Health is a very touchy thing. Most expats have pretty strong feelings about the Russian Health Service. In the first of a series of articles about health care available in Moscow, Moscow expat Life looks at what is available free or comparatively cheaply from the Russian Health Service. Following articles will look at semi-private and private options.

Officially, when it comes to life-threatening situations, Moscow has absolutely free medical assistance. You don’t need to show your medical insurance policy if your guts are hanging out after a car accident. Emergency medical care is provided to all foreign nationals in case of  life-threatening conditions that require immediate medical treatment. No foreigner I know of has ever been refused access to care in an emergency. The question is, what kind of care?

This question is fairly academic in 90% of real emergencies, as there may not be time to summon an ambulance from your private health care provider, and traffic jams may make it impossible for them to reach you anyway. Private health care providers may rely on Russian emergency services to deliver their patients to them. If you have private medical insurance, it is a good idea to keep an updated insurance document with you at all times.

Having been put into an ambulance, you will then be taken to a local Russian state-run hospital, unless your insurance states you to be taken elsewhere, where you will be given first aid and emergency surgery when necessary. After that, The Russian health care system does not have to provide any further treatment to people without a ‘Compulsory Medical Insurance’ which virtually all Russians have.

Without such a policy, the foreign national will not be offered free treatment for a hip operation, for example, unless he is danger of dying. With a policy, he can get surgery for free, but only if he waits anything from a few weeks to a few months, as resources in the Russian Health Service are limited as they are in most countries’ national health services. There is usually some paper work involved but all of these issues do not present insurmountable problems if you speak the language or know somebody who does. If you are very busy and earn enough to take out private insurance, the Russian Health Service may not be for you. If you want to jump the queue and do not have the time to wait your turn for surgery, then you will need to pay a certain amount of money to the private sector within most hospitals, something which is now done quite legally, as most hospitals have commercial departments. In this case, you can get reasonably good treatment at a very reasonable charge. There are as many different stories about Russian doctors as there are patients, but most of the people I have spoken to who have paid for treatment within the Russian health service were satisfied. You don’t actually have to be a ‘Compulsory Medical Policy’ holder to access these services.

Emergency treatment aside, ‘Compulsory Medical Policy’, holders are able to get free consultations in the nearest polyclinic to where he or she lives. So if your ear is blocked up, you have an ingrowing toe nail or you think you have cancer, you can get to see a specialist and undergo all necessary scans, tests for free.

Clearly, you will have to be prepared to wait in line for to see a specialist. Whilst there may be only a few days wait to get to see a doctor to clean your ears out, it may take a week or two to get treatment for an ingrowing toenail. This is something that the local polyclinic will be able to handle, and at this level, in terms of quality of treatment, there probably won’t be a vast difference between the treatment provided by the Russian Health Service and that provided by the private sector, apart from the fact the polyclinic’s facilities may not be as clean as that of a private hospital, and the attitude is different. When I, for example, had to have one my big toenails removed, I was given a lecture about why I look after my feet so badly in the first place. I wasn’t expecting his little telling off, but it was actually very useful. The equipment at many state clinics and polyclinics is now vastly improved in comparison to the situation 10 years ago, however it may take you a couple of weeks to get all the necessary scans done before any surgery can take place, if you have cancer for example.

Getting a ‘Compulsory Medical Insurance’ is easy if you have a residence permit вид на жительство or a temporary residence permit, even a long-term visa. Further details can be found on the site: http://www.mgfoms.ru  which is a Russian language site. You have to scroll down to the bottom of the page and click on: Реестр пунктов выдачи полисов.

So what do those foreigners who have used the Russian health care system think of it?

Aik Gobbling is from London. In Moscow he has been teaching English for 5 years. Aik speaks Russian quite well. He is almost a Russian as he calls himself.

