Who Is the Leper Here?

Our world beggars description by a single truth

Ilya Prigogine

Contents

My Motives
The Beginning
The Physician-cum-Researcher Dream
If We Don’t Close You Down, We’ll See
Straitjackets
No Love Lost
Whims
Making Myself Clear
Fear
An Excerpt from a Conversation
Telephone Law
It’s Not the Places That Grace the Men?
The Matrix
A Whistle Stop
You Are Not Alone
Things Old and New
Paranoia
My Kids
The Rake
The Rake For Ever?
The Right to Sue
From the Professional Council to SAC and into the New Millennium
The Arrow of Time
What Gives Me Strength
The MOH Saga
Things to Remember

My Motives

A little about my motives in writing this book.
“Exasperated?”
“Not really.”
“Then what, er, made you put pen to paper?”
“Educational reasons.”
“?”
“A lesson of democracy.”
This is how I imagined my conversation with the Bureaucrat (not necessarily a character of this book).
Nature is stingy with its laws. I mean, its applicable laws. In this sense, my book is a good textbook for the author himself. Not that I think too highly of the author… and yet I hope the Reader will leaf through it with interest. The situation it describes has standard didactic value: it’s all about the human-bureaucrat interface (face-to-face) and what it can produce if there’s a conflict of interests and the tricks being used stink of the good old U of SSR, excuse my French.
So much for my first motive. As you may have guessed, it’s about furthering the democratization of this sorely undemocratic society.
My second motive is to make a positive impact on the average Ukrainian – a person just like myself. Everything is not so bad on the imperial shambles. Wherever you look… oh, that you may live in times of change. But our times of change are about not only destruction. They are about creation, too. Even though they could be less difficult, to be sure. So, as you can see, this book was born of the author’s own experience.
My third motive is to commit to memory (my own memory, to start with) the remarkable story of rebirth of one of the finest traditions there is. It’s the story of rebirth of classical medical education in Ukraine. And it is set in the University I went to in my day. The Kharkiv National University named after Vasyl Nazarovych Karazin. It’s a story that seems absolutely incredible in the destroyed Empire which never cared a fig about International Experience. Because that Empire lives on in our brains, bidding us to “raze the old world to the ground”, as The Internationale goes.
I’m proud of my University. And its Department of Medicine. And my Mission, which is no piece of cake.
I invite you to read this book. You won’t regret it. Believe me, I’ve done my very best.

