Western newspapers have many ways of savoring the victory of the Cold War. While corporations and politicians are busy colonizing the conquered territory, journalists function as the rear guard, surveying the burnt out husks of cities that dared confront American hegemony. Their function is similar to that of Spanish missionaries of lore: writing home with the dual purpose of justifying the forced civilization of local barbarians on the one hand, and securing money on the other to continue the process of bringing God to the heathens.
    The first is simple in Russia. It's a pretty barbaric place. There is no shortage of whores who, for a couple of bucks, will describe how they sell unprotected anal sex for 60 rubles. Throw in a few more dollars, and they'll even let you photograph their forearms scarred by shooting up with doctored BIC pens full of fourth-rate heroin. These stories require minimal tweaking to convince the average reader that Russians are savages needing to be contained.
    The second mandate requires many more factual distortions. It can take the form of singing Putin's praises as a president who gets things done, or of talking about how Russia seems to be turning the corner eco- nomically. More infrequently, an arti- cle will write about how a handful of starry-eyed Americans, armed with little more than good will, managed to effect change in a place as terminally screwed as Russia.
    The reason for the infrequency of the latter is obvious. The colossal fail- ure of foreign aid packages, from the IMF to USAID, hasn't provided much a journalist can use to justify sending more money. However, rather than critiquing these programs and calling for accountability, journalists dig up obscure examples of regular Americans in contact with Russians, and then blow them up into stories about how Americans can act as civilizing agents even here, in the most uncivilized of nations.
    Michael Wines of the New York Times did just that when he wrote about health care in the provincial city of Dubna on December 31. Through a USAID program, Dubna and its American sister city, La Crosse, Wisconsin, ran a series of exchanges that Wines decided to advertise. Part of the reason he chose Dubna, perhaps, is that it is conveniently located for journalists. If you have a well-organized fixer, it's close enough to Moscow to avoid a dreaded overnight stay, but it's far enough away to qualify as Ônot exactly Moscow.'
    However, this proximity to Moscow posed an unforeseen problem. It was- n't hard even for a slacker like me to get on a bus and check the facts of Wines's story.
    Wines thought he was doing everyone a favor when he wrote this story. By publishing it on the last day of 2000, he figured he had found a good day for a light human-interest story. Nobody wants to read about decay on the eve of the millennium. And even the grim micro-printed Times needs happy fluff stories sometimes. Besides, after running a series of articles trashing the Russian medical establishment (while, miraculously, avoiding the fact that poverty is at the roots of the system's problems), he must have felt that his readers could use a little dose of positivism. Dubna would get a pat on the back from America's paper of note, the fine folks of La Crosse would gain more mater- ial for their scrapbooks, the masses would see hope for the world. Everybody would be happy.
    His article, A Fit City Offers Russia a Self-Help Model, offers an excellent example of what happens when a journalist decides on the article's substance before he makes his first interview. Out of laziness and a reliance on his pre-determined assumptions about Dubna's healthcare, he created a completely distorted view of the city's hospital system. To complete the illusion, he ordered his photographer James Hill to only take pictures of that which supported his stance.
    The article weaves between two irreconcilable arguments: that Dubna is helping itself, and that Americans were the agents of change in Dubna. The former assertion was entirely rhetorical in character.
    "[Dubna is] a textbook example of how Russia, the developed world's sick man, could heal itself."
    "Most of Dubna's luck is home-made."
    "The two sides' early agreement that theirs was not a relationship of American mentor and Russian protugu, but of equals..."
    None of these statements mean anything, however, because Wines didn't provide any meat to back them up. All the facts and anecdotes he recorded support the second argument, that a band of doctors from La Crosse swooped into Dubna on USAID-funded chariots and illuminated the path of righteousness for a group of backward Russians. According to Wines' article, the only way Dubna "heals itself" is by relying on Americans' sage advice and encouragement to transform the city.
    Wines's article claimed that every advance in Dubna's health care in the last ten years was initiated through ideas generated by the USAID program and the resulting contact with Americans. The USAID program provided about one million dollars, the bulk of which was spent on exchange programs which sent about a thousand health care workers from each city to the other.
    Wines emphasized that the money was not spent on buying new machinery (which Dubna desperately needs), but on bringing to doctors first- hand knowledge of how a superior system works. This neatly fits into the American myth that money and equipment are not as important as human resources.
     But even a cursory look at all the programs instigated over the last few years have one thing in common. They all needed money to get started. Amazingly, Wines completely sidestepped the question of the availability of funding for new programs in Dubna. The implication here is that these were the only that requested funding or were necessary.
    Virtually every doctor I talked with in Dubna put monetary woes as among the most severe problems of city health care.
