/* Written  3:10 AM  Mar 23, 1995 by nphhi in igc:aiha.med-pol */
From: National Public Health and Hospital Institute 

                     From the NISHEALTH Clearinghouse
                            (nphhi@igc.apc.org)

         *********************************************************

                 International Federation of Red Cross and
                          Red Crescent Societies
                        Moscow Regional Delegation

                            Medical Assessment
                          Republic of Azerbaijan
                              17-21 June 1992

                                Version 1.1

                            Jean Mireault, M.D.

         *********************************************************

[Reproduced through the NISHEALTH Clearinghouse with the permission
of Dr. Lawrence Probes.]


The population of Azerbaijan is 7,000,000 people.  The capital
city is Baku, which has a population of more than 2 million.  The
country covers an area of 86,000 square kilometers.  There are
two autonomous regions:  Nakhichevan is the capital city of the
autonomous republic of the same name with a population of 285,000
persons;  the autonomous region of Nagorno-Karabakh was composed
of 75.9% Armenians before the actual conflict.

In 1989, Azerbaijanis constituted 83% of the population of the
country.  Azerbaijan has two significant minority groups:
Armenian (5.6%) and Russian (5.6%).

Politically speaking, since February 1988, tension between
Azerbaijanis and Armenians has become stronger.  After the
declaration of independence from USSR on August 30, 1991, the
situation increased. On November 1991, Azerbaijan launched a
massive military operation against the Armenian enclave of
Nagorno-Karabakh.  Life for these peoples began to deteriorate
(food supplies, medications and water) in that region.

As a result of all this political conflict the number of
displaced persons is increasing daily.  There are now
approximately 200,000 persons from or close to Nagorno-Karabakh
whose have been displaced.

The country is very rich in mineral resources.  The most
important industry is the oil industry.  By the way, the original
name of Azerbaijan means the land of fire.  It is also an
important cotton-growing and sub-tropical base.

THE RED CRESCENT SOCIETY OF AZERBAIJAN REPUBLIC

CENTRAL COMMITTEE

CHAIRMAN: Abdulhalim Shamsaddin oglu Ahmadov
DEPUTY:   Ariz Asiev

ADDRESS: Baku, pr. Azerbaijan, 19
Tel. (8922) 93-19-12
Fax (8922) 93-15-78

Thirty-five persons work for the Society in seven different
departments: General, Immigrants, Humanitarian, Editorial,
Finance, International and Commercial departments.

The Humanitarian Department is responsible for the nurse's,
youth, and blood donor programs.

All financing comes from the government. The annual budget was
unavailable to me.

1.  HUMANITARIAN DEPARTMENT

A.  NURSES' PROGRAM

The Red Crescent has a staff of 308 nurses.  The program has been
in existance for more than 30 years.  They receive 460 roubles
per month, but the Red Crescent would like to raise the salary to
1,200 roubles.  Some of them have left their jobs because the
salary was too low. By way of comparison, a nurse working in a
hospital earns 3,000 roubles.

Basically, two types of nurses work for the Red Crescent: medical
nurses (208) and social nurses (100).  In Baku alone, ther are 60
social nurses and 150 medical nurses.  Actually, at least 18
regions are not covered by the Red Cross's nurses due to the war.

The medical nurses are trained at a special institute for nurses.
They are trained for different jobs:  giving injections,
administering first aid, changing dressings, measuring blood
pressure and conducting medical evaluations of patients.

Social nurses (normally younger women) receive a two-day training
orientation by the Red Crescent Society in which they are
instructed on how to clean the patient, go to the bazaar for
shopping, stay at night to observe some patients, etc.

Normally, nurses work in pairs.  When a patient needs some
medical services, the medical nurse takes care of him while the
other nurse does the social work.  When medical care is no longer
required, the social nurse continues her work for the patient
until she or he dies or goes to a home for the aged (which are
not very popular).  At least every two days, each patient is seen
by a doctor.  Every day, the team follows 16 patients.  In the
Republic, more than 6000 patients are under the Red Crescent
umbrella.

