MY “DOCTOR-WEEK” IN RUSSIA

This past week has been my “doctor week.” Last Monday I went to an ear, nose, and throat specialist; Wednesday I went to the physician who treats my neck/discs problems; and Thursday I went to a dermatologist; this morning I went to a surgeon to have a large mole removed. So I thought I’d give an update and a few more details on the medical care here in Russia.

The first difference I noted between the way we do things in America and here in Russia was the way “appointments” are made. All three physicians had been recommended by friends who gave us the doctors’ phone numbers. The dermatologist scheduled the appointment with the surgeon. Oksana called the doctors directly, and and told them the days we could come, and they told her when we should show up. They didn’t give exact appointment times but just told her when they start seeing patients. Now, since we go to the neck doctor each week, we set up a standard weekly time. With the others we showed up and essentially took a seat in line. When we arrived we asked, “Who is last?” That way you know when you are next. You do not sign in since you do not have a set time. That seems like it would lead to problems, but everyone understands the “system.” Frankly the wait was less time in both cases than it was most times I had an “appointment” with my doctor in America.

From the time I was a young man I have had ear trouble in that when the weather changes or just gets very humid or cold my ear canals clog up. In northwest Russia, since we are so close to the gulf of Finland, the weather is often quite humid and since we are so far north it is very cold. Of course, that means a lot of snow, but it also means I feel like I have cotton in my ear a lot. When I got to her office I realized the ENT was actually Svetlana, a lady I had taught when I filled in for another teacher at our school. Russian doctors frequently try to study as much English as possible since most of the medical information on the internet is in English. She treated my condition well with the same kind of “machine” my doctor in America used. She also asked about my overall health, any joint issues, etc. When I told her about my neck and TMJ she offered as much information as she could. Then we discussed a hearing test because I think maybe I don’t hear as well in my right ear. They’ll let me know when there is an opening. The treatment gave me immediate relief, but she graciously refused payment. When Oksana tried to pay her, she smiled and said, “You need to leave now.”

Then Wednesday I went back for my usual appointment with the doctor who treats my neck problems. As I mentioned last time, during my treatments I get to practice my Russian, and the doctor practices his English. This time, however, we mostly spoke in Russia. Since he speaks more slowly and distinctly for me I like talking with him. The treatments, which consist of massage as well as manipulation of the joints, last forty minutes. When I took my shirt off he saw I had a large, irritated mole on my back which is looking kind of bad. He went and got a different bandage (he didn’t like the one Oksana had put on it) and then insisted I go to a dermatologist and get him to look at it. After the treatment, I thanked him and paid the lady the $8.45 after he reminded me again to get the skin problem checked because the mole was so large. Oksana had her appointment with this same physician that afternoon, and he made sure we had made an appointment with the dermatologist. He also asked her questions about how I was handling Russia, how are my moods, if I am I doing fine emotionally during my time of adjustment in Russia. She assured him I am fine. (She may or may not have told the truth.)

The next day (Thursday) I went to the dermatologist, whom I had met when I had my physical for teaching at the school. He examined my back and said it does not look like anything that is malignant, but if I do not have it removed then it would continue to grow and get in the way and bleed. He said that normally they remove moles with a lazer, but given the size of this one it would have to be removed surgically. He called his friend who is a surgeon and scheduled me an appointment to have it removed Monday morning. Oksana was there so he was interested in chatting about America and how we saw some of the political changes going on. As with Svetlana, he would not take any money for his services. So I left with with a hearty hand shake and smile.

My appointment with the surgeon was this morning at 8:30. I have been to this facility before, and it is very nice, modern, and clean. We got there a little early but after a short wait he was ready for me. He looked my mole over and measured it. Then he took me back to his operating room. He asked Oksana to wait a few moments until everything was sanitized. He made sure I knew how to say, “That hurts!” in Russian. I assured him I know how to let people know I am hurting. He warned me the injections to numb the area usually hurt some, but they were not bad. What surprised me is how quickly they took effect, yet I could tell from his touch that the area an inch away was not “dead.” The surgery turned out to be a bit more complicated than any mole removal I’ve ever had. It took him over thirty minutes. He said the problem was it was also quite deep. He put in two layers of stiches. He used cat gut to sew inside the incision, and then a kind of metal surgical thread for the outer skin. He was very careful, and his nurse was at my side the whole time. Oksana watched him sew me up and said he put the stiches very close together, and there were a lot of stiches. I asked him how many, and he smiled and said, “I wasn’t counting, but it was three packs of surgical thread.” I was hoping to find out so I could brag and get a lot of sympathy, but that has not worked out for me so far!

