First-hand experience finds Russian medicine lacking

(By Sara Hannan.

From the Juneau Empire, Wednesday, February 17,1993)

Vladivostok - Before coming to Russia, I had strong preconceived beliefs about the Russian medical system. I had heard and believed a variety of horror stories about the level of medical care. I came to Vladivostok confident that I could take care of myself in all but the most life-threatening medical circumstances.

I was well prepared with basic first aid and medical knowledge and well stocked with medical supplies. I had a self-supplied pharmacy (Band-Aids, vitamins, a variety of antibiotics, pain medicine and disposable needles). Additionally, I made two promises to my mother - first I would not get married while in Russia, and second, if I needed medical care, and would come home.

Yet I had no idea that my formal education about the Russian medical system would begin with a violent physical assault in the safety of my Russian home.

A drunk young man invited to my house by a female friend became violent with me one evening. For the teen-age female guest who brought this brutal young man along, and witnessed the assault, it was a real lesson in the danger of letting a stranger into our lives.

Initially after the assault, it was recommended that i be hospitalized. This is standard treatment in Russia for a concussion and head trauma. It is not standard in America where a day in the hospital costs hundreds of dollars. I had seen the emergency room and there was no way I was going to be hospitalized as long as I was conscious. The American Consulate's office sent me to the elite hospital with a referral to see a neurologist. The Consulate's office told me that at this hospital the doctors had medical training equivalent to ours. They also said the equipment was modern, including an X-ray machine with safety systems and lead aprons.

On this surreal, nightmarish night, I ended up a patient in this emergency room. The doctor had a stethoscope, but no blood pressure cuff. A painkiller was offered, but in a needle so large I knew it had to have come from a veterinarian's office. There were no ice packs. The exam room was sparsely furnished with a sink, desk and chair, and one exam table with a dark green rubberized cover on it. The yellowed paint was peeling from concrete walls and ceiling. The enamel bowl tucked tightly under the exam table was filled with bloody gauze from the last patient.

The doctor used an overhead light to check my eyes. She examined the extent of my swelling and bruising, asked about nausea, blackouts and bleeding, took my pulse, offered me the injection for pain and sent me back home. I was given papers to authorize a house call from a doctor the next day. It was 4:00 a. m. and all I wanted were two aspirins and to call my doctor in the faraway morning.

Instead of requiring hospitalization, the neurologist prescribed several medications, home visits and some injections. My fear of injections was alleviated a bit when they explained that this hospital used only disposable needles. At home, I received alternating-day visits and exams by doctors or nurses, received glucose injections and had my blood pressure closely monitored.

Medical care is one of the areas where you quickly see differences between Russia and the United States, but much of the disparity is in the style of care. Early in my stay here, my "Russian daughter", a normal 16-year-old teenager, declared she was sick and going to the hospital. With my stateside orientation, I became quite alarmed at her condition and began to inquire "What's wrong? Where does it hurt, what are the symptoms?"

It was, in my analysis, simply a cold and justifiable cause to miss school, but not severe enough to need a hospital. Yet a day's absence turned into a missed week of school and several visits to the hospital, along with the mandatory paper exchange. Somewhere along the line, I was able to gain the more accurate perspective that going to the hospital in Russia is as normal as calling your doctor in the States and discussing a minor ailment.

In Russia, all doctors and nurses work for the government and are located at "polyclinics", or what we think of as hospitals. Generally, the patients come from a regional service area. Vladivostok has five districts within the city that oversee local governmental functions, such as medical (polyclinics), schools, police and courts. I live and work in the Forensky District, and there is a polyclinic nearby, along with a train station that serves the area.

In the United States, there are drug stores that provide a wide assortment of medical supplies that can be used to self-medicate, and you simply call school or work and say that you are ill and won't be in. The Russian system does not work that way. If you are absent from work or school, you MUST have a medical confirmation that you were sick. If you wake up feeling sick, you go to the polyclinic, get a sick leave paper validated and possibly some sort of medicine, then go home and go to bed. If your ills are chronic and ongoing, you may find yourself seeing a variety of medical personnel. You are a patient of the policlinic, not of a doctor. There are specialists who do see patients in an ongoing relationship, but in general, it is a system of waiting for the next available doctor.

As an outsider, my first impression was that this system encouraged hypochondria among the population. People go to the doctor without substantial ailments. But that is the perspective of someone who must fulfill an insurance deductible, only has some services covered, has access to buy thousands of medicines in a store open 24 hours a day and can ask a medical professional for advice over the phone.

The Russian medical system is designated to serve Russians in Russia. If you are too ill or frail, the doctor will come to you. Each polyclinic has doctors who provide home service to patients, seven days a week. It appears that these doctors are regular doctors from the polyclinics whose schedule periodically puts them on the home service circuit. During a cold spell in November, my host family had relatives visiting from an outlying village. The youngest was a baby of 15 months who became ill. On a cold, snowy Sunday afternoon, a friendly young pediatrician made a house call to see him. Follow-up care was required later in the week, and again a doctor was dispatched to our home to treat him.

In conjunction with the district polyclinics, there is one major hospital. Called the "Thousand Bed Hospital," it is the location of surgical procedures, births and long-turn hospital care of most citizens of the city. The emergency room of this main hospital has no medical supplies. Every doctor's office in the remotest corner of rural Alaska or Arkansas, is better supplied.

I soon discovered there is a separate, but not equal, system of medical care available to serve specific audiences, usually through work. For example, there is a hospital that serves the employees of the merchant marine fleet, the cadets and some employees of their academy. There is a polyclinic that served the former high Soviet officials and their families that now has some elite clientele, but it is not clear who is admitted. I do know that one way to be treated in this almost-modern elite hospital is to be an American, for whom the American Consulate's office arranged care.

After I recovered somewhat, I went to the doctors, but for two weeks, I was more than content to receive medical care at home. My assault resulted in significant facial bruising and swelling. Police business required me to leave the quiet of my home a few times, and I was always relieved to return and be out of the public stares. The medical personnel who treated me were genuinely kind and concerned about my health. The care element of the medicine was excellent. But I hope I never need a doctor in a foreign country again.

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