Daily, the medical nurse goes to the regional hospital and talks
to the doctor in charge of a certain number of patients and
discuss each case separately.  In the health system, each doctor
takes care of 800 patients.  The doctor keeps a list of those
patients; invalids and elderly persons without any relatives are
identified.  The nurses of the Red Crescent take care of these
most needy groups of the population.

Until recent years, the Red Crescent Society provided the
equipment, including syringes and medication, for each nurses.
Now, it is impossible.  Each nurses takes her syringes or
medicine from the polyclinic. With the situation at the moment,
it is difficult to obtain medical supplies.

If a patient is not satisfied, she or he can lodge a complaint
with the Red Crescent.  The head nurses give their telephone
numbers to each patient.  It seems that there are not too many
complaints.  The nurses love their jobs, and they do them
properly.  Twice a year, the social nurse takes an educational or
refreshment course.  The salary is the same for the both types of
nurses.

Questions from the head nurse?

1.  Is it possible to have different salary levels?

2.  Is it possible to pay 1,000 roubles per month for her
    transportation costs?

RESPONSE TO THE CONTENTS OF THE BASIC UNIT FOR A SISTER OF
CHARITY

They like the idea of being independent from the hospital and
feel that the quality of care will increase.   Nothing on the
list was needless.

PLANS FOR THE FUTURE

They plan for November 1992, a nurse's school with a two year
program.  I have no more details concerning the cost or the
curriculum.  There is a possibility that the chairman, Mr.
Akhmedov, will request money from the Federation to implement
this project.

Also in October of this year, under the responsability of the
Minister of Health, they are planning a refresher session of two
months for 30 medical nurses.  Using a rotation system each
medical will receive this refresher session.

B.  YOUTH PROGRAM

DIRECTOR:  Asim Agaleviv

This is a very new program which was only started one month ago.
In this program, young volunteers help elderly to do house
repairs, painting, and shopping, they also help in distributing
clothes.  The Red Crescent Society teaches all the necessary
skills for such work, as well as some medical techniques to help
the medical nurses. Presently, there are 25 very active
volunteers who finance their activities by selling artistic
creations.

C. BLOOD DONOR PROGRAM

It is not a problem here to recruit donors.  The people are
patriotic and give blood without any financial incentives unlike
in the other Former Soviet Republics.

2.  INTERNATIONAL DEPARTMENT

DIRECTOR: Elchin Bagirov
Tel. office: (8922) 93-84-81
     home:   (8922) 94-12-80

At the moment, he is involved with displaced persons from
Nagorno-Karabakh and other places where there is military action.
He works with the ICRC in different aspects such as prisoner and
researching missing people.  The department is very busy because
there is only one other person working with him.  In addition,
they are currently being faced with a new problem of an
increasing number of Azerbaijanis coming into the country from
different places such as Central Asia and Russia.  At the moment
there are more than 250,000 of them.

3. COMMERCIAL DEPARTMENT

This department is working on some potential joint-venture
project (hygienic utilities, tent, hotel).  No agreements have
actually been concluded.

MEETING WITH THE MINISTER OF HEALTH OF THE AZERBAIJAN REPUBLIC:
MR Ragim Mamed oglu GUSEINOV

PRESENT: A. Ahmadov: Chairman of the Red Crescent Society
                  Daniel Prewitt: Deputy of the IFRC Moscow
Delegation

The minister has held this position for two months only.  He
explains that he faces the problem of reorganizing the system.
Reorganization means nearly starting form scratch.  Under the FSU
the decision was dictated from Moscow, all the budget planning,
all the delivery of medicines and equipment was under the control
of the central committee in Moscow.
Now they want to organize themselves with their owns views. The
economic crisis plus the war situation complicate in many ways
the difficulties. The budget for the last six months was 1,134
million rubles and it represents only one third of the real
needs.  Due to the inflation rate, they only budget for this
short period.

They also face another problem.  They do not have a specialized
institute in the country.  Before independence, patients who
needed specialized treatment were transferred to Moscow.  Now
Moscow demands hard currency.  They plan for the future, but
without precision, a system with health plan insurance.  It is
possible also that private practice would be accepted, but under
the government regulation. The doctors will not use the
government facilities (hospital, equipment, staff).

