МЕДИЦИНА И ЗДРАВООХРАНЕНИЕ В РАЙОНАХ ПРОЖИВАНИЯ КОРЕННЫХ МАЛОЧИСЛЕННЫХ НАРОДОВ СЕВЕРА ЯКУТИИ В 1980-Х ГГ.

МЕДИЦИНА И ЗДРАВООХРАНЕНИЕ В РАЙОНАХ ПРОЖИВАНИЯ КОРЕННЫХ МАЛОЧИСЛЕННЫХ НАРОДОВ СЕВЕРА ЯКУТИИ В 1980-Х ГГ.

Научная статья

Егоров П.М.*

ORCID:0000-0002-1107-2662,

Институт гуманитарных исследований и проблем малочисленных народов Севера Сибирского отделения РАН, Якутск, Россия

* Корреспондирующий автор (epm77[at]mail.ru)

Аннотация

В статье на основе архивных источников рассматривается состояние здравоохранения и медицины в районах проживания коренных малочисленных народов Севера Якутии впервой половине 1980 годов. Здоровье коренных народов обусловлено весьма специфическим характером жизни в суровых климатических условиях, а также характером их ремесел и питания.

В 1980-х гг. в Якутской АССР в районах проживания народов Севера были полностью укомплектованы врачами и средним медперсоналом. Однако, в указанный период в сельских, и особенно в Арктических районах Якутии не удалось разрешить кардинальные проблемы строительства жилищно-коммунальной инфраструктуры медицинских учреждений. Сельские медучрежде­ния часто находились в неприспособленных, а значительная часть в ветхих зданиях, в которых не было водопровода, канализации и внутреннего туалета, и даже центрального отопления.

Ключевые слова: коренные малочисленные народы Севера, Якутия, медицина, здравоохранение.

MEDICINE AND HEALTH CARE IN THE PLACES OF RESIDENCE OF THE INDIGENOUS PEOPLES OF YAKUTIA IN THE 1980S

Research article

Egorov P.M.*

ORCID:0000-0002-1107-2662,

Institute for Humanities Research and Indigenous Studies of the North, Russian Academy of Sciences, Siberian Branch, Yakutsk, Russia

* Corresponding author (epm77[at]mail.ru)

Abstract

Based on archival sources, the article examines the state of healthcare and medicine in the areas where indigenous peoples of the North of Yakutia lived in the first half of the 1980s. The health of indigenous peoples is determined by the very specific nature of life in harsh climatic conditions, as well as the nature of their crafts and nutrition.

In the 1980s in the Yakut ASSR, the areas where the peoples of the North lived were fully equipped with doctors and paramedical staff. However, rural medical facilities were often inadequate, and there was a significant part in dilapidated buildings, in which there was no water supply, sewage and internal toilet, even central heating.

Keywords: indigenous peoples of the North, Yakutia, medicine, healthcare.

Introduction

Recently, in connection with climate change, melting glaciers, the natural resources of the Arctic have attracted close attention not only of the Arctic states, but also of the countries of the European Union, China, Japan, South Korea, India and others. Therefore, Russia faces the challenge of developing Northern Sea Route and the shelf of the Arctic Ocean. Arctic territories should turn into a zone of continuous human economic activity [8, P. 5]. The successful development of the natural resources of the Arctic and the North is closely linked to the health of the population living there. The living conditions in the Arctic are extreme for humans. The organism of the northerners adapted to the conditions of the Far North has significant features in the metabolism. Thus, the indigenous population is dominated by protein-fat metabolism in contrast to the carbohydrate metabolism, which is typical of residents of the southern and middle climatic zones [1], [9]. Northerners have their own characteristics in the structure and function of the cardiovascular, respiratory, nervous and all other systems, organs and tissues [12].

The health of indigenous peoples is determined by the very specific nature of life in harsh climatic conditions, as well as the nature of their crafts and nutrition. The state of health of the indigenous population largely depends on how the network of medical institutions is developed, what kind of personnel they are provided with [11, P. 357]. However, at the same time, in the modern period there is a problem of maintaining ethnic groups in conditions of depopulation of the indigenous and small peoples of the North of Russia [3], [6].

Extreme climatic conditions make it necessary to develop a life support system based on accumulated experience and the creation of new principles for disease prevention and medical care. In this regard, the task of studying the Soviet experience of circumpolar and Arctic medicine, as well as protecting the health of the indigenous peoples of the North in Yakutia in the early 1980s, becomes urgent in the industrial development of the Arctic.

Methods

The study is based on a secondary analysis of statistical archival sources devoted to the problems of medicine and health care in the places of residence of the indigenous peoples of the Republic of Sakha (Yakutia) in the 1980s. Their use, along with a system analysis method, made it possible to study the state of medicine and health care in Yakutia in period of social and ethnocultural processes of the 70s and 80s of the XX century. The authors in the course of their work relied on the principles of objectivity, historicism and systematicity in the studied circle of problems, a comparative analysis of phenomena, facts and documents. The main research method was chosen as a system analysis using quantitative and qualitative methods for collecting and processing information.