“Right now in case of health problems I go to the public hospital mostly. All I needed was a policy which I was given for free because I have a permanent visa. In you go to a pubic hospital, you should be prepared to wait for a doctor for a long time. You may be told something like: ‘the doctor is sick’.

“If you are healthy and need to make just a check up, if you don’t want to spend money, go to the public hospital. But it is going to be hard in case you don’t speak Russian language. I can say 90% of doctors have poor English. Sometimes they try to understand you. But this is not everywhere. For instance, two weeks ago I went to the public hospital to have a check up because I was too weak to work. The women at reception asked me: ‘If you don’t speak Russian then why are you here?!’ I didn’t want to reply her, for me it was painful.

“Before I got my permanent visa I went to the American Medical Center and it is quite OK. The quality of treatment in a public hospital and in a private one is the same but the attitude is different. You buy your own medicines in both types of clinic. But in the private clinics and hospitals there it is much more of a personal touch. They ask you more questions and basically look after you better.

“If we talk about urgent treatment, the Russian system works well. If you need surgery or you had an accident or you are in a serious condition you are taken into a hospital. They will treat you well. I think in that way they are very good because it is not the weekly check up, it is something like life threatening. Even in case you don’t have the documents they won’t tell you to go away.

 

“Two years ago, for example I came down with pneumonia. Fortunately for me, my friends called an ambulance and they took me to a hospital. I spent one week there and then I was transferred to a special clinic at Taganskaya. I was treated completely free of charge and I am quite satisfied. In 2009 one of my friends had a cancer. He was here and he needed quick treatment. He is from UK. The ambulance took him to a special cancer center at Kaschirskaya. As my friend had no insurance but was ready to pay, he was admitted to the hospital, before making payment, by the way. My friend had two operations. The first one cost him 200,000 roubles. They gave him a private room, and he didn’t complain about the treatment. Whatever they did to him, it worked. It is saved his life because of immediate medical intervention.

 

Thierry Cellerin came to Russia from France about 10 years ago, and has now set up his own business. He treats health issues no less seriously than business affairs and chooses Private Health Care System.

Within the first 3 years French person is here, he can get medical assistance paid for by the French government, but the amount claimable is very small. So as I was stuck to the National French System it cost me 300 euro a year. Three years later I got Russian insurance from my company which included public hospital care only.

I am a healthy man who never had huge things wrong, fortunately. When I needed a doctor for the first time, my director advised me to go to the hospital on Profsouyznaya. He said that it is for free and it is good. If somebody had told me beforehand about the public medical system in Russia I would never have gone there. The service was terrible. The system itself is very strange. You have to queue to go to the doctor, than you have to queue to the place where you should say that you have visited the specialist and give the documents with the medical insurance. Then I said why should I do this and waste 8 hours of my life when I can pay 1000 rubles and get straight ahead? So I bribed people in the line. In general the doctor was not bad and the treatment was ok. I should have come back to get another X-ray, but I never did. I stopped using that insurance.

 

Haidar Abdulla is studying engineering. He has been studying at Peoples’ Friendship University of Russia for 6 years. He is one of the few who is completely satisfied with the Russian Medical Care. In comparison with his country Syria, the Russian medical service surprised him a lot – in a positive way.

“I have a one year visa which I have to renew every year. My insurance is voluntary. Usually I go to the Medical Center of my University or Moscow Public polyclinic №25 when I am sick.

“The first thing which pleased me a lot is the annual medical check-up. We don’t have such a system in Syria. At home, people get to see a doctor when their illness has already become serious, whereas an annual examination helps to prevent illness.

“I like the medical treatment and the doctor’s attention to the patients. All the specialists I had are quite friendly. I can say that they never refused to give me a consultation. I am a healthy man and normally need a full check up once a year. I have never been taken to a hospital but I know how the doctors work. Several years ago on Sunday morning I injured my leg. There was nothing serious but I needed help. So despite a day off I found a surgeon who carried out a small operation, everything went really well. Another story I remember concerns my friend. We were playing football when he fell passing the ball. His leg was badly injured. The ambulance came in 5 minutes, and he is fully recovered now.

