16 July 2010

Russian Hospitals Practical, While America’s Lavish

imageCartoon by Riverh

Each summer at the dacha I spend  a week in Peno Hospital.  I am lucky to have  insurance  on my вид на жительсво, spoken~ vide na jeetelcva , my permanent resident passport, and  a great doctor...  my wife’s cousin.  She reviews my diagnoses and orders IVs for reducing edema and to tone  my heart.

I usually have a single room.  This trip I was in a room with four beds, but I was the only occupant.  I was there from 21 - 26 June, when I returned to Zaloza with arriving family.

I’ve been reading about the problems of schools and hospitals  in the US.  Seems that self-aggrandizing administrators have over-built, while ignoring what really counts... getting an education, and getting well.  Things aren’t always good in education and medicine here either, but in medicine you don’t find the unproductive frills that are found in much of America.

My observations are based on my experience in six St Petersburg hospitals and the one  in the  former agricultural community of Peno... and as a patient at New York Columbia, Cabrini downtown, and at Hunterdon Medical Center, Flemington NJ.  

In progress Moscow is usually a step ahead of St Petersburg, the other cities less advanced, and the vast  rural section of Russia can seem fifty years behind the times.  There may be exceptions as medicine is getting government attention and things seem to be changing.

So, if you are a pampered Westerner, prepare to be surprised at what Russians do without, and ask, “Is this item really necessary to help a patient get well?  Or, is it something that is a luxury, a frill, presented as a necessity?”

Guest Pack... Water glass, ice water pitcher, bed pan, soap, shower cap, slippers, toothbrush, toothpaste, tissues, hospital gown... all disposable .  In Russia you wear your own sports togs.  I wear pajamas.

Wheeled adjustable tray with compartment and mirror.  I’ve never seen one of these here.

Bed linen and pillowsSheets changed often,  pillows disposable.  Here you get a sheet on top of the mattress, and then a пододеяльник, spoken pododeyelnik...  a double sheet in which you push in a blanket, like the filling in a sandwich.  You make your own bed and are not expected to spend much time in it.  Clean sheets are available once a week on request, or as needed.

**  I am always impressed with the beautiful wool hospital blankets.  A great genuine souvenir from Russia would be one of these blankets, that rank in my mind with the American Indian blankets of my youth.

Private or shared toilet and showerHere most people walk down a hallway to a communal men’s or women’s toilet.  The men’s room often has smokers standing at an open window .  Don’t forget your own paper products.  You can request use of a shower but most people don’t.  Its condition can be shaky.

Television on the wallThe hospital isn’t in the TV rental business.   There is a TV lounge on every floor.  TV on 8 to 10 PM.

Private or Room for TwoMost Russians share a room with four or five .  Great for card games.  I’ve been in singles, doubles, and once had five other patients with me.

 Electric-powered hospital bedThe hallmark of the Western hospital.  Most hospital beds in Russia are unmechanical  narrow beds.  In the hospital where my heart surgery took place, the bed had hand cranks, and a rope the patient used to pull himself  to a sitting position.  You won’t see a nurse buzzer attached to a cord, but occasionally there is a  working call light on the wall.

Large observations windows from the hallway, and the door kept openYou are the easily seen goldfish.  Here, except in ICU, privacy wins over attentive care.  No hallway windows, the door has no window and is always kept shut.  But, strange to me, the staff usually enters without knocking.  

When I visited my surgical hospital the first time, I though it was next to empty.  Larissa explained that it was rest time and all patients were shut in their rooms, while at other times they walk the halls.
**  A Zaloza friend reports that he was at a hospital in Moscow that had American-style hallway windows... so at least in that hospital... times are changing!

Night time nursingAfter 10 PM everyone settles down... your nurse, too.  They go to sleep in a room or in the hallway.  No one checks you.  If you have pain, are cold, or whatever, you need to yell for the nurse to wake her up.  

Most Russians would never do something so out-of-place  as bellow for the nurse.  They are стесняется, spoken stesnighetca,  reserved and shy.  But one night last year I gave in to my American initiative and willingness to be loud...  “Ah-ooh!  Ah-ooh!  Nurse, I need a blanket!  And so do the other patients!... and caused quite a stir!

**  Responsive, not pro-active nursing, is typical of Russian thinking.  Prevention is low priority.  Few people plan well for future negative possibilities.

Patient-centered careFew doctors, and no nurses will encourage questions.  They will tell you what they think you need to know.
No one has ever given me a Patient Satisfaction Form to fill out. 

Clergy visitsThey won’t ask your religion when you check-in and no clergy will call.  The church won’t know or care if you are sick.

Get Well Cards though the mail.  Not a custom in Russia.  People are more likely now to call your cell phone.

