This article demonstrates the complications of rural healthcare modernization in the context of the Belarusian Socialist Soviet Republic. While reforming public healthcare, the Bolsheviks managed to revive pre-revolutionary networks and provide the rural population with basic medical assistance. Various propaganda campaigns by the medical administration also aimed to improve sanitary condition and the state of healthcare in the countryside. However, due to political transformations in the interwar Soviet state, many of these plans ultimately proved unsuccessful at the local level.
This article focuses on the development of healthcare in Soviet Belarus, officially known as the Belarusian Socialist Soviet Republic (BSSR), a young republic which appeared on the ruins of Imperial Russia. In 1917, the collapse of the Russian Empire as a result of the February Revolution meant the beginning of a new epoch. During the short period from 1917 to 1921, governing authorities in this region changed frequently. Once the new Soviet regime was established, however, it actively introduced a variety of reforms, which affected all spheres of life, including healthcare provision. Nevertheless, while the Russian Revolution created an impetus for the development of society, culture, science, and medicine in the Soviet republics, many issues remained unresolved at the local level. Thus, although healthcare in Soviet Belarus officially developed according to the Soviet model, the Bolsheviks often had to improvise in order to solve acute problems inherited from the previous regime. While Soviet propaganda extolled the success of healthcare in the countryside, but sources indicate that in the villages this picture was not as positive as the propagandists wanted to demonstrate.
This article shows how, despite obvious limitations, the authorities still attempted to modernize healthcare services in the Western periphery, maneuvering between ideological guidelines and pragmatic necessities. It traces the progress of healthcare provision through several crucial stages in Soviet interwar history, beginning with the Russian Civil War through to the period of the New Economic Policy (NEP), the collectivization of Soviet agriculture, and the consolidation of the Stalinist regime in the 1930s. In doing so, it explore the efforts of the BSSR’s medical administration as it sought to overcome the consequences stemming from the collapse of the territory’s healthcare services during the First World War and improve medical care in the Belarusian countryside. During the 1920s, the republic was attempting to rebuild it local network of pre-war medical institutions, which had suffered greatly as a result of war and political cataclysm. By the mid-1920s, the Communist Party had started to call attention to the problems deemed inherent to rural areas. In response, the Soviet authorities announced a range of campaigns to target non-urban population, mainly the Belarusian peasantry that represented the dominant social group in this predominantly agricultural region. In the after of the Russian Civil War, and subsequent social unrest that had accompanied it, the Soviet state used the NEP to win the support of the peasants economically. At the same time, access to qualified healthcare services and the necessary medical treatment in the countryside was far from ideal. Villages experienced a deficit of medical supplies while their inhabitants did not enjoy such modern benefits as medical insurance. Throughout the 1920s, the Soviet medical administration of Belarus linked these frequent shortcomings in healthcare to so-called “socio-historical conditions” within the territory.
From the 1920s onwards, Soviet literature continually emphasized poor sanitary conditions and medical care services in rural areas as being closely linked to the economic and social problems that generally faced the Soviet Union in the aftermath of the First World War and Russian Civil War. Using Marxist-Leninist theory, many Soviet authors sought to prove the advantages of the Soviet healthcare system in comparison to the West or what had existed in the pre-revolutionary public sector. Among the authors who actively propagated the Soviet model in the interwar period, Nikolay Semashko (1874–1949), the Head of the People’s Commissariat of Health of the RSFSR, was one of the most prominent. In the BSSR itself, the People's Commissar of Health, Mikhail Barsukov (1890–1974), was equally significant in the discussion of measures to improve public healthcare, particularly in emphasizing local factors and difficulties.
As a Soviet borderland directly adjacent to the “bourgeois” states Poland and Latvia, the BSSR was a region of great concern for the Bolsheviks. Unlike the large cities of Russia and Ukraine, Western experts rarely visited during the interwar period, while foreign authors directed their scholarly interest primarily at more generalized processes and revolutionary transformations in Soviet healthcare, rather than looking at factors specific to individual republics. In modern Western historiography, scholars have also tended to examine the vectors of Soviet healthcare progress, considering various problems related to its economic basis in the interwar period. Their research has also focused on issues of international medical cooperation and the image of Soviet healthcare among foreign audiences. Soviet and contemporary Belarusian historiography, by contrast, has tended to focus more on the training and distribution of medical personnel, the activities of medical societies, and the problem of personnel shortages, particularly in rural areas. As a result, many important aspects in the history of medical care in Soviet Belarus have been neglected, including such problems as the social history of medical doctors, especially those based outside of the big cities, the role of Jews in Belarusian healthcare, and the Bolshevik regime’s relationship to medical workers.
The study of these problems in Belarus is further complicated by the fact that during the Second World War, most of the materials collected by the People's Commissariat of Health of the BSSR, and the Belarusian Red Cross Society, throughout the 1930s was destroyed or lost. Consequently, the most valuable surviving sources were those documents produced by the Central Committee of the Communist Party of Belarus (TsK of the KP(b)B), which have been preserved in the National Archives of Republic of Belarus in Minsk, as well as the rich collections of data housed across Belarus’ various regional archives. Ongoing problems related to medical care were also frequently discussed in medical journals published in Soviet Belarus, such as Belaruskaya Medychnaya Dumka [Belarusian Medical Thought] or Meditsinskiy Zhurnal BSSR [Medical Journal of the BSSR]. These articles were based on original research carried out by medical experts eager to inform the medical community across the republic about the work their colleagues were doing in the Belarusian countryside.
The pre-revolutionary Belarusian provinces (gubernii) had seen tremendous growth in the number of hospitals in cities, towns, and rural areas. In the early twentieth century, hospitals, including Jewish hospitals, began to operate in townships. Although the number of patients was small, this burgeoning medical network slowly expanded into more rural areas through the activities and diligence of the territory’s zemstva. These local self-governing institutions were in charge of health issues and promoted the idea of a decentralized healthcare; zemstvo doctors played an especially crucial role in studying the living conditions of the population and discovering the causes of diseases. In the late Russian Empire, medical doctors were also actively engaged in political and public life. The specificity of the Belarusian countryside was itself largely the product of shifting political conditions: zemstvo self-government in the western provinces, including Belarus, had been introduced much later than in the center of the Russian Empire to the east. The Tsars did not permit the formation of zemstva in these provinces until 1906, fearing that the Polish landlords would dominate the elective district councils. Moreover, there were no higher medical education institutions on the territory of present-day Belarus, resulting in nearly all of its qualified medical doctors being graduates of Western European or Russian universities. However, prior to 1914, various medical societies were operating in Minsk and other larger towns and cities demonstrating the emergence and maturation of specific branches of medicine before the 1917 revolutions.