 

Evgeny Avetissov, M.D,
EMC Medical Director

What do you think of the Russian Health Care System?

“I think that the problem is the qualifications of the doctors. What we can see from talking to  patients who have been exposed to the Russian Health Care System is that some very strange systems of treatment are used, very strange use of prescriptions etc. Sometimes their use is not really logical or done according to international guidelines. There is a clear disconnection between the Russian and international medical systems such as in Europe or America and this is a big problem, in my opinion.“

 

Tanguy de Lassagne, General Manager Russia,International SOS

What do you think about the Russian Health Service?

“After a long period of stagnation, considerable amounts of money are now being invested into building hospitals, procurement of brand new equipment, infrastructure and training of medical staff. Yet the Russian system is not what Western expat would be used to. It remains very bureaucratic, patients should wait in queues for some 1 – 2 weeks until for treatment, and there is a lot of paper work to fill in.

“Ambulances are technically inferior to their western counterparts. Once in hospital, wards are often basic 4-6-8 bedded with no nurse call system and obsolete or no oxygen piping. Hygiene standards are infrequently not being adhered to and nosocomial flora not properly monitored.

“There is an ongoing shortage of nurses and doctors in some areas (emergency, ICU). Medical staff is often overloaded and demotivated being remunerated far below levels dictated by basic common sense. The level of care is overall known as badly substandard with inattention, unprofessional behavior, long waits, and inconsistent access to some specialists and in adherence to internationally accepted guidelines. Over-prescription is common.

“It is said that doctors trained and graduated before the end of Soviet era are very good. But English is not spoken by many doctors and nurses – the further from big cities the less the likelihood. I will not talk about mention fake medications – this does not seem to be a problem now.

Thanks to Alexander Khoderevich, the head doctor  of the People’s Freindship University Medical Centre, and of Moscow Polyclinic No. 25 for help in preparation of this article

This year is the seventieth anniversary of the end of the decisive battle at Stalingrad which lasted from August 1942 to February 1943 and left over a million dead from both armies and countless casualties and deaths amongst the civilian population. The total devastation of the City, the horrors of fighting at close quarters in the ruin and rubble, the uninterrupted shelling and bombardment, the deprivation and wholesale slaughter must make Stalingrad the closest man has come to creating hell on earth in the history of human warfare.

Although the price of victory at Stalingrad by the Red Army was high, the reward was the capitulation of the German sixth army and the continuous retreat of the Wehrmacht from Soviet territory from that moment onwards culminating in the final defeat in Berlin in 1945. Those of us lucky enough to have been born afterwards must stop for a moment to reflect on this and what it must have meant for our seniors living through those times.

My father was of that generation and wanted me to take him to Stalingrad. I had to remind him that it had been renamed Volgograd in 1961 and rebuilt in Brezhnev-era style with some post-Soviet modern high-rise apartment blocks and a lot of bad roads. A few of the destroyed buildings are ‘preserved’ as reminders of the destruction and there are imposing socialist-realist war memorials to look at. It is not exactly the tourist attraction you would travel half way round the world to see. “Ah, but I want to pay my respects”, he said. “It was the turning point of the War!” He was in his late eighties at the time and, knowing his Yorkshire grit, despite his somewhat decrepit physical state, he was up for making the trip from where he lived in Cincinnati for the last twenty years of his life. Unfortunately, his second wife, an American lady, was not of the same opinion and discouraged me from the attempt. It remains for me to do it one day for him on my own, something I promised him that I would do.

