The Russian economy collapsed into chaos years ago; its political system has been in near-permanent paroxysms since any key event in the country's history you care to choose as your starting point.
Now the whole of Russia is dying - not just metaphorically but literally.
Life expectancy among Russian men has fallen by a decade to just 58 - at least 15 years less than in Western Europe. The death rate outstrips the birth rate by a factor of 1.6 - in other words, Russia is losing a million of its 150 million people every year.
And a third of those dying are of working age.
Suicide rates among young men have doubled in the past five years. But it is the spread of infectious and parasitic diseases that is truly alarming. Last year saw 376,000 new cases of syphilis. Even official statistics suggest that more than 2 million people have tuberculosis, and there are 140,000 new cases each year.
Blame capitalism if you like: the billionaire financier George Soros does. The man who made his fortune in the maelstrom of the money markets believes Russia has moved 'from the excesses of the Soviet system to. . .
robber capitalism', and he is particularly concerned at what is happening to health.
Last summer, Soros handed over $3m to the New York-based Public Health Research Institute to set up a Russian Infectious Disease Project. It will concentrate on hospital-acquired infections and TB.
Priorities for action include healthcare management reform and the catastrophic rise of TB in prisons.
Yet one of the project's first targets must be to overcome resistance among the medical establishment to the World Health Organisation's very effective DOTS approach to TB treatment. The project has selected Tomsk as a DOTS pilot site, and work begins next year. Watch this space.