However, it was this period’s crucial political events and social transformations, namely the First World War, the collapse of the Russian Empire, the Russian revolutions, the founding of the Soviet regime, and the formation of new national states in the rest of Eastern Europe towards the end of 1918, which had a salient impact on Belarusian healthcare. Since 1915, Belarus had been divided by military frontlines, with the Great War having an especially negative impact on healthcare services through worsening sanitary conditions. Many of the existing civilian hospitals were subordinated to military needs while emergency sanitary trains, maintained by the zemstvo, operated across the region. As with the war’s other military theatres, doctors based at or near the Eastern Front were frequently diverted from strictly medical tasks, often spending excessive amounts of time dealing with military administration issues such as sanitation and transport.
The initial efforts made by the Bolsheviks, who seized power in October 1917, towards transforming healthcare provision in the former Russian Empire have attracted particular attention from researchers. Starting in 1918, public healthcare was concentrated under state control, with all medical institutions being directly managed by the People’s Commissariat of Health (Narkomzdrav). Following his appointment as the first Soviet People’s Commissar of Health, Semashko, had publicly declared that the separation of medicine “for the rich and for the poor” had come to an end. Any Soviet worker could turn to a first-class specialist for medical assistance or advice free of charge. In Soviet Belarus, healthcare reform was also carried out under the supervision of the state. As part of this drive to nationalize the territory’s healthcare infrastructure, the zemstva were promptly dissolved and all medical institutions placed under the supervision of the People’s Commissariat of Health. Hospitals supervised by Jewish communities were also nationalized by the local Soviet administration. Nevertheless, this nationalization of healthcare was itself gradual and rather complex, as recent historians have shown.
In order to quickly bring the healthcare situation under their control, the Bolsheviks were obliged to implement a series of fairly severe measures. This can be explained by the ongoing state of emergency and the myriad political and social problems that needed to be resolved as soon as possible. Massive contagious diseases and the outbreak of numerous epidemics across the former Empire occurred in parallel with military actions and the Russian Civil War raging in the provinces. In Belarus, which the Red Army had had to liberate first from occupying German troops and later an attempted annexation by the Second Polish Republic, the Narkomzdrav was tasked with carrying out the registration of all medical personnel. This urgent measure went hand in hand with their drafting into the ranks of the Red Army, with special medical groups being established to visit those areas worst affected by epidemics. Although the new medical administration faced the continuing threat of declining loyalty, many of its trained doctors such as Barsukov, the incoming People's Commissar of Health of the BSSR, were quick to accept the policies and ideas of the Bolsheviks. The new regime also represented new possibilities with many Belarusian medics viewing it as a chance to contribute to the revolutionary transformation of the entire healthcare system. Nevertheless, some Bolshevik leaders still continued to view the professed loyalties of the territory’s pre-revolutionary medical professionals (the “old medical cadres”) with suspicion during these early years of Soviet rule. This was due to the fact that some physicians did not support the Communist Party, being adherents of the liberal views characteristic of the Russian intelligentsia.
The transition to the NEP precipitated new social problems, particularly since the punitive methods employed under the policy of War Communism during the Russian Civil War were no longer in effect. In 1921, conditions on the ground in Soviet Belarus were nothing short of desperate: many medical institutions had been destroyed or had lost all of their trained personnel by 1921. Moreover, the mobilization and evacuation of medical staff had resulted in an acute shortage of physicians, further aggravated by the fact that those doctors who remained were mostly elderly or disabled. In rural areas the situation was made considerably worse due to widespread banditry. Moreover, at the beginning of the 1920s, Belarusian Jewish communities, like those in Ukraine, were subject to regular attacks, especially in the countryside, with some settlements greatly suffering from pogroms. By contrast, the Soviet bureaucratic apparatus was unable to adequately respond to the changing situation leading to medical assistance to victims being routinely delayed. As a result, non-governmental medical organizations cooperated closely with the local authorities to provide suffering families with urgent medical attention. As the situation improved, however, the authorities and medical administration no longer needed this constant assistance. This led to all medical societies being gradually absorbed by the Commissariat of Health and the Red Cross societies.
Under the NEP, the government of the BSSR, analyzing the general medical situation in the republic, emphasized the obvious shortcomings of medical provision in the villages and townships. Moreover, the authorities were fully aware of the causes of the epidemic diseases in these rural areas. In June 1924, the People's Commissariat of Health started to act more decisively in sending medical groups out to rural areas where many of the epidemics had originated. A special brigade to combat malaria, for example was dispatched to the Mozyr district, an area dominated by mosquito-infested swamplands. This also prompted more general initiatives, such as the authorities’ successful campaign against widespread trachoma by improving access to clean water and treatment.
Soviet healthcare had also inherited the practice of medical congresses, which were actively held until 1917, where medical activists, scholars, and the authorities continued to debate how to solve lengthy lists of problems relating to public health. The most important and serious of these issues were brought up for discussion at the congresses. The first All-Belarusian Congress on Rural Medicine, for example, discussed many acute problems and decided to repair hospital buildings and supply medical wards with additional bedding, underwear, and other necessities in order to alleviate the problem of treating patients suffering from trachoma, tuberculosis, and various venereal diseases.
By the early 1920s, two distinctive categories of medical personnel were operating in the Belarusian countryside. The first of these were the many representatives of the medical community in Belarus who had started their careers as zemstvo doctors. In various memoirs written in the 1920s, they described all the hardships that they experienced in their daily work. Despite enjoying an often indisputable level authority in the Belarusian villages, their roles typically involved working without rest and making visits within a radius of several tens of kilometers. Many of these doctors often demonstrated a great degree of inventiveness and were deeply immersed in their activities, often being unable to spend much attention with their families owing to them having to work over weekends. The second category were the newly trained Soviet doctors, dentists, and midwives who worked in the countryside only within the “mandatory period” of one year before moving to the cities, contributing to the extreme turnover of medical staff in rural areas.
