In Rural Siberia, the Hospital Comes to You

Patients wait for medical treatment and laboratory results on the Saint Lukas medical train, which stopped in the remote town of Kuragino, Russia, on November 13, 2016. The train comes about once a year to each town on its route. Emile Ducke

The Saint Lukas train doesn't accept passengers—it accepts only the sick. The Saint Lukas is one of five government-funded medical trains that travel to remote towns in central and eastern Russia. Each stop lasts an average of two days, and during that time the doctors and nurses on board provide rural populations with basic medical care, X-ray scans, prescriptions and referrals to seek specialist help.

"People started queuing to make an appointment early in the morning, around 6:30 a.m.," says Emile Ducke, a German photographer who traveled with the staff of the Saint Lukas for a two-week trip in November through the vast regions of Krasnoyarsk and Khakassia.

Russian local government and state rail services have operated the five trains since 2010, although the Saint Lukas started running three years earlier. Each one carries medical staff from a regional city like Krasnoyarsk. The service is in particular demand right now: The fall in the price of oil and the Western sanctions on Russia for its involvement in the Ukrainian conflict have helped create an economic crisis that led parliament to approve a 30 percent cut to the national health care budget in December 2016.

Russia's public health care service has been in dire need of modernization since the Soviet Union's collapse. Its services have dropped to last place out of 55 of the world's most developed countries, according to a 2016 Bloomberg index, and a study last December by the Economist Intelligence Unit ranked Russia's health care on par with that of the developing world. The government has struggled to come up with measures to address the problem, particularly in the poorer, rural areas east of the Volga River, including arranging doctor's appointments by video chat and expanding funding programs to incentivize medics to establish practices in remote parts of the country. This year, up to 100 doctors will receive compensation payments of $17,400 to move and work in Krasnoyarsk.

The annual arrival of the Saint Lukas, funded by the local government and Russia's state-owned rail holding, is another attempt to improve the situation. Ducke says that while most towns weren't totally lacking in health care and had at least one doctor and nurse, "people go for checkups when the train is in town because they trust experts from the big city." And, he adds, some "applied for an appointment with their local doctor and waited for several months, and then they were too badly equipped, or they did not trust them."

The Saint Lukas has increased the number of stops it makes each year from the 55 it made on its first journey a decade ago to 75 today. For 10 months every year, the train stops at about eight stations over two weeks, before returning to the regional capital to refuel and restock. Then it starts all over again the next month. Most stations wait about a year between visits.

Doctors see up to 150 patients every day. The train's equipment allows for basic but comprehensive checkups. D octors and nurses administer blood tests and can provide sonography, brain wave scans (EEGs), heart rhythm tests (ECGs) and X-rays. The duration of each stop depends on the degree of health care available on the ground; some larger towns have several thousand inhabitants and a hospital, while others have a population of only a few hundred and just one overburdened local doctor. (The Saint Lukas is the only one of the five medical trains to include a carriage that houses a chapel, where believers can pray between medical tests or baptize their children if their town has no place of worship.)

Elderly patients in particular look forward to the arrival of the trains. "There were hardly any kids lining up," Ducke says. "There were some parents with young babies, but I would say most of the people coming for checkups were pensioners or over 50 years of age.

"I was very impressed by the doctors and their assistants working and living in such little space and with so little time for each of their patients but still staying focused and very concerned," says Ducke. "They were the best chance for many living in these rural parts to get the treatment they want."

Patients register at the train's reception, where they will be assigned appointment times with doctors in the village of Son, Russia, on November 6, 2016. The treatments are free of charge. The train's duration of stay is dependent on the size of the village—the train only stopped for one day in Son, which has 740 inhabitants. Emile Ducke
Kuzmin Vladimir Pavlovich is radiographed after consulting nearly all the doctors on the train, who determined he had a chest injury, on November 11, 2016. He made his way from the village of Karatus to Kuragino to receive his diagnosis. The doctors ordered him to undergo two operations in Krasnoyarsk, the region's capital. Emile Ducke
Elena Semina from the town of Kuragino waits for the beginning of her EEG examination in the village of Tuba on November 10, 2016. She traveled to Tuba, where the train stops before reaching Kuragino, in order to avoid the rush demand for treatment in her town. Emile Ducke
Patients wait in the narrow gangways of the train for their medical treatment in the village of Tuba, on November 9, 2016. The train gives them the chance to consult several specialists in a single day. Emile Ducke
Evgeny from the village of Son undergoes an ECG examination on November 6, 2016. The train includes a laboratory for blood tests and all necessary equipment for EEG and ECG tests, X-rays, and more. Emile Ducke
Alexey Antsiferov poses with his mother Natalia at their home in the village of Son, on November 19, 2016. Alexey still suffers from injuries from a serious car accident eight years ago. Since then he depends on his mother's care. Due to the remote location of Son, it's difficult to access therapy at the region's capital, Abakan, as well as the supply of special medicine he needs. The train allows doctors to prescribe medicine to patients, and it also has a pharmacy where patients can have their prescriptions filled. Emile Ducke
A group of pensioners exercise together in the town of Kuragino on November 16, 2016. They founded their own fitness class in order to stay healthy between medical train visits. Emile Ducke
The medical train is named after Saint Lukas, a priest and doctor who operated in Krasnoyarsk during the Second World War. The back of the train functions as a chapel in his honor, where patients can go before and after their medical treatments. Emile Ducke
Priest Igor rings the bells before the chapel service starts on November 11, 2016. Emile Ducke