22 December 2014

How to find medical care in Astana

We may have left Astana a few months ago but finding (and coping with visits to) a doctor were such an important part of life there.  I meant to post this some time ago but  the demands of moving caught up with me.

Medical care in Astana ranges, in typical post soviet style, from the excellent to the dreadful.  You can find treatment for just about anything but you will not necessarily receive the comfort or care that you might expect back in your home country and the bedside manner is very different.  Doctors also subscribe to a holistic view of the person so expect to be given alternative and homeopathic remedies alongside your prescription.

Medical services in Astana can be confusing, particularly for expatriates as specialists transfer between hospitals so you may go to different hospitals on different days to be seen for one particular problem. Expatriates tend to have international standard health insurance managed through a local clinic, many of these claim to speak English.  Most of these claims are fanciful at best so be prepared to translate for yourself or bring a local friend along and give up all rights to medical privacy.  The standard of English at SOS is generally decent – they provide GP services and will arrange hospital appointments where necessary and attend with you to translate.  They have helped us with ophthalmologists, dentists, radiology etc.  OB/Gynae assistance was provided but was not as smooth as other services.    

Many of the clinic services will also claim to provide 24 hour responses but again not all of them do.  About one year in to our time there our daughter came to tell me that our son could not breathe.  I went to see him (of course this would happen when my husband was away on business and in the depths of winter), his lips were turning blue and he was rasping.  I was concerned that he was suffering from epiglottis (try working out how to explain that in a foreign language at 1 am) and called our clinic (who had promised a 24 hour emergency response) to hear that they worked only 8am-8pm.  I called our head of HR who was the emergency contact but she was travelling for the weekend and her ‘phone was out of signal.  As I did not know which hospital was providing services that evening I called our insurance international hotline and had my son assessed over the telephone.  They were mostly sure that he was ok but given his age and symptoms they wanted him checked by a doctor on the scene.  They were able to co-ordinate with one of the other clinics to make an appointment at the Mother and Child hospital and I then had to drive out in the middle of the night to find them.

Our employers changed clinics the following week and we found ourselves with SOS who do provide a guaranteed 24 hour response and ambulance services, in fact in the scenario we had experienced they would have sent a GP out for a home visit to decide whether or not hospital admission was warranted – a much better system.  A few weeks later I found myself using their services as I had suddenly become very unwell and needed an operation.  They arranged for pre-op  tests in Astana and then arranged for me to fly to Germany for the operation as they were not confident that the hospital providing those particular operative services that week was safe. 

Kazakh doctors tend to overmedicate. This collection
was for a simple case of tonsillitis.  
You can find yourself being given somewhat strange remedies – a visit to the dentist resulted in me being given super strength pain killers (phenol-barbitol!) and a herbal mouthwash.  When my daughter had tonsillitis we left the surgery with antibiotics, an antiseptic spray, painkillers, probiotics and a herbal remedy.  In the UK you just get the antibiotics and then only if you really push for them.  Conversely when I came down with tonsillitis a few weeks later I was given nothing at all except for instructions to have someone scrape my tonsils with a spoon dipped in hot antiseptic (they told me that I should ask my husband as I would bite the person who did it so it might ruin a friendship).  I was expecting our third child at the time and Kazakh doctors seem to take the precautionary principal very seriously with regard to medicines and pregnancy, the exception to this being herbal remedies – I was given prescriptions for all sorts of strange concoctions that I have to say went straight in the bin! 

Top tips:

  • Make sure that your insurance registers you with a primary care clinic.  In my experience SOS provide the best service.  
  • Download an app like google translate on your phone and enable a Cyrillic keyboard.  That way if you do not speak Russian or have an interpreter you and your doctor can communicate through google.
  • Check dosage instructions, contraindications and potential negative interactions of medicines thoroughly with the Doctor.  Pharmacists will very rarely double check your prescription with you and will not happily answer questions.  Instructions on the packets will usually be in Russian or Kazakh.
  • Following on from this if you are on regular medication bring it with you when seeing the doctor.  Sometimes your home doctor will have prescribed something that is not regularly used in Kazakhstan and it is helpful for them to be able to check the medicine and its interactions with any prescription they would typically write as they may need to amend their usual practice.
  • While Dr Internet is a recipe for worry and disaster it can help to research your medical issues before you go to the doctor.  Medical paternalism is still rife in Astana and doctors will not volunteer information, particularly when there is a language barrier, you will need to be quite specific in your questions.
  • Your insurance will probably have a 24 hour medical hotline in addition to the claims people.  Don’t be afraid to call them to check any questions you have with regard to your treatment or medication.
  • Try to arrange for regular ‘well woman’ or ‘wellman’ tests to be done in your home country when you are back – it is just easier than wading through results in Russian and coping with different cultural norms of privacy.
  • If you want your child to follow the immunisation schedule of your home country arrange for a letter from your home doctor outlining the schedule and provide this to your primary care clinic to arrange necessary injections.  You may have to give this to your child’s school and make it very clear that you do not give automatic consent to the Kazakh schedule.  We were quite happy for our children to sit on the Kazakh schedule but you may not wish to interrupt a part established regime.  
  • Try not to worry – the doctors want what is best for you.  They might not explain in the same way that you are used to but if you are having a heart attack you want them to treat you not talk.  Methods of treatment may be different but at the very least they will be providing the best available care to you.  One of my husband’s colleagues had an emergency appendectomy at a local hospital and was well looked after – certainly better than having an appendix burst on a flight to Europe or Dubai. 
Click  on the picture for more posts on life in Astana.