This lack of experienced medical personnel posed a serious problem across all the Soviet republics and represented a challenge that the authorities needed to address. In peripheral areas such as Soviet Belarus, there were two approaches: to invite experts from other republics, or to create its own capacity for training new medical personnel. Recruiting doctors to work in the BSSR proved especially difficult owing to difficult labor conditions medical staff were required to face, particularly in rural areas. However, the People’s Commissariat of Health of Belarus did succeed in attracting some leading experts to the republic, which permitted them some means, at least in the short term, for creating the basis for to further develop its own medical sciences. The establishment of the medical faculty of the Belarusian State University in 1921 represented the first step to providing the republic with medical doctors. Furthermore, the development of higher and secondary medical education in the BSSR increased the number of local personnel. The Narkomzdrav also organized special training courses to help better facilitate the training of medical staff needed to resolve the sanitary situation.
This issue of medical undersupply to rural regions was a sufficiently large problem to be discussed at the highest echelons of the Belarusian republican administration. In July 1926, the Belarusian Council of People’s Commissars debated a recently published report “On the State of Healthcare in Rural Areas,” that had been written by a team of medical instructors. The report’s authors informed the republican authorities about the difficult situation in healthcare in the countryside, noting that medical services were often missing in many rural areas. Inequalities in the distribution between urban and rural areas were also noted for being particularly drastic. Barsukov himself admitted that the majority of doctors were concentrated in cities and towns and did not want to work in the countryside. The same situation was observed not only in Belarus, but also in other parts of the Soviet Union.
To solve the situation, throughout the 1920s, the government of the BSSR increased investments into the medical sector. By the end of the decade, new physicians were gradually arriving while new hospitals, dental points, and out-patient clinics were being erected in all rayon centers, allowing the pre-existing medical network to continue slowly expanding into the rural areas. The medical administration vigorously encouraged more established physicians to move their practices into rural areas, while younger nurses and doctors were often sent directly to work in villages and small towns after completing medical school.
Health protection regarding maternity and infancy in rural areas was also a key focus among these new medical institutions with the medical administration having established “Special Departments for the Protection of Motherhood and Infancy” (Okhmatmlad, Okhrana Materinstva i Mladenchenstva). Instructors based within these departments monitored questions related to such fields as pregnancy, childbirth and its consequences, and nursing. At the same time, Soviet health institutions specifically focused on improving the wellbeing of mothers and infants for social policy reasons. This was also a way to socialize peasant women and involve them more closely in the Soviet economy; the Soviet authorities, as well as local women’s activists, arranged meetings of working-class or peasant women, some of whom were even elected as delegates.
Special attention was paid to the strengthening of Soviet physical culture. In the 1920s, physical training and sports activities were popularized in urban and rural areas.  In some small towns, the local administration promoted physical activity among workers by organizing sporting competitions. Unlike the larger cities in the okrug (oblast), however, rural administrations’ budgets could not afford the financial resources needed to support sports clubs. The Soviet authorities also encouraged sports throughout the country and provided financial assistance to mass societies. Special emphasis was placed on more popular and accessible sports such as running, swimming, and football. This development of physical training in the interwar period was itself closely related to the militarization of the Soviet society.
In the mid-1920s, the Belarusian medical administration began discussing the possibilities for reviving the Belarusian village by way of campaigns against alcoholism and diseases such as typhoid or malaria, as a means of promoting higher standards of public health. To this end, the pre-revolutionary epoch was portrayed as the “dark past.” For example, Soviet propaganda claimed that before 1917, the tsarist regime had deliberately encouraged peasants and workers to become drunkards with alcohol abuse in the Soviet republics described as a heavy cultural burden left over from the Russian Empire. The village was also treated as a social paragon in order to find optimal methods for “sanitary enlightenment” (sanitarnoye prosveshcheniye). The Red Cross Society, supported by the state, also sought to improve sanitary conditions in small towns and villages. Periodically, so-called “health weeks” were proclaimed and organized collaboratively by the local authorities and medical doctors. Brochures addressed to various social groups were also published throughout the interwar years. However, since the late 1920s, the activities of all societies had been placed under the control of the various medical administrations and of the Soviet authorities.
Medical doctors who came to work in Belarusian villages often played prominent roles in state-run campaigns against tuberculosis, sexually transmitted diseases, and alcoholism. However, due to transport issues, the perpetual deficit of medical staff, and other such issues, medical consultation mainly covered the smaller towns, rather than the villages. Moreover, rather than soliciting a change in public attitudes, the Soviet anti-alcohol campaign simply culminated in further draconian regulations on the distribution of alcoholic beverages in the second half of the 1920s. Indeed, official propaganda even argued that only the Soviet state was attempting to tackle the problem of alcoholism, in contrast to the authorities in Imperial Russia and the Western states. Peasants were especially targeted with brochures explaining the root causes of alcoholism in the Belarusian village communities. A “Society for the Struggle against Alcoholism (OBSA)” (Obschestvo po bor’be s alkoholizmom) was also established with branches in many rural districts. What distinguished late-1920s anti-alcohol propaganda was the fact that it was carried out together with a broad process of anti-religious agitation. Drunkenness was associated with religious practices, and more specifically the Russian Orthodox Church, both of which were considered the basis of potential counter-revolutionary activities.
At the same time, the Narkomzdrav focused on improving environmental conditions. Inspectors and medical workers, who came from the bigger cities, typically characterized rural sanitary condition as very poor. Many settlements across the republic were also noted as lacking in proper sanitary facilities, especially those towns that were not district centers. The water supply in many places was a particularly sore point for the sanitary services, given that the majority of townships did not have water pipes. In addition to wells, the number of which was far from sufficient, water was regularly consumed from sources that were often deemed unsafe, such as local rivers. The sanitary bodies also focused on disseminating preventive medicine through vaccination, personal hygiene, and health-based education. Throughout the 1920s, eye-catching posters with hygienic-sanitary propaganda were widely published. Such improvements frequently involved the local authorities, monitoring hygiene, for instance, was the assigned duty of the local soviets. Special health commissions were set up to promote sanitary knowledge, organize so-called “explanatory work” among the residents, and to observe how sanitary regulations were being implemented. These commissions conducted sanitary inspections of houses and the neighboring territory. The local authorities also set up “sanitary circles” to popularize sanitary knowledge and fine anyone seen as failing to uphold proper hygiene standards.
