By Galina Mursalieva

In Novaya Gazeta

DR. ROSHAL: We have not even begun to heal the human tragedies in Russia

“There’s a bottom rung being put on the social ladder.  That’s the impression that I’m getting.  They tell me that there’s no bottom rung, that it’s simply the marketplace, another country, different conditions, and that everything’s different now.  But I’d like to know how it’s different?  I was, by the way, chairman of the coordinating medical council for the ‘White House’ (Russian parliament building) defenders in 1991, I could’ve died, as could everyone there.  Who knew how it would all turn out back then?  And I should know: what was it I could’ve died for?  Later it all turned out so monstrous, just take a look at our industry, at agriculture, at public health…”

Public health, certainly, worries the man speaking more than anything because he is a physician.  What have they not called this doctor?  He is the world’s pediatrician, and an FSB officer, and a national hero, and…

The man I am speaking with is a member of the Presidential Human Rights Commission, which he entered even before ‘Nord-Ost’.  He is the director of the Moscow Research Institute on Urgent Pediatric Surgery and Trauma, a professor, and a doctor of medical science.  He is the legendary Leonid ROSHAL.

“I don’t want to turn things back.  I was 55 when for the first time in my life I left the country!  Perestroika opened up the world to me, but the country the whole time was solving tactical problems, while there was no strategic thinking going on.  Here, take a look at these papers… Don’t you see?  The World Bank in 2002 allotted Russia only 336 million dollars for public health.  And one of the projects here is public health reform, so everything that we see is being done with the International Bank’s money.  The Strategic Research Center is using this money and it’s mainly the economists doing it, not the physicians.  Certain people are dictating how you and I are going to live, and in such a way they’re introducing ideas foreign to us about public health.”

But, Leonid Mikhailovich, money is money — it cannot hurt public health. 

“In the first published project on the Russian Ministry of Health website we were supposed to destroy all children’s polyclinics and obstetrical-gynecological advice bureaus.  I spoke to the president about this.  I said that Article 41 of the Russian Federation Constitution guarantees free medical service in government and municipal facilities.  If there’s a desire to do something else, then it means that one must first change the constitution.  We are now preparing a working conference where, in part, we’ll discuss the legislative project concerning government guarantees of medical assistance.  There we’ll also discuss laws related to public health.

“It’s planned for the Minister of Public Health and Social Development, Mr. Zurabov, to speak first, and share his thoughts and conceptions on development.  Later, perhaps, I’ll speak if they let me.  Then we’ll divide into 23 groups and move to different rooms: village medics, physicians in out-patient clinics, emergency medical specialists, heads of city hospitals, chief physicians in polyclinics, heads of district, regional, and republic hospitals, directors of research institutes, and they’ll give their expert evaluation on everything that is going on, and work out specific plans.”

Am I to understand that these groups will either support you, or Zurabov?

“What do I have to do with it?  Before Zurabov there was Minister Shevchenko, against whom I spoke rather sharply.  Now there’s Zurabov and our relationship, unfortunately, also has some misunderstandings.  I still can’t understand where he’s trying to take us.  People ask me: ‘What sort of minister is it that you need?’  I need one who’ll answer for public health, and, it follows, who’ll make sure the people of Russia don’t suffer another great catastrophe.  I’m hoping that there’ll be a reasonable compromise found at the conference, a compromise between the government and the public.”

You are speaking like a specialist about an urgent condition?

“Exactly!  Our public health needs urgent assistance!  Now here this conference will take place with the participation of the Ministry of Economic Development and Trade, the Ministry of Finance, as well as the Strategic Research Center.  We hope to receive a truly expert evaluation of what has already been done and what is being done.  We’ll ask colleagues: what are the most serious problems, in your view, that need solving?  What kind of financing is more rational?  Would a system of directing and organizing public health bother you?

