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Text and photos John Harrison

We were flying back to Moscow after a break in Dubai over Christmas. I started to feel the same discomfort that I had felt over the past few days. My fiancee is a doctor, she diagnosed that it was probably my appendix. Not wishing to take any risks, and the pain increasing, we went straight from Domodedovo airport to the EMC (European Medical center) clinic in Moscow; I trust the people there after a knee operation last summer. At the door, doctor Pierre Konchalovsky met me, I was given tests and admitted for surgery which took place a couple of hours later. I was out again in two days.”

Moscow-based publisher and retail magnate John Ortega’s story, dramatic as it may seem, is not unusual for staff at EMC or any one of the few medical centers catering for foreigners in Russia. “Over half of the cases coming here [EMC] are emergency situations, Leonid Mikhailovich Petchatnikov, Medical Director at EMC said.

Birger Oldorff, Business Development Manager, INTERNATIONAL SOS, said that they have on average of 350 calls coming in a day at their Alarm Center in Moscow, which coordinates INTERNATIONAL SOS’s services in Russia. “People call in needing help: anything from broken glasses on a Saturday night to a heart attack on an oil rig in Siberia.” INTERNATIONAL SOS’s clients are international corporations, of which there are several thousand in Russia, he commented.

Most visitors and expats who work for corporations expect their employers to provide medical insurance that will allow them to be treated in the same way as they would be at home. They do not want to be treated as a Russian in a Russian hospital or clinic. For them, this is part of the package that the company offers them and their families when hiring somebody to work in Russia. As Birger Oldorff, put it: “There is the cultural aspect, then there is the procedural difference, this is not to say that one system is better or worse than another; they are just different. An American is used to being treated differently than anybody else from any other country, as is a Japanese or Canadian.” A particularly sore point is children. If something happens to an expat’s children, the first thing he or she is going to do is to leave the country,” commented Oldorff.

Leonid Mikhailovich Petchatnikov,
Medical Director at EMC

But why should people have to leave Russia, surely there are enough good-quality hospitals here? Perhaps. Nobody will argue about the high standards of Russian medical training. Many Russian-trained doctors speak rather negatively of the state medical system. As Leonid Pechatnikov commented: “Medicine in the Soviet Union was available to all, but the quality of care was always bad. Now the situation is different. If I know that I don’t have the right medicines and I know that if I have money I can buy them in a chemist. In Soviet times, you couldn’t get hold of these medicines for the love of money. It was always very difficult for me psychologically. I knew that it was possible for me to help somebody, but because of lack of money, because of lack of medicines, helping was impossible, and that person died. There are millions of Russians who have kidney problems and need treatment. In some countries, diabetes problems are taken care of; you come into a clinic two or three times a week, open a newspaper or watch television, and your blood is cleaned. In the Soviet Union, only 4% of diabetes-sufferers had access to these facilities. Now the figure is up to 10%. Today in Russia, if somebody has enough money, he can always find a way to get treatment outside of the state system. Today, high quality medical care is only available for the well-off.”

When the Russian health care system is going to improve, is a question that a lot of people would like to know the answer to. Undoubtedly the talent is there, the problem is when. Pierre Konchalovsky commented: “If you take as an example French hospitals, they achieved the high standards after a great deal of efforts had been made, and after many years, and with very significant government investment. We are talking about a period of 20, 30 or 40 years. I consider that a similar period in Russia is necessary.”

Alexander Lazarev, Vice-President & Group Division Director of AIG Life in Russia added: “It is not only the medical infrastructure that is lacking. If it takes an ambulance 45 minutes to get to a patient having a heart attack in Moscow, it doesn’t matter what state-of-the-art facilities are available, the patient will probably die. Even if we [AIG Life] arrange medical care, we still recommend that the patient rings the 03 service to make sure that they get emergency local help asap. Our doctor may arrive first, but this is not a risk we are prepared to take.” AIG Life, like SOS international concentrates on corporate clients, with the accent on preventative care and emergency help. Most of AIG Life’s clients are Russians both working in Russia, and increasingly, travelling abroad. The company recommends corporate clients insuring with a Russia-based company familiar with the situation on the ground here, that has a wide network of providers.

John Ortega shortly after being admitted to EMC

Another major criticism leveled at the system is that the head doctor takes all the responsibility, thus reducing the responsibility of individual hospital practitioners. Idiosyncrasies within the Russian healthcare system create problems for citizens from other countries posted here, as they simply are unable to cope. Expatriates who have lived here for any years, who speak good Russian or have capable Russian friends, are in a different situation, but they may not be handle an emergency as well as they think. Medical insurances packages for individual foreigners are actually quite hard to come by, and policies may not include cover for some afflictions. You have to read the fine print. “Such insurance services are improving, however they still have a long way to go,” commented Birger Oldorff. “A company like BUPA or Sigma’s international packages will cover situations like by-pass surgery, but this might involve evacuation, particularly if the patient is outside of Moscow and St. Petersburg. Russian medical insurance companies do not.” INTERNATIONAL SOS organizes between three and six evacuations a week form Russia. Evacuation is not always straightforward, the logistics problems involved in arranging a passport for a new born child who gets seriously ill, for example, are not straightforward,” he added.

All of this means that the few centers that do offer western-standard services in Russia are doing well. EMC, the only private facility whose foreign doctors are completely legalized to work in Russia, for example, is expanding its Moscow operations this summer, with the opening of a 5,600 sq. meter facility with 4 operating theaters (up from their present two), 30 beds (to augment their present 15) and new equipment. At present, the number of hospital beds in facilities where doctors are able to at least speak English, is ridiculously low; “there is EMC, AMC, the INTERNATIONAL SOS clinics, UPDK and a couple of others, all of which together offer only about 100 hospital beds. Moscow and St. Petersburg are far better served than elsewhere,” said Alexander Lazarev. “It takes as much

Doctor Pierre Konchalovsky

effort to legalize a foreign doctor in Russia as it does to legalize a Russian doctor in Europe,” commented Leonid Pechatnikov. Previously, doctors at foreign embassies cared for the needs of their employees. After the appearance of medical clinics of European level , some embassies, like the French embassy, have stopped offering medical services altogether.

Costs in private clinics are not cheap when compared to Russian facilities. Leonid Pechatnikov explained the situation a EMC: “Expenses are very high. Firstly there is the rent, apparently it will fall now although it is not clear exactly when. Secondly, the salaries of foreign doctors who work here. Not every doctor is suitable for our work here, and not every doctor will leave France, German or England and will travel to Russia, these people need to be compensated at the right level. We demand that they rent a flat very near to the clinic, and this is a very expensive part of Moscow. All of this reflects on our prices, although the level of profit is less than in cheap clinics.” Cost, however, is a relative thing. John Ortega commented: “I don’t have a total cost yet, they took a run on my credit card before I went into surgery, and blocked Euro 5200, however the treatment is not all over yet. If I got something like this done in America, the clinic would bill the insurance company twenty or thirty thousand dollars.”

Clearly being insured by a reputable insurance company which offers full cover, including evacuation if necessary is essential for an expatriate working in Russia for any length of time. For the rest of us who are not employed by corporations, or who have recently lost our jobs, perhaps the time has come to hunt for a decent insurance policy on offer here. Let me know if you find any please.

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