Why Russia needs to legalize ‘street medicine’ Pandemic be damned, a movement of volunteer medical workers is providing a lifeline to the country's unsheltered

Under normal circumstances, unsheltered people face enormous obstacles to getting necessary medical care. During the coronavirus pandemic, this assistance has become even harder to obtain, thanks to formal limitations (unsheltered people often lack passports and state health insurance policies) and simple neglect. In Russia, so-called “street medicine” is largely responsible for providing healthcare to the unsheltered. Meduza looks at how these volunteers have built an unofficial infrastructure to protect one of the country’s most vulnerable communities.

You’re reading an article released as part of Meduza's charity support program MeduzaCare. You can read more about the program (in Russian) here.

“Street medicine” is the charity-driven, largely improvised healthcare system available to unsheltered people in Russia. The volunteers who make these programs possible are a medley of noble souls, ranging from general practitioners, specialists, nurses, and paramedics working in their free time to medical students and people without any professional training at all. Volunteers come to soup kitchens, shelters, and heating tent posts, administering primary care, dressing wounds, providing over-the-counter medications, and calling ambulances, when necessary.

Sergey Ievkov, the founder and director of the St. Petersburg project “Charity Hospital,” says his team comprises roughly 130 people, including 20 professional medical workers. Volunteers regularly come and go, he says, and every ruble donated to the group is spent on medicine. 

Despite these resources, Charity Hospital lacks the wherewithal to operate independently. The organization often coordinates with other St. Petersburg NGOs that work with unsheltered populations, such as HIV testing centers. Ievkov says his group regrettably lacks the funding necessary to help with retroviral therapy.

Since the start of the coronavirus pandemic, Charity Hospital has been forced to scale back its work with unsheltered communities and reduce the number of people it sends on each visit. Ievkov says the group has also started limiting volunteer participation to trained medical professionals, while other volunteers remain at home under self-isolation. Charity Hospital has even stopped visits to shelters because these facilities are all quarantined, and the organization now spends some of its donations on protective personal equipment for volunteers.

Why can’t unsheltered people in Russia utilize the nation’s universal healthcare?

Technically, anyone in Russia with a passport and a Mandatory Medical Insurance policy number can get primary healthcare. In reality, even unsheltered people with these documents encounter enormous hostility from both medical workers and other patients when they seek assistance at public clinics and hospitals. Sergey Ievkov says a lot of people living on the streets stay away from medical institutions “for fear of contempt, bullying, and humiliation.”

Evgeny Kovosvskikh, the creator of the Chelyabinsk project “Other Medicine,” says unsheltered people in his city are mistreated at hospitals even when they have all the necessary paperwork. When they don’t have these documents (which is very common), unsheltered people are unable to get routine healthcare and their hospital access is limited to life-threatening emergencies or situations where they’re at risk of becoming permanently disabled. 

Doctors told Meduza that many of these emergencies could be avoided relatively easily, if unsheltered persons simply received preventative care earlier. A lot of the diseases that kill people living on Russia’s streets are ordinary, treatable illnesses.

Sergey Ievkov says part of the problem is that unsheltered people often ignore injuries or ailments, allowing infections to fester. “A patient came to me after being bitten by a rat in the forest. He ignored the small wound for a week. By that time, half his face was swollen and he needed to be taken away in an ambulance. He survived. There are a lot of cases like this,” Ievkov says.

Providing direct medical aid also seems to encourage better self-care among unsheltered persons. Evgeny Kovosvskikh says he’s seen this happen when the unsheltered have regular contact with “street medicine” volunteers. “Unsheltered people have started reaching out before it’s too late, and we’re able to dress wounds and start treating infectious diseases in the early stages,” he told Meduza.

At the same time, volunteer groups are careful not to condescend to the unsheltered, avoiding the judgmental attitudes that keep many people on the streets from turning to the state healthcare system in the first place. But charities still do what they can to work with the government to improve the care available to unsheltered people. For example, “Other Medicine” recently obtained rent-free premises from the Chelyabinsk city authorities to create a space where unsheltered people can bathe and wash their clothes, which should in turn make it easier for them to go to public clinics.

Kovosvskikh says he’s also working with local medical institutions to reserve special time slots when unsheltered people can come in for help without encountering other patients who would likely sneer at them or even drive them away.

Bit by bit, volunteers and activists have managed to bridge the divide in Russia between the medical care available to the general public and the medical care offered to the unsheltered. Three months ago, Kovosvskikh’s group finally convinced Chelyabinsk officials to earmark money allocated to hospitals for surgical, therapeutic, and pulmonological treatments for uninsured, unsheltered persons. It took three years of lobbying.

Russia’s volunteer efforts with the unsheltered community enjoyed the spotlight briefly last December, when one of Kovosvskikh’s colleagues named Tatyana Avdeeva publicly asked President Putin to “legalize street medicine,” giving the volunteer movement its first national news attention. 

What is there to “legalize” in street medicine? While volunteer work with unsheltered groups isn’t against the law, the lack of regulations means doctors volunteering with charities risk crippling liability if an unsheltered patient in their care suddenly dies or becomes seriously ill.

Additionally, volunteer groups lack the resources needed to license their work under Russia’s existing regulations, which would require them to have a physical headquarters and register as a legal entity. “We don’t even have a person [on staff] who could deal with licensing without being distracted by something else,” says Sergey Ievkov. 

Together with colleagues from the “House of Mercy” Novosibirsk charity group, “Other Medicine” volunteers recently drafted a legislative proposal that would lift street medicine out of Russia’s legal gray zone. They’ve shared their idea with the federal government and hope to get a response sometime this summer.