Putincare: Russia’s Alternative to Obamacare

(Voice of America – James Brooke – October 31, 2013)

James Brooke is VOA Moscow bureau chief, covering Russia and the former USSR

With Obamacare dividing the U.S., I thought it my patriotic duty to do an undercover investigation of “Putincare.” My weekend did not have the drama of Solzhenitsyn’s 1967 novel “The Cancer Ward,” but it had its moments.

The Soviet Union had a two-track health system: for the Communist Party elite and for the masses. Modern Russia also has a two-track system: for cash-paying patients and everyone else.

For me, it all started a year ago. I noticed an odd cyst on a normally hidden body part. Alarmed, I took the classic expat step: off to the American Medical Center.

Foreigners like the American Medical Center and its rival, the European Medical Center, for two reasons: pretty trilingual nurses and pretty English language invoices that foreign insurance companies swallow without squawking.

The hospital names seem to be largely labels for marketing to Moscow’s golden 1 percent. These successful clinics are champions in overcharging. I once visited one of these centers to kick a bad cold. Ninety minutes later, I was presented with a $800 bill. Their smooth technique puts Moscow subway pickpockets to shame. So when I visited the urologist, I turned down his offer of a full body MRI but followed his advice on buying lots of medication.

Four months later, the problem continued unchanged. I went back to the same department. But there was a new urologist. After questioning, I learned that first doctor had been let go for “mistakes.”

Great, I thought. We can start from a clean slate.

The new doctor was snapping on his rubber gloves. Plok! Plok! This exam got off the track.

More tests, more prescriptions but no MRI

Two months later, no progress.

Finally, in August, I got a reminder from a place where Moscow’s male elite receive the best health tips: the medical ads posted above urinals in the international terminal at Domededovo Airport.

Google took me to a street behind the Moscow Zoo. There I found a Russian clinic and a quiet, businesslike doctor. The clinic was efficient: tests on the spot, pay by cash and lab results by email.

The doctor himself called me in with the results. All was OK except for one test. He used a phrase you do not want to hear in any language: ?????????????? ??????? ??????, or “precancerous cells.”

I decided to surrender my private parts to Putincare.

I Googled the specialist hospital. It was the same one the Soviets rushed Lee Harvey Oswald to in 1959 after he tried to commit suicide in Moscow’s Hotel Metropol. I figured it must be elite, right?

Russian friends guided me through an obstacle course of building passes, advance payments and meeting doctors who did not give out e-mail addresses or cell phone numbers.

Putincare is stuck in the 1970s. My file was a swelling batch of papers, updated by blue pen and hand-carried from office to office. At the same time, however, all professionals had solid Western exposure.

The head anesthesiologist talked excitedly about her upcoming trip to San Diego for an anesthesiology congress.

Her main question was: “Don’t they have fotodinamicheskaya terapiya in the U.S.?”

To which I replied huffily: “This is not “meditsinsky turizm.”

I added proudly: “I live here.”

Her eyes rolled. My heart sank.

Check-in time came in early October, five weeks after the original diagnosis.

I arrived with my big bag, prepared for a weekend of urban camping. I had been told to bring a knife, fork, spoon, plate, mug, cup and bottled water. I added comfortable pillow, battery-powered radio and a three-meter extension cord for my laptop, although no WiFi was available.

I was soon settled into my room and getting acquainted with my new roommate, Sergei. He was a gregarious patent lawyer with a disconcerting circular scar in his forehead.

At 4 p.m., I was summoned to the office of the operating doctor. She brusquely informed me that I had four hours to buy three flasks of photodynamic therapy radachlorine for $1,300 cash. In all of Moscow, only one pharmacy had radachlorine in stock, and it was 30 kilometers away.

I turned on the irritation, dialing it to medium high. The doctor did offer a “concession”: She personally telephoned the pharmacy and reserved three flasks in my name.

Scrounging up $1,300 in crispy cash on a four-hour deadline was not easy. Two weeks earlier, I lost my Citibank card in a mob scene at the opening of the Krispy Kreme donuts store near Red Square.

But thankfully, hospital lobbies now come with cash machines. By using my Visa card, I milked the money machine for $1,300. Of course Visa pocketed another 6 percent: 3 percent for cash plus 3 percent for a foreign transaction.

Later, a Russian friend told me that I could have bought three flasks of radachlorine for $800 if I had ordered in advance. Hmm, could that be why the pharmacy wanted the name of the referring doctor? But, do you really want to irritate the doctor who is about to drill your private parts with the Photodynamic Therapy Light Beam?

That evening, Sergei stomped out of the room, announcing he want to watch TV Rain, the opposition channel. So he stomped off. Peeking from my covers, I thought: whatever.

The next morning, the A-Team arrived. I was fast-forwarded in only a few meters from 1983 to 2013. I was in the Photo Dynamic Therapy Room.

Danil, the congenial, red-haired anesthesiologist greeted me and launched into a long anecdote about a 100-year-old American man driving in Nebraska, a highway patrolman and sex. He prepared two large syringes. I thought: whatever.

One hour later, I was rolled back into Room 1, my room where patients supply their own soap and toilet paper.

The next two days were a blur.

There was the nurse who expected all patients to hobble to meals, juggling trays and catheters in the food line. Then, there was lovely Saida, the nurse from Dagestan with bewitching, coal-black eyes who came only once to draw blood.

Sergei was incredibly generous. His surgery was postponed, so he gave me two large sacks of fresh fruit, which I took home and gradually consumed.

My exit interview with the doctor was brief. She suggested that I take it easy for a month. She said there was a 95 percent probability that I was cured.

She neglected to mention that healing involves excruciating pain. (Note to cross-cultural researchers: Outpatient pain control not high priority with Putincare.)

Three weeks later, I drove behind the zoo to visit the clinic for a second opinion. The doctor gave me a qualified clean bill of health. And he said the checkup was free.