Health Concerns in Russia

Firstly, "Don't panic." Moscow provides an overload of information and misinformation. Do not accept uncritically myths and superstitions passed down from previous ex-pats who have spent, on average, two to three years in Moscow or Russia.

The medical situation in Moscow constantly changes, and major improvements have taken place in the last 3 years. There is now, for example, much improved access to western quality pharmaceuticals. Many medical treatment and diagnostic facilities have been upgraded.

The ex-pat population is generally young. Serious medical or surgical illness is relatively uncommon although, of course, it does occur (appendicitis, renal lithiasis, hepatitis, etc.). Preparations should be made in advance for routine medical care and for emergencies. A clinic should be identified that is able to respond 24 hours per day. In the event that emergency hospitalization is required in Moscow, high quality facilities will require an advance financial deposit. Not all hospitalization insurance policies will be readily accepted. It is wise to inquire at your preferred medical clinic in advance as to how this situation would be handled. Some medical conditions are best treated in the west. It is recommended that travelers and ex-pats living in Moscow have medical evacuation insurance. This provides not only financial protection in the event of medical evacuation, but just as importantly greatly speeds the process of evacuation. If medical evacuation insurance is provided by your employer, it is important to be aware of the precise nature and extent of this coverage.

Insurance Considerations - what health protection is required in Moscow?

Quite simply, you need all of the following -

1) Secure access to sound and prompt medical advice. This is usually obtained by western foreigners through an agreement with one of the "western" medical clinics in Moscow;
2) Secure access to ambulance services;
3) An agreement or means to pay costs of clinic services;
4) Ability to guarantee payment (sometimes on short notice) for emergency hospitalization in Moscow;
5) Ability to guarantee payment (sometimes on short notice) for emergency medical evacuation from Moscow;
6) Ability to guarantee payment (sometimes on short notice) to cover costs of receiving hospital in cases of medical evacuation.

We cannot overemphasize the importance of resolving these issues prior to a medical emergency. This is not only a financial issue, but a logistic one. Treatment delays, even in emergencies, have occurred because these financial issues were not dealt with in advance.

Particular concerns in Moscow

1.Pedestrian Trauma - There is an increased incidence here. All pedestrians are potential victims. Never expect road courtesy, it does not exist in Moscow. Instruct your children that when it comes to road safety, they must be especially alert. This cannot be overemphasized. Do not expect traffic lights, marked pedestrian crossing areas, sidewalks, corners, etc. to be respected.

2.Assaults - Moscow is dangerous. This is a fact. Taken in context, however, Moscow is no more dangerous than any large American or world city. We should all be aware of normal common sense precautions to be taken in a foreign environment. Assaults are unpredictable. Do not be an obvious target. Use reliable drivers (best found through personal or company reference). Blend. Be aware that if you are a member of a "visible minority" that you are at particular risk of random violence. Be "street wise".

A specific and interesting variant of assault that should be mentioned is poisoning. The local variant of of the "Mickey Finn" is Clonidine poured typically into an alcoholic beverage. Dry mouth, a period of amnesia, significant weakness and sedation are the usual symptoms.Onset of symptoms occurs within 30 minutes of ingestion. If poisoning is suspected, a physician should be promptly consulted.

3.Sexually transmitted diseases - Venereal infectionsare a significant risk in Moscow. Chlamydia and Gonococcal infections are common. Hepatitis B has a significantly higher incidence in Russia than in North America. Syphilis is alive and well in Russia. HIV is poorly documented, but we may assume from statements of Russian public health authorities and from the incidence of STD's in general that there is a serious risk.

Please be aware that spouses are also at increased risk of STD.. Our physicians have found it wise to consider STD in any patient who presents with urethral or vaginal complaints. Generally, all appropriate specimens to exclude STD should be sent with any genito-urinary complaint.

4.Water - Do not drink tap water. Tap water is usually safe, but intermittent contamination occurs. This is especially common in the Spring. Commercially available drinking water is available in Moscow (Clearwater) and should be used. This water is also available in fluorinated form and is recommended. Water filters are of variable quality. For objective information, try Water Purification Techniques for general information or NSF International: Certified Product Listings to look up a specific product.

5.Air - Typical patient complaints relate to dry air in Moscow apartments in the winter and seasonal allergies through the warmer seasons. Many also suffer from non-specific respiratory irritation due to pollution from car exhaust which occurs especially within the Garden Ring. Patients with history of rhinitis, sinusitis or asthma are advised to seriously consider the area of Moscow in which they are about to live.

6.Food - High quality imported western foods are freely available in Moscow. Fresh vegetables and meat sold in local markets are generally safe. An unusual hazard is that occasionally such innocent appearing items as watermelons and tomatoes have been injected with water to increase appeal and weight. Common sense dictates that the customer should deal with a regular merchant, preferably by recommendation.

