The Warming of Siberia:
Medicine, Mission, and Miracles

William P. Cheshire, M.D., Assistant Professor of Neurology,
Mayo Clinic, Jacksonville, FL

One by one, our boxes of medical supplies emerged. We were thankful that nearly all of the antibiotics, analgesics, syringes, bandages, antiseptics, and dental supplies had cleared Moscow customs. These provisions would save lives.

Yes to Yeshua

This was my second mission trip to Russia with Yeshua Medical Ministries.¹ Yeshua is the Hebrew name for Jesus, the "Great Physician," whose example of healing, compassion, and sacrifice recorded in the Bible had moved me to leave the comfort and safety of home to travel overseas for two weeks of medical practice.

The opportunity to practice medicine in a foreign land is a special privilege. Working closely with colleagues abroad toward a common goal cultivates true friendships. And the special glimpses into their personal lives that patients share with their physician offer a view into another culture more intimate than the casual tourist can ever know.

In the center of Novosibirsk stood a huge statue of Lenin poised defiantly against howling winter winds that can reach 60°F below zero. Nearby, the river Ob, frozen from October to May, wound past the hub of the trans-Siberian railroad, flowing north through green birch forests and frosted tundra into the Arctic Ocean. There was no hot water in our hotel, where it seemed that the bath water could have been only warmed by adding some ice cubes.

I had come expecting to endure certain hardships. They proved trivial, of course, in comparison to the daily conditions of life for Russian folk. Most Americans seldom face the privations familiar to people in remote regions of the world. Following the collapse of the Soviet Union, the health care needs here were enormous.

Carrying only what rations of medical science could fit within a few suitcases, our small team had come to Russia to demonstrate the love of God by word and deed. Although our own resources seemed inadequate to the needs before us, our faith was placed in something greater. Our medical team had come as part of a larger multi-denominational evangelistic effort comprising people from diverse backgrounds and from a dozen nations. We were united in our purpose of sharing a message of hope with the Russian people, whose government had until recently indoctrinated them with the idea that God does not exist.

The Team

Leading the team was the founder of Yeshua Medical Ministries, Dr. Paul Williams, a neonatologist who has organized medical missions and relief projects in 120 countries. Also participating were psychiatrist Dr. Ann Goodman, cardiologist Dr. Keri Teplinsky, and dentist Dr. Lee Rogers. We were just five in number, and this was the first mission trip for Ann and Lee. The general practitioners, pharmacist, and dental assistant we had expected to join us had all cancelled at the last minute due to unexpected obligations. To make matters worse, efforts to obtain clinic space had failed. Russian authorities told us that regulations would not permit us to set up a medical clinic. Nevertheless we proceeded in faith, and indeed our needs were met.

The first morning we met with the administrators of municipal hospital #18, who sternly put to us a series of questions about our credentials and our purpose in coming to Russia. Dr. Williams replied in his accustomed gentle manner. A young lady from a local church translated our responses in turn. The chief of staff then smiled warmly and granted us the use of an entire wing for the week. Several Russian physicians generously yielded their offices to give us working space. We returned the favor by donating, at the end of the week, the medications we had not used, including supplies of oral and parenteral antibiotics that surpassed what this struggling hospital normally possessed.

As we proceeded to unpack and sort medications at the hotel, several people from the mission team stopped by to ask if they could help in some way in the medical clinic. Dottie, who had come as part of the intercessory prayer team, offered her experience as a retired Ph.D. microbiologist. Drawing from her scientific background, she ran the pharmacy with the help of Ed, a retired NASA engineer, and Elena, a Russian lady from a local church who happened to be a pharmacist and helped translate instructions to patients. Michelle, a young missionary from South Carolina who had established an orphanage in Romania, happened to have been trained as a dental hygienist. With skill she assisted Dr. Rogers.

We offered medical care freely to all who came, without condition or expectation. We clearly identified our clinic as a Christian ministry and offered to pray for any who desired prayer for the spiritual dimension of their health. Each physician worked out of a private exam room. A counseling team was also set up in the room next to our temporary pharmacy.