Ersatz Expat

11 December 2014

Expat Memories

This week's post is a self indulgent memory. 

I have written before about the problems of bureaucracy that are created by expat life.  As we are sending a request for our newborn daughter’s first passport back to the UK we decided to renew our other daughter’s passport at the same time.  She has only about 8 months left to go so we may as well get it done now.  They should be processed together (or so we are told) and then we will minimise the amount of time we are without papers for the girls. 

Paddling in Lake Bohinj - Slovenia
I have been leafing through her passport and I realise it is a record of her life.  Of course, holding an EU passport means that many of her experiences are not tracked.  Her trips to Ireland to meet my father’s family or our holiday in Italy where she delighted us all with her ‘ballet’ shows.  Our four week driving holiday in Europe with our tenacious girl who at 18 months walked through Budapest with only the odd piggy back, paddled bravely in the icy cold Lake Bohinj in Slovenia and giggled away as we read George’s Marvellous Medicine to while away the motorway miles.  All of these are invisible - even her return trips to the UK to see her grandparents are tracked only in exit stamps from our host countries. 

Exploring Tuscan towns
But more experiences are documented than not.  The visas to Kazakhstan track her development from precocious 2 year old to sophisticated 5 almost 6.  Our tiny little toddler has grown into a confident child, quick to smile and laugh.  Our girl who could hardly dress herself now showers on her own and chooses her own clothes, makes her own packed snack for school and reminds her older brother to bring his sports or swimming kit on the right days.

Early days in Kazakhstan - learning to walk in the cold.
The stamps for Lebanon bring back to my mind our just three year old, meeting her Granddad, Step Grandmother and Auntie for the first time since leaving England.  I remember her expression when she saw my sister in the Airport – she ran straight to her and would not leave her side for two hours.  She was able to explore crusader castles, see the legendary Cypresses and the Jeita caves.  I remember her charming the military garrison at the Tripoli castle and the pair of us running dripping into the souk to get out of some truly nasty rain.  I think how lucky she was to go there before hell descended once again on that beautiful country.

Exploring Kazakhstan - Borovoye Lake
The visa for Russia brings back memories of her tramping down Arbat and through Red Square, frozen in the icy winds and snow that had unexpectedly descended on spring time Moscow – thank goodness we had our Kazakh winter gear with us.  Our brave girl walked for miles, undaunted by the weather but ever so grateful for a restorative hot chocolate from time to time.  I remember seeing the understanding dawn on her that Russian was  a world language –every bit as useful as English and not just for use in Astana and impressing the staff at museums and in restaurants as she chatted away confidently.

Playing in the Moscow Spring
Defrosting indoors.
The stamps for Turkey bring back memories of her first trip to Istanbul – exploring the Topkapi Palace, the cisterns and the Sulemaniye mosque – places I had explored as a teenager.  I remember her enjoying the Grand Bazaar – getting sweets, tea and cuddles from all the shop keepers we spoke with.  I loved watching her dance at the wedding of an old friend of mine and introducing her to people I had known and loved in my years living in Turkey.

Hagia Sophia (plus scenic scaffolding!)
They also bring back memories of our trip to the South West where I was able, finally, to fulfil a dream of 20 years and see Ephesus and Pamukkule and enjoy this with the children.  Our daughter discovered a love of carvings - one of my favourite photos shows her running her hands over some plinths in Aphrodisias (with the full permission of museum staff) – enjoying the tactile nature of the carving and then pointing out similar carvings as we went round the site.

Walking around Kaya Koyu
In my memories I see her spend her first day ever on a sandy warm beach  and play in the sea, my mind watches her learning to swim in the pool at our apartment, enjoying pancakes in a roadside café after roaming through the ruined village of Kaya Koyu and wondering through the famous Lycian towns that pepper this part of Turkey. 

Her visa for Cambodia is redolent with memories of Angkor Wat, a place she professed (age 5) that she had wanted to see ‘since forever’.  She enjoyed her time there so much that one year on she talks happily of the beautiful apsara carvings and her friend Mr Theng, our Tuk Tuk driver.  When my husband and I married we honeymooned in South East Asia.  During the trip we went to Ayutthaya and I remember us saying that it was probably the closest we would ever get to visiting Angkor.  I am so pleased that this has changed and we were able to share it with our (older) children. 

