Modern civilian medicine in the Arctic represents on the one hand a triumph of civilisation over nature and some of the harshest climatic conditions on the planet and, on the other hand, a set of unresolved challenges that still need to be overcome. Today, as a hundred and even fifty years ago, doctors, scientists, emergency managers and officials are trying to find the best scheme to make healthcare fully accessible across the AZRF, just like the rest of the country.

Task conditions

Health care in the Russian Arctic can be divided into three global segments: urban health care, treatment of people at remote industrial sites and outreach to remote communities. In the first part, the Polar free medical care for a resident of Norilsk, Murmansk, Arkhangelsk or Salekhard is not organisationally different from its counterpart in any other Russian region. There are polyclinics, an ambulance service, an inpatient clinic and various specialised dispensaries. Their number, level of equipment and capacity understandably vary, but citizens' access to them is as described in the regulations.

The second type of health care is also clear and worked out. Nuclear icebreakers, polar stations, drilling rigs and expeditions usually have a full-time medical specialist with at least paramedic-level training. He provides first aid, treats minor illnesses and injuries and, in the case of serious illnesses, calls in a helicopter with rescue personnel. The system is organised in this way also because people have to undergo a comprehensive health check-up at the entrance, i.e. at the time of recruitment, in order to work in a harsh environment. Accordingly, they are not expected to be affected by anything more serious than a cold for, say, half a year on the shift, and they will receive qualified assistance in their place of residence.

On the third point, however, no universal solution has yet been found. On the one hand, residents of remote settlements in the Arctic zone of the Russian Federation should be provided with the full range of free medical care on an equal footing with the rest of the citizens. On the other hand, doctors and aid stations in these regions, often cut off from civilisation by many hundreds of kilometres of rugged terrain, are still scarce. According to the statement of Lena Afanasyeva, Minister of Health of the Republic of Sakha (Yakutia), the number of specialists serving the population is still low—57.3% for doctors and 73.2% for nurses in the region. It is primarily a question of access to specialised medical care—'acute' patients are still urgently evacuated by helicopter by rescue personnel. 

Who do we call?

In the remote communities of the Russian Arctic, local medical care is currently provided mainly by medical offices (outpatient clinics) and medical and obstetrical stations (MOS). They are regularly consulted and decide on the need for hospitalisation. They are regularly upgraded, equipment is purchased and medication is restocked. But what if you don't need to go to a hospital but can't be treated without the care of, say, a cardiologist or gastroenterologist? There are practically no specialists in remote areas, and locals do not always have the opportunity to travel into town for outpatient specialised treatment or examinations.

Mobile teams staffed with specialists, medicines and equipment have been set up to deal with the issue. Today, the project is actively developing in Yakutia — in February 2023, doctors provided examinations and treatment to more than 5,000 residents of Arctic settlements. This is the first pilot run of the programme, which has already seen 4,912 adults and 858 children examined, 1,424 patients referred for outpatient observation and 524 people taken to the hospital for inpatient treatment. The expedition required long and thorough preparations, as the success of the venture depended entirely on overcoming the nightmares of polar logistics. Specialised equipment, helicopter support and a detailed route adapted to the weather and traffic conditions made it possible to cover 31 settlements.

According to Fedot Tumusov, State Duma deputy and member of the health committee, the new scheme for working with residents of Arctic settlements should be divided into several stages. First, a doctor arrives in the village to examine the patient and prescribe and provide medication. The patient then keeps a register of observations and medication, informing the doctor how they are feeling. This is where the telemedicine system, which is being actively developed in the Arctic regions, helps. Then, after a few months, the doctor comes to the settlement again and adjusts the treatment plan after the examination. This keeps the person's condition under control while freeing them from having to make the long and costly journey to the district centre.