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. Last Updated: 07/27/2016

When Moscow Maladies Become Serious

He had persevered through his first Russian winter without illness. But when Tom Rathjen could not shake a nagging cold last week at the onset of yet another frigid period, he sought the help of a doctor. The 32-year-old accountant from Texas chose the clinic for which he had seen the most ads, the one that most resembled a system he had known back home: the American Medical Center.

But there are another three Western style outpatient clinics in Moscow, each providing the fundamentals in health care -- with variations in cost, convenience and special capabilities.

"I didn't even know about those," said Rathjen, referring to the European Medical Center, International Medical Clinic and Mediclub.

Since the failure a year ago of a fifth clinic, US Global Health, which had amassed some 3,000 patients, the once-contentious scramble for customers wealthy enough to afford Western-caliber medical care appears to have quieted.

All four remaining clinics reaped an influx of patients following the closure of US Global Health. Now, although incentives are easily found for both corporate memberships and one-time patients, even staff physicians agree the levels of basic care are effectively on par at each clinic.

The distinctions are drawn mainly by cost, access to specialists and how clinics cope with serious illnesses beyond their treatment capabilities.

Dr. Andre Kobouloff, the French physician who serves as director of EMC, believes the quality of basic care available at each clinic is about equal. His assessment is supported by Dr. Jacques Roy, a Canadian physician at Mediclub.

"Our limitations are created by the fact that, because our access to secondary and tertiary care is limited, we have to rely upon what is in Moscow," said Roy.

Christina Garnett, AMC's American marketing director, agreed. "Once something gets out of our control, what's the next step? It's a Russian hospital, and it's still not up to American standards," she said.

In light of such a reality, all four clinics provide or arrange for evacuation by air to medical facilities in Helsinki or London; some even suggest undergoing serious procedures in the patient's country of origin, whatever the distance.

"The main reason we evacuate is psychology, because if we do an operation and we fail, people will accuse us of being substandard," said Vladimir Danilenko, a Frenchman who is the managing director of IMC.

IMC is unique in that it also houses the offices of International SOS Assistance CIS, a long-established evacuation service which owns the only medically-equipped jet currently based in Moscow.

Such a jet could shave life-saving hours in medical response time, according to Danilenko.

Representatives from each clinic advise all potential customers to purchase medical evacuation insurance, as the cost for a single flight can spiral beyond $10,000.

When an illness or injury is less serious, however, EMC, IMC and Mediclub juggle patients among local hospitals -- including the Kremlin Hospital, formerly staffed exclusively for the Soviet elite. Garnett said AMC directs those members in need of inpatient care to ZiL Hospital, a local facility IMC's Danilenko insists is worthy only of a reserve role, as it is still reminiscent of the Soviet period.

"An American who goes inside it will run away," said Danilenko.

Garnett counters that ZiL is simply more cooperative than the Kremlin hospitals, which provide excellent care but do not allow AMC's physicians inside to monitor their patients' progress.

"Our doctors do daily rounds [in ZiL]," said Garnett. "Our patients want us to continue our involvement ... because being hospitalized in Russia, for an ex-pat, is still a scary experience."

Patients seated in waiting rooms among the four clinics last week recounted numerous tales attesting to the limits to health care in Moscow: One said a neighbor's young son broke his arm and was flown to Helsinki to have the bone set in a cast. She added that a friend's wife was flown to London in order to receive care for an impacted tooth.

A mother from Zimbabwe, accompanied by her 7-year-old daughter and 3-year-old son, said she was forced to reschedule a child's treatment because AMC was out of stock of a vaccine. Several days later, she said, the child was inoculated -- with a serum purchased by AMC from IMC.

"It happens from time to time," said Danilenko, who added that the competition among clinics has sufficiently thawed to the point where it is not uncommon for one to assist the other in providing a service.

Sometimes the clinics will even cherry-pick employees -- from office workers to health care professionals -- from their rivals. For instance, IMC employs Western-trained doctors formerly of AMC and US Global Health.

One constant among the Western-trained physicians, however, is their brief tenures in Moscow. Most of the physicians leave after a year or two, at which time patients must re-establish a rapport with someone new, said the mother from Zimbabwe -- who has received care at three clinics during her nearly three-year residence in Moscow.

Roy, who also serves as medical director of Mediclub, concurs that most doctors plan on working in the city only temporarily. "In every profession you have roamers," he said. "But the clientele, of course, likes to relate to the same person."

A perk solely available to members of Mediclub -- but none of the other clinics -- is a physician who is present 24 hours a day to field phone calls ranging from emergencies to the medically mundane.

"They speak with a Canadian doctor ... directly, and not a receptionist. That's important," said Tatyana Yamnitskaya, Mediclub's former director of public relations.

A Russian physician who is fluent in both English and French directly fields off-hour calls for the EMC, but is not present in the clinic, according to Kobouloff.

Yamnitskaya notes that Mediclub's most salient asset is its laboratory, which spans three large rooms. All the clinics have labs, but Mediclub completes a wider range of tests that could take two days to two weeks elsewhere, she said.

Yet a significant drawback to Mediclub is its location: It is virtually inaccessible by foot, because it is located nearly an hour's walk from the nearest metro stop, Kievskaya. IMC, too, is not as centrally located as EMC and AMC, which are situated within three blocks of Mayakovskaya metro -- literally down the hall from each other in the same building.

"I don't think it's a handicap, though," said Danilenko, whose well-marked clinic requires a brisk, 15-minute walk from the Prospect Mira metro station.

Alexis Brunner, 27, a U.S. citizen working for the Mosfilm studio, chose EMC last week for a one-time appointment. "It's cheaper than the AMC, and it's easier to get to from the metro than Mediclub," she said.

When the American-based joint venture US Global Health closed unexpectedly last fall, approximately 3,000 members scrambled to recover lost fees. It is still unclear whether the liquidation of Global Health's assets has advanced to a stage where the membership fees are being refunded.

Such misfortune is being parlayed into an advertisement by the EMC's Kobouloff, whose clinic carries no such risks because it does not require membership for any service or convenience.

"We treat everybody," said Kobouloff. "And we are still far below the inflated costs of our [competitors]."

AMC, IMC and Mediclub memberships entitle patients to 24-hour assistance, seven days a week. If a patient is not a member, the costs of services during off-peak hours are significantly enhanced. Similar price increases hold true for after-hours aid at EMC.

Kobouloff aims to ensure a foothold in Moscow through the addition of specialized fields of medicine such as dermatology, cancer screening, obstetrics/gynecology, psychiatry and minor surgery.

"More and more people want to consult with specialists ... The overall goal of our center is to get more and more specialists, and less and less general practitioners," he said.

Kobouloff said EMC currently offers a Western-trained pediatrician and dermatologist three times a week and twice a week, respectively. A Western radiologist is available daily for procedures such as ultrasounds, he said. He said he anticipates the arrival Friday of a French gynecologist.

IMC staffs a Western-trained pediatrician twice a week, as well as a gynecologist up to five times a week, said Danilenko.

AMC provides the widest variety of Western-trained specialists, including a psychiatrist twice a week and the following as needed: dermatologist, nutritionist, pediatrician and physical therapist.

While prices and the availability of specialists vary from place to place, the basic level of care has stabilized along with the market. "It's not an ever-expanding market as far as the expatriates are concerned," Roy said. "I think four clinics are enough."