I’ve come a long way since early November when I transitioned from the Western-run international clinic to Kazakhstan’s National Center for Mothers and Children for my prenatal care. Having only been to one hospital outside of the U.S. for care, it was hard to know what to expect. There are definitely some differences between the healthcare system in which I grew up and the one in which I find myself now.
Our first visit to the hospital was easy because we had a nurse from the international clinic with us and she navigated us to our first ultrasound, but we were on our own after that. Our first and second solo trips were incredibly stressful to the point where my eyes were brimming with tears and my anxiety was through the roof. It began when the girl at the information desk gave us wrong directions to my doctor’s office, and after being directed by others to three completely different parts of the hospital, we finally made it…15 minutes late, but it didn’t seem to be a big deal since my doctor is always busy and always has people waiting. My doctor works in a team composed of herself, a midwife, and a medical student. She was recommended to me because she is one of the few at the hospital who speaks English, and her medical student speaks some, but the midwife doesn’t speak any (she has a good way about her though that made me like her from the start despite our language barrier). In my brief visit, I learned I had a list of things I needed to do before I could technically be a patient at the hospital.
The next day, we had to return to make a contract for first trimester care with the hospital (one must make a new contract for each trimester. While I found this very annoying at first, I can see the sense in it now. One pays everything up front, and if something were to happen to the pregnancy, it would be difficult to get the money back for the care that was not received). We were told the contract manager would speak English, which she didn’t, so a variety of other people jumped in to help. I had a referral from the doctor at my clinic, but not the right referral which needed to be from the clinic itself (and I need a new one for each trimester…). We first had to go meet with a department head to confirm what was to be included in the contract and it all worked itself out eventually.
After we had a contract in hand, I needed to wait in line for a blood test and ultrasound. This is when things got really stressful for me, and still stresses me out at times. There are, and there aren’t, appointments. This applies to blood tests for sure, definitely no appointments, but ultrasounds and even visits to one’s doctor can be done without an appointment. It is called a “live line” or “active line.” Basically it involves arriving, asking who is last in the line, and claiming the next spot; however, people with actual appointments get priority, so a live line can take several hours. Those waiting in it fill every free moment a doctor may have, such as someone not showing up for a scheduled appointment or an appointment going faster than planned – free time is always filled. Luckily, I met my first Kazakh friend outside of the university in one of these lines and she has been amazing about helping me schedule appointments or translating when things get tricky. All-in-all, that second day at the hospital took nearly three hours.
And from here on out, this has become my life. Sometimes I have to go to the hospital three times a week – Monday to drop off a urine sample (one must do this before each visit to one’s doctor), Tuesday to see my doctor, and possibly another day for a different test – other weeks I have nothing going on, it just depends. Overall, without anything to compare it to, the care seems decent and follows a similar schedule to what my childbearing friends in the States have experienced. An additional requirement here that seems unusual is that one must visit an endocrinologist and a general practitioner in the hospital in the first trimester – I think this is to make sure your diet and overall health are good and to get a baseline should you have complications later.
I have observed there are some key differences between care in Kazakhstan and care in the States.
I quickly learned modesty is not a thing. I had my first pelvic exam in what I can only equate to one of those Roman chairs used for crunches in a lighted room at night with broken blinds, which I later realized faced the parking lot. Unlike in the States, there are no paper blankets to alleviate one’s feelings of vulnerability, you’re just out there for everyone to have a look. At least this makes me laugh now.
The bedside manner of doctors is quite…abrupt and withholding. Doctors do not want to give you any more information than is necessary, at least nothing that is not pertinent to the current trimester. There is also no coddling, so celebratory feeling that “yay, you are pregnant, congrats!” One gets the sense that you are not special because you are pregnant, women are pregnant all of the time, no big deal. While this stung a bit at first, I now see it as a sign of experience – these doctors have seen it all and your pregnancy is just another one to them, nothing to worry about.
People warm up to you with time. I really felt awkward and out of place the first few months, but now other employees, not just my team, recognize me, are quite friendly and try to speak with me in Russian or bits of English, or try to help me if I’m having a problem. It just takes time.
Patience is key. Without appointments, one has to learn to sit back and wait. Everything will work out.