But We Are Not Heard"
with Dr. Swetlana Rafaelevna, Director of the Maternity Hospital in
following interview was written for Chechan readers. It would have been
grotesque to have described to them in detail the unbelievable
which the work in the maternity hospital has to be carried out. The
are aware of their situation; they know what 10 years of continual war
hospital in Grosny is the only one in the whole country. The women come
all over the republic, and have to pass uncountable guard posts to get
For the Chechnyans the maternity hospital is a symbol of resistance
occupying forces, an island in the midst of the terror which is capable
providing glimpses of happiness. Never before have so many children
in Grosny: 30-50 children are born in the maternity hospital every day.
hospital has no heating, only seldom electricity, the water has to be
from a well and only two buckets are at the disposal of the whole
material is not sterile, there is no disinfectant, the instruments are
with water in a bucket, the disposable gloves are used as long as
Very often the births take place by candle light or in the light of a
lamp because the Russian soldiers shoot for fun at the electric cables
The mothers often
cannot breast-feed their children, they have no milk, are
and anxious about their sick children. Only one in eight children is
birth. The nights are hardest for the women. Danger comes at night. It
that death squadrons move through the country. Will my husband still be
Will he be a human wreck, having been tortured, traumatised,
to the depth of his soul - or is he dead already? These are also
which Swetlana Rafaelevna and her team have to deal with. We feel
before them; they are helping to replace death and violence with new
Swetlana Rafaelevna, the population of
Chechnya is going
through difficult times at the moment, especially for the women and
How would you characterise the situation of the only maternity
remains in Grosny?
The situation is not ideal; we
really are in a fix. The project of the Ministry of the Interior for
planned 220 beds, but only 110 have been given to us, and only 100 of
at our disposal. There used to be three maternity homes and one
ward. Today there is only one maternity ward in City Hospital Number
course, this is not enough for a city. The population is increasing
In 2000, the number of births was 585, in 2001 it was 1,500 and in 2002
reached 2000. Today, this number has been surpassed by a figure of
the only maternity home which includes a department for pregnancy
have only got 30 instead of 70 hospital beds at our disposal.
order to carry out sanitary measures, we must close twice a year. But
nobody who can take over our pathology department. The hospital staff
white-wash, paint, wash etc. and at same time take care of the pregnant
those giving birth. Of course, this is very difficult, but we have been
I talked to
the pregnant women and nearly all of them complained about the water
water is not only a problem for us, but for the entire city.
and the reanimation department exist here in the hospital, but the
Department has not allowed us to use them because water pipes have not
been installed there. 'Wodokanal' and 'Groztrubostroy' are still
who is responsible. Everything also depends on financing. One of the
is that 'Wodekanal' has no plans of the water pipes in the maternity
only person who knew where the pipes were was unfortunately killed
have been cooperating with 'Doctors Without Borders' for three years.
given us a lot of support and are prepared to finance all the costs of
the water pipes. If the French back this project, the anaesthetic
and reanimation department with its 10 hospital beds could move into
building; and then the free space could be taken by the department of
pathology. At the moment we are unfortunately forced to refuse help to
women because we lack beds for them. The problem is that if we do not
woman today, she will come back tomorrow with oedemas, and the day
tomorrow with oxygen problems for the embryo etc.
well known that in Chechnya today most women live in poverty. Their
for earning money is at market. But not all of them are capable of
business. Oftentimes a mother is also a wet nurse. If she then gets
addition to this dual occupation, she will no longer have the time to
go to a
doctor and look after her health. Lack of health care causes her
situation to deteriorate
further. That in turn leads to more premature births, and premature
practically no chance to survive because their lungs are not capable of
breathing properly. Those are serious losses.
What medical measures can be taken
in your maternity
hospital in order to save the lives of premature children?
be honest: none. There is one (!) incubator where we can put a smaller
normal child, but the problem is that such a child needs to be
easier to treat a child injured during birth that one that has been
for a long time. That's where we have most of our losses.
Can you give me the number of these
of course. I'll give you the number for the first three months. Out of
smaller than normal children, seven died. Of those six were premature
Children: 75 premature births; 14 with genetic defects; 11 with
sustained during birth. Sick women: 233 women had problems
oxygen to the embryo; 578 with anaemia, nine with severe anaemia; total
fatality rate 0.9 %
What sort of developmental
abnormalities occur and what is
their percentage of the whole?
