Red Medicine: Socialized Health in Soviet Russia
INDUSTRY, which supplies the necessaries and many of the amenities of life, is a chief condition of national welfare. It is of primary importance, for sustenance of the individual and of the family depends on working. A descriion of working conditions in the U.S.S.R. is an account of an essential part of the country's government, for the Soviet organization of industry can be described as a vast national congeries of about one hundred national combines or trusts. This organization is of unprecedented magnitude; it is organized vertically to embrace all stages of industry, and horizontally to embrace the operation of industry throughout the entire U.S.S.R.
Each industry constitutes a division of this main organization, which includes not only production, but also transportation, sale, and consumion, with the accompanying financial problems at each stage.
This is the theory; but there are obvious difficulties in ensuring its satisfactory working. The rub is to ensure due interadjustment among these various complex activities. Failure at one stage compels readjustment elsewhere, and is likely to put out of action a vast number of related works and workers; and the experience of the Five Year Plan affords numerous illustrations of this and of continuous readjustment among industries.
But communist Russia escapes one great source of industrial anarchy, that of reckless competition of rival producers or vendors. It is evident, furthermore, that collective national planning of industry is easier in a communist than in a capitalist country; for in the latter it has often been found impossible hitherto to secure combined unanimous action.
Were we to judge solely from what we saw ourselves and from our investigation of the medical supervision and care of factory life, our account would be roseate in color. An example of what can be secured in the best type of new factory life in Russia is to be seen in Selmashstroy, the great plant at Rostovon-Don for manufacturing agricultural machinery. Reference to this has already been made in Chapter II.
This great factory covers an immense area, which in 1928 was an open field, and is now an immense hive of organized industry, in which men and women carry out work, much of it involving high technical skill. There are eighteen "shops" in the factory, each having a complete organization, closely linked up with that of the entire factory. In each of these shops about one thousand men and women are employed.
Dr. Marcus, the chief doctor of the factory, is what one would call in the United States a "gogetter," and she had the medical organization in admirable control. Little medical treatment is undertaken at the factory, but the doctors (one in each shop) act as a clearing house to secure treatment for all needing it. Thus patients are relegated as may be necessary:
to the general ambulatorium of the district in which they live,
to a polyclinic,
to tuberculosis or venereal disease clinics,
to special physical or other treatment centres; or to general or special hospitals,
to university hospitals,
to tuberculosis sanatoria,
to venereal disease hospitals, or
to a night sanatorium.
One night sanatorium is for tuberculosis separately; but we saw also a night sanatorium for other cases needing special rest, connected with the factory, for example, cases of nervous exhaustion or of digestive troubles.
The night sanatorium for tuberculosis is used for patients who can do some work. Here they sleep and are fed under hygienic conditions. The institution has fifty to sixty beds. Lighter work is arranged for these patients during their six- or seven hour working day, but reduction of hours of work in accordance with physical ability has not yet been definitely arranged.
Persons beginning their work at the factory are passed through its sanitary bureau. Here they have a bath. They then receive protective vaccination against smallpox and typhoid. No further medical examination is undertaken at this stage; but when the worker is sent to his future "shop," he joins one of several brigades, and the members of each brigade are examined systematically for medical needs. The examination is undertaken jointly by a commission of doctors and is stated to be very complete. After three or four months he must return for a further examination.
Meanwhile treatment is given at the appropriate institution in the town. Some dental treatment, including provision of dentures, is given at the factory.
We were told that no applicant for work at the factory is rejected; he is put to work suitable for him. There was no unemployment in Rostov.
The doctor at each shop is usually a woman. She gives first aid in emergencies, exercises general supervision, and receives daily records from the dispensary doctor who is treating factory patients. The doctor of the shop writes out a list of absentees, and this is given to the director of labor. She pays special attention to those who are frequently ill. The shop doctor does not as a rule visit factory patients at home, but a fellowworker from the Shop Committee does this. There is stated to be no malingering. The doctors of the dispensaries obviously have no temation to be lax in certification. Workers sometimes complain that the doctors are too severe. Then they can complain to a Medical Control Committee, which consists of a worker as chairman and two or three doctors appointed by the Commissariat of Health. A similar committee decides as to sending patients to sanatoria in the Crimea, or elsewhere.
