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11.12.2000

Which medicine we have in Ukraine?

   

640 thousand people are registered as TB-infected, 28 thousand out of them have the active form. Family TB has become more often.

In the Vinnitsa oblast 226 persons died last year. More than four thousand TB-infected children live in the Crimea and they are not treated.

The official number of the AIDS-infected in Ukraine by 24 May 1999 was 31991 (including 1.5 thousand children). Since the beginning of the year as many as 1605 AIDS-infected have been registered, among them 202 children.

During the first quarter of this year 83 adults and 2 children died of AIDS in Ukraine.

The Odessa, Donetsk, Dnepropetrovsk, Nikolayev oblasts have the doubtful honor to head this list.

If in the Western Europe one syphilis-infected person is counted for 100 thousand population, then in Ukraine this index is 182.

According to the Ministry of Health data, there are 136 abortions in Ukraine for 1000 newborns. 100 thousand women in Ukraine, who have never born children, have abortions. It ends lethally for 320 women. The birth rate in Ukraine is decreasing. In villages the situation is especially grave. According to the data of the State statistical committee not a single child was born in 1998 in 12673 out of 28794 villages. In 1999 the situation did not improve. Children in the age bracket from 6 to 15 years are absent in thousands of villages. There are 253 such villages in each of the Kharkiv and Sumy oblast. In the Chernigov oblast the number of such villages is 224, in the Poltava oblast — 223.

33486 handicapped children up to 16-years-old are registered in the Crimea. 25 newborns out of 100 have congenial defects of development or pathologies.

Last year 14 babies with the Down decease were born in Kyiv.

In the Crimea there are 17 special schools for children with defects of mental and physical development, totally they count 3455. In the Ivano-Frankovsk oblast 7956 children and 2795 youths, who have psychic disorders, were registered by the end of 1998. 

‘Golos Ukrainy’, No. 118, 6 July 2000


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According to the data of the International organization of health protection (Geneva), Ukraine occupies 130 place for men’s mortality and 109 place for women’s mortality, which is typical of weakly developed countries.

According to the data of the same organization, our country holds the 79th place our of 191 as to the level of medical aid.

This year our state plans to spend for health care $20 per capita. To compare: in Poland the corresponding figure is $170, in Slovakia -- $200, in Hungary -- $300, in the USA -- $2000.

As a consequence of the negative demographic processes, the mean life-span has diminished by 4 years during the last decade. This figure is 13 if compared to the similar figures for men and 11 for women in the Western Europe. 

‘Ukraina i svit siogodni’, No. 39, October 2000


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Nowadays the health of the Ukrainian population is abominable. According to the statistics, 2.5 million of people died in Ukraine during the years of independence.

The medical statistics treat these figures as ‘natural’, old-age losses. But this is not so. Too many people die from vessel and cardiac illnesses, cancer, traumas, infectious diseases and the like before the mean life-span, which is 62.7 for men and 73.5 for women in Ukraine. This figures have a tendency to decrease. To compare: in Japan the mean life-span is 74.8 for men and 80.8 for women, in Canada — 74.3 for men and 80.8 for women.

In our society the most dangerous maladies, such as TB, AIDS, hepatitis, gonorrhea, flue, vessel and cardiac illnesses, cancers. About 33 millions of Ukrainian citizens have already suffered from the above-mentioned diseases. That is a big figure for the total population of 49 450 thousand. The number of alcoholics and drug addicts continues to grow. Children mortality rate is 2 — 4 times higher than in other countries, and the maternity mortality rate is 3 — 6 times higher than in developed countries. The mortality rate is higher than birthrate, so we have the so-called ‘super-mortality’. 

‘Dzerkalo tyzhnia’, No. 40, 14 October 2000


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The level of consuming medical drugs in Ukraine has fallen this year to the critical value: from 2 billion dollars per year to 4 million dollars (calculations of the Tacis expert commission). Thus, the average Ukrainian consumes medical drugs for $8 per year, while an average American spends $4000, German -- $2000, Hungarian -- $90 for medicines per year. 

Weekly ‘PiK’, No. 38, 17-23 October 2000


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According to some data, the number of psychic cases in Ukraine has grown during late 10 years by 86.9%, and the number of mentally retarded – by 66.5%. The main demographic reasons are of social nature: the material and spiritual pauperization of the population, unemployment, alcoholism, drug addiction, difficulties in family and social life, permanent stress resulting from the soaring of prices, pay arrears, etc. Technogenic and ecological cataclysms have contributed too.

