You can't get used to it, Gombo says. — At some point, it became simply unbearable. Then I went to the Lama.

Lama explained that the body is a coat. If the coat sleeve is torn off, the doctor can help to mend the hole, to sew buttons. But if the soul doesn't want to come back, there's nothing you can do about it.
«What to answer to the words of the correspondent... Answer that everything is freaking us out? To be responsible for the sheds, so called hospital; that paying someone's declared wages is a path to ruin; that no one goes to these frozen villages and settlements; that there is no life beyond the Moscow Beltway… That he feels sorry for the locals, ashamed of what is happening. He took a moment and wrote: «It's all right! Here is such a nature, hospitable inhabitants, here is a beautiful air! It's good to live here. Bored? No, I meant that there is no leisure time yet, that there are no normal sections, no swimming pool. Oh my God, what am I talking about...» .
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