At the moment, there are no pharmaceutical companies in the
country. The Minister said that some discussions are in progress,
but it is a secret at the moment.  They have received from
Medecins sans Frontieres (MSF), ICRC, AMOCO (corporation from
USA) and other countries (Pakistan, Turkey,France,Belgium) a
total of 175 tons of medicine and basic medical supplies.  They
received from Turkey some autoclaves, gloves and sutures
materiel.

Sometimes, there are significant problems with international
assistance; they receive different medicines which they do not
know how to use, creating a problem of identification and loss of
energy and money.  I have attached some examples and the list of
the requirements for the country (annexes A, B).  It is very
difficult to buy drugs and equipment at the moment because of the
shortage of hard currency.

The political situation (i.e. fighting in Nagorno-Karabakh)
increases pressure on the health system.  There are approximately
200-300 wounded per day.  The need for treament is increased and
the turnover of different medicine and medical supplies is by
extension expanded.

There is a lack of water in different regions, and displaced
persons are placed in different locations: schools, barns, tents
and hospitals, sometimes with minimal sanitary service.

The Health Minister said that there is the potential risk of an
increasing incidence of gastroenteritis.  At the moment, there
are no outbreaks of communicable diseases (i.e., measles,
hepatitis, dysentery).

One thing was very clear also during the discussion, he is
frustrated answering a lot of question and getting no
humanitarian aid from those different organizations.  The
question concerning the refugees or the displaced persons is
covered by Mr. Daniel Prewitt.

We interrupted the discussion after 45 minutes and I went to the
discussion with other officials from the Health Ministry.

We had left an extensible questionnaire.  The goverment was very
kind to answer.  You will find annexed (C) a compilation of
different data.

MEETING WITH OTHER OFFICIALS OF THE HEALTH MINISTRY

PRESENT:

Velibekov Abbas Sultan-ogly: Deputy of the Sanitary's Department
Guseynova Zemfita Gadgi-kizi:  Children's Department
Mamedov Nazim Mamed-Aly ogly: Mother's department
Efendiyeva Tahira Ziyad-kizi: deputy of the department of child
    and mother

After the formal presentation, we started to discuss more
specifically the children's situation.  There is a high-risk
problem for the future.  At the moment the vaccination program
faces a dramatic situation: they have no vaccine for the coming
years.  With all the displaced children and refugees, the
vaccination profile of this group is unknown.  Normally each
child in the country is supervised by a doctor.  Now a lot of
children travel without a vaccination certificate.  It causes two
critical problems; firstly there is a lack of vaccine, and
secondly there is need for more vaccine because we don't know the
medical records of some children.  Presently, there is no
evidence of any outbreak.  The vaccines needed are for measles,
diphteria, poliomyelitis, pertussis.

Another point was discussed concerning the cases of displaced
children arriving from Armenia.  These groups represent more than
one-third of all displaced persons.  They suffer from physical
illnesses and post-traumatic stress disorders.  These children
increase the charge of the children's hospital.

We discussed a normal diet for children.  It is difficult to have
diary product because they are very expensive.  They eat every
two days.  Less than 40% of the population can afford to buy
fruits and vegetables.  There is no problem for bread.

They buy potatoes (30 R\kg) and tomatoes (50R\kg) on a more
regular basis.  I asked one man who earned 2 000 roubles per
month what is a regular daily diet for his two children: the day
starts with bread, tea, butter and rarely jam; the lunch is a
soup; for dinner, they eat soup or meat and potato.

We also had a discussion about their Blood Institute.  In the
country, because of marriage between close relatives, there is a
significant number of thallassemias and hemophilia.  The
thalassemias are a diverse group of congenital disorders in which
there is a defect in the synthesis of one (or more) of the
subunits of hemoglobin molecules.  Hemophilia is a congenital
plasma coagulation defect that causes bleeding into muscles,
joints, and body cavities, hours or days after an injury.  I was
not able to obtain more official data to figure out the exact
importance of the problem in the country.