Due to a lack of resources, however, state medical institutions were unable to provide medical help to the entire population under the NEP. Any state financial support for public health was allocated to industrial enterprises and various institutions, meaning that medical services were only directly available to industrial workers population and family members who were covered by insurance policies. During this earlier phase, the “laboring masses” (Soviet employees and workers) were entitled to medical assistance. Public discontent with the healthcare services, however, quickly grew into more general grievances against the local authorities. In rural areas, the attitude of medical personnel towards patients also provoked discontent as, for example, when they refused to help patients for free. Indeed, such issues even came to the attention of the Joint State Political Directorate (OGPU).
Still isolated from most modern health services, many Belarusian peasants sought medical advice from alternative sources, turning predominantly to paramedics, or feldshers. Even before the revolution, a phenomenon known as “feldsherism” had drawn criticism, since these paramedics, many of whom had originally received their training while serving in the military, were often incompetent and struggled cope with their subsequent workloads. Due to the lack of professional medical help, and a persistent adherence to various rural folk traditions, patients also appealed to healers and midwifes (znakhari). In some places, residents even received medical assistance from both modern physicians and traditional healers. During the 1920s, Soviet medical propaganda depicted both male and female practitioners of traditional medicine as charlatans who were frequently the targets of sustained criticism in the specialized press. Yet, traditional medicine continued to persist in places where qualified healthcare remained unavailable and where the BSSR’s network of medical institutions was insufficiently developed. According to the press, traditional healers typically increased their activities in those villages where local physicians had fled to large cities due to ongoing financial insecurity. However, despite the rather negative attitude to folk medicine among the Soviet authorities, some traditional methods were also promoted in the medical and local press.
The BSSR medical adminstration’s ambitious plans for improving the sanitary situation and health of the villages could not be implemented quickly and required significant resources, time, and concerted educational efforts. Since 1929, the political agenda had changed, with the Soviet leadership shifting to a more gradual course of industrialization and the mass collectivization of agriculture. In matters of medical provision, the government was guided by a purely pragmatic goal: maintaining public health and, above all, the health of the industrial labor force and those peasants who had already joined the collective farms (kolkhozy). In the countryside itself, new organizational forms of Soviet medical provision were also developed in parallel with the policy of collectivization. In December 1929, the Soviet government passed a decree “Concerning Medical Service for Workers and Peasants.” The decree criticized the medical administration and insisted on “a clearer class proletarian line,” by which healthcare services would be distributed according to the party’s perception of the economic importance of each population group.
The authorities were thus prepared to implement unpopular measures dictated by ideological goals, knowing that this would cause discontent. In 1930, physicians reacted negatively following an official ban on private medical practice. Previously it had been legal for medical workers to combine their duties in state hospitals with private practice. Since state medical services could not meet the needs of the entire population, the administration had been forced by necessity to permit this degree of autonomy. In Soviet Belarus, however, the number of medical doctors who had relied on private practice as their main source of income was not significant.
In connection with the state’s industrialization and collectivization programs, medical workers were tasked with reducing the incidence of sickness among workers and peasants. Such measures were supposed to increase their productivity and contribute to the fulfillment of Stalin’s five-year plans. Thus, the public healthcare system was required to operate on the same model as Soviet industry, with medical workers having to fulfill so-called “production plans” and participate in socialist competitions. Officially, such an approach was necessary in order to help better facilitate the modernization of Soviet industry and agriculture within the first five-year plan. Under collectivization, medical assistance to collective farmers was given more attention. Following an order from above, all medical institutions were required to send their personnel to the villages, providing medical support for the sowing campaigns. In the spring of 1930, large hospitals in Minsk were further instructed to provide employees (mainly nurses) to supervise collective farms. Medical care for collective farmers was intensified during the sowing and harvesting seasons, causing a massive outflow of paramedical staff from hospitals.
Additionally, from the early 1930s, medical doctors were tasked with overseeing political campaigns that had nothing to do with their direct responsibilities. Since personnel often enjoyed a degree of social influence among peasants, the local authorities often deliberately tried to use them for political goals. During their visits to villages, for instance, they were often forced to collect money from the rural population in order to finance the industrialization projects in the towns and cities. Obviously, such activities were highly unpopular. Indeed, the secret police even monitored medical collectives and informed on doctors and personnel who resisted such campaigns.
Facing an acute shortage of the personnel required to solve the BSSR’s current economic and political deficits, the People’s Commissariat of Health sought to accelerate the training of new medical cadres. Consequently, in the 1930s, medical professions in the Soviet Union experienced a rapid growth in number. The organization of medical institutions in Minsk and Vitebsk was especially important in contributing to this influx of young professionals into the healthcare system. Medical education was especially popular among girls who graduated from secondary schools, both in urban and rural areas, leading to an increase in female applicants to the BSSR’s medical universities and subsequently higher numbers of women working in the health service. Moreover, in addition to the existing ones, ten more new schools were planned in the Belarusian republic. However, the lack of medical personnel working in rural areas remained an unresolved problem, even at the end of the 1930s. A medical doctor based out in the countryside had to deal with a far greater workload than their colleagues in urban hospitals, while also coping with shortages of medicines and equipment. The medical administration was thus forced to resort to coercion in order to keep rural doctors in their posts.
Based on the principles of political loyalty, during the 1930s, the Stalinist regime was seeking to gradually replace those professionals associated with the old pre-revolutionary generation with younger but more loyal cadres, focusing on fulfilling ideological commitments, even at the expense of the more practical goals that had previously been the priority. It was for such ideological reasons that the social status of students recruited to medical schools and universities was strictly controlled by the medical administration. Preference was given to children of workers, officials, and farmers, whereas it was difficult for children of “non-proletarian groups,” such as merchants or artisans, to enroll as students. This was compounded by the fact that many medical workers were also being accused, arrested, and even assassinated as “enemies of the people,” during the years of Stalin’s “Great Terror” from 1936 to 1938, when Soviet propaganda talked of “enemies” infiltrating the healthcare system to undermine it from within. In the periphery, however, some of these replacement processes continued to be impeded by the ever-acute shortage of medical personnel.