June 20, 2000
The Author

The Beginning

It was really the beginning of the whole thing, and this is how it all started.
I came home from a business trip (I worked at one research institute at the time). The first thing my wife told me was that Professor N had called from the University.
I could not put the face to the name for a time. Then I recalled. He had once been to our research institute. Our director said he was a scientist of world renown.
“Renown my foot,” I remember saying to myself. “If there are so many of them in this country, why is its science up the proverbial creek?”
My scientific interests did not cross his in any way, so I couldn’t figure out why he had called. And I forgot all about him.
The next Saturday he called again.
“I have to pass you an offer from the Rector. The University is opening a school of fundamental medicine. To function as a part of the Department of Biology. The faculty will have the right to practice. The Rector proposes to discuss the possibility of your assuming – “
“I have to think it over.”
“Will a week do?”
So I got to thinking. Talked with my teachers, colleagues and friends. The local Establishment, too, to be sure. “A most interesting and important thing,” everybody said with one voice. “You have to.”
A week after he called again.
“Are you ready to discuss our proposal?”
“I am.”
“Four o’clock tomorrow.”
“I’ll be there.”
My pride soared as I approached the University. A long time ago I attended the evening classes of its department of mechanics and mathematics, and I had never even seen the rector. And the very fact that I was being invited to my alma mater…
We got down to discussion. The subject was revival of classical medical education. Bright vistas. Great prospects.
We agreed I would work part-time and then we would see.
The decision seemed to suit all parties. The Rector poured me some Napoleon brandy. It went down good, on an empty stomach. Warmth radiated throughout my body. My head swam.
I did not even notice him slip that piece of paper under my hand. The next thing I knew he was dictating an application to me. It was an application for a full-time job, with an official transfer from previous place of employment. As if we hadn’t agreed that it would be like a trial for starters.
I felt a bit uneasy in my new role as I went to the University the next day. Too abrupt a change. But what can you do?
So I headed straight for the department of biology to try on my new clothes.
The beginning. What would it be like?
I introduced myself to the medical students and talked with them. Late March, and they had not even gotten around to medicine. They were still into the ABC’s of biology. Almost a year down the drain…
I regrouped the column on the march, changing the plan completely. And we took on the ABC’s of medicine.
Problems galore. But we got a lot of help, too.
Textbooks were the number one problem. Where could I get them?
I asked our neighbors at the Medical Institute. They said sorry.
Then I turned to my people at the research institute. They helped me out, may God bless them.
The city medical library also helped us a lot. We used its services for a long time after. A magic wand of tested quality.
Things developed at a breakneck speed.
Then the summer examinations set in. And the “production practice”. And the holidays.
The holidays were for the students. For the faculty, it was a month of preparations for the new academic year.
Our first priority was the kids – the students we had gotten from the Department of Biology. There was no enrollment for the school of medicine. We had selected a number of biology students based on the results of the winter exams.
We got the cream of the crop. I mean it.
It was with them that we started out. They became the beginning. They wrote the first lines into the annals of the rebirth of classical medical education.
A whole new vista opened before us.
The perestroika, the Ukrainian independence and the democratic process bolstered our bold plans. The inebriating wind of change went to our heads. We painted ourselves a rosy picture of our prospects.
Nothing betokened struggle. Hard struggle. No holds barred. Struggle for the life of our baby. And the Constitutional right (endorsed by a whole string of laws and acts) of the revival of classical medical education.
The new academic year began. We had barely got under way when the Ministry sent a commission to check on our progress. We had only been working two months (without the summer exams), and they sent a commission!
It was the beginning of a bitter confrontation. An artificial, absurd confrontation engineered by the MOH Bureaucrat.
But I did not know it right then. I didn’t know that it was the beginning of something like a lingering skin disease that makes people steer clear of you.

The Physician-cum-Researcher Dream

The University had introduced the medical school with the intent to train physician-cum-researchers for the nation. The same kind of physicians as those the MOH trains within its education system. The same career opportunities. The same rights. But different, too. Different in that they would have a medical education based on a solid classical university foundation – something that other universities cannot deliver no matter what they call themselves.
This is what we had been striving for, popping out of our skins.
Everything would not turn out as I expected. And yet we did well.
We trained them to be physicians-cum-researchers. Physicians in the first place.
The researcher part was OK with the MOH Bureaucrat. The other part was not.
“You can’t have it. I’ll tell you why.”
Medicine had been re-introduced in the University shortly after the Independent States had come into being. It was when the heady spirit of freedom seemed to whisper: “Just make your wish, and it will come true.”
But the dream remained a dream. The dream of bringing the medical education home – getting it back into the higher education system. The way it had once been in the Russian Empire, out of which we too have emerged, whether we like it or not.
Alright, alright. Let’s leave the Russian Empire alone (lest somebody ascribe politically incorrect ideas to me) and say, The way it is in the civilized world of today. Let our physicians’ qualifications keep up with the state of the world. A world in which education and health care are two different things. No conflict of interests. Highest quality results.
I am confident that the reason why we have fallen behind almost for good and will hardly ever overtake the West is precisely this conflict of interests: medical education in the health care instead of the education sector.
Dreams beget action.
A whole series of conferences on the organization of MD training in universities was held in Russia back when there were no pseudo-universities. The establishments of higher learning that were called universities in those days now have to add the word “classical” to their names.
Yes, and one such conference took place in Leningrad University. It was attended by all the Russian academic beau monde, complete with the luminaries from the Academy of Medical Sciences of Russia. Or the USSR? No matter.
One report hit me where it lives. The subject was experience of the then Second Medical Institute of Moscow. Its department of medicine slash biology trained physicians, and its graduates were thought very highly of and were high in demand throughout the former Soviet Union. I heard it from a number of internationally recognized academics whom I personally value very highly, too. Somebody may not care a damn about my evaluation, but it has value for me. Within my own set of values.
The problem that came in the limelight was a serious one. Graduates of the med-slash-bio department had better qualifications than their counterparts from “purely” medical departments but had no access to patients. They were more like physicians assistants.
“Can you imagine an assistant who is stronger than you? This is sheer discrimination.”
It was that series of conferences that formulated the approach I can only dream of introducing: physicians-cum-researchers with the right to practice. The brightest of the graduates would go into research, to be sure. But in all event, they all should have the same rights and duties.
To avoid problems, we may follow the example of the Lomonosov University in Moscow and write “physician, physician-cum-researcher” in their diplomas.
Twice a physician. To eliminate all suspicions.

