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Communist Daze

The Many Misadventures of a Soviet Doctor

Indiana University Press

Beginnings

* * *

Let's call it, Gradieshti, shall we? An elliptical riot of twisting, unnamed, muddy alleys and streets caught between hills swarming with brush, the rural village could be found, if one looked long enough, about ten miles from Tiraspol in the Moldavian Soviet Republic (today the Pridnestrovian Moldovan Republic). When I stepped off a dilapidated bus on August 1, 1964, Gradieshti was home to some five thousand souls and an assortment of chickens, ducks, goats, sheep, pigs, cats, and dogs, including a most agreeable three-legged mutt whom we will meet in a while. Stepping over a stray dog lying sprawled and still in the heat, I set on the ground two small pieces of luggage — one filled with medical books, of course. Taking a deep breath, I looked around at my new home.

A huge Communist propaganda poster, faded by time and weather, gazed down on me. Welcoming me to Gradieshti was a large, radiantly smiling peasant woman with hands raised wide and dressed in Moldovan folk costume. Seemingly endless wheat fields rolled into the distance behind her. The bottom of the poster proudly proclaimed, glory to THE HANDS THAT SMELL OF BREAD.

Rolling my eyes, I took a few steps, squinting in the bright sunshine and hoping for a glimpse of the real Moldovan village where I had been sent to serve and practice.

Well ...

Under a scorching noon sun, color seemed to have fled Gradieshti, like most Soviet villages, long ago. Most streets and public areas were bare of vegetation. Thatched, one-story adobe dwellings made from a mixture of muted local clay, water, straw, and horse manure crowded rutted unpaved streets. Some houses were sheaved with just branches and twigs coated with clay on both sides. Primitive fences made from rough unpainted boards or branches and twigs struggled to hold in gardens that, I soon learned, oozed thick black mud after rain. Every now and then I heard the unmistakable sounds of small livestock in a handful of backyards, signaling those lucky enough to enjoy meat and eggs, which were rarely available in our stores.

Lacking street numbers and resigned to gray, the venerable houses of Gradieshti were jumbled together around a centrally located public center plaza, where stood communal buildings housing the village council, the collective farm management, the rural post office, a small pharmacy, a milk kitchen, a dental office, a large two-story high school made of bricks, and the Village Cultural Center, which boasted a library and a spacious assembly hall. (The church on the plaza had been destroyed decades before.)

There was nary a person or car in sight, though I did spot a few horse-drawn carts and heard the puttering of a motorcycle. Shaking my head and sighing, I picked up my bags and began trudging along the two-lane asphalt road on the outskirts of town. Somewhere beyond the exhausted dogs and cats wandering in the heat were the village hospital and my new job.

* * *

My journey toward that little gray village had begun months earlier, before graduation from the medical school in Kishinev (now known as Chisinau, the capital of the Republic of Moldova.) As a Russian Jew, I had not dared to think of becoming a student there — Kishinev had long been a hotbed of antisemitism. My dear parents, however, had used all of their life savings for a bribe that opened the door to my highest dream. I was so happy, having long yearned to become a physician and to practice the most meaningful profession. Among the books from my childhood, many romanticized the field of medicine, and I wanted to be a part of it. I especially wanted to help children.

It was so exciting to start those six years of tuition-free medical school! My time as a student began with service to the state — required work "for the glory of the Socialist Motherland," as our saying went. On the day before my first year began in August 1958, we newly fledged students were informed that we were being "entrusted" with "a high honor" of helping kolkhozniks (farmers) harvest the cornfields of Sarata-Nova, located about forty-two miles southwest of Kishinev.

This order was not uncommon. An abiding socialist practice of the Soviet era was the massive use of urban populations as seasonal workers in agriculture, mostly for harvesting crops during fall seasons. During harvest, an army of high school, college, and university students as well as workers and employees from countless enterprises were transported to the country to help the farmers bring in crops. Every late summer and fall, present and future professors, engineers, doctors, teachers, musicians, and humanitarians from all over the country spent two to eight weeks harvesting corn, potato, carrots, apples, and grapes. Although students were hardly ever paid for this work, workers and employees continued to receive their regular salaries.

The official reason for the yearly mass exodus of urban dwellers to villages was always the same, each time I heard it: "This year it was a surprising bumper crop (Gasp!) and there is no way, dear comrades, for the local residents to gather it by themselves!" I didn't really mind this time, being in good spirits about starting medical school and accustomed since high school to being sent to the country to harvest corn and grapes.

