Faith and the Ukrainian Medical System

This post first appeared on Assist News Service under the title “Medicine and Faith” in April 2015.

My first exposure to the Ukrainian medical system came early on. I moved to Ukraine to begin life with my husband, who had already been living here for ten years with his parents and siblings. At our wedding ceremony in Kyiv, one of the groomsmen, my husband’s 11-year-old brother Aaron, fainted. I will never forget the sickening sound of his head striking the tiled floor. He ended up spending about a month in the hospital.

During that time, my mother-in-law practically lived at the hospital with her youngest son, but I didn’t know why. Later I would learn that most nursing care in Ukraine only provides medical services. Nurses give injections, administer I.V.s, take blood pressure, etc. If a patient isn’t able to fend for himself, he needs a caretaker around the clock. My brother-in-law needed someone to feed him, help him use a bedpan, give him sponge baths, change his sheets, and even turn off his I.V.s when the fluid ran low.

He also needed someone to bring things into the hospital for him, because beyond their medical equipment, public hospitals here provide only the barest of necessities: beds, toilets, showers. Everything else—from medications to things like sterile gloves, bandages, needles, and syringes to the toilet paper you use to most of the food that you eat—has to be brought in by family or friends. This keeps costs down, since much of the medical care is technically free.

But I didn’t know any of this at the time. All I knew was that the other women in my new family were wrapped up in Aaron’s care, and I felt simultaneously guilty and relieved not to be involved. I did go to visit him, and that was an overwhelming experience in itself.

Ukraine was the first country outside the developed world where I had ever spent any amount of time, so I had no idea what to expect. While it’s not a third-world country, the infrastructure and living conditions lag behind what most Americans would consider normal. However, we were in Kyiv, the capital city, and it was well developed, with a subway system, beautifully restored old churches, impressive monuments, and large malls with international name-brand stores. Given how well-kept the city was, I think I expected something similar to what most Westerners would envision when picturing a hospital: gleaming white corridors, hospital beds with medical equipment within reach, and helpful orderlies. While such conditions do exist at private clinics located in Ukraine’s larger cities, that was not the scene that awaited us.

We arrived at the hospital in the early dark of a winter evening. It was an old building, possibly built even before the years when communism held sway over Ukraine. Although I now know that Ukrainian hospitals employ women to clean regularly, the place felt anything but clean, because no amount of mopping and scrubbing could have made those aging halls glisten. There was no reception desk or signs to guide visitors. I would have been lost on my own, but my husband had gotten instructions beforehand and deftly led the way down several corridors, their wooden floors warped with age, and up a flight of stone stairs, each step worn down in the middle from the passage of decades of feet, to the ward where his brother was staying.

No sooner had we entered the ward, than a scowling nurse began to yell at us in Russian. We were supposed to remove our coats and other outerwear, as these items were considered dirty and not allowed near the patients. We hurriedly complied, piling our things on a chair in the hall, before she grudgingly allowed us to enter Aaron’s room.

It was a largish room, crammed full of about eight beds, most of them occupied by children with their mothers. There were no beds for the mothers, who had to share with their children, unless there were vacancies in the room. The beds themselves were narrow, more like camp cots than full-sized beds. Besides an I.V. stand beside one child’s bed, there was no sign of medical equipment. It was just a bare room, filled with listless children and haggard-looking women. The whole atmosphere was oppressive and stifling. My mother-in-law is one of the strongest women I know, but it was obvious that she was under tremendous strain.

My next encounter with the public medical system didn’t come for several years. During that time, if we needed a doctor, we just called a private general practitioner who made house calls. He was extremely competent, and we trusted him, but when I became pregnant, we had to find a gynecologist to oversee my prenatal care.

Thankfully, we were able to find a wonderful gynecologist who was knowledgeable, experienced, compassionate, and reassuring. Delivering the baby with her was not an option, but we got a recommendation for an obstetrician at a government birthing hospital and interviewed her. The hospital felt more modern than the one where Aaron had been hospitalized, and the doctor seemed to be in agreement with our wishes for a natural childbirth. But when I showed up in labor, things didn’t go according to plan. It seemed the staff was trying to rush things along using unnecessary interventions, and we were never asked for consent or even informed about what they were doing. By God’s grace, neither I nor the baby sustained any permanent damage, but there were complications that could easily have been avoided, and it took me a year to make a full physical recovery.

Our next three children were not born in Ukrainian hospitals. We had our second child in the U.S., and with our third and our fourth, we chose to stay in Ukraine and have home births.

That’s not to say there aren’t good doctors in Ukraine. There are. My mother-in-law was pleased with the neurologist who oversaw Aaron’s treatment, and the three gynecologists who have given me prenatal care have been wonderful. I also don’t mean to say that it would be impossible to have a positive hospital experience here. However, for me the main problem is the prevalent attitude that the patient’s rights, wishes, and feelings are of no concern. As a soft-spoken person who already feels at a disadvantage because I am a foreigner, I find this attitude terrifying, so I do everything I can to avoid the medical system.

Now that we have children, however, that is not possible. They need annual check-ups for school, and that involves going in to see the pediatrician at our local children’s clinic, which is more difficult than it sounds.

Here, instead of keeping appointments, doctors keep office hours. Patients show up and wait outside the examination room. When you arrive, you ask who is at the end of the line. One of the people gathered will respond, and you know that after that person sees the doctor, it’s your turn.

This system would work fine, except for the number of people who ask for cuts or just push their way in ahead of everyone else. I’m always surprised when no one objects, but the few times I’ve mustered the courage to protest, I’ve been ignored, so I’ve learned just to take it silently like everyone else. To add insult to injury, sometimes after waiting an hour or longer, you can be turned away because the doctor’s office hours are over. I’d be embarrassed to admit how many times waiting in line for the doctor has reduced me to tears, so I won’t, but suffice it to say that it’s a trying ordeal for me.

The last time I went to the doctor with my kids, the waiting area was a zoo, and although we arrived early and were first in line, we were in danger of never making it into the examination room because of all the people literally shoving their way in out of turn. Finally, I told my kids, “The next time that door opens, I don’t care what you have to do—get through it.” Their eyes wide, they nodded solemnly, and when the door opened, they dodged their way between people’s legs to get into the doctor’s office, and I followed in their wake.

It felt like a minor victory, but now I wonder if it wasn’t ultimately a defeat. Did I give in to a mentality of asserting my rights at the expense of others? During my first few years in Ukraine, as I was struggling to cope with some harsher aspects of the culture, my husband gently reminded me that the whole reason we have chosen to live here is because we want to see the truth of the Gospel transform people’s lives. Part of our calling is to live the Gospel out in our dealings with others. If we can’t do that, especially in the face of hurt or injustice, we might as well just go home.

Now that we have children, the stakes are even higher, because I want to impart to them a legacy of living this way. As far as the Ukrainian medical system is concerned, I have to ask myself if my fears and insecurities keep me from demonstrating a vibrant faith in a sovereign and loving God who has promised to be with me no matter where I go. Could He accompany me into the uncertainty of a Ukrainian hospital or stand beside me while I meekly endure injustice? Of course He can. The real question is, will I allow Him to lead me where He pleases so that His power can be displayed in my life?

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