Two additional insights from the past week

In my last essay on my week of hospitalization, I omitted a couple of issues. One of these is highly relevant to all prospective travelers to Russia. The other relates to general security and lawfulness in urban Russia today,

The first issue is health insurance that you are obliged to subscribe to when you apply for a visa. The most common provider of this health insurance for foreign visitors is Ingosstrakh. Applying for the insurance is fairly complicated if you do not have a friend in Russia to guide you through the process and to pay the insurance fees on your behalf since you cannot pay them using a non-Russian credit card. Somehow people do solve this problem and I will not dwell on it.

The problem is how do you actually get the insurance benefits if you require medical assistance here.

As I said in my first essay, when I entered the emergency room of the Mariinsky Municipal Hospital no one took an interest in my presenting my insurance policy. But three days later, a lady from their Payments Department visited me in my ward and pressed the point: how will the first bill for 300 euros equivalent be paid? I showed her my policy and then at her request called Ingosstrakh to get the ball rolling. They were indignant that it was only on day 3 that I contacted them but reluctantly acknowledged that there is a claim. I turned the matter over to the hospital Payments lady to resolve directly with the insurer. I heard nothing more, meaning that settlement, that guaranty of payment was issued by Ingosstrakh. But then a day before my release the Payments lady visited me again to say that Ingosstrakh was refusing to pay 75 euros in claims on the xrays which were administered, saying they were excessive in number. Wow! Some bureaucrat in the insurance company deciding what is and what is not a proper insurable expense and proper medical procedures without having access to the details of the case. At their request, I phoned Ingosstrakh and protested vehemently at their refusal without knowing why my treatment required supplemental control xrays. After that the issue disappeared and I checked out of the hospital. Simply amazing that Ingosstrakh was trying to weasel out of a 75 euro charge when the face value of my policy is for 10,000 euros. So, dear friends, be aware of what awaits you if you have to make claims against your health insurance.

The second issue of broader importance relates to the traffic police. As you may understand, all of my health travails began with my being knocked down by an SUV that backed up into me while I as waiting for a taxi. The driver got out of his car, cursed me for being in the roadway and not on the pavement and then just drove off. Hit and run is what this is categorized as and it is a criminal act everywhere including in Russia.

On about day two of my hospitalization I got an SMS from the local brokers of Ingosstrakh responsible for northwest Russia putting me in touch with the Petersburg Traffic Police, whom they informed about my case. I assume that the motive of the insurer was to eventually claw back their expenses from the driver in damages.

The Traffic Police took the initiative to request that I visit them to make a deposition. When it became clear that my hospitalization was being extended, the Police then came to me in the hospital. A very smart young officer listened to my story of the incident, wrote it up for me to sign. He also took down the coordinates of my wife who had been an onlooker to my being struck. From his case folder it was clear that they had recovered the videos of the whole incident that took place at 10.50 am on 9th October. The whole space in front of the hotel is covered by multiple video cameras that send the images to the municipal authorities.

Then the real surprise came on the next day, Thursday, when the Police officer brought with him the already apprehended driver of the car that struck me. This was an act of generosity by the Police in deference to the driver’s wish to buy me off and persuade me to withdraw my accusation. Indeed, the driver’s first words were: “You are an American. Let”s do a Trump-like deal.” He offered to pay the medical costs, to pay for my staying on in Russia for several weeks until I am allowed to board a plane and leave.

I was not obliging: I refused to withdraw my deposition. But I did offer in writing a statement that will surely lessen his punishment when the case goes before a judge: I said that I very much appreciated his apology now and that I will not seek damages of any kind over this incident. That leaves it to the insurance company to go after his scalp as I am sure they will do.

I have presented the foregoing to make a very important fact: Russian Traffic Police are today highly competent, have at their disposal the video recorders everywhere to prove or disprove allegations in cases of violation of the law. And they have on board diligent and smart policemen. All of this is a radical change from when I was living and working in Petersburg in the 1990s. Then the traffic police were themselves among the most corrupt state employees, shaking down drivers for imaginary or insignificant offenses, demanding payment in cash on the spot to drop the case. It was scandalous.

Judging by what I saw this week, the police are now well under control and are performing a meritorious mission.

Copyright Gilbert Doctorow, 2026

To hell and back: my release from the hospital yesterday

In my first couple of essays this past week addressing the question of what Russian medicine looks like from inside the beast, I was largely positive about the operations of the Mariinsky Municipal hospital where I was being treated for Pneumothoras (collapsed lung) consequent to being knocked down by a car in front of my hotel.

