Spoon Full of Sugar

A Soviet ambulance-hearse

One of Almaty’s two dual-purpose ambulance-hearses left over (as best I can tell) from the Soviet period. Who said the Soviets were inefficient?

Although I’m neither particularly knowledgable about nor interested in medicine, Kazakh medical beliefs and the national healthcare system have featured heavily among my conversations since I moved here. From my perspective, at least, local attitudes towards health and treatment are nothing short of bewildering. There are aspects of both traditional, “old-wives-tale”-type prescriptions and proscriptions as well as behaviors lingering from the Soviet period. Many of my discussions with foreign friends attempt to disentangle these two strains and figure out if there are any “merits” (from a Western medical perspective, at least) in the mix of remedies and precautions.

Grandmas will upbraid young women for sitting directly on hard or cold surfaces of fear that doing so will cause the younger woman’s ovaries to detach. Going outside with wet hair or eating cold foods in the winter causes pneumonia, and people looked at me wild-eyed in the winter when I dared step outside without a hat. Most sinister of all, however, is a draft. A skvozniak (сквозняк) through a room can wreak havoc on one’s “organism,” and it is for this reason that in the colder months, especially, there can be no two open apertures in a room. This rule holds true no matter how over-heated the apartment, car or train compartment.

I am lead to understand that because neither patients nor healthcare providers in the Soviet period saw or were responsible for the costs of treatment, medical care was both responsive (as opposed to preventative) and aggressive. When a man entered a hospital in poor condition, the doctors threw the whole kitchen sink of treatments at him, often disregarding the potential negative effects of such physical bombardments. Hospital stays were also prolonged and frequently used by the healthy-but-exhausted as an excuse for a few days relaxation. Workers supposedly checked themselves into hospital in order to catch up on sleep. The result was high rates of in-patient infection. There was also a predilection for injections. Even now, one can get vitamin injections!

I equate the desire for injections to the sounds – the beeps and pings – that computers used to make when connecting by modem to the internet. Those sounds were entirely artificial, but they gave the user a sense of something being done while we waited for AOL or Netscape to load. Getting an injection simply feels medical, and thus doctors go on giving needless injections.

A big problem confronting the medical profession in Kazakhstan at the moment is the low quality of medical education. The education system as a whole is ravaged by corruption: teachers taking bribes, students buying diplomas, and plagiarism by academics and students at almost all levels. Of course this has a negative impact on the country’s human capital as a whole, but it makes one particularly nervous in the medical profession. I was advised that, should I need medical attention, I should find an old doctor with a Russian surname. He or she would have been Soviet trained, and that is (despite what we might think of the Commies) a guarantee of at least some standard of training. Otherwise I might be treated by a doctor who bought his or her medical degree instead of studying.

I don’t really know if it is as bad as all that; knock-on-wood, I’ve not yet been to a hospital here. But I have heard some horror stories, including one young American student returning to the USA after being he diagnosed with cancer based on some flu-like symptoms. Knowing the rumor mill in Almaty as I do, there may be a miscommunication somewhere in the chain of gossips, but I’d rather not put it to the test. I’d be extremely uncomfortable getting into the ambulance-hearse / hearse-ambulance.

  1. Becca said:

    This is a great post Paull, and I can personally confirm it, having now been to more Central Asian hospitals than I would have liked. Travelers in the region should be very aware of food intake/utensil cleanliness/exposure to animals (including not touching stray cats/dogs or farm animals) on the prevention side. On the treatment side, they should make sure their needles are in fact disposable and that they are not being prescribed antibiotics and injections willy-nilly, especially ones that they are allergic to (as happened to me, but luckily I caught it in time). Sadly the medical systems and expertise have vastly deteriorated since Soviet times and are generally not trustworthy. I think our MUSKIE fellows and other US-funded exchange programs should definitely include candidates in the medical fields.

  2. kazaknomad said:

    I can relate to all that you wrote. I know I blogged several years ago about someone in Taras who was trying to get a boy’s arm in a cast and the Kazakh family didn’t have enough money so the “medical” doctor put his arm in a cast but with the bones still broken. Needless to say after much pain, they took the cast off and did it again. (What’s that oath doctors take: “Do no harm.”???) I think this was also where the family had to pay for all the vegetables and fruit to make the hospital canteen look good for the inspection. Of course, you have to bring your own food to the hospital to feed you family member who is a patient. Oh yes, I’ve heard stories. If you keep your expectations low, you may be pleasantly surprised. I know I was and those in the medical field who had the latest equipment from Germany were proud to show it off and use it. Almaty has a LOT of what other cities throughout Kazakhstan do NOT have.

  3. Looking forward to not getting into a hearse when we come visit you next month in Almaty, Paull. I mean an ambulance, sorry…alright either way I don’t want to be in one on my way to get vitamin shots for my draft exposures.

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