On coming to power, the Bolsheviks were quick to use the pre-existing medical infrastructure in order to establish a new administrative to take control of healthcare facilities. The formation of healthcare according to the Soviet model in Belarus started under the unfavorable conditions created by war and political unrest, which undoubtedly had an impact on medical provision in the countryside. As it attempted to solve these urgent problems, however, the new Soviet medical administration and local authorities were guided by purely pragmatic goals and objectives while ideology was reduced to a secondary importance. The authorities were ready to sacrifice their principles and accept help from bourgeois countries and philanthropic organizations. In the 1920s, medical assistance in rural areas remained a burning problem demanding the immediate attention of the state. The Soviet periphery received assistance from the center for further development, especially when the problems of the rural population were brought to the government’s attention during the NEP.
The measures brought in under the healthcare provision of the BSSR corresponded to those introduced in other parts of the Soviet Union, while the Narkomzdrav was never an autonomous unit and remained subordinate to Moscow. However, local initiatives produced some short-term successes in Soviet Belarusian healthcare. Throughout the 1920s, the local authorities managed to develop some effective methods to improve the sanitary situation and health facilities with local medical and hygiene campaigns being launched in order to “revive” the Belarusian village. The establishment of two medical institutes in Minsk and Vitebsk also served, to some extent, to resolve the shortage of medical personnel in the republic. During the 1930s, the authorities closely connected the sanitary situation in the countryside with the policy of collectivization. This model of Soviet modernization in the countryside remained both imperfect and incomplete. One constant problem was that medical personnel did not share the authorities’ desire for moving in order to work in the villages, which were associated with social problems, lacking hygiene, and a low standard of life. Thus, the repressive policies instigated in this later period only worsened an already complicated situation in the countryside.
Dr. Andrei Zamoiski is a historian who was born in Minsk. His dissertation examined the Jewish small towns (shtetls) of Soviet Belarus in the interwar period. Since then, his research more has more broadly focused on the history of Soviet Belarusian eugenics and healthcare. Zamoiski is currently a researcher in the German-Russian project “Soviet and German prisoners of war and internees,” conducted in collaboration with the German War Graves Commission, the German-Russian Museum Berlin-Karlshorst, and the German Historical Institute in Moscow.
 In 1918, the German army seized Belarus, making previous attempts by Belarusian intellectuals at establishing a Belarusian People’s Republic appear unsuccessful. In 1919, the Bolsheviks established the BSSR which they later merged with the Lithuanian SSR to strengthen their positions in the region. The Polish state also claimed these territories and in the same year occupied the majority of the Belarusian lands. The Bolsheviks restored the BSSR in the summer of 1920, when the Red Army liberated Minsk, the capital of the republic, during the Polish-Soviet war. The eastern Belarusian provinces became part of the RSFSR, and were reincorporated back into the BSSR in 1924–26. For more on the topic see Ivan Lubachko, Belorussia: Under Soviet Rule, 1917–1957 (Lexington: The University Press of Kentucky, 2015); Per Anders Rudling, The Rise and Fall of Belarusian Nationalism, 1906–1931 (Pittsburgh: University of Pittsburgh Press, 2014).
 See Sally Ewing, “The Science and Politics of Soviet Insurance Medicine”, in Health and Society in Revolutionary Russia, eds. John F. Hutchinson and Susan Gross Solomon (Bloomington: Indiana University Press, 1990), 69–96.
 According to the sources prepared by the medical officials for the party functionaries in the 1920s, various factors predetermined the morbidity of the rural population. Among them were the so-called “legacy of Tsarism,” “the lack of proper culture”, the poverty of the population, various wars, and the unfavorable natural conditions (dampness, swamps, and winds). The National Archive of the Republic of Belarus (NARB), f. 4p, op. 1, d. 2533, l. 696.
 Parallel to the slogan “Face to the Village,” announced by the Soviet authorities in 1924 to target the peasantry, Jewish communists announced their own slogan, “Face to the Shtetl” (a Jewish small town, myastechka in Belarusian) (Zwi Gitelman, Jewish Nationality and Soviet Politics. The Jewish Sections of the CPSU, 1917–1930 (Princeton: Princeton University Press, 1972), 355.
 See Igor Sheiman, Sergey Shishkin and Vladimir Shevsky, “The Evolving Semashko Model of Primary Health Care: The Case of the Russian Federation,” Risk Management and Healthcare Policy, no.11 (November 2018): 209–220; Nikolai Semashko, The Care of Health in Soviet Russia (New York: Soviet Russia Medical Relief Committee, 1920).
 See Mark Mirsky, M.I. Barsukov (Moscow: Meditsina, 1979), 4.
 This literature is rich, but influential examples include James Purves-Stewart, A Physician's Tour in Soviet Russia (London: Allen & Unwin, 1933); Henry E. Sigerist, Socialized Medicine in the Soviet Union (New York, W.W. Norton & Company, 1937); Edward Podolsky, Red Miracle. The Story of Soviet Medicine (New York, N.Y.: Beechhurst, 1947); Arthur Newsholme and John Adams Kingsbury, Red Medicine: Socialized Health in Soviet Russia (Garden City, N.Y.: Doubleday, Doran & Co, 1933).
 See, for example, Christopher Davis, “Economic Problems of the Soviet Health Service: 1917–1930”, Soviet Studies 35, no 3 (1983): 343–361
 Christine Böttcher, Das Bild der sowjetischen Medizin in der ärztlichen Publizistik und Wissenschaftspolitik der Weimarer Republik [The Image of Soviet Medicine in the Weimar Republic’s Medical Press and Science Policy] (Pfaffenweiler: Centaurus, 1998); Soviet Medicine: Culture, Practice, and Science, eds. Frances L. Bernstein, Christopher Burton, and Dan Healey (DeKalb: Northern Illinois University Press, 2010).
 Ekaterina Shishko, Razvitie i deyatel’nost’ Minskogo gosudarstvennogo meditsinskogo instituta (1921 - 1971 gg.) [Development and Activity of the Minsk State Medical Institute (1921 - 1971)] (Minsk: Belarus’, 1971); Grigoriy Kruchok, Ocherki istorii meditsiny Belorussii [Essays on the History of Medicine in Belarus] (Minsk: Belarus 1976); Mikhail Abramenko, Zdravookhranenie BSSR – stanovlenie sovetskoy sistemy [Healthcare of the BSSR: The Formation of the Soviet System] (1917–1941) (Gomel: GGMU, 2005).
