15.12.2003 | Inna Sukhorukova, Kharkov

The vicious circle


It is difficult to disagree with the recently published conclusions of the Board of the Organization of soldiers’ mothers of Ukraine that the legislation on military service and conscription is imperfect. And it cannot be perfect, since it does not take into account the real situation, which changes rapidly in our young state. It seems that our laws are created by the people, who live on the Moon: they are so far from army, medicine and jurisprudence! Yet, the main problem is that they are also far from common people, since the task of laws is to stipulate and ground the responsibility of all involved persons in every case.

Let us consider, for example, the law on conscription. This law must accurately envisage the responsibility of the parties: servicemen, medical doctors and officers. Yet, our law stipulates only the responsibility of servicemen (and this is usual for the majority of our laws: the most unprotected persons are responsible for everything). As to the law on the conscription, Orders Nos. 2 and 207 of the Ministry of Defense and “The regulations on the conduction of the conscription”, they were adopted as early as in the Soviet times and are much better than other legal acts in this sphere. Yet, none of these documents envisages the efficient scheme of medical examination of recruits, as well as the strict criteria, according to which the military medical commissions should take the decisions about the dismissal of servicemen because of the state of health. That is why this relatively liberal legislation, which gives the opportunity not to enlist the ill youths, does not work. And we continue to receive the complaints from military units with the lists of the soldiers, who were dismissed because of poor health in the first months of their service.

For some reasons our data noticeably differ from the information, which is possessed by the oblast military commissariat and the oblast health protection department, but we are unable to guess this riddle.

So, let us consider what elements of Orders Nos. 2 and 207 have, in our opinion, the negative influence on the quality of recruiting campaigns. Article 90 “The regulations on the conscription” of Order No. 2 contains the list of data about recruits, which must be presented to the medics of the district and oblast military commissariats for taking the decision about the fitness for military service. A recruit must have the fluorogram or roentgenogram of lungs, clinical tests of blood and urine, electrocardiogram (1 time per three years), TB tests, medical certificate about childhood diseases, certificate from doctors-specialists of the district polyclinic. Besides, the comments to the articles describing the diseases are indistinct.

Yet, we are living in the country, which occupies one of the first places in Europe by the incidence of TB, AIDS and viral hepatitis. We observe the great quantity of psychical disorders among youths, mass media publish many materials about adolescent and child drug addiction. At the same time, the rules on the examination and the list of the necessary data, which must be passed to the district military commissariats from medical establishments, remain invariable during recent 10 years.

However, in 1993, when the Ministry of Defense adopted Order No. 2, the epidemic rate was much lower and drug addiction was not so widely spread. What can a doctor see, looking at the arms of a boy, who regularly smokes, snuffs or swallows some narcotic drug? And what conclusions can be drawn from the clinical tests of blood and urine, if the youth is infected with AIDS or viral hepatitis? The pulmonary tuberculosis is the most often, but, unfortunately, not only form of this terrible disease, so it is impossible to diagnose TB only by fluorography. And what about the numerous endocrine pathologies that stroke the entire Central Ukraine after the Chernobyl catastrophe? How to diagnose the early stage of such diseases?

The list of the basic documents is not, of course, the entire examination. Doctors of the medical commissions of district and oblast military commissariats must examine a recruit, listen to his complaints and, if these complaints are confirmed with the documents, send him for the additional examination. Yet, some recruits conceal their diseases, since they want to serve, although sometimes they have extremely serious health problems: schizophrenia, psychopathy, retrogressive amnesia, encephalopathy with loss of consciousness, acute stomach ulcer, etc. Young soldiers with all above-mentioned diseases were dismissed from our army. We talked with some of them (the majority of these boys deserted from their units and turned to the Kharkov oblast union of soldiers’ mothers for aid). They wanted to serve, did not complain and did not present any documents about their sicknesses to the medical commission. Nobody examined them additionally. We know that district medical commissions often consist of 3-4 doctors. And how frequent these doctors send recruits for examination to the oblast center? Very rarely.

So, it is insufficient to list the diseases that make a recruit not-able-bodied, it should be also stipulated which examinations must be conducted after the medical inspection of a recruit or after his own complaints. The methods of additional examination must be described in details for every disease. Maybe, such thoroughness would be inexpedient in some other country. Yet, in Ukraine, where the mass army exists side by side with the extremely imperfect system of health protection, the actions of every participant must be scheduled step by step. Otherwise, some of these steps will not be made, a disease will not be disclosed and the ill recruit will be enlisted with all inevitable consequences.

In what follows we want to give some concrete examples.

