Russian Health Care-- an adventure and exploration

This is an account of the last two weeks in my life, which were pretty strange. I’ll start at the beginning, I guess, which happens right after my last blog post, when I made the apple pies. That very night I began to feel rather sick, although I refused to admit it to myself and trudged through the next day of classes and meetings. The students and I got together to eat pie in the afternoon and we all got ice cream cones, which we ate on the street in -25 degrees Celsius temperatures. Then I went home, where Namdolma had arranged a surprise celebration for Thanksgiving with some relatives and colleagues and a roast chicken. Unfortunately, and rather rudely, I fell asleep at the table in the middle of dinner. I went to bed and slept pretty much straight through the next four days. I had a really bad sore throat, high fever, body aches and chills. I was kind of irrational through the whole thing--Namdolma said I was as cranky as a grandmother. I was determined to save my antibiotics for “when I really got sick” and also adamant about not going to the hospital, so I just lay there and sweated my brains out. It was not a good situation, and in retrospect my behavior was not the smartest.

Eventually I agreed to go to the hospital, and then the adventure really began. Through the advice of a relative, they took me to the Infection Hospital in Kyzyl, which is probably the best one out of the six or so hospitals in town. The building was pretty new and there was plenty of space, in comparison to the other hospitals, none of which were actually designed as hospitals. The infection hospital was made of concrete and very institutional. There were many rules. When they admitted me, I had to sign a contract agreeing to the rules of the hospital. Some of the ones I remember were: not to spit on the floor, not to throw sunflower seeds in the toilet, and not to grumble when they woke me up at 6 am. At the same time, Namdolma was desperately trying to explain to the doctors that I needed everything to be clean, needles should be one-time-use. The doctors scratched their heads at this, and somebody went to get a sterile tongue-depressor, which a nurse carried in on a piece of paper like a royal proclamation. They looked at my throat, took my temperature and chewed me out for not coming to the hospital earlier. Then they charged my 50 rubles up front to take my medical history and another 5 rubles for shoe covers, because I hadn’t brought any slippers with me.

I should mention here the frantic bag packing that had happened right before we left for the hospital. I was ready to put on just my winter clothes and get in the taxi. However, Namdolma made me pack like I was going on a major trip, even bringing toilet paper and ceramic dishes. At the time I was not very enthusiastic about this, but it turned out to be a life-saver. I really did need those dishes and toilet paper; the hospital didn’t have any. The nurses chewed me out every day for not having any slippers until Namdolma eventually bought me some and dropped them off. The hospital was a very regimented place, similar in many respects to what I imagine prison is like. For the doctors and nurses it was incredibly important that I had the right supplies.

The first night in the hospital I was given a bed in a room with a student from my faculty at the university who studied in the Tyvan language and literature department. It was nice to have company. The room was pretty small, and more like a summer camp dormitory than hospital rooms in America. I had a cot and a nightstand, and I was under strict orders to keep my bed made neatly and the top of my nightstand organized. We had a big bathroom with broken tiles and a bathtub in the middle of the room. The florescent light overhead flickered all day long, until finally an extremely tall electrician came on a ladder, removed the faulty bulb and rewired the lamp.

They put me on an IV of antibiotics and gave me penicillin shots in the bottom. I found this rather funny the first time a nurse bustled into my room with a long, sharp needle and asked me to bare my popa (bottom). In retrospect, I suppose these are the things that helped me the most, but at the time I was not very convinced. Also, I was rather disturbed by the fact that the nurses would not tell me what they were injecting me with, or why. The IV technology was rather ancient. There were glass bottles full of medicine and they put a new needle in me every single time. However, the nurses were pretty good at finding my veins, I suppose this is one of the benefits of having to poke people so much. At first they would tape the needle to my arm with a single, ceremonial piece of medical tape… then they ran out of tape, and started to tie the needle to my arm with a piece of string.

I was also sampled nearly to death. They repeatedly gathered samples from almost every part of my body. They even took blood from different places, and they weren’t very good about telling me before they poked me. They milked blood from my fingers to fill tubes and their hands were very good at milking, considering that probably most of the nurses had grown up on farms, caring for sheep and cows. They swabbed my nose regularly, rubbed iodine on my poor swollen throat, and gave me several more shots in the bottom. They had me wearing a hula print sun dress and Christmas holly bathrobe. They didn’t change my sheets the whole week I was in the hospital, and I learned that there is folk-wisdom among the people of Kyzyl that you should never change your clothes in the hospital, because if you do you will get to leave sooner. I just found it kind of absurd that I smelled so bad.

