|
English Language Page The two prevalent types of structures are barracks and pavilions. The former, barrack type of structures was used for the construction of gigantic district hospitals. Oftentimes it is one big multi-storey building. The latter, pavilion type of structures — is a number of smaller one-storey cottages located on a common territory. The majority of all institutions in Russia are designed to simultaneously admit a large number of patients. Therefore large high capacity barrack-style hospitals prevail in the psychiatric care structure. The main drawback of barrack-style buildings is that the psychiatric requirement of individual approach to therapy and treatment of patients is hard to accomplish in a situation when the therapy process is organized as an industry even though a specific one. The number of pavilion-style hospitals is extremely small although from the viewpoint of rehabilitation and treatment of patients with mental conditions accommodation in one-storey cottages that do not look like hospital on the surface is more preferable. Pavilion-style hospitals that are currently functioning were constructed as a rule before the revolution. It is not surprising that in view of the scarce funding of psychiatric care they are in a deplorable condition and the buildings are disintegrating very rapidly. Although the poor condition of hospital buildings is characteristic of not only hospitals that had been constructed before the revolution, but also of those that have been constructed relatively recently. Most recent capital maintenance Results of the survey indicate that no capital maintenance has been done to many a hospital and the overall exterior of structures is unsatisfactory. For example, buildings of the Sverdlovsk regional psychiatric clinic #1 are “run-down and flaking in certain places, the walls require a paint job,” while the Altai republican hospital resembles “a city after bomb-shelling” (except for two new buildings): trenches that look like construction in ruins, old decrepit structures. Buildings of the Magadan regional neuro-psychiatric dispensary are crumbling right in front of one’s eyes: one can see broken facades and tumbling walls, the children’s department and kitchen being in the most dilapidated condition. Some old wooden structures of the Tver regional psychiatric clinic #1 named after Litvinov are falling apart, while the buildings that were constructed in the 1970s look like industrial structures. Note that the wear of buildings is one of the main criteria used to assess the condition of hospital structures. Presently one third of all facilities of psychiatric institutions are not operational. They require a serious overhaul and reconstruction and part of them is subject to demolition. However there is no money to pay for capital maintenance. No new buildings for psychiatric hospitals were constructed in the 1990s and 2000s; therefore those that are currently being exploited are wrecks. For example, the first building of the Bryansk regional psychiatric hospital (that was constructed in 1938 and used to be a plant that manufactured fire extinguishers) has been written off for demolition, but patients are still there. Old and decrepit buildings of the Republican neuro-psychiatric clinic of Mordovia were found to be in a similar condition. 20 of the surveyed psychiatric institutions (21%) had never been overhauled during the entire period of their existence (Kirov regional psychiatric clinic named after Bekhterev, Chita regional psychiatric clinic #2, Republican psychiatric clinic of the Health Care Ministry of Karelia, Republican psychiatric clinic of Alania, and others). Some of these institutions are accommodated in buildings constructed before the revolution. For example, the geriatric department of the Orenburg regional psychiatric clinic #1 occupies a building constructed in 1800s which used to be gubernatorial printing-house, the main building of the clinic dates back to 1904, and all the other departments are located in buildings constructed in the second half of the XX century. Due to on-going maintenance the exterior of the buildings is satisfactory but they have never been subjected to capital overhaul. Buildings of the Perm city psychiatric clinic constructed in 1970-80s are worn out by 35%: water pipes and heat radiators have decayed, the pipes are clogged up; the sewage is not working, window frames and doors have become unusable. Astrakhan regional psychiatric clinic requires a capital overhaul since its hot water pipes have become hopelessly decrepit and its sewage is constantly malfunctioning. The psychiatric clinic in Rostov-on-Don (Kovalyovka settlement) that moved into a set of buildings previously occupied by a construction battalion in 1996, has no sewage and its coal boiler requires immediate replacement. The Smolensk municipal psychiatric clinic that was opened in 1972 in the building of a former kindergarten has never been renovated; neither has been the Smolensk regional psychiatric clinic (Gedeonovka settlement) that was constructed in 1905. Hospital buildings of the latter are in an extremely unsatisfactory condition and are not usable for accommodation: mould and fungus are everywhere, as are patches of blackness, rotten roofs, and cracks. But the hospital has no means to afford an overhaul. The Republican psychiatric clinic of Komi located in buildings constructed in 1940, 1968 and 1979 has worn-out sewage pipes and the cable that connects the hospital with the