Thursday, October 25, 2012

The Ukrainian DENTIST!!! Ahhhh!!!!!

I just saw a Ukrainian dental surgeon. And it's only 10:30 AM!
Pharmacy booty: Catafast, Cifran, and Dr. Reddy's Cetrin
Although I much prefer to ignore problems like this and just hope they go away, last night's frantic midnight Googling of "pain in back teeth" (and that terrible scene in Castaway, you know what I'm talking about!) convinced me to wake up early today and see the dentist. D and I, like naive Americans, assumed that we'd see a receptionist this morning and at best be able to schedule an appointment for tomorrow.

Haha. Ha.


There are two dental clinics nearby that we've passed a million times before. D vetoed the first one for looking too sketchy. Instead we headed to a large clinic with an old plaque for identification in place of a flashy modern sign. People are always coming and going from this place... that's good, right?

Inside was a maze of corridors. We found the reception room and almost immediately were in front of the receptionist. She asked for name, patient ID card (nope), and passport (nope). I was amazed that she had NO COMPUTER- she was taking notes by hand and recopying them in a notebook! Although I probably shouldn't be so surprised, this system was also in place at the immigration office, OVIR. Anyways, she struggled with my American middle and last name (D made me do the talking) and when she asked for my first name I totally freaked out and said "Katya". Katya is a nickname in Russian and it must have been quite strange to be writing this on a formal document. She directed us to another woman behind a desk, who then took my patient book, expressed dismay over my choice of Katya ("why not Yekaterina?"), and charged us 10 uah for another slip of paper.

Immediately we were sent into a different room, this one behind a frosted door. It opened into a large area filled with dentists, chairs, equipment, and patients. I tried to get a count- at least 12 stations. No walls, everyone just busy doing their own thing.

A woman in scrubs took my slip of paper and sent us away to the coat check. Ah, the coat check. An essential part of any Ukrainian experience! We returned to the dental room and, again with no wait, I sat down in the chair and the dentist began peering and poking about in my mouth. This only took about 3 minutes. She put down her tools and informed us that a wisdom tooth was beginning to emerge and while she thought it would be okay, we should go see the surgeon to make sure.

On one hand I was cheered by this- yeah!! Almost 30 years old, it's about time I got some wisdom! :p On the other hand, ehhhh, not so excited. Surely I had already enough material for a blog post, no need to see a real surgeon, right? Promising myself that I'd write about the experience in this blog was how I worked up the courage to even get to the dentist in the first place. While writing about the dentist can be interesting, I had zero interest in writing about anything to do with surgery. Zip. Zero. Nada.

But then I remembered that scene from Castaway, where Tom Hanks' character didn't go to the dentist and later had to remove his tooth with an ice skate and a rock after getting marooned on a desert island.

Yep.

Off to the surgeon's we went.

He was past the coat check, at the other end of the corridor maze, behind another frosted door.  Again we opened the door and found ourselves in an open room, this one with 3 chairs, 3 surgeons, and several nurses. One chair was available. The surgeon was sitting at the counter reading the newspaper. He took my slip of paper and asked about my strange name. "A foreigner?", he said, "From America? We don't treat foreigners here. You'll need to go to another location." Our faces fell. "У тебя страховка?", he asked, and then repeated in English, "Insurance?" We shook our heads.

Something must have changed his mind, for he stood and motioned for me to sit in the chair. He grabbed his instruments and began examining my molars with a mirror and pick. "Is this the first time you've had this pain? Do you feel it at night?"  "No, yes", I responded as well as I could in Russian with my mouth wide open. "Ah-ha! You understand everything I say, don't you?" he remarked pleasantly. I could smell the cigarette smoke on his clothes and breath as he stood over me. He decided that while the tooth was indeed growing in correctly, he'd need to make a cut to... and then I lost the translation. But since he was assuring me of this and D (my back-up translator) offered no interference, I went with his authority and nodded.

AND THEN HE SUDDENLY GRABBED A GIANT NEEDLE!!!! I have no needle phobia but this needle literally appeared out of thin air. I was thinking oh, we'll schedule an appointment, blah, blah, blah. In America these things take forever. The idea that a medical professional could diagnose a problem and treat it in the same day is literally an alien concept.