At the moment they do not have modern equipment to make the
diagnosis. The diagnosis is based on the symptoms.  They do
electrophoresis but no plasmapheresis.  The ministery is ready to
discuss with pharmaceutical companies.  Presently, there is no
official contact in this particular medical field.

They do not have a problem of recruiting blood donors in the
country.  This confirms what the Red Crescent said to me.  They
fractionate the whole blood in each components (platelets,
plasma, coagulation factors, red cells).  I have shown our
proposed medical list for children hospital.  The contents of the
list causes no problem. In addition of this list, they want other
things: vaccines, gamma globulins, immunoglobulin, disinfectant
and chloramine.

They request different prepared forms of baby formula.  They
especially ask for a form resistant to warm temperature like in
Africa.  They have received some from Finland but resitant just
for a "cold" country.  The preservation quality was not good
because it was not adapted for the climate of Azerbaijan.  I
explained that it is impossible at this point to take a decision
but I took note of their demands.

The environmental problem was discussed.  At the moment, they
complained about the bad quality of their soils caused by the
extended use under the FSU rules of a large quantities of
pesticides.  They are starting to realize the problem of chemical
pollution in Baku.  There is a concentration of chemical,
petrochemical and metallurgic industries.  They said that the
health situation is aggraved with all the toxic substances used
to increase the production of their different industries when
they were under the FSU.

VISIT TO DIFFERENT HOSPITALS

We went to Sabunga located 20 kilometers east of Baku where we
visited the city hospital #3.  This hospital was built by Nobel,
one hundred years ago.

PRESENT AT MEETING:

Chief physician: Dr Kadynova Nabat
Department of nursery and gynecology: Dr Sultanova Svetlana
Shizouna
First deputy: Yabloneva Natalia Dmitrievna


Total number of beds: 1200
Number of children's beds:120
Bed occupancy: 60 %
Average length of stay: 17-18 days
Number of admissions per year: 33 000
Number of physicians of staff: 180
Number of nurses on staff: 600

This hospital's catchment area covers three raions (districts)
which together have a population of 400,000. Thirty percent are
children under fourteen.  The hospital is a complex of 17
buildings and some at the moment are functioning without water.
The water in these buildings is carried by hand.  Some of the
buildings are under repair which has been heavily delayed by a
shortage of money.

There are 20 departments including:
reanimation: 15 beds
nursery: 110 beds
surgery: 120 beds
therapy: 300 beds
infectious diseases: 60 beds
gynecology: 100 beds
two children's department: orthopedic\surgery (50 beds) and
    somatic (70 beds).

Currently several departments are under repair.

In the last four years, the ordered supplies received from Moscow
have decreased by 80%, and in the last 2 years, they have a
maximun of 30% of what they need to run the hospital.  It is the
responsibility of the chief doctor to make priorities in terms of
requests, and the decision so far has been to focus on the
children's and nursing departments.  The lack of medications
forces them to use old remedies. For example, they prepare the
active element and add purified liquid to recreate the medicine.

The equipment, especially surgical instruments, is old and in
small numbers.  However, they stated that currently no delays in
surgery occur as a result of the lack of equipment.  In this way,
they again differ from other regions of the former Soviet Union.

The most desperate needs at the moment are very basic surgical
gloves, syringes and baby formula.  As a result they are
sometimes forced to operate without gloves and to re-use
disposable syringes.  More than 3,000 injections are given daily,
although annually, they receive only 15,000 syringes.
Surprisingly, even though there are more cases of hepatitis, no
case of transmission (needle or blood) had been reported in the
hospital.

The nursing department takes care of 3,000 - 4,000 newborn babies
annually; 30% are premature.  Each normal new born stays in the
hospital for 5 days.  There is a great need for oxytocin or
prostaglandins because those two particular drugs are very
important during the delivery period.  They help to regulate the
contractions and to stop abnormal postpartum bleeding.

More specifically, there is a great need for different drugs
which are useful for various diseases: asthma (prednisolone,
aminophylin), diabetes (insulin), cardiac (lasix, tonic).

