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   May 26
 Survival Guide
Health Care
General Information
The Russian health care system has seen major improvements in recent years, both in technologies and pharmaceuticals. Moscow hosts a number of Western medical clinics that can look after all of your family's health needs. The clinics are spread out over the city; therefore, regardless of your location, there is sure to be medical provision in the vicinity.

When coming to Russia, bring a good supply of any prescription medicine needed. Ensure you can continue that supply from a local facility or that you can find a local substitute acceptable to your original prescribing physician.

Early in your stay - when there is no emergency - identify the closest medical facility with English-speaking personnel. Ascertain its working hours and its reputation, if possible. If in Moscow for the first time, bring a copy of your medical records with you to assist your new doctor in becoming familiar with your past medical history. The approach to the provision of medical care as a service to both the population and the individual may be quite different to what you are used to.

Unless absolutely necessary, as in major medical emergency, it is suggested that you do not go to the local hospital on your own without first contacting your medical assistance company; if you must, at least ensure you have a Russian speaker to assist you. Unsure that you have enough money to guarantee any admission fees that may be charged.

Many medications can be purchased here over the counter that would only be available by prescription in your home country. However, in most cases the manufacture is different and, therefore, the drug is identified by a different brand name. Know the generic (chemical) name of your medicines if you think you are going to need to restock locally. Bring the package insert from your previous prescription with you. Fraudulent drugs are not a major problem in Russia, but be careful and check the dispensed drug before you pay for it.

Some medications including controlled drugs and drugs of dependence (i.e., sedatives and hypnotics; medications to treat the hyperactivity disorders of children; strong pain relievers; and some drugs for diabetics and epileptics) are simply nor available in Russia. If you are on such a medication, please speak to your physician in your home country and a physician at one of the medical clinics in Moscow to find out how to best handle this situation.

Vaccinations
Russia has no vaccination requirements, but it is a good idea to keep your shots op-to-date. If you need a shot while here, please contact one of the medical centers in Moscow. The following vaccinations are recommended for individuals traveling to or living in Russia for linger periods of time:
Hepatitis A or immune globulin (IG). Transmission of hepatitis A virus can occur through direct person-to-person contact; through exposure to contaminated water, ice or shellfish harvested in contaminated water; or from fruits, vegetables or other foods that are eaten uncooked and that were contaminated during harvesting or subsequent handling.
Hepatitis B, especially if you might be exposed to blood or body fluids (for example, health care workers), have sexual contact with the local population, or are exposed through medical treatment.
Typhoid. Typhoid fever can be contracted through contaminated drinking water or food, or by eating food or drinking beverages that have been handled by a person who is infected.
As needed, booster doses for tetanus, diphtheria and measles. Outbreaks of diphtheria have been reported in states of the former Soviet Union.
Tick-borne encephalitis is a viral infection of the central nervous system that occurs in the southern parts of the non-tropical forest belt in Europe and Asia, including Russia. Travelers are at risk who visit or work in forested areas during the summer months and who consume unpasteurized dairy products.
Rabies, if you might have extensive unprotected outdoor exposure in rural areas, such as might occur during camping, hiking or cycling or engaging in certain occupation activities.

Skin Care
Newcomers frequently have difficulty in adjusting to the dry air conditions in their apartments. Ladies complain of dry skin, broken fingernails, etc. Most women find that they use extra face cream. An electric humidifier helps a great deal. It is also useful to place pans of water around you apartment.

Eye Care
Dry, cold and polluted air is hard on eyes, especially if you wear contact lenses. Users are advised to give eyes a rest from contact lenses from time to time. It is advisable to have spare lenses or glasses with you. You can purchase all kinds and brands of imported prescription and non-prescription contact lenses (including Johnson & Johnson, Bausch & Lomb, etc), colored contact lenses, contact lens cleaners, glasses (including designer frames) and sunglasses at any larger optician's.

Most of them have qualified opticians or ophthalmologists and sophisticated equipment and will carry out a complete eye exam before fitting you with contact lenses or glasses. Fees for the eye exam are usually very moderate. Do not expect the ophthalmologists or consultants to speak English though. If you have just started you Russian lessons, take someone along who can communicate in Russian. Most pharmacies carry imported contact lens cleaners and moisturizing eye drops, while contact lens containers may only be available from specialist shops.

Digestion Care
Generally, it is advisable not to buy meat or diary products from anywhere other than a reputable market or shop. Meat purchased in the market should be inspected carefully to ascertain its freshness, and particular care should be taken in the summer months because of lack of refrigeration. Any meat bought at a market should be well cooked. Diary products bought at outdoor markets may not be pasteurized and should not be given to young children or consumed by pregnant women. All fruit and vegetables should be washed thoroughly before eating. Water from the tap is suitable for cooking, but people normally filter drinking water or use bottled water.

Health Care Insurance
Before coming to Moscow, make sure you have full medical and dental insurance coverage for yourself and all family members that will cover any emergencies (and medical evacuation) that occur during your stay in the Russian federation. Western medical and dental services in Russia are very expensive if you are not covered.

If you are not insured when coming to Russia, please contact several Moscow medical centers to find out whether they offer their own insurance plans, or ask them for recommendations of reputable companies in Moscow or abroad that offer health insurance for expatriates. If you already have insurance, call the medical or dental clinic you intend to visit to make sure that they accept and have a direct billing agreement with your insurance company and which, if any, restrictions apply in an emergency situation. If you are not insured or your insurance plan requires you to pre-pay all services for later reimbursement, check which credit cards are accepted or whether payment must be made in cash.