Holiday in Cambodia.
Fascinated by carvings
When I look at her entry stamps for Kyrgyzstan I remember how she enjoyed the Burana Minaret and the trip along the Silk Road from Bishkek to Cholpan Alta on the shores of Lake Issykul.  She became very ill very quickly with a nasty bout of tonsillitis the day we were due to fly back to Astana.  It was not worth enduring a Kyrgyz hospital for antibiotics as we were due home in less than 18 hours and I remember how she bravely wondered from coffee shop to museum to coffee shop with a horrid temperature and a scratchy throat as we bought enough drinks to give her an excuse to sleep on a comfy sofa for an hour at a time before moving on to the next place.  I have never been so pleased to get back to our rather rickety healthcare provision in Astana!

On top of the world - sick but enjoying the old Kyrgyz Silk Road
Her final entries on the passport are her visa for Malaysia and stamps into and out of Brunei (trips to take Granny to see monkeys).  Every time I see her Malaysian visa I think about how well she has coped with this move (the first that she really understands), saying goodbye to her friends, teacher and school and launching herself into a new adventure.  The move has transformed her as well – there is less of the Central Asian sophistication and more of the South East Asian cute to complement her sunny, smiling personality. 

Six years on - playing by the South China Sea
So many of these experiences she has only had because she is an expat – we would not have flown to Cambodia from the UK, spent spring in Moscow, Christmas in Lebanon or Easter in Kyrgyzstan. She has packed more into her six years than many do in a lifetime and in the process she has learned to appreciate all the advantages that our life brings.  Whenever I am back at my father’s house I love to look through the pages of my old passports and the family photograph albums, marrying together photographs with stamps.  When our daughter’s old passport is returned to us I think I will scan the pages and put them, together with photographs and some memories, into a scrap book so that she can revisit them and share the memories with her own children in time.  

This blog is part of the My Expat Family Link Up hosted by Seychelles Mama - click on the link to read the other fascinating blogs on expat family life.

Seychelles Mama

Click on the picture for more posts on the challenges of expat life.

Ersatz Expat

2 December 2014

How to buy a car in Sarawak

We were one of only a handful of expats to buy a locally registered car (as opposed to a diplomatic registered car) in Astana.  The whole process was long winded, tiresome and incredibly confusing.
Here in Sarawak most expats buy their own car and the process is very easy.  

Miri is home to many second hand car shops (and a number of dealers).  Most cars for sale are either the Malaysian brands (Perodua and Proton) or Japanese models.  If you buy a new Japanese car you should check whether it is CBU (completely built up or made in Japan) and CKD (completely knocked down or build on license in Malaysia.  Second hand cars may be ‘recon’ (reconditioned).  Unfortunately most cars are automatic and it is difficult to find a car with a proper transmission.

Many people choose to buy a 4x4 – either a double cab flat bed truck or a seven seat/five door car.  I have wanted a flat bed for many years but sadly it is not practical for us here in Miri as the dogs need an air-conditioned boot to ride in so we went for the seven seater option.  This has the benefit of ensuring that all the family plus dogs can travel in the one car and that we can transport visitors without the need to take two cars on trips. 

Most dealers will sell the car with a finance package, road tax, registration and insurance.  If you prefer you can take out finance with your bank.  As with most car finance packages the larger the deposit the better value the repayments.  We looked at several finance options on newer cars but we wanted to buy something fairly old but in decent condition that would hold its resale value reasonably well and preferably to buy outright rather than finance (we had the proceeds from our Astana sale).  We had heard that it can be difficult to get financing on cars older than 10 years in any event.  It is also possible to purchase cars through private sale - many local internet forums list cars but make sure to check any judgements outstanding against the car and make sure that the ownership is proved if you decide to go this route. 

A colleague of my husband’s had an older car he wanted to sell so after a few test drives and an independent garage check we decided to buy it – we are now the proud owners of an ancient Mitsubishi Prado.  It certainly seems comfortable and the kids are looking forward to my being able to give their friends lifts home for play dates.  We decided to register the purchase in my name – the Astana car was in my husband’s as I was out of the country when the purchase went through.  This caused us endless problems as he had to  authorise any work, be present for the annual check and sign all sale documents.  Finding time in his schedule was next to impossible.  I was slightly worried that the authorities would not want me to own the car as I am on a dependant visa and driving on an International Driving Permit and not a Malaysian licence.  This did not, however, seem to cause any problems at all.

The purchase and insurance process was fairly simple and is handled by the JPJ (Road Transport Department) in Miri. We used an agent to help us as all registration papers are in Bahasa Malay.  We had to provide passport and licence copies for all named drivers, the passport of the seller and my passport as the purchaser.  We had to sign the transfer ledgers in the presence of the JPJ official and the registration paper was then stamped in my name, I paid for the Road Tax (about 800RM (£150)) and insurance for a similar amount.  The tax sticker and cover note were issued immediately and the car was mine to drive.  The whole thing took less than an hour - much simpler than the multi-step/multi agency process in Astana.  

The tax sticker, certificate of ownership and proof of insurance have to stay in the car at all times and must be produced if required by the police.

Click on the picture for more posts on life in Borneo.

Ersatz Expat