My second day in the hospital was the worst. In the morning they were pumping several bottles of IV fluid into me, and it was really hurting my arm for some reason. Then my mom called and I started to cry a little bit, just to hear the voice of my mom so far away. Then the doctors came in and gave me a stern lecture that crying in the hospital was not allowed, which just made me cry more. Finally they gave up and left. I started to shiver from the fever and cold IV fluid. I was shaking pretty uncontrollably, and finally a bunch of doctors came in and started to freak out. They gave me two penicillin shots in the bottom in a row (which really hurt) and took out the IV. The shaking stopped and they marched me downstairs through an unheated staircase to the X ray department, because they were afraid I had pneumonia. The x-ray technician was no where to be found, and they called someone else. I was feely very poorly and they let me lay down on the cot in the room for AIDS testing. Then the technician came, and also a woman came who they had called to do the technician’s job. The technician was a middle aged Russian babushka and she told a bald faced lie to the other lady, saying that she had been there for 20 minutes already, so why had she come? This made me mad. Then the lady started to boss me around, saying that I needed a surgical mask before I could get my X-ray. They found a surgical mask for me. Then I got ready for the X-Ray. The lady was pushing me around in front of t X-Ray machine, trying to bend my arms somehow they wouldn’t bend. I lost my temper and shouted at her not to touch me. She looked fairly shocked and said ok, but that she would only do one X-Ray instead of the three the doctors had ordered because I was so badly behaved. I didn’t care and she took the picture. Then I went to lay down again, and suddenly felt like I was going to vomit. I told a nurse and tried to make for the door… but ended up vomiting right next to the bed in the X-Ray room. They told me to lay down and wait. In the meantime the X-Ray lady came back and almost walked into my vomit. I was telling her to stop and not keep walking, but she wouldn’t listen. Thankfully the nurse came back at the last moment and saved her from stepping in my vomit and they took me back upstairs and let me lay down again. I think I will always remember the quavering sarcastic tone of voice the X-Ray babushka had as she bid me farewell, calling me her krasavitza, horoshenko (her good little beauty). In retrospect, I feel sorry for her. The experience was probably traumatic for her, and nothing in her life prepared her to deal with a misbehaving sick American.

Which leads me to an important question: who the heck decided that all the walls in Russian institutions and public spaces should be just two colors. The hospital looked a lot like our university, and the hallways in our apartment building. I’m just curious when in the Soviet Union they decided this would be a good idea, and what the motivation was. Somewhere it must have been written that the walls should all be two colors, the top half white and the bottom half turquoise, green, beige or peach.

The next day in the hospital we got another roommate, and Russian lady with a hacking cough and a drunk husband that she loved to argue with on the phone. And she smoked in the bathroom. I wasn’t so fond of this woman, although we were all congenial and shared fruit and candy that people dropped off for us.

I should talk a bit about the hospital food. It was basic institutional food, very simple and filling, and probably healthy. We had porridge, salty milk tea and bread for breakfast; soup, bread, potatoes with meat sauce and compote for lunch; and pasta in milk with bread for dinner. Vegetables were in short supply, but my friends and colleagues were very kind about bringing me fruit and yogurt. The food was all delivered through a slot in the wall. We could tell when food was coming because the cart would rattle in the hallway. At this point we were expected to deliver our dishes to the wall slot and close the door on our side. Then they would fill the dishes and shout to us “EAT!” then we could get our dishes and enjoy our meal.

So, this was the life in the hospital in Kyzyl. The antibiotics helped me and I slowly began to get better. After a few days they moved me into a private room which was much more boring. I read a lot of stories. This was my favorite thing I read, from Joseph Conrad’s short story “An Outpost of Progress.”

Few men realize that their life, the very essence of their character, their capabilities and their audacities, are only the expression of their belief in the safety of their surroundings. The courage, the composure, the confidence; the emotions and principles; every great and every insignificant thought belongs not to the individual but to the crowd: to the crowd that believes blindly in the irresistible force of its institutions and of its morals, in the power of its police and its opinion. But the contact with pure unmitigated savagery, with primitive nature and primitive man, brings sudden and profound trouble into the heart. To the sentiment of being alone in one’s kind, to the clear perception of the loneliness of one’s thoughts, of one’s sensations--to the negation of the habitual, which is safe, there is added the affirmation of the unusual, which is dangerous; a suggestion of things vague, uncontrollable, and repulsive, whose discomposing intrusion excites the imagination and tries the civilized nerves of the foolish and the wise alike.

