Thursday, 12 February 2009

Our continued solo-family financial support of the SOS clinic in Almaty

As previously described, our key concern about moving here was the lack of adequate medical facilities in town. It is not that Kazakhs are all dying on the streets for a lack of doctors (although I believe the life expectancy for Kazakh males is only about 56 – need to check that) but that without perfect Russian one is completely at the mercy of the doctors here unless you use the International clinic. Also, the method of studying medicine in this part of the world is completely different to the UK. Instead of learning all about medicine for about five years, then specializing, the doctors here train exclusively in their specialism from more or less the beginning (once they have done parts of the body I think they then move on to their chosen special subject) and so a fully qualified doctor who specializes in, say, bones will have almost zero understanding of the needs of, say, a 14 month old baby.

Basically, if you move to Kazakhstan you have to pray that you don’t have a serious accident or health problem, because you won’t be able to treat it here. If it is an emergency, they will patch you up and get you on the next plane out to Frankfurt, London or somewhere. If it is a long term serious thing, you have to basically go home.

The health care here is provided by SOS  and the name probably gives you a clue – you have to be in pretty desperate medical circumstances to want to use these guys. They are a health care and security services firm who operates in all the dodgy parts of the world where normal western standard medicine is not available. Places like Africa, Central Asia, the middle of China. One of our friends works for them, and was previously in Nigeria where one of his biggest headaches was getting the bodies out fast enough since the volume was so high.  Their clinic is full of ‘exciting’ pictures of private jets taking off in rural locations, I suppose to make people feel they are living on slightly wilder but safe side of life. For me, the thought of being so far from adequate health facilities that you need to charter a jet to get to any, and the imagined image of me (or anyone I know) being stretchered onto a plane to go to the doctors, is my idea of total hell. For some, it is what makes living in these places worthwhile – lots of gory stories, and extreme living.

The doctors work six weeks on six weeks home leave, and are on 24 hour call for that time. At the moment we have a nice South African doctor and when he goes home, we have a nice Australian doctor. Both seem competent but have different attitudes to certain treatments, so if you go with one issue one week and then go back with the same issue but continued problems the next, you may be diagnosed or prescribed with totally different conditions and solutions by the other doctor. But not to worry, there is always an element of critical analysis required of doctor’s opinions anyway I have found since starting to use private health care 10 years ago. (It was lucky we were advised to get a second opinion on the back doctor who wanted to have a go at My husband’s disk problem with a ground breaking laser technology in Brazil – the country’s No 2 back man who My husband got an appointment with thru friends’ contacts subsequently advised that the chances of irreparable damage to My husband’s spinal cord could have been up to 70% if he had gone thru with that procedure). And most of the time, people don’t have serious medical issues. So for day to day run of the mill things, the general doctors are absolutely fine.

The last few years, our family has spent thousands of pounds in private health cover and in total I think we have been to the doctors about 8 times for totally minor things like ear infections. When we came, we just thought that we would probably be fine since our track record for the last 5 years has been pretty good. But it has not been quite as planned. As you already know if you have read the rest of this blog, I have already had a general anaesthetic here. And unfortunately we moved into round two medical trauma a week after New Year when our baby Connie developed a high temperature of 40 degrees or so for days and days, didn’t respond to antibiotics, had green diarrhea so badly that her bottom turned inside out, and eventually had to be put on a drip for a night in the clinic.

We have been very lucky with our kids and not had serious problems, let alone hospitalization of any of them and it was quite shocking how quickly she went downhill and became a really sick baby. The doctor came to our house for a visit and she seemed to be rallying, but by the end of the day, she was flopping around, eyes sunken, drifting in and out of fitful sleep, occasionally crying as her tummy cramped and more of that awful green, mucousy poo came out. It was pretty awful.

In the end we called the doctor and told him that she hadn’t improved at all, and what did he think, so he told us to bring her in to go on a drip for one night, but that she might have to remain on it for 36 or even up to 48 hours.

Putting a drip in a tiny baby is a tricky thing since they have such small veins. Getting the needly thing to stay in is also tricky since they tend to wave their arms around and bend them, so everything comes out. We were lucky, the doctor is experienced and it only took about three attempts to get the line in. Then we splinted her arm and settled down for the night. At about 10.30 the doctor went home and handed over to the Local Night Doctor. The South African doctor told me that if there were any problems to call him and he would come down. But I thought, well, she is a doctor, (not knowing about the way Doctors become doctors here as previously described) and local, so her methodology might not be quite as expected but she is qualified so I expect that “Everything will Probably be Alright” – my motto for living in Kazakhstan.

The local doctor looked a bit nervous at being left with a foreign woman and her baby. She also looked, I thought, a bit like the sort of doctor who might accidentally kill someone and then try to cover it up – but perhaps that was my being worried! I suspect that her specialism might have been geriatrics, she certainly didn’t know much about babies. Her first bit of advice to me was that reading with a reading light (which we had brought in so that the room was not lit with strip lights) was bad for my eyes, and that I ought to stop. “It’s OK, I am only reading for a little while, I think my eyes will survive,” I told her, smiling politely but holding my ground as she actually tried to switch the light off.

Later that night, the drip machine started to beep an alarm. She changed the bottle to the next bottle and it continued to work. But at 5am the alarm went again, and I noticed a large air bubble coming down the tube so I rang the bell to call her. She looked at it, and started fiddling around near the shelves, obviously not knowing where anything was. She farted around trying to suck the air out with a syringe (and almost injecting more air into the tube), then took the machine apart about five times getting all the tubes tangled up and spilling saline all over the floor. Still no solution. Then she fiddled about so much with Connie’s arm and dressing and splint that she managed to make the line fall out but would not admit that she had done that. Finally, at 7am she gave up and switched the machine off. She didn’t tell me that she was waiting for the doctor to come in, so after a while I asked her if she was going to switch the drip back on (after all, if I was just going to be lying on a bed with a sick baby I would much rather have been at home, and not in the SOS day room), to which she tetchily relied “No, I am waiting the doctor.” After being awake almost all night and enduring the last two hours of watching some technical incompetent trying to fix my baby daughter’s drip, I have to admit that I was feeling slightly frosty. So I asked her if it would be OK to switch off the light so that we could both go back to sleep. She was fiddling around counting medicines and recording them on a clipboard. She tutted, rolled her eyes, and stomped off to leave us to sleep for 20 minutes before Husband arrived with some breakfast. Not a great night.

However, no need for anything apart from this small bloggy moan, since the baby did recover eventually, and is now fine. The South African doctor patiently explained the way local doctors are trained when I told him quietly later in his surgery that the night doctor had been a bit ‘interesting’. And he said that the clinic is really working hard to try and get their local staff up to more recognizable standards of patient care (and bedside manner!) which is good I suppose.

We were glad to go home, and thought that would be the end of it, but we were back again last Saturday at the end of another interesting set of circumstances which probably deserves its own blog entry title.

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