A few weeks ago, I saw first-hand how health care is provided in the US and Russia. In the US I accompanied someone who needed care. A short time later, in Russia, I got a few stitches in the emergency ward after falling on the ice. It wasn’t my fault, nor was my dog to blame. All he did was jerk the leash as I stood on a patch of ice. The Russian winter was the guilty party. It causes every person in the country to go crashing to the ground at least once a year, dog or no dog.
When you get medical care in the US, nothing happens until the insurance situation is worked out. In Russia, nothing happens until you take off your coat and check it in. When I came to our local emergency ward in Russia, I forgot to take off my coat. The nurses wouldn’t so much as look at me until I had turned in my coat at the coat check area. This is an inescapable fact of life in Russia, the dictatorship of checking in coats before entering restaurants, theatres, government offices and other buildings across the land.
In a US hospital, the receptionist sits at an open counter, usually behind glass, enters your data into a computer and directs the patient to wait until someone comes out of the hospital to provide instructions. Those waiting for care sit in a lounge, watching TV. It’s possible in the US to drive up to the entrance of the emergency ward and drop someone off. In Russia, I couldn’t drive up to the entrance of the hospital because the road leading to it was blocked off by a shlagbaum (barrier) manned by a guard. I had to park on the street and walk up a small hill on an icy road. Along the way, I passed a woman with a bad knee, limping up the same slippery road on foot.
Inside the emergency ward, called a Trauvmpunkt or trauma ward, was a long narrow hallway with a few benches and about 20 people in it, mostly standing. The nurse who registered the patients was in a small room behind a closed door. Everyone would carefully open the door and politely ask permission to go inside. The first thing I did, in time honoured Russian fashion, was to find out who was last in line. Some of the people in the corridor didn’t look like anything was wrong with them. Others did. One woman was clutching her wrist. The lady with the bad knee limped in, clearly in bad shape. One or two other patients seemed to be suffering from trauma. The rest might just as well have been applying for their pension benefits.
My wound wasn’t all that serious, but it was impressive. A woman ran out and gave me a clean towel, then she hurried away into the reception area behind the closed door. After that, I was told that I had to have an x-ray done. I didn’t think I needed one, but I had little choice. The fast-moving receptionist came out and abruptly told me where to stand in line for the x-ray. The lady with the bad wrist went first, then it was my turn. The woman with the damaged knee followed me, having limped too slowly up the hill to get a better place in line. Another guy showed up with an injured elbow. All of us were victims of the Russian winter.
In the US no one would ever ask who is last in line. As for an x-ray, it isn’t done as a matter of course. Having one done depends to a large degree on insurance coverage or absolute need. In Russia, insurance is not the issue. The key is the procedure. First an x-ray, then the doctor.
After I was x-rayed, and without having seen the results, the doctor took over. He was a red-head, which for some reason made me feel confident in his abilities. In my imagination he had been an army surgeon, with war experience. He had me lay down on a rock-hard hospital bed that looked like it dated from the 1950’s. The doctor gave me a few injections. After that, he stitched me up before waiting for any pain relief from the shots to kick in. I gritted my teeth and took it like a man. It was all over in a few minutes. A nurse sat me down in a chair and said “shoulder” (plecho), leaving me guessing. She then impatiently explained by saying “either one” (lyoboe). Finally, I understood. I needed to show her one of my bare shoulders. She quickly gave me a shot without saying a word. Before I knew it, I was done. In the US, polite warnings and explanations are provided. A doctor might say, now we are going to inject you with a strong local anaesthetic. Nothing happens until it takes effect. If a nurse in the US gives someone a shot, a claim is made that it won’t hurt much. Minimizing pain is a high priority. This is not how Russia normally works. Here, doctors do their thing and the patients wait for the outcome. A bit of pain isn’t the end of the world.
In the US, bandages are widely used. Russian doctors and nurses prefer bint, or gauze. After I was finished the nurse wrapped white gauze, about six inches wide, tightly around my wound. She did it fast. The gauze is secured by splitting the end in half and making a knot. Such gauze goes on all wounds, large and small. Often, green iodine is used as an antiseptic, leaving a dark green spot on your skin. This is visible evidence that a wound has been treated. It stings, further proof that the job of disinfecting has been achieved. I went home looking like a wounded World War 1 veteran, wrapped in white gauze.
Nothing is complete in Russia without paperwork. Russians are skilled at writing things out in long hand on special, brown forms. My doctor quickly wrote something at great length on a form and stamped it, allowing me to go my polyclinic in Moscow and have my stitches taken out. I held onto this piece of paper for dear life; had I lost it my Moscow doctor might not have given me the time of day. Two weeks later, I was able to come back to the emergency ward and get a piece of paper showing the x-ray results. In my case, nothing was broken, good news albeit well after the fact.
US emergency wards and hospitals are by and large modern. My local trauma ward looked like it dated from the 60’s. However, the x-ray machine worked and the place was clean despite not being new. My red-headed doctor got the job done. He didn’t mess around. The cost couldn’t have been lower, being free. Now that the ice has melted, I can finally go outside again with my dog. I have an impressive scar, proof that the contents of this article are true. It’s all good.
Daniel Brooks, copyright, 3 May 2019