Kaliningrad doctors - Expat in Kaliningrad, Russia

Have you heard the one about the expat Englishman at the Russian doctor’s?

15 December 2023 ~ Kaliningrad’s Healthcare System Compared to the UK’s

The majority of us climb the hill if not exactly with ease, then at least with a sense of relative complacency. It is only when we pass our peak and go rattling off down the other side, with bits flying off us on the way, that healthcare, and quality of healthcare, begins to figure more prominently in our lives. Accessibility, efficacy (and ‘if I go into hospital will I come out alive?), take on greater meaning when we are over the hill, or, to paraphrase a friend who has just turned 76, when “we spend more time at hospital than we did in the past.”

I was hardly surprised, therefore, that on letting the cat out of the bag back in 2018, ie the cat called Moving to Russia, one of the top 10 questions directed at me was, “What’s the health service like out there?”

It was a valid question and one that only now I feel I have a worthy answer for.

Kaliningrad’s Healthcare System

It was December 2018, and we had just left England bound for Kaliningrad. I had a huge travelling case crammed with winter clothing and was carrying one other weight: I was feeling under the weather. The thought flashed through my mind that I must be coming down with something, and sure enough, within forty-eight hours of our arrival, a right old snot of a cold developed. I searched around for someone to blame, as you do, and homed in on a friend who had exhibited signs of a sniffle but removed him from my suspect list almost as soon as I put him there, noting wryly that he was the type that would give you nothing and then invoice for it later.

Over the next couple of days, the ambient temperature continued to fall, whilst my body temperature continued to rise, and it wasn’t long before I found that I was incubating one of the most distressing respiratory illnesses that I had experienced in a long, long while. It should be noted that the symptoms to which I refer occurred pre-coronavirus, so although I was uncomfortable, I was not unduly concerned.

Three or four more days passed, and my health continued to deteriorate. Now it was getting serious. I had just arrived in my favourite city and should have been skiing from bar to bar, not holed up in a hotel room playing master of ceremonies to my own snot fest. None of it was good and eventually, against my biased judgement, I had to give in and go to the doctors.

Kaliningrad’s Healthcare System Compared to the UK’s

There was no messing. In England I had grown used to having to fight to get a doctor’s appointment. The UK surgery where I had been registered subscribed to a policy whereby on no account should prospective patients gain access to a GP easily, at all or ever. Sore throat or ‘knock, knock, knocking on heaven’s door’, you had three options: (1) claw out of your sick bed ready to phone the surgery at 8am sharp (On your marks, get set, go!!) whereupon nine times out of ten the line was engaged; (2) book an appointment via internet access, which again necessitated a countdown procedure, commencing at 8pm sharp. Note that within the space of two minutes all the appointments for the following day were gone, your doctor of choice was not on the list, and if you wanted to book in advance, your next appointment would be three weeks minimum; and option (3) physically turn out of bed and drag your sad and sorry carcass up the road to the surgery.

Waiting to see the doctor in the UK — **Have you been waiting long to see the doctor, Mr Hart?**

With the last option being the only real option, it was imperative that you were outside the doctors by a quarter to eight in the morning, since any later than that, the queue, whatever the weather, would be 15 deep or more (pretty grim stuff if you happened to have a leg complaint or are practically on your death bed). Oddly enough, this option almost always resulted in doctor availability, completely contradicting the ‘no appointments slots left’ message routinely rolled out on the ironically named Patient Internet Access. Before proceeding, however, I feel obliged to add that this process had a strong inherent dissuasion factor: (a) the reception staff were incredibly rude, and (b) you were required to state very loudly at the reception window what it is that is wrong with you.

“So, what is the matter with you, then!?”

“I’ve got a pain in my lower abdomen.”

“Speak up!”

More quiet than before: “I’ve, er, got a pain in my lower abdomen.”

Someone behind you, way back in the queue: “His balls hurt!”

So much for patient confidentiality.

It’s rather like the post office experience:

Lady behind the counter: “What is in the packet?” Loud voice; queue of 20 people behind you and getting longer every minute.

“Er, I’d rather not say. It’s confidential.”

“You must say. It’s the rules!”

“Mumble, mumble …”

“Speak up!”

