Under the knife at Moscow's finest

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As President Boris Yeltsin went under the surgeon's knife yesterday, Alexei Nesterov, an ordinary Russian citizen, was nervously awaiting a similar heart bypass operation, writes Helen Womack.

After he suffered his second heart attack a month ago doctors told him he should undergo the operation, which is routine in the West but still rarely performed in Russia. "To be frank, I wasn't keen. They had to persuade me," he said. "You see, I was a doctor myself and we doctors are all cowards. We know that 2 per cent of patients die during this kind of surgery."

But Dr Nesterov, at 62 three years younger than Mr Yeltsin, had no complaints about the standard of care he was receiving in Moscow's Botkin Hospital. "Of course no specialist from Texas will fly out to advise in my case," he joked. "But I am perfectly satisfied with how I am being looked after here. The doctors are excellent, I am sharing a nice little ward with only one other person and they are feeding me well."

The 1,800-bed hospital, founded 85 years ago with money donated by a pre-revolutionary Russian merchant, comes as a pleasant surprise after all the horror stories one hears about the state of Russian medicine.

True, the hospital is prestigious, being the centre to which foreigners are always referred if they fall sick in Moscow. But the majority of its patients are Russians receiving state treatment, free of charge if they are residents of the capital or the surrounding region.

"Five years ago, when the West was sending humanitarian aid, things were difficult," said Vladimir Yakovlev, the hospital's chief doctor.

"We really did need help then. But the economic situation is slowly improving. We are getting modern equipment and have all the medicines we need."

The cardiology department, newly renovated, is the showpiece of the hospital. The doctor in charge, Shamil Arifulin, offers me a cigarette, then realises he has perhaps blundered, and there is no toilet paper in the lavatories.

But the 12-bed unit gleams and whirrs with the latest computerised equipment from America. The department deals with emergency cases brought in by ambulance and examines other heart patients in a 50-bed unit. But if they need surgery, they go to other hospitals.

Dr Nesterov will not have to wait for his operation and afterwards, he will be sent to a sanatorium in the woods outside Moscow to convalesce. "It won't be Barvikha [Mr Yeltsin's sanatorium] but it could be Peredelkino, you know, where Pasternak lived, and that's just as good," he said.