According to the data made public by Angelina Niagu, the head of the center of psychic consequences of the Chernobyl catastrophe of the Ukrainian scientific center of radiation medicine at the Academy of Medical Sciences, six out of ten adults, who suffered from the irradiation, need ‘psychic correction’. Chernobyl children happen to be mentally retarded twice as often as the children of the same age, who did not suffer from the irradiation.

On the background of the permanently decreasing population of our country, the proportion of persons with psychic disorders grows (1.5 millions of the registered cases). This figure permits us to set the problem on the total psychic health of the nation. According to the data provided by professor Boris Demyanenko, more and more people are registered as invalids. Only in 1992 – 94 the proportion of psychiatric invalids grew by 201.4%, and the number of invalids of this category moved from the 7th to the 4th place among the groups which completely lost the ability to work. Chronic patients are in a very difficult financial state. The pension to such invalids is misery (Hr 43 per month at most). 

‘Nasha gazeta’, No. 31, 29 July 2000


***

To the editor-in-chief of the bulletin ‘Prava ludyny’


The city directorate of health protection informs that, according to the instruction of accountancy for describing the main financial operations of budget establishments, approved by order No. 61 of the state treasury of Ukraine of 10 July 2000, the accountancy is carried out in the entire medical establishment. All hospitals of the city (except the psychiatric hospital) have beds for various patients. That is why it is impossible to separate what is the cost of the upkeep of one patient with concrete disease.

On the average, the upkeep of one patient for one day for the reported period of 2000 costs:

in hospitals of the city — Hr 12.39;

in particular, the cost of medicines — Hr 0.92;

feeding — Hr 0.76;

in TB dispensaries — Hr 5.52;

in particular, the cost of medicines – Hr 0.68;

feeding — Hr 0.37;

in psychiatric hospitals — Hr 9.78;

in particular, the cost of medicines — Hr 0.37;

feeding — Hr 1.41. 

 
Acting head of the directorate of health protection L. F. Kostenko


We have presented some figures of International organization of health protection, some statistical data and the response given to us by the main directorate of health protection at Kharkiv city executive committee. We also have direct evidences of our visitors, who are quite ignorant concerning the statistical data and their own rights. Usually the specifically medical topics appear on the background of other complaints. For example, a mother comes to out office and complains that representatives of a recruiting commission cannot decide whether her son is able-bodied. The son is directed to some hospitals for additional examination, and the doctors require money for some kinds of examination. We get many such complaints and we know that this practice violates the operating laws. Our demands and requests were answered in a somewhat peculiar way: ‘we have a duty to render necessary sufficient medical aid’. What is the sense of this answer is unknown to anybody. But it sounds convincing. To our request we got an answer from the directorate of health protection at Kharkiv city executive committee that demanding money from recruits for a medical examination is a violation of operating laws, we were informed that head doctors of the city hospitals got the corresponding instructions. Nonetheless, when it concerns recruits, people come to public organizations, since they are driven to the dead-end: recruiting commissions still request examinations, hospitals still demand money for it and recruits and their parents still have no money. As a final result, recruits come to the commissions with almost blank medical cards. ‘Prava ludyny’ often wrote about situations, when sick young men were taken to the army. The situation with ordinary patients is even worse. People, who have no money are not treated at all.

Recently the Kharkiv Union of soldiers’ mothers received the letter from a woman, whose son was conscripted in spite of the fact that he had rheumatism and a heart disease, as a consequence. He stayed four months in army hospitals and finally was dismissed from the army. All in all, he did not serve half a year. This situation is rather typical, as well as the reaction of the mother. She said, that in the army they corrected his health a bit, but what shall she do now with her tiny pension? Those who know the state of our medicine, would not be surprised when learning the answer of the Minister of Defense to a complaint of Union of soldiers’ mothers concerning the quality of recruits. The minister said: ‘… at least, they get some medical treatment in the army’. At least, here we have an uncoordinated, but still existing cooperation of two agencies.

And what can be said about our general-purpose medicine… How do they treat all of us? A very small proportion of our population, who has money, may be treated abroad, so they are not ‘threatened’ by our medicine. As to a wider section of our population, even those who work and get their remuneration in the proper time are able to pay, if necessary, for the domestic medical services and drugs, they still have what to brood about.