And I open this essay with a frank expression of gratitude to the hospital staff for saving my life.

So much for the Big Picture. Now let us move on to the realities of this past week which were a week spent in hell, with much of the suffering unnecessary if hospital care were reorganized here, not just in this one hospital but in Russia generally, because what I describe here is the rule not the exception in Russian medicine.

I am well aware that subscribers to this substack account are favorably disposed to Russia, that many of you would happily come here to experience Russia for yourselves. For that very reason, I issue this essay so that you understand the risks that face you in case you need medical attention, especially hospital care.

I address particular attention to how they deal with patients’ pain, because this was the single most devastating element of my time in the hospital and does not require capital investments, changes in personnel hiring or anything complicated and expensive as require my other observations of what is wrong in their hospitals.

I have in mind the very rare use of general anaesthesia in Russia, when it would be entirely possible to spare the patient the kind of excruciating pain that was inflicted on me 4 times in the past week:

first when a tube was inserted into my right lung to evacuate the air that had entered the thorax and compressed the lung, then twice when it was discovered that the tube had become wrongly lodged and was not facilitating the evacuation so that it was removed and a new tube was inserted. Then finally, yesterday, when that tube was pulled out.

In Belgium, everyone undergoing a colonoscopy is offered the option of general anaesthesia. This has a medical benefit, because it keeps the patient steady, without twitching at each move of the probe. But it also eliminates the discomfort bordering on pain from the probe itself.

Here, the insertion/removal of the tubes inflicted terrific pain, the sort that causes you to black out, without a thought being given to general anaesthesia, or even to strong local anaesthetics. The needle injections of some pain killer around the point of entry of the tube were less effective than what your dentist administers before treating a cavity and they did not wait one minute for even that to take effect. In the best of cases, these local injections could treat only the point of entry and not the pain delivered deep in the chest by the tube’s positioning.

I do not want to sound categorical. One of my ward-mates told me that in his abdominal surgery they used general anaesthesia and he came out fine. But for non-invasive surgery, the Russian philosophy seems to be ‘grin and bear it.’ And for post-operative pain, very little is offered. Another ward-mate in our 3-bed ward who was recovering from a knife stabbing by a disgruntled employee, suffered terribly each evening without adequate pain killers being administered.

In my ward no one slept at night, most likely due to untreated pain. When I returned to my hotel yesterday, I went to bed and slept deeply for 8 hours as partial recovery from sleep deprivation of 6 nights.

Now, I move on to problems with the hospital administration that do have remedies that are not costly if anyone cared to pay attention.

First, the food. The meals were heavily composed of hot cereal or potatoes 3 times a day, with a chunk of ground meat at lunch or dinner, and with some broth or light soup. I like cream of wheat and hot oatmeal. But not 3 times a day. And not when I am immobile as nearly all the patients were. If you go out and chop wood all day, the caloric hot cereals are a blessing. If you lie in bed all day, they turn to cement and clog your intestines. No wonder that my fellow patients and I refused the meals after a day or two.

Second, the manner of address to patients by the hospital personnel which deprives you of any shred of dignity and sharply depresses your morale. In an earlier essay, I pointed out that the support staff, meaning orderlies, janitors, the guy who brings you the meals are quarrelsome nags who speak to you as ‘boys and girls’ or ‘hey, you!’ Who are they? Why are they so rude and offensive? I speak now not just of the female staff aged over 50 but also for their male colleagues of similar age. It is a safe guess, confirmed by Russian friends who visited me in hospital that the lower level personnel are all out-of-towners living at the edges of this metropolis who are not favorably disposed to the urban population and who also, as very underpaid employees, make class war remarks to your face. When I asked if I could just have some soup for dinner, the hag who was serving remarked tartly: “this is not a resort! Go downstairs, go outside and walk to the restaurant on our territory and go eat what you want!”

I initially praised the Russian hospital for having so much personnel on hand to ensure 24/24 surveillance of the patients, all of which compares favorably with the situation in Belgium, France and Germany where support staff is in short supply because these employees came largely from Africa, from the Middle East and Southern Europe who cleared out during Covid and never returned. But, our Gastarbeiters in Belgium were/are all very respectful and kindly towards the patients, not resentful and aggressive as is the case with the Russian support staff in Russia. It would be better if they had here more Central Asian or Caucasus orderlies and helpers, since they too will be better disposed to the patients. And the total number of support staff could be reduced so as to give those in employment real living wages.

