Personal View: Learning from the Russians
Authors: Belinda Hirsh
Journal: BMJ (2006)

Liz sneezed again and Alexandr's worried countenance became almost panicky. He summoned his secretary into the office who, in response to a few barked commands, adopted the same anxious look and hurriedly ushered Liz out of the room. It was our first full day in Russia and we did not want to appear rude or lacking in diplomacy, but we were worried by the apparent abduction of our colleague. The interpreter laughed and explained to us that Liz had been taken downstairs to the “salt cave” for treatment of her cold.

We had been sent from the United Kingdom to conduct a review of the Podmoskovny Lyceum, a charity-funded boarding school near Moscow. The lyceum provides top quality care, education, and accommodation free of charge for a specially selected group of children who come from disadvantaged backgrounds, have been victims of terrorism, have lived in areas of conflict, or whose parents serve in the Russian Border Guards in remote corners of the country. The school had approached a charitable foundation in the UK for funding, and the foundation had set up a review team of advisers to visit the school and make recommendations. Details sent with the funding requests included paying full time salaries for four doctors, a dentist, and two nurses to serve a population of only 136 children, so there was no argument with the suggestion that a doctor be part of the review team.


All food served is first tasted by a doctor


My first impression was one of pure astonishment at the medical facilities with which the school had been equipped. There were consulting rooms, treatment rooms, and isolation rooms, spinal stretching beds designed to treat minor spinal misalignments and mild scoliosis, inhalators and ultraviolet lamps to treat colds and runny noses, heat therapy, ultrasound therapy, magnet therapy, laser therapy—“Lasers can treat everything” was the repeated refrain of the senior doctor—a visual biofeedback machine to correct squints, and of course the aforementioned salt cave. The salt cave is a small room with the walls, floor, and ceiling covered in salt; salt dust is fanned into the darkened room while the patient lies on a deckchair listening to classical music and looking at soothing coloured lights. It is used to treat coughs and chesty colds and also for a number of skin conditions. At the lyceum they believe that if all the children spend prophylactic time in the salt cave, it will reduce the overall number of colds suffered, so each child receives a total of 10 hours of salt cave therapy in a year.

Perhaps the most striking feature for me, and that for which I was least prepared, was the cultural difference in healthcare attitudes. I have heard it described as Russian health paranoia but I think this is inaccurate. Of course it sounded extreme to learn that term time interaction with children from outside (such as in sports matches) is discouraged for fear of bringing infections in; that at the first signs of a cold a child is isolated from his or her peers for two to five days; that all kitchen staff undergo a daily medical examination; that all food preparation is supervised by either a doctor or nurse; and that all food served is first tasted by a doctor. However, despite the lack of evidence for many of these interventions, there is perhaps a lot to be learnt from such an attitude.

While at such an institution in the UK we would think, “What do the children need in terms of health care?” at the lyceum they think, “What more can we provide?” The medical team are fully involved in the daily life of the lyceum and are able to take a holistic approach to the health of the children. This includes attention to diet, physical exercise (a doctor can “prescribe” physical exercise for children in addition to their normal fitness programmes), hygiene and sanitation (the doctors conduct weekly inspections of the living accommodation), and health education delivered either individually or in small groups.

Visiting this Russian institution has given me a new perspective regarding primary care and public health in the UK. How many doctors in this country wish they had more power to control the diet, physical lifestyles, and living environments of their patients?

As for the salt cave, there is some evidence for its role in respiratory medicine though I could find none regarding dermatology or resistance to viral infections (Allergy 2006;61: 605-10 [PubMed] and Journal of Aerosol Medicine 1995;8: 221-32 [PubMed]). I did, however, expose myself to a short treatment and found that the soothing combination of classical music, coloured lights, and comfortable deckchair left me with a tremendous feeling of wellbeing. I imagine for the children it is a greatly appreciated break from the general hustle of a busy boarding school, and I only wish I could afford the $10 000 (£5,400; €7,800) to have one installed in my own home.