 Kate Schecter, “Soviet Socialized Medicine and the Right to Health Care in a Changing Soviet Union,” Human Rights Quarterly, 14, no. 2 (May 1992): 206–215.
S. Balkovets, “Pervye shagi sovetskogo zdravoohraneniya v Belorussii (Vospominaniya uchastnika)” [The First Steps of Soviet Healthcare in Belarus (Memoirs of a Participant)], Belaruskaya Medychnaya Dumka (further- BMD) 1 (January 1927): 28–33.
 Paul Weindling, Epidemics and Genocide in Eastern Europe, 1890-1945 (Oxford; New York: Oxford University Press, 2003).
 Charlotte Henze, Disease, Health Care and Government in Late Imperial Russia (New York and London: Routledge, 2011).
 Geoffrey Hosking, The Russian Constitutional Experiment: Government and Duma, 1907–1914 (Cambridge: University Press, 1973), 117.
 Jacqueline Friedlander, “Difficult Sciences: The Emergence and Development of Medical Specialization in Russia, 1880s–1920s,” in Russian and Soviet Health Care from an International Perspective Comparing Professions, Practice and Gender, 1880-1960, ed. Susan Grant (Cham: Palgrave Macmillan 2018): 31–54.
 Peter Waldron, “Health and Hospitals in Russia during World War I,” in Hospitals and Communities, 1100–1960, eds. Christopher Bonfield, Jonathan Reinarz and Teresa Huguet-Termes (Oxford: Peter Lang, 2013). 363.
 Fiona Reid, Medicine in First World War Europe: Soldiers, Medics, Pacifists (London: Bloomsbury Publishing, 2020), 8.
 For more on this topic, see John Hutchinson, “Russian Physicians and Medical Politics in the Revolution of 1917,” Canadian Bulletin of Medical History 3, no. 2 (1986): 153–165; Christopher Williams, “War, Revolution and Medicine: The Case of Petrograd Doctors, 1917–1920”, Revolutionary Russia 4, no. 2 (1991): 259–287.
 Neil Weissman, “Origins of Soviet Health Administration: Narkomzdrav, 1918–1928”, in Health and Society in Revolutionary Russia, 97–120.
 Zdravookhranenie v Sovetskoy Rossii. Sbornik statey k S’’ezdu Sovetov s predisloviem Narodnogo Komissara po Zdravookhraneniyu tov. N. Semashko [Health Care in Soviet Russia: Collection of Articles for the Congress of Soviets with a Preface by N. Semashko] (Moscow: State Publishing House, 1919), 4.
On 9 March 1919, all zemstvo medical institutions in Minsk were transferred to state ownership with some of them having been renamed as “Soviet” (NARB, f. 808, op. 1, d. 4, l. 88).
 Among them were Jewish hospitals in Minsk, Vitebsk, and other places (NARB, f. 808, op. 1, d.1, l. 6).
 Pavel Vasilyev, “Flirting with the Market: The Early Soviet Government and the Private Provision of Health Care, 1917–1932,” in Health, Technologies, and Politics in Post-Soviet Settings: Navigating Uncertainties, eds. Olga Zvonareva, Evgeniya Popova and Klasien Horstman (Cham: Palgrave Macmillan, 2018), 39.
 A boycott by medical workers during the Bolshevik’s seizure of power in Petrograd has been discussed (Mikhail Barsukov, “Proletarskaya sushchnost’ sovetskogo zdravookhraneniya” [The Proletarian Character of Soviet Health Care], BMD 9–12, (1927): 3–10.
 This mistrust would manifest itself in the future, for example, during the Great Terror and so-called “Doctors’ plot”. See Yakov Rapoport, The Doctors’ Plot of 1953 (Cambridge, Massachusetts: Harvard University Press, 1991).
 In 1932, an OGPU officer reported that before the revolution in the city of Mozyr, the majority of intelligentsia, including medical doctors, had belonged to “counter-revolutionary political parties.” See Iryna Ramanava, Ulada i hramadstva: BSSR u 1929–1939 hady u dakumyentakh Sakretnaha addzela/Asobaha syektara TsK KP(b)B [Power and Society: the BSSR in 1929–1939] (Minsk: Lohvinaw, 2019), 78.
 On May 27, 1921, the Collegium of the People's Commissariat of Health was informed that medical workers were staging protests against non-payment of their salaries by hospitals (NARB, f. 6, op. 1, d. 30, l. 289.
At the beginning of 1921, the Narkomzdrav reported that 69 doctors worked in Minsk, while the healthcare system required at least 350 specialists. Only three physicians were working in the Minsk region by the autumn of 1921 (NARB, f. 4p, op. 1, d. 18, l. 68).
 Since the beginning of the Great War, the Jewish Committee to Aid Victims of War (EKOPO) and the Jewish Health Society (OZE) extended their activities to helping Jewish families, providing them with food and medical assistance. In 1920, the Jewish Public Committee (Yevobshchestkom) was established to take on the responsibilities of wide-scale relief to suffering Jewish families. See Simon Rabinovitch, Jewish Rights, National Rites: Nationalism and Autonomy in Late Imperial and Revolutionary Russia (Stanford, California: Stanford University Press, 2014), 181; Lazar Gourvitch, Twenty-Five Years OSE, 1912-1937 (Paris: OSE,1937), 56.
 There was no proper state help to the victims; medication and bandages were unavailable. (YIVO, Tcherikover papers, R-81, folder 106, item 8584).
 So-called letuchie meditsinskie otriady (mobile medical squads) were established in order to visit those settlements suffering from pogroms and banditry (Ibid, item 8600).
 The Jewish Medical Society (EMSO), which aimed to help the poor, was closed down by the authorities as it was deemed “unnecessary.” See Elissa Bemporad, Becoming Soviet Jews: the Bolshevik Experiment in Minsk (Bloomington: Indiana University Press, 2013), 35–36.
