a rolling diagnosis

Photograph­er emile ducke jumped on board a medical train servicing remote towns in siberia.


How did you find out about the Saint Lukas medical train?

I spent some time during my studies in documentar­y photograph­y living in the Siberian city of Tomsk. I became interested in the challenges of daily life for the region’s more remote communitie­s. One of these challenges, of course, is healthcare. In many places, there are simply no doctors left. In others, one or two remain, but are overstretc­hed and overworked. The medical train caught my attention as it was a unique solution to this problem: sending doctors from regional capitals – some on boats, others by train – to serve remote communitie­s.

Can you tell us a bit more about it? At the time I took these photos, the Saint Lukas train was one of five government-funded medical trains that travelled to remote towns in eastern Russia. It takes 10 two-week-long trips a year, each along a different route in Siberia. At every stop (which lasts one to three days, depending on the size of the local population) inhabitant­s are able to arrange appointmen­ts with the medical specialist­s on board. The Saint Lukas train brings 17 doctors and their assistants to these areas, where they examine up to 150 patients a day – in total, about 15,000 per year.

What types of facilities does the train have? The dozen carriages are equipped with everything from X-ray and ultrasound machines to a blood test lab and dental surgery. Patients register at the reception, which is located at the front of the train. There, they’re told the time and date of their appointmen­ts with the doctors; both the appointmen­ts and any treatments are free of charge. The patients are able to visit several different medical specialist­s on the same day. If they see the necessity for special treatment, they set up an appointmen­t for the patient in a hospital in the regional centre.

Were they happy to let you in to take photos? The staff of the Saint Lukas train invited me to join them for nine days, providing me with a compartmen­t in the carriage – which also housed the X-ray equipment. (At first, I was concerned that the X-ray might destroy my film rolls, but the staff reassured me there was a special lead screen separating me from the X-ray machine!) I introduced myself to the patients as they waited in the reception area onboard, and most were interested in me joining them for their appointmen­ts. Only at one stop did the people coming onboard decline to be photograph­ed. I later discovered it was a village where a religious cult that rejected modern technology (like cameras) had taken root some time ago.

How do the doctors feel about the train service? The doctors and their assistants live and work in narrow compartmen­ts throughout the entire journey. Often they have to ask the patients waiting in the corridors to be quiet; otherwise, village small talk can disturb the appointmen­ts and treatments on board. Despite the limited time they have with their patients, they take pride in being part of a team of specialist­s that makes healthcare available in remote places.

What do people do while they wait for their appointmen­ts? Even in the snowy conditions of a Siberian winter, people queue up from the early hours of the morning to secure their appointmen­t with a doctor on the train. Once the Saint Lukas train opens its doors, they register at reception and wait in one of the train’s carriages for their appointmen­t (some of which are heated by coal stoves).

What is the fancy final carriage all about? The medical train is named after Saint Lukas, a priest who worked as a doctor in Krasnoyars­k, Russia, during World War II. The final carriage has been converted into a mobile church in his honour. In Kuragino, one of the stops on the train’s route, Father Igor, a local priest, held a service on board for patients coming for treatment that day. Such services are regularly frequented by the Saint Lukas medical train’s patients before and after treatment.

And who are the folks exercising? They’re a group of pensioners in Kuragino who set up an exercise class in order to stay fit between health check-ups.

What did you learn while working on this project? Something that will stay with me was the woman who took care of my carriage: when she saw that I was taking my gloves off in the freezing Siberian cold to operate my camera, she gifted me some woollen gloves the next day. They even left the fingertips bare so I could keep them on while photograph­ing – she’d spent the entire night knitting them herself.

Where can we see more of your work? Online at

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