It is striking that our society treats such an acute problem so lightheartedly. This is a more serious problem than the abolition of the death penalty or the protection of the freedom of speech. These problems provoke a lot of articles, debates and sociological polls, and this is fine. But, in our opinion, the problems of medical aid require more serious attention of the entire public. This is obvious, because this is next to impossible to find a person, who never needed medical aid and drugs. There exist many problems related to the crisis of our economy, and some drawbacks of our medical services have appeared rather long ago. The medical bulletins, for example, that working people must get if they are sick, are given by the instruction of 1938. According to this instruction, a doctor has the right to give a bulletin, if it is not a trauma or a surgical operation, by the term of not longer than three days (five days during an epidemic). After this sometimes a quite sick person has to get to a hospital, more often using the public transport. And if a person is sick more than a fortnight, he or she is proposed (almost coerced) to be taken to a stationary, where there is no food and no medicine. Because nobody can imagine, how to feed a patient for Hr 0.76 and provide him with medicine for Hr 0.92 per day.

It is impossible to comprehend such a careless attitude to an institution, which is practically the base for a normal life of a society? Everybody affirms that our medicine is in decline and ruins, but no one suggests any realistic program, how to go from this crisis, even discussions are not held. One has a suspicion, that the society spits upon itself and upon the life and health of their citizens.

Many citizens of Ukraine complain at the decision of the Constitutional Court of 25 November 1998 as to the accordance with the Constitution of Ukraine of the Decision of the Cabinet of Ministers of Ukraine ‘About the list of the paid services, which are offered in the state medical establishments’. This Decision of the Constitutional Court gives a distinct formulation: ‘The development of state and other programs, according to item 4 of Article 116 of the Constitution of Ukraine, is related to the rights and duties of the Cabinet of Ministers of Ukraine, while their confirmation is a right of the Supreme Rada of Ukraine (item 6, Article 85 of the Constitution of Ukraine).’

That is why the Constitutional Court reckons that ‘the way out of this difficult situation, which occurred with the financing medical aid from the budget, lies not in the introduction of longer lists of the paid medical services, but in the change, according to the mentioned statements of the Constitution, of conceptual approaches to solving the problems related to constitutional right for medical aid.’

We complain at the decision of the Constitutional Court without proper reasons, since Article 49 of the Constitution drove the court to this decision. Yet, both in the decision of the Constitutional Court and in Article 49 of the Constitution of Ukraine the necessity of the development of insurance medicine is pointed out. Almost four years have passed since the adoption of the Constitution, but we only daydream about the insurance medicine. To be exact, only those, who know what is the insurance medicine, dream about it.

The decision of the Constitutional Court about the discord of the decision of the Cabinet of Ministers of Ukraine ‘About the list of the paid services, which are offered in the state medical establishments’ with the Constitution of Ukraine did not make the paid services free ones, but drove most of these payments ‘into shadow’. The result was that the poorer part of the population completely lost the opportunity to be treated.

But the Constitutional Court is the least guilty. First, it should be noted, that Article 49 of the Constitution of Ukraine is written with a lot of populism and rather as a declaration, as well as Article 48 about the dignified living standard and other articles about social, economic and cultural rights. This approach caused that the Constitution is not executable.

Unfortunately, the mentioned decision of the Constitutional Court, as far as we come across in practice, especially when dealing with recruits, is not executed. Here is another example of neglect on the side of our medicine. An elderly man with a cerebral brain trauma was dismissed from a hospital too fast, since he had no money for the cure. In three days of staying at home his trauma developed into paralysis of lower extremities. The situation with handing free medicine to psychic cases is even worse. And now we often come across with obviously psychic patients in the streets and in the public transport. We have not come across with such a situation before. Now, without proper medical drugs, they may be dangerous, so this problem must not be neglected. If we ourselves are unable to take care of our health and safety, whom can we depend upon? Which ministers?

And, by the way, the countries, which introduced the insurance medicine were not all prosperous at the time of taking the decision. For example, Israel, that in the 60s was far from being a developed country, and that nowadays often suffers from bursting military conflicts, has now a well-developed system of the insurance medicine, which functions well and provides the citizens an excellent level of medical services. The first medical insurance company ‘Kupat-Knolit’ was founded by a trade union. As to our trade unions, that have a rather ramified organizational structure, own estate and control funds of social insurance, if they diminished their political activities and occupied themselves with insurance medicine, then in several years the matter could begin to move at last. Many countries of the East Europe started the insurance medicine on the background of rather difficult economic state.

I do not insist that we must blindly copy some system of insurance medicine, undoubtedly we must develop a system of insurance medicine that would suit the Ukrainian population. But we have preferred to do nothing, and, as a result, the chaos and disorder have increased. ‘Prava ludyny’ suggests to start debates about what must be done in order to make the level of medical aid in Ukraine corresponding to the world level. That is why we appeal to our readers with the request to read carefully our materials and to answer our questionnaire. Let us decide together, what should be done in order to protect our health.

I. Sukhorukova

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