We visited the pharmacy and spoke with some people there.  It
seems there is a lack of each medicine, although the counter was
not empty. I saw a lot of aminophylin, prednisolone, etc.
Compared to other hospitals, the condition of the pharmacy was
not so bad.  The sterilization room included 4 autoclaves and was
modest but very clean.  They showed me the water purifier where
they reconstitute their own drugs.

During the discussion, the chief doctor said that the
humanitarian aid which had already been received was for the
hospital treating the wounded from the military struggle.

In general, Dr. Kadynova feels that the situation here is not so
bad compared to other places, and I personally agree with her.

AMIRJAN'S CHILDREN HOSPITAL No 8

Chief physician : Dr. Manedova Sophia

This is a 50 year old hospital for infectious diseases with a
department for hepatitis and a department for gastric diseases.
Each of these departments has 40 beds.  Bed occupany is 75%, and
the average length of stay per child is 14-21 days.  There are
800-1,000 admissions per year.

Ten doctors and seventy nurses work in this hospital, which is
divided into two wards depending on age: 0-3 and 3-14 years.
This hospital also treats children from the neighboring raion.

This children's hospital treats basically only two kinds of
pathology: hepatitis and infections of the digestive system.  The
three leading causes of admission are dysentery (salmonellosis),
food poisoning and hepatitis.

The equipment to diagnose hepatitis was rudimentary, but they
said that they were able to diagnose different forms of
hepatitis.  I asked how they monitor each case after discharge
and how they monitor carrier states.  The answer was vague except
that every 6 months, they make a blood test.

As a result of the low standard of living in this petrol workers
region, the incidence of large numbers of people sharing one
house is quite high and there are significantly more cases of
transmitted disease.

Dr. Manedova confirmed that the war has created a budget crisis,
because more money is going to the war hospital.  Another cause
for financial hardship is the long delays which occur between
their requests for money and government responses.

At the moment, there is a lack of syringes and medicines but as
yet, no deaths have been attributed to a lack of drugs.  The same
conclusion has been reached with regard to the nutritional status
of the children's population.  They badly need syringes, needles,
multivitamins, bandages, gloves and and hypoallergenic
desinfectant. Actually they reuse nondisposable syringes and
gloves.

During our visit I saw six childrens with their mothers, all
living in the same room.  The crowding was conspicuous.  I asked
who paid for the mothers' meals, and the answer was that the
hopital would take care of that.  There are also some rooms
within which there are several small rooms, closed off from each
other by glass and just large enough for a bed (less than 7
square meters) in which both the mother and her small child live.
During our visit, a very nice little boy was eating soup with
piece of meat and vegetables.

The pharmacy was very small.  The medicine for the hospital was
in one cabinet.  There were some drugs from different countries
(Finland, Yougoslavia, Austria), although the number of different
kinds was less than 30 and the quantities were small (15 boxes).
They had some disposable syringes in this cabinet.

VISIT TO A GENERAL HOSPITAL IN BAKU

Chief physician: Guligeva Minaya
chief pediatrician: Professor Karagev.

This hospital has 500 beds and 13 departments; reanimation
(infectious-general), gastric infections, hepatitis, meningitis,
respiratory disease, rheumatic disease, ENT (Ear-Nose-Throat),
pathology, stomatology, pulmonology and newborns.

There are 40 beds for children in this hospital.  There are
between 11,000 and 12,000 admissions annually, including 600
pediatric.  The average length of stay per patient is 13 days and
3 days for a newborn.  The polyclinic received more than 18,000
patients per year. Each pediatrician takes care of 800 children.
One important duty is the vaccination program which is easy to
follow.  I visited the vaccination room in the polyclinic and I
saw a chart with the specific period when each child is supposed
to receive each specific vaccine. There were no children during
my visit.  I saw few disposable syringes.  There was a
refrigerator in the room.  Each "family physician" takes care of
1,500 to 1,800 adults.

