Organization of the Health Care System in Surkhandarya District During the Soviet Era

Бюллетень науки и практики / Bulletin of Science and Practice

Protecting and strengthening people's health, taking care of prolonging their life, and improving the quality of medical services are important parts of the social policy of every state. In all past periods since the formation of states, efforts have been made to raise the health of their citizens to the level of government policy and implement it.

In the early Soviet period, the establishment of medical services in the Surkhan oasis was not aimed at preserving the health of the local population, but rather at monitoring the health of Europeans and military personnel who worked there. From the report of A. Shevalovich, who served as the head of the district health department, it can be seen that the first hospital in the district had 10 beds and was established in May 1924. In 1925‒1926, only 7 people worked in the health department [1]. The district health department had 4 medical stations, where 2 doctors and 4 paramedics worked. Naturally, at that time, when infectious diseases were at their peak, they could not monitor the health of the entire district population [2].

In the 1920s, dangerous infectious diseases - malaria, typhus, cholera, yellow fever, trachoma, malaria, and blood diseases — were common among the population. The inhabitants of the oasis rarely resorted to modern medicine, relying mainly on traditional folk remedies.

In 1925-1926, the main task was to open medical institutions in the oasis and provide them with specialists [3]. Work was carried out on the establishment of a hospital in Sherabad, the center of the Surkhandarya district, which was formed in 1925. Since the fight against the above-mentioned infectious diseases was considered one of the most important tasks [4]. In 1926, a district hospital with 25 beds was completed. During this period, medical examination centers and hospitals with a small number of beds were opened in many districts of the Surkhandarya district.

By 1926, the Termez city hospital had been expanded to 20 beds and was called an outpatient clinic. Health-oriented branches in the form of a medical center with a specialist doctor in the city of Sherabad, a paramedic station in the village of “Poshkhord”, a medical station in the city of Boysun, and medical aid stations in Yurchi and Sariosiyo began to operate. All of these were staffed by medical personnel sent to the oasis in cooperation with doctors from the military unit. This was because military garrisons were located in the aforementioned districts and cities. The hospital in the city of Termez was staffed by only three people: a civilian doctor, a treating doctor, and a midwife. The central building of the district hospital was located in the building of the 31st Amu Darya Guard Brigade of the military border guard detachment, which was built in 1889 [5].

However, the material and technical conditions were very difficult. The existing building given for the hospital had very large window frames, and in the winter months it was very cold because of the rain dripping from the roof, and there were no conditions for treatment. In 1926, 10,645 people were registered and treated in rural medical departments. Of these, 7,442 women were treated per midwife [6]. In the following period, in order to maintain the health of the rural population, the staff of all hospitals and outpatient clinics of the district were tasked with organizing vaccinations to prevent infectious diseases among the oasis population.

On July 6, 1927, the district executive committee adopted a resolution on improving the sanitary situation in cities. In the second quarter of 1927, it was planned to open a hospital for 20 beds in the Boysun district, 40 beds in the Denov district, and 25 beds in the Sariosiyo district [7]. In 1928, the old hospital was moved to the district center, Termez, and was renamed the 1st district hospital. It was staffed with medical personnel from military units who had been discharged and were unemployed [8].

At the initiative of the chief physician of the district hospital, A. Topilsky, a children's department, a dental clinic, a women's clinic, an internal medicine, surgery and eye diseases department were established. However, at that time, treatment and medical examination were charged. 50 kopecks were charged for a medical examination of one patient, 3 rubles for a day and night stay of one patient, and 10-20 rubles for a surgical operation, depending on the cost of medicines and dressings. This fixed price was expensive for ordinary working people [5].

In 1929‒1930, 764,230 soums were spent on regional health care. With these funds, the number of treatment places was increased, and favorable conditions were created for the work of qualified medical personnel [9]. According to it, it was stated that 50 rubles per year should be spent on one place for adults, and 45 rubles for children.

By 1936, water pipes were laid in the city of Termez, the center of Surkhandarya district, to provide the population with clean drinking water. The necessary funds of 67,000 rubles were allocated for this by the People's Commissariat of the Uzbek SSR [10]. In the same year, the Institute of Dermatological Diseases of Uzbekistan organized a medical expedition to Surkhandarya district. The purpose of the expedition was to examine patients suffering from dermatological diseases, fungal diseases, ringworm, and tinea versicolor [11].

Health care facilities began to be established in rural areas. In 1930, a one-story hospital with a capacity of 50 beds was built and put into operation. In those years, hospital staff provided medical services to residents and immigrants from Zharkurgan district, part of Angor district and Kumkurgan district, in addition to residents of the district. In 1939, a one-month inpatient department with a capacity of 15 beds was established at the agricultural machinery and tractor stations (MTS) [12].

However, even by the 1940s, the shortage of medical personnel and medical equipment were among the main problems in the field. For example, in 1941, the health system of the Shurchi district consisted of 5 doctors, 1 paramedic, 7 nurses, 6 midwives, and 1 medical worker [13]. In 1941, only 27 of the villages in the region had village medical stations, 12 of which were staffed by paramedics. In the same year, due to the expansion of medical institutions, a total of 19 medical institutions with 1,715 beds served the population of the district [9].

In short, when necessary, qualified medical personnel were called from the center to the places, but no attention was paid to training local personnel. Qualified medical personnel from the center worked for a certain period of time and then left again due to lack of conditions. The housing situation in the oasis is very poor, and many sources confirm that the medical personnel who came to work did not want to stay here because of this problem.

Based on the data considered, it can be said that in the first years of Soviet power, a number of practical works were carried out in the oasis to maintain the health of the population. In particular, positive results were observed in the organization of new medical facilities, increasing the number of doctors and medical personnel, and in the prevention and treatment of certain diseases. However, hospitals, outpatient clinics, medical rooms and kindergartens were not enough for the population of the oasis. At the same time, the supply and material and technical base of medical facilities was at an extremely low level. This experience serves as a basis for understanding the complexity of the tasks facing the regional health system in subsequent years, especially during the Second World War, and the difficulties in solving them.