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07.02.2007

The situation with healthcare is critical

   

The tragic death of the well-known politician and State Deputy from the Party of the Regions Yevhen Kushnaryov immediately raised a number of issues of concern in society. The unclear circumstances of the incident, as well as the vague, confused and varied commentaries from the authorities aroused people’s suspicions. Doubtless, it would be naïve to hope that we will ever gain an even remotely accurate picture of the circumstances. Nonetheless, there are questions which those in power must hear and answer.
Let’s leave politics. Firstly, because one speaks well of the dead or not at all. Like all of us, the Deputy had family and friends and we extend our sincere sympathy.
It transpired unexpectedly that a State Deputy, although seen as living in some “higher realm”, is an ordinary person, and like any other can get ill, have an example, receive serious injuries. And this does not depend on the Speaker of the Verkhovna Rada, or on the Cabinet of Ministers. The money allocated for treating the so-called “elite” in Feofaniya, the possibility of bringing in doctors from European countries, etc, can all prove futile. In my opinion, the best way of honouring the State Deputy’s memory would not be to rename streets or cities, but, for example, to equip at least one central district hospital, to provide full staffing and constant maintenance – and then name it the Kushnyarov Hospital. Kharkiv residents’ experience testifies that Sumska St has already been called after Karl Libknecht, and Lavrenty Beria, yet it continues on as Sumska and let’s hope that that’s how it stays. And there have also been the names for the city Zinovyevsk and Voroshilovohrad, yet Kharkiv remains Kharkiv.
We must definitely draw certain conclusions from this tragedy.
Some of these conclusions relate to the state of our medicine. Even before the tragedy in Izyum, I had explained to journalists why there is such a pitiful health service in Ukraine. I didn’t mention our deputies’ taste for hunting, but simply said that, considering how much deputies have to travel by car on Ukrainian roads, elected representatives of all political shades would be wise to at least gain an approximate idea about what kind of hospitals they are travelling past, and the conditions they’re in. We are all created in the same way, and in general people are fragile creatures and illnesses can attack anyone in any place. It is high time that deputies concerned themselves with urgent problems, did their real work – legislating reforms of outdated institutions in our society, in the first instance, the health service. If they don’t know how to do it, aren’t able to, then they should call in specialists, even from abroad, who understand something in this area.
I said then that nobody is guaranteed against car accidents when driving, for example, on the roads between Kharkiv and Poltava. And having received injuries which make it impossible to transport them, deputies will be forced to experience the full spectrum of medical services of the same quality that ordinary mortals get. They end up in a central district hospital and then it’s up to fate.
I do not share the view of the Deputy Ministry of Health V. Ivasyuk that Yevhen Kushnaryov was not given adequate medical care. I know enough Kharkiv doctors to get information about the care provided at first hand. You can rest assured that the best doctors and the necessary medicine were all sent from Kharkiv to the patient.
However, I’m sorry. Even a superstar doctor from Germany cannot replace an artificial lung ventilation machine. And no medical genius is a walking dialysis machine. And it’s senseless to ask whether an ordinary district hospital has such equipment. Even in Kharkiv there are not enough such systems. District hospitals are catastrophically short of modern resuscitation equipment and accordingly of resuscitation specialists. In Soviet days there were cases where rich enterprises, like the Izyum optical plant, provided material assistance to hospitals, money to update and maintain the district hospital. Now all those factories can scarcely survive and certainly aren’t able to think about helping hospitals.
This means that those in power, by not concerning themselves with the material condition of our hospitals, are not only failing to care for ordinary citizens, but are hurting themselves. And if we don’t change our attitude to health care and to appropriate funding in this area, we will remain forever in the jungle. We don’t know whether Yevhen Kushnaryov would have survived such serious injuries had he been taken to a properly equipped hospital with modern means of resuscitation. There was at least a chance.
However the fact that most central district hospitals become, to be brutal, morgues or effectively hospices, is clear not from rumours, but from the numerous complaints and some monitoring carried out by KHPG experts, together with the International Society for Human Rights – Ukrainian Section, over several years. This monitoring, although it covers a fairly narrow group of the population – young lads before conscription or conscripts, makes it possible to draw conclusions about the level of equipment and provision of medicine and staff in our district hospitals. The conclusions are not cheering.
