With a land mass nearly twice the size of Canada; Russia is the world’s largest country. With this vastness, regional variation is natural. The time I spent in Russia was exclusively in the country’s Far Eastern Federal District (a mere 9302 km from Moscow). The Russian Far East is a large region that stretches from China and North Korea in the south, to the Arctic Ocean in the north. The Pacific Ocean serves as the eastern boundary, where much of the population lives.
The natural environment of eastern Russia is very beautiful and home to a rich biodiversity that combines elements of Asia with those of the North. The amur tiger is native to the area and there is a surprisingly large selection of snakes and butterflies. Water is abundant, with numerous mineral water springs and significant hydroelectric power production.
During my trip, I spent time in the cities of Vladivostok (population 634 000), Khabarovsk (pop. 583 000), Ussuriysk and Nakhodka (pop. 150 000 each). These cities serve as the major industrial, commercial and cultural centres of the country’s Far East. The economy consists primarily of fishing, lumber, agriculture, mining and import/export trade from Asia. Vladivostok and Nakhoda are important Pacific Rim ports and currently the entry point of millions of Japanese vehicles; the automobiles of choice in modern Russia. Ussuriysk is a clean agricultural city and home to heavenly ice cream! Khabarovsk is in a separate krai (province) from the others and is a more affluent and modern city.
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Although there is an increasing Asian presence, the population is predominantly ethnic Russian. There is also a sizable Armenian presence, although it is dominated by Russian culture. The region seems to be in transition in its post-communist phase: since the Russian Far East is neither clearly European nor Asian it seems to be in search of an identity that has yet to be defined. For the most part, the architecture of the cities is drab and decaying, although the new buildings that are appearing as part of a growing economy reflect a wider variety of architecture. Interestingly, advertising is rare on the outside of buildings, making it hard for a visitor to identify the purpose of a given building. Seeing as there are few visitors, this may not be detrimental to business.
B. Population Health
Life expectancy at birth in Russia is 59 years for males and 72 years for females.1 Cardiovascular disease is the top cause of death in the country. The regular diet consists of meat, potatoes and fried food served with rich creams and sauces. True to stereotypes, the beverage of choice is vodka. On the whole, the population appeared rather sedentary, although soccer was especially popular among youth. During my time in the Russian Far East I was discouraged from running in public, having been told that “it was not safe.” Seeing as one of my traveling companions was bitten by a stray dog while jogging in the street, I’m rather confident that the safety issues were not limited to crime per se.
There are many economic hardships in the post-communist Russian economy. Although people with astute business sense appear to be doing well, government employees are not well-paid. Teachers and doctors earn US $300-$350/month, while the average monthly rent for a 2 bedroom apartment is US $400. Under communism, it was expected that the state would continue to provide services for adults after their working years, therefore there were no pension systems. As a result, older people who are not receiving pensions from a private enterprise have no source of income and are forced to work indefinitely, unless they are lucky enough to have savings or children to support them.
This trip was focused on professional and cultural exchanges, thus a tight schedule was planned in advance. This left little time for diversion or independent exploration. As such, I never did get a wide perspective on living conditions. From my observations, the majority of people lived in small apartments with decent amenities. I didn’t get a sense of the extent of homelessness or sub-standard housing; although I’m sure it’s present to some degree.
C. Health Care System
Health care seemed to be delivered primarily in the hospital (my friend was taken to the hospital post-dog bite), although the lack of signage made it difficult to identify the presence of doctors’ offices or clinics. Hospitals were run by the government. Surprisingly, there was a significant range of infrastructure between hospitals. While some facilities had “dated” equipment (prehistoric may be a more appropriate description), others had access to state-of-the-art surgical suites and substantial computer technology.
Some private clinics do exist. I was able to tour one such clinic. The care provided at this site seemed to be similar to that seen in Europe. Potential patients needed to pay out of pocket. I’m not sure how common these clinics are or what percentage of patients are able to afford such services.