Malingering is not favored by the workers themselves, who are kept profoundly interested in the output of the works. Diagrams are exhibited in each shop of relative weekly output and of daily incidence of illness.
There are other means of reducing malingering and of increasing general efficiency. In each shop is a "wall newspaper," on which anyone can write complaints of abuses or comments on the methods of working. This form of publicity is freely adopted; and it appears clear that no evil results to the complainant follow the most candid or even overcandid criticism of shop working. This seemed to us a wholesome institution, worthy of wide imitation, perhaps with modifications. But how, outside Soviet Russia, could such criticism fail to be followed by evil consequences for the informer?
In one shop we saw a paragraph in the "wall newspaper" asking, "Why does comrade Aranova so often go on sick leave and will not work like the rest of us?" This was illustrated by a caricature of the woman, signed by the worker presenting the indictment.
It should be added that each person thus gibbeted has the right of response. There appears to be no law of libel. If the indictment is against methods of administration, the manager or committee of the shop may answer the statement, pointing out its error, or acceing its suggestions ; and important criticisms or suggestions are formally considered by the Shop Committee.
Among other notices seen on the "wall newspaper" was the announcement of a competition between two "shock brigades" in the shop in respect of quality and output of work. These contests are watched with much interest.
The whole factory has a newspaper, supplementing the "wall newspapers." During a rest time we saw one worker reading it to a group of other workers. This is said to be a general custom in all factories as well as other establishments.
We saw the workers' kitchen, at which cheap meals are provided for workers. Annexed to it is a special diet kitchen, where meals as prescribed by the doctor are given to employees under medical care. In this diet kitchen, 70 kopecks are charged for a meal. The average cost is 1 r. 70 k., the difference being paid by the insurance organization. Tuberculosis patients are not admitted to this diet kitchen.
The wages vary with the work, but there is no system of payment in proportion to size of family. At the time of our visit a chief engineer was getting 800 rubles a month. An average engineer and an average doctor received 175 to 250 rubles a month, but the doctor could do supplementary work at a second institution.
The children's nursery, or creche, of the factory is in a separate building and is well organized. At present its accommodation suffices for only 40 per cent of the children of workers in the factory. Children are admitted from three months old to three or four years old. Mothers can come every three hours to nurse their infants. Children are provided with meals, and workers on night shifts leave their children over night.
A "comrade court" is constituted in each factory to settle difficulties arising in disputes and to take action in regard to loafers, shirkers, and drunkards. In each small factory and in each shop of a large factory there is a "Red Corner" for committees. Larger factories have a special committee room for discussions, and the great factories have trade union clubhouses. Thus there may be said to be a general Parliament in every industry; and this wide distribution of discussion and responsibility doubtless is an important factor in the prevention of "ca' canny" and in speeding up and improving the standard of work and, not the least important, in safeguarding the health of the worker and providing for recreation and culture. The day's work lasts only seven hours, and these frequent meetings of workers give added interest to industrial life from which everyone profitsa partial solution of the "leisure time problem."
There is no uniformity of payment in each factory or in each shop. In a particular occupation there may be as many as eight grades of wages. All work' at Selmashstroy is now piecework, and this has been found greatly to increase efficiency.
The above account shows that at its best the factory organization in Russia is admirable. It is conducted on a large scale, and all the advantages of mass production are secured. There is specialization in the distribution of work. Each shop has its medical and general organization coordinated to that of the whole factory; and in this shop every worker knows what is the output as compared with other shops. There is evidence of intense competition to secure a maximum output, and slackers appear not to be tolerated.