My father was only in the British Army for six weeks, but he was no slouch for the war effort and, despite not fighting, did his bit. He was called up for army training in 1941 and, having not learnt very much about how to fight Hitler’s Wehrmacht, was returned gratefully to civilian life to make steel for the war effort. Having been born near Huddersfield, in what was then the West Riding of Yorkshire, he remarkably avoided being sent down the coal mine like his father and brother before him and at seventeen enrolled as an apprentice at Samuel Fox and Company, Stocksbridge, an important steel works in those days, about 10 miles north west of Sheffield. He earned his degree in metallurgy at Sheffield University by studying in his spare time and attending night school three times a week, walking the ten miles to the city, there and back, to save money on the bus fare. Some of those night school excursions were not without event. On 12th and 15th December 1940 Heinkel, Junker and Dornier bombers in several waves dropped high explosive and incendiary bombs on the City in an attempt to destroy the steel-making capabilities for which Sheffield was then renowned. Apart from destroying the Marples Hotel, a popular pub, the C&A store and some unsightly nineteenth century housing there was relatively little damage to the steelworks themselves and they continued to work almost uninterruptedly throughout the War.

I remember as a nipper in the fifties being taken on shopping trips to Sheffield by my Mum when the City centre was still in parts in bomb ruins. The High Street was still a blackened, windowless front and the back-end of the Cathedral was annihilated. When I look at the photos of the destruction of Stalingrad, I am reminded of those images from my early life. I  imagine what it must have been like to be in that bloody mayhem on the Volga, not on the Don. But no matter how awesome it must have been in Sheffield in those nights of the Blitz, it was not Stalingrad. There were no German soldiers firing at you from 30 yards from the debris of C&A; there were no panzers blasting at you coming up Pond Street. Just a few thousand tons of bombs dropping fairly randomly out of the December night sky. In Stalingrad there was no Uncle Albert knocking back a sneaky pint in the Marples before the night shift and not making it back home to Auntie Vera’s for his egg and chips! There was no ‘hugging the enemy’ tactics employed by the Soviets to discourage the German artillery from hitting their own troops. There was no Pavlov house to withstand a 59-day relentless onslaught by the Nazis near Victoria Station. There were just six hundred and sixty dead from those two nights of the Blitz. In Stalingrad, as many as forty thousand civilians and almost half a million Soviet soldiers died, equivalent to the entire population of Sheffield today!

Samuel Fox steelworks, apart from one minor but quirky incident, was never hit by German bombers, although by all accounts they had been desperately trying to locate it as a target. Dad was wire department manager throughout the rest of the War and had cooked up a steel alloy to draw the rods used to make the armour-piercing bullets for the Spitfire which had been very successful in knocking out German tanks. This must have been a source of annoyance to the enemy and a good reason to want to find and destroy the production facility. Being quite well hidden in the upper Don valley, the Stocksbridge works was obviously difficult to find, made more confusing by the fact that the British boffins had built a replica of Sheffield somewhere on the top of the Pennines on the way to Manchester. This false town actually got bombed several times with happily no loss of life, except perhaps for a few sheep.

Bringing the action back to Russia, I overheard a conversation once at the bar in Silver’s pub when a young English expat was describing to a couple of his incredulous drinking mates a war-time experience related to him by his grand-father. The relative in question was working the night shift during the War in number two melting shop at Samuel Foxes when one night a lone Dornier, perhaps lost on an abortive sortie to find a suitable target, dumped a stick of bombs over the steelworks. Some of the explosives dropped in the goods-yard killing a guy who was late for work and the others went through the roof where the open-hearth furnaces were working, dropping one by one into the molten steel of each furnace with nothing more than a plop and a thud. If they had missed the furnaces full of steel and landed in open space, there could have been significant damage and loss of life.

The amazing coincidence of hearing this account told independently in a Moscow bar was that the same story had been told to me by my father who, during this incident, was in the wire mill next door producing his rods for the Spitfire bullets! Small world!

