10 May 2009

My Experience in St Petersburg Hospitals

Frequent Patient Miles

I have been a patient in many St Petersburg hospitals these last nine years and have been a part of the routine medical care that exists here for Russians. Also I had open heart surgery and two pacemaker implants. With all this unwanted experience I can give some idea of the current state of medical care in this part of Russia.

Our Unusual Situation...

Most American expatriates on business or as students have continuing benefits from home or take expatriate policies that do not cover preconditions. Having sold this type of insurance I know that for me such a policy would be worthless.

Expatriates in St Petersburg usually go to expensive medical clinics that can communicate in English and have western style treatment. If they are really sick they fly to Western Europe or back to the States. Larissa and I are long term residents of the city, with no home in the States, so we participate in the Russian medical system.

Back in America...

The leading worry for many Americans is finding and keeping adequate medical coverage. Unlike the various national health plans in Europe, Americans have to get coverage at work or pay for a policy themselves, if they can afford the premium, and provided they are healthy at the start.

If you compare the reality of medical care for Americans, and how Russians get treatment, the system in St Petersburg at times is worse, sometimes equal to, and other times better than what I saw and experienced in America. We usually pay for doctor care and prescriptions out of our own pocket, but my Russian health insurance pays for much of my hospital room costs.

My Unusual Qualifications to Explain All of This...

I found I had a heart condition in 1993. For the next seven years, except for a few episodes of fast beats that required a night's hospitalization each, I was able to control symptoms with prescriptions. Arriving in St Petersburg I found these same prescriptions were around 20% the cost of what they were in America.

Overall a Better Prescription System...

Prescriptions were usually not covered by my health insurance in the US, so paying much less was very welcome. Unlike New Jersey, most compounds do not require an Rx, and often the pharmacies don't require a prescription even when they should.

I worked for a few pharmacies one summer when in college. A customer would bring in his prescription to be filled. The pharmacist counted pills from a larger container, typed a label, and stapled a receipt on a bag. Only once do I remember a pharmacist actually compounding a prescription.

In Russia this song and dance is skipped... We buy small cartons of pills in bubble strips. The multinationals have pricing that varies by country, and Russia has a lower rate than the US. The only drawback is that most pharmacies have no pharmacist present to double check the propriety of the prescription you bring to them.

Hospital hospitality...

Along with prescriptions, medical treatment is very different from what is usual in the United States.

I often was placed in a room with 1 to 5 other patients, flat metal cots (not hospital beds), no bed tray, no TV (good!) or prints on the wall. I was issued a blanket (usually attractive with Russian village patterns), a cover for the mattress, and a cover for the blanket (padadianik) which covered the patterns! I was expected to put them on myself. Every morning I made my bed. New sheets are given as needed, but usually not more than once a week. The standard hospitalization is for 10 days.

Patients wear their own sports outfits. I wear pajammas, which marks me as an older man. No one would recognize the American hospital gown.

The atmosphere reminded me of my Navy days. Many Russians view a time in the hospital as a sort of vacation, and can be much more outgoing than expected. One morning a fellow patient woke me up with a whisper... "Come over to the table with your tea cup!" He poured out cognac for each of us, and we toasted his birthday.

Patients don't sit in their beds as in American hospitals. You get up, go to the stolivaya, the dining room, with your utensils and crockery from home, have breakfast there or bring the meal back to the room and sit at the table. If you are too sick a food server will bring your meal to the room. Sometimes people crash, sleeping several hours curled up on top of their made bed.

Just as in the States, the doctors do rounds, and once or twice a week the top doctor appears along with junior doctors and students. All patients sit on the side of their beds, waiting for their turn to answer and ask questions. If my Russian is inadequate, the other patients speak up to describe my symptoms and what they think I need.

One time my drip was finished and no one was around to disconnect it. Another patient walked over and took it out for me. This man often spoke up as to what he throught the doctor should do to help me medically. He and I got along well even though we only spoke Russian, and he called us later a few times just to say hi and see how I was doing.