Shop newspapers, in which all workers can advance suggestions and lodge complaints against individuals or details in factory work, appear to be really valuable, though the complaints against individuals run strangely counter to what the western world worker, like the public schoolboy, would regard as "playing the game." But if to "play the game" means defeating justice and in the shop means a reduced output and, for the nation as a whole, a relatively low standard of living, is it not in large measure a wrong ideal? If the right to complain and the intention to publish faults are known beforehand, taletelling against one's fellow workers or foreman or manager (let us hope after the failure of personal expostulation) is robbed of its unsavoriness, in part at least.
The conditions doubtless vary greatly in different factories; but although insanitary and otherwise unsatisfactory conditions could almost certainly be found in smaller factories and those of older date, it is nevertheless true that in factories erected under the Soviet regime the arrangements made for the welfare and health of workers are excellent. Perhaps precautions against accidents should be exceed partially from this statement, though the whole staff of factory inspection is appointed by the trade unions themselves.
In 1927 the gradual introduction of a sevenhour labor day was ordered, but in many factories it is still eight hours. Before the Revolution it was much longer.
Equal payment of wages for a given number of hours of work is not part of the policy of Russian communism. Wages are graduated differently in different factories, and often somewhat complexly. Skilled and specially needed work receives high wages, and men are encouraged to pass from one class of work to another when adequately skilled. The general standard of work is probably lower than in many other countries, a not surprising fact, as but recently most factory workers were peasants. In the Five Year Plan the wastage through misuse of machinery and through defects of manufacture has been great; and this has been especially the case in the use of tractors in farm work.
Payment on a piecework basis is very general, and we naturally questioned as to the risk of overstrain for the less vigorous section of workers. This was emphatically denied, wherever the point was raised in our inquiries. Prolonged overstrain in work, we know, may be an important factor in bringing latent tuberculosis into activity. In a few places there has been a small beginning of psychological tests of working capacity. But it is urged that everyone is eager to work to the full extent of his capacity, and that no risk of overstrain emerges even in the "shock brigades" in which competition as to quality and quantity of output is challenged between shop and shop in a factory. A check is exercised by the fact that the pace to be attained is determined by a Factory Committee. Moreover, attention was called to the short day and week, and to the provision for vacations as mitigating the strain.
Piecework system means, of course, inequality of wages. This change was one of the six chief points made in a wellknown pronouncement by Stalin. Wages vary greatly, but no figures can be given which would be fairly comparable with those of other countries. The cost of articles needed or desired by the workers has to be taken into account, and this again varies greatly.
Probably the average worker is better off than he was in 1914. He is better off in that he is almost continuously employed; but his level of living is probably still "considerably below that of the American or the British worker of equal grade who is fortunate enough to be in regular employment."(Sidney Webb, in Current History, December, 1932. )
Strikes are almost unknown in Russian factories; but there is sometimes discontent, usually due to two conditions. First, the food position may be unsatisfactory owing to the lack of coordination between rural and urban work, the difficulties with rural workers, and the imperfect transport of produce. Second, workers have no adequate outlet for their wages. Luxuries are unobtainable. Even boots are not yet manufactured in adequate numbers.(1)
The cooperative shops are not very satisfactory, and priceswhich are proportional to scarcityare exorbitant. We met workers dining at the chief public restaurants and paying high prices for their meals; though immensely more were seen dining in public kitchens at a low cost, and in many factories special meals were provided for those under dietetic treatment. It remains true, however, that much money is spent on food, drink, and traveling, which might advantageously be diverted in part to the many items conducive to family comfort which hitherto were, as they say, "in short supply."
The shortage of manufactured consumers' goods is one of the chief grievances of Russian life. It has been primarily due to the concentration under the Five Year Plan on the manufacture of machinery for factories and similar capital goods considered necessary in order to industrialize the nation. The difficulty is increased by the unwillingness of the Government to import consumion goods for which foreign money must be paid until the urgently needed machinery has all been obtained. Meanwhile the vast increase in Russia's city population increases the famine for consumers' goods. In villages the same difficulty is felt even more markedly. Such articles as nails, boots, textiles, are very scarce. It is true that the peasants now have no rent to pay; on the State farms they are paid wages, but there is little they can buy. As Chamberlin puts it, there is "a tremendous unsatisfied internal need for manufactured goods." It is not that there is less than before the Revolution, but there is not nearly enough to satisfy the greatly increased demands of a rising standard of life.
