Wednesday, January 15, 2014

Foreign Medicine: Remembrance and Recovery

At the end of an intensive year and a half of study at the Naval Postgraduate School, I submitted the final draft of my master's thesis.  It is titled The Demise of Russian Health Capital: The Continuity of Ineffective Government Policy.  My professors and thesis advisor were excited for the topic.  Compared to topics covered by the other military officers seeking degrees in National Security Affairs, it was a decidedly un-military type of topic.  At the time I wasn't sure what drove my interest, but looking back I think it was an attempt to understand some of my past experiences with the Russian health care system.  The stories below will serve as a belated prologue to my master's thesis.

The Questionable Transportation of Medical Supplies 
At the end of my two month stay at the Missionary Training Center in Provo, I was excited to pack my luggage for my departure to Russia.  While we were wrapping up our packing we were asked to head to one of the administrative offices.  Upon arrival we met with a good brother and were given multiple bags of syringes and vaccines for us to take over in our luggage to the mission home.  These would be used as booster shots for the missionaries.  We were instructed to pack them in our bags to prevent them from being stolen by the Russian customs inspectors who commonly plundered items sent through the mail.

As we prepared to go back to our rooms with the bags of supplies, I stopped and asked a simple question, "Are the customs people at the airport in Russia going to have any problems with us transporting this stuff?  Should we have any paperwork with us?"

The good brother suddenly looked uncomfortable.  Looking down, he said, "Well, we're not sure.  We hope that they won't check or if they do, that they won't care."

Back in our rooms I hoped to get the other missionaries to put all of the supplies into their luggage.  Unfortunately they were not able to fit it all and I was forced to take a large bag of syringes.  If I had been aware then of what it would be like to go through passport control and customs, I likely would have refused to take the package.  It was an especially touchy time because the Russian government had recently started blaming the West, and America specifically, for carrying HIV into the country. 

(For a general story of my arrival in Russia please read the blog at this link: "Welcome to Russia!  Welcome to Siberia!")

When I finally made it through passport control and customs I found my luggage.  Some of my clothing had been pulled out.  Sitting on top was the large bag of syringes.  No questions were asked of me or of the other missionaries who had brought the syringes and vaccine.

Not In My Country, Comrade!
In the late 80s and early 90s HIV was spreading quickly in Russia.  All foreigners were suspected of being carriers.  Any who resided in Russia for any period of time were subjected to random blood tests.  We were given detailed instructions, in case we were selected for testing, to make sure that a the syringe used was new and taken from a sealed package.  Initially, I was shocked to even consider the idea that they recycled syringes.

I was only selected once for a random blood test, while living in my first apartment.  A knock came on the door early in the morning.  A uniformed officer was there.  He asked to see our passports and then invited us to follow him to a local clinic to have our blood drawn.  As we walked through the snow I started to run through my mind how I would ask for a clean syringe.  Having only been in the country for a couple of weeks, my vocabulary was severely lacking.  My only hope was that my companion, who had been in the country for just over three months, would have sufficient skill with the language to keep us safe.  I envisioned two scenarios.  In one they didn't have clean, fresh needles and syringes.  After arguing we would be held down while a nurse pulled a needle out of a sink full of water and other needles, attached it to the syringe, and then it being plunged into my vein to extract my blood while leaving behind pathogens and viruses from others.  In the other scenario, my companion utilized his budding, yet proficient, Russian skills and some cash to convince the nurse to reach into her hidden stash of safe needles.  Then we were arrested for bribing a medical official.

Neither scenario played out.  As we entered the medical facility, we were taken into an exam room where a nurse was waiting for us.  On the table were two brand new needles and syringes still in their sealed wrapper.  The relief was so great that I believe that was the first time I enjoyed giving any amount of blood.

The Novosibirsk Regional Hospital: "Hello, Nurse!"
After two months in Russia I started to experience significant stomach and digestive issues.  The pain would come and go, but it could be quite intense.  At some point my mission president put me in touch with an American doctor the Church had assigned to Moscow.  We spoke over the phone a few times.  I shared my symptoms and he asked me questions.  Without the ability to run tests he was unable to diagnose my problem accurately.  (He did, however, contribute to an incident that scared me badly at the time.  He asked if I had seen any blood in my stool and told me what to expect.  Up to that point I had never really looked.  A day or two later I ate a beet salad and some borscht.  I had never in my life eaten so many beets at once.  Well, the next day, while in the bathroom, I was convinced that I blood in my stool.  Luckily, my companion at the time, who had been in Russia for almost two years, calmly reminded me that I had just eaten a lot of beets and that this was normal.)