Restaurants - Numerous well known western restaurants exist in Moscow. MacDonalds, Baskins-Robins, Pizza Hut, TGIF, and KFC for example are represented. It is not necessary to be suspicious of the standards of food preparation at these establishments.

7.Vaccinations - Aside from STD's, there are a few particular infectious hazards in Moscow. Diphtheria, which is now almost unheard of in the United States, is endemic in Russia. Immunizations must be up to date. Recommended immunizations for adults are influenza, Diphtheria, Polio, Tetanus, Hepatitis A and Hepatitis B. Tick-Borne Encephalitis vaccination may be recommended to certain individuals depending on their travel requirements. Up to date information regarding vaccinations may be obtained through the Center for Disease Control

Tuberculosis is a threat in Russia generally, including Moscow. Strict attention should be paid to TB skin testing. For further information Tuberculosis Resources

Giardiasis, a disease caused by the intestinal parasite Giardia lamblia, is frequently encountered in Russia. Infection may be followed by severe symptoms such as abdominal pain, fever, and diarrhea. It may also be asymptotic. Giardiasis is especially common in individuals who have traveled to St. Petersburg.
check these resources: FDA/CFSAN Bad Bug Book Giardia lamblia and Parasites and Parasitology Resources

Hepatitis A - Russia is considered an area of intermediate risk for Hepatitis A. A vaccine is available and is highly effective. Individuals age 2 and above may be considered candidates. Hepatitis A immunization should be considered for individuals intending to live in Russia for six months or longer, and is definitely recommended for those travelling frequently within the country.

Further information regarding hepatitis is available at Hepatitis Information Network

8.Medical Services - Simply stated, medical services in Moscow range from excellent to abysmal to downright dangerous. The causes for the low-end conditions are multi-factorial, but include historical factors such as intellectual isolation, bureaucratic intervention in the medical system, radical social changes, etc. Current additional difficulties such as severe under funding, disruption of authority due to political changes, intervention by commercial forces, etc. create difficulties.

It is interesting to remember that the superior medical facilities in Russia just a few years ago were geared to treatment of VIP Communists and that overnight this clientele disappeared.

Well educated, competent and dedicated physicians in Russia exist. It is necessary to be selective. Occasionally we see patients who tell us that under no circumstances would they allow themselves to be treated by a Russian physician. We suggest that this is an unreasonable position while in Russia.

9. Ambulance Services - Ambulance service in Moscow is variable. The general city ambulance phone number is "03". Be prepared to give your address in Russian. Do not expect prompt arrival. These ambulances are staffed by physicians who will make decisions regarding treatment, transportation and destination hospital. Cooperation may be enhanced by a small gift (say 50 RBl.).

A number of private ambulance systems exist. Due to the size of Moscow, traffic, and the limited number of ambulances and dispatching sites of these private ambulances, delays are not uncommon. There may be delays of 30 to 90 minutes with even the best systems.

10. Taxis - It is quite common in Moscow to obtain "taxi" services on the street by hailing a passing private vehicle. Recently I read advice by Andrey Sebrant at his GoRussia site discouraging this habit entirely. He argues rather convincingly that safer alternatives now exist and should be used.
Although I have never heard of a specific case of assault by a driver obtained on the streets of Moscow (in fact there has been considerable publicity given to drivers being assaulted by passengers), I am forced to admit this is not a habit that should be encouraged. "Gypsy Taxis" obtained at the airport may be particularly dangerous. Visitors are encouraged to make advance arrangements for transportation from the airport. Failing this, commercial prepaid taxis are available at the airport. see  Sheremetyevo 2 for a map of the airport. Taxi hire is on the ground floor and the area is indicated in the map.

Medical Clinics in Moscow

There are now several medical clinics in Moscow that endeavor to provide medical services at a western standard. At the "Family Physician" level, all achieve their goal. From the medical service point of view, all ex-pats have access to reliable medical care equivalent to a western family practice clinic. Due to competition, a variety of services are available. All "western clinics" provide access to a western trained physician.

In conclusion, Russian medical services are variable. In many circumstances it is advisable that patients be treated locally. Individual decisions must be based on the knowledge of local medical resources. The situation changes rapidly. In no circumstances should a patient be treated locally without the observation of a qualified "western" physician. This physician must be able to use sound judgment, local knowledge and diplomatic skills to ensure proper patient management.

Certain emergency medical situations in Moscow remain especially problematic: head injuries, emergency pediatric care and emergency psychiatric treatment are examples. These situations must be dealt with on an individual basis considering the clinical situation of the patient, capabilities of local facilities, timing and logistics of possible medical evacuation, etc.

Please direct questions, comments or criticisms regarding this guide to prmir@glasnet.ru

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