Inside Ukraine's Collapsing Medical System

One of the greatest fears many new expats living on a shoestring face – not all expats are wealthy – is that of falling into a third world medical system. The following story, one of 59 very short chapters in my new book A Weak American in Russia & Ukraine, offers firsthand insights into the collapsing post-Soviet medical system in Ukraine. Since the 2004 experience I describe, I have used the same state medical system more than a handful of times, most recently in late 2011. Sadly, conditions there have continued to deteriorate.
 
The good news is that new expats living in Ukraine and Russia can easily receive adequate, basic, outpatient medical attention for most ailments in state clinics for $25-50 a visit without needing special documents or local connections; an important change in recent years and a further reflection of the increasingly desperate state of state medical facilities.
 
The bad news is that inpatient treatment in Ukrainian and Russian state hospitals, in my experience, should be avoided like the plague. Conditions there in 2012 remain medieval: 20 years after the collapse of the Soviet Union hospitalized patients are still required to buy and bring their medicines, food and even linens. To their credit, however, Ukrainian and Russian doctors generally remain very dedicated professionals despite deteriorating medical facilities and average monthly salaries of $200 – slightly larger in Russia.
 
The following story is reprinted here exclusively for Expat Interviews readers (copyright 2012 Walter Parchomenko). Additional chapters of travel horror, and much more, may be found at www.aweakamerican.com.
 
 
 
 
Inside Ukraine’s Collapsing Medical System
 
A man wakes up in a Ukrainian ambulance and asks the
doctor, “Where are we going?”  He replies, “To the
morgue.”   “But I’m not dead yet!” the man protests.
The doctor replies, “But we’re not there yet.”
-a Ukrainian anecdote
 
As luck would have it, I was destined to experience Ukraine’s collapsing medical system during 2004. I developed an urgent need for medical attention shortly after arriving in Ukraine for a 9-month stay. An injury I received a few years earlier was greatly aggravated by weeks of climbing the steep streets of Kyiv and the endless steps leading to street underpasses and metro areas. As a result, my right knee had swollen to twice its original size and I had sharp shooting pain in it. Hoping against hope, I rested the knee for almost a week saying a silent prayer for the swelling to go down. But my prayer went unanswered.  
 
I had used the American Medical Center in Kyiv earlier but it was very costly and it relied for the most part on the same Ukrainian doctors and facilities available to natives. I decided to try to cut out the middle man. In Ukraine and Russia it’s who you know that counts. Good connections are most important to survive and prosper, and payment of cash on top of meager salaries is a fact of life that makes the Slavic world go ‘round.
 
The Soviet free medical system had been collapsing steadily in Russia and Ukraine for a dozen years when I turned to it in Kyiv in 2004. Doctors were drawing meager salaries of about $100 per month and required cash contributions in envelopes from patients in order to survive. Impoverished, elderly patients, meanwhile, typically waited hours in the dark, dingy corridors of hospitals and outpatient clinics to see a doctor. Once hospitalized, they were required to provide their own medications, food, linen, and contributions for staff as well as doctors.
 
Over my many years in Ukraine, I was fortunate to develop several close friends who would always offer unconditional support in my darkest hour of need. One of these friends was Valya, a dentist, who worked at a large, hospital-size outpatient clinic that served pensioners and Ukrainian residents living in its district. I failed to meet these requirements, so Valya’s assistance was crucial. She told me not to worry and promised to take me to meet a surgeon who worked at her clinic.  
 
It was February and the streets were snow-covered and icy.  Getting to the clinic with my bad knee, even with the assistance of a cab, was very difficult. The only entrance to the clinic had very steep, crumbling stairs coated with ice, and its poorly lit interior had not been upgraded since Soviet times. I arrived at the clinic shortly before noon and just before the start of Valya’s shift at the dental dispensary. Although the hall was crammed with patients waiting to see her, she quickly changed into her doctor’s frock and immediately escorted me to the surgeon’s office, a floor below, and cut ahead of a large group of elderly, grumbling natives waiting outside that office without blinking an eye.  
 
In keeping with Slavic tradition, I had a large box of chocolates for Valya and an envelope with $50 (more than traditional). She instructed me to give the chocolates to the doctor who would treat me. She repeatedly refused the money in keeping with Slavic tradition, but finally accepted it saying that she would share it with the other doctor and her assistant.
 
Valya introduced me to the surgeon, Natasha, who was sitting at an old wooden desk with her female assistant at her side. Valya quickly explained my predicament and lack of authorization to use the clinic. The doctor instructed her assistant to immediately prepare a small treatment booklet which would allow me to receive care at their facility. I then gave the large box of chocolates to the doctor who in turn gave it to her nurses.
 
