__________________________________________________________ The Health System and the Russian Orthodox Church: Prospects for Development Ershov Bogdan Anatolievich, Muhina Natalia Evgenievna, Voronezh State Technical University, Moskovsky Prospect, 14, Voronezh, Russia, E-mail: bogdan.ershov@yandex.ru, 8-919-243-06-34 ABSTRACT: The article examines the participation and assistance of the Orthodox Church in solving problems that allowed to give a scientific justification for the cooperation of health care and Orthodox religious institutions, to determine their role in the historical context and structure of modern healthcare in Russia. The article presents an algorithm for organizing sisters of mercy, their system of upbringing. Particular attention is given to the possibility of teaching the course "Foundations of Orthodox Culture" in secular educational institutions. Research materials can serve as a basis for the formation of morally sound positions of medical workers and the population on the main problems of medical activity. Based on the study, the authors published a series of articles in which the experience of the work of the Orthodox Church in the charitable sphere has been summarized. This experience can be used to create new charitable institutions, including those who provided medical assistance. In preparing the article, the authors used concrete historical, civilizational, formational and social methods of research that allowed us to uncover facts, phenomena and processes in the interconnection and unity of the past, present and future. KEYWORDS: Medicine, church, charity, state, priest. I. INTRODUCTION State-church relations as a combination of historically emerging and changing forms of relations between state institutions and religious organizations are one of the main parts of the domestic and foreign policies of any state. Russia has always been a multi-confessional country, here all major religious confessions coexist: Christianity, Buddhism, Islam, Judaism. At the same time, in the modern Russian consciousness there is a close connection between Orthodoxy and national identity. 80-82% of the population of Russia consider themselves Orthodox. The role of the Russian Orthodox Church in the economic and social life of the country was significant throughout the history of the country until October 1917. Even in the Old Russian period, the spiritual foundations of charity were formed under the influence of selfconsciousness. Since the late 1980's. in our country, the gradual return of the Church to the sphere of charity and medical and social services began, the process of uniting the interests of the Church and the state in the field of protecting human health was intensified. The main legal documents in this area were the "Fundamentals of Legislation on the Protection of Health of Citizens in the Russian Federation" of 1993 and the "Agreement on Cooperation between the Ministry of Health of the Russian Federation and the Russian Orthodox Church." The importance of the church mission in the health sector was expressed in the creation of hospital temples, church hospitals and an almshouse. The number of monasteries engaged in social activities is increasing, fraternities are being organized. At the same time, the catastrophic situation in the field of public health in Russia is growing. The state public health system is developing mainly around the world, the volume of medical care often increases without regard for quality. Many researchers believe that the public health system can not function effectively under the current conditions. In this connection, studies that reflect the relationship between the Church and medical institutions in modern Russia are of great importance. . II. METHODOLOGY The study was conducted in the methodological field of the sociology of medicine. The research program was of a multistage nature and provided for the use of a methodology based on traditional methods of socio-hygienic, medical-organizational and historical-analytical nature, adapted to the specifics of the purposes followed by statistical processing and data analysis. In the work to achieve the goal and implement research tasks, a number of methods of concrete sociology are offered: a survey, indepth interviews, expert interviews, content analysis, a biographical method. The organizational chart of the interaction of Orthodox organizations and bodies of practical health, developed in this article, is based on historical traditions of the charitable activities of the Russian Orthodox Church. This scheme takes into account modern socio-economic realities. This scheme proved to be effective in the organization of medical care and can serve as a basic model for the development of cooperation between the Church and medical institutions. Given the deep historical evidence of the important role of Orthodox Christianity in preserving health and creating a healthy lifestyle for the population, it should be recognized that the development of special programs for cooperation between medical organizations and the Church is justified in modern conditions. III. RESULTS The article shows the results, which testify that medical and social assistance to the population of Russia is mainly under the aegis of monasteries. The nature and scope of this assistance in different periods were not the same and depended on the policy of state power towards the Church. If at the initial stages of the country's development there were no other shelters for the sick and disabled, with the exception of monasteries. By the beginning of the 20th century, shelters occupied a leading position in state, public and charitable organizations. They created a unique system of medical and social assistance to the population. The church has been active in this area since the late 1980s, and both traditional and new forms and methods of medico-social and charitable work were realized. The cooperation of the Church and the state in the field of health and social services, the legal basis of which is in the process of formation, testifies to the recognition of the Church in the life of Russian society, contributes to the expansion of social health and the participation of a wide range of people to solve health problems and revive the spiritual traditions of medicine. The Orthodox Church provides medical and