A fleet of buses soon delivered us first-year college students to the village of Sarata-Nova. We were lodged in classrooms of a local school: women on the first floor and men on the second, about twenty students to a classroom, all sleeping on mattresses strewn on the floor and stuffed with the highly lauded "best-quality" straw. As running water was absent inside and outside of the building, we washed up using water brought in a cistern. On each floor stood a water tank, complete with spigot and attached copper mug, from which everybody drank. A special treat awaited us out back — a decades-old brick outhouse without partitions between the holes. Undoubtedly built way back during the October Revolution, this most attractive facility accommodated up to fifteen of us students on full display at the same time, putting into practice the Russian expression "[TEXT NOT REPRODUCIBLE IN ASCII]," or "There are no secrets among community members."

Young, heady, and exuberant about the opportunity to fight hard for my medical career, I worked steadily in the cornfields and, yes, sang with loud gusto for four weeks. I really enjoyed toiling in the fresh air under the generous warming rays of the Moldovan sun, surrounded by green fields and feeling the tender touch of wind gusts. Against my will — probably because of my enthusiasm — I was soon appointed to be a [TEXT NOT REPRODUCIBLE IN ASCII], or field-team leader. Unfortunately, I was never good at telling people what to do, especially in situations like this, where my commitment to work exceeded the other team members. They had been admitted to the medical school easily and without problems, and now, restless and full of energy, most wanted to have a good time rather than harvest corn for the state. My desire to be a role model and to inspire my field-team failed utterly — everyone else seemed to work faster, without songs to motivate them — but the effort did not go unnoticed.

One day, as usual, I was enthusiastically cleaning corncobs and adding them to the large pile on the ground. Full of zeal, I was singing my own words to the melody of a popular song "Rio de Janeiro":

To village Sarata-Nova
I came to harvest corn,
And now I am sure
That here I was born

Two of our notables suddenly stepped out from a thicket of tall corn plants to my left. The Komsomol (All-Union Leninist Young Communist League) leader Petru Sarakutza, recently discharged from the army, and one of the Senior Students (crapocra,) Kolya Chernenko, had been observing my fired up labor. They walked past, speaking to each other and ignoring me completely.

"I told you, Kolya," insisted Sarakutza, "even though he is a Jew, this guy, Tsesis, works like a horse."

Pausing for a moment, the Senior Student shrugged as they strolled away. "OK," he muttered, "we will see how he will behave in the future."

Apparently, the Senior Student was never fully convinced. During a general meeting of students some time later, a classmate sitting next to me asked whether we would be paid for our daily work. This question, for some reason, made Chernenko very nervous.

Piercing me with his eyes as if I was the one who had asked the question, he snapped, "To those like you — and everybody understands what I mean by that — let it be known, that the rest of the students are here to help our brothers and sisters in the village. Unlike you, they are not thinking about material rewards."

This was nothing new. Acquired by birth and not by choice, my ethnicity, as always, worked against me. I had heard hate speech during my younger school years, and now the cancer was surfacing again in medical school. Initially hurt by such contemptuous manifestation of a sick mind, over time, I — more or less — had developed immunity to it. Now, it made me even more determined to work hard and do what I wanted: become a doctor.

A few months later during my first year in medical school, I crossed paths again with the other notable, 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 by referring to the structure of atoms. Looking very puzzled, my pupil lit a cigarette, leaned back, and casually inquired through a cloud of smoke: "But what is ... an 'atom'? "

Petru Sarakutza later went on to become an instructor in the Department of Biochemistry there, another bright Communist future guaranteed. It figures.

* * *

Let's fast forward through years of dedicated schoolwork and getting married to my lovely wife, Marina. About five months before graduation, it was time once again for me to work "for the glory of Socialist Motherland." I was asked — well, instructed — to become a military physician. During a short interview with an army colonel, I firmly refused to sign the army contract, since doing so would have forced me to serve in the military for twenty or more years, like my father, a career officer. Lowering his voice, the colonel told me that if I did not sign, he had official orders to prevent me from passing all my graduation examinations. Perhaps a bluff, maybe the truth, but I had no choice. I signed the contract and became resigned to continuing the family tradition. Marina and I braced ourselves for the nomadic and unpredictable life of an army medical officer, but months passed with no word from the military. Finally, confused about what was going on, I went to a military representative for an explanation. To my immense relief, I learned that "the Moldavian Republic currently has a critical need for pediatricians, and therefore, you cannot be drafted into the army."