Encountering Russian Medicine

A number of Russian medical students and residents accepted our invitation to work with us. Their help in translating medical terminology unfamiliar to our interpreters was invaluable. At the bedside we taught them some clinical medicine, and at the end of the day we would sit down together with cups of chai (tea) and discuss difficult cases. Some of the staff physicians introduced us to their most challenging inpatients for a second opinion, including one patient with diphtheria neuropathy and another with atypical motor neuron disease. The level of education, breadth of clinical knowledge, and professional dedication of the academic physicians in Novosibirsk was quite impressive.

The physical condition of the Russian hospitals, however, was saddening. Weathered entryway steps crumbled. Dark interior hallways opened into rooms that made good use of sunlight, electric lights being uncommon. Unpredictable heating made rooms with windows facing the afternoon sun the most comfortable. Potted plants lined the window sills. Scarved ladies dutifully mopped the corridors clean of city dust. Each wing had its own pharmacy closet, sparsely stocked, with only a few drugs for hundreds of patients. Procedure rooms appeared half a century behind American standards which we so often take for granted.

Rooms along the wards accommodated six inpatients arranged in parallel cots. Once admitted to the hospital, the patient was responsible for purchasing some of the basic medical supplies, for example, intravenous catheters available for 51 rubles across town. Families were expected to bring the meals.

Interestingly, Russian patients preferred to receive medications intravenously, even when oral preparations were equally efficacious. Intravenous diclofenac was used to treat "osteochondrosis" (a general term for spondylosis and osteoarthritis), and piracetam for chronic stroke and for the tick-borne encephalitis endemic to the region.

The mean life expectancy in Novosibirsk is 53 years. This is partly due to the rugged conditions of life, but also to the high prevalence of hypertension,² much of which goes untreated since many patients cannot afford to fill their prescriptions and also buy food. Some of my patients with histories of angina and stroke were young men, usually smokers, in their 30's and 40's. Alcoholism, tuberculosis, and hepatitis C were common.

Some aspects of the Russian medical system seemed strange to us. Patients kept and carried their own medical records. I was startled when, as soon as I would pull out my stethoscope, my patient would promptly stand erect to be examined. After bumping heads, I asked my interpreter about this. In Russia, I was told, patients are trained to stand to be examined by the doctor. Some patients were unaccustomed to being touched during a medical examination.

Other aspects were familiar. One afternoon when trying to decipher some handwritten Russian medical records, my interpreter remarked, "Why can't doctors write legibly?"

Selected Consultations

The prospect of making the transition from tertiary to primary care had left me rather uneasy. However, to our astonishment, a steady flow of patients appeared at our door requesting to see the neurologist. Word had spread that an American neurologist was in town seeing consultations for free. I was delighted to be able to practice my specialty. The faces of these dear people are etched in my memory. In summarizing some of their cases, I will refer to them by other than their real names. There was the depressed widow whose husband Alexei had been killed in his early 40's by acute radiation poisoning in the Chernobyl disaster. May we never see this in the United States.

Tatyana had suddenly become deaf shortly after her husband died. She could understand only fragments of loudly shouted phrases. Her deafness was, however, incomplete. I watched as her daughter gently moved in close enough that their cheeks touched. Then, as her daughter whispered softly directly into her ear, she heard perfectly. After our counsellors prayed and cried with her, she opened up to a degree that amazed her daughter, who told us she had not interacted like this in years.

Boris had suffered from many years of intense deafferentation pain following multiple cervical nerve root avulsions from a motor vehicle accident. His doctors had even amputated the arm in a desperate attempt to relieve the agony, now compounded by phantom limb pain. The simple analgesics we gave him would accomplish little. We prayed with him.

Other patients had such common ailments as migraine headaches, epilepsy, stroke, radiculopathies, myelopathies, vertigo, and postconcussive syndromes. A tough veteran of Afghanistan and Chechnya, Alexander had suffered a mild stroke. He appeared at least 20 years older than his stated age of 35. He could not afford to buy medication on a regular basis for his hypertension. We gave him enough to last the next two months.

