Being an Expat Means Being a Self-Advocate



Last weekend we took Rudy to the veterinarian. He wasn’t sick — there wasn’t anything wrong — but he was due for his annual check-up and vaccinations.

And, yet, we dragged our feet with making the appointment and taking him in. We chose to go to a new vet, and this meant figuring out how to contact the staff (Facebook chat), where to go (Google Translate and then Google Maps), and how to get there (Uber).

But mostly it meant crossing our fingers that the appointment would go okay.

Rudy’s first vet — the one we went to for his first three appointments — comes highly recommended in the Kyiv expat community. Why? Because he speaks English and his name has been passed from one expat to the next. It’s comfortable to know there’s a vet available, but at what price?

After Rudy’s last visit to his previous vet, he was violently ill. He threw up repeatedly; his little body shook. When we called the vet concerned with the reaction, he off-offhandedly mentioned several pets had been having a similar reaction and it must have been a bad batch of vaccinations. If several pets reacted the same way, stop using the vaccination.

But it wasn’t just this one appointment at this particular “expat-friendly” vet that went sideways.

Some friends of ours have a dog who has constant ear infections. This vet brushed them off, saying they’d clear up on their own. When our friends went away for a holiday, their pet sitter took the dog to a Ukrainian-speaking vet, who thoroughly cleaned the dog’s ears and prescribed antibiotics. And, what do you know … the dog’s ear infections cleared up.

Another friend took her cat in for a dental cleaning, and the cat had a terrifying reaction to the anesthesia.

This particular vet’s “office” is in a house. It’s dark and dank. The equipment looks like it’s been around since the Soviet era. And, as I thought about our previous three visits to this vet, I realized he never weighed Rudy. Monitoring an animal’s weight is one way to gauge health.

Yes, these kinds of incidents can happen with any vet. And yet, there were so many incidents from this one particular vet. But we all put up with it because it was easy. Because we didn’t know what else to do. It was safe, and it’s what we knew. We didn’t advocate and demand something different.

Well, things needed to change. We don’t play roulette with our pet’s health.

First, one of our friends took the plunge and tried a new vet with great success. The one with the anesthesia issue followed. And we were next in line.

I worried we were once again falling into the “we-went-and-it-was-okay” routine, but we had to try something new.

Prior to the appointment, I committed to being Rudy’s advocate. I bought a notebook to keep a written log of each and every one of his appointments. A vet would dutifully transfer the vaccination sticker to his pet passport, but I wanted to note his weight and other pertinent appointment notes.

I admit I was nervous. What if this vet didn’t work out? Putting off Rudy’s most recent appointment meant putting off the potentially difficult chore of starting again with finding another vet.

I’m happy to report, however, his appointment went well.

The office actually resembled the kind of vet’s office with which I feel comfortable — clean, well-lit, examination rooms with doors, a computer system to log and track animals’ visits. His vet was soft spoken and patient. She helped me update my notebook with information about all the stickers in the pet passport. She weighed Rudy, and told me his weight so I could record that too. And, at the conclusion of the appointment, she explained possible vaccination side effects and printed off a sheet of post-appointment care instructions.

Rudy doesn’t love the vet, but he arrived home more relaxed. His face swelled up a bit (something that always happens, and something I know I should ask about), but he was eating, drinking, and back to being himself significantly faster than any previous appointment.

I’m cautiously optimistic we’ve found a vet that will suit our needs as long as we live in Kyiv.

Yet, the struggle to find a vet — and the commitment to do our best for Rudy’s well-being — is a reminder of something I’ve been learning as an expatriate: Being an expat requires a commitment to self-advocacy.

Over brunch with a friend last weekend, we talked about how Kyiv appears to have at least some modern, respected services, but it’s often a facade. My friend, who has been living in Kyiv for five years, made the observation that going to the eye doctor or dentist is never just tending to a routine need. She’s right.

Along the same lines of finding a high-quality vet, Cory and I have encountered the following scenarios since moving to Kyiv.

The Anti-Vegan Conversation

Our general practitioner mentioned to Cory he needed to lose some weight. Following our long-distance hike this summer, which kicked off his weight loss, Cory went on a strict vegan diet and adopted an impressive weight-lifting routine. He has lost a significant amount of weight, is devoted to his new healthy lifestyle, and feels and looks amazing.

Upon going to the general practitioner this past fall to refill an ongoing prescription he takes, Cory also inquired into any additional vitamins he should be taking because of his vegan diet. The doctor told Cory he shouldn’t be a vegan and instead he should just eat meat and cheese every once in awhile. Cory insisted the new lifestyle choices were permanent, and he needed to know what vitamins he needed to supplement his vegan diet. Cory then visited the school doctor to confirm the general practitioner’s suggestions when he acquiesced to the request.