electricity transmission line is constantly breaking up. The Republican psychiatric clinic of Udmurtia that has been in operation since 1977 is unable to afford an overhaul either. Presently it is experiencing an acute need in a new kitchen facility: the existing kitchen facility is very old and does not meet sanitation authority requirements. In addition to that, the current kitchen facility is designed to serve 250 people but in reality it serves 800. The Pskov regional psychiatric clinic #1 that was constructed in 1985 has been limiting itself to cosmetic upkeep for a long time. Only 26 clinics (28%) reported to have undergone capital overhaul lately. Six psychiatric clinics are currently undergoing capital maintenance, and 14 clinics have just finished it (2001—2003). Due to lack of funding the conduct of capital maintenance extends over indefinite periods of time. For example, the first capital overhaul of the buildings of the Yaroslavl regional psychiatric clinic “Afonino” took 10 years to complete (1980—1990), while the overhaul of its heating infrastructure and boilers was undertaken in 1998—1999. Some psychiatric clinics have managed to undergo only partial capital overhaul. For example, the Krasnoyarsk territorial psychiatric clinic #1 overhauled two of its buildings in 1994 and 2000, the Oryol regional psychiatric clinic — one building (1994—1995), the Tver regional psychiatric clinic #1 named after Litvinov — only three departments. Note that wooden buildings of this hospital are falling apart and the water and sewer pipes require immediate replacement. Capital overhaul of the decrepit heating system of the Vladimir regional psychiatric clinics began in 2002, but while psychiatric clinic #4 managed to replace its entire heating infrastructure, psychiatric clinic #1 had enough funds only to repair heating systems of two departments. A significant number of psychiatric institutions (61 or 65%) permanently find themselves in a condition of current upkeep as certain buildings or departments are repaired as funds become available. Such repairs however usually have a cosmetic character and are unable to solve cardinal problems associated with the wear of buildings. For example, the Kursk regional psychiatric clinic (built in 1906) completed repairs last winter but hospital’s buildings are currently in an unsatisfactory condition and require a capital overhaul. Departments inspected by human rights activists require immediate capital overhaul in 35 of the surveyed institutions (37%). Here are some records from observation charts: “plaster is flaking from the walls” (Voronezh regional psychiatric clinic), “the ceilings are covered with rivers, the flooring is old” (psychiatric department of the district hospital of the Komi-Permyatsky autonomous district), “the paint is old, with yellow spots at the ceiling, walls are pitted due to flaking plaster” (Kostroma regional psychiatric clinic), “the women’s department had been originally designed to be a workshop, the floor is made of wooden boards and requires repairs” (Kurgan regional psychiatric clinic), “the floor is wooden with slots, the ceiling is covered with rivers” (Dankovskaya psychiatric clinic of the Lipetsk region), “the paint has flaked and cracked, the floor is old, the tiles are pitted out” (Moscow regional psychiatric clinic #2), “walls are stripped, cracks, rivers” (Nizhnii Novgorod city psychiatric clinic #1), “the ceiling is covered with rivers, the roof is holed” (Nizhnii Novgorod regional psychiatric clinic #1), “everything is in a deplorable condition, the floor is made of concrete covered with patches of old linoleum, requires repairs” (Pskov regional psychiatric clinic #1), “walls are covered with mould, linoleum lies directly on top of the concrete floor and it is cold and damp in winter” (Republican psychiatric clinic of Alania), “floors made of boards have rotten through” (Republican psychiatric clinic of Kalmykia), “rivers, mould, plaster is being eroded by fungus, dampness in the cafeteria” (Republican psychiatric clinic of Tatarstan), “ceilings and floors have rotten through, fungus on the walls, cracks” (Smolensk regional psychiatric clinic #1), “the floor is old, with slots, and it squeaks” (Stavropol territorial psychiatric clinic #2), “wooden floor is significantly worn out, holes are covered with metallic patches” (Cheliabinsk regional psychiatric clinic #1), etc. Year of construction and initial designation Effective provision of psychiatric care among other factors significantly depends on the level of development of hospital’s infrastructure and its material base. Utilization of buildings that are not designed for psychiatry, adaptation of these structures to accommodate the needs of a psychiatric institution cannot meet the requirements of modern psychiatry and create conditions that are necessary for patients to stay at an institution. According to the RF Ministry of Health Care one fifth of all psychiatric institutions in Russia was built before 1917 and one half of them are wooden buildings. The term of their exploitation expired a long time ago; many institutions are literally falling apart. At the same time brick buildings that were constructed before the revolution are characterized with robustness and longevity but require reconstruction and adaptation to meet the needs of a contemporary psychiatric facility. Because the majority of them as well as the structures constructed before the war during the soviet period do not take into account the