 Andrei Zamoiski, “Eugenics on the Periphery: or why a ‘Belarusian Eugenic Project’ did not Come True (1918–44)”, Acta Poloniae Historica 114, (2016): 59–84.
 Ya. Rakhovskiy, “Trakhoma v Mozyrskom uezde v 1924 godu” [Trachoma in Mozyr District in 1924], BMD 2–3 (1924): 20–40.
 Rodsteyn, “Trakhoma i organizatsiya bor’by s neyu v Borisovskom okruge” [“Trachoma and the Organization of the Struggle Against it in Borisov District”], BMD 1–2, (1925): 28–30.
 Mikhail Barsukov, “Novye zavoevaniya na fronte bor’by s tuberkulezom” [“New Conquests on the Tuberculosis Front”], BMD 2–4 (1929): 10–12.
 Ales’ Adamovich, Sobranie Sochineniy. Tom 1, Voyna pod kryshami [Collected Works, vol. 1. The War under the Roofs] (Minsk: Mastatskaya Litaratura, 1981), 616–617.
 In 1928, the Medical Department in Gomel summed up such facts in its report (GAGO, f. 114, op. 1, d. 4, l. 183ob).
 Mikhail Barsukov, “Na fronte bor’by za sanitarnuyu kul’turu” [On the Front of the Struggle for Sanitary Culture], BMD 2 (1928): 7–12.
 A comparison of health expenditure in cities and villages was not in favor of the countryside. Proportionally, in cities it was about 3 rubles per a person, in villages and small towns about 0.48 rubles per person. In August 1926, this imbalance was also discussed in the report “On the Sanitary Condition of the Small towns and Rural Areas,” submitted to the Central Committee of the KP(b)B (NARB, f.4, оp.3, d.14, l. 694).
 In 1926, there were 250 medical doctors in villages and small towns, while 550 worked in cities (NARB, f.4p, op.1, d. 2533, l. 696).
 Mikhail Barsukov, Materialy po dokladu Narkomzdrava BSSR “Meditsina v derevne” na 7 Vsebelorusskom s”ezde Sovetov [Medicine in the Village. Report of the People's Commissar of Health at the 7th All-Belarusian Congress of Soviets] (Minsk: Izdatel’stvo Narkomzdrava BSSR, 1925): 4
 Zakhar Mahilyowchyk, Sanitarnaye stanovishcha BSSR i dzeynasts’ sanitarnych organaw respubliki [The Sanitary Situation of the BSSR and the Activity of the Republic’s Sanitary Organs] (Minsk: DVB, 1928), 7.
 After medical courses, physicians were obliged to work in rural areas for several months (NARB, f. 4p, op.1, d. 2156, l. 10).
 Р. Bravaya, Okhrana materinstva i mladenchestva na Zapade i v SSSR [Protection of Motherhood and Infancy in the West and in the USSR] (Moskva: Gos. Med. Izdatel’stvo, 1929)
 The activities of the Okhmatmlad had been discussed during public lectures held for both an urban and rural female audience (NARB, f.4, op.1, d. 1197, l. 69).
 Susan Bridger, Women in the Soviet Countryside: Women’s Roles in Rural Development in the Soviet Union (Cambridge: Cambridge University Press, 2008), 10.
 Tricia Starks, The Body Soviet: Propaganda, Hygiene, and the Revolutionary State (Madison: The University of Wisconsin Press, 1999), 25–27.
 Mikhail Barsukov promoted various activities in the countryside. He also proposed carrying out broad educational work among the rural population (Mikhail Barsukov, Meditsina v derevne, 4).
 Ya. Baranowski, Shkodniki nashaha zdarowya [Pests of our Health] (Mensk: Belaruskae Dzyarzhawnae Vydavetstva, 1929), 25.
 Zakhar Mahilyowchyk, Saniatarnaya pamiatka: Za zdarovy satsyialistychny byt [A sanitary booklet: For a healthy socialist life] (Minsk: Vyd. NKAZ, 1930).
 For example, the Jewish Medical Society (EMSO), see: Bemporad, Becoming Soviet Jews, 37.
 Milhail Barsukov, Za dva goda : Stroitel’stvo zdravookhranenia v BSSR 1925–1926 [In Two Years: The Building of Healthcare in the BSSR, 1925-1926] (Minsk: Izdanie Zhurnala BMD, 1927), 37.
 Boris Segal, The Drunken Society: Alcohol Abuse and Alcoholism in the Soviet Union: a Comparative Study (New York: Hippocrene Books, 1990), 46.
 Mark L. Schrad, Vodka politics : alcohol, autocracy, and the secret history of the Russian state (Oxford ; New York: Oxford University Press, 2014): 223.
 Baranowski, Shkodniki, 26.
 Newsholme and Kingsbury, Red Medicine, 284.
 In August 1926, Narkomzdrav submitted to the Communist Party officials the report “The Sanitary Condition of the Townships and Rural Areas” (NARB, f.4, оp. 3, d. 14, l. 694).
 Vasil Samtsevіch, “Ekanamіchna-kul’turnae stanovіshcha myastechka Bahushevichy Barysawskay akrugi” [The Economic and Cultural Situation of the Small Town of Bahushevichy in Barysau District], Nash Kray 18, no. 3 (1927): 29–34.
 V. Samtsevіch, “Lahoysk Menskay akrugі” [Lahoysk in Minsk District], Nash Kray 31, no. 4 (1928): 25–32, here 28.
 Mogilevchyk, Sanitarnae stanovishcha BSSR, 6.
 They were inviting residents to get vaccinated or to use soap, to be alert for small children safety etc. Katherine Eaton, Daily Life in the Soviet Union (Westport, Conn.: Greenwood Press, 2004), 176.
 Sergei Elizarov, Stanovlenie i razvitie sistemy mestnykh sovetov BSSR v 1919–1929 godakh [The Formation and Development of the System of Local Soviets of the BSSR in 1919-1929] (Gomel: GGTU im. P. Suchogo, 2016), 64.
 In September 1926, the national Jewish council in Vuzda had set up its own sanitary commission. (State Archive of Minsk Region (further – GAMn), , f. 29, оp. 1, d. 62, l. 55).
 In February 1925, the Vuzda council ordered that all wells at Karl Marx Street be repaired and cleaned, otherwise they would be sealed (GAMn, f. 29, оp. 1, d. 78, l. 9).