Difficulties of transport still further embarrass the situation. During the winter, fuel becomes scarce in cities. In short, Russia is still a country of rations and of queues, though efforts are now being made to increase the output of articles needed in daily life.
Queues, especially at food shops, impress the foreign visitor as sadly frequent. Sometimes they mean scarcity of essential food or other articles, but they are alsoas we foundcaused by shortage of salesmen and cashiers. At such times, the people simply fall in line as a routine of good order, just as we do at ticket windows.
The possibility that work in "shock brigades" is likely to result in overstrain appears to be recognized in the fact that "shock brigade" workers may receive longer holidays and have certain privileges as to sanatoria and rest homes. ,
On this question an interview we had on board a Black Sea steamer with a lady who is a professor in Moscow is interesting. She stated that the principle of "shock brigades" is extended into scientific work. Her assistant works in several institutions, but retains her brightness and does not appear to suffer from overwork. She obtains premiums for her work, which may be monetary or otherwise advantageous. These premiums, as for other workers, are given by the vote of the workers themselves.
Questioned as to the risks of overwork, this professor mentioned the following counteracting influences:
1. The extra work is entirely voluntary;
2. Every fifth or sixth day is a rest day and the worker may go to a night sanatorium if this is found desirable;
3. There are arrangements for recreation and gymnastics ; and
4. The worker can obtain admission to a rest home for a month.
She recognized that there has been some overwork, but social competition has been a great stimulant. Everyone wants to be on the "red board" (see page 44.) , and those on the "black board" take care not to remain there long.
Returning to the subject of professorial work, she pointed out further that each professor makes his or her own plans of work for each day and longer periods; and thus overwork is in the main voluntary.
As regards premiums in professional work, all the workers in the laboratory hold "production meetings," at which candidates for premiums are proposed. This is further discussed at a meeting of the professors, and there may be successive meetings. Finally the premium is given at a grand meeting of all the workers. Thus workers themselves take a large part in the giving of premiums to individual workers for superior work.
There is seldom abuse in the giving of premiums or in the sending of workers to homes of rest, she continued; such abuse leads to indignant letters published in the factory paper or in the local newspaper, and if proved leads to exclusion of the offender from his trade union or from the Party. This has become so true that Party men may even fear to recommend other Party men for a post. Of course there is occasional corruption ; but this is exceptional.
It is convenient to give here the opinion of this enthusiastic and highly intelligent professor on the general question of the "keenness" of workers. When we asked her about the general "keenness" and enthusiasm displayed by workers and others seen by us at various places, especially as to whether this was limited to a portion of the workers, she was emphatic that it was general. Workers generally realize that they are now not mere cogs in a machine, she said, but that each worker is a conscious part of a great organism; and that he may in his particular work have a creative function in improving it and making it perfect. Every slogan to this end is eagerly caught up by the workers, and there is generally the enthusiasm which characterizes a racing horse.
In every department and stage of industrial work there is "democratic centralization," she continued. All discussions and the opinions expressed by each single nucleus of workers are received by the managing body and are adopted or modified in practice.
We appreciate that these statements, which agree with the results of our own observations, refer to the best side of Russia's industry. There is another and less favorable side, which recent reports from Russia ( January-March, 1933) have brought into prominence. Official Soviet statements make it clear that there has been much "slacking," a large amount of incompetent work, and even willful "hooliganism" in some industries and in collective farms here and there.
