“There is Moscow, then there is the rest of Russia”. It is often said here, and that is the spontaneous response Dr Vladimir Butyrin gave us when asked how the hospital is doing in handling the COVID-19 cases that plague the region.
He works in the emergency room in Nyandoma, a town of 25,000 people in Arkhangelsk Oblast, 1,000 kilometers north of Moscow.
We met him at the ambulance dispatch center, where he manages calls and priorities. These days, one does not come without the other.
It had been barely five minutes since we had arrived when a team was already leaving to pick up an infected patient in distress.
The scene is chaotic, the staff are few in the circumstances. He is devoted, but he lacks the means.
Several sections of the hospital have not been renovated since the 1950s, says Anastasia Denissova, a nurse.
We were forbidden to enter any further than the emergency room, but the photos she shows us from inside the premises are sad and shocking.
Wet blankets, rusty sinks, mold in patient rooms …
There are people in the corridors, medication is often missing. If there are funds for our hospital, I can tell you that we don't see them here.
She is one of the few health care workers to dare to speak openly about the working conditions in this hospital.
Others told us that they were too afraid of reprisals.
In fact, the hospital management did everything to prevent us from speaking with the staff throughout our stay in Nyandoma.
A stay that allowed us to measure the impact of the pandemic on these small outlying towns, like there are hundreds of in Russia.
They are the big forgotten ones in the health system.
One does what one can. Often times, patients take our heads off because it's far too late. Sometimes we don't even surrender, explains Pavel Denissova, Anastasia’s spouse.
He is an ambulance driver and arranged to meet us in a garage where four old ambulances are parked.
They no longer drive. It's either a lack of funds or a lack of will, says Pavel. In any case, we only have two more on the road this week.
Under the vehicle, his colleague Igor hits a wheel with a hammer. He says he took the initiative to fix it because he is working the same evening.
Yesterday was madness in the emergency room, I didn't have time to stop once, said Igor.
How many confirmed COVID-19 cases are there in the city? How many deaths? It’s almost impossible to know, Evgeni Zaitsev tells me, because it seems the authorities are manipulating the statistics.
He owns a small funeral home and assures us that here is a disaster.
Behind the counter, his employee Katia prepares the fourth funeral of the day.
It is not yet noon.
There are funerals every day, bar none, four today, four tomorrow, and from what we understand, at least half have died from COVID. This is our Third World War.
In the room, just behind her, four young men prepare a coffin and then put on white overalls. This is for a man who died of COVID-19 in hospital.
We are told, looking low, that the family will not even be able to see the body. He will be buried wrapped in a black bag as a precaution.
Celebrating the dead with an open casket is a sacred tradition for most Russians.
Katia can't help but breathe an exasperated sigh, wreath in hand.
Our hospitals are dilapidated, poorly equipped, they lack medicines, some even say that they sometimes lack oxygen, she laments.
Outside the wing of the old, visibly neglected polyclinic, where COVID-19 patients are being treated, a truck has just pulled up to drop off oxygen cylinders.
We constantly refuel, says a man, out of breath before getting back into his vehicle as another truck approaches; he has just recovered a body.
Evgeni, the owner of the funeral home, says the city is currently managing to bury its dead. This is not the case in other parts of Russia.
Videos posted on the internet and authenticated show a hospital in Barnaul, Siberia, where dozens of body bags are stacked in the basements.
Social networks are flooded with testimonials from hospital workers in isolated provinces who speak out against the horror of health care.
The pandemic will have really revealed the decline of the system in the regions, says Anastasia Denissova, as well as the poor salaries of employees.
Defending their rights has become her main mission since joining the Alliance of Doctors, an independent trade union that opposes the Putin government and is the only one speaking on behalf of healthcare workers in Russia.
We have to protect our colleagues because there is abuse, and we need people to shake up and move the hospital administrations, to demand health standards. We are not asking for luxury, but for human conditions, a little dignity.
But breaking the health care silence is not without risk, and she knows it.
Her partner Pavel, the paramedic we met earlier, was violently pushed around by the hospital director's husband while we were interviewing him.
And earlier this month, when the Alliance president came to Nyandoma to distribute protective equipment, she was harassed and followed by the police.
Sometimes I think I shouldn't get involved, but I do. For me, for my colleagues, for my children, we deserve better.
$ 325. This is the average earnings of angry women we meet, out of sight, hidden behind a hospital wall.
We are housekeepers, we are paid as housekeepers, but we take care of the sick, shouts the most talkative of the six.
Wrapped up in their scarves and woolen hats, they told us that, among other things, they had to change diapers, feed patients, without the necessary protective equipment in the midst of a pandemic.
It's not only frustrating, she says, it's downright humiliating. They wanted to go on strike this week, but gave it up quickly after being summoned by management.
There is no other job in town and they have mouths to feed at home.
If you ask me, it's the result of a diet that doesn't give a damn about ordinary people, says Evgeni, who is about to leave with the funeral team for the hospital.
Regions are left to fend for themselves in the midst of a pandemic, and it is only just beginning.
Tamara Alteresco is Radio-Canada correspondent in Russia