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. Last Updated: 07/27/2016

Doctor Brings Together Best of Both Worlds

Getting a doctor's license takes six to seven years of intensive study and work. For Marina Kuznetsova it took twice as long.

Her career as a radiologist has spanned two decades and, to her surprise, two continents.

In the United States, where she emigrated with her husband and two sons in 1989, medical licenses received in Russia were not recognized. So Kuznetsova, who had 10 years of work experience and a doctorate in oncology under her belt, had to start from scratch to be allowed to practice.

"This process is a very long and brutal one. I do not envy anyone who's only now starting it all," Kuznetsova said, referring to Russian colleagues wishing to work in the United States.

Six years of exams, licensing procedures and residency in a completely foreign environment proved to be a tough challenge for Kuznetsova, already a 30-something professional at the time. But she found the return to studying exciting.

"I would think, 'Even if I don't pass the exam, it's all right because these textbooks are just so interesting!'"

On her second visit to Moscow in 12 years, the Chicago-based emigr? — now the medical director of the Radiation Oncology Department and an assistant professor at Rush University — was back in her native Moscow to take part in several medical events included in this week's Chicago Days festival. (See story.)

On Monday, in a demonstration for her colleagues, Kuznetsova performed an advanced procedure quite rare in Russia — called prostate brachytherapy — on two Russian prostate cancer patients at the Health Ministry's Urology Institute.

The technique, pioneered in the United States in the mid-1980s and also known as radioactive seed implantation, is designed to kill cancer cells in the prostate gland with radiation applied directly to the affected area. The operation is an outpatient procedure and typically has none of the long-term side effects associated with prostate surgery.

Because brachytherapy is a localized procedure, it allows doctors to apply greater quantities of radiation without exposing unaffected tissue, to avoid the attendant risks, Kuznetsova said.

Guided by an ultrasound device, she implanted the radioactive seeds using a needle inserted directly into the prostate. The results of the brachytherapy were not available immediately, but Kuznetsova said the method has a high success rate overall.

She also said the choice of venue for the demonstration was not random, as the Urology Institute happened to be the only hospital in Eastern Europe with the experience and equipment necessary for the procedure. Doctors at the institute had performed brachytherapy at least a dozen times before Kuznetsova's visit.

Because the radioactive seeds necessary for the procedure are not produced in Russia, the ones for the demonstration were donated by a U.S. branch of international firm Nycomed Amersham.

The limited availability of brachytherapy is a predictable reflection of Russia's drastically underfunded state health system, where official salaries are a pittance and the latest equipment and methods of treatment are sorely lacking.

While the technique is used in some 800 clinics throughout the United States, its cost is exorbitant for Russian doctors and they continue to rely on cheaper methods, such as traditional surgery and external beam radiation, according to Kuznetsova.

Asked to compare the two countries' health systems after a decade in each, Kuznetsova said she had been prepared to find Russia's medical institutions lower in quality than U.S. hospitals, but avoided criticizing them.

"All this is very recognizable and I found nothing unusual in it," she said, adding that it was difficult for her to judge how the system she'd once been a part of had changed.

"When I worked here, a doctor had nothing but internal motivation to work. I hope things are changing."

One of Kuznetsova's best impressions from her U.S. experience was made by the textbooks she had used in her studies.

"They are actually designed to teach," she said, complaining that many of the Russian textbooks she'd once used had been inferior.

As part of the Chicago Days charity activities, Kuznetsova on Wednesday will present some 9,000 American medical textbooks to the students of the Second Medical Academy.

Apart from the obvious differences between the two nations' health systems — such as the glaring disparity in state funding — Kuznetsova noted that patients in the West are much better informed about their ailments than Russians, and American doctors generally have a better grasp of modern medicine, as the demands of the profession are tougher. "A doctor must remain up to date with all the latest developments," Kuznetsova said.

She added that the hardest thing for her to learn as a doctor in America was telling patients the truth about their condition. "It has been hard for me to accept that patients must always be told the truth," Kuznetsova said. "In Russia it was customary to use euphemisms."

As for her participation in the Chicago Days festival, Kuznetsova said her knowledge of Russian, curiosity and nostalgia were not the only reasons she came to Moscow.

"I highly value any kind of cooperation and find it useful," said Kuznetsova, sitting at a lunch with doctors from the Urology Institute, discussing the details of the surgery she had just performed.

"In all these discussions, the truth is born."