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NYT Syndicate
They are small as physician assistants go, about 2 inches long, and slithery. They wiggle about for a bit on Elena A Kalinicheva's back before getting down to what they do best: sucking blood.
Leeches ” yes, leeches ” are still widely prescribed in Russian medicine, about 10 million of them every year, in many cases as a low-cost substitute for blood thinners like warfarin.
"When you do it the first time, you think, 'My God, leeches!'" Kalinicheva said."But after you go through it, you understand there is nothing to worry about."
In Russia, a medicinal leech costs less than $1, and a typical application requires three to seven of the ravenous little creatures. Leech treatments, available throughout the country, take 30 to 40 minutes, though the resulting wounds ooze blood for an additional six hours or so until the natural anticoagulant in leech venom wears off.
Though Russia under President Vladimir Putin is muscling its way back onto the world stage militarily, economic development has lagged woefully, and that includes the medical system.
In developed countries, leech applications are often, and perhaps unfairly, associated with quackery, like the once popular practice of bleeding patients.
In fact, leeches are creeping back into Western medicine ” as many as 6,000 are used annually in the United States, the BioTherapeutics, Education and Research Foundation estimates ” but not for the same purposes as in Russia.
The Food and Drug Administration in the United States cleared the sale of leeches as medical devices in 2004 ” along with maggots ” while European pharmaceutical companies have focused on isolating therapeutic, blood-thinning chemicals in the venom and delivering it in a less creepy manner.
The FDA has approved leeches for draining blood, for example using them to remove excess blood from severed body parts that have been reattached.
In the Russian tradition, the therapeutic benefits are seen in the venom, a natural anticoagulant prescribed as a preventive treatment for stroke and heart disease, at a fraction of the cost of pharmaceutical blood thinners.
Russians are in theory covered for most doctor care and drugs under a socialised medical system written into the post-Soviet Constitution in 1993. Modernising this state health care was a priority that Putin enshrined in decrees early in his third term as president. They set ambitious targets for medicine: Doctors' salaries would double by 2018, the end of Putin's term; life expectancy would rise by four years.
But the oil price collapse, sanctions and military spending intervened. Russia remains a poor country, albeit one with geopolitical ambitions. The average income in Russia is $642 a month, compared with $3,584 in the United States, according to government statistics in both countries.
"We need investment, and in medicine new technology requires state investment," Yevgeny Gontmakher, an economist and authority on the Russian health care system, said in a telephone interview.
In rural areas, doctors are often too scarce to find in a timely manner. Russian life expectancy for men and women, at 70.3 years, has hardly budged since Putin issued his decrees and is still 10 years lower than the European Union average of 80 years.
Similarly, while government-approved"vitally necessary" drugs are theoretically covered, in practice they are as likely as not to be out of stock at the state-run pharmacies that distribute them free. Left to pay out of pocket at clinics or commercial drugstores, patients gravitate toward cheaper options, like leeches.
Kalinicheva, a secretary in a Moscow office, said she had suffered from intolerable lower back pain before trying leeches, applied weekly at a walk-in medical center, the Hirudotherapy Clinic.
She said she had chosen leeches for cost savings and to avoid taking painkillers."I wanted something natural, to minimise the chemicals," Kalinicheva said.