The report of the head of the Organization of soldiers’ mothers of Ukraine mentions Article 87 “hypotrophia”, which was almost cancelled by Order No. 207. The matter is that the precise parameters, according to which the doctors had to diagnose this disease, disappeared. The article now contains a rather vague definition: “The insufficient development of osseous-muscle system and hypodermic tissue”. So, the commanders of military units complain that the youths with underweight get to the army, the underweight that was the first symptom of more serious pathology, which showed up only during the service.

Let us consider another example: Article 90 of Order No. 207 “allergic diseases”. Undoubtedly, the very appearance of such article is a great step forward. Yet, owing to the vagueness of the text of the article, the doctors turned out to be not ready for the examination of the recruits, who complained about the allergic diseases. Once I disputed with an allergist, who surprised me with the question: why the youths, who suffered from polynosis, might not be taken to the army? The discussion was purely theoretical, since this allergist had no connection with the conscription. Yet, the recruits could get to her hospital at any moment. It appeared that the doctor knew nothing about the real situation in the army, and this is not a rare phenomenon. The doctors of military commissions also do not know (and nobody explains to them) what conditions are waiting for the youths acknowledged by them to be able-bodied.

As to Article 90, it does not stipulate what analyses, tests and examinations must be carried out. Allergy has many forms, and each form demands individual testing. Yet, there exist some common peculiarities: immunity changes, for instance, or the stable respiratory disorders. It is easy to disclose such symptoms. However, we often come across the complaints of recruits, who have grave allergic diseases, but were badly examined and had to organize the additional examination by their own efforts to prove the existence of their illnesses. Here are two examples. Patient O. was examined in the allergic ward of the local hospital, where the doctors made neither the immunoassay nor the corresponding tests. The allergy was not found, and the boy was acknowledged to be able-bodied. After our request O. was additionally examined in the oblast allergic ward. All necessary analyses were made, and the diagnosis “allergy in the form of recurrent polynosis with frequent exacerbations and Quinke edema” was confirmed. Recruit K., who suffers from the allergic rhinitis since his childhood, who has the Quinke edema and cannot breathe through the nose, was also declared able-bodied even without the consultation of an allergist. This decision was made on the basis of the conclusion of the town laryngological hospital, although this conclusion undoubtedly pointed out the allergic origin of the disease: allergic rhinitis. Yet, the doctors forgot to mention the stable inability to breathe through the nose. K. also had to pass the alternative examination. This story is not finished yet.

I gave the quite usual examples – the first ones that I found in the list of the complaints connected with Article 90. Yet, the conscription of a youth with serious allergic disease is dangerous for his life. For instance, a young soldier with the allergic reaction to flowers and with the inclination to Quinke edema gets to the maneuvers in a forest or a field. The medical unit is far away, and the commanders cannot understand the problem, since they are not medics!

So, considering the practical application of Orders Nos. 2 and 207 one can see that, as usual, the intentions were good, but the results are bad.

Article 256 of Order No. 2 prohibits the enlistment of the youths with the aggregate of chronic diseases (each of which does not give the right for the release from the service) that makes impossible the army service. Yet, we do not know a single case, when this article was applied. And this is not strange, since it is impossible to understand what the enigmatical text “the aggregate of chronic diseases that makes impossible the army service” means. The vagueness of formulations is inadmissible in the military sphere, especially when the army cannot influence the quality of the conscription being unable to give the orders to the civil persons, who are involved in the recruiting campaigns. That is why we cannot improve the situation with recruiting the sick youths.

This question becomes the most acute, when the matter concerns the responsibility of a concrete person, who is guilty of the enlistment of an unhealthy recruit. Every doctor, either neuropathologist, or therapeutist, or surgeon, can answer that nothing depended upon him, that the recruit did not complain and the documents contained no information on the disease. This means that every doctor must have his own duties stipulated by law. And, if the law were not fulfilled, then the doctor, or those, who impeded him to examine the recruit, or the medical establishment that issued the erroneous conclusion about the health of the recruit, would be responsible. However, even the demands that are envisaged in the law are regularly violated, and the doctors of medical commissions are not always guilty of that. Orders Nos. 2 and 207 demand to examine each recruit in a separate room, but this demand is not executed: the doctors work in one room, or the rooms are situated side by side and the doors are not closed. Moreover, several recruits enter a room at the same time. So, who will dare to complain about enuresis or hemorrhoids? Nobody. And who will be responsible?

Our country does not want to calculate the money, either its own or the money of tax payers. That is the reason why the level of social protection is so low in our country, why our pensioners and handicapped are so miserable. We adopt the worthless laws and resolutions, and we release from responsibility everyone, except the most unprotected and poorest people. All this creates the vicious circle in our state…

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