I also really like a story by H.L. Davis, an author I had never read before, called “Open Winter.” Anyways, reading was a good activity to do in the hospital.

The other main form of entertainment was watching passerby on the street. Sometimes people would come to the fence surrounding the hospital and try to communicate with patients using body language. This was really interesting to watch. The Tyvans were much more creative with body language than I think I would have been, and a lot of genuine communication seemed to occur between people in the hospital and people on the street. Cell phones were also important. I got a steady stream of text messages from students and people I didn’t even know all day long. My students mothers’ sent me advice on herbs I should take, although there was nowhere to obtain them in the hospital. My parents called pretty frequently from the states, which was nice. Also, the windows on the other side of the hospital looked out over a huge old graveyard. I found a lot of irony in this fact. It seemed like bad planning to put the infection hospital next to the cemetery--or good planning I guess!

Eventually it seemed like mostly I was getting better, but the doctors had begun to worry about my heart. Apparently I was having a low pulse and blood pressure, and they were worried that the antibiotics hadn’t killed all of the infection and it had crawled into my heart. They began to take my blood pressure every half hour and cluck a lot over me. The nurses by this point were getting fond of me, and would come into my room just to talk. They told me that they were telling their friends and family stories about me, and they had lots of questions. They asked about me if I was beautiful like Americans in the movies, and they told me they answered yes, which I think was just flattery. Then they said that their families asked if I was very long, as in tall (but I was lying down, so I guess long makes sense) and they said also yes. Which I found funny because in my family I’m short, but compared to Tyvan women I am pretty tall.

Probably my least favorite part of the hospital was the fact that we were required to wake up at six am to make urine for them to count. This seemed cruel and unusual to me, and also counterproductive, seeing as I don’t think sleep deprivation would help me get better any faster. All the same they woke me up--I had signed the contract after all.

One day I went on a field trip to all the other hospitals in Kyzyl. Because they were worried about my heart they wanted to do an ultrasound, and only one hospital in Kyzyl had the right machine. I went out in an unheated ural van with a nurse from the hospital doing errands. It was strange to suddenly leave the hospital and drive around town. We drove around for about two hours before they dropped me off at the other hospital--and I immediately realized how good I had it at the infection hospital. The other hospital had sick people everywhere--lying in beds in the hallways, lying two in a bed even. It was surreal. Patients were walking around in their winter boots and everybody looked kind of lost. It was super chaotic. I waited in a room full of feisty arguing babushkas for a heart scan. I didn’t participate in the scrabbling for a place in line, and eventually they let me in anyways. They decided that my heart was abnormally large, although I only heard this information later second hand. They didn’t tell me anything at the time.

Because of the heart issues Fulbright decided that I needed to get to some Western-quality medical care to check things out. I had to talk to insurance doctors on the phone, who were pondering sending me to a hospital in Singapore or South Korea. Finally they decided on Moscow, and I was relieved. It would have been a whole different level of surrealism to fly from the hospital Kyzyl to Singapore, and not something I would ever want to do in my life. The next morning they told me to pack my things, and 10 minutes later I was in an ambulance driving over the mountains to Abakan. A doctor from the hospital was going with me as a medical escort. She was very nice, and keep grabbing my wrist the whole way to take my pulse.

We hadn’t been driving for thirty minutes before the bus had a flat tire--this, luckily was still on the flat plains before the road starts to climb into the mountains. The driver was a pro. He removed the jack, which was holding up the dashboard of the ambulance, and had changed the tire within twenty minutes. He put the jack back, and we were on the road again. I was really surprised how much snow was in the high mountains---a good six or seven feet of snow was piled up on the side of the road. It seemed like the maintenance on the road was pretty continuous, and we met several parties of what looked like prisoners with shovels cleaning rough patches and spreading gravel. There was plenty of ice and snow--the roads weren’t clear like in Alaska, I think because there wasn’t enough traffic to clear them off. All the same, we did pretty well in the ambulance, which I’m pretty sure didn’t have snow tires. As far as I can tell, very few cars in Russia have snow tires, although I did see some commercials for Blizzak tires in Moscow.