“I personally believe that the creation of a new Ministry of Public Health and Social Development is a blow to medicine, because we have lost professional vertical management (of public health).  We have suffered many misfortunes in the administrative reforms as they are now presented in public health.  It’s simply that the people who made these reforms didn’t have elementary knowledge about the organization of public health.  Their motto was: let’s wreck everything, and later…  One can’t play such pranks on the nation.  But a shortage of x-ray film?  The provision of technical resources?  Not long ago I read a document from the accounting department: 80 percent of the medical devices in the country have become unfit for use.  But Zurabov assures me in front of the president that public health needs no more money…  He doesn’t see ‘the mechanism’, how they can be wasted.  He laughs, and that’s all.  I’m very frightened when people think in macro-categories, because they can’t imagine the social consequences of their own ideas, even if they are brilliant.  So here Zurabov maintains that a budget prevents the head of an organization from working.  But I’m the director of an institute, the budget doesn’t bother me one bit.  What bothers me is when there’s no money in the budget.  At a conference he asked me: ‘Do you want me to go to a medical institute?’  As if physicians don’t know how to handle money, that only financial officers and economists can.”

But you know how?

“Every hospital chief physician, who in the course of this decade has twisted in the wind due to lack of money, who managed to preserve little islands of normal public health, can out-do any financial officer.  And I’m against them making behind the scenes decisions that in the end affect terribly the level, the quality of medical service.  I don’t worry about pay as you go medicine and I have nothing against it.  But let it be for those who can pay for the service, let them have two toilets for every person, two televisions, even three if they need it.  BUT I WANT THE LEVELS OF DIAGNOSTICS AND TREATMENT IN PAY AS YOU GO AND FREE MEDICAL FACILITIES TO BE THE EXACT SAME.  Especially in the medical care of children.  With joy they bring out the numbers, that 40 percent of the money spent on public health comes in from extra-budgetary sources, i.e.: from pay as you go medicine.  They say, how nice: extra-budgetary expenditures will increase, while budgetary ones will decrease.  But the budgeted expenditures serve millions, while the pay as you go serves only a few thousand rich people, and each person from those thousands, of course, uses up more money than someone from the millions.  So how can the financial people and the economists even bring up such numbers?  They can’t even evaluate an indicator of public health in the GNP, which is two times lower than international standards.”

You butted heads over questions of management and organization of governmental public health.  I can imagine how important this is, and how much work went into it.  How did you shift gears after Beslan?

This is work, a specialty.  Catastrophes and terror acts are for me a continuation of my usual life.  They once asked me: did my life change after ‘Nord-Ost’?  But the year of ‘Nord-Ost’, before this tragedy I flew to Afghanistan 3 times after the earthquake, I was in Israel where there’s the Intifada, I was in Kaspiysk where there was a terror act on May 9th….  I live this way my whole life, I’m always doing urgent matters, and so I don’t have any kind of daily routine.  I can’t plan a trip to the theater, I never know if I can be at a friend’s birthday.  I often get home at 1 or 2 in the morning, and I get up at 7 am.

Before ‘Nord-Ost’ and especially during those days you were an absolute hero in the eyes of the public.  Your moral authority was not doubted by anyone in the country.  But later you went over to the authorities’ side, why?  Why would you, a person with a worldwide name, need this?

“In our society, to have one’s own independent opinion or judgment is difficult – they beat at you from one side or the other.  But it’s important either way not to lose face, not to fake it.  I’m an independent person, and, if I see injustice, right away I’ll speak about it, no matter how it’ll be taken.  It’s been said: Putin wanted to kill the hostages!  But this is a lie, and absolute lie, I said so and heard: “Ah, he’s speaking on the president’s behalf!  Lickspittle!”  But at the same time there were the signatures of thousands of simple people who voted to award me the rank of Hero of Russia.  Average readers, everyday readers of ‘Arguments and Facts’, they chose me as the ‘The National Pride of Russia’.  This means that they understand that everything I do, I do as an independent person who feels the urgency of justice.”