Unfortunately there are more
developmental abnormalities with children. It's difficult to give an
Spina bifida (underdevelopment of the spine) is the number one defect,
followed by anencephaly (underdevelopment or complete lack of the
followed by skeletal defects.
What happens to these children?
They die. The war also helps in
this regard. Do you understand? I wanted to warn pregnant women about
neglecting their health, so that their children wouldn't have to bear
consequences. Let's assume that a woman has a miscarriage or
abortion, they then say, "God gave us the child and God took it away
But we might be talking about an internal infection here. If the woman
have a thorough examination after her miscarriage, she can become
again, but she won't be able to carry her child to term as long as the
isn't taken care of.
Is it possible to have a thorough
medical examination in Chechenya?
No. Our lab hasn't been
rebuilt. As of now you can only have a medical examination in one of
neighboring republics, like Dagestan or Ossetia. For 250 rubels you can
four tests and a referral for treatment.
What are the most common diseases
The most common problem is
failure on the part of the mother to transmit oxygen to the embryo.
also frequently suffer from Gestos-Taksikos during the second half of
pregnancy. This pathology is common throughout Russia. Often the
when the mother is sick. If the mother doesn't get treated, then
discomfort and undernourishment are the consequences. The hemoglobin
sinks, because the embryo takes whatever its needs for its
a result the mother is suffering from any number of deficiencies by the
she gives birth. In the last six months we treated eight women who had
hemoglobin levels of 30. That is a catastrophic number. But thank God,
able to save them.
Simple arithmetical calculation
forces me to conclude that you
have to discharge some women from the hospital early or that you simply
admit them in the first place.
We only refuse admittance to
those who aren't yet pregnant. There are chairs and cots in the
the women can stay, because we don't want to turn women away. If the
without complications and the baby is healthy, then the patient can be
earlier, with the approval of the pediatric ward.
It's well known that there are more and more
frequent cases involving surgery; one also hears complaints about c-sections . .
That can be explained by the
fact that women who lack treatment don't get diagnosed properly.
pregnancy that get diagnosed too late and help that comes too late
surgical measures. Frequently women come to us only when they and their
are in danger, so that we have to terminate the pregnancy in her own
Statistically the surgical interventions number around 12 percent of
whole. Yes, that is a high percentage for Chechenya.
How does that affect the health of
the mother, and can she then have
children afterward? The Chechen families are in the rule rather large.
It's well known that the woman
who has a C-section is not welcomed back into the family as a healthy
For us she is in many ways "marked" and, if we didn't take that into
her life would be in danger. You have to stick closely to the rules.
and her relatives are informed beforehand. There is no reason to fear.
patients in the maternity ward follow the instructions of the doctors
recommendations of the gynecologists, she can go on to have another
What do you need most? Are you
lacking competent medical personnel
Our hospital has virtually no
facilities, and we also lack medicine, but in comparison to the way
in the year 2000, the situation has improved. We have been saved from
emergency situation through our collaboration with the federal union of
insurance. We earn money and buy medicine and food. The women get three
day here. As a result, their relatives, who often come a long way to
don't have to worry.
also get medicine each month as a result of our connection with the
organization "Doctors Without Borders," so that in this respect we
advantage over other institutions. But it does happen occasionally
don't have expensive medicines, and in this situation we have to turn
relatives for help. We have more medical personnel at our maternity
than we need. I'm new here, but I can say, that luckily the previous
for Maternity Hospitals has held together. All of the doctors here are
work is made difficult because we lack the necessary infrastructure -
closets, mattrasses, bed linen, etc. Unfortunately we no longer have
laundry in the city for the maternity hospital's linen. As a result we
ask the women to bring their own sheets and nightgowns. We have enough
here; we can't take care of everything.
If someone were to volunteer to
help you, what would you ask him for
First of all, I would bow down
before him in gratitude. We often knock on the door, but it isn't
speak, but we are not heard. I would first ask him to renovate the
hospital. The maternity hospital has to be fitted out so as to meet the
standards. We are now working in conditions out of the Stone Age. Our
are well-educated and experienced. I'm quite certain that not every
in Moscow could fulfill our requirements. They have modern facilities;
heads and hands. We need just about everything, from ball point pens to
was conducted by Tamara Achtaeva in November 2003. We reprint it here
kind permission of the newspaper "Dosch", Grosny.