Results

The Soviet period in the history of Yakutia was associated with the large-scale industrial development of its natural resources; in the 1970-1980s, the Yakut ASSR was considered an industrial-agrarian republic with high prospects for the further development of industry in the republic. In the 1970-1980s, industrial enterprises were operating in all Arctic regions of Yakutia; however, their development was characterized by great unevenness.

Reindeer husbandry is a traditional branch of agriculture in most areas of the indigenous small-numbered peoples of the North of Yakutia.

In the 1980s in the Yakutia, 19 districts belonged to the areas of residence of the peoples of the North: Aby, Aldan, Allaikhovsky, Anabarsky, Bulunsky, Verkhnekolymsky, Verkhoyansk, Zhigansky, Kobyaysky, Mirny, Momsky, Nizhnekolymsky, Oymyakonsky, Olemyksky, Tomsk, Maynek Ust-Yansky and Iengra of the Neryungri district. The area of these regions is 2.529.400 sq. km. or 81,5% of the entire territory of the republic. As of January 1, 1982, there were 6 cities, 46 urban-type settlements, and 125 rural Soviets in the regions where the peoples of the North of the Yakut SSR lived.

The population in these areas according to the 1979 census amounted to 362,500 people or 39,7% of the total population of the republic, including the urban population of 253,200, the rural population of 109,300 [10]. According to the All-Union Population Census, more than 22 nationalities of the North, Siberia and the Far East lived in these areas. Among the small peoples of the North, Evens, Evenks, Chukchi, Yukagirs lived here. The number of Evenks and Yukagirs in comparison with the 1970 census increased 12,7 and 13,1%, respectively, the number of Evens and Chukchi slightly decreased. Of the total number of Evenks of the republic, 89,5% live in areas inhabited by ethnic groups of the North: Evenks - 86.0%, Yukagirs – 88,2%, Chukchi – 89,1%. Evenki mainly live in areas: Oleneksky, Bulunsky, Aldansky, Zhigansky, Ust-May, and in the village Iengra of the Neryungri district; Evens - in Verkhnekolymsky, Nizhnekolymsky; Chukchi - in the Oymyakon district.

As of January 1, 1982, in the regions where the peoples of the Far North lived, there were 131 hospitals, 174 feldsher-obstetric and feldsher posts, 148 medical outpatient clinics, which employed 1214 doctors of all specialties (without dentists) and 3881 paramedical personnel.

The areas of residence of the peoples of the North in 1981 were fully equipped with doctors and paramedical staff. So full-time posts of doctors (without dentists) included 1073 people, individuals - 1214, the percentage of staffing was 113,1. Accordingly, the average medical staff was 3551, 3881 people and 109,3%. But, despite being staffed by doctors, indicators of security (33,4) per 10,000 people were below the level of the Autonomous Soviet Socialist Republic (34,0) and below the figures for the Russia (38,0). In only one Abyysky district the indicator of medical supply was 39,2. In all other areas it was lower than it was in the republic and Russia [4].

Outpatient services for the population in the areas of the peoples of the North were characterized by the following data:

 

Table 1 – Outpatient and polyclinic services for the population in the areas of residence of the peoples of the North of Yakutia

Years	Made by visits by urban and rural residents			Average visits per inhabitant per year
	Total	In urban areas	In rural area	Total	In urban areas	In rural area
1979	2256,0	1782,5	473,5	2,7	3,5	1,5
1980	2352,1	1829,3	522,8	2,7	3,4	1,6
1981	2527,7	2073,0	454,7	2,8	3,6	1,4

 

As can be seen in table 1, residents of the countryside due to the lack of appropriate specialists in the 1980s were forced to seek medical help in city hospitals.

In order to improve the health of the population, prevent morbidity, and injuries, preventive examinations were regularly conducted in all areas during the indicated period. However, in 1981, for example, the plan of preventive examinations to be performed was carried out only in the Aby district (101,5%). The remaining areas of this plan were not implemented. In comparison with 1980, the percentage of medical inspection decreased in Aldan, Allaikhovsky, Anabar, Kobyaysky, Oleneksky, Tomponsky and Ust-Yansky districts.

During this period, in the rural, and especially in the Arctic regions of Yakutia, it was not possible to solve the cardinal problems of the construction of housing and communal infrastructure. In 1981 in the Yakut Autonomous Soviet Socialist Republic only 7 out of 716 rural settlements had water supply, in two there were canalizations, three were connected to the gas network. A little more than one third of the socialized housing stock was connected to the central heating system. During this period of organizational and economic reorganization in the countryside, the main attention was paid to the construction of production facilities, and the formation of rural social and household infrastructure was considered in the republican management scheme as a secondary task [2].