According to our information, in the Dvorichansky district, an ambulance team would not be able to get to many settlements – due to the lack of both cars, and roads. So employees of medical assistance [feldsher] and midwifery units [MAMU], if the family of the patient don’t have their own car or can’t pay for petrol, answer urgent call outs either on foot or by bicycle. We’ve heard similar stories from doctors on the Izyum ambulance service. On Channel 5 TV they told all of Ukraine that they had one old car which when it freezes in winter doesn’t start at all. So if an ordinary citizen had ended up in the same situation as Kushnaryov, it turns out that he wouldn’t have even been able to get to the hospital in winter.
And who would have brought blood and plasma from Kharkiv if they’d been needed? And imported medicines with a price not in the hundreds, but in the thousands of UH. And in general would they have called out, if not doctors from Germany, then from Kharkiv? No need to even ask.
And it’s not doctors’ fault that the State over the fifteen years of independence has kept them in such an unenviable position. Responsibility for the life of a VIP even of district level is a normal thing. I’m even surprised that the hospital is brave enough to treat these VIP. But for the ordinary citizen in such a hospital there’s little left. Even when we’re talking about being called up to the army. As we know, if a young man in ill health is accepted for military service, it is first of all the State that incurs incredible costs. The young man needs to be treated in a military hospital, then undergo tests to be released. Unfortunately, however, deputies are unable to either value human life, or calculate state expenditure. They’ve been squabbling for almost a year about who’s most important in the country. And the Mayor of Kharkiv, instead of resolving the city’s problems of which there are a huge number which really jeopardize the health and safety of its residents has plunged into political rowing with the regional administration. Communal charges have almost tripled, the cost of medicines is rising and the notion of a free health service is pure illusion. Nobody is cleaning the streets, and the central square is covered in ice. To replace the ZHEKs [housing departments] which, albeit badly, did maintain communal services, new structures are being created which do not improve the state of affairs, but collect money from the population. For whose benefit? The “Mayor’s” TV channel and newspapers from morning to night talk about how they’ll improve Kharkiv residents’ lives – tomorrow. At the elections they promised: “An improvement in the standard of living already today”. Empty promises.
It’s funny to look at this, one feels sad and bitter for Kharkiv voters who brought to power such party and other (completely non-party) groups who can’t even speak Russian, not to mention Ukrainian. If you watch the meetings of the Kharkiv City Council, it’s impossible to design whether you’re in a doll’s theatre, a den of criminals, or simply a madhouse.
However the main thing is that those who get to power spend all their time thinking up things for themselves, and maybe they imagine that medicine will be found for them. It won’t be found – at some point they’ll definitely be caught out since we all live next to people with tuberculosis, and anybody can end up in difficulties far from Feofaniya or from an airport.
As far as real, and not fabricated, changes are concerned, there are none. For example, in the Kharkiv region around 1 billion UH is envisaged by the 2007 budget for healthcare. According to the head of the permanent commission of the Regional Council on healthcare, Volodymyr Svyatash, this is 163 million UH more than in 2006. If we recall the rules of arithmetic, knowing about the sharp increase (several times higher) of communal charges and rise in prices for medicines, an increase of 20% will simply bring most medical establishments of the region near penury. It’s good that at least the head of the commission understands this, since he’s added to the “optimistic” figure, that not enough has been allocated for buying medicines which have also become more expensive, an 4.95 UH (nearly 1 USD) is allocated per patient per day for food.
The Kharkiv Human Rights Protection Group, in monitoring healthcare services in medical establishments, plans in the next months to establish how transparent in fact the expenditure on central district hospitals is, what modern equipment they have, whether they have ambulance teams and cars and how able they are to send doctors to each populated area, as well as whether they have sufficient supplies of blood.
We will pass on all information we receive in response to questions we have put to the Kharkiv Regional Administration and the Ministry of Health.
It will then be possible to predict what level of healthcare a patient who needs urgent hospital care and cannot be transported to the regional centre can expect.
