Prague, 13 December 2004 (RFE/RL) -- From Kyiv to Prague and Baku to Bratislava, presidents and prime ministers have sought medical treatment abroad since the fall of the Soviet Union.
Viktor Yushchenko, the Ukrainian former prime minister and opposition candidate for president, is just the latest example.
For Yushchenko, who accuses the government of poisoning him, the decision to go abroad may have had less to do with the state of Ukrainian health care than with political trust -- or lack of it -- in local doctors.
But for many other leaders in Russia and across the former communist world, access to foreign healthcare can often be a matter of life and death. Aleksei Titkov is with the Carnegie Moscow Center:
"In principle, it is a common opinion in Russia that the quality of medical service is higher in Western countries than in Russia, even if we take as an example medical service provided for the Russian elite. Russian medicine is of a high level in some kinds of surgeries, but most medical services cannot compete with [those provided by] the majority of Western medical centers," Titkov said.
Foreign health care has arguably saved the lives of several foreign leaders, including former Azerbaijani President Heidar Aliyev, former Czech President Vaclav Havel, and former Slovak President Rudolf Schuster.
Aliyev had several life-saving heart surgeries during the 1990s at the world-renowned Mayo Clinic in Cleveland. He died last year at the age of 80. And both Havel and Schuster had emergency operations in Austria for life-threatening intestinal disorders. Doctors in Innsbruck saved Schuster's life after he nearly died following several days of ineffective care in Bratislava. The case was a scandal in Slovakia as it pointed to clear deficiencies in the nation's postcommunist health-care system.
While quality is important, being treated abroad may also shield leaders from the danger of citizens finding out about their health problems.
In 1998, Havel was also operated on in Innsbruck, just two years after having half of a lung removed in Prague. But his personal secretary, Jakub Hladik, told RFE/RL that Havel was visiting Austria when he fell ill and that he normally uses the services of Czech doctors.
"No, he gets treatment here; he is under auspices of his physician from Prague. He searched for specialist abroad and got treatment from professor Bordner from Innsbruck, Austria. It was several times, I would say, but only once President Havel had been in Innsbruck and asked professor Bordner to consult President Havel's medical problems. It was during his presidency. The consultation also took place after his presidency, but he remains in contact with professor Bordner. They became friends," Hladik said.
Still, Havel's frequent visits to foreign doctors often raised embarrassing questions in Prague about the state of Czech health care. Such questions are apparently not as welcome in other countries, however.
Turkmen President Saparmurat Niyazov, who does not leave his country very often, sees German doctors. But the issue, like so many in his secretive country, is rarely discussed.
Uzbek President Islam Karimov disappeared from public and political life in January 2003. Rumors about his being seriously ill spread across Uzbekistan. Foreign media reported that he had gone to Germany for treatment.
But presidential spokesman Oybek Kimsanbaev denies that Karimov received any medical treatment in Germany. He told RFE/RL in a phone interview from Tashkent that Karimov only uses the services of Uzbek doctors.
While quality is important, being treated abroad may also shield leaders from the danger of citizens finding out about their health problems. "Possibly, this kind of danger also exists. But information may leak even in [hospitals in] the Western countries, however it is less probable there," Titkov of the Carnegie Moscow Center explained.
And in some places, it is virtually impossible. Take the Gulhane Military Academy in Ankara. It's been used by many CIS leaders, including Aliyev -- but there is rarely information on these visits.
A spokesman for the academy, who asked not to be named, said there are strict internal rules for medical staff that deal with journalists. "Sure, of course. There are commanders in our hospital and all journalists must ask questions to them, not to the clinics," he said.
But the commanders need permission to disclose information from the powerful patients. "[In order] to give answers to that kind of questions, our commanders must also be given permission," the spokesman said.
Secrecy is obviously a major concern to many leaders. Poor health can reveal weakness to both the public as well as political rivals.
Russian President Vladimir Putin would appear to be one of the healthiest of all post-Soviet Russian leaders. Yet Titkov says that the Russian public has no information where Putin gets treatment.
Havel's secretary, Hladik, believes health is always a private issue, whether it's that of an ordinary citizen or a president.
But former Kyrgyz Foreign Minister Muratbek Imanaliev disagrees. He told RFE/RL that the public should be kept informed on president's health. "We should know about it, because the president is a person who the nation's fate depends upon. Therefore, it is very important to know how he feels," he said.
Putin's predecessor, Boris Yeltsin, was arguably hurt by his constant health problems while in office, which analysts say contributed to an image of weakness and uncertainty. Yeltsin has often been treated abroad but had heart surgery by a top specialist in Moscow.
Carnegie Moscow's Titkov believes that in general, the issue of leaders going abroad for medical treatment is perceived positively in the former Soviet republics. "The CIS [Commonwealth of Independent States] citizens perceive the fact that [politicians] get medical treatment abroad instead of their own countries as a normal practice, compared to [more scandalous] information about high-rank politicians buying property abroad or sending their children to foreign schools. [By contrast] that kind of information may be used as a political blackmail by their political rivals," Titkov said.
Meanwhile, some Central Asian leaders appear to prefer to travel to Russia than to the West for their health care. Tajik President Imomali Rakhmonov, for example, has reportedly received treatment in Russian hospitals.