     The one notable exception was Dr. Vadim Kalakin, the second gynecologist at the new maternity ward. Since his ward recently underwent a 9-million Ruble renovation, he only complained about salaries. Salaries for doctors in Dubna range from about 1000 to 3000 Rubles a month. Each doctor I talked with had ambitious plans for expanding hospital services. Some of these plans draw on the experience with doctors from La Crosse, some don't. What matters is that there are extremely limited funds to undertake the rebuilding of hospitals. "We make proposals, but the city budget decides what gets financed," said Sergei Ryabov, the Director of Dubna's Health Department. "Obviously, we don't get everything we want." Instead, Dubna's authoritarian mayor Valery Prokh decides what to finance and what to put off. One doc- tor, who asked that I not use his name, claimed that the mayor was more likely to approve projects that reflected the town's relation with La Crosse, as this program was a pet project of his. Wines played up the Americans' role in rejuvenating Dubna's health care at every possible juncture. Phrases like "The exchange has liter- ally transformed medical care here" were common throughout the piece. One American, Sandra McCormick was given the label "nursemaid to Dubna's public- health recovery." This is not the language of a partnership of equals.
     Throughout his article, Wines listed all the new programs in Dubna and credited La Crosse with inspiring them all. However, when I asked, Dubna's doctors did not agree.
    Wines opened the article with a heartwarming image - 93-year-old Nina Nikolayevna belting out love songs on an upright piano. As an old woman without relatives to care for her, she receives house calls several times a week from nurses giving her everything from checkups to groceries. According to Ryabov, about 400 old people get this service, which is modeled on American home care.
     Ryabov claimed it is a successful program. But it is not, as Wines's article would have you believe, the whole story. While in Dubna, I stumbled into an old age home, where pensioners were not as satisfied in their old age as Nina Nikolayevna.
    The single story building, which reeked of urine, was literally crumbling down. The heat didn't work very well. Five people in white coats were crammed in a little room and chainsmoking. In that room, the cloud of smoke mitigated the piss-odor. Decrepit old men in ratty bathrobes shuffled unsupervised along the filthy corridor. One babushka sat in a chair unmoving. All the pensioners looked slightly confused, as if they didn't quite understand exactly how low they had sunk. I didn't stay long; the smell was overpowering and I had an appointment to keep. That Wines didn't find this place is understandable. I simply chanced upon it while looking for another clinic. But it is symbolic of his complete lack of a critical gaze. His piece was generated by a tour of what the doctors wanted to brag about. He wasn't looking for any problems. The piece was already written; all Wines needed was to punctuate it with a few quotes of Russians praising the moral righteousness of Midwesterners. That Wines didn't write about Dubna's problems is remarkable. Only one statistic in the piece - that Dubna's death rate remains pinned to Russia's - hints that Dubna has got more problems than an average American city.
    It didn't take any effort at all to hear about Dubna's problems. The doctors openly discuss them. They complain about their financial problems even when not asked. It was Wines who didn't want to listen, in order to create a Utopian system that just isn't there. Dubna doctors don't consider most of their current reforms exceptional, although Wines clearly does. "Reform is happening everywhere," Ryabov told me, "not just here."
    A good example is the diabetes education center, which has lead to a five-fold drop in hospitalizations for diabetes patients. Wines implied that this improvement, like everything else in Dubna, was due solely to La Crosse's guidance. In fact, it was a region-wide program that 30 cities in the Moskovsky oblast are currently taking part in. Dubna was one of three cities that started the pilot program.
    Wines misleads the reader into thinking that La Crosse inspires every change in Dubna. "After another trip, Dubna found some local funds to convert a little-used kindergarten into a rehabilitation center for children with bone deformities and other growth-related problems."
    According to Dr. Evgeny Murovyev, the center's director, the timing was coincidental and that the center, which caters to kids with either mental or growth defects, had been a long time in coming. "Two of our specialists visited La Crosse, but most of our doctors use the tried and true old methods," he claimed, with a touch of pride.
     One thing that really did come from the Americans was the technology to create an orthopedic cast that is superior to the earlier alternatives Dubna relied on. Earlier, children had to go to Moscow to get fitted with a more awkward, heavier mold.
    Wines made much of this example, but failed to report that the casts are not made by the city hospital, but by a private firm. This example would have fit in beautifully with the Times' party line that Russian health needs to be in private hands. How could he miss it?
    Perhaps Wines arrived on such a tight schedule - God forbid he have to suffer a night at Hotel Dubna - that he didn't have time to find out any information that he hadn't planned on.
     At this center, I also spoke to the head doctor, Maria Shpankova, who had given Wines and his translator a tour. She seemed very disappointed that Wines had forgotten to send a copy of the article, even though he had promised. When I asked her how well he spoke Russian, she said, "Oh, he understood about half. He got on great with the kids, though," referring to the mentally-retarded patients. Years of catering to an American audience left Wines on their wavelength, apparently.