We write “physician” in our graduates’ diplomas. Not that we want to. This is an outcome of numerous commissions. It suits me for this transition period, though. Just so it’s not a problem with the Bureaucrat. Some day – soon enough, I hope – we will be able to put them down as “physicians, physicians cum researchers” in their diplomas. The kids we are teaching deserve that.
Dreams tend to come true, if they’re for real. This is what my chief dream is about: Physician cum researcher.

If We Don’t Close You Down, We’ll See

And then the first MOH commission arrived. It had a serious task to perform. In fact, it had been initiated by both MOH and the Ministry of Education, so the tasks were several. One was to close down my school. The other was to keep it.
It was not an easy time. The early stage of perestroika. On the one hand, everybody painted themselves a rosy picture. On the other, we all were still up to our necks in the totalitarian system. That meant that the Bureaucrat’s opinion carried a lot of weight with us.
For me, it was a doubly difficult time. The school had only been in existence for six months when a new Rector came to the University. As any newcomer, he needed experience. And, like so many of us, he was a graduate of the old system. He supported me all right, but he was also afraid of the MOH Bureaucrat. On his part, the Bureaucrat felt all too well that he was feared.
In all times, the Bureaucrat’s main trick of the trade has been to put the fear of God into you and keep you in fear as long as possible. If you fail to do something prescribed by their rules, Fear comes back and things get completely out of hand. I remember one instance when one of them tried to use that trick on me and I thought I saw a cloud of Fear sailing my way.
“You are not afraid,” he told me after a while.
I was not. Nor am I. That is, I can feel fear just like the next man. But not in situations like those.
Was the time suitable for a commission in the first place? The school had just been born and was three months old – two months in the spring and one in the fall. A newborn baby, you could say. We had just been allocated some space. The University had about as much money as the national government (there were no contractual students at the time). In fact, a lot of things at the University looked as appalling as in the country at large. At first, my heart bled to see it. Then I saw that other universities fared much worse.
But all the same, I will never get used to that.
The commission consisted of two inspectors. One was a Friend, the other a Foe, even though it pains me to say that. The merit went to the MOH Bureaucrat.
Even as the first commission was working, we could feel that the seeds of hostility toward “classical university education” had been planted. The situation could have become even clearer if not for a bit of good luck: for reasons of state importance, the MOH Bureaucrat could not attend in person. So everything went off fairly well.
And yet not well enough. Later I heard that the MOH inspector had signed the protocol but painted the Bureaucrat an altogether different picture.
Luckily, a spoken word cannot be filed. What is said is said, what is written is written. I still keep a copy of that protocol for the School’s annals.
In a timid attempt to establish contact, I rushed to the MOH. The appointment was for two o’clock. I sat waiting in the reception. In came the Bureaucrat, tall, lean and straight as a ramrod. I could almost see him feed on the fear of his subordinates.
Someone was ahead of me in the lineup, and I felt genuinely glad. In the hope that he would have less Fear left for me.
I went in. Said hello.
He fired a broadside right off. Could not keep it in anymore, the poor thing.
“Let him talk it away,” I thought to myself. “Maybe he’ll soften up.”
I can’t say how long his monologue was. Not less than forty minutes, I think.
Then he stopped in the middle of a sentence and there was nothing to talk about. If we don’t close you down, we’ll see. That was all I read in his eyes as an answer to my quizzical look.

They did not close us down. The School is eight years old now and is accredited until 2009. We still have time so they could see. Time is the best eye doctor.

Straitjackets

An ugly, vulgar little world left over from the “Iron Curtain”. The rules of the little world (directions for use) included. The Bureaucrat will tell you how to play. His is not to change the rules. No-no, his is to oversee compliance.

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