D. Disability and Rehabilitation
It was hard to get a clear perspective on if and how rehabilitation was delivered. There was a physical therapy department in some of the hospitals, generally with large amounts of electrotherapy equipment, including respirators and electrostatic devices. I was never sure if the employees in the department were technicians or physicians. I was introduced to a class of MDs undergoing physical therapy training at the university. This was optional post-graduate training for those planning on incorporating physical therapy treatments into their practice. Physicians used acupuncture as a treatment modality and electrotherapy was commonplace, but otherwise, I’m still not sure what was implied by ‘physical therapy’.
I had little interaction with people with disabilities during this trip. For whatever reason, it was uncommon to see people with disabilities out in the community. I’m unsure if this is a sign of a low prevalence of disability or of reduced community mobility for people with disabilities. I was told that people who had an injury or an illness would “stay in the hospital until they were better.” Asking about people who would never be ‘better’ didn’t lead to any further revelations. Seeing as I had to ‘choose my battles’ in terms of what I wanted to learn about, I did not pursue this further.
When I asked health providers what type of treatment someone would expect after an orthopedic injury I was told “first aid.” I didn’t get the impression that there was any treatment geared towards improving function post-injury, although I could have missed it. Some ongoing care (for example, for people post-stroke) was provided at “sanitoria”. These facilities resembled spas, with mineral baths, massage therapy and exercise classes. As all clients were performing the same exercises, I don’t believe that there was specific exercise prescription for individuals
I was able to visit a rehabilitation centre for children that was comparable to what one would see in Canada. The centre worked with children with both intellectual and physical disabilities. The staff there worked on creative strategies to improve the function of the children. For example, a child with severe hypotonia was learning to walk with a supportive device. The team included a speech therapist who was working on fairly difficult pronunciation with a child. The facility was also equipped with a sensory integration room. (Snoezelen Rooms)
E. Personal Experience
I participated in a Rotary Club group study exchange project. Along with 4 other professionals (a university administrator, a biologist, radio personality and political aide) I traveled to Russia to learn about my profession in a different culture over the course of 4 weeks. While there, we were billeted with a separate host family in each of the cities. The families offered great hospitality and a window into the local culture and passive lifestyle that Russians' in the Far East live.
I spent most of my time visiting facilities and meeting people. Initially this led me to hospitals, where I spoke with administrators, doctors and nurses, but was never really able to find my counterpart. I did, however, have the opportunity to observe different procedures and see many facilities that gave a reasonable understanding of the hospital system.
Part way through the trip I changed strategies and tried to learn more about the professionals involved with physical activity, in the hopes that I would find someone with a job description closer to mine. I arranged a meeting with the trainer of a high level soccer team, but unfortunately the plans fell through.
Russian was the predominant language and many of the people we interacted with had no or basic understanding of English. As such, language barriers were enormous obstacles in trying to express my profession and learn about local practice. Interpreters were available but didn’t have a solid grasp of medical terms and language, thereby limiting their effectiveness in a professional context.
Lost in translation was physiotherapist. When I arrived I was deemed a doctor with a few months of physio training. It was very challenging to explain that I was not a doctor and that I indeed had much more training than a few months. Despite this confusion, the welcome I received was very warm everywhere I went. The professionals that I met and talked with didn’t appear to be trying to hide anything and were very open about helping me understand their facilities.
F. Recommendations
If I were to relive this experience, I would put more energy into describing what I do professionally before arrival. While preparing for this trip, I spoke to colleagues here in Canada about the state of physiotherapy in Russia and was led to believe it to be very advanced. Although this may be true in the more metropolitan areas of the country (Moscow, St. Petersburg) it was not the case in the Far East. I was under the impression that the title physiotherapist would be clear and self-evident to locals; ultimately it was not. A detailed description of the type of work I do would have been far more effective.
The following websites profile different aspects of the Russian Far East:
