Yeltsin's heart could do better Bypass: The surgery that the Russian president is to undergo is far less common in his country than in the United States, and the quality of care is below Western standards.

Sun Journal

September 18, 1996|By Clara Germani | Clara Germani,SUN FOREIGN STAFF

MOSCOW -- Dr. Mikhail Alshibaya, one of Russia's leading heart surgeons, has mixed emotions about President Boris N. Yeltsin's decision to have a bypass operation in Russia at the end of this month.

Alshibaya says the president's decision was "the best advertisement we could get" for bypass surgery, an uncommon operation in Russia.

But he says it probably would be safer for the president to go to the West for the operation.

Heart disease is the leading cause of death in Russia, as it is in the United States.

But there are as many hospitals performing bypass surgery in the Baltimore-Washington area as there are in all of Russia, and the options for heart patients here are not so attractive.

"I saw American surgery, and there is no principal difference between our methods of bypass and those in the U.S.," said Alshibaya, who performs 150 bypass operations a year and spent three months in 1992 working with surgeons at St. Luke's Hospital in Milwaukee.

"But there is a certain difference," he added with a laugh. "The U.S. system works much better at all other stages -- in post-operative care, in preparation for surgery and in rehabilitation."

The Bakulev Institute cardiac ward of Moscow Municipal Hospital No. 15, where Alshibaya works, is considered among the best of Russia's 10 heart surgery centers.

But the contrast between this top-notch Russian hospital and those in the West is apparent.

The linoleum floors are peeling. The dim lighting and overall institutional-green add to the oppressive atmosphere.

Alshibaya's office is cluttered with X-ray photos and is a permanently smoke-choked haven for his chain-smoking colleagues.

Alshibaya specializes in combining heart bypass surgery with surgery on the carotid arteries to clear them of plaque buildup, milky gobs of which he has in vials on his desk.

He is in the prime of his career at 38, but the state pays him only $200 a month.

He wouldn't discuss how he makes ends meet. But he acknowledged the expectation among all Russians, who are guaranteed "free" state-funded medical care, that for better-than-ordinary care they should offer cash or gifts to physicians and nurses.

While heart surgery is perhaps as advanced here as anywhere in the world, it isn't common.

Most heart patients have two or three heart attacks before they ** are referred to a surgeon, and the $20,000 to $30,000 operation is harder to finance in post-Soviet Russia.

But there are more important reasons the average heart patient has never heard of the bypass option, said Dr. Giya Kvitivadze, one of Alshibaya's colleagues: "Those who work in cardiology don't refer patients to surgeons -- they like to treat with other methods, like medicine."

"We have to ride around the suburban polyclinics searching for patients," Kvitivadze said.

And like rocket scientists given just wood and nails to work with, the bespectacled Alshibaya and his colleagues conduct modern heart surgery in what one American doctor working here calls 1940s conditions.

"The problems sometimes aren't so important, but they show the difference," said Alshibaya.

He jealously guards the 7-year-old American-made needle-holder he uses to make precision stitches in sewing together blood vessels. In American operating rooms, the device is almost ordinary, but it is unavailable here.

Alshibaya bought his used while working in the Milwaukee hospital.

He has nothing to plug into the wall jacks labeled for modern heart and oxygen monitoring equipment. He gives pre-operative injections of morphine and Valium to calm his patients, as American surgeons do.

But the Russian morphine is of poor quality, so patients come to the operating table with dangerously high heart rates.

Doctors in this leading institute take post-operative temperatures with inexact mercury thermometers that take too long to register.

If these are the problems and deficiencies at one of the best cardiac programs, what kind of care can Yeltsin expect?

The Kremlin's chief physician, Dr. Sergei Mironov, said he hopes the president's Russian surgeons will be assisted by Dr. Michael DeBakey, the Houston physician who pioneered bypass surgery; and Kremlin has announced that two top German cardiologists will come to assist.

Dr. Renat Akchurin, head of cardiovascular surgery at the Cardiology Institute in Moscow, was trained by DeBakey and is expected to be involved in the surgery.

Yeltsin will, of course, have a much more comfortable room and much more attention than the average Russian bypass patient.

At the respected Bakulev Institute, which conducts about one-sixth of the country's 3,000 bypasses annually, most patients are lodged in rooms of five beds each, the beds with yellowed and crumbling foam cushions for mattresses.

The ubiquitous bustle of nurses in American hospitals is absent; nurses exist, but aren't always in sight.

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