Flowers delivered to you room, or brought by visitors.  No flower delivery.  Visitors are more likely to bring food.  

**  But remember, if you do bring flowers to a Russian, it’s an odd number for the living, an even number for the dead. Never thoughtlessly order a dozen roses for those still alive and kicking!

Plastic foodI remember American hospital food as wrapped in plastic, shipped from far away, microwaved, and sad to look at and taste.  Here the food is cooked locally, and it’s tasty and nutritious.
You  walk to the столовая,  spoken stolovaya, a dining room.  Or you may take your food back to the room to eat at a table with your roommates.  Often the food workers brought my food to the room... either because of my diagnosis or perhaps because I was a foreigner.  

No dietician will stop by to ask about your food needs.  You don’t get a daily  Check-off  Sheet to order what you want.

Heat and Air Conditioning available year round.    Russian District Heating is turned off around May 15 and back on by October 1, depending on the weather.  If it gets colder when it is off, you need to  add some clothes and get another blanket.  Year round heat control may be found in only the newest hospitals.

Memorial and Donation Plaques, charity appealsThe hospitals here miss a great opportunity to get help to fix the rooms.  Russia has a weak tradition of charity, especially toward those you don’t know.

Hospital Community Board,  Hospital Auxiliary, involvement of young people such as Candy Stripers... People are just not so social here, and don’t show interest in Western ways to improve a hospital.  Administrators  are poor in asking for help and money... maybe something to do with pride.  

** Russian culture discourages community involvement, volunteering, showing initiative.  A popular saying states that инициатива наказуема... Initiative is punished!... which applies to doing something wrong when you don’t wait for instructions.  Therefore, much of charity for hospitals comes from overseas and from the expatriate community, where people are raised to look for ways to help people, even strangers.

NPO’s, non-profit organizations, were banned during Soviet times.  Only organizations sanctioned by the Party were allowed.  Private initiative is still viewed with suspicion.

We are happy to hear from you!

What items are worth keeping in American hospitals?

Which add to the expense of healthcare without really helping you get better? 

Do you have some facts or ideas you want to tell about?

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  1. Private or shared toilet and shower. Here most people walk down a hallway to a communal men’s or women’s toilet. The men’s room often has smokers standing at an open window . Don’t forget your own paper products. You can request use of a shower but most people don’t. Its condition can be shaky.

    When I was diagnosed with breast cancer in Florida, I had no medical insurance. And plenty of assets. Not a good combination)) The logical step was going back to my native Russia, St.Petersburg.
    I had a private room, and shared the toilet and shower with another woman. The cleaning lady was not very enthusiastic in her efforts to sterilize our rooms, and I took it upon myself to keep our floors clean))) We had plenty of toilet paper, and our own TV sets.
    On the third day after my operation the surgeon spied me exercising in the hall. He asked me with surprise, "What are you doing?". When I explained that I subscribe to the notion that life is motion, he dramatically opened the door to the large hospital room where six women were lying in beds, and demanded, "You tell them!" Only one woman joined me in my morning callestenics, but I considered it a small victory.
    Another example of the private initiative -- we, the patients, were given some advice regarding post-operational period. After listening to the short lecture I got plenty of paper and wrote down all suggestions the nurse gave us. Then I copied it and prepared a copy for each room. I placed the copies on the wall, and told the ladies to copy it to take home with them. Next year when I visited my doctor I noticed professionally made copies of the instructions in every room.
    The same happened once before when i broke my wrist dancing in a restaurant celebrating New Year in St.Pete. The doctor did a superb job setting my bones but the advice she gave for rehab was lame. When I returned to Florida in three weeks, I got on I-net, found some University website with sport rehab program, applied it to my own rehabilitation, and made a Russian translation of all necessary exercises. I mailed it to St.Pete and visited the doctor a year later. She enthusiastically told me that every one of her surgeons has a stack of my instructions on his/her desk, and no patient with broken wrist leaves her clinic without it. I strive to make a difference and often see gratitude and acceptance from my fellow Russians.

  2. American Russia ObservationsThursday, August 26, 2010

    Russian Floridian has wonderful initiative that is good for her and the people she affects. Life is Movement is a motto I will remember.

    There are Russians that don't give in to a defeatist attitude. It's much harder to stay positive when your country has so many problems, and at times things seem to not be getting better.

    I bet you keep your town in Florida on its toes, too. America also has many serious problems that need the help of a positive Russian such as you!

  3. Thanks very much for the info! I attended a MedGaurd hospital in Samara a few years ago, and found your remarks to be true. I really wanted to get an idea of more hospital experience, because I'm writing a short story about one Aleksandr in a hopital bed. Thanks again!


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