    The jewel in the crown of Dubna's medical establishment is the new maternity ward, which opened at the start of this month. Dubna doctors claimed that it is probably unique in Russia. Clean, white corridors and a policy of letting mothers remain with their newborns bear little resemblance to most Russian maternity wards. But for Wines to call it "a La Crosse-style birthing center" is equally absurd.
    Similarities do exist; families can visit the mother and child, each room has a telephone, and the mother gives birth and sleeps in the same private room. "This maternity ward was built independently of the Americans," said Aleksei Osipov, the assistant director of the hospital where it was located. "The American system is completely different, because they have more space and better antiseptic technology. While some fundamentals such as early breast-feeding are the same, the mechanism is entirely different."
    In this maternity ward, each birthing room has a separate entrance to the street, thereby lowering the risks of infection. Fear of infection is what keeps mothers and newborns separated in most Russian maternity wards.
    But in reading Wines piece, you would never know that this ward differs from one in La Crosse, where an insurance company representatives make sure mothers don't waste anytime getting dressed after giving birth.
    Nor would you know that Dubna's doctors, without exception, voiced criticism of American medicine, especially of insurance companies and for-profit medicine. "The system of profit doesn't impress me," said Kalakin, the gynecologist, who twice traveled to La Crosse. "Providing free care isn't a minus, it's an obligation of every doctor."
    Wines also wrote that the Americans inspired the city hospital to a purchase of two dialysis machines, and then trained them how to use it, "sending operators and technicians to La Crosse for training, while a La Crosse expert helped set up the Dubna site." According to Osipov, this simply isn't true.
    "Every hospital should have these machines," Osipov said. "But they are expensive. Earlier, we just didn't have the money. But we got an invitation for help, and the mayor budgeted money for it." Osipov himself is trained to operate the machines, but he only had to travel as far as Moscow to gain that expertise. He laughed at the presumption that Americans were needed to provide training for them. American influence in Dubna health care is perhaps most apparent in the two women's health centers in the city. These appear to be a carbon-copy of their American counterparts. Much of the literature is translated from American pamphlets. They offer family planning classes, gynecology exams, training for pregnant women, and breast cancer education. About fifty women a day stop by the center.
    I met with Irina Kosabutskaya, the center's director, to find out what made the center a success. In her office two framed certificates hung on the wall, saying she had received training from the American International Health Organization. One of them had a golden aluminum seal on it, and resembled a reward for participating in a third grade spelling bee.
    Kosabutskaya was blunt about the center's successes, which include reducing the city's abortion rate from 2 per birth to about 1.5 and supplying 70 percent of the city's women with free birth control (donated by an American organization). "When you recommend birth control, women ask, what will it cost?" she said. "When they find out it's free, of course they are willing to use it."
    The reason Russia's abortion rate is so high is because it is free to get one, while birth control costs money. In poor provincial towns, this is a deciding factor. And, while distributing free birth control is a huge success, it hardly represents, as Wines would have it, the success of Dubna's medical reforms. Give any Belorussian provincial town free birth control and you will get the same results.
    The photographs that accompa- nied Wines' article are equally stilted. They show bright images like the sterile white corridor of the renovated maternity ward, young healthcare workers in baseball caps taking blood pressure counts on a sunny day, a kid playing on a colorful course of pads designed to help spinal injuries.
    All these things exist, but where are the pictures of the overcrowded children's hospital with puke green walls? Or, in the same building as the colorful course, pictures of the gaping holes in floor that have been covered over by large planks? Or, in the building next to the maternity ward, images of peeling paint in the corridor?
    The photos selected have little relation to the overall picture of health care in Dubna. The hospitals look like most Russian hospitals; some rooms have been renovated, but the overall physical plant is completely run down.
    Wines fails to give a picture of what is going on in Dubna. Doctors there have made some impressive gains against a system stacked against them and there are cities in more desperate shape than Dubna.
    But that isn't the point. For every building that gets renovated or sex Ed class added to the high school curriculum, new endemic problems like alcoholism and drug-resistant tuberculosis emerge. Every doctor in Russia could visit La Crosse, and the country's health care would still be in shambles and life expectancy would continue to slip.
     Every advance that Wines cites still doesn't add up to a complete health care system. A maternity ward, better care for diabetics, dialysis machines, rehab for disabled children, home care for some of the elderly and women's wellness centers are the sum of the successes of Dubna's medical establishment. These simply don't add up to a revival of the town's health infra- structure. They don't even come close.
    Wines wrote, "Last year, United States funding for the health care partnership between Dubna and La Crosse ended, for the best of rea- sons: Dubna did not need more help." It is absurd. Of course they need help.
     Because what the health care system needs, like the rest of Russia, is money. Every doctor in Dubna knew that. Why couldn't Wines figure it out? Maybe it was lost in translation.