social assistance to the following groups of people: terminal, somatic, mental, HIVinfected, drug addicts, patients with toxic and alcoholic diseases. The expediency of creating hospitals for religious confessions as a whole was recognized by 41.7% of doctors and 46.1% of patients. In addition, it can be noted that the main types of institutions that are actively engaged in medical and social activities are: a) medical institutions of a stationary type, incl. hospitals operating under the Moscow Patriarchate, diocesan hospitals, monastery hospitals, hospitals in theological schools; (b) outpatient medical facilities, including first aid centers for religious schools, monastic medical posts; (c) Medical and social institutions. For example, the diocesan hospital of Saint Blessed Xenia helps orphans and elderly people. The average length of stay in the hospital is 31 days. Among the patients, pensioners were 95.4%, disabled people 71.3%, lonely 30.4%. The hospital staff was selected from among Orthodox believers. The satisfaction of patients with treatment is high (98.4%) and the ratio of medical personnel (100.0%). A special form of medical and social activities of the Church are care centers (in 2016 in the Russian Federation, 14), designed for outpatient rehabilitation of mentally ill, alcoholics and drug addicts affected by totalitarian sects, psychics. The task of Orthodox priests and doctors is to closely cooperate in these centers. The course of rehabilitation takes an average of 1-2 years. In addition to institutions, the Church creates medical organizations that carry out their ministry in public medical and social institutions: for example, the society of Orthodox doctors; sisterhood of mercy, brotherhood of mercy, parish communities of hospital temples. The Society of Orthodox Physicians is a new form of association of medical workers for Russia on the basis of a religious community. Their goal is to provide medical and spiritual assistance to sick poor people, coordinate the activities of charitable brotherhoods and sisterhoods, organize a system of qualified diagnostic, therapeutic and preventive care for churchmen, discuss current medical problems in accordance with the canons of the Orthodox Church. For example, the society in Moscow consists of medical , scientific and educational and training departments. For the years 2000-2016. The number of people seeking help was about 25,000 people. Training courses for Orthodox doctors and psychologists have been organized. Today, the centers of the sisters of mercy, organized in Russia in the XIX century, demonstrated their effectiveness. Based on the analysis of the development of nursing, five main stages (periods) of the movement of nurses in Russia were identified. The distinctive features of this movement were medical and social assistance, strict morality, love and charity toward one's neighbor, diligence and dedication, discipline. In 2016, there are about 40 communities and groups of sisters of mercy in Russia. An algorithm for creating a community of sisters of mercy is developed and conceptual principles of its organization are formulated. The main thing is to find a job for a sister, where she can perform church obedience in addition to medical, within the framework of jointly developed contract documents regulating the status and order of service in the conditions of a particular institution. Clearly organized sisterhoods, consisting of religious, morally educated and at the same time professionally trained sisters, can undoubtedly provide more effective assistance to public health institutions and social workers, since there is a shortage of medical specialists of junior and middle level. The activities of nurses, based on Christian charity, combine medical care with spiritual care for the patient. The main goal of the sisterhood was to strengthen the moral and spiritual foundations of society. As a result, today the revival of the brotherly and sister movement is an objective process of returning to traditional forms of religious life in Russia. At the same time, the current socio-economic situation in the country does not allow many Orthodox movements and organizations to revive the church and social life and fully understand the tasks of social services. Despite the positive results in the social and philanthropic activities of individual brotherhoods and sisterhoods, the author believes that the revival of the sister movement is associated with the same problems that led to the suspension of the work of Orthodox brotherhoods. Today, 150 brotherhoods and sisterhoods registered with the Ministry of Justice of the Russian Federation operate independently and in isolation, without information and coordination However, despite the artificial suppression of the fraternal movement, the Unions of Orthodox brotherhoods should be attributed to institutions that seek to mobilize community and church organizations to jointly solve social, spiritual and ethical problems. In these unions, new technologies are being developed in various fields of medicine. In the percentage ratio, it looks like this. Thus, history shows that such forms of Orthodox life as brotherhood and sisterhood, unlike secular and some church institutions, can not be created or canceled only "from above". They are based on believers and want to fulfill one or another church ministry together. IV. DISCUSSION Some aspects of the participation of the Russian Orthodox Church in protecting public health were examined in the works of Mirsky MB, Pospelovsky D., Siluyanova IV, Filimonova SV, Cherkasova AE. and other domestic scientists. However, few works are devoted to a comprehensive study of the interaction of the Russian Orthodox Church with medical personnel. Almost in the scientific literature, there was no analysis of the participation of the Russian Orthodox Church in protecting the health of the population of the Voronezh Region. The author of this article proposes to classify various aspects of the historiography of this problem by periods. The first historiographical period from the beginning of the XIX century to the 70-ies. At that time, a complex historical work was carried out to collect and publish materials that had the character of historical data, reference data, the Charter of various institutions of public charity and