Very loud voice: “A selection of dildos, an inflatable doll and a hundred extra large condoms.” (Admittedly, the ‘extra large’ bit was gilding the willy somewhat.)

This is not something I do at the post office regularly, you understand, only when I’m in need of a different kind of entertainment.

Kaliningrad’s Healthcare

OK, so, what’s it like getting to see a quack in Kaliningrad? I hear you impatiently say.

Before I proceed to whisper these facts in your ear, let me at once clarify that I was not accessing the state healthcare service. I was going down the private route. This is what I found.

There is no GP practice as such, at least not in the sense of a gatekeeper. Whilst I had a very good GP and an extremely patient one at that in England, there are reasons to suspect that in the UK one of the GP’s most important roles is to obstruct you from seeing a specialist. And, of course, for a very good reason ~ the good old NHS is buckling under the strain of an ever-rising population, more and more of which needs access to its over-stretched services.

In Kaliningrad, you self-refer, or rather refer by recommendation. Thus, as I was suffering from a respiratory problem, my first port of call was a specialist in this field.

Having decided who I needed to see in terms of which medical discipline, all I had to do was telephone the clinic of my choice ~ yes, telephone and speak to a real person! We did this, were answered immediately and an appointment was made for the following day.

To ensure that I arrived on time for the 10am appointment, I took a taxi. The medical establishment to which we were taken looked neither like a typical UK doctor’s surgery or hospital. It was a fairly non-descript building, possibly Königsbergian, set back from the road in its own yard and surrounded by a high and rather wanting wall.

The reception area was small, the staff, three in all, standing not sitting behind a tall counter. My wife checked me in, whilst I sat on a bench restyling my footwear with a pair of those delightful blue plastic shoe covers. Once on, we were off, but not into a large waiting room as in the UK, off along a maze of narrow corridors, containing doors with sequential numbers. On reaching the numbered door behind which my doctor lurked, we took a seat outside.

Waiting time to see the doctor was no more than 10 minutes. About seven minutes elapsed, and we were on.

The doctor was female (90% in Russia are), middle-aged, wearing a white coat and rather more officious than most British doctors. As my command of the Russian language is only applaudable when the Russian people to whom I am speaking have consumed copious amounts of vodka, my wife did the talking ~ she usually does. The doctor listened attentively, fired off half a dozen questions and ~ here’s something that you do not see any longer in the UK ~ wrote down my responses on a sheet of paper. Out came the stethoscope and there I was, shirt up, breathing in and out.

On completion of the examination, the doctor sat down, took a deep breath and delivered the verdict. Olga translated as the monologue proceeded.

“It’s bad.”

“It’s very bad.”

“The doctor cannot be sure, but there is a possibility that you have pneumonia.”

“This could be very serious.”

“The doctor recommends that you have a chest x-ray to see if you have pneumonia.”

I sat in silence, thinking that all the pneumonia cases that I had ever witnessed had been in Hollywood films, such as Gone With The Wind. (Was this film sponsored by Gaviscon? If it was, the sequel would have been, Wind Gone and With It The Money.) In such films as these, pneumonia patients were hot and sweaty, feverish, confined to their beds and in a right old ‘two and eight’. The thought of it made me cough.

Meanwhile, the doctor had produced a blue lined and letter-headed piece of A5 paper and was writing, what exactly? It looked like War & Peace, but it turned out to be a prescription.

Kaliningrad ~ a Haven of Chemists

The Aptika (dispensing chemists) was just on the corner (every corner, in fact). I had a list of pills, potions and embrocations as long as my, let’s see, ahh yes, as long as my arm. Talk about kill or cure. And these medicines were not cheap! It’s a good job that I hadn’t gone to the doctor with a case of bad arm, or else I could never have pushed them home in the wheelbarrow made for the purpose.

I am not a pill popper, in fact, I try to avoid them like the plague, but I was losing valuable beer time, so on this occasion I sank the pills and within a week, I was on the road to recovery, and within a fortnight off to the bar. I never condescended to undergo the chest x-ray to determine whether or not I had contracted pneumonia, as x-rays are like pills to me ~ I don’t go a lot on them ~ and, in my judgement, whatever it was that was ailing me (and it wasn’t ale), the symptoms were not pneumonic. The end for me did not seem nigh; but for my cold it certainly was.