We almost wiped out a couple times on the road, but thankfully did not. The most hairy moment was when we drove into the tunnel at the highest point on the pass. There were two trucks parked on either side of the road, and a guy kneeling by one of them. Then there was some oncoming traffic. The driver managed to slip between the trucks, and we skidded a little, but stayed on track and slipped into the tunnel. There were some drifts in the tunnel, but we kept going. Also, I should mention that the ambulance didn’t have seat belts, and we were all three (driver, doctor, and I) sitting perched in the front seat.

We finally got to Abakan--by this point the clock was ticking down to the flight’s departure from the airport. Then we got lost in Abakan and couldn’t find the airport. The city is shaped like a donut, around a beautiful little hill covered in dachas in the center of town. We got lost in a neighborhood of dachas. The driver was panicking, we were on a dirt road that eventually turned into a riverbed and the ambulance was convulsing over the huge bumps in the road. Eventually we found a cement and barb wire fence, and could see airplanes on the other side. Everybody we asked for directions just said the airport was on the other side of the fence, but couldn’t tell us how to get there. But finally we did. We turned around and drove back out of dacha-land to the main road and found the right turn.

The flight was ok. The doctor continued to take my pulse and fuss way too much. Getting to Moscow was kind of surreal. A cab took us to the hospital, but traffic was so bad it took an hour and a half. At the hospital I was again poked with all sorts of needles and had lots of tests. I stayed in the hospital in Moscow for three days. The food was unbelievably gourmet. They had goat cheese and shrimp, espresso and real lettuce. The cardiologist was really nice, and said that my heart was actually normal sized and quite healthy. I was relieved to hear this. I also missed a little all the company at the hospital in Tyva. The hospital in Moscow was comparatively lonely. I watched a lot of TV, including almost an entire day of World Cup Bobsledding. It was interesting, but I don’t want to do it again.

When they let me out, I was kind of in shock. I spent some time wandering around Moscow before I found the Fulbright office and a hostel for the night. The hostel was nice, but I didn’t feel like talking to anyone else there. I met up with Bryan, the Moscow ETA for coffee and had a good talk. Then I decided to head back to Kyzyl the next day and try to get back to normal life again. I bought a ticket for the 23:00 flight and went to a Moscow star bucks in the afternoon and had an “American moment.” I guess it was kind of gross display of consumerism, but I really enjoyed that caramel macchiato and chocolate cake, and even more I enjoyed listening to Ella Fitzgerald Christmas music. It was sublime, in a strange culturally-dislocated way. Then I went to the airport and slept through both the flight to Abakan and the taxi ride to Kyzyl. Then when I got to Kyzyl I slept some more.

One cool thing happened in the airport--I met some English-speaking German engineer/contractors who turned out to be working for the European Monetary Fund. They were heading to Abakan to work on assessing the damage done to the Sayanski Hydroelectric Dam that had the catastrophe last summer. They were really nice people. Apparently their purpose was to decide if the situation of the dam was secure enough that the EMF should lend Rushydro 400 million dollars for repairs on the dam. I hope they get the dam fixed soon--electricity is serious business in Siberia. Although who knows what they really do with the electricity from the dam--maybe they sell it to China.

I watched a lot of the BBC reports about the Copenhagen climate conference while I was in the hospital in Moscow, and it made me think a lot about Kyzyl’s problems, and how much better things would be in the city if the people weren’t dependent on burning coal and if there wasn’t the Black Cloud of Doom. It should be possible to find another energy source for 90,000 people! The cold, immobile air of Kyzyl’s sharp continental climate means that the coal smoke doesn’t go anywhere, just hangs above the city, blotting out the sun and covering all the poor city dwellers in grime. As someone told me, it’s like London was at the turn of the century. I did enjoy being able to breathe a little in Moscow, although in general life and traffic is too crazy in the big city.

Anyways, now I am back. The bad dream is over, and the only task that remains is explaining my illness and strange departure to all the people at the university, who are frankly a bit shocked that somebody cares enough about my health to fly me to Moscow. It’s just unimaginable here, where people just die if the hospital can’t help them. And hospitals don’t have tape and toilet paper. But then I got to thinking about how a lot of the problems of the modern world were related to the fact that we in the US burn so much energy making tape and toilet paper so available that we don’t really appreciate them. And maybe Tyva is the place where healthcare makes more sense! Anyways… I can’t regret the experience of getting sick because I learned a lot. Though I don’t want to get sick again.

That’s all for now… all the best, you guys!