The problems of a "sector" paediatrician.

For many decades now even initial medical training in the Soviet Union has been conducted along specialist lines. Given that there is no single curriculum that all intending doctors must follow, there can be no place for the concept of a general medical practitioner whom patients will consult with any presenting symptom, irrespective of their sex and age. The "first line" of the Soviet health service, far from being embodied in a single type of doctor, has been fragmented among various basic specialists to whom patients may refer themselves. Nevertheless, the Soviet health planners have recognised the desirability of deploying two kinds of specialist in the role of vestigial general practitioners. As readers may recall from one article in this series,' a proportion of specialists in internal medicine (terapevti) are made responsible for overseeing the adult population in a sector or subdivision of the area served by a policlinic. Similarly, the staff of policlinics include paediatricians who are assigned to separately delimited sectors of children and young persons. One such paediatrician recently felt the need to write about her job in a long letter to the newspaper Meditsinskaya Gazeta2; named as Maria Sergeevna Krutova (the surname was altered by the editor), she lives in Kerch, a town with a population of 157 000 situated in the Crimean peninsula. In this article I draw heavily on the vivid and sometimes moving portrayal of her working conditions and her morale.