Yeltsin Politically Correct in Having Heart Surgery in Russia, Not Abroad

The quality of medical services in Russia may well be inferior to that in the West, but no politician could ever make such an unpatriotic admission--least of all the ailing man in the Kremlin.

Horror stories of Russian hospital stays abound even among the best-connected people who have fallen ill here, but President Boris N. Yeltsin’s decision to undergo cardiac surgery in his home country is dictated more by political concerns than by medical ones.

At a time when Russians are smarting over their lost superpower status and economic inadequacy, Yeltsin has no choice but to heed the chauvinist boasts of leading Russian doctors that hospitals and health care in this country are second to none.

“For him to leave the country for two months to be operated on in America would be political suicide for the president and psychological humiliation for the country,” said Anatoly I. Utkin, a leading foreign policy analyst and member of parliament.

“He has to see how wrong it would be to go to a hospital in the West while ordinary citizens die by the thousands in the south, in Chechnya,” Utkin said, referring to Russia’s 21-month-old war against separatist rebels in the southern republic.

*

Infant mortality rates here exceed those of many developing countries, and Russia suffers the dubious distinction of having the highest death rate from cardiovascular disease in any country for which such statistics are kept.

Epidemic alcoholism, widespread pollution and poor dietary habits also conspire to lower recovery rates and the general health standard. The 65-year-old Yeltsin has already lived eight years beyond the average life expectancy for Russian males and is not thought to have taken particular care with his health for most of his adult life.

The Kremlin Clinical Hospital, where Yeltsin recuperated from two heart attacks last year, has taken in many Western patients stricken with illness or injury that required immediate treatment. Many were left with less than favorable impressions.

“You could go for days without seeing a nurse, never mind a doctor,” said a photographer treated at this capital’s most prestigious hospital earlier this year.

When the son of CNN founder Ted Turner was seriously injured in a car crash here a decade ago, the facial reconstruction surgery he received was judged to be of the highest quality, but he reportedly nearly choked to death one night in what was then considered the finest surgical hospital, and he survived only by hurling himself from his bed onto the floor to attract attention. After the incident, colleagues and friends set up a nursing rotation to ensure that further complications would not go unattended.

Even at Moscow hospitals, relatives often must bring in food for the patients because funding cuts for public health care have slashed the budget for such nonmedical “extras.”

*

While the image of Russian medicine is abysmal, Yeltsin can be assured of getting the best treatment and care available in the country, and most doctors here contend that this top echelon emulates the highest Western standards.

“Needless to say, technologically they are more advanced than we are,” Vitaly I. Dmitriyev, health statistician at the renowned Moscow Cardiology Research Center, said of Russian surgical equipment in comparison with that available in U.S. hospitals. “But precisely because of this, our cardiac surgeons are better, because they have more experience in using their hands.”

The cardiological center is headed by the famed surgeon Yevgeny I. Chazov, who cared for Soviet leaders Leonid I. Brezhnev and Yuri V. Andropov during their long absences from the public light in the early 1980s. Brezhnev died in 1982 and Andropov two years later.

On Friday, Chazov told the Russian news agency Interfax that no decision had been made as to where Yeltsin will undergo the heart operation that he announced he needed in a televised address the day before. But Chazov claimed the type of surgery Yeltsin is reported to need “is carried out nowhere but at our center.”

Cardiologist Mikhail Semenovsky said there are four medical facilities--all in Moscow--capable of operating on the president and in conditions up to Western standards. But Semenovsky conceded that Russian surgeons annually perform only about 1,000 of the coronary bypass operations of the type Yeltsin needs, compared with more than 200,000 carried out each year in the United States.

Yeltsin’s announcement that he needs heart surgery to be able to fully function during his second term as president was groundbreaking in its candor about the health of the Russian leader. Yet details about Yeltsin’s ailment and what type of surgery is needed remain subjects for speculation, even among Russia’s leading surgeons.

“It is premature to say what way the operation is to be carried out,” cardiologist Yuri Belenkov said on Russia’s independent NTV. But he echoed most of his colleagues in assuring Russian citizens that their leader would be in capable hands.

Mikhail Alshibaya, a leading heart surgeon from the Moscow Scientific Center for Cardiovascular Surgery, told the Echo of Moscow radio station that, even though Russian surgeons may perform fewer bypass operations of the type needed by Yeltsin, their success rate matches the Western standard.

“The difference is limited to the quality of equipment and the availability of medicines,” Alshibaya said of the general situation in Russian hospitals. “But this does not apply in the case of the president of Russia.”

(BEGIN TEXT OF INFOBOX / INFOGRAPHIC)

Heart Disease Rates

Russia easily outdistances other selected nations in its rate of cardiovascular disease (rate per 100,000 population).

*--*

Men Women Russia 1,318 607 Hungary 1,015 468 Poland 862 381 Argentina 628 287 Britain 516 234 Norway 463 176 U.S. 460 222 Germany 457 192 Mexico 286 202 Japan 231 110

*--*

Note: Data are for ages 35-74

Source: American Heart Assn.