The doctor suggested that I visit a local clinic or hospital for testing.  He also instructed me to write down any medications that I was given so I could tell him.  Our mission president gave us permission to travel to the Novosibirsk Regional Hospital just outside of the city.  The director of the hospital had been trained in Germany and our mission president, who served his mission in Germany, had befriended him.  My companion had quietly been suffering from his own ailment so it was a good opportunity for both of us to visit the doctor.

We boarded the bus early one winter morning.  The bus ride took about an hour.  Upon arrival we made our way to the office of the director where we described our symptoms.  He brought in two assistants and gave them instructions regarding which tests needed to be done.  Unfortunately, he split us up.  I was terrified.  While I was beginning to understand more of what was being said, I still wasn't confident or very skilled in my ability to communicate in Russian.  No matter.  We were rushed off in separate ways.

The hallways of the hospital, especially on the main floor, were packed with people waiting in line to be seen.  I heard two people talking about how they had been there for two days waiting to speak with someone.  As guests of the director we were taken to the front of every line.

Approaching my first stop I tried to ask my escort what was about to happen.  I don't remember if I understood or not, but as soon as I stepped into the room I saw a large ultrasound machine.  The previous patient had just finished dressing behind a white curtain and quickly exited.  My escort explained my situation and what tests needed to be completed and then left.  Suddenly I realized that I was alone with two young, female nurses who were very attractive.

As my heart rate begin to rise and I considered running out the door.  One of them smiled at me and said in Russian, "Please take your clothes off."

I responded in my best Russian, "May I take off just my shirt."

She stared at me for a few, uncomfortable seconds before she answered, "Well, okay. Take your shirt off."

After I removed my shirt I lay on the exam table.  One of the nurses sat next to me while the other sat at the desk with my paperwork.  The one next to me squeezed some of the ultrasound gel into her hands.  She rubbed the gel around in her hands to warm it up and then began to rub it onto my abdomen, smiling at me the whole time.

As she was doing this, her partner at the desk asked, "What do you think of Russian women?"

Trying to answer while looking away, I said, "I'm a missionary.  I don't think about that."

Her reply, "Yes, you do.  You're thinking about them right now."

Both of them laughed.

Finally, they got started with the actual procedure.  One moved the instrument around on my abdomen and read off the measurements while the other wrote it down.  Once they were finished they continued to tease me, asking me if all American men were so shy.  I put my shirt back on as quickly as possible and stepped out into the hallway to find my escort.

From there I went for an EKG which was uneventful.  Once the EKG was finished I met up again with my companion.  He went with me for my final test of the day.  They were going to draw a bit of blood for some tests.  I was told it would just be a finger prick.  We entered a lab ahead of a long line of people waiting to be seen.  I only remember a few things about the lab and the experience.  The nurse was wearing one of those cool, old-style nurse hats.  She had me walk over to a large metallic sink where she cleaned my hand with water and then some antiseptic.  She then pulled out a small cylinder made out of what looked to be paper or cardboard.  It was about two inches long and maybe an eighth of an inch in diameter.  She snapped it in half and revealed in the casing a small razor blade with an angle on it.  The light glinted off of the edge of the razor.  Immediately I realized she was going to jab that into my finger to produce some blood.  My knees buckled a little before I recovered.  I struggled to find the words to ask why they couldn't use a small needle.  As I was struggling to speak and stay conscious, she jabbed the razor blade into the tip of my index finger.  Needless to say it produced sufficient blood for the tests.

Following our tests, we met again with the director who told us we would be contacted again soon regarding the results.  He also informed us that another of our missionaries was being seen in the hospital that day for some treatment.  We asked if we could stop by to see him before we left.  We were escorted to another treatment room, a large hall with curtained off areas.

We were somewhat aware of this elder's medical issue.  He had developed a visible and painful rash on his neck.  This wasn't his first trip to the hospital to receive treatment.  Walking into the room we saw his companion sitting on a chair.  He smiled as soon as he saw us.

He said, "Elder Hurlburt (names have been changed to protect the victims) is behind that curtain over there.  Go look at him.  But do not laugh!  The nurse will get very angry if you laugh at him."

Intrigued we made our way over to the curtained off cubicle and looked inside.  I was not prepared for what I saw.  What appeared to be an alien creature looked up at me.  He had two long bronze or copper tubes going up into his nasal cavities.  The tubes came out and each was capped off by a large metallic ball of the same color.  A curly cable was attached to each ball and went back into a large electrical machine that was thrumming at a regular rhythm.  The tubes and balls seemed to be held in place by some type of Ace bandage that had been wrapped around his head several times.  His eyes were barely visible and his shock of dark curly hair was forced out of the top of the bandages.