People died from the gas, but you said that the gas was harmless…

“I didn’t say it like that.  I said that you couldn’t call the gas lethal.  In that case, all gases we use for anesthesia need to be called lethal.  There’s a huge difference between this and the gas that the fascists used to suffocate innocent people in gas chambers.  There’s this understanding of individual tolerance.  In operating rooms we also work with narcotic gases.  We use them for analgesia.  Any anesthetic, including the use of Fentanyl, sometimes people, to our great misfortune, die from the anesthetic.  This is well known in medicine.  At Dubrovka 130 people died.  This is awful.  Now I’ll use the terrible definition “medical losses”.  They are calculated in wars, catastrophes, and earthquakes.  They’re greater in number, and more tragic, but if the gas hadn’t been used, then all 800 people would’ve been blown up.”

But everyone knows that Barayev and his people at the moment of the assault were not preparing to blow up anything.

 “You couldn’t negotiate with them, check for yourself, I talked to them more than anyone else.  They practically held me hostage when I went there the first time, and I sat up there with everyone on the balcony for six hours.  I was saved by an English journalist who asked: ‘Where is the doctor?’  They said: ‘He left’.  And then the journalist started talking about me.  How I was the world’s pediatrician, how I treated all kinds of children, and even saved Chechen kids.  And they let me go.  When I was leaving I asked if they’d let me in another time, and I was happy when they replied in the affirmative.  Because while I was sitting there all those hours I was able to ask everyone who needed what: someone needed to change contact lenses, someone asked me to get feminine hygiene packets, someone else – medicine.  And two hours later I returned with medicine.  And then I repeatedly brought in everything needed.

“One preacher on his website wrote: ‘Judas Roshal did not bring medicines to the hostages, but poison, he wanted to poison all the hostages’.  What, should I sue him in court?  Never.

“By the end of the third day the terrorists began to get nervous.  This is for sure.  On the last night they killed one and mortally wounded another, while they managed to save a third woman, a pediatrician.

“But I won’t talk about this.  I’d like to say the following and I ask that you believe me: IF MY GRANDDAUGHTER WAS IN THIS SITUATION AT DUBROVKA, OR MY SON, AND THEY ASKED ME – HERE IS THE PLAN, DO YOU AGREE TO USE THIS GAS TO FREE THEM?  I AM A PROFESSIONAL PHYSICIAN AND I’D ANSWER – YES.”

Are you serious?

“I’ll repeat once more that I’m asking you to believe it.  I’d answer – yes.  Because I’d see in it a chance at life, while otherwise, no, I wouldn’t see…”

Otherwise, for example, the withdrawal of forces from Chechnya?

“Chechnya is a complicated matter.  I’m one of the first, from the start, in an interview on NTV with Boris Koltsov at Urus-Martan during the first Chechen war I was strongly against this war.  But then there was Budennovsk.  And what?  Was there less blood?”

But at ‘Nord-Ost’ they destroyed them, and what?  Did Beslan not happen?

“You must try to negotiate with terrorists, but you can never come to their decisions.  The French, who refused to fight in Iraq, found themselves in a difficult situation.  They had journalists kidnapped there and they gave in and paid a huge ransom.  You pay and then tomorrow they’ll kidnap others.  You don’t pay and they cut off heads.  And then how can president look into the eyes of the French people?

“You know what terrorism is to me?  Here, I’ve asked myself this question.  Is it ‘shahidki’ (suicide martyr women) wrapped up in explosives belts?  But back during the Great Patriotic War (WWII) they went up to enemy tanks all covered in grenades, and these are our national heroes.  Were they terrorists or not?  No.  Terrorism is when innocent people die.  People die sometimes who are of the same faith, even the same political persuasion.  There was a hostage at ‘Nord-Ost’ named Fatima Shakhova, a Moslem woman.  She’s a physician and did much good there.  I found all the doctors who were there, who saved others; I showed the people that they were heroes.  Everyone received the Order of Courage, and one posthumously, but not her.”

How do you explain this?