Whew.

I soon realized that there was a shortage of pediatricians everywhere during that time, and there was a good reason for it. So many of my classmates at medical school who came from rural areas stubbornly insisted on being transferred from pediatric to internal medicine specialties. It was all because of politics. The catastrophe of child mortality in the Soviet Union was so bad and widespread that it could not be hidden from the rest of the world. All attempts to reduce its prevalence were unsuccessful. Child mortality, as an indicator of the overall quality of medical care, was constantly under the microscope of the party functionaries responsible for public health care. Politicians harassed medical professionals about the necessity of improving the statistical data. Childcare providers were called to meetings and seminars where they were reprimanded if child mortality was high in the locality under their responsibility. Thus rural areas were badly understaffed with pediatricians. Few physicians were willing to work in the countryside where they would be paid less, work longer hours, lack adequate backup by specialists, and wrestle with poor laboratory and medical imaging capabilities.

So, my services were desperately needed.

Two months before graduation from Kishinev Medical School in 1964, all of us last-year medical students gathered at the grand auditorium for orientation about our future employment. The key speaker for this important occasion was the Minister of Public Health of the Moldavian Soviet Socialist Republic, Nikolai Andreevich Testemitsanu, a former surgeon, born and raised in a Moldovan village.

"Most of you will be sent to work in the country," he announced. "The Motherland provided you with a free education. Now it is time for you to repay your Motherland and help people in rural areas by providing quality medical care."

In exchange for six years of free professional education at the medical school, graduates were required to work in underserved areas for three years. To ensure the mandate was carried out, we graduates would receive our diplomas only after fulfilling that obligation.

Naturally, there were special exceptions to the rule. A diploma was immediately given to male students drafted into the army, to women who were married and pregnant, and to a privileged group of students who were awarded well-paid research and teaching positions at the Kishinev Medical School itself. Those elite few were children of the party elite or indigenous Moldovans whose fellow villagers or relatives already occupied teaching positions in the medical school.

Some in this select group were shockingly undereducated. 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 and failed it repeatedly. Due to his high-level connections, he was not expelled but was permitted to take the same anatomy course three years in a row until finally passing the test. 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. Apparently, the nominating committee had concluded that three long years of studying the same damn material had produced a brilliant expert on the subject.

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. Time and again, I met and worked with representatives of the honorable medical profession — ignoramuses with a doctor's coat and stethoscope — who just were not appropriately prepared to provide qualified help. It is thus not surprising, but such a national disgrace, that the level of medical research was of such low quality that research papers then were rarely published outside of the Soviet Union.

Not having connections like the esteemed and most learned Dr. Istrati, I was appointed kustovoj pediatr, which can best be translated as "provincial pediatrician," for the rural village of Gradieshti in the Moldavian Soviet Republic. At the young age of twenty-three, as a fledgling specialist, I also assumed responsibility for the health of a large population of children living in five smaller, surrounding hamlets. In such places, medical care often rested in the hands of feldshers, medical or surgical practitioners, who lacked full professional qualifications or status (something like physicians' assistants in the United States). I was not unhappy with the assignment, as Gradieshti was relatively close to Odessa, where Marina was attending the Meteorological College and living with her mother. We would be able to meet from time to time, especially on weekends.

Well, it sounded like a good, simple plan to see each other regularly. Actually getting there and back sometimes proved to be, as you will see, quite ... interesting. As was my mother-in-law.

* * *

So, there I went, and here I was now, stubbornly plodding the asphalt road outside of gray Gradieshti, caught in the sweltering glare of noon sun. Eventually, I reached the hospital grounds and the relief of shade: Unlike the rest of the village, the hospital grounds boasted generous, lush old trees and bushes that flourished along paved alleys, free of mud and ruts. I followed one of them to the hospital's main building — decades old, L-shaped, single-story, sheathed in brick, capped in iron, and sporting a row of double-framed windows on each side. A woman orderly, dressed in a white gown, directed me to the office of the hospital's chief doctor. (In small rural hospitals, the hospital's chief or senior doctor combined their administrative duties with the responsibilities of a regular physician and were paid correspondingly more money.)

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Excerpted from Communist Daze by Vladimir A. Tsesis. Copyright © 2017 Vladimir A. Tsesis. Excerpted by permission of Indiana University Press.
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