My first thought was that they had turned him into a Tuscan raider from the planet Tatooine.

Trying not to laugh and remain quiet we asked him what the machine was supposed to do for his rash.

"They are shooting ultraviolet rays into my sinuses in hopes that it will kill the infection that is causing the skin rash."

Standing there listening the thrum of the machine and looking at his misshapen head, I lost control and started to laugh out loud.  Immediately a rather large, middle-aged nurse was next to me.  I'm not sure exactly what she said, but from the tone of her voice it was clear that I was being asked to leave.

A week or two later this same elder had been checked into the hospital for care.  We stopped by to see him when we came back for the results of our tests.  He had been there for a few days and his face was covered in stubble, not usual for a missionary.  As we were visiting in his room he told us that one day a nurse or a doctor had come in to give him an injection.  Expecting the injection in his arm or backside, he was shocked when the person injected the needle directly into his neck and pushed the plunger down.  His skin immediately felt as if it were on fire and the feeling spread.  Once he had recovered sufficiently from the shock he asked the name of the medicine and wrote it down so he could give it to the Church doctor in Moscow.  Then he asked what the medicine was supposed to do.  The answer basically was:

"Oh, we don't know in your case.  Usually we use it for something else entirely, but we wanted to see what it would do for your rash."

Eventually he recovered.  My test results all came back negative, with no obvious problems.  The next step was for them to perform an endoscopy and a colonoscopy.  Due to the invasive nature of those procedures we decided to hold off for a week or two.  Luckily by then I was feeling surprisingly better.

One more quick story about treatment at that hospital.  One of our senior missionaries had developed a painful boil.  The mission president took him and his wife to the hospital for treatment.  As they were waiting in the room, the mission president stepped out briefly.  When he went back into to room the elder was lying unconscious on the exam table.  According to his wife a nurse had come in and given him an injection that put him out immediately and completely, all for a skin boil.

Miscellaneous Hospitals
While I never returned to that hospital or went to any other for treatment, I did have reason to stop by a couple of others.

One day my companion, who was new and didn't speak much Russian, were out looking for a pool we could rent for an upcoming baptism.  We decided to visit a hospital to ask if theirs would be available.  Along the way, my companion realized he needed to use the bathroom and the feeling got stronger as we walked.  By the time we reached the hospital he had an almost overwhelming need to take a leak.  It's important to understand that in Russia, especially at that time, there weren't many public restrooms.  The few public restrooms usually were in parks and cost a few hundred rubles for access and a short length of toilet paper. 

As we entered the hospital, he begged me to ask them if he could use one of their bathrooms.  The lady with whom we spoke was not friendly and did not want to speak to us.  I asked her immediately if my friend could use one of their bathrooms.  She refused and said that none were available.  I told him that they didn't have anything but that as soon as I asked her about the pool we would go find something.  He looked like he was going to cry.

I explained our need for a pool and asked with whom we needed to speak to in order to find out if it was for rent.  She said we couldn't speak with anyone about it because it wasn't for rent.  She was the receptionist at the door.  I was sure if I could get past her I could find someone who would be willing to work with us.  But, I couldn't get her to budge.

Turning to leave, I saw the panic in my companion's eyes.  He grabbed me by the arm, and squeezing said, "Please ask if I can use their bathroom again!"

So, I turned and begged.  The lady started to say no again, and then she smiled.

"I do have a room he can use.  Please follow me."

We walked down a hallway and she showed us the door to a room.

"He can go in there and then you must leave."

With that she walked away.  I looked up at the door.  The sign said "Enema Room".  (For an explanation of how I recognized that word, please see this previous blog post: Incongruities.)  I wasn't sure what that meant exactly so I opened the door and saw a tiled wall with water running down it.  It became clear that enemas were administered in an adjoining room with a separate entrance.  The patients would receive their enema and then rush into this room to complete the process against the tiled wall.

Not wanting to scare him, I decided not to tell him about the purpose of the room.  I said, "Go in there and pee as fast as you can."  I was weak and waited in the hallway.

Unfortunately it was in January and very cold.  It must have taken him some time to work through the layers of clothing.  Suddenly, I heard a scream from inside the room.  It was followed by another scream.  He came running out, holding his coat.

"Do you know what I just saw?  A woman came running in wearing a hospital gown and she...!"  

I won't share his description, but he saw it all.

As you can guess, these experiences likely contributed to my desire to study the foundations of Russian health care.  I have one or two other personal stories, but nobody wants to read about me looking into a room full of dead bodies, bodies with surgical instruments still stuck inside of them.

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