Where do I even start? I suppose by telling you that I have had the privilege and the horror of utilizing the Moldovan health care system.
Now, I should be fair and say that the horror is almost entirely on my end.
But I should also say that I haven’t used the true Moldovan health care system. For the past week or so, I have been frequenting the fancy-pants, “I make money outside of Moldova”, private hospital.
Even still, the nurse and the American in me feels like I have SO MUCH to say about my experience.
The Unknown Horror…
So, I’ll admit, the horror has been mostly in my own head. You know how they say that some nurses are hypochondriacs and some nurses refuse to see a doctor even if they are legitimately facing a life-threatening situation? (The classic “sure I’ve lost a lot of blood but I haven’t fainted yet and the room is only spinning a little bit so I’ll probably be fine” type.) As much as I wish I were the cavalier nurse, I think I tend toward the hypochondriac side. My mind instantly jumps from headache to migraine to stroke, or from vomiting to bowel obstruction. And to be fair – I’ve seen these situations more than enough times to know they happen.
But, in the US, I can mitigate my medical anxiety because I understand the medical system and how to use it.
…Exacerbated by living abroad
I have found out that I can’t mitigate here in Moldova. Living abroad is all about trying to build a life in a world that you fundamentally don’t understand. And usually for me that is exilhirating. Unfortunately, it becomes extremely anxiety provoking when it involves health.
For example, let’s take a simple headache. Treating a headache involves going to a pharmacy to speak to someone in Romanian about your symptoms. They show you three different boxes of medication and let you choose. If you are lucky one of the medications is ibuprofen and you already know dosing, etc. If you’re not lucky, then it’s something like Voltaren – meaning you have to read all of the drug instructions in Romanian to figure out how and when to take this medication.
And then if the simple headache is something more? Well now you are left calling MedPark Hospital because that’s the only place you know of that has doctors who speak English. Meanwhile you are starting to second guess yourself and wonder if it’s just better to wait until you are back in the US to figure out this headache. Or maybe you are blowing the whole thing out of proportion and you CAN be one of those cavalier nurses who just rides it out at home.
The Actual Situation
So this is more or less what happened. Except that instead of a headache it was a period that lasted almost 3 weeks. I had visions of fibroids and cancer and forgotten tampons inside me for weeks. Believe me – I imagined all the possibilities. I raged against the anxiety machine inside my own head for days before I finally made an appointment at MedPark to see a gynecologist.
And the anxiety continued in the cab ride with Daniel to the hospital…and as we checked in at the front desk…and even at the beginning of the appointment. But I then realized that nothing about the situation itself was anxiety provoking. Medpark was perfectly fine. (Or even more than fine, as I’ll get into in a bit.) It was all a fear of the unknown. Which – let’s be real – is the fear of just about everyone around the world when they go to the doctor. After years in the hospital, I’ve forgotten what it’s like to be on the other side. It kind of sucks.
Looking back, with the anxiety now in the rear view mirror, I have some thoughts (hopefully not terrible subjective) about my experience with the Moldovan health system. And I actually have a lot of good things to say.
The Great Parts
PRICING TRANSPARENCY. There was literally no question of what something would cost because I paid before I received the service. Are you interested to know what some of the fees are at the premiere health institution in the entire Republic of Moldova? That would be 450 lei ($25.86) for a consultation with a specialist and 390 lei ($22.42) for a transvaginal ultrasound. This is the price without insurance. I few days later I needed a swab for strep throat and that cost 220 lei ($12.65). I received the following receipt:
There is absolutely no question of what I am being charged for.
SPEED. Despite being a new patient, I was able to see a specialist two days after I called for an appointment. We waited a minimal amount of time on the chairs outside of the gynecologist’s office before entering. After deciding that I needed an ultrasound, the gynecologist called another doctor straightaway who squeezed me in just 15 minutes later. (Side note, the doctor who ran the ultrasound was my favorite. She was gentle and funny and reassuring in all the right ways…and all that translated through her Romanian. She didn’t speak English.)
The Not so Great Parts
JUST A COUPLE OVERSIGHTS. Now I know that people who work in health care are the toughest critics of the very place where they work. But when the gynecologist told me that an NSAID suppository would not have systemic effects…I must admit I instantly became a little concerned about her medical background. (I’m talking to all my medical friends here.) And then when I saw on the printed visit summary that she had fabricated vital signs for me (she never took any during my visit), I found myself that much more hesitant to trust her medical advice. Thank goodness for google searches and my ability to read at least some drug information in Romanian. I swear, this is the one time that googling medical advice reduces – rather than increases – anxiety. (Side note – it might actually be a positive that she didn’t take my blood pressure because it would certainly have been high during that visit.)
EXPENSIVE. I know I told you earlier that the health care prices were transparent and low even without any kind of medical insurance. However, “low” is relative. For an American, Medpark is a dream compared to health care costs at home. For a Moldovan, Medpark is also a dream….just one that they will never be able to access or afford.
A Moldovan experience at MedPark
Which actually leads me right back to another positive. Although MedPark is expensive, it is also bribe free. A few months ago I was talking to a Moldovan friend here who was pregnant at the time. She said that she planned to deliver at MedPark for two reasons: the prices are clear and nonnegotiable, and her husband would be allowed to be present for the delivery.
She explained to me that the state-run hospitals are cheap, but you receive next to nothing for that price. If you want your husband to be allowed in the delivery room then you must bribe. But how much should you bribe? There’s certainly no bribe pricing list that tells you how much is appropriate to get what you want or need. Perhaps you give more than you financially can but it still ends up not being “enough.” You have lost your precious money and your husband isn’t there for the birth. Or perhaps you give too much to begin with. Now you are out money you really could have used elsewhere.
Why must I be continually reminded to walk a mile in someone else’s shoes? It’s the lesson I forget so easily…
I don’t think about bribes EVER in the U.S. And to be frank with you, even within the bribe-free US health system, I have forgotten what it’s like to be on the patient end. It’s frustrating to not speak the language, to feel like you could get a better medical explanation if both provider and patient were speaking their native tongues. It’s frustrating not knowing how best to access health care.
For example, when I needed a strep throat swab I was told that all of the ENT doctors were away at a conference that day. I tried to explain that I didn’t need a specialist….I just needed a primary care doctor. Nonetheless, I was directed to go to the emergency room at MedPark. I felt awful explaining my situation to the ED doctor, and rather ashamed when he directed me to pay for the swab and then head to the lab. I would NEVER go to the ED for a strep throat swab in the US.
I’m not sure exactly what type of nursing I will go back to when we get home. But my experience at MedPark has added to the mountain of life lessons that are piling up from our year abroad. As I speak with future patients, I hope to remember what it’s like to be on their anxiety-filled, disoriented end of things. Hopefully I will be like the ultrasound doctor who playfully said while inspecting my ovaries, “Let’s see what that left ovary is up to. Is she eating ice cream? Off to the coffee shop?”