They had received aid from Iran, Turkey and United Nation, but it
insufficient.  There is still a great need for medical supplies
and drugs. They badly need injectable and oral antibiotics,
cardiovascular medicines (digitalis, cardiotonic) and
prednisolone.  They asked for catheters (peripheral, central).
There is a problem with diabetes. The lack of insulin is a
critical issue.  At the moment, they order drugs from the central
state pharmacy every two weeks. The stock is very low, and the
future in uncertain.

We visited certain portions of the hospital.  The reanimation
unit had no children at the moment.  They asked for more
incubators.  They have one modern incubator from an American
company (Air-shield Vickers) for 40 children.  They want to
upgrade their equipment (children's pediatric table, endotracheal
tube for children and adults, cardiac monitor, ventilatory
apparatus).  I saw some empty incubators, heating table for new
born and electronic perfusor for intravenous drugs.

VISIT TO THE OBLAST CHILDREN HOSPITAL No. 12 OF MARDAKEN

Chief physician: Raginova Sahubar Khananovna

For three years now, this old dacha has been converted into a
hospital.  Different old datchas are used as hospitals, as well
as some other buildings specifically built for this purpose.  The
hospital consists of a group of one-story buildings.  The
outpatient clinic forms part of the hospital.  There are 100
somatic beds in the hospital, wich beds are divided into two
groups: the first group for children under 3 years of age and the
latter group of beds for children of 3 and up.

A total of 8,600 patients come to the clinic each year.  The
clinic serves fifteen refugee settlements (38,500 children).
These children including a large number from Armenia suffer from
physical and psychological stress.  They arrived without any
medical records, so doctors are unaware of their vaccination
history or if they suffer from any health problems.

The average number of admissions per year at the hospital is
2,461. The average stay per person is between 14 to 20 days.
Every bed is occupied 295 days each year.  Children between the
age of 2 months to 14 years are treated at the hospital.  The
principal pathologies are pneumonia, rheumatism and bronchitis.
There are 32 doctors and 60 nurses working in the hospital.

Due to the war, it is obvious that the drugs and medical supplies
have diminished.  There are no cases of malnutrition at the
hospital, except for few displaced children from Armenia.

After discussion concerning the content of the medical supplies
list, they have asked for, in priority: blood giving sets, scalp
vein infusion sets, prednisolone, disinfectant, antibiotics
(gentamycin, claforan, kefzol), diazepam, cocarboxylase,
antihistamines and immunoglobulins.

We have visited a couple a hospital buildings.  There are 6 or 7
children sharing the same room with their mothers. Surprisingly,
the walls in different rooms were quite dirty.

Our visit attracted much attention in the hospital, actually more
than usual. I think that the mothers with their children were
following us. They talked about missing persons and the atrocity
of the war.  It was very touching.

CONCLUSION AND RECOMMENDATION

It is clear that this new independant state is undergoing at the
moment some difficult organizationnal problems.  The conflict
with Armenia raises problems at higher levels.

The country has rich natural resources.  The possibility of
improving the health situation of the country is better here
compared to the other new independant states.

Medically speaking, because of the political reorganization,
armed conflict and displaced persons, there is a potential risk
for a degradation of the health profile for children.  Even if
there is no outbreak of epidemic disease, the risk is there.
Also, very strangely, they asked spontaneously for medical
supplies used to treat wounded persons.

My recommendation is to inform other international organizations
of the potential risk of an outbreak of disease and to bring only
basic medical kits.  I am afraid that if we send specialized
kits, they will channel some of our supplies in the "war-
hospital"

The nurses program like the other one in CIS has to be supported
by the Federation with salary and the kits.


Public Health Statistics

All figures are for 1991 unless otherwise specified.