Now let’s return to our deputies. Over the entire 15 years, with all their shameless infighting, they haven’t been able to pass any contemporary laws to really improve the healthcare situation. All of their pseudo-reforms, like bringing in a system of family doctors, have only led to a breakdown in the system of duty doctors, and the system of family doctors has still not begun functioning. Among the huge number of draft laws on mandatory medical insurance, some have been reasonably sensible. There was one, for example, by a Deputy from the previous session of parliament, Ms Markovska. The draft law was inconvenient for medical bureaucrats, who received considerable profit from issuing licences for private medical practice, especially from cooperation with pharmaceutical companies, this business demanding not only lobbying and ensuring tenders, but also legislative “protection”.
And the political forces in power now are also not bothered by troublesome questions of healthcare. Although Deputies T.D. Bakhteyeva (PR), S.V. Chervonopysky (SPU), P.S. Hryhorovych (NU) and others have submitted a draft law on financing health care and medical insurance, in our view, this is another attempt to con the public and maintain dodgy arrangements in the medical sphere and legitimize payment for medical services outside those which the draft law defines as a “vital level of medical care”.
The main thing that is unclear is how much money the insurance companies have to pay to medical establishments for medical services provided to patients.
We would note that in no other European country are there such non-transparent arrangements for receiving and using funds as those proposed in draft law No. 2192. In European countries the authorities try to make the system of financing and use of medical insurance understandable and transparent to the public. As a rule, there are several competing insurance companies and people have the chance to choose their own company. Insurance premiums also depend to some extent on a person’s income however there is a clearly defined list of free services and subsidies on medicine, especially in countries with high social standards.
Deputies have not proposed anything similar to regulate the draft law mentioned. So either it will simply be a legalized way of collecting more money from people, whereas in cases where medical care is required, people will again pay themselves for treatment, and also directly to the medical staff, or a whole range of other laws will need to be added. Then perhaps the system will somehow function. But then it will be necessary to review and analyze the entirely legislative base for medicine as a whole.
One already feels a certain scepticism in society with regard to this draft law. Journalists write about this, and specialists who provide arguments to show that the law as it stands at present will not bring positive results.
However we well know that if some official or other want a piece of nonsense to become law, it will be passed and the people’s representatives will probably support a law proposed by their socially close bosses.
While Ukrainian citizens remain at best in the same position, while at worst – not only will norms of the Constitution (Article 49) be violated, but also international laws – Article 2 of the European Convention for the Protection of Human Rights and Fundamental Freedoms.
Although the norms of the Constitution and of the Convention are norms of direct force, it is virtually impossible to prove in court that in a medical establishment a person’s right to healthcare or right to life was violated. The forensic medical examinations in our country, and this is absurd, are under the control of the Ministry of Health. Therefore it is much simpler even to bring the law enforcement agencies to answer, than irresponsible or unprofessional medical staff. Of the huge number of complaints alleging inadequate medical services which human rights organizations receive, it is possible to prove at least administrative liability in only 3-4 cases a year. In the first instance this is connected with the lack of a clear system of division of responsibility in medicine and related fields.
Who, for example, has analyzed the negative consequences of the Law “On the circulation of narcotic substances and precursors, the introduction of which has led to neurological divisions of some medical research institutions being deprived of the right to prescribe patients whom they continue to treat after hospital care Sibazone? Sometimes this is the only medicine capable of dealing with an epileptic fit. Even pills of Sibazone or Repanium are prescribed on strict register forms. This law first and foremost helps not to fight drug addiction, but to maintain and expand a black market in medicines.
In neighbouring Russia, all whose actions the present government tries to blindly emulate, prescriptions for precursors to elderly people or the disabled are issued for a month and on usual prescription forms.
The black market in medicines is a trap for patients. On the one hand, many patients who are on the registers of psycho-neurological establishments and have the right to free medicine, receive them and immediately take them to people reselling them on the market, and remain themselves without medication. On the other hand, for patients who buy the medicine on the market, there is always a risk that they will buy a fake, or medicine beyond its sell-by date. The law jeopardizes not only people’s health, but their life, since if you don’t stop an epileptic fit, the patient can die.
The Prava Ludyny editorial board will be presenting a number of articles on these issues and would invite human rights colleagues to engage in discussion on them.
We would stress that the medical sphere urgent requires reform, but that this must take into account both world experience and Ukrainian reality.
Otherwise nobody and nothing can help a patient – regardless of social status, if s/he is brought in an emergency to a normal Ukrainian hospital. It would be advisable for our esteemed Deputies to think about this after the tragedy in Izyum.

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