Ambulance in Kaliningrad, Kaliningrad’s Healthcare System

About three months later I was off to the doctors again. I usually need a Dr fix every two months or so. This time it was for something different; something more sinister.

Our appointment was at the same place, the admin procedure was the same, but the doctor was a specialist in a different field. He was an amiable fellow with a pleasant personality, but, once again, when it came to the diagnosis, and indeed the prognosis, out came the black cap.

“It’s very serious,” my wife barked. “I told him [the doctor] you won’t take what he prescribes, and he said that if you do not that will be my problem, as I will be the one nursing you at the end …”

I must confess that I left the clinic and headed towards the aptika under such a preponderous gloom cloud that I couldn’t have felt more despondent had I been walking arm in arm with the Grim Reaper himself. A wheelbarrow full of medications later and my wallet 100 quid lighter, I felt like the Reaper had mugged me. And, no, much to the chagrin of my good lady wife, I did not take the medications, as research advised against it.

Two weeks later, in response to the same illness with which I had presented to the doctor, I elected to undergo an MRI scan. The appointment was made, and I was admitted within a week. Admittedly, the scan was undertaken at a very funny time of day, 11pm at night, but all it took to get an appointment was one quick phone call and 40 quid from my wallet. The results were handed to me twenty minutes after the test, both in hardcopy and electronic disk format, together with recommendations as to which specialist(s) should be consulted.

Summing up, therefore. From my own experiences with the Russian healthcare sector, I would say that ease of access gets ten out of ten. All you have to do is pick up the phone and make an appointment. What Bliss! I am old enough to remember a time when this is all you had to do to get an appointment in England. The phone call took less than a couple of minutes, and I was in to see a specialist the very next day. Cost £10-£15.

Kaliningrad medics van. Kaliningrad’s Healthcare System

I am not so enthusiastic about the prescription ethos. In England, doctors routinely send you home with the simple directive to take Paracetamol or Gaviscon. Here, in Kaliningrad, you are sent to the nearest aptika to buy shares in several pharmaceutical companies. Both approaches have their shortcomings: go home and take paracetamol for a week and come back if you are not cured involves another round of appointment roulette and, most likely, considerable worry, or you might just go and peg-it!; head to the chemists and buy a hundredweight of pills severely robs your pocket, threatens to give you a hernia and is liable to scare you to death.

But where I believe healthcare provision really loses out in Kaliningrad to its UK counterpart is in what used to be quaintly (and suspiciously) known as ‘the doctor’s bedside manner’. (When I was a boy, our British doctor was known by the sobriquet ‘Grabem’ ~ work it out for yourself!)

In the main, British GPs and NHS staff, from top downwards, are friendly, considerate, relaxed, reassuring and embody the true spirit of compassion and goodwill ~ obviously, there are exceptions. In Kaliningrad, an old-fashioned brusqueness prevails, no quarter is given and sensibilities are none too high on the pecking order. So be advised, you may go to the doctors with hope but may well return believing it’s hopeless!

Once again, however, one needs to be careful about over-generalising. In the course of my illness regime, I was introduced to two wonderful specialists here in Kaliningrad, whose down-to-earth attitude and amiability dovetailed reassuringly with their holistic efficiency ~ their trained ability to assess your symptoms within the parameters of their own specialism and, where need be, to recommend other fields of follow-up specialisation.

On the diagnostic front, access to private healthcare in Kaliningrad is reassuringly swift, and throughout the various procedures to which I subjected myself, I felt that I was in good hands and have no gripes about the level of efficiency or efficacy of outcome. The clinics that I attended were smart and clean, the attitude officious but professional and the time for which the appointment was made was the time the appointment took place. No overburdened waiting rooms; no running impossibly, annoyingly, frustratingly nerve-rackingly and, arguably, dangerously late.

I suppose at the end of the day, one needs to be philosophical about healthcare wherever it may be: for whether its Dr Death or Dr Grabem, one paracetamol or several crates, where medicine is concerned the lottery rule applies: you pays your money and you makes your choice! Conveniently for me, I was happy with the choices made.

Feature image:
Mick Hart wearing silly mask. At this clinic I decided to try ultrasound. I have to say that, without wanting to give the impression that I am an ultrasound addict, the going over was very thorough and the lady ultrasound doctor very nice!