 In the small town of Lapichy, poor Jewish residents were punished for unsanitary conditions (NARB, f.4, op.10, d.30, l. 132).
 In the town of Chachersk craftsmen could not claim any free medical services and consultations, since their Craftsmen’s Society (Obschestvo Kustarey) did not support a local hospital financially (Pamyats’: Chacherski rayon: Khіstarychna-dakumentalnyya khronіkі garadow і rayonaw Belarusі [The Chachersk Rayon: Historical-Documentary Chronicles of the Cities and Districts of Belarus], ed. Ya. Rayskiy (Minsk: Belta, 2000), 152.
 In 1925, the craftsmen’s orators at the local conference of kustari (craftmen) in the Minsk province pointed out the inaccessibility of local medical services. They also criticized the policy of the Communist Party. The secret police characterized such speeches as “anti-Soviet attacks on the Soviet republic” (GAMn, f. 12, оp. 1, d. 270, l. 24).
 In February 1925, in the hospital in Zhitkavichy, a physician known as Kleiman refused to examine a female peasant, and she died (The State Archive of Public organizations of Gomel region (GAOOGO), f. 69, оp. 2, d. 27, l. 183).
 This phenomenon was criticized actively by the zemstvo activists and in the 1920s by the official press. See Samuel Ramer, “Feldshers and Rural Health Care in the Early Soviet Period,” in Health and Society in Revolutionary Russia, 121-145.
 In Bahushevichy healers practiced folk medicine actively, their patients were both local residents and peasants. Samtsevіch, Ekanamіchna-kul'turnae stanovіshcha, 34.
 The residents in Lahoysk not only visited doctors in a hospital, simultaneously they continued to treat some diseases with assistance of women folk healers (so-called “babki-sheptukhi”) Lahoysk Menskai akrugі, “Nash Krai” 4 (31), 1928, 27.
 The mass spread of this practice in some rural areas and the need to combat this phenomenon was reported on by Drozdov, an Instructor of the National Commission, on 15 January 1931 (NARB, f. 701, op.1, d. 92, l.178–180ob).
 A correspondent from the village of Telush informed about healers in his village, Kommunist (organ Bobruyskogo okruzhkoma KP(b)B i okrispolkoma) (no. 138, 6.12.1925), 2.
 V. Kuprevich, “Lekavyya srodki w narodnay medytsynie” [“Herbal remedies in folk medicine”], Nash Krai 55, no. 4 (1930): 55–60.
 Resolutions of the first All-Belarusian meeting of district health inspectors, consultants, and inspectors of NKZ on 16 January 1928, “Rezalyutsyi”, BMD 2, (1928), 136–137.
 Davis, Economic Problems, 355.
 The secret police OGPU reported on such facts in Gomel (GAOOGO, f. 3, op. 1, d.714, l. 86).
 M. Garbel, “Meditsinskiy personal Belorussii” [Medical Personnel of Belarus], BMD 4-5, (1928): 18-20.
 This policy was announced by the People’s Commissar Mikhail Vladimirsky, who was preceded by Nikolai Semashko, at a meeting of medical doctors of industrial centers of the USSR on 16 November 1930. During this meeting the various tasks concerning healthcare during the reconstruction of industry were discussed (Russian State Archives of Socio-Political History (RGASPI), f. 357, op. 1, d. 127, l. 7).
 Mikhail Barsukow, Budawnitstva akhovy zdarowya Savetskay Belarusі і chargovyya zadachy w razreze 5-gadovaha plana [The Building of Health Care in Soviet Belarus and the Next Tasks in the Context of the Five-Year Plan] (Minsk: Izdatel’stvo TsK BOKK, 1929), 7.
 The Narkomzdrav of the BSSR had discussed that problem on 16 May 1930 (NARB, f. 305, op.1, d. 664, l. 9).
 On 25 August 1933, the Central Board of the Trade Union Medsantrud reported that medical institutions had collected money for a squadron named after Lazar Kaganovich (1891-1991), a Soviet politician and Communist functionary (NARB, f. 305, op. 2, d, 183, l. 7).
 In 1930, medical brigades working in the countryside forced peasants to buy the state tickets for compulsory loans for industrialization and the Soviet five-year plan. “Khronika,” Sovetskiy Vrach 2, (February 1930): 38.
 The OGPU reported on such grievances being prevalent against the administration in hospitals in Gomel (GAOOGO, f. 3, op. 1, d.714, l. 546).
 Some leaders of the Narkomzdrav supposed that that the older generation of physicians also idealized the pre-revolutionary period and so-called “Western bourgeois medicine.” Those professionals who maintained contacts with foreign academic institutions and scholars remained under suspicion (RGASPI, f. 357, op. 1, d. 127, l. 17).
 In some locations, it often had doubled or tripled when compared to pre-revolutionary numbers (GARF f. 8009, op.5, d. 249, l. 17).
 Among the students at the Minsk Medical Institute, the ratio of men and women was approximately the same and fluctuated between 40% and50%, depending on the year of admission.
 The competition for the nursing schools reached 5-6 people per place (The State Archives of Russian Federation (GARF), f. Р-8009, op.1, d. 82, l. 12).
 These measures were discussed by the Central Committee of the KP(b)B in summer 1935 (NARB, f.4, op.1, d. 8919, l.13). The Mogilev nursery school saw up to 160 nurses graduate annually, Komunar Magіlewscchyny, 6 June 1941, no 131, 4.
 In the summer of 1939, the Second Congress of rural district doctors announced that only half of the appointed medical doctors had come to work in the countryside (“Rezalyutsyya”), Meditsinskiy Zhurnal BSSR (MZhB), 8–9, (August- September 1939, 119).
 Andrei Zamoiski, “Weißrussische Psychiater vor dem Krieg und unter der deutschen Okkupation” [Belarusian Psychiatrists before the war and under the German occupation], in Diskriminiert – vernichtet - vergessen. Behinderte in der Sowjetunion, unter nationalsozialistischer Okkupation und im Ostblock 1917-1991 [Repressed—annhiliated—forgotten. People with disabilities in the Soviet Union, under Nazi occupation and in the Eastern Bloc], eds. Alexander Friedman and Rainer Hudemann (Stuttgart: Franz Steiner Verlag 2016): 141.