Another minor coincidence resulted in the fact that I exist at all. There was, in the year following the blitz, a day-light bombing raid on Sheffield which very nearly killed my mother. She worked as a shoe-shop assistant in the centre of town and, as the manager was busy, was asked to take the day’s takings to deposit in the bank across the road. As she was queuing in the Midland Bank, a German bomb obliterated Saxone’s shoe shop and killed everyone in the building. Having literally lost her job, she found another in her home town of Stocksbridge polishing steel samples in the lab at Foxes where she met the young head of the wire department. The rest is, of course, history! For this we have to thank the immense sacrifice made at Stalingrad, and a bit of Sheffield steel!

After writing last issue about what expats miss when they leave Russia and return to their home countries, I thought I should turn the proposition around and write about what Russian expats miss about home. As before, my research is not particularly scientific, but hopefully contains some interesting thoughts.

Ten or so years ago, I remember the head of an international pharmaceutical firm in Russia telling me that, of his top 20 best-selling products in Russia, only 2 were on the list of bestselling products in his home country. He explained this by saying that for the most part, the medicines that were popular in Russia were ‘old’ (he must have hesitated to say ‘outdated’), whereas in the ‘West’, doctors were prescribing more advanced medicine. We smiled knowingly, almost certainly condescendingly.

But now I find, from my own wife and from other Russian friends, what a nightmare British medicine is in comparison to Russian. For a start, says Katya, a 30-year old HR specialist and mother of Misha, 6, one’s relationship with one’s doctor in Russia is much clearer – friendly, professional, you can contact them directly whenever you need, have them visit at home (in a white coat!) and take your concerns seriously, not to mention offer treatment before they become serious. I guess private medicine in the UK is not that different, though certainly more expensive, but the National Health Service that most of us use really only performs in an emergency. In the experience of many of my Russian friends, British GPs usually have their minds set on getting to their next patient, an impression which probably has more than a grain of truth to it given the targets-based culture of all our public services, and doctors are always reluctant to prescribe medicine when time might eventually lead to the same result. Unexpectedly, Russian medicine, though maybe strangely old-fashioned, is something that Russians definitely miss.

One thing that Russia has in abundance, of course, is space. I’m not sure I ever really understood that, living in Moscow. I went out to dachas of course, and even managed trips north to the Kola peninsula for the salmon, and south to Astrakhan for the ducks, but somehow, the sense of space mostly eluded me. In fact, dacha villages just seemed to confirm the sense of people living cheek by jowl. But then my friend Pyotr (now in England) mentioned how he missed the fishing, and I noticed my Russian parents-in-law looking in British fishing magazines at the typical photos of grinning fishermen clutching the carp they had just caught (and would shortly release). They commented on how pot-bellied and unnatural the fish looked, not like the wild fish they caught and ate on their 3-week long, mosquito-bitten, sunburnt, vodka-fuelled adventures down the Volga. If you want to fish in Russia, you can travel into serious wilderness, catch wild fish, and live on them!

Sergei Sokolov, a web developer and entrepreneur freshly returned from a year and half in Thailand, commented on Russia’s particular dairy culture. Thais are not big on dairy – no tvorog or kefir (not to mention buckwheat!) – though Sergei did acknowledge that fresh fish and fruit every day went some way to compensating for the lack of Russian comfort food.

Again on the subject of food, Katya mentioned the lack of varieties of honey. In my innocence, I thought she was probably just disappointed by the lack of choice in Sainsbury’s, and offered to bring a pot back from my native Shropshire. The response was withering: “Thank you for your Shropshire honey, but can you find me camel thorn honey from Kazakhstan or honey with propolis from the Siberian taiga?” I looked up propolis, also known as bee-glue, and found that bees use it to fill small holes in their hives, and people as something of a panacea for all ills. Though much promoted by the alternative medicines industry, I agree it is unlikely to be available in natural form direct from the producer. Then there is the lack of mushroom picking opportunities.

Sergei also mentioned energy! Who could deny that? The energy in Moscow has something to do with adrenilin, and however much of a paradise life by a warm tropical sea might be, something existential draws one back to where the action is.