"Calm down, calm down, good, умничка (smart girl)" and then bam!, in went that needle into the back of my gums. And it HURT! My body went rigid in fear.

I guess I should be grateful for the painkiller though. Last night D and I were discussing dental work in Ukraine. "I'm so glad we're here right now", he said with confidence. "There's no way we could afford to have any dental problems if we lived in the US." He's right. His family has always come to Ukraine to get dental problems fixed. In 2007 he saw the dentist and had several cavities filled for $200. Meanwhile my American dentist wanted $800 per tooth to fix my cavities! (And I couldn't help but notice his nice car out in the parking lot.) D's father just came to have some dental work redone for thousands less than he would pay in the States. So I had this glowing view of Ukrainian dental practices... until last night, when D revealed that all his dental work as a child was done with no anaesthesia and the drill used on cavities was an ancient old contraption with multiple belts and revolutions so slow that you could count them. He recounted, "One day my sister came home from the dentist- 'They gave me a shot! I could hardly feel anything! Incredible!' and I was amazed at the idea you could avoid the pain." At that point, the lure of dental tourism abroad began to dim for me.

But back to the surgeon's chair. While we waited for the anaesthesia to take hold, he began discussing my life with D. "What does she do? Oh, teach English, uh huh." He came back to me and began practising his English- "Все правилно, everything is correct, right?" Unfortunately that was the end of the English lesson. He ordered me to open wide and went into my mouth not with a knife, but with a freakin' pair of scissors. Snip, snip, snip, went the scissors. Quite violently, mind you!! I silently thanked the deity of all dental work that I couldn't feel whatever it was that he was doing. More snip, snip, snip and finally he was done.

There was a stop-the-bleeding bit, then a lecture bit and a small piece of paper was handed over with the names of several lovely pharmaceuticals. "No exercising, no hot baths, no chewing on the right side, do you understand?" Now I can watch America's Next Top Model with no guilty I-really-should-be-exercising-instead-of-watching-TV feeling : ) We asked him where to pay and he told us to pay him directly. We asked about the little handwritten patient book and he said it was worthless. I think it got left on the counter near his newspaper.

So, overall summery:
  • Yes, it was all done in Russian.
  • Total time: 1 hour, 15 minutes (to get an appointment, see a dentist, see a surgeon, have work done!)
  • Cost for registration: 10 uah, approx. $1.20 USD
  • Cost for dental work: 100 uah, approx. $12.25 USD
  • Cost for medicine at local pharmacy: 80 uah, approx. $9.80 USD
  • People were friendlier than I expected. The surgeon was gruff but polite.
  • Shockingly, at the reception area I wasn't asked why I wanted to see a dentist. This means I never said it was an emergency, they were just willing to see me anyway.
  • Um, it was all clean but it wasn't hysterically clean. No gleaming equipment, no big display of this-is-a-clean-needle, this-is-a-sterile-mirror, but everyone did wash their hands in front of me and use gloves. No dental bib for the patients either, you're just sitting there in your street clothes.
  • Overall, I'd rate this a positive experience. The language barrier was a little bit intimidating, as we couldn't have much discussion of the what, how, and why (no second opinions, just straight to it!) but I felt like I was in good hands. Hooray for Kharkov dentists!

The dentist prescribed antibiotics and put a little piece of antibiotic-covered something in my mouth. On Saturday I'll go back and his assistant will remove it. Please keep your fingers crossed for me! :p