The Prescription Medication

The point of Cory’s appointment was to get a refill of a prescription for a chronic condition. However, the medication he’d been prescribed by this doctor originally was a new prescription, and it was making him feel unwell. Instead of an actual refill of that medication, he needed an entirely new medication. Why? The original medication contained lactose. Cory is allergic to lactose. When he started having symptoms he recognized, Cory looked up the medication’s ingredients and discovered lactose in the list. He explained why he needed a different medication to the general practitioner. The doctor insisted it didn’t have lactose. Cory insisted it did, and showed him the list of ingredients. Again, the doctor acquiesced and wrote out a prescription for a new medication.

This took self-advocacy, personal research, and insistence. Luckily for Cory, this is a fairly harmless allergy, but what if it wasn’t? Another friend of ours recently went through a bout of kidney stones. To combat an infection, the clinic gave her antibiotics. The medication made her sick. When she called in to report the side effects, she found out they prescribed the wrong dosage.

The “Eye Doctor” Who Wants Referrals

There is a so-called eye doctor several expats use, so I went as well when I needed a new pair of glasses. To be clear, he’s not an eye doctor. At least, I don’t think he is. Using relatively antiquated tools, he determined the prescription I needed for my glasses. However, he didn’t conduct any tests for glaucoma, color blindness, or any other actual eye health concerns. Then he steered me toward the “high-quality” frames, something he does with every single expatriate.

When my new glasses came in, I was immediately concerned. They made me dizzy. The doctor insisted my eyes needed to adjust. He told me I should try them and then return for a new pair if they didn’t work out because he wanted me to “be able to recommend his services to my friends.

Long story short: They didn’t work out. I returned them and he made me a different pair at no additional charge. But that’s not enough for me to recommend his services, because at least two other friends have had problems with this eye doctor. One is currently suffering through a pair of lenses he insisted she needed, but they’re giving her a headache. I told her I’d go with her to return them, even though she thinks he’ll be upset. We have to advocate for ourselves, I’ve told her, because no one else will do it for us and people like this eye doctor will continue to get a flood of expats through their front door.

The Unnecessary Ultrasound

I went in for my occasional women’s health appointment, which should have been a quick in-and-out check-up. Three hours later, I left practically traumatized. It’s kind of a thrill to actually have a doctor that doesn’t rush you into and out of a room without hearing a thing you have to say — an entirely different kind of self-advocacy is needed there.

During my appointment, the OBGYN scoured the notes from the general practitioner, and even though everything was completely within a normal range, she “just wanted to be sure.” At least, that’s what I gathered. This is how I ended up in a room with an ultrasound machine and a technician who spoke exactly zero English. As he headed toward me with a very questionable device, I stood up from the exam table and demanded to know what was going on. I opened the door and walked down the hall in the clinic robe to find the OBGYN. She put her arm around my shoulder and cooed into my ear that it was okay, I didn’t need that test.

Damn right, I didn’t need that test, and get your arm off my shoulder.

I’ve spoken to several people about this situation, and the answer is often the same: That doctor loves ultrasounds. Well, she loves ultrasounds, but more than that, the clinic loves to milk every penny out of our insurance companies. Just about every woman who goes in for a pap smear ends up in the ultrasound room. People talk about whether to see the older or younger of the two OBGYNs at this euro-centric health clinic. I chose the older of the two, but apparently both are pretty awful. A friend of ours saw the younger one who was ready to admit her to the hospital. When our friend got in touch with her OBGYN in the United States to get more information about this supposed condition she had, the U.S. doctor had never even heard of it.

Self-advocating for yourself is hard regardless of where you live.

It takes effort and energy and time. And yet, it feels exceptionally difficult to me in our situation right here and right now. The language barrier is brutal. Not being able to communicate in the immediate moment makes self-advocacy more frustrating and energy-draining. Finding that English-speaking vet or eye doctor or general practitioner makes it easy to fall into a trap. It’s easier to just put up with the inadequacies than to stand against them. It takes less energy to utilize the services you know “get the job done” than actually seeking out something better.

Sometimes, I think finding a better solution is essential, such as with Rudy’s vets. At other times, such as with the general practitioner, I think standing up for what we believe is right and wrong is okay. Cory and I discuss this often. We don’t always have a choice, so sometimes the best option requires more work on our part. It means being open-minded but aware of our own bodies and needs. It means doing our own due diligence and research.

And it means being actively involved in our health and wellness — something we should do anyway.

It’s easy to embrace comfort, to go along with what others already do. To take suggestions and simply use them because they exist. And doing that in a country where everything feels so damn hard some days feels like the best we can do at times.

But if being our best selves means doing the hard thing — keeping our own vet records and translating medication ingredients on our own terms — then so be it. Because to be an expat means standing up for ourselves and being our own self-advocates.

2 Responses to “Being an Expat Means Being a Self-Advocate”

  1. Jill

    Can’t imagine how tough it is with the language barrier. Self advocacy with health providers is tough enough, even when you do speak the same language! People seem to forget that they, personally, know their body best….

    • JoAnna

      It’s an ongoing struggle, and it’s so easy to be passive when it’s been so difficult to get yourself into the medical practitioner’s office in the first place. But, I’m learning that the language and cultural barrier makes it that much more important for me to stand up and say what’s right for me.


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