As the ruble continues its catastrophic tumble, hitting another historic low last month, the pain is being felt keenly across Russia.
Among those worst hit are patients in need of urgent surgery abroad or other life-saving treatment billed in foreign currencies.
"It all started with a bad cough and a lingering cold," says Viktoria Aksanova, 32, who was diagnosed with a severe form of Hodgkin's lymphoma, a type of cancer that originates in white blood cells, in 2011. "My son was 5 at the time. It was as though life had stopped."
After six rounds of chemotherapy, a bone-marrow transplant, additional high-dose chemotherapy, and two relapses, Aksanova is now awaiting a second bone-marrow transplant at a St. Petersburg hospital. She hopes the procedure will allow her to finally beat the disease and return to her home city of Krasnodar to care for her son, Kirill.
Like the majority of Russian patients with no siblings, Aksanova has been unable to find a donor in her country, whose organ-donation program is still in its infancy.
So she must find and import a suitable bone-marrow sample from Europe, an expensive process made even more costly by the ruble's dramatic decline against the euro.
"I need 18,000 euros" -- or around $19,530 -- "plus 2,000 euros to transport the sample here," she says. "I'm worried, of course, because I can't control how the currency exchange rate will fluctuate and I don't know whether I will be able to afford treatment. Some patients die if they don't get treatment. So it's very hard."
When Aksanova underwent her first transplant in 2013, the ruble was trading at 42 to the euro; it has since lost half of its value, pushing the cost of a transplant way out of her reach.
The young woman is now pinning all her hopes on Advita, a Russian charity that raises money for cancer sufferers.
Like other medical charities in Russia, however, Advita is scrambling to adapt to the new economic reality.
"Eighteen thousand euros with an exchange rate of 50 to 60 rubles to the euro and 18,000 euros with an exchange rate of 80 to 90 rubles to the euro are two entirely different things," says Advita spokeswoman Lada Davydova.
Many of the patients it sponsors require imported bone marrow, Davydova adds.
She says Russia's financial meltdown has also taken a toll on donations.
"We now work more creatively," she says. "We try to come up with unusual advertising campaigns and new approaches, to attract types of businesses with which we had never worked before."
Even Russia's biggest, most successful fund-raising charities are feeling the crunch.
"We unfortunately need to collect more money in rubles than before to cover the expenses of our patients," says Yelena Chistyakova, who runs the Podari Zhizn aid group, which collects funds for children with cancer and other serious diseases. "We now spend more time writing donation appeals; we are more active in soliciting sponsors. So yes, we work even harder than before."
According to Vladimir Berkhin, the head of a religious medical charity called Predanie, at least three well-established medical fund-raising groups have shut down over the past year.
By putting in longer working hours and broadening its pool of benefactors, workers at Predanie have been able to continue raising an average of $2,500 per day for its patients, many of whom are children suffering from life-threatening diseases.
Due to the weak ruble, however, the group cannot help as many families as in the past.
Worse still, soaring exchange rates are forcing some patients to delay vital surgery abroad, and in some cases even launch a second round of fund-raising.
Predanie has been raising money for Volodymyr Lekhno, a 3-year-old boy from Ukraine who urgently needs a kidney transplant. Due to a rare congenital disorder, Volodymyr must undergo the operation at a special clinic in Belarus.
By the time Predanie collected the required sum in rubles calculated at the start of the fund-raising campaign, the Russian currency had fallen so sharply against the Belarusian ruble that the charity found itself short a sizable chunk of money.
"You already collected the money once, but the exchange rate jumped, prices rose, and once again we don't have enough money for the operation," Volodymyr's parents wrote on Predanie's website. "Please, help!"
Berkhin says his group must now find another 1 million rubles ($13,000) to compensate for the sinking ruble.
"If currency rates leap again, we will need not 1 million but 1 1/2 million," he laments.
Patients who can undergo treatment in Russia are hit hard by the ruble's steep decline, too. Health experts say Russian hospitals, which rely heavily on imported medical products, have been hiking prices to cover their rising expenses.
Berkhin says Predanie long ago burned through its emergency reserves to cushion the economic blow for patients. And with the ruble's prospects looking increasingly bleak, he and his colleagues are bracing for tough times ahead.
"I have never been very optimistic about our country's future and the future of our organization, and I'm not optimistic right now," he sighs. "I guess all we can do at this stage is pray and work harder."