For my Ukrainian readers, here is how the system is different in the US (although I've had very little work done, only 1 or 2 cavities filled, mainly teeth cleanings):
  • the dentist always sees you in a private room or a cubicle, never in an open space.
  • usually you see a dental assistant, then you briefly see an actual dentist.
  • loooong waits: first you schedule an appointment (usually a week to several months from today), on the day of the appointment you wait in the lobby, then wait in the chair for the assistant, then wait in the chair for the dentist, then the assistant again, then you pay at the front desk. Same- day service is very rare, only for dental emergencies (if that!)
  • the size of your wallet determines the quality of care you get (probably the same here in Ukraine, I know). I used to work with refugees and they would have to use the public (government) health clinic. It would take ages to get an appointment and then they'd only get the bare minimum and probably have to schedule another appointment for more care. And you still have to pay, it's not free. Meanwhile, last year I saw an ad for a local private dentist- he was having a "new patient special package"- cleaning, exam, x-rays. It only cost about $200 (1600 uah) and the entire time he was trying to sell me $15,000 braces to "have a Hollywood smile." Ugh. 
  • There's a law that says non-English speakers are supposed to be provided a translator (on the phone or in person), but this often doesn't happen because hospitals and clinics don't want to pay for it. Instead, usually patients bring a family member or friend to translate (just like I did here).
  • Maybe this Ukrainian dentist just had older equipment, but he told me to spit in a little trash-basket. In the States the dentist always has a suction tube and they stick it in your mouth and suck out saliva, blood, etc. I prefer to spit on my own; the suction tube is just weird and you have to wait for the dentist to remember to use it while you sit there uncomfortably.
  • American dentists emphasize cleanliness and sterility. Everything is shiny, needles are unwrapped right in front of you. And the patient always wears a dental bib, a long piece of paper that covers your body and protects your clothes.
  • Sometimes there's a picture on the ceiling to distract you while the dentist works.
  • You MUST MUST MUST have ID. And if you don't have insurance, well, you'd better cough up all that money in cash right at the receptionist's desk or you probably won't get the appointment. The only other option is to sign up for a payment plan.
  • The American dentist usually gives you a free toothbrush at the end of the appointment :P  


14 comments:

  1. Somehow I knew that someday you will need to see a dentist. I should have told you, I know a good one. With all that gleaming stuff, and suction tubes. But the main thing he is a good doctor and a very nice guy.
    But I'm glad to hear that everything is alright with you! :)

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    1. Haha, yeah, you should have told me not just about the dentist but that you had a suspicion I'd have to see one! Do you see anything else in my future? :p
      Thanks for the comment, Timur!

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  2. Great post, Kate! I admire your courage :) I'm absolutely terrified of dentists because I had exactly the same experience as a kid, as D had. And even though I've been to a good dentist as an adult and everything was tip top, those early memories still give me a panic attack when I think about a person with tools approaching me. I've never been at the dentist office in the US, especially after I've learned that cleanings are not done by the actual dentists, but by some semi-qualified assistants or technicians or whatever they are called. Just the idea of it freaks me out. Out of curiosity, what would be the co-payment for cleaning here?
    Now, regarding a good dentist in Kharkov. I do my dental maintenance when I visit home too. Not even for financial reasons, but because I'm that crazy when it comes to dentists. There's a clinic called "Немецкая стоматология". The address is 26 Чернышевская, it's at the 5-streets crossing. It's not cheap (still probably better than US), but it's worth every penny. For reference, last December cleaning was about 700 UAH, cavities filling in 2009 was something like 400 UAH for a simple one, closer to a 1000 for a more complicated one. The service is FANTASTIC. Private rooms, plasma screens on the walls, that are hooked up with a tiny video cam at the dental chair. They use it to show you exactly what the problem is and explain what and why they are going to do. They even give you a dental bib and hospital overshoes. And what's most important, they do everything they possibly can to make it painless for you. So if you want, I can hook you up with the doctor there.

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    1. Hi Sergiy, thanks for your detailed response! That's funny that you mention Немецкая стоматология... I noticed them a month or two ago while walking in that area of town and had heard good things about them (from someone? from the internet?). Will definitely keep them in mind if one of us has to visit the dentist again. Your description of that clinic sounded pretty great! My students told me that the place we visited this week was actually the public dental clinic. Now I understand why the 10 uah registration fee was called "a donation" and why the surgeon just put the money into his pocket! :p He also advised that I eat only soft foods, or- in his exact words "red caviar and black caviar". Overall it was a good visit, I just wish there could have been a follow-up to make sure it's all okay.

      Hmm, not sure about the co-pay for cleaning in the US. When I was a kid my mother worked for a large healthcare provider and we had amazing dental coverage with a copay of $5-$20 (if any!) for yearly cleanings. But I don't know if that's an outdated number now. Or nowadays they might charge a percent (like 10%) instead of a flat fee. Still, yeah, like you said, the assistant does most of the work and the dentist just comes to check it over. So maybe I'll see you at the Ukrainian dentist's office this winter? :p

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  3. I would love to charge my patients 110 uah. As long as I can pay my employees 10 uah/ hour. Pay nothing in taxes and have a country that is so politically screwed up it was just invaded. When the gum grows back over your wisdom tooth and the pain returns good luck. The implication that ukranian dental care is better than western dental care because of price is rediculous

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    1. Agreed!! I hear stories of people that head to Mexico for their dental work because of the price. Yes sometimes it works without any issues but frequently they come back with more issues. Also because of the language they loose a lot of the education that goes with dental treatment in the states.