Vitaly, an older gentleman, told me about the time he had prayed to God to save his life. As a fighter jet pilot flying a secret mission over Afghanistan, suddenly he heard a thud. His windshield was hit. A labyrinth of cracks began to buckle inward. He barely kept the glass from caving in by wedging a box against the window. He survived the ordeal, but over the years he had forgotten God . . . until now.

Valentina, an 81 year-old woman, told me she was "too old" to deserve medical attention. I replied that Sarah was 90 years old when God called her to be the mother of a nation. Valentina was no less important to her Creator. Later that morning in the hallway she caught me by surprise as her two hands reached up, laid hold of my head and pulled it down within reach to plant a kiss on my cheek.

Nikolai was a frail, blind, 84 year-old man with a hand tremor. With the help of my Russian colleague, I was able to direct him to a pharmacy where he could get levodopa for his Parkinson's disease. Later that morning he prayed with our team to receive Eesoos (Jesus) as his Lord and Savior. He prayed with conviction as his expression filled with joy beyond words. In tears he told us that knowing Jesus reminded him of the time he met his loving wife, who had rescued him from a dismal institution for the blind, married him, and had taken good care of him all these years.

Jakov, a Jewish gentleman I treated for neck pain, had spent two years in a Nazi concentration camp. While in Russia we heard accounts of ongoing persecution of Jews. Christians have, I believe, a responsibility to bless the Jewish people. After all, the church has been grafted into a Jewish olive tree of faith.³

A Russian physician had been treated with herbs for trigeminal neuralgia. She inquired what medications might be effective for her exquisite facial pain. I wrote down some suggestions and, upon return home, mailed her a reprint in answer to her question.⁴ Ludmilla had recently developed seizures. She brought a paper copy of her head CT showing a large meningioma overlying the parietal cortex. Her neurosurgeon had already scheduled her for surgery.

Natasha complained of relentless headaches ever since the death of her son, for which she blamed herself. Reasoning had failed to convince her otherwise. We told her of God's love for her. I placed my hand on her shoulder, and as we prayed, I felt a heavy tension lift from her. She told us she felt warm inside. The next day she returned with a box of freshly baked cookies and with great excitement exclaimed that, for the first time in years, all of her pain was gone.

Desperate parents carried in their withered daughter, Svetlana, who for years had been confined to bed—quadriplegic, able to speak by struggling, and nearly blind. No medication could correct this devastating condition. Through a careful history and examination, the diagnosis of multiple sclerosis became clear. We had no cure, but we could offer education, instruction in dealing with contractures, empathy, and prayer. Julia, one of our interpreters who conveyed the love of God in all that she did, held Svetlana's hand and told her that she was very special to God, that God loved her, that there was no one else like her in all the world. Julia's words were true.

We had the opportunity to engage in some interesting and mutually respectful dialogue with several of our patients from the Muslim Tatar tradition. In these cases medicine proved to be, not only a vehicle through which we could express the Judeo-Christian ethic of loving one's neighbor,⁵ but also a universal language of beneficence transcending political, ethnic, and religious differences.

Our patients told us that in our clinic they felt they were treated with dignity and were given time to open their hearts to us. Our Russian colleagues also offered feedback as they shared their wisdom. Zhenia, a senior medical student who had been raised in the Russian Orthodox faith, worked with me for two days. He remarked approvingly, "Prayer is important, but first you practiced excellent medicine." Roman, a neurology resident to whom I am debted for his generous hospitality, said that he was impressed by the gentleness and kindness the American physicians had shown their patients. He shared with me a Russian medical proverb: "If, after seeing the doctor, the patient does not experience relief, that patient has not seen a doctor."

Piloting the Sputnik II

Tuesday afternoon three Russian medical colleagues arrived at the clinic to escort me across town for a fascinating visit to the oldest hospital in Siberia. Our car sped past urban apartment buildings, signs I could not read, gold-domed Orthodox churches, and unlabeled former KGB offices rumored to be conducting the same operations they always had. Vodka freshened the breath of our driver, who swerved to and fro, narrowly missing the gaping potholes that cratered the boulevards. Quick reflexes and improvisation were essential to negotiating overlapping lanes of traffic. The car was not equipped with seatbelts.