1.  Total population of the republic:  7,297,000

2.  Average population density:  78.6 persons per square
         kilometer (area of the republic:  86,600 square
         kilometers)

3.  Urban population:  54%

4.  Capital city:  Baku
    Overall population:  1,758,000 (not including including
         refugees from Nagorno-Karabakh and adjoining areas)
    Children up to age 14 years inclusive:  28%

5.  Population distribution by age (thousands)

    Ages       1981       1991       1981       1991
                                   % growth    % growth

    0 - 4      728.1      875.0       11.0       12.4
    5 - 14   1,389.9    1,490.7       24.5       20.6
    15 - 59  3,740.5    4,178.6       57.0       59.0
    60+        444.1      575.5        7.5        8.0

6.  Ethnic composition (1989 census, in percentages)

    Azeris          82.7
    Russians         5.6
    Armenians        5.6
    Lezgins          2.4
    Avartsi          0.6
    Ukrainians       0.5
    Jews             0.5
    Tatars           0.4
    Talysh           0.3
    Turks            0.3
    Georgians        0.2
    Tsakhuri         0.2
    Kurds            0.2
    Udins            0.1
    Others           0.4

7.  Birth rate:  27.0 per 1,000  (26.4 in 1990)

8.  Crude death rate:  6.8 per 1,000  (6.1 in 1990)

9.  Age-standardized (European standard) mortality rate (per
         1,000)

     Age    Percent Mortality
      0 - 14         3.1
     15 - 59         3.5
     60 & older      ?
     Total          88

10.      Average life expectancy at birth (years):

    Total           71.1
    Males           67.0
    Females         74.8

11.      Infant mortality:  25.3 deaths per 1,000 live births
    (note: in some regions the rate is as high as 50 - 60)

12.      Total fertility rate:  23.6%

13.      Marriages:  10.6 per 1,000 population

14.      Divorces:  1.5 per 1,000 population

15.      Marital status (percentage of all persons aged 16 and
         older)

                            Males       Females

    Never married            30.9         22.7
    Married                  64.4         59.4
    Widowed                   1.9         13.2
    Divorced & separated      0.9          2.8

16.      Level of education (percentage of persons aged 15
         years and older)

    Higher                   10.5
    Higher (incomplete)       2.0
    Middle (specialized)     14.4
    Middle (general)         41.7

    *Note:  Middle education encompasses the first 11 years
         of schooling, and is nearly equivalent to a
         combination of primary and secondary education in the
         United States)

17.      Ratio of physicians to population:  88.9 physicians
         per 10,000 population)

18.      Number of hospital beds:   99.4 per 10,000 population
         Total beds:               72,700 (approx. 50,828
                                   adults, 18,431 child.)
         Russia:                   137.4 per 10,000
         Europe (average)               94.0 per 10,000

19.      Literacy rate:  99.0%

20.      Life expectancy at birth:  71.1 years

    Female:    73 years
    Male:      66 years

21.      All causes of death:

    Overall mortality 638.7 per 100,000

Total deaths      All       Neoplasms      Organs of      Accidents
Both sexes       Causes                   Respiration     Poison
By age                                                  Trauma


 0 -  1         2,629.8        2.8         1,180.6        44.8
 1 -  4           528.8        8.8           270.5        58.1
 5 -  9            63.7        5.2            14.9        20.8
10 - 14            41.9        3.5             5.6        16.0
15 - 19            53.8        6.6             3.2        19.6
20 - 24            85.5        8.5             5.6        34.1
25 - 29           120.5       12.5             5.0        48.4
30 - 34           149.5       21.1             5.5        54.7
35 - 39           217.9       39.5             9.5        64.7
40 - 44           330.8       66.9            19.2        62.7
45 - 49           530.0      131.2            18.6        65.2
50 - 54           825.6      194.2            38.6        64.1
55 - 59         1,297.7      295.2            66.4        65.3
60 - 64         1,972.8      418.1           119.6        54.8
65 - 69         2,790.0      496.8           185.6        63.7
70 - 75         4,196.9      565.5           284.2        80.0
75 - 79         6,676.1      654.4             -            -
80 - 85             -           -              -            -
85 & older     13,624.2      546.8         1,280.5        74.2

22.      Diseases of the circulatory system; mortality per
         100,000:  633.7

23.      Ischemic heart disease; mortality per 100,00:  311.9

24.      Cerebrovascular diseases; mortality per 100,000:
         62.5

25.      Malignant neoplasms; mortality per 100,000:  68.2

26.      Cancer of trachea, bronchus, lungs; mortality per
         100,000:  11.5  (13.13 in 1990)

27.      Diseases of the respiratory system; mortality per
         100,000:  89.6

28.      Diseases of the digestive system; mortality per
         100,000:  27.4

29.      External causes of death; mortality per 100,000:
         47.1

30.      Infant mortality (per 1,000 live births)

    1981        34.4
    1982        30.4
    1983        31.2
    1984        30.3
    1985        29.4
    1986        30.5
    1987        28.6
    1988        27.0
    1989          -
    1990        23.0
    1991        25.3

