OGJ SPECIAL Remote Medicine Oil Companies Focus On Emergency Care For Expats In Russia

Flight Time from/to Helsinki [99277 bytes]

About this report. . .
The international oil industry, catalyzed by a surge in exploration and production projects in remote regions, is giving health care for its travelers and expatriates a high priority.
L.R. Aalund, the Journal's Managing Editor-Technology, reports on why and how this is happening now. He covers this in articles on: health care in Russia, air ambulance evacuations, and the deployment of remote paramedics. Aalund gathered the information during trips to Finland and Russia and interviews with oil industry personnel, physicians, and other medical professionals in North America, Europe, and Siberia.

The grandeur of St. Petersburg (above), Russia's magnificent city of the North, belies the economic and social chaos gripping the country, which international oil still sees as a prime prospect.

A deplorable medical and public health system, compounded by social unrest, makes living and working in Russia risky for oil industry travelers and expatriates. This situation, coupled with a surge in overseas ventures, has prompted oil companies to put increased emphasis on medical care for their employees at medically remote sites. These are places from which it is difficult to reach western-level medical care and treatment for a variety of reasons-geography, culture, terrain, or weather.

The irony is that some of the worst locations are not in the malarial jungles of West Africa or Viet Nam but in Russia, homeland of world famous scientists, composers, and writers and an industrialized superpower with advanced technologies and manned orbiting space stations.

Western expatriates

The collapse of communism in Russia opened prime oil and gas country there to western oil companies. These ventures are highly attractive because the odds are good they will blossom with the introduction of modern, western oil field technology. Practically all oil companies looking to the future must have the former Soviet Union (FSU), whether it be the Russian Federation, Azerbaijan, or Kazhakhstan, in their plans.

A result is that major oil field service companies have also flocked to Russia and set up offices and field bases.

Halliburton Energy Services was a leader in setting up operations in the FSU. In 1992, it put in service centers in the cities of Usinsk in the Komi Republic, and in Nizhnevartovsk, east of the Ural Mountains in West Siberia. Archangel is another important oil center.

The accompanying map gives the flying times from Helsinki to these and other cities in the oil regions. The map only shows part of Russia's hugeness, which covers 12 time zones. When it is high noon on the Bering Strait between Russia and Alaska, it is midnight in St. Petersburg. Most oil industry expatriates today are in the region around Niznevartovsk and in Moscow.

The number of oil industry expatriates in Russia is difficult to estimate. The majority in the field are "rotators," commuters that spend a month in Russia then return home for a month. They come primarily from the U.S., Canada, Norway, and the U.K. However, companies as far away as Argentina have been engaged in Russian ventures.

Administrative and support staffs in Moscow have longer tours.

It is roughly estimated that at the peak of activity there were 600 oil industry expatriates in the field, or the "bushes," in Russia. There are perhaps 1,200 in support functions in Moscow.

This number could increase if and when the Russian government gets its political house in order and passes petroleum laws that set up solid rules and incentives for exploration and production ventures (OGJ, Mar. 25, pp. 56-61). Russia is in dire need of oil money to help lift the country out of its economic malaise.

There is a community of astute oil industry managers, engineers, and technicians in Houston who are going in and out of Russia frequently or who have been on the ground there since the early 1990s. They have a practical understanding of Russia and the Russians that would be difficult to duplicate anywhere. They haven't given up on Russia.

Many of these former expats believe the government will eventually pass favorable petroleum laws. There is also the prospect that resource-rich Russian republics, even big oblasts, may get weary of the waffling and start pushing independent development programs to get a money stream flowing.

Russian health care

In Russia, the best advice to foreign travelers covers much more than the usual, "don't drink the water."

Experienced travelers or expatriates in Russia fear having to be treated in most hospitals. There are a few good hospitals in Russia, mostly in Moscow and St. Petersburg, but they are a long way from the oil fields.

A nightmare would be an automobile or oil field accident that would require a blood transfusion. Russia, too, has a major AIDS problem and plenty of hepatitis and other diseases. Tainted blood is a worry.

As a result, western paramedics in the field keep blood expanders on hand. They can in some cases delay a blood transfusion until a safe supply is found.

The field medics also have another option in such cases. At least one company requires that the blood of all its expatriate employees be typed and tested for disease, including HIV. This gives the medics at remote locations a sort of emergency "walking blood bank."

The good and bad

The root cause of medical deprivation in Russia is, of course, lack of money. Often, there are no funds to buy such common items as disposable gloves, towels, and syringes, much less modern drugs, medicines, and diagnostic tools.

The few first class and high-dollar hospitals in Russia, however, have skilled physicians, staffs, and state-of-the-art equipment. They cater to the diplomatic community, government officials, business expatriates, and rich Russians.

Some hospitals and clinics have strongly embraced capitalism and jumped whole heartedly into market-based medicine. The telephone yellow pages for St. Petersburg have numerous ads in English, offering medical services. One hospital, claiming to have 120 years of history, announces, "New technologies in surgery, cardiology, gynecology, orthopedics, therapeutics, physical therapy, and other fields." Another ad offers "Kidney dialysis for patients on vacation in St. Petersburg."

One top facility in Moscow is the Zil Hospital, a company hospital for the Zil limousine company, which is also open to outsiders. The American Medical Center in Moscow often sends its expatriate patients to the Zil Hospital for further stabilization and diagnosis, even long term care.

Dr. Bruce Kineamore, Amoco Corp.'s medical director for Russia, says that except for the language, the Zil Hospital is not all that different from a good western hospital. The doctors and staff, he says, are well trained, and they have access to good equipment.