 The World Health Organization (WHO) has established criteria for providing the population with inpatient medical care (per 10 thousand inhabitants): the minimum level is below 40 beds; medium - from 40 to 70; high - from 70 to 100; very high - 100 beds or more [5]. In accordance with the above criteria, the Arctic regions of Yakutia, as well as all of Russia and Yakutia, should be assigned to territories with a very high level of hospital provision for the population.

Thus, the provision of beds per 10,000 people in these areas amounted to 132.7. However, at that time, the bed provision rate was lower than that in the republic: 142,3 and 139,0 in the RSFSR. In areas such as Ust-Yansky 129,0, Kobyaysky 131,0, Aldan 127,3, the standard of providing the population with beds was lower than the standard of providing in general for the areas where the peoples of the North live. Insufficient provision of beds is due to insufficient construction of medical facilities.

However, N.N. Tikhonov in his work will raise the question: could the population of the region satisfy this "very high" level of medical facilities? Apparently, they could not. The fact is that the vast majority of rural medical institutions in Yakutia were housed in the non-adapted buildings, a significant part - in dilapidated buildings that lacked not only a water supply, sewage and internal toilet, but even central heating. Many rural hospitals had to make lake ice for drinking and sanitary purposes. Obviously, it is impossible to prepare as much ice as is necessary to fully meet the needs of the hospital according to modern sanitary standards, and in such conditions there is always a danger of spreading infection in the hospital. Therefore, it is difficult to argue that in some serious outbreaks in rural areas of viral hepatitis, bacterial dysentery, tuberculosis, the hospitals themselves were not to some extent to blame [11].

In 1979, there was a significant increase in the incidence of acute infections, for example, the incidence of infectious hepatitis increased by 54,8% from 1970 to 1979 (per 100 thousand people, it increased 2.3 times).

The incidence of typhoid fever in 1979 compared with 1970 increased 2.2 times, since 1978 - by 26.1%. The largest number of cases recorded in 1979 was in Verkhoyansk and Ordzhonikidze (Khangalass) regions [7].

Inhabitants of the Arctic regions, due to a rare network of medical institutions and difficulties with transport, suffered from mild forms of the disease “on their feet,” which led to complications, severe chronic diseases, or even death. So the death rate (per 1000 people) in the Olenek and Verkhoyansk regions in 1982 was 12,3 and 11,3 people, or 40 and 28% higher than the republic average. For example, in the tundra regions of Yakutia per 100 workers, there were 1,5 times more cases of pneumonia and 2 times tuberculosis compared with the suburban areas of Yakutsk, where settlements are relatively compact, and transport is well developed.

The incidence of gastrointestinal infections was largely influenced by the sanitary state of cities and towns and poor-quality wastewater treatment, the lack of sewage and water supply. Large overcrowding in children's institutions led to a violation of sanitary and hygienic standards and contributed to the frequent occurrence of infectious diseases.

Conclusion

In the 1980s in the Yakut Autonomous Soviet Socialist Republic, the areas where the peoples of the North lived were fully equipped with doctors and paramedical staff. However, residents of rural settlements due to the lack of appropriate specialists in the 1980s were forced to seek medical help in city hospitals. In order to improve the health of the population, prevent morbidity, and injuries, preventive examinations were regularly conducted in all areas during the indicated period. In accordance with World Health Organization criteria, the Arctic regions of Yakutia of that period, as well as Yakutia and the rest of Russia, should be assigned to territories with a very high level of hospital provision for the population.

However, during this period, in the rural, and especially in the Arctic regions of Yakutia, it was not possible to resolve the cardinal problems of the construction of housing and communal infrastructure of medical institutions. Rural medical facilities were often inadequate, and there was a significant part in dilapidated buildings, in which there was no water supply, sewage and internal toilet, and even central heating.

In recent decades, the health status of the population in the Arctic regions has significantly decreased compared to the Soviet period. It should be noted that the attention paid by state bodies to solving the existing socio-economic problems of residents of the Arctic and northern regions of Yakutia is not enough.

In this regard, in our opinion, it is necessary to strengthen the work on creating the necessary conditions for improving medicine and health care in the areas where the peoples of the North live. In particular, the provision of a sufficient number of highly qualified doctors and nurses, the construction of new well-equipped hospitals, the provision of modern medical equipment, the improvement of the general standard of living of the population, the improvement of working and living conditions, the increase in the level of remuneration of medical workers, the development of transport infrastructure. Undoubtedly, all of the above factors would significantly improve the health situation of people not only in the areas where the peoples of the North live, but also for the entire population of Yakutia.

Конфликт интересов Не указан.

Conflict of Interest None declared.

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