31.      Infectious and parasitic diseases; mortality per
         100,000:  21.8

32.      Suicide and self-inflicted injury; mortality per
         100,000:  1.9

33.      Birth weight less than 2,500 grams:  5.3%

34.      Maternal mortality:  ?

35.      Causes of maternal mortality:  (deaths per 100,000)

    Extrauterine pregnancy                 1.1
    Artificial medical abortion            0.5
    Other complications of pregnancy and labor       8.9

36.      Abortions:  19.9 per 100 births

37.      Abortions:  18.8 per 1,000 women of childbearing age

38.      Annual prevalence of diseases registered at health
         care institutions

Main categories of diseases (ICD-9)
                                        0-14         age 15+
                                                     (no. per
                                       (no. per
                                                     100,000)
                                       100,000)


Infections & parasitic                 6,358.0         2,300.9
Neoplasms                                 40.8           714.7
Endocrine & metabolic                  1,839.5         1,649.9
Blood & blood forming organs               -               -
Mental disorders                         562.6         2,114.0
Nervous system & sense organs          4,644.6         3,741.0
Circulatory                            1,137.8         8,804.8
Respiratory                           24,518.1        12,982.8
Digestive                              2,537.4         5,791.7
Genitourinary                              -               -
Complications of pregnancy                 -             543.9
Skin & subcutaneous tissue             1,858.9         1,521.8
Musculoskeletal                          601.1         1,195.8
Congenital anomalies                     321.1            32.7
Injury & poisoning                      3764.8         3,450.1

39.      Temporary disability:  57.85  cases per 100 workers

40.      Temporary disability:  649.8 calender days (626.4
         working days) lost per year per 100 workers,
         comprising 27% of all workers

41.      Mortality from intestinal infectious diseases:  8.3
         deaths per year per 100,000

42.      Measles morbidity: 84.9 cases per 100,000

43.      Pertussis morbidity:  2.1 cases per 100,000

44.      Diptheria morbidity:  0.9 cases per 100,000

45.      Morbidity from viral hepatitis:  191.7 cases per
         100,000

46.      Tuberculosis morbidity:  37.3 cases per 100,000

47.      Morbidity from bacterial dysentery:  21.9 cases per
         100,000

48.      Alcohol and drug abuse morbidity (new cases of
         alcoholism and new cases of drug abuse per 100,000):
         21.4

49.      Proportion of water samples from water supply system
         not meeting national standards by chemical
         indicators:  67.3%

50.      Proportion of water samples from water supply system
         not meeting national standards by bacteriological
         indicators:  22.7%

51.      Expenditures on health and physical training from
         state budgets (roubles per person):

    1986 - 43.0
    1990 - 61.3

52.      Number of hospitals and public health care (PHC)
         units:

    Hospitals               733
    Ambulatory polyclincs 1,678

53.      Number of physicians and dentists per 10,000:  38.9

54.      Visits to PHC units per person per year:  9.1

55.      Number of hospital beds per 10,000:  99.4

56.      Number of hospital admissions per 100 population:
         13.6

57.      Syphillis morbidity:  3.9 new cases per year per
         100,000

58.      Gonorrhea morbidity:  8.1 new cases per year per
         100,000

59.      Breast feeding rates:

    up to 3 months           37.9%
    up to 6 months         39 %

60.      Pollutants:

Solids                            111.889
Liquids                         1,387.131
Sulfuric anhydrides                 92.89
Carbon monoxide                     65.39
Nitrogen oxide                     48.162
Carbohydrates                  15,556.617
Organic airborne compounds     37,291.191
Other                               7.221

61.      Economic base (leading industries):  oil, cotton,
         chemicals, tobacco