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    2. Hi Anonymous and Anonymous! Thank you both for your comments. I agree with you that it can be risky to get treatment abroad- it's not just the language barrier, it's also a difference in standards of care and potentially less government oversight/regulations. That said, it wasn't like I came to Ukraine solely for dental work- I was here, I had a problem, and hopping on a plane to go see a US dentist wasn't an option. I had no choice but to go to a dentist here and although I was a bit leery, it went really well.

      It wasn't a perfect experience, of course- I would have liked to have been a bit more knowledgeable about what was going on- but it was what it was. I like to look for the positive parts of experiences; that's what led to the creation of this post. I'll admit that part of this experience was luck but they did treat me immediately as a non-emergency walk-in (let's admit that's not likely to happen quite so easily in the US) and I can't complain about the price. The point of this post wasn't to lure unsuspecting Americans to Ukraine or supposedly equally-shady countries, it was simply to share a day in my life that turned out better than I had expected.

      Thanks for reading, good luck to you both : )

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  4. How cool to come across a post like that. I was born in Kharkov and became a dentist in New Jersey. :)
    I do remember getting root canals in Kharkov with out the local anesthetic! Well, maybe that is the reason I became a dentist!?
    In any case, all things said above seem true and correct. If you need a good service in NJ, look me up.
    Vlad Detinich, DMD.

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    1. What a small world, Vlad!! : ) It's very cool that you dropped by! You must have an interesting story... Ukraine to New Jersey is quite the change :P I'll definitely look you up if we ever end up in your area, and please drop me a line if you're ever back in Kharkov for a visit.

      PS: D says he sympathizes with you (about the lack of anesthetic)... I can't even imagine, ouch!

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  5. Hi,
    Great article. Always interesting to see how things are in other countries. BTW: It is not a coincidence to have three dentists from the U.S. post here the same day on a blog post from 2012. Thought you might be interested in that: http://practicemanagement.dentalproductsreport.com/team/first-hand-look-dental-practice-ukraine?cid=DPRDPM
    All the best!
    Nick

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    1. Thanks for your comment, Nick! It's a big honor to get a mention on Dental Practice Management, I'm very grateful to Kevin Henry : )

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  6. I just returned from two months in Ukraine which included some medical work that I did not plan for. The description is a herniated disc in my neck. This was caused during my backswing when rolling a bowling ball one night. I didn't even know I had a problem until the pain started in my right arm a few days later. It got worse and affected my right shoulder and eventually my neck over the course of about three weeks. At the end of that period. I couldn't raise my head.

    I started in a public hospital in Odessa and I got an MRI for US $75. Incredible. After about ten days Odessa referred me to a hospital in Kiev. I spoke to the surgeon in Kiev on the phone and I was in Kiev the following morning. It was very simple. No messing around. I was in the operating room at noon. He went into my neck from the back (anterior) which he said was not the normal way to do it. The surgery removed the blow out pieces of my disc which were causing me to have serious pain.. To make this story short my entire medical bill including two hospitals, surgery, and a hospital bed for your days was less than US $2,700. This was spinal surgery in my neck. Incredible. I remained at the hospital for another three days for general observation. Then I was released and healthy. I don't know what the costs would have been in the United States but I'll bet it would be more.

    Let me make a note about the surgeon. He met me at the door of the hospital when I arrived. He photographed my passport so that the hospital security could check me out. (this was a national security facility) The surgeon would come to my bed and escort me to anywhere I needed to go in the hospital. After I was released he walked me to the local bank as a translator and helped me to do the financial stuff. Then we walked around Kiev for 45 minutes so he could give me a short tour. This was business as it could be, maybe it used to be like this in the United States.

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    1. Glad you had such a good experience, Merle : ) Wow, during bowling, huh? Hope your next game is less eventful!

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  7. Nice post.. Dentist North york we put stock in giving tender medications utilizing cutting edge innovation and effortless methodology.

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