The nurse went downstairs with us to explain what the doctor did to the folks who do the paperwork. That took a while, since Russians consider every little detail of paperwork of great importance. Given the current exchange rate the cost for both the surgery and for the test for my tissues to make sure there is no cancer was just under $70.00. The surgeon charged me $51.00 for his services and the rest was for the histological tests. I’ll have to pay $20.00 for two follow up visits including the one to remove the stiches.

Health care in Russia is a very different system than in the United States, and I cannot give an in-depth analysis of it because I don’t know all the different aspects of it. There are a few things I’ve learned, however. First, the socialism of Russia’s past and its current democratic system has left basically two “paths” of health care. There is the free, government supported health care. Citizens can choose to be treated in free clinics. Non-citizens like me or other Russians who prefer and can afford private care opt for what many think is the superior care you get for private care. Many of the physicians, however, just work different locations so I’m not sure private care is all that superior. It clearly is more convenient, however. You call the doctor, as we did, and show up and you get treated ASAP. But compared to America, the government is far less instrusive—or so it seems to me—and there really are no large health care companies involved. Thus, even in the private systems the costs are much lower than in the United States. I do not get the sense the doctors are under any pressure to see “X” number of patients to make a profit for a health care company or hospital system as sometimes happens in the US. They also want to take time to get to know you. And as a matter of courtesy two physicians did not want to take money from a “foreigner” who is adjusting to the rigorous winters of Russia.

I am somewhat baffled by the changes in health care in America, and I certainly am not qualified to offer expert analysis. I offer the following observations only as a “consumer” who tried to keep up with changes in health care from various news outlets and a few conversations with friends who work in the medical field. While it is not expert analysis, I can explain how the way I and my family were treated changed. I went to the same medical clinic for many years in our small town in South Carolina and saw the same doctor for almost all of my visits. He treated all members of my family. I had good affordable health insurance, so costs were reasonable both for medical treatment and for medicine, which we bought at a pharmacy that adjoined the medical clinic. I could not have been more pleased with medical treatment in America. It was excellent. Then a larger hospital system/health care company bought out the clinic a few years back. After that I had to take whatever doctor was available. I think the care I received was good, but there was a distinct changes from before in the way I was able to interact with the physicians. I rarely got to see the same doctor. There was no small talk; no asking about other members of the family and, frankly, very few questions about my overall health. They treated the immediate problem, and I was sent on my way. I finally changed doctors and upon his first evaluation he concluded that I had had an undiagnosed thyroid condition probably for years. I do not fault the doctors. I think the system created the pressure which led to poorer care. Further, with the health care changes and the government getting more involved under “Obamacare,” the financial strain on a family of five like ours was very intense and our care became, frankly, inadequate. The question when one of us got sick was, “Do we want to pay $150 for an office visit? Is it that bad?” The deductable was so high it did not help cover most expenses. Thus, it has been refreshing to be able to address some health concerns of our family in Russia without the undue financial stress. We remain confident we are receiving excellent care here. One of the odd things is that some friends and family have encouraged us to go to St. Petersburg or another big city for treatment like I received today. I can say for those who are considering moving here or spending time in Russia, medical care even in a small city like Luga is above what we expected and, to be honest, above what we received the last couple of years before we came here. On the other hand, there is still poverty in Russia and many people in Luga cannot afford the kind of care we receive. The average wage is still quite low so the perspective of some here would be different from ours. What I regard as extremely affordable care is, for some residents here, not within their financial reach.

In all of the appointments here the doctors all seemed very concerned about my overall health and wanted to discuss aspects of what could be causing the various problems. They all took quite a bit of time with me and wanted to get the “total picture.” Also, they all were concerned about how I, an American, am adjusting to life here in small town Russia—especially knowing I come from the very different climate in the southern part of the United States to live in northwest Russia. There was absolutely no “prejudice” or animosity shown toward me. Actually, it was quite the opposite. I was conscious while interacting with them, as with many of the people I deal with here in Luga, that I may be the only American they have ever met—probably the only one they’ve ever gotten to know personally. I want to let them know I have great respect for this town and its residents. I also sense that they really respect the fact I am living here. Another friend tells Oksana frequently how much he and others admire me for living here. It is nice to hear, but I really do not think I deserve any special admiration because my family and I chose to live here. I appreciate their respect, but I also appreciate their kindness and generosity towards me and my family.

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