Thursday, May 23, 2013

Return of the Blog: Part I

A friend and I were discussing recently how difficult it was seeming of late to blog about something "interesting."  As you've no doubt noticed, beloved reader, I haven't posted anything for almost five months, which I partly attribute to wanting only to share what I find new and fascinating about living here in Astana.  After eight months here, things are beginning to feel more or less normalized, and my life has acquired the kind of mundanity that doesn't inspire great blog posts.  And, yet, blogging -- like any form of public writing -- is at its core an act of constructed intimacy, of sharing selected parts of one's everyday life in an effort to find some relevance in them.  So, here goes… 

Part I: The Hospital

If what Uncle Lev said about happy families is correct, then I’d like to say the same about hospitals: they are indeed all alike.  Before you scoff at this idea of comparing the Mayo Clinic to a rural hospital in Botswana, consider the commonalities that do exist in every hospital regardless of geography.  

The smell of disinfectant.  The sounds of illness.  The harried faces of doctors and nurses.  And, of course, the endless waiting.

When I broke my elbow in January – on a foolish attempt to beat back impending old age through ice-skating – I made a few visits to the local hospital to get it examined and fixed up.  The hospital, like most things in Astana, is a brand new building – and, like most new buildings in Astana, was undergoing ремонт ("repair") at the time of my visit.  Expatriates in Astana generally receive treatment at an international clinic, but with my local health insurance, I didn't have much of a choice as to where I went.  Perhaps my naiveté, combined with a childhood of visits to third-world hospitals/doctors, made me less apprehensive than some of my colleagues about getting treatment at the quote "local hospital." The hospital facilities were clean and well-equipped, and my doctor had the right combination of tiredness and gruff competence I instantly recognized as a universal trait in ER doctors around the world.  Besides, a broken elbow is a common-enough ailment that I imagine even the most poorly-trained doctor could fix without too much trouble. 

Getting my cast off for a final X-Ray at the hospital. 
This experience was, on the whole, much more pleasant – and far cheaper, costing me a grand total of 0 – than my previous visit to the hospital in the United States a year earlier.  An unplanned visit to the ER with a gastrointestinal infection last year nearly cost me several thousand dollars after my insurance refused to pay the hospital bill on the grounds that I should have followed their procedure by contacting their 24-hour doctor on the phone (in between vomiting, of course) to get permission to go to the ER.  While the insurance company eventually caved in to my demands, the entire experience left me – as many other Americans can attest to – with the distinct feeling that getting sick or in an accident would ruin my life with or without insurance. 

Free (and first-ever) ambulance ride to the hospital.
Since my unexpected foray into the medical world of Kazakhstan, I have been trying to better understand the health care system in this country.  The collapse of the Soviet Union meant that Kazakhstan, like many other post-Soviet states, had to figure out how to retain the free, universal health care system that was no longer centrally funded.  Today's system, as far as I can make out, is a combination of guaranteed public benefits paid for by the state, including emergency, outpatient and inpatient care, and user fees for services outside those benefits such as medications that are either paid by private insurance or patients.  The majority of hospitals and polyclinics are publicly-owned, though there are a growing number of private hospitals and public-private ventures. 

By American standards, Kazakhstanis seem to have it pretty great, considering that an uninsured working adult in the United States could hardly walk into an ER and expect free treatment. 

However, when you look a bit closer at the numbers**, the Kazakhstani system is not without its flaws.  For one, government expenditure on health care is low – less than 5 percent of the GDP in 2009 – and is one of the lowest in the countries of the Commonwealth of Independent States.  Salaries for health care workers, especially nurses, are low.  The resource imbalance between rural and urban areas is marked, but even living in the capital city doesn't ensure better treatment.  A neighbor told me once that it took several trips to get her 3-year-old daughter treated for a fever because the clinic was overwhelmed with patients on that day.  Because one's official place of residence determines which clinic in the city one can visit, her options were limited.  In short, Kazakhstan faces the same health care challenges as many other middle-income countries around the world.

Overall, would I rather have been treated in the United States?  Absolutely.  Despite the costs associated with medical treatment, I do believe the average American patient rarely questions the quality of the care and has recourse when things go awry. (I read a report that suggested that a state commission here began tracking medical errors and negligence only recently).  While the problems faced here in Kazakhstan differ from those in the United States, they are governed by two underlying questions: how much do we invest in the health of our community, and whose responsibility is that investment?  Let us hope that these two societies – and their governments – decide to tackle these questions in the near future.   

Or, at the very least, before my next broken bone. 

**This comprehensive European Observatory on Health Systems and Policies report on Kazakhstan was helpful. 

Next time on Wanderlost… 

Part II: International Women’s Day 

1 comment:

  1. This was well worth the long wait---it is entertaining and informative! And I feel specially proud about the fact that I knew who "Uncle Lev" was :)
    It is sobering to put health care in a global perspective and as someone who has seen many different countries' systems you raise interesting points. I wonder if anyone who has experienced the French or the British system would respond.