In stark contrast, however, are hundreds of facilities in Russia called hospitals without hot water or flush toilets. The clearest indictment of the Russian health care system can be seen in the fact that oil companies are willing to spend $10,000 to $40,000 to evacuate hurt or sick employees to the West.

Russian doctors

The communist system valued physics, moon shots, rocketry, and the military more than medical training and, except for lip service, certainly more than the environment. As a result, Russian physicians, over half of whom are women, historically haven't gotten the professional respect and recognition scientists and other professionals get in Russia.

A manager with an American oil industry service company in Moscow says cardiologists work in his company's Moscow offices as secretaries because the pay is better.

There are critics of Russian physicians, particularly of their mind set. Often this judgment is reinforced with frightening anecdotes, like visits by a western nurse to Russian hospitals with Turkish rugs, which are excellent media for breeding germs.

An experienced western paramedic tells the Journal he encountered a physician who wanted to amputate a patient's leg at the knee because of a sebaceous cyst on the lower leg. The paramedic on hearing this took the patient back to his clinic, excised and drained the cyst, and saved a leg.

Another case involved a doctor who refused to release a heart attack victim even though his hospital had no "clot busting" or other modern medications. The doctor insisted the patient was doing well. A friend of the patient, however, got a copy of his electrocardiogram (EKG) and faxed it to the west. The patient's doctor there saw it and ordered an evacuation service to get the man out and on a plane any way it could. They did and he survived. Of course, one can't say he was not on the road to recovery in Russia.

Another nurse reports seeing a gynecologist simply wash his disposable gloves after a pelvic examination, and hang them up to dry for reuse. It was probably that or not use any gloves at all.

Similar true stories can, of course, be related about the practices of medicine almost anywhere, even in the U.S.

Nevertheless, with some reservations, most foreign medical professionals in Russia respect the Russian doctors there. The consensus of several veteran paramedics interviewed by the Journal is that the Russians are good physicians, generally likable, reasonable, enthusiastic, and eager to learn.

Their weakness primarily comes from not having had the chance to travel, learn modern techniques, and work with sophisticated instruments. They must constantly improvise. Even with these limitations, many have become excellent diagnosticians.

Based on a recent trip to Russia where he observed medical practices and visited hospitals, Dr. David Clyde, medical director of ARCO International Oil & Gas Co. in Plano, Tex., says, "It is amazing what they can do with what they have."

He wonders if many American physicians could do as well with the limited resources.

Education

Medical education in Russia is quite different than that in the U.S. A student goes directly from what is probably the equivalent of a first class high school directly to 6 years of medical school. On graduation, he or she is a licensed general practitioner who can perform surgery.

As a result, there are some very young physicians in Russia. One western paramedic at a Siberian project tells of a 24 year old surgeon in a local hospital, who, he says, is "quite good."

Further training and education are necessary for going into specialties like cardiology or urology.

Power

Another aspect of the Russian system is the absolute power a doctor wields. Such authority is not unique to Russia, but is more pronounced than in the U.S. where insurance companies now have major influence on medical decisions.

The chief Russian doctor in a hospital alone decides whether a second opinion is necessary or valid, how many visitors a patient can have and, certainly, when the patient will be released.

This release authority poses a potential problem for most western medical directors, paramedics, and medical evacuation services. They must approach the doctor diplomatically and establish a working relationship to resolve such situations if they occur. But again, one veteran paramedic says, most Russian doctors are reasonable and will see the rationale for release, even if only to put the patient in more familiar surroundings with people that speak the same language.

Nevertheless, this professional interface between haves and have nots is a reason westerners are hesitant about speaking for the record when describing shortcomings of the Russian medical system.

This could be a reason a physician told the Journal, even though his Helsinki hospital gets numerous Russian evacuation cases, that he could not describe a typical Russian hospital because he had only visited teaching hospitals there, "which are not typical." Of course, there will always be exceptions to any observations about a country that stretches nearly 6,000 miles from the European Baltic to the Asian Pacific.

In some cases, Russian physicians and hospitals don't get involved with expatriates. Many evacuations are made directly from the field to the west.

But because western oil industry personnel are relatively young and get thorough physicals before departure, and because safety gets top priority at the work place, evacuations are not an everyday occurrence (see related article). However, when they are needed there is no alternative.

Fundamental problem

The major problem in Russia, according to one oil company medical director, is not equipment, hospital facilities, or physician competency, but a lack of government commitment to public health. Many Russians are smoking and drinking themselves to death. Life expectancy of a Russian male has dropped to 59 years. The old people in Russia are 55 and 60, not 75 and 80, says one American physician.

Perhaps a sadder development is the faltering immunization programs for children.

Unhealthy city

Although many Russians now say things were better under communism, especially health care, that is not the case. The system was, in some cases, the major culprit in declining health.

The city of Niznevartovsk, as far north as Anchorage, Alaska, lies in the heart of the vast West Siberian oil basin (see map). Oil fields within 500 miles of this city of nearly 250,000 produce 75% of Russia's oil. But instead of being noted for the relative prosperity this should bring, Niznevartovsk is one of the most unhealthy cities in Russia.1 The reason is that the Soviets misused the resource in the region and polluted the air and the water.

The Russian Nature Development Institute in Tyumen says there are alarming consequences from this. It reports that in Niznevartovsk and surroundings there are much higher rates of abnormal pregnancies, endocrinal diseases, rheumatism, and malignant cancers than the national average.

Russia, as they say in oil country lingo, is obviously one of the riskiest plays around.

Reference

1. Whitney, Andrew, Petroleum and the Environment in Western Siberia: Challenge and Opportunity. The Institute of Petroleum, Petroleum Review, February 1996, pp. 65-66.