While we bounced along they showed me the program booklet for the annual Siberian conference of the Russian Academy of Medicine. The print was entirely in Russian. Pointing to a line on the second page, my host startled me, saying, "Look, there is your lecture." The conference was to begin the following morning, and I was to be the first speaker. (Gulp.)

My topic was trigeminal neuralgia. I had come prepared with slides, expecting, based on an advance e-mail invitation in broken English, that I would be speaking to a small department. Instead, here were several hundred physicians from throughout the region.

On the lecturn sat the Sputnik II slide projector, a remarkably compact piece of technology not much larger than a flashlight. Once unfolded, its maximum capacity was two slides. I was permitted to operate the Sputnik II, even though I did not hold a valid cosmonaut's license.

My closing slide was a photograph of the Russian space station Mir. This solitary white craft orbiting high above the magnificent blue oceans of planet Earth had recently been the destination of joint Russian-U.S. space missions. Mir, which in Russian means "peace," seemed for the occasion an apt symbol of professional cooperation and international friendship.

Mir Miracles

During this extraordinary time of sitting down face-to-face with Russian people, as we discovered our shared humanity, the words of Psalm 23 came to mind: "You prepare a table before me in the presence of my enemies."⁶ These words are not an image of being blessed while watching one's enemy go hungry. Rather they are a picture of reconciliation, sitting down to break bread together in shalom. Likewise, Jesus taught, "Love your enemies."⁷

Just ten years ago Russia and the United States had been enemies. Who would have thought that, after decades of the tense nuclear weapons standoff of the Cold War, we would now be entering into partnership with our former adversary in the new international coalition against terrorism?

Following recent events in Afghanistan, the Middle East, even terrorism on our own soil, many Americans are wondering how to respond to the expressions of distrust and hatred toward our country now evident in some corners of the globe. While such anger stems from complex political, economic, and ideologic origins, it also represents a critical medical problem. Landmines, for example, the needs of refugees, the trauma of war and terrorism, and the specter of biological, chemical, or nuclear warfare all pose formidable challenges to preventative medicine. These dangers threaten human health universally.

Relationships among physicians and scientists are not irrelevant to efforts toward world peace. Consider, for example, that just 20 miles east of Novosibirsk lies the small Siberian town of Koltsovo, home of Russia's premier biological weapons research laboratory, Vektor. What values and predispositions, fears and hopes—what worldview—will guide future policy decisions determining the use of the genetically engineered pathogens now stockpiled at Vektor?

Physicians need not leave home to enlist as ambassadors of peace. It matters how we treat our patients and colleagues, whether they be citizens of our country, visitors, or immigrants with families overseas.⁸ Caring words from physicians are potent vaccines against distrust, capable of forestalling epidemics of hatred if applied liberally. Although disease and death may be inevitable, our compassion for our patients is never futile. May the blessings of the Author of compassion and hope be upon all people.

 

Figure 1. Dr. Cheshire at St. Basil's Cathedral in Moscow.	Figure 2. Boxes of medical supplies undergo scrutiny by customs officials at the Moscow airport.
Figure 3. Dr. Teplinsky unpacks a suitcase of antibiotics.	Figure 4. The Neurology Department at the Institute of Internal Medicine in Novosibirsk.
	Figure 5. Left to right: Major Kostya Korenkov (a pulmonologist from Nizhny Novgorod), Dr. Cheshire, Marianna Emelyanova (Kostya's wife and Dr. Cheshire's interpreter).

References

1. Yeshua Medical Ministries, operating under the new name International Healthcare Network, is led by Paul R. Williams, M.D., 167 Hart Rd., Pisgah Forest, N.C. 28768.
2. Stegmayr B, Vinogradova T, Malyutina S, et al., Widening gap of stroke between east and west: eight-year trends in occurrence and risk factors in Russia and Sweden. Stroke 2000; 31: 2-8.
3. Romans 11, Jeremiah 31:31.
4. Cheshire WP. Trigeminal neuralgia: a guide to drug choice. CNS Drugs 1997; 7: 98-110.
5. Leviticus 19:18, Mark 12:31.
6. Psalm 23:5a.
7. Matthew 5:44.
8. Exodus 23:9.

January, 2002/ Jacksonville Medicine

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