The Saint Lukas train doesn’t accept passengers — it accepts only the sick. The Saint Lukas is one of five government-sponsored medical trains that travel to remote towns in central and eastern Russia. Each stop lasts an average of two days, and during that time the doctors and nurses on board provide rural (乡村) populations with basic medical care, X-ray scans and prescriptions.

“People started queuing to make an appointment early in the morning,” says Emile Ducke, a German photographer who traveled with the staff of the Saint Lukas for a two-week trip in November through the vast regions (区域) of Krasnoyarsk and Khakassia.

Russia’s public health care service has been in serious need of modernization. The government has struggled to come up with measures to address the problem, particularly in the poorer, rural areas east of the Volga River, including arranging doctor’s appointments by video chat and expanding financial aid programs to motivate doctors to practice medicine in remote parts of the country like Krasnoyarsk.

The annual arrival of the Saint Lukas is another attempt to improve the situation. For 10 months every year, the train stops at about eight stations over two weeks, before returning to the regional capital to refuel and restock (补给). Then it starts all over again the next month. Most stations wait about a year between visits.

Doctors see up to 150 patients every day. The train’s equipment allows for basic checkups. “I was very impressed by the doctors and their assistants working and living in such little space but still staying focused and very concerned,” says Ducke. “They were the best chance for many rural people to get the treatment they want. ”