new ideas about the sanitary and hygienic norms of living space and new approaches to treatment and rehabilitation of mental patients. Over the past several years psychiatric hospitals were not constructed in the Soviet Union and Russia therefore psychiatric clinics located in modern buildings are practically nonexistent. At present only half of all psychiatric institutions are located in structures that are designed for this specific purpose. Of all the surveyed psychiatric clinics 22 (23%) are located in buildings of the pre-Soviet period and many of them are in a condition that is unsuitable for accommodation, let alone treatment and rehabilitation of mental patients. Nine of them occupy structures that date back to the XIX century (1860—1900), and another 13 were constructed in the XX century but before the revolution. The other 47 psychiatric clinics are located in buildings constructed during the Soviet period, eight of them occupying buildings of the pre-war time (1921—1939), and another 12 psychiatric clinics occupy buildings constructed in 1940—1950s. The largest number of psychiatric institutions (27 or 29%) occupies buildings that were constructed in 1960—1980s. During the Soviet period the construction of psychiatric clinics was conducted in stages which were sometimes separated from each other by several dozens of years. For example, the construction of the Kirov regional psychiatric clinic named after Bekhterev began in 1921 with a conversion of a monastery hotel and continued in 1973-74 and 1989. The construction of the Shadrinsk city neuro-psychiatric hospital took 40 years to complete: the first building was finished in 1956, while the last one — in 1996. The construction was extended over time due to the lack of funds and its completion in essence is largely due to the illegitimate use of labor therapy — employment of patients in construction works. Only 42 out of 90 clinics (47%) are located in buildings that were initially designed for psychiatric institutions. 17 of them are located in old pre-Soviet structures (1884—1917) and reflect pre-revolution ideas of how mental patients should be accommodated. The other 25 psychiatric clinics were built on the basis of Soviet ideas of conditions of treatment and accommodation of mental patients (1940—1980) which first and foremost required isolation of patients and convenience for staff. As it has been mentioned before precisely one half of all the surveyed psychiatric institutions occupy structures that were initially not designed for the psychiatric service. 11 psychiatric institutions are located in buildings that were constructed to accommodate military or law-enforcement entities: correctional colonies (Krasnoyarsk regional psychiatric clinic #3, Tyumen regional psychiatric clinic), military units (Kurgan regional neuro-psychiatric hospital, Perm city psychiatric clinic, psychiatric and tuberculosis clinic “Lesnoye” of the Marii El Republic), barracks (Krasnodar territorial psychiatric clinic, Stavropol territorial psychiatric clinic #1, Magadan regional neuro-psychiatric dispensary, Adyg regional neuro-psychiatric dispensary), prison (Dankovskaya psychiatric clinic of the Lipetsk region), and construction battalion (Rostov regional psychiatric clinic (Kovalyovka settlement). 10 psychiatric institutions were opened in buildings that used to belong to social protection services and ministries of education, — it is former boarding schools (two psychiatric clinics), a retirement home, a foster home, kindergartens (five psychiatric clinics), and a school. Another 10 psychiatric clinics were converted into ones from a variety of health care establishments: hospitals (two psychiatric clinics), military hospitals (two psychiatric clinics), a tuberculosis colony and a tuberculosis dispensary (two psychiatric clinics), a sanitarium (two psychiatric clinics), a general hospital and a day-care facility. Nine psychiatric clinics are located in buildings that were originally designed to be living quarters: private estates (four psychiatric clinics), a monastery hotel, dormitories (three psychiatric clinics), and an apartment building. Buildings accommodating three psychiatric clinics were originally designed to serve as industrial facilities — warehouses of a tradesman, a gubernatorial printing-house, a textile factory. Some buildings which now accommodate psychiatric institutions have previously had a number of different owners. For example, the building that is now occupied by the Chita regional psychiatric clinic #1 used to be a silicate plant hostel, then — a dermatological dispensary, later — a narcological dispensary which later on turned into a narcological dispensary with a geriatric department for women, and only in 1996 was this facility transferred over to a psychiatric institution. It is only in extremely rare cases that one manages to completely reconstruct and adapt originally unsuitable buildings to meet specific needs of the psychiatric service. As a rule the business is limited to regular upkeep after which both patients and staff suffer from all sorts of inconveniences for years on end. For example, the Adyg regional neuro-psychiatric dispensary is in a very onerous situation as it catastrophically lacks space. The only building houses all administration, accounting, subordinate services, and outpatient treatment facilities. It is a barrack-style building constructed before the revolution in which there were stables during the Second World War. |
Íàøà êíîïêà  |
|