Archive for Sunday, January 19, 1992

S HEALTH CARE

January 19, 1992

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Easy access to health care in Russia is overshadowed by a shortage of almost all medical supplies, said a Lawrence doctor and nurse who recently spent two weeks in Russia studying the country's medical system.

Dr. Wayne Tilson, a specialist in emergency and internal medicine, and Lori Heacock, a registered nurse in the Lawrence School District, traveled to the former Soviet Union with a group from Illinois State University in Normal, Ill.

The group toured a regional medical center, four hospitals and 12 "polyclinics" in Vladimir, a Russian city of 350,000 people about 100 miles east of Moscow. Tilson said the polyclinics were similar to health maintenance organizations in the United States.

He said Russian health care was centralized and without private practices.

"ACCESS IS very good," Tilson said. "You can find a doctor and get medical care very easily. They have doctors and nurses in the plants where people work, in the schools and all around the neighborhoods in the polyclinics."

But shortages, faulty equipment and doubts about cleanliness showed that the Russian medical system is years behind the system in the United States. He said Russians were lacking rudimentary equipment, such as rubber gloves, intravenous tubing and needles.

"They use the gloves over and over again until they break or the rubber gets sticky," Tilson said. "They use the tubing until it breaks, so frequently it's brown and doesn't look very good. Needles, the same thing, using them over again until they're dull."

Heacock said the needles are sterilized in autoclaves, but it was hard to tell how well the cleaning equipment worked. The situation has caused major health problems the leading factor in the spread of AIDS in Russia is through the medical system. As a result, many parents are wary of having their children immunized because of the possibility of contracting AIDS from dirty needles.

THE QUALITY of medical care was difficult to judge, Tilson and Heacock said. Russian doctors offered thorough patient histories and physical exams, but they had little diagnostic and laboratory equipment.

"They can really only do plain X-rays," Tilson said. "They have no CAT scans or MRIs (magnetic resonance imaging). What they try to do is give care to everybody on a basic level, and I think our system tries to individualize it a bit more."

Heacock said Russian treatment also was limited because the country is short on medicine.

"They try more short-term remedies that don't require medication, kind of home remedies in some ways," she said.

An example of a home remedy at one hospital was a room with its floor, ceiling and walls covered with salt. They said patients would sit in the room to improve their breathing while viewing slides and listening to music as relaxation techniques.

ONE REASON for the medicine shortage is that only a few companies produced pharmaceuticals in the former Communist centralized system, Tilson said.

"Those are all disrupted now with the republics being independent, and the distibution system is terrible," Tilson said.

The hospital rooms were "nice looking" and generally had four to six beds. Tilson categorized them as something "like you would find at a Boy Scout camp."

Patients stay longer in Russian hospitals than in the United States, he said. Depending on the illness or affliction, a stay can be prescribed for seven, 10 or 14 days, Tilson explained. Since there is no cost, patients stay the entire prescribed time, even if they recover before the time elapses.

HEACOCK SAID Russian hospitals have a kitchen and common dining area on each floor, and some rooms have refrigerators. Patients' families, she said, sometimes bring food.

"In a way, the patients (have) a little more self-care than ours, but they're not as sick as our patients are in the hospital," Heacock said.

Tilson and Heacock said Russians had learned in recent years that their health care was not the best in the world as they had been told.

"They seemed very aware that their equipment was old, almost to the point of embarrassment," Heacock said.

But the doctors, most of whom are women, seemed motivated to give good care, they said. Most of the male doctors were surgeons, Tilson said. On a per capita basis, he said, Russian doctors outnumber U.S. doctors by a two to one ratio.

Heacock pointed out, though, that Russian doctors often undertake tasks that are performed by nurses in the United States, such as taking a patient's vital signs. Tilson said he was struck by how caring the doctors were toward their patients and how well run the hospitals were, despite the shortcomings.

ONE EYE-OPENING part of the journey was a tour of a hospital that had treated only members of the Communist Party. They said the building, which was in a secluded area out of public view, included more and much better equipment and furnishings than the other hospitals.

The Communist Party hospital had been stripped of some equipment after the August coup to oust former Soviet leader Mikhail Gorbachev failed. It now will be integrated into the regular hospital system.

"There was a big discrepancy before," Heacock said of comparing hospitals. "They almost have more class separation than we do."

Tilson and Heacock said they planned to send medical journals and supplies to the hospitals in Vladimir. They also will sponsor the trip of a Russian physician to Lawrence and Kansas City later this spring.

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