Keeping the Doctor Away

Photos by Sergei Kaptilkin.

If there’s any aspect of life in Russia that’s guaranteed to produce a regular batch of horror stories, it’s the health service. With the virtual breakdown of the country’s free and universal, but also primitive and inefficient, health care system, and continuing absence of a viable alternative, getting sick in Russia for the uninitiated can be a bit like playing Russian roulette. Some basic knowledge of what to do and expect, however, could save a lot of unnecessary pain.

Here we provide some advice on preventative measures, and what you should do in the event of sickness in Russia.

Precautions

Insurance: Check your current policy to see whether you are covered for travel to this area. If not, purchase a rider to this policy granting the necessary coverage or take out separate travel insurance. This will safeguard you against the necessarily high bills of Western-operated centers, which you may find yourself turning to in Moscow or St. Petersburg. Note that if you go to fee-paying Russian healthcare organizations, you may have to pay in cash and claim back later.

You should also consider getting coverage for medical evacuation — local services should not be relied on in the event of serious accident or illness, and the cost of such evacuation can be as high as $100,000.

Drugs: In Moscow and St. Petersburg at least, basic drug shortages are things of the past, though some more obscure medicines may take some finding. Many prescription drugs, particularly antibiotics, are more readily available over the counter here than in the West, but don’t rely on this and bring any prescribed drugs with you from home.

When traveling outside these cities, it is essential to take with you disposable needles and syringes (transmission of HIV via dirty needles is still a worry), a kaolin preparation for diarrhea, bismuth, antacids, ibuprofen and iodine tincture or tablets for water purification.

Vaccination: Make sure you are up to date with your regular vaccines (tetanus, diptheria, polio and typhoid) — diptheria has been a particular problem in major Russian cities in recent years. The havrix vaccine for hepatitis A is also a good idea if you’re going for a long stay. Consider the unreliable cholera vaccine only if you are visiting southern areas with poor hygiene and sanitation (like Dagestan, where there was an outbreak in summer 1994). Immunization against tick-borne encephalitis is only necessary if you are planning to camp in remote forest areas of Siberia.

If the worst does happen...

No one, however well prepared, is guaranteed against accident or sickness, so what should you do in this event? In Moscow and St. Petersburg there is a reasonable choice (listed here) of international standard facilities, both from Western firms and Russian organizations with long-term experience of treating foreigners.

In other areas, you will inevitably have to rely on the same facilities as the local people, which could mean a few culture shocks.

If you need immediate medical help in the provinces, many hotels have their own doctors, or can call one if necessary. Otherwise try to find out which of the local polikliniki (outpatient clinics) is the best (usually the one formerly used by the local Communist Party elite). It is usually possible to get an appointment at a platny (fee-paying) poliklinik.

Bear in mind that, as a rule, Russian doctors are much worse paid than in the West, and this often reflects on their manner and professionalism. Many are brusque and heavy-handed with patients, and in some areas such as dental surgery, methods are often primitive or simply painful (see this month’s Survival Russian).

If you are presented with the option of hospitalization by Russian health service staff, treat it with healthy scepticism. If at all possible, get a second opinion from a Western doctor, as the Russian and Western concepts of what constitutes serious illness differ widely. While Americans tend to avoid hospital as much as possible, Russians can go to the other extreme and often spend far more time in them than is really necessary.

For this reason, Moscow’s Western health organizations generally advise their members to take out evacuation insurance, particularly if they are traveling beyond Moscow and St. Petersburg. Once someone is sucked into the local health system, these organizations lose their control. Of course, in the event of a serious accident or anything else requiring emergency treatment, it may not be possible to avoid local emergency care, but if you have the chance, evacuate. Major operations and long-term hospitalization (except possibly at the hospitals mentioned here) are areas where horror stories are particularly thick on the ground. For something less serious or not requiring evacuation, consider simply returning home earlier for treatment — even a short stay in an average Russian hospital will expose you to heavy doses of bad food, bad air and other people’s illnesses.

A few silver linings

The very uneven nature of Soviet medicine meant that against a background of general mediocre standards in the health service, several fields brought important and often brilliant breakthroughs, the fruits of which may still be reaped today.

The most obvious example is the eye microsurgery empire of former presidential hopeful Svyatoslav Fyodorov, one of the few Russian medical enterprises to attract foreign patients. Visitors undergo the center’s unique operations and courses of treatment, staying in the nearby hotel complex in northern Moscow.

Another is the Barocenter, which treats a whole range of illnesses by putting patients in space-age low pressure capsules called barochambers. Even for those without serious need for a cure, a few minutes in these chambers is an invigorating and not unpleasurable experience.

Evacuation Services

Aero Ambulance International: Executive Airport, Philadelphia, PA, tel. (800) 443-8042, (305) 776-6800.

Air Ambulance of America: tel. (800) 323-4444.

Euro-Flite: Box 187, 01531 Vantaa, Finland. Tel. (3580) 174-644.

International SOS Assistance: Tel. (800) 523-8930.

Recommended Western-owned

and Russian medical

enterprises

Moscow

Adventist Health Center: 60-letiya Oktyabrya pr. 21a, tel. 126-7906. Dental care, physiotherapy and rehabilitation after serious illnesses.

American Medical Center: 2nd Tverskoi-Yamskoi p. 10, tel. 956-3366, 956-2306. Dental care, pharmacy, family medicine, diagnosis, emergency service. For insurance from the US call (800) 393-3127.

Athens Medical Center: Michurinsky prosp. 6, tel. 143-2387, 147-9121. Attached to the so-called ‘Kremlin hospital,’ the top Russian medical institution.

Barocenter: Ul. Bolshaya Kosinskaya 139, tel. 700-0445, 700-3272, 246-8565.
See text.

Botkin Clinic: 2nd Botkinsky pr. 5 building 5, tel. 945-0033. Moscow’s main hospital for foreigners.

Diplomatic Polyclinic: 4th Dobryninsky p. 4, tel. 237-8338, 237-3904.

Eye Microsurgery: Beskudnikovsky bulvar 59a, tel. 484-8120. See text.

European Medical Center: 2nd Tverskoi-Yamskoi 10, tel. 251-6099, 250-5023. Consultations, minor surgery and immunizations.

International Medical Clinic: Grokholsky p. 31, 10th floor, tel. 280-7177, 280-8374. Consultations, immunization, minor surgery, ambulance service.

(Note that the American Embassy Clinic in Moscow caters to diplomats and their families only.)

St. Petersburg

American Medical Center: nab. Reki Fontanki 77, tel. 119-6101. See Moscow.

Hospital No. 20: ul. Gastello 20, tel. 291-7960, 293-7010.

Polyclinic No. 2: Moskovsky prosp. 22, tel. 292-6272. Former clinic for diplomatic staff.