Rural Medicine: Remedies and Realities

“Remedies and realities of rural Russian medicine”

Igor pulled up to the local hospital in our UAZ jeep and ran around to the passenger side to pull me out. I winced as he lifted me out and carried me up the crumbling steps to the entryway. Inside, the building was dark, damp, and quiet. After some searching, Igor found a nurse, who directed us into a small room with a three-legged bathtub in the middle. Tiles were missing from the walls and the floor and one of the windowpanes was broken. Soon a man in a white smock and a tall white hat resembling that of a pizza chef came in and pointed me to a low bench in the next room.

“What happened?” he asked.

“I fell off my horse when he spooked upon seeing a snake. I hurt my hip, maybe broke it,” I replied.

He kneaded the flesh around my hip as I bit my lip, trying not to scream.

“I don’t think it’s broken,” he said, just bruised. “Let’s take an x-ray just in case.”

He told us to go to the x-ray room on the second floor, at the end of the hall.

Finding the elevator broken, I hopped up the stairs on Igor’s arm, stifling the screams I wanted to utter with each step. I hopped all the way to the end of the dark hallway, into a large room with a gigantic x-ray machine in the middle. As I lay on the machine, the nurse disappeared and the ancient machine detonated a blast of radiation.

“It’s not broken,” the doctor said, looking at the developed film in the light filtering through the dirty window. Take some pain killers and stay off it for 10 days.

That was my first encounter with a rural Russian hospital. It was 1997, the year I moved to the remote village of Chukhrai to be with Igor and work in the nature reserve he then directed. Chukhrai doesn’t have a hospital or even a country doctor or nurse. The next village – Smelizh, six miles down the rutted road, has a feltcher (village medic), who gives out pills and vaccines. Any greater ills require a trip to the hospital, 40 miles away. Many of my village neighbors have never been to a hospital, relying only on herbal remedies or fate.

Luckily, except for bruising my hip, I had always been healthy and had had no reason to become acquainted with our district hospital and its staff. But, after the birth of our son Andrei in 2001, Igor and I felt that we needed to find a local doctor we could trust. So we befriended the pediatrician at the district hospital. We invited Dr. Sharov and his wife to visit us in the nature reserve, taking them on sleigh rides and introducing them to our banya (steamhouse). They were a very pleasant couple, intelligent and good-natured. Over the next couple years, Dr. Sharov would come to our house to administer vaccines or treat my son when he had a cold. He refused to take money and in time became a good friend of our family. We were grateful for his generosity as he spared us trips to the hospital and waiting in long lines with our infant son. One can’t make doctor’s appointments in Russia. You just show up, get in line, and hope to be seen that day, or the next.

I especially admired Dr. Sharov because, like many Russian doctors, he always suggested herbal and home remedies. Perhaps it was a way to avoid administering unneeded medication, or to help patients save money on drugs, or maybe he just felt home remedies were more effective. When my son’s lungs were congested, the doctor had me rub salo (pig lard) on his chest until it was warm, and then wrap him in a blanket and put him to bed. When his throat hurt, he recommended gargling with a chamomile infusion and chewing beeswax with pollen and honey. When his nose was stuffed up, I had him breathe over a pot of hot water with dissolved baking soda, holding a towel over his head to trap the steam. If one of us was sick, I would hang a garlic clove on his neck to ward off germs. These remedies suited me fine, as the nearest pharmacy was 40 miles away, and I was reluctant to give my son drugs when it wasn’t absolutely necessary. Pig lard, garlic, and beeswax were always available in the village.

It wasn’t until 2004 that I was destined for my next major Russian hospital experience. I was seven and a half months pregnant. I was scheduled to depart for the US in a week, where I had planned to have my second son, Makar, in the same hospital in Maine where Andrei was born. Makar, however, had other plans. Igor had been gone all day on errands in Bryansk, 70 miles to the north, when my water suddenly broke. In a panic, I called Dr. Sharov. I wondered if he could find a midwife to come to the village. I envisioned having a water birth in my own bathtub. He made some calls and called me back, saying that I should go to Bryansk, since Makar was premature and there might be complications that the local hospital couldn’t handle due to its lack of modern equipment.

Igor’s cell phone was out of reach. I had no car. I hastily gathered a hospital bag, taking baby things out of the suitcase I had already packed for the U.S. Slippers, a robe, a change of clothes, a towel, soap, shampoo, dishes, my childbirth book. I would need everything. The hospital would have nothing. I left Andrei with our nanny and asked her husband Sergei to take me to the next village in his jeep, hoping to meet Igor on the way. As we pulled into the next village at about 10 pm, I saw Igor standing by our jeep, the hood open. He knew something was wrong as we drove up, and his face grew pale as his eyes widened.

