Letter from Riga

The financial crisis has hit Latvia hard. But its medical care remains excellent—it's just a shame there are so few Latvians to benefit
April 25, 2009

As one of my friends has just found out, being sick in Europe's sickest country—as Latvia was recently dubbed, thanks to half a year of economic decline that has been precipitous even by current standards—is a surprisingly painless business. At least, it is if you're British and have travel insurance. We were there to make our contributions to one of the few still-booming games in town: that of the foreign stag night, a British industry now worth over £0.5bn thanks to the 70 per cent of pre-marital bonding/self-harming celebrations that now take place outside of Britain. In Latvia, as elsewhere, it's a sector that regularly throws up ugly stories of arrests, indiscretions and fleecings. A different kind of disaster, however, struck us before any beer had even been quaffed, as a lunchtime snowboarding session outside Riga ended with a friend breaking his arm.

Cue terrified looks from our guide and piste attendants, furiously sympathetic discussions between the several doctors in our party, the arrival of an ambulance, and a number of phone-calls to insurance companies about what exactly one does when injured in Riga. The answer, it turns out, is that you sit back and let them take you to a public hospital, where within a few hours our friend had been X-rayed, CT-scanned and had a successful operation to re-align his displaced bones. His arm pinned together in four places, he spent the night under observation in a spotless ensuite room before returning to our hotel the next day.

All of which made the trip a better opportunity than we might otherwise have had for cultural observation, and for some eye-opening conversations with the young Latvians who generously and variously assisted us. There was, they told us, no work for anyone. Unemployment officially stands at just under 10 per cent, but is expected to hit 15 per cent by the end of the year; the Latvian economy is predicted to shrink by up to 10 per cent. The once-burgeoning tourist trade is down; in January, there were riots in the streets; in February, the country's coalition government collapsed; a property boom in which prices increased by 5 per cent a month over the last few years has skidded into reverse.

Yet these swings of boom and bust have taken place against a slower, stranger story of decline. When Latvia left the USSR in 1991, regaining the independence it had last held in 1940, the population of Riga was 910,000. Today, this figure is 720,000, a fall of 21 per cent. It's a decline that stems from a combination of economic migration, low birth rates and the outflow of Russian-speaking citizens. As one of our guides explained, the fact that she was born in Latvia in no way made her feel Latvian: her parents were Russian, Russian was her first language, and as soon as she could afford it she would head off to study in Moscow, never to return. By 2050, the Latvian population may have fallen as low as 1.3m, compared to 2.3m today.

The Gailezers public hospital, where our friend was treated, is an eerily compelling vision of this decline. Built in 1979 on the most monumental scale the Soviet Union could muster, Gailezers is a concrete city set in a desolate site, a 20-minute drive from the centre of Riga. At first glance, you'd think it was abandoned: its crumbling brutalist towers rise above acres of cracked paving, linked by warrens of low corridors, unfilled waiting rooms and vacant atriums. What it represents, however, is not so much a shutdown as a slow retreat. Built to serve a population that has gradually dispersed, entire wings stand disused or incomplete. Walking to the emergency department, we passed a makeshift art gallery and a ramshackle restaurant squatting in what was once a reception area, before arriving at the foot of an 11-storey building the size of an aircraft hangar. We were the only visitors.

Our friend lay in a room on the top floor, one of two patients on a bright, clean ward with a central corridor 300ft long. Four nurses moved up and down, there was a pleasant smell of cooking, the equipment glistened, the care was attentive. To reach this floor we had walked along perhaps half a mile of dimly lit, utterly silent corridors, some scattered with abandoned chairs. The ward was a small hive of activity in the middle of spectacularly tranquil decay. Everything that was needed still worked; our friend had received an operation as expert as any he would have received on the NHS within hours of arrival. Yet there was so much that wasn't needed—so much spare capacity—that the atmosphere was more like a museum or a mausoleum, than a hospital.

"The Gailezers hospital has a lack of patients," observed a Latvian department of health report back in 2004, when the heady days of the boom were promising a future of vigorous capitalist modernisation for Europe's resurgent east. To some people protesting on the streets today, Gailezers reminds them of something very different; of grander, if not better, times; of more people in public places; and of fewer Brits with broken bones.