But making full allowances for the many failures in the gigantic effort towards rapid industrialization, we must pay tribute to the marvelous extent to which the
U.S.S.R. has managed to secure a complete reorganization of industry. We cannot better express our views as to the facts than in the, following remarks by an American philosopher:
I cannot obtain intellectual, moral, or aesthetic satisfaction from the professed philosophy which animates Bolshevik Russia. But I am sure that the future historian of our times will combine admiration of those who had the imagination first to see that the resources of technology might be directed by organized planning to serve chosen ends with astonishment at the intellectual and moral hebetude of other peoples who were technically so much further advanced.(John Dewey in Individualism Old and New. New York, Minton, Balch & Company, 1930.)
Before closing this chapter we must add a comment on the philosophy of work in Russia. Three features are outstanding. The basic one is that in the Communist philosophy the personal incentive of gain, although it persists to some extent in wages, has been largely eliminated. This point is well stated in a report by a group of American observers as follows :
The Russian experiment is based on the theory that there is more to be gained by coordinating industry to a functional plan and so eliminating the waste of the business cycle, duplication of plant facilities, etc., than can be lost through failure to stimulate individual initiative, animated by the private profit motive. (Soviet Russia in the Second Decade. A Joint Survey of the Technical Staff of the First American Trade Union Delegation. Edited by Stuart Chase, Robert Dunn, and Rexford Guy Tugwell. New York, The John Day Company, 1928.)
It is too early to judge whether the Russian colossal experiment in the elimination of private profit and of competition between industries employed in the same sphere can succeed. But in every other part of the civilized world, by combines, trade agreements, and allied devices, increasing efforts are being made to reduce the evils associated with unrestricted competition; and for countries which cannot support themselves as selfsustained entities, the absolute necessity, as well as the almost insuperable difficulty, of international cooperation and interchange, is being realized more and more. Can a modus vivendi be found between the extremes of communism and the suicidal competitions of capitalistic countries? The future of the world hangs largely on finding a satisfactory answer to this question.
Another striking feature is that the factory in Russian towns and the State farm or the collective farm have been made the units of social life. The electoral system both for the Government and for the trade unions is based on this unit. The factory is the social unit in other respects. It is the centre for nurseries and schools, libraries, anti study circles, newspapers, trade unions, clubs, and sports.
Finally, the factory has been made the focal point of the Communist philosophy of life. This was emphasized by university professors interviewed in Moscow, and their statements are summarized in the following sentences. Life in Soviet Russia largely turns on factory organization. Each factory is in process of becoming a health centre. There are already many thousands of these, which concern themselves with sanitation and with the organization of hygiene and medical treatment. There is continuous health propaganda for work, rest, and cultural development, the medical staff of the factory cooperating with the executive staff in this work. Dispensary service is not only for personal treatment, but is also vocational and concerned with the general hygiene of life. Science and work are made to cooperate. The ideal is increased psychophysical strength and not merely protection from disease and treatment when ill. This, of course, is the ideal everywhere, but these professors claim that it is exceptionally developed in modern Russian factories; that in Russia the ideal is embodied in a definite program; that in England in the main it is chiefly implicit; and that in the United States it has scarcely reached this level. They further urge that Russia has many mystics, and that Russians reason by deduction from first principles. Thus the philosophy set forth above has been reached.
Research work is going on, they stated, as to the rationalization of rest. Rest, like work, it is urged, should be organized, not anarchistic. Labor thus may be regarded as the central point of life, as being not a personal thing, but the embodiment of a high humanism. Labor in fact changes the worker's personality. It is philosophized ; it becomes the ideal of service for the community, not for self, and a central point of life: This conceion is regarded as the philosophical justification for making the factory and the workshop the focus of the community's social as well as economic activities; work is to be idealized, and to this end all the resources of science and of education are to be invoked; while rest and recreation, preventive care and medical treatment, are in their right setting when they are regarded as adjuvants of work.
(1) This in large measure is due to the fact that the demand for boots has enormously increased. Dr. Alexandre Roubakine, of Moscow University, has stated that last year twenty times as many boots were manufactured as in any pre-Revolution year. He adds that other countries might well be envious of a country in which there is no surplus of boots in the store windows.