Medical and sanitary expeditions ofthe People's Commissariat of Health ofthe RSFSR in the Tuvan People's Republic and the development of Tuvinian healthcare (late 1920s - mid-1930s)

This paper analyzes medical assistance of the People's Commissariat of Health of the RSFSR to the Tuvan People's Republic in the late 1920s - mid-1930s. The study aims to assess the role of the Soviet medical and sanitary assistance in shaping the Tuvinian healthcare during the sovereignty period. Based on understudied archival documents from the funds of the State Archive of the Russian Federation (GARF) the author traces how Soviet physicians exposed and tackled health problems of the Tuvinians and Russians. During that period a network of medical facilities was being formed on the principles of massiveness, universal availability and a free-of-charge basis. Using a geopolitical approach the author reveals a hidden agenda of cultural and ideological influence in Tuva in the sphere of geopolitical interests of Moscow, noting that from the second half of the 1920s the interaction of the USSR with Asian countries was based on the use of "soft power" where medicine occupied a key role. The first expedition of the People's Commissariat of Health of the RSFSR worked in Tuva in 1928. The author highlights that Soviet physicians faced a complicated medical and sanitary situation in the country. Skin and venereal diseases were rampant among Tuvinians; Russians suffered from chronic internal diseases. The country lacked children's and women's hospitals. The Tuvinian governmental network consisted of a single hospital in Kyzyl. The author concludes that the 1928 expedition achieved a considerable success. A single healthcare authority - Tuvzdrav at the Ministry of Internal Affairs - was created in Kyzyl. The state funding of healthcare increased. The main threats to the health of the Tuvinian and Russian population were identified. The doctors disproved a thesis about the extinction of Tuvinians. The authority of European medicine among Tuvinian herders grew drastically. Analyzing archival sources the author assesses the work of other expeditions (1929-1934) as a consistently developed success. The second expedition strengthened hygiene instruction among Tuvinians. More medical stations and hospitals were built in the districts of Tuva. Soviet medical expeditions faced shortage of funding, premises, personnel, medicines and equipment, measles and scarlet fever epidemics. These problems were successfully tackled by the People's Commissariat of Health of the RSFSR and the Tuvinian government. The author calls it a definite achievement that the Soviet physicians popularized socialist medicine winning trust of Tuvinian herders and lama priests. The article highlights that the ambiguous attitude of the Russian population was to be overcome through comprehensive measures to change the traditional lifestyle. The author concludes that, like in other countries and regions of Inner Asia, in Tuva struggle against social diseases was the kernel of the healthcare policy. The use of the state-of-the-art means of European medicine and an ideological impact on the population through medical facilities was essentially the Soviet "soft power" influence that led to deep sociocultural transformations.

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