Patient without tongue.
How the Russians who left for Serbia are trying to gain access to the legal market of medical services.
more than 140,000 Russians entered, according to local authorities. Not all of them speak Serbian or English, not all Serbs speak Russian, especially when it comes to medicine, where the accuracy of statements is very important. As a result, a real gray market in medical services has emerged in the country: Russian doctors who do not have a license visit Russian-speaking patients at home. Hundreds of physicians and thousands of patients were involved in this scheme.
The Russian doctor already explained everything to me"
36-year-old Galina (her real name is known to the editors, but she asked not to be identified) is from Moscow, in July this year she moved to Belgrade. In September, her 8-year-old son developed a fever. Instead of calling a doctor or going to a hospital, she found a pediatrician from Russia on Telegram who had also recently moved to Serbia. "He came to the house, examined the child, explained what we should do," Galina told the BBC.
She moved to Serbia with her son and husband, they have a residence permit and private health insurance, but she decided to use the services of a Russian doctor because of the language barrier. “After all, this is a child, I wanted to be sure that the doctor would understand me when I described the symptoms - and that I, in turn, would understand the advice of the doctor,” says Galina.
So she took advantage of the services of the rapidly growing gray market. Yes, anyone can give advice to another person. But a doctor without a license by law cannot take money for services - for this in Serbia there is a criminal liability. Home consultation can be risky for the patient, and it also prevents the authorities from keeping statistics that are taken into account when planning health care development. The Russian pediatrician Galina contacted was not licensed to work in Serbia and therefore could not write a prescription for the medicine the child needed.
Then Galina had to take her son to a private Belgrade clinic, where, she says, there were no Russian-speaking doctors. “But it was easier for me, because the Russian doctor had already explained everything to me, and when we received the prescription, I called him again to clarify the dosage of the medicine. “I assumed that it was written in a Serbian recipe, but I just wanted to make sure,” Galina explains her concern.
Telegram medicine
In 2022, more than a hundred medical workers from Russia applied for the recognition of their diplomas by Serbia, the Qualifications Agency (AQA), the state body responsible for nostrification, that is, recognition, of diplomas obtained abroad, told the BBC.
Aleksey Prakhov, a doctor who moved from Moscow to Belgrade in the spring of 2022, says recognition of a diploma is only the first step, and it takes at least eight months for medical workers to obtain all the necessary permits. "Many medical workers who have moved from Russia in recent months have been forced to work illegally just to survive," says Prakhov. Serbian lawyer Dušan Rajakovic, who specializes in protecting the rights of patients, says that foreigners need to undergo a procedure to confirm their medical qualifications in Serbia.
Prakhov, who works at a private clinic in Novi Banovci, says that Russian-speaking patients themselves are looking for doctors who understand their language. That is why they often consult with Russian doctors in their apartments, which, in his opinion, "is a risk for both doctors and patients." Dr. Prakhov says that Galina's example is not the only one - many are looking for Russian-speaking doctors in the telegram channels that have appeared and are developing. These groups include doctors who give free consultations in Russian, explain prescriptions and the like, he says.
BBC journalists found several groups on Telegram dedicated to medical services in Russian, where not only Russian, but also Serbian doctors place ads. The ads contain short biographies of doctors and contact information. Among the authors of the ads are doctors practicing at home, as well as employees of private and public clinics in Serbia. The groups also advertise the services of nurses and medical professionals to care for patients. The BBC has tried to get in touch with several doctors from Russia who advertise their services, but none of them agreed to talk.
Tourists without a return ticket
Many Russians in Serbia do not yet have a residence permit, de jure they are tourists and in Serbia they can receive medical services under a private insurance policy. If they do not have insurance, they may receive paid medical services from private or public institutions.
Serbia has international health insurance agreements with more than 20 countries, which provide for various benefits for foreign patients. However, Russia is not among them. Foreigners with a residence permit can be insured at the Republican Institute of Health Insurance. "In this case, they pay a fixed monthly amount of 3,180 dinars (just over 2,000 rubles) and have exactly the same rights as all other insured persons in Serbia," says lawyer Dusan Rajakovic.
Foreigners who are employed or registered as entrepreneurs are also eligible for public health insurance. According to the Serbian authorities, from February to mid-November 2022, almost 800 companies founded by Russian citizens and 2,100 independent Russian entrepreneurs were registered in Serbia.
How many Russian health workers came to Serbia?
More than 100 people, according to figures provided by the BBC to the APC, the government agency responsible for recognizing diplomas earned abroad.
A similar picture is given by the unofficial list of contacts of medical workers from Russia from local Telegram channels. Between January and December 2022, 169 Russian citizens applied for the nostrification of their higher education diplomas, the APC said in a response to a BBC inquiry. Nearly 120 of them received higher education in general medicine, dentistry or pharmacy. As of December 9, 86 doctors from Russia, 29 dentists and three pharmaceutical specialists have confirmed their diplomas.
But the general procedure for starting to work legally in Serbia can take more than a year. "Nostrification or recognition of a diploma is only the first step towards legal employment," explains lawyer Dusan Rajakovic. In particular, he clarifies, all medical workers in Serbia must complete a six-month internship in general medicine - and this is a volunteer, free job.
The Ministry of Health of Serbia may recognize an internship completed abroad, but only if it meets local requirements, plan and program. After this internship, you must pass the state exam for knowledge of the Serbian language. This is the duty of any foreigner who will work in a public institution, including hospitals. He must learn the language on his own - there are no state language courses here. Doctor Alexei Prakhov has 25 years of experience and specialization in cardiac surgery and anesthesiology, which he acquired in Russia.
But he did not undergo an internship like the one needed in Serbia. "There is no such thing in Russia - doctors work in clinics immediately after graduation," says Prakhov. Another important point: APC can confirm only a diploma of a general practitioner. There is an additional step for medical specialists. They must obtain a license depending on the specialty - it is given at the Medical Faculty of the University of Belgrade. The license can be temporary - for a period of 180 days, and a permanent one is issued for several years, then renewed.
Russian nurses and pharmacists were not issued such licenses in 2022. Accreditation centers that issue licenses to medical specialists and dentists did not respond to a request from the BBC.
Temporary solution
Dr. Prahov has already worked in Serbia in 2018 - by invitation in a private clinic. In the spring of 2022, he returned here with his wife and three children, the youngest of whom is eight months old.
I made the decision to leave on February 24 when the Russian army crossed the border into Ukraine. It goes against my beliefs," he says. Old contacts helped him find a temporary job. Prahov was invited by one of the drug treatment clinics near Belgrade. The fact is that foreign doctors who come at the invitation of Serbian clinics have the opportunity to obtain a temporary license, which is renewed every six months.
He considers himself far more fortunate than most of his colleagues leaving Russia, but says it is a "temporary solution." "I can't renew my temporary license forever, and I can't get a permanent license without doing an internship. And that means six months of volunteer work," he says. The doctor simply cannot afford it, because now he is the main source of income in the family. Dr. Prahov already speaks Serbian - he speaks slowly, alternately using Russian and Serbian words, explaining the bureaucratic ups and downs he faces.
Anesthesiologists like me are more likely to work with patients who are not conscious, but in some areas of medicine, details are important - a human life can depend on it, ”he says.
President Aleksandar Vučić recently said that Russians and Ukrainians who have moved to Serbia will soon be able to apply for citizenship on a fast-track basis as the country lacks a workforce. In October, he announced that procedures for obtaining work permits and Serbian citizenship would also be simplified to make it easier for the country to attract and retain workers from abroad.
By Dr Sher jahan
Source: BBC NEWS
