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

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