I like the friendliness of a group room, but the average Russian has a higher tolerance for noise... and smoke... than I do. One group had a card party each night. I was feeling particularly crummy... surprise, I was sick!... but the lights, exhalting yells when someone won a hand, and loud conversation kept me awake until around 1 PM.

A young patient had a passion for one of the girls dishing out food in the stoyavaya. One night he stayed out too late on her day off and couldn't get back in the hospital, so he climbed the outside to our floor and knocked on our window. This was a guy around 20 with very serious heart rhythm problems but, typically here, he wasn't so scared as the typical American would be.

Angels of Mercy...

Aren't the nurses walking around and enforcing rules? Well, no. Doors are kept closed so you can look down a hallway and think that no one is occupying the rooms. No nurses station as in America... just a small desk facing the wall... with a little lamp. No windows in the door or any other way to see in the room. The duty nurses bed down for the night around 11 PM in a room or in the hallway. If I have a problem it is up to me to find the nurse, wake her up, and ask for help. One night with no nurse around I pushed a very sick patient to the bathroom, and realized it made me sicker.

Nurses have a lower status in Russia as their training is just now improving. As with doctors, they are paid inadequately. Most are good and kind, but some have trouble with some procedures.

Russians are not safety conscious. This is true in medicine, also. The phlebotomists often don't wear gloves, and if they do, they often do not change them between patients. Sharps and old bandaging are tossed in the trash with everything else.

Have a Weed!

Sometimes there is a toilet nearby, but usually patients have to walk to the men's room, which doubles as the unofficial smoking club. Whenever you visit a public building in in Russia, you are likely to find every other light turned off, no hot water, soap or toilet paper, and if there is an electric hand drier, it may be disconnected. A shower is available down the hall, but may be in bad repair.

Some heart patients told me that their doctor said to not try to quit smoking as the effort is too stressful. The men continue to smoke in hospitals while receiving treatment... in the men's room, on the balcony attached to their room, and just outside the hospital entrance in plain view. I associate the smell of smoke with hospital toilets and stairways.

A Turn for the Worse...

After years of intermittant hospital visits, I was diagnosed with a damaged thyroid, and given a hormonal prescription that was supposed to fix things. Problem was, it was a bad diagnosis, and the drug only sent me into a cardiac tailspin.

After 10 days, the patient is often considered cured and sent home, no matter what's happening. I wanted to get away from this a clearly inappropriate treatment that seemed worse than death anyway. I went home, but soon needed two blood cleaning treatments, called lasmopherosis. I felt better for a few days, but then I relapsed, and no hospital would take me again.

Russia has no emergency rooms. It has poorly equipped 03 Ambulances , but they take you to invariably slow initial treatment at the hospital. It is necessary to sit and wait to be admitted even if you are injured or have shortness of breath.

We were so desperate I called Finland, to no avail. We took a cab to another hospital that did plasmoferosis but, on seeing me collapsed on their sofa, they said I was too sick and refused to take me as a patient.

We went down the road to another hospital that accepted me. The cardiologist told my wife she thought I might be dead in a few days. This same abrupt woman decided to give me everything she could think of that might help pull me out of my decline. After a few days I was much better.

Larissa called the admitting officer of the Heart Institute hospital where I had often been a patient and left a message that we were on our way. We arrived by taxi, sat by the admitting office, and waited perhaps 20 minutes. This doctor said that she was angry that Larissa put her in a difficult position, as she wasn't used to people just showing up expecting to be admitted. Having said how she felt, she admitted me and I gained strength during the next weeks.

Time to Cut...

All my echoes, xrays, tests indicated that some fairly risky open heart valve surgery could make a significant difference in my health. My subsequent stay at the Heart Institute's surgical hospital Sant Georgi opened my eyes to how good medicine in Russia can be.

To be continued...

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