See­ing the ob­vi­ous: Why Ukraine's cur­rent health­care sys­tem must be changed

The Ukrainian Week - - CONTENTS - An­driy Holub

“While I write your re­fer­ral for test­ing, please fill out this form,” says the physi­cian at the county clinic. I pay close at­ten­tion to what’s writ­ten in the doc­u­ment. This is an agree­ment that my per­sonal data can be pro­cessed for the pur­pose of an HIV test. “Thanks,” I tell the doc­tor, “but I’ve al­ready been tested for HIV to­day. “How... where?” he asks.

An hour prior to this con­ver­sa­tion, at an­other hos­pi­tal where I was be­ing ex­am­ined by a dif­fer­ent spe­cial­ist I was al­ready asked to fill out the same doc­u­ment and go for test­ing. I was forced to visit two clin­ics in one day be­cause in each one of them dif­fer­ent spe­cial­ists are on duty.

“Oh, that was quick of you!” the physi­cian con­tin­ues. “What a shame...” “What’s go­ing on? Did you all get or­ders to have peo­ple tested for HIV?” I ask this doc­tor out of cu­rios­ity. “Oh, brother, you don’t know the half of it,” says the physi­cian. “The ex­piry date is com­ing up on all the reagents and so now they’re send­ing ev­ery­one off for HIV test­ing, whether they need it or not. This could have been dragged out over a year or two, but no.”

This is one of the fun­nier sto­ries about con­tem­po­rary health­care in Ukraine. But be­hind it are thou­sands of tragic sto­ries caused by the in­her­ently ir­ra­tional sys­tem that’s sup­posed to pro­tect the health of or­di­nary Ukraini­ans. It’s hard to com­plain to any­one about how I was taken care of in a spe­cific in­stance. In ad­di­tion to the test for HIV, the doc­tor re­ferred me to take all other pos­si­ble tests and to un­dergo an ex­am­i­na­tion to es­tab­lish a di­ag­no­sis, with­out tak­ing a sin­gle kopiyka for any of this. I was lucky. Where I live, the clinic is pretty de­cent by Ukrainian stan­dards—al­though it doesn’t cover all spe­cial­iza­tions.

Still, at this same clinic, I watched a young boy try in vain to pay for some­thing at the self-ser­vice ma­chine while the lady at the reg­is­tra­tion of­fice watched care­fully. The rea­son was be­cause the boy resided in a dif­fer­ent city. The ma­chine stub­bornly re­fused to take his money. In the end, the boy shoved a UAH 100 note into the woman’s hands and was given per­mis­sion to go to the spe­cial­ist. “I’ll write out a re­ceipt af­ter,” the woman shouted af­ter him, as if to make it clear that the money wasn’t re­ally for her.

That Ukraine’s health­care sys­tem does not sat­isfy the needs of or­di­nary Ukraini­ans is clear to all. This ob­vi­ous fact can be seen from the bro­ken toi­let in the clinic, with its tank con­tin­u­ously leak­ing wa­ter that Ukrainian taxes pay for. It’s ob­vi­ous in the smell of dis­eased, un­washed bod­ies and ex­cre­ment that I could smell in one of the de­part­ments in a Kyiv (!) hos­pi­tal for res­pi­ra­tory dis­eases. It’s ob­vi­ous in the am­bu­lance car that looks like it will sim­ply fall apart next time it hits a pot­hole at high speed.

De­spite this ev­i­dence, dis­cus­sions about re­form­ing health­care con­tinue, the Verkhovna Rada con­tin­ues to ig­nore all the key bills that have been on its agenda for the last hal­fyear, and now it’s in re­cess. On their last work­ing day, deputies had enough time to re­view ex­port duty on scrap metal, but some­how did not man­age to get to health­care re­form.

For jour­nal­ists, the is­sue of med­i­cal re­forms in Ukraine is com­pli­cated. A pri­ori, we have to main­tain a healthy skep­ti­cism to­wards those propos­ing changes. We have to play the devil’s ad­vo­cate and ask awk­ward ques­tions, be­cause that’s the only way that bills are im­proved.

In our case, the main ques­tion is what should we be tak­ing down. What might get worse if the re­forms pro­posed by the Min­istry are im­ple­mented? Will even more wa­ter leak from the toi­let? Will the smell in hos­pi­tals be­come ever stinkier? Will the am­bu­lance stop go­ing out on calls? Will the boy from an­other city have to pay even more? Will the doc­tors who are al­ready paid peanuts be paid even less? For­tu­nately, the an­swers to these ques­tions are also ob­vi­ous and do not re­quire ad­di­tional ver­biage. We know for sure that this will all hap­pen if noth­ing is done. The de­bate of health­care re­form to­day is be­tween do­ing “some­thing” and do­ing “noth­ing.” To look for the pos­i­tive as­pects of “noth­ing” is im­pos­si­ble, even to write an ar­ti­cle.

Of course, op­po­nents to the Min­istry’s pro­posed re­forms are try­ing to present a dif­fer­ent po­si­tion. They say that they re­ally have an al­ter­na­tive bill to of­fer, but it will mean al­lo­cat­ing even more money from the bud­get. This ar­gu­ment can be com­pared to keep­ing some­one alive on a life-sup­port sys­tem: the pa­tient is prob­a­bly al­ready dead, but we can main­tain signs of life if we just hook up a few more ma­chines.

There are some re­ally ex­otic ar­gu­ments as well. For in­stance, the main op­po­nent of the Min­istry among deputies wrote an opin­ion piece for a rep­utable pub­li­ca­tion in which he ex­plained why it’s bad to shut down in­ef­fec­tive med­i­cal fa­cil­i­ties: once the life ex­pectancy of Ukraini­ans rises to the level of the Swiss, there won’t be any­where to treat all those peo­ple!! One fi­nal ar­gu­ment is that the Min­istry is propos­ing medicine ex­clu­sively for the rich, while the poor will find them­selves shut out. Well, if that were true, we cer­tainly ought to give it some thought. But I keep re­mind­ing my­self con­stantly of the smell in the Kyiv hos­pi­tal. In­ci­den­tally, that treat­ment was also not free.


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