education. Studies were often onesided and subjective, devoid of profound scientific medical analysis. The second historiographical period from the 70s. XIX century until 1917. During this period, a great leap was made in historical science for the collection, processing and publication of official documents and extensive factual materials, as well as bibliographic indexes. In the works of EE Golubinsky, AP Dobrolonsky, SG Runkevich, Runovsky, Znamensky, Klyuchevsky, Barsov, FV Blagovidov, B. Titlipov, B.II. Kudryavtseva, Papkova, Prugavina, Makariya (Bulgakova), Berdyaeva, various aspects of the development of medical charity were systematized. Scientists also considered the medical and social role of church parishes in the development of assistance to the needy. There was a significant amount of biographical work, about the most vivid representatives of the parish clergy and their ministry. Statistical information on the total number of medical societies and fraternities in the Russian Empire is also found in the encyclopedia "Russia", published in 1898. A valuable group are modern published reports and surveys that contain data on the history of the church and statistical work. Therefore, the relevance of studying the problems associated with the embodiment of Christian ideals in medical practice, both public and secular authors, is topical. Thus, in this article, all of the above indicates the necessity and importance of scientific research, conducted in terms of a systematic approach, in-depth analysis, justification and implementation of results in educational and medical institutions. V. CONCLUSION Currently, the medical and social charitable activities of the Russian Orthodox Church are actively developing. The cooperation of Orthodox organizations with medical institutions can give such positive results as: the revival of the spiritual traditions of medicine; awareness of the interdependence of man's spiritual and physical health; attraction of additional financial, organizational and especially human resources for medical care; formation of morally grounded positions of medical workers and the population on the main problems of medical ethics (bioethics); formation of a healthy lifestyle of the population and combating the spread of bad habits; expansion of the base of social health and involvement of the general public in solving health problems. The views of doctors and patients on the problems of clinical ethics (the relationship between a doctor and a patient, including the ethics of informing, obtaining informed consent for treatment, confidence indicators, medical secrets, etc.) are not very dependent on their attitude to the Orthodox faith. In the performance of their duties, most doctors prefer professional views on medicine. The opinions of many doctors and patients about modern medical technologies are not yet formed, they have no solid moral justification. There are significant differences in the assessment of modern biotechnology of doctors and patients, depending on their religious affiliations, and the views of church members are more in line with the norms of religious morality and medical ethics. The organizational chart of the interaction of Orthodox organizations and bodies of practical health, developed in this article, is based on historical traditions of the charitable activities of the Russian Orthodox Church. This scheme takes into account modern socio-economic realities, has proved effective in the organization of medical services and can become a basic model for the development of cooperation between the Church and medical institutions. REFERENCES American Medical Association, Council on Ethical and Judicial Affairs, Ethical considerations in the allocation of organs and other scarce medical resources for patients Archives of Internal Medicine. (1995) 155. 29-40. Benrubi, G. I., (1992) Euthanasia the Need for Procedural Safeguards New England Journal of Medicine. 326 / 3. 198. Cyril, Metropolitan. (2000) On the «Fundamentals of the Social Concept of the Russian Orthodox Church» The Anniversary Bishops' Council of the Russian Orthodox Church. Collection of reports and documents. 133-149. Dmitrieva, (1998) T.B. On urgent measures to implement the Concept of the Development of Health Care and Medical Science in the Russian Federation Problems of Social Hygiene and the History of Medicine. 1. 7. 25-28 Glushkova, V.A. (1985) Medical error and accident in medical practice Clinical surgery. 1. 63 64. Gromov, A.P. (1988) Medical duty, medical responsibility, medical secret Deontology in medicine. 73-122. International Commission on Occupational Health (ICOH), International Code of Ethics for Occupational Health Professionals (1992) Bull. Med. .82. 9. Ivanov, A.E. (1993) Mental Health of the Population: Demographic Aspect Health Protection of the Russian Federation. 12. 7-11. Karpov, A.S. (2002) On the interaction of state bodies, health services and the Moscow Patriarchate of the Russian Orthodox Church Health. 12. 12-16. Kondratiev, F.V. (2001) Orthodox-ethical aspects of euthanasia Orthodoxy and problems of bioethics. 98. Largey G., (1978) Reproductive technologies: sex selection Reich W. T. (ed.), Encyclopedia of bioethics.-The Free Press, New York, 1439-1443. Matveev, G.N. (2001) The modern hospital and the rights of the believer Sisterhood. 2. 38-39. Miller, F. G., (1994) Regulating Physician Assisted Death, New England Journal of Medicine. 14. 120. Not available А.В. Health Reforms: Problems and Prospects (2001) Orthodoxy and Bioethics. 9195. Shchepin, О.P. (2001) Problems of health of the population of the Russian Federation and its forecast for the period up to 2005 Problems of social medicine, public health services and history of medicine. 3. 3-10. Shevchenko, Y.L. (2000) Priority tasks of the Russian public health services for 2000 Bulletin of compulsory medical insurance. 1. 4-6. Siluyanova, I.V. (1998) Modern Medicine and Orthodoxy. Moscow: Publishing House of Holy Trinity Sergius Lavra. 296 p. Sorokina, Т.S. (1994) Russian Sisters of Mercy in the Crimean campaign of 1854-1856. Problems of social hygiene and history of medicine. 6. 51-53. Vasileva, O.Y. (1993) Russian Orthodox Church and Soviet Power in 1917-1927 Questions of History. 8. 40-54. Vlasov, P.V. (1987) History of the formation of nurses in Russia Med. sister. 3. 248-249.