“I can’t find any other explanation, other than stupidity and foolishness.  I won’t rest until she’s decorated, I’ll write to the president’s administration over and over.  She should’ve been decorated first!  But I had to put my name on the line to get her away from the interior ministry, to convince them that she wasn’t with the terrorists.  Afterwards she defended her master’s thesis brilliantly, but then one of the big papers went and buried her…  as a terrorist.  Later they issued a retraction.  They gave me the job title of FSB officer; go read ‘Chechen Press’ on the Internet.  There they wrote: ‘FSB colleague Doctor Roshal’.  Then this ‘newspaper’ with great pleasure started to exaggerate about everyone who had a bad relationship with me before this.  It was specially planted; they wanted to ‘put me down’.  Though it’s true that one friend of mine before ‘Chechen Press’ said for everyone to hear that had he been a terrorist, he wouldn’t have let me go, since I know too much.  Later at one of the conferences I met Patrushev and I said: ‘Say hello, I am one of your new colleagues’.  Tell me, what FSB officer could tell Putin in the presence of the prosecutor general and the armed forces ministers that he didn’t agree with the arrest of Khodorkovsky?  Not long ago I spoke out loud against an impermissible declaration by the prosecutor general, that they needed to arrest a terrorist’s entire family.  It’s simply awful to hear this from a prosecutor.

“Officers from the FSB during ‘Nord-Ost’ offered to put a micro-camera in my buttonhole.  I refused.  By the way, the terrorists later searched me and looked from this micro-camera, even in my stethoscope, to say nothing about buttonholes.”

But they say that at Beslan you confiscated film from journalists.  It this true or not?  Did it happen?

“It’s true.  I didn’t just ‘confiscate film’, but held negotiations with the terrorists, made ready the medical facilities for the possible arrival of wounded, and repeatedly consulted on all 200 wounded children in Vladikavkaz.  But I really confiscated the film.  This is the absolute truth.  I was ready to kill one of them!”

A journalist?  For what?

“Imagine this: there’s a huge flow of wounded, horror, hurrying around, seriously ill…  I’m out in the street in front of the admissions department, and I’m looking at the wounded, deciding, with the other physicians, who needs to get into intensive care right away, who to send to the operating room.  The people are in a panic, vehicles are arriving one after another, bringing in more and more victims, and here at the worst time this Russian journalist, representing, it turns out later, some American company, gets right in the blood with his camera.  Here’s the blood and here’s the camera.  I lost it and shouted: ‘What are you doing?! Who are you?! Give me that film!’  It was shameless!  I still have this film, by the way, and I can show it to you if you wish.  There were also the boys from RTR and NTV taking pictures, but from further away.  They conducted themselves a bit more delicately.  I also confiscated their films so that they couldn’t say: ‘He confiscated from some, but not from others’.  But when things had calmed down that night, I returned them all to them that very same day.  There was another group that was working impudently, cynically.  I couldn’t confiscate their film: they were four big strapping men and a camera operator, so physically I couldn’t.  They wouldn’t even identify themselves.  They didn’t say what channel they were from.  They said something about me not wanting the world to find out what’s going on here.  No tears, just like robots.  The people there were crying, they couldn’t endure it all, and in place of assistance, participation, and sympathy there were all these journalists pointing television cameras at their mutilated children. This is inhumane!  I had to act this way.  From the point of view of ethics, at the very least.”

Here you speak about ethics, but let us once again return to the events of two years ago, to the moment when, I will say straight out, my disappointment in you, the legendary Doctor Roshal, began.  Remember: people were rushing about the morgues, looking for their loved ones, while the authorities at the time were giving medals to ‘Chekists’ who successfully coped with the hostage rescue operation…  Then you got a medal, and you handed your medal to the president.  From the standpoint of ethics, what was this?

“Let’s put things in order.  The president gave me an award several months after what happened, and no one was ‘rushing about’ the morgues.  I had already buried two kids and was howling at the cemetery like a Beluga.  Further: I believe that I didn’t do anything spectacular and that they were decorating me for nothing.  Every person can judge my act for himself, depending on his desire.  Not a single Chekist received an award alongside of me.  Kobzon was decorated along with me, but my life’s ‘ethnics’ even before ‘Nord-Ost’ and after ‘Nord-Ost’ and before Beslan and after Beslan, well, I’m not ashamed of them.

“Listen!  It seems that the whole time here I’m just making excuses for myself.  I’ve never done this before in my life, and I’ve nothing to make excuses for.  I decided to answer all your questions openly.  As far as disappointments in life, well, unfortunately they happen.  What to do about it?  Too bad.”

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