Now a word about the professional medical staff. They are good, without question. The senior doctors work as a collegium. Each morning five of them came to visit the wards and to speak with each patient. However, the treating doctors are all younger women, seemingly recent graduates of medical school. What will be the career progression of these women is unclear. Let us remember that from Soviet times, the medical profession was mostly populated by women and was systematically underpaid. Males predominated in dentistry and gynecology, which were uniquely well paid domains.

My closing advice to the Community is to avoid hospitalization in Russia if you have any chance to get out of the country on the first plane. I did not have that option and paid the price. I cannot imagine how someone who does not know the language will survive the experience intact: no one in the Mariinsky Municipal Hospital spoke a word of any language other than Russian.

Copyright Gilbert Doctorow, 2026

Breaking news: Trump reaches deal with Putin for release of Russian diesel stock to global markets

This morning’s Financial Times feature article tells us the following:

Quote


Donald Trump has struck a deal with Vladimir Putin for Russia to release diesel to the world, sparking a backlash from Ukraine as Washington aims to quell fuel prices ahead of November’s midterm elections. The US president on Friday said Moscow had agreed to “immediately” release 300,000 tonnes of the fuel “to the American and Global Marketplace” followed by another 500,000 tonnes in November and a further 1mn tonnes “immediately thereafter”.

Unquote

The article goes on to analyze the impact that this deal will have on prices for diesel at gas stations in the USA and elsewhere, as well as to consider how the Russians will find the spare fuel to fulfill these commitments.

Let us consider here other, rather different dimensions of this extraordinary deal: what it says about the two-way relationship of Putin and Trump, what it says about the likelihood of a U.S. deal on restoring the Nord Stream pipelines which is being rumored in the German press, and what it says about how and when the Russia-Ukraine war will end.

As we have heard in recent weeks, Donald Trump has sought to explain the soaring prices of diesel by the damage done to Russian refineries from Ukrainian drone attacks This issue all by itself requires some unwrapping.

First, our biggest loudmouths in the Alt Media, Scott Ritter and Larry Johnson, long denied that there was any significant damage to Russian refineries. Even as major media showed enormous lines at gas stations across Russia, our Alt Media experts said this was just a nuisance which the Russian authorities were busy fixing up. Anyone who said otherwise was now denounced as an agent of Western Russia-haters. Other analysts piled into that story and it became a chorus.

The dominant Alt Media narrative was repeated for some time, until Mainstream media produced figures showing that 40% of Russian refinery capacity had been knocked out and was taking long to repair. This news in turn was first said by our youtube heroes to be false, CIA and MI6 inspired. However, finally it was tacitly but never explicitly accepted as true. Then their attention shifted to discounting the importance of the loss of Russian refinery capacity on global market prices. Somehow they counted on universal amnesia and ignorance of records from global diesel markets showing that Russia had traditionally accounted for 10% of global diesel trading. When you remove 10% of supply to the market the effect on prices is vastly greater. Nonetheless, our Alt Media experts pooh poohed that reality when they directed all attention to Donald Trump and his repeatedly blaming high diesel prices on the Ukrainian destruction of Russian capacity rather than on the closure of the Strait of Hormuz resulting from his war of aggression on Iran.

With that background situation explained, let us move on to consider what the deal announced today suggests with respect to Russian-US relations. It is a thunderbolt! Vladimir Putin is now openly assisting the electoral prospects of Trump in the mid-term elections. This suggests a deal of far reaching proportions. Some kind of quid pro quo has been agreed. It is likely that the quid pro quo is in several directions. Almost certainly it suggests that there is a real U.S. plan for financing repairs to the Nord Stream pipeline and for the U.S. to be selling the Russian gas to Europe over the ferocious opposition of Chancellor Friedrich Merz. This in turn envisages a fierce battle with the European Parliament and European Commission who have put in place a total ban on Russian hydrocarbon imports as from 1 January 2027.

It is inconceivable that these plans for commercial cooperation are being laid down without some US-Russian understanding on how and when the Ukraine war will end. I will not speculate here and now on the content of such an understanding. However, I will be paying very close attention to all developments in the forthcoming meeting of Trump’s emissaries with the Kremlin, to any changes in the Russian negotiating position on truce in the maritime war on civilian shipping and on attacks directed at critical infrastructure on both sides in the conflict.

But if one element in this deal is worth speculating on now it is the timing: by holding out for this deal till the last weeks before the midterms, Putin surely has been able to extract the greatest benefits for Russia. He has also waited till the Russian harvest is largely collected already. Remember that agricultural equipment is a major and time sensitive consumer of diesel fuel and that domain in the Russian economy has already been served.

Copyright Gilbert Doctorow, 2026