In vast, sprawling Russia, many people still live in small villages far from the nearest medical clinic.
The government has been busy ‘optimising’ medical care, a euphemism for the closure of thousands of rural hospitals and clinics, to save cash.
The situation has gotten worse in recent years, so now one region has taken matters into its own hands.
Dozens of old people, mostly women, have been training as first-aiders and offering emergency care to their neighbours.
Sarah Rainsford has been to meet some of them, in villages near Saransk in central Russia.