Saturday, March 23, 2013

Another Russian medical adventure

As an ex-pat and missionary, the question of medical care can be tricky. In general, it comes down to choosing between a state-run clinic and a private one (or waiting until the next time I'm in the U.S.!). Each option has its pros and cons.

Private clinics look more like Western ones. Aesthetically, the facilities are more like what I'm used to, and seem more sterile. Another advantage is that there are no lines. I can call to make an appointment and they'll ask me if I want "tomorrow or the day after". Since many people pay out-of-pocket, it's in the clinic's best interest to accommodate you.

Meanwhile, the private clinics are a business, and they often recommend that you see multiple specialists and order lots of tests. It can be confusing because you're never sure if it's necessary from a medical point of view or if they are just trying to get more money out of you. Equally confusing is when they DON'T insist on you pursuing a certain treatment plan. David's pediatrician never tries to make us come in for regular check-ups or keep up with vaccinations. We are responsible for taking initiative because we're the clients and it's our choice.

I have a lot more culture shock in dealing with the state-run systems. And even though they have departments for non-insured patients who will be paying out of pocket, it seems that not many people choose this option. I tried to see a doctor once in a regular clinic. The department for paid clients was closed and finally a doctor took pity on me because I was feeling so ill and took a look at me, and then she wouldn't accept any money, so that ended up awkwardly. Turns out I should have offered a box of chocolates...who knew?

Now for the treatment itself. The care in state-run facilities may be more Soviet, less of a Western approach. But there is an advantage to them treating so many people: lots of experience. The private clinics may have all the latest technology, but don't see as many cases per day/week/month. I felt that way a little with OB care, though my doctor herself seemed VERY qualified. Actually, I think it's common for private clinic staff to have another job in a state-run facility. But they still might not deal with so many patients.

So here is what we were up against: David's clogged tear duct wasn't getting any better, at 8 months of age. He'd had a fairly goopy eye since he was just a few weeks old. It was diagnosed early on and the pediatricians in the U.S. said to just leave it alone and see what happened. They may have mentioned the massage, I forget.

Once we had seen a Russian doctor, it was the typical contradiction: The Russian doctor wanted to do something as soon as possible (before 1 year of age or else), while information I'd gotten in the U.S. favored more conservative treatment, considering probing the tear duct AFTER a year if there was no change.

We tried the conservative route for several months, cleaning and wiping and administering eye drops and breast milk and whatnot. Oh, and the massage, to an extent. These routines clearly made him uncomfortable, and the skin around his eye was often quite tender from all the rough handling. :(

The Russian doctors pressured us to get the procedure done, while we were nervous about taking the risk unnecessarily.

Finally, we decided to do it...

I realized that one of the advantages of doing it at a younger age is that he doesn't see it coming. A few months ago I could suck out his boogers, put drops in his eyes, etc., and he would barely flinch. Now he hates it and sees us coming from a mile away. That means a more traumatic experience.

We headed out to a university hospital that had been recommended. It took us a long time to get there and we were late and I dreaded having to turn around and go home.

The hospital was in a complex made out of all these little separate buildings, and we had to ask for directions. Once inside, we went through the familiar ritual of checking our coats (taking things out of the pockets), and getting little booties for our shoes to avoid tracking dirt through the hospital. Then we squeezed (with the baby carriage) into an elevator with no light, and went up to the designated department.

The post was commanded by the usual matronly staff members. One lady came out and yelled at us for having the stroller in the controlled sterile environment, while asking us which doctor we were there to see. She said if we would do as she asked and take the stroller downstairs, she would go tell the doctor we had arrived.

I was holding David while Andrei took the stroller downstairs, and I was feeling pretty nervous. What if we had to go into the examination room before Andrei got back? I didn't even know the name of David's condition in Russian. I mean, I can understand almost everything, but forget the names of all the medical terms.

The commandant lady came and had me sit in a waiting area, and then Andrei came back. He had stashed the stroller frame somewhere, and carried the other part upstairs. Interesting (though typical) that a children's department doesn't have a place to park strollers. Of course, the same is true of children's department stores and places like that. People just bring a lock or leave one person outside.

The doctor called us in and checked out David's eye. I hadn't done a thorough cleaning so they could see the real condition it was in. Then she asked when he had eaten and said we could do the procedure in another hour. Yikes! Of course we had been planning on getting it done, but we had thought we would have to do diagnostics first and then make an appointment.

Well, we were ready, sort of. We agreed.

We were escorted to a waiting room. We sat on the couch with David and tried to keep him happy, hoping he wouldn't get too hungry before I would be allowed to feed him. A little girl in the room was coughing. She was cute, but I was thinking about cuteness as I was concerned that we were in a hospital and David could catch something. Suddenly she came right over, and the next thing I knew, she SAT right with us on the couch. We got David out of her reach and I practically froze with fear that she was about to give us some awful germs.

Some hospital workers came in and did paperwork with us right there in the room, and then sent Andrei to go pay. He had to actually go outside to another building (which would mean stopping to wait in line to get his coat), and once again I was antsy waiting for him to get back, being unsure of what was about to happen.

A few minutes later, a young nurse (maybe university student) came in, all dressed for the operation, and said "I'll take him now." I had to hand David over. I asked if I could come, and she told me to stay in the waiting room. Of course it wouldn't have done any good for me to be present. It's not like I could have kept him from crying, but at the same time it was hard to think of him there with strangers, being tortured worked on.

Andrei popped in right after they took David, and we let his parents know so they could pray. The doctor had warned us that the price would be higher since David was an American citizen. However, they wrote the regular amount and the cashier didn't adjust it (even though Andrei was honest about it), so the price was the same as for a Russian private client. Well, he IS Russian, just not on paper!

Then David was back about 10 minutes later. He was crying, but calmed down fairly quickly, especially once I started feeding him.

I think in the end we made the right decision. Who knows how long his goopy eye condition would have continued. He was definitely a bit traumatized and hates letting us touch his face now, but I think that's partly the age he's at.


4 comments:

  1. Such interesting observations, Liz. With Obamacare coming to the States, healthcare as we have known it is in for a rude awakening. We'll see how much it changes the quality of healthcare and the approach (East vs. West).

    On a personal note, I'm so glad David is better!

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    1. So far it sounds like changes to the U.S. system are not good. I have heard some bad stories. But it seems like a crazy system in general. I try to make sure I have coverage for really bad situations, but I mostly end up paying out of pocket.

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  2. Fascinating LONG post! Is this the one promised on FB?

    Well worth the wait. We had to have the "8 Medical Tests" in a Russian clinic in Moscow. I was fascinated by the "sterile" floor, with the booties and so forth. And, wondered if my shoes were nearly as germ-filled as the rest of my self. As I always felt I was doing the "incorrect thing" in Russia it is fascinating to see that even Andrei (so inappropriately) brought the baby carriage up. That's the sort of thing I would have felt I should have known.

    My son says that he notices a big difference in medical care from here (in Michigan) and where he now lives in the DC area. Where he is now he feels that they are always trying to "sell him" unnecessary services and are so anxious to recommend extra procedures and tests that he feels aren't needed.

    Sounds like things with David's eye are going well. Typically I prefer the conservative approach, but I let my instincts weigh in, too...as it sounds like you did. I'm glad it seems like the right decision.

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    1. Yeah, I kept getting interrupted and then I had to go back and remember.

      I found that in my hometown this summer some of the practices were trying to save me money. My eye doctor told me I really didn't need to come back for another 2-3 years.

      I do try to remain informed, but it's hard when they just tell you to do something without really saying that it's optional. That's the way I feel about the private clinic here.

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