At that point in the small office, Natasha told me to drop my pants for a look at my knee. For a shy American, this scene with three Slavic women in attendance was a bit embarassing. Slavic men, however, are accustomed to this. They grow up receiving treatment from a medical community consisting mostly of female doctors, dentists, and other medical staff.  
 
Without so much as an X-ray, Natasha immediately told me I had deformed knees and suggested a 10-day therapy regime to include 10 sessions of electro-therapy, a total of 30 injections in my right knee and vitamins. Happy to receive quick attention, I readily agreed. Natasha then began to write feverishly for five minutes filling three medium-size notebook pages. I thanked her and went with Valya to the clinic’s drugstore where I was able to purchase enough medicines and hypodermic needles for a few days of treatment at the cost of about two dollars.  
 
Valya next escorted me further down the same corridor to the electro-therapy room. There a grandmotherly-type doctor in her seventies recorded my name, age and place of employment. She then asked me to sit on a bed in a curtained corner of the room while she prepared my knee for electro-therapy. After about 20 minutes of treatment, the therapist told me to come back the next day about the same time.
 
I then went to the office where nurses give various types of injections. Once again I gave my name and age, presented the hypodermic needles and medicine to the two young nurses working there. One then told me to go into their treatment room. After asking me where the pain was, she gave me three injections in my right knee. At that point I thought the injections for the day were finished. However, the nurse then instructed me to lower my shorts and brace myself for an injection in my bottom. To my further surprise, I received a second injection in my other cheek, and a third one. These last two injections were the vitamins the surgeon had mentioned earlier and which I naively thought were to be taken orally. I took a deep breath when she finished and thought: Only nine more days of treatment!     
 
Things were going smoothly until I went to a local drugstore as directed to purchase drugs and needles for my next injections at the clinic. Neither of the two attendants on duty could decipher the doctor’s illegible handwriting. Finally, to try to solve the riddle, I called Valya, the dentist, who knew the name of the injection, plazmol. I returned to the same drugstore but learned it was temporarily out of stock.
 
Barely able to walk, I went to the opposite end of the same very icy avenue in search of another drugstore. Luckily the next drugstore had plazmol and I purchased 27 vials, enough for the remainder of my therapy. I then made my way back to the clinic for my second day of treatment.  
 
I thought my second electro-therapy treatment went smoothly until the elderly doctor returned and removed the pad from my knee to find that it had been burned. She seemed really upset and asked why I didn’t turn down the knob on the wall. I told her I thought I was supposed to feel a burning sensation. Instead of remaining in the treatment room, she left for the full 20 minutes of my therapy session and now was worried that I would complain to a clinic administrator and that she might lose her job. I assured her I wouldn’t make a fuss. As a reminder of that day, I still have a small scar on my right knee.
 
I continued receiving electro-therapy and three injections into my knee and bottom for the full 10-day therapy, for a total of 60 injections—more injections than I’ve probably received during my entire life in America. The swelling in my knee did eventually begin to go down but I still had a sharp, shooting pain in my knee. After a week I decided to go back to the clinic and again see Natasha, the surgeon.
 
However, when I reached the clinic I found that another elderly surgeon, Volodymyr Volodymyrovich Kononenko, was on duty. I explained the course of therapy Natasha had prescribed for me and my continuing pain to the grey-haired, good-humored doctor.  Volodymyrovich carefully examined my injured knee, bending it in various directions. He then asked me pointedly, “Do you know what this 10-day therapy has done for you?” I said no. He replied, “Nothing!” He dismissed my earlier prescribed therapy as useless and said the only thing the electro-therapy did for me was to burn my knee in several places. He also similarly dismissed the anti-inflammatory plazmol injections into my knee and the B vitamin injections.
 
Instead, he wrote a prescription for a single injection of cortisone which I purchased at the clinic’s drugstore. When I returned with it, he first drained my knee, then gave me a very deep injection and suggested a return visit in three days.  
 
Did the shooting pain in my knee stop after I finished visiting this clinic? Not at all. However, I did learn to manage the pain by circumventing Kyiv’s many steep hills and limiting my use of steps whenever possible.
 
Did I feel better after I stopped visiting the clinic? I was very grateful that I no longer had to search Kyiv’s drugstores for medical supplies, make my way through ice, snow and slush, and climb the steep, crumbling steps to the clinic. And this made me feel better. 
 
(You can also read Walter's expat interview on this site by clicking here:  A Weak American in Russia & Ukraine. -Eds.)