This article represents one mans personal experiences of the Russian health service, gathered over several years of travelling to, living and working in Siberia. As they are personal and necessarily restricted to a small part of Russia, they should not be taken to reflect the health service situation across the whole of the country. The comments and opinions are intended to be balanced, unbiased and try to tell both sides of the story....an almost impossible situation for everyone concerned, the government, the professionals and most of all, the people.
The views expressed are not just of one man, but as a result of hundreds of interviews with Russian citizens from the entire social spectrum, the rich, the poor, and everyone inbetween.
Under the Russian constitution the health system is, technically at least, free. In reality there is a two tier system, go private and pay a lot, or use the state system and pay a little, either way you usually pay, something, and if you can't pay, then unfortunately you suffer, the government has short arms and deep pockets when it comes to paying for expensive operations and high cost palliative care. There is free care available to certain high risk categories, and following referrals from some local doctors.
As a foreigner visiting Russia for less than 3 months there is no problem, you simply complete the questionnaire for your visa, tick all the right boxes, provide adequate travel/medical insurance for your journey, and that's it, no proof, no documents from doctors, nothing. If you have a medical problem whilst you're in Russia, your insurance policy will no doubt help with the arrangements and pick up the tab for the treatment.
When, as a foreigner you want to stay longer than 3 months or in my case apply for temporary residency ( which would authorise a stay of 3 years ), that is when you'll come into contact with the real Russian medical system, not to mention the astounding and often incomprehensible bureaucracy that envelops Russian life.
From the list of medical documents, receipts and test results that I have to submit with my application you'd be forgiven for thinking that foreigners really are the source of all evil, the harbingers of disease in apocalyptical proportions. You must remember that a foreigner, to the bureaucratic state is a non Russian citizen, and so all the people in the 15 ex-Soviet Union Republics are foreigners too, despite speaking the Russian language.
For my application I must provide test results from a designated doctor or clinic, for the following :
human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS)
tuberculosis
leprosy
gonorrhoea
syphilis
certificate of no drug dependency
Aids For the aids test you must go to an aids clinic authorised on your application details, it is a simple blood test and the results can be collected in about 10 days. Make sure that the nurse takes a syringe from an unopened pack, it's not uncommon for syringes to be re-used after a fairly lukewarm sterilization process. If you're in any doubt at all, don't take the test and enlist the help of a fluent Russian speaker to allay your concerns, don't be intimidated by all the bluster, shouting and yelling that goes on in polyclinics and hospitals.
Tuberculosis For the tuberculosis test you must go to your local polyclinic for a simple blood and urine test, then go to another clinic to have a fluorogram ( type of chest x-ray that would identify symptoms of tuberculosis ), collect the results from both clinics in about a weeks time and take them to another clinic where a doctor will review them and issue the certificate that says you either have or don't have tubercpeaulosis. The Russian Federation takes tuberculosis extremely seriously along with Aids, persuading a doctor to falsify a certificate would be almost impossible, the consequences and penalties are severe and far reaching for the doctor and the patient.
Narcotics and drug dependency You can get this certificate by attending your local narcotics clinic, asking for a certificate, then you will see a doctor who will look at your hands, arms and stomach, presumably for tell-tale needle marks before asking you ..."are you a drug user and do you drink alcohol". No and no, plus 200 Roubles at the cashier will get you a certificate on the way out, strange but true.
Gonorrhoea, leprosy, syphilis For these diseases you must be tested at a designated venereal disease clinic, until recently the test involved a quite unpleasant scraping of the genital area, nowadays the tests are combined into a simple blood test, ready for collection in about 10 days.
The difference in clinics is hard to believe, from a spotless, immaculately presented, refurbished narcotics clinic with a European repair to a local "polyclinic" ( a Russian citizens local doctor, allocated to each individual based on the index or postcode of the address ), where the hygiene is, at best questionable.
My first visit to a local polyclinic filled my heart with despair, not for me, as a "sensitive foreigner", but for the people that I observed, real Russian people struggling with a system inadequate to cope with even the simplest of ailments.
The most disheartening experience was on entering the clinic, first impressions are the ones we all remember. I remember vividly looking, in almost open mouthed disbelief at the condition of the walls first...crumbling plaster, holes left open exposing bare brickwork, sub standard wiring strewn across corridors in haphazard loops to unprotected circuits, clearly this polyclinic had been under funded for several decades not just years. The floors screamed at me for my attention, long corridors of patchwork quilt chipboard squares butt joined to blockboard which in turn was tongued and grooved to plywood in a higgledy piggledy fashion. But the most attention grabbing detail was the unevenness of it all, and as I stood at one end of the corridor, I surveyed a scene to behold, of people young and old adapting to the gently undulating floor, narrowly avoiding the 2 inch steps between boards, subconsciously altering course around the nail heads left unhammered, showing no surprise, disbelief or disgust, just a tacit message in their broken faces.
Broken !, it's not a particularly descriptive word in itself, but its one well suited to my first experience of a run down, under funded local polyclinic for the Russian people. Broken doors, windows, floors, lights, walls and most importantly broken people, staff and patients, their faces crying in the solitude of hopelessness and despair, it was indeed a striking first impression.
Compare this then, to the narcotics clinic that I visited only a few days earlier, immaculately clean, an old structure scrupulously refurbished to western European standards, bright lighting, attention given to the colour scheme, well signed directions and yes, a level well tiled floor. Not surprisingly the staff were different too, helpful ( I wouldn't go as far as to say friendly ) and professional.
It seems that the standard of the clinic or hospital depends on so many factors that ordinary people have no control over, and so, faced with the choice of bad buildings or no buildings, the former is the best option.
If you're going to Russia as a tourist, triple check your travel insurance, if you get ill, use only public services recommended to you by a Russian citizen that you trust or use private medical facilities, be prepared to pay up front and recoup your losses from the insurance company back home, keep ALL receipts, bills, diagnostic test results...everything. Best of all...get ill before you go, after you come back ..or not at all. Hungry for more, become better informed !
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