Note that coverage with foreign insurers must be purchased abroad, under Russian law it is illegal to sell insurance policies that are issued by an insurer that is not licensed in Russia. Before you choose a health care insurance provider, whether local or foreign, make sure you read the fine print and discuss any questions you have. Many insurance companies do not pay for health problems pertaining to pre-existing conditions, which might include any chronic health problems such as diabetes. If you use a foreign insurance provider, deductibles may apply. Since the cost of medical services in may medical centers in Russia is lower that abroad, the doctor's consultation fee may fall under deductible.

Most foreign health care insurance providers have contracts with a limited number of medical clinics in Russia. This could mean that through your insurance policy you are forced to use a certain health care provider in Moscow. Unless your insurance company has a direct billing agreement with the medical clinic you intend to use, you will have to advance the payment and then claim reimbursement from the insurance company later. Some providers require pre-authorization, meaning that you must contact the insurance company before using medical services in Russia.

Clinics and Dental Care
Several Western medical centers and dental clinics operate in Moscow. Most have at least some expatriate doctors and friendly English-speaking support staff and are equipped to handle both minor and major medical emergencies. Some also offer house calls and medical evacuation services. Most clinics are open 24 hours a day, seven days a week or at least provide emergency services during the night.

While most Russian hospitals are not up to Western standards, Russian doctors are generally very good. Several Russian hospitals in Moscow have special arrangements with GlavUPDK (the main administration for the foreign diplomatic corps in Moscow) and accept foreigners for checkups and treatments at more moderate prices that the Western medical clinics.

Psychological Care
Living in a foreign country is always challenging and stressful. Everyone - from the working partner to the spouse and children - can be affected, and there is absolutely no shame in turning to professional help, which is available in Moscow. Problems frequently experienced by expatriates on international assignments include stress, anxiety and loneliness. A problem specific to northern countries, such as Russia, is SAD (Season Affective Disorder). If you find yourself in any situation you feel you cannot cope with on your own, please call someone. This someone can be a friend, a member of your women's club's newcomer's team, a nurse or a doctor at your medical center or some professionals.

PREGNANCY AND GIVING BIRTH IN MOSCOW

General Information
If you are an expecting mother who is moving to or currently living in Moscow, you will need information and advice for the period of your stay in Moscow. One option is to join a "mother-to-be" support group to share experience and useful information. Contact details and useful information can be obtained through one of the international women's clubs in Moscow and - if you have older children that are attending school - through your school's community liaison office or school newsletter.

You can attend childbirth education classes for further advice on pregnancy, delivery, breastfeeding, and baby care and to learn about what to expect in Moscow. Most classes offered in Moscow are held in Russian, but you can contact any of the Western medical clinics in Moscow to find out about English-language pre-natal classes.

Hospitals and Doctors
Not all hospitals have maternity wards, and even less have neonatal care units. On the other hand there are several hospitals that cater exclusively to future mothers and their babies. A maternity hospital is called "roddom", meaning "house of birth". Most hospitals in Russia require visitors to wear plastic shoe covers. These are usually available from the concierge or at the coat check area near entrance for a small fee.

To make arrangements to give birth at a hospital in Russia, you will need to sign a contract and pay a deposit. Some Russian doctors speak good English (less frequently German or French), but if you need language assistance during labor and birth, you can make arrangements with an English-speaking healthcare provider in Moscow for an interpreter to be present during labor and childbirth. Make sure the hospital of your choice is aware of this arrangement.

Many things are done differently here than in your own country. The layout of the delivery room, for example, is different from those in American or European hospitals and usually offers less privacy.

Once you have chosen a doctor you will be issued a certificate regarding your pregnancy to carry with you. This certificate includes all pertinent information on your pregnancy and prenatal visits. Information on the birth itself and data for the newborn baby will be added later on. The certificate is issued in Russia, and it helps to avoid additional testing on admission to the maternity hospital. It provides the doctors and nursed with all the information they need to ensure a safe delivery and good prenatal care for your baby.

Hospital Stay
The usual length of stay in hospital is between three and five days; if you want to leave earlier you will be asked to sign a special form. After the baby is born you should contact your embassy to receive citizenship for your child and to apply for a passport.

Pediatrician
The Russian public health care system provides a local pediatrician for the first time home visit and a few follow-up visits by the district pediatric nurse. You can make an appointment for the well-baby visit in most family clinics. Some clinics in Moscow provide pediatric house calls. However, if you live a great distance from the clinic, please, check with your pediatrician if this service is provided.

Immunization
You can have your baby vaccinated through a private clinic or you can have vaccinations done for free (Russian-made vaccines) through the public health care system. Most expatriates prefer to use private clinics for their baby's immunizations where only Western-made vaccines from the world's leading manufacture are used. In Russia, a few days after birth a BCG vaccine is administered. You should discuss with your doctor whether you want this vaccination to be done or not. The immunization schedule in Russia differs from that in America and Western Europe - Hib, Varicella and Hepatitus A vaccinations are not on the national immunization calendar.

Private medical clinics will let you follow the immunization schedule from your home country, and most vaccines are readily available. Many local day care centers and play schools will ask you to provide your child's vaccination certificate, and many schools in Moscow test children for tuberculosis (PPD skin) on an annual basis.
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