“My water broke!” I cried.

“The jeep broke down,” he replied. “What are we going to do?”

He and Sergei fiddled under the hood and got the engine running, though there was something wrong with the starter and we couldn’t turn it off the whole way to Bryansk. Two hours later, at 1 a.m., we pulled into the Bryansk maternity ward. A nurse took me by the arm and led me into an examination room, motioning to Igor to leave. Men are traditionally not allowed to accompany their wives during birth in Russia.

“He’s not going anywhere,” I protested.

The nurse said it was not permitted. I turned to the door, saying, “If he goes, I go.”

I was not going to go through this without him. I played my foreigner card, saying I was an American and I didn’t understand Russian very well. I needed him there.

After consulting with the doctor, they let him in. I went through several different rooms and procedures, most of which I rejected to the medical staff’s dismay. They tried to insist, but I was steadfast. I had done this once before without being shaved, injected with needles, hooked up to an IV, or anything else.

For labor and birth I was left entirely to my own defenses. I was grateful that it was not my first time, since no one gave me guidance. I flipped through the pages of my childbirth book between contractions to refresh my memory as Igor held my hand. Makar was born to the sounds of two other women giving birth in the same room at the same time. He was a healthy little boy, albeit a little early, weighing in at just under six pounds. I was moved into a recovery room, and he was taken away. A sandbag called a brick was placed on my stomach, and I was told to lie still. Two hours later Makar and I were united again in a separate room at Igor’s request. They rolled me down the hall on a metal cot with only my feet sticking out. I felt like I was headed for the morgue.

I was kept in the maternity ward for a week, as is the Russian tradition. It was one of the most relaxing weeks in my life, truth be told. All Makar and I did was sleep and eat, and I would read. And I would have slept restfully if it wasn’t for the endless stream of hospital staff doing morning rounds. At 6 am, the woman who collected the cloth diapers would barge in. Then came the woman who gave me a clean gown and disrobed me of my old one, forcing me into the shower bright and early each morning. Then the various nurses would check the baby and me. Then the doctors would come in. And so it went until about 10 am, when I was finally left alone until evening. I could have opted for various procedures. Some mothers got ultraviolet light treatments. Others received some kind of magnetic impulses to their bellies to speed healing. I declined them all to let nature take its course.

At the end of the week, Igor paid $300 for the birth and hospital stay, steep by Russian standards only because I had had a hospital suite to myself, whereas other mothers shared rooms with three to six other women. As I returned to our village and came out of the shock of things not going as planned, I realized that having Makar in Russia had its advantages. He immediately became a Russian citizen (two months later I received his American citizenship as well). Igor’s family was able to spend time with us while the baby was young. The whole affair cost a lot less than it would have in the U.S. And I had the unforgettable experience of having a child in a Russian hospital, where I learned a lot and probably taught the medical staff a thing or two, too.

In sharp contrast to my Russian experience, I recently had my tonsils out while visiting family in the US. The facilities were impeccable, the hospital staff incredibly accommodating, and the doctor professional. I was in and out of there in two hours, though I slept at home for the next three days. When I asked the doctor if he could recommend any remedies to speed the healing and ease the pain, he prescribed codeine and antibiotics.

“Can I gargle with chamomile or something?” I asked, searching for alternatives.

“I don’t care what you do, he replied. Just take the drugs.”

A visit to an American pediatrician for a medical problem my son was having drew a similar response.

Despite the frustration I had experienced in rural Russian hospitals, my admiration for the doctors and nurses there grew. Surviving on salaries of under $300 a month, working without modern equipment or facilities, latex gloves, or rolls of paper to line cots, they had managed to heal generations of Russians. If there is a way to treat a patient without drugs, they first prescribe that remedy, only reverting to medication when absolutely necessary. And, for better or worse, they force people to spend the time and energy to care for their children or themselves, taking a half an hour to rub chests with lard, rather than swallowing a teaspoon of decongestant.

In the village I prepare my medicine chest for spring – a time between seasons when the children seem more prone to getting colds. Beeswax from my father-in-law’s beehives. Garlic from last year’s harvest. Some lard the neighbors brought after butchering their swine. Bushels of herbs collected last summer retrieved from the attic. And beneath it all, a bottle of children’s Tylenol I picked up in the U.S., just in case.