Thursday, September 20, 2012

Post-Soviet Pediatrics

I find the cultural differences in approaches to medicine so fascinating! The "common cold" argument attracts a lot of discussion, but there are other aspects, like sterilization, that are very interesting to compare. I read a book about Soviet medicine that I reviewed awhile back and it explained a LOT. Let me know if you can recommend any other sources on this topic, because I just find it interesting in general!

Meanwhile, I had a taste of culture shock taking our son to the Russian pediatrician for the first time! Here are my quick American observations: 1) They want to fix everything. 2) They don't give you a choice. 3) You have to go to see specialists for things that a general practitioner in the U.S. would take care of. 4) Private clinics like to milk all the money they can get out of you!

We went to a clinic that a friend had recommended; in fact, she even gave us a ride!

When we went through all the Russian rituals of taking off our outer clothing and putting plastic booties over our shoes, we made our way into the examination room. The doctor asked me to lay the baby on a table and then said "We're getting undressed."

To give a command, Russian sometimes uses the "we" form. In fact, this is true when talking about children in general. "We're 1 month," "We're learning how to walk," etc. Even when you have one child.

So I thought to myself, "Well, I already took off my coat, so she must be talking about the baby." And I started undressing him.

David was perfect the whole time even though he was due for a feeding. He smiled, showed off, didn't pee/poop on anyone, and then nestled into Andrei's arms and went to sleep after the examination was over.

So now for the diagnoses.

-If his feedings are taking a long time, I must "not have enough milk." I was sort of waiting for that one, but at least she didn't recommend supplementing.

-...Then we weighed him and he had gained a ton and was above average. Ha! It was interesting though that by American standards he was considered 30th percentile for weight and by European he's over average! Same with height, but he was already 80th percentile or something in the U.S.

-If we're inside too much/don't take Vitamin D we might get Rickets. The doctor told us we should be outside for 2-3 hrs each day.

-His oozing "outie" belly button is horrific and must be fixed so it looks like everyone else's. I was starting to get defensive about needing to fix an outie belly button, but the U.S. pediatrician had said it was borderline hernia. He is supposed to get more tummy time+we are supposed to buy an exercise ball and roll him on his tummy or whatever. Plus an antibiotic powder to fix the oozing.

-His cradle cap is due to Mommy's diet. What is Mommy eating? Mommy needs to go on a diet so he doesn't have any allergic reactions. Mommy needs to take some pills and powders to get rid of toxins.

-His blocked tear duct needs to be flushed out several times a day and treated with drops and massage.

-Most of these issues (outie belly button, cradle cap, tear duct) were things the American doctors had noticed, but were not alarmed about. They had said to give it time. And most of the books I'd read about them said they were perfectly normal and would be "gone by the end of the first year." But Russian doctors seem to be more proactive. If you have a cold, you don't "let it run its course." You gargle and wash and drink and dab and swab, etc.

-Visits to the neurologist, orthopedist, and oculist are in order.

-He needs to be immunized against tuberculosis.

About overspecialization:

At least in Soviet times, professions fell into fairly narrow categories. It's hard explaining that I have a BA in "Russian Studies." I'm not an expert in any one area.

In my experience visiting private clinics in St. Petersburg, I kept getting referred to different specialists. The first time was several years ago when I had a persistent scratchy throat. The general practitioner didn't see anything and asked if I'd wait for the ENT specialist to arrive. When he arrived, he didn't see anything either and just prescribed some topical medications. I was charged for two separate consultations costing $100 each, very expensive for Russia, but not uncommon for paid services nowadays. Though I had signed a release form upon registration, I never imagined that I'd be charged for two separate examinations lasting about 5 minutes each!

When I went to my first prenatal visit at a different clinic, the doctor went through my whole medical history and wanted to send me to a different specialist for each symptom. I managed to keep it limited to a physical exam with the general practitioner and avoided seeing their in-house orthopedist, eye doctor, physical therapist, etc.

The pediatrician wants David to see a whole list of doctors to test for various things that can go wrong in infants. While I don't know if there's any harm in just looking, it's certainly a different way of doing things. In the U.S. it can be so hard to get in to see a specialist, while in Russia (if you have money), the general practitioner seems to act as a triage unit who sends you off to separate specialists for each symptom.

My poor husband was very brave to witness all of the procedures I went through in the U.S., which took place in a different manner than he's used to.

So here I am trying to follow all the pediatrician's instructions: a list for David (morning, afternoon, evening), and a list for me. On the plus side, it gives some structure to my day. Plus, getting out into the sunshine for daily walks isn't a bad course of treatment.

P.S. I forgot how the hide/expand feature works with my blog template. I'll have to go back and review.


5 comments:

  1. Our Russian pediatrician says that the difference is based on a different perspective. The Russian doctors have in their mind a perfectly healthy body and compares the patient to that....so, you can see how so much appears wrong. The American doctors see the individual patient and only look closely at symptoms if they are causing a problem.

    Nastia picked up the idea that the baby should go out every day. Meanwhile, my husband is appalled that we'd take Monica out of the house at all. To his mother and grandmother that would be tempting fate - all that "cold air"!

    We were told that so many of the things you mention (cradle cap and outie belly button, in particular) were "normal" and "don't think a thing of it".

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  2. Hi Elizabeth,
    Congratulations on your baby! I do remember being surprised by some of the same things. My friend Sveta, on the other hand, is a nurse who now lives in the U.S. and she is often indignant about how "lazy" her children's pediatrician is (not ordering tests, saying that something will clear up on is own, etc.). My sense is that all those routines are good for keeping you busy or adding structure to your day and not a lot else :)

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  3. Cold air on the street is okay but cold air in the house=draft=you'll get sick!

    I guess it's nice to actually have doctors admit something is wrong with you. In the U.S. it is so hard to actually convince doctors to try to figure out what's wrong (and it costs a fortune). I wish doctors could find the happy medium!

    Thanks, Elizabeth! It's true, routines can't HURT. But I don't think moms should be scared into thinking something is wrong or could go wrong. Seems we worry enough as it is!

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  4. Liz, i really enjoyed your blog today. And especially this particular piece on pediatric care. Not only i am a Russian mom raising a child in the USA, but i am also a public health practitioner now, working with health care quality issues. As a mom, i was shocked when American pediatrician advised me to give formula to my baby instead of breast milk and let him "cry it out"", ie cry himself to sleep. Or for instance, the practice of adding rice cereal to formula to make babies sleep longer at night shocked me. That was when i switched pediatricians. My current one is more "Russian" i guess :) He is into treating infected tear ducts with breast milk and all that natural homeopathic stuff i was raised on. The beauty of the health care in America, though, is that i think it is a lot easier to switch pediatricians and find one that you like better.

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  5. Thanks, Sasha! I think the general trend is that pediatricians and lactation consultants are in disagreement. Most of what I read about "sleep training" contradicts what I've been told by breastfeeding advocates. I agree that babies and parents both need sleep, but if he wants to eat I would rather not mess with his internal schedule. I don't see why you would want to "make" your baby sleep longer at night if he is just hungry. And what does that do to your milk supply? I found our pediatricians in the U.S. to be pro-breastfeeding, but not lactation experts. They said things like "keep the feedings to 30 min. or less," not knowing my child. But I actually heard similar things from the Russian pediatrician, as I mentioned in the post.

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