To Ex-Minister from Ex-Adviser
The fantasies. On the advisor theme. The real and made-up experiences. With a practical goal. To support the administrative reform. Of the Central Executive Organs too. With the aim to improve standards of ordinary Ukrainians lives. Obligatory to improve life of Ukrainian officials. In order it to be with dignity - as they deserve.
Not to be put aside
Look from below
The ministry board
The informational letter
To take of control
All the misfortunes in bad management
The National seminar
I should apologize
The World Bank
Tuberculosis and AIDS
I love you, Eliot
Need for conception
About transitional processes: optimal ones and others
One hundred days
Look from above
Not to be put aside
We are living only once. At least in this life. I don’t know about the others, but as for me – I feel life’s rhythm intensively. And this feeling is heightening day after day. Because above all is willingness to lose as little time as possible, the desire to have time do a little more.
I do not know exactly who had turned on this chronometer. My Medical School old physiology professor probably. It was quite a long time ago, during my student years, when I was second year student...
Remember that warm and tender spring morning. While I was running from one school building to another I suddenly met the grey-haired professor in his well known black with wide brims hat whose long-long slightly stoop figure gravely approached to me: “How is your dying going?”
But, the old man was right. With every passed day less and less days left…. So, how is my dying?
That spring morning, the school path and the professor had been engraved on my heart forever.
Since that time my chronometer is turned on. It is rigorous and painfully frank chronometer. “We are not living, we are dying” And with every other day we have less and less time left. Thus, one has to harry up.
Yes, I am harrying up.
The first thought that I will have the possibility to write this book and should do this came with the first proposal to become the advisor of Health Minister.
I accepted the proposal. That appeared possibility to write and publish this book played important role in my decision.
Almost a month has passed since I am not Ministerial Adviser any more. Minister had gone and the Adviser followed her.
For somebody else this time may be not the best time to cool down, to receive the right for soberly and comprehensively appraising all I have gone through. To promulgate that experience. Because the true experience is always important.
Now I recall me being in the Ministry as something happened a long-long time ago. This is because of the fact that after nine months as an adviser, I have completely returned to “normal” everyday university activities. This university life is restless, but that makes it attractive, interesting, because this life reflects interests of students, departments, the faculty, and the whole university.
That happened the day before yesterday. Without any visible reason. That day in the morning I visited the faculty, then went to the hospital. While on the midway to hospital I “saw” the book, all from the very beginning to the end.
As soon as I had seen the book I understood that I should “put” it on paper. And not to be put aside”.
The process of become an adviser was very easy. I received a proposal, thought it through, and consulted about it. The Head of the University supported me. Give his consent to my transfer to the Ministry. So I was transferred and officially admitted as councilor.
We are in the Ministry study. The two new advisors. Later we ave worked together. Many ideas in this book were chosen from our mutual efforts.
- So what, guys, we need to work in such a way, that…
- Our intentions are very serious.
The main orientations were received. The conflict with “the view from below” was avoided. That created the basis for the future fruitful work in the Ministry. It is impossible for me to work in other way.
But I am not completely sincere when completely denying the conflict. The “slippery” point was connected with me being the head of a medical faculty in a classical university. The educational sector. It means a foreigner. But at the same time a doctor too. It was always a question in the health ministry about the place of medical education. Where should it belong? To the educational sector or to the of health care? Since a very long time my principal attitude to that problem is that medical education should belong to the ministry of education. I suppose this may help to overcome the conflict of interests between the educational and practical medicine sectors and turn the number of future doctors to be estimated by the needs of practical medicine.
This topic is the favorite for our ministry’s sarcasm. That’s why I tried not to raise this question by myself.
However somewhere in the depth of my soul I believe that this attitude of mine in some circumstances prevented my Lady- Patron from accepting the right (as I see now) advises. I suspect, she was reminded. Who her adviser was.
It is my fault that I failed to close this topic.
On the last working day my Minister was absolutely frank. I believe, that was not the last working day for my Lady - Patron. I’m sure of her fruitful future. The world is nonlinear. Especially today, when the whole country is a strange attractor. The next step will be ours.
I didn’t plan to work at the Ministry. Though I am acquainted with the Ministry work as a work of sector quite well.
After graduation from the Donetsk Medical School I worked as a Deputy Director on Science Issues in the Ukrainian National Research Institution of Internal Medicine and in the Kharkiv Research Institution of Microbiology and Immunology for a period of five years in each place. This means that I will be pretty acquainted with the Ministry and its subordinate’s environment.
For the last eight years I was working as a Dean of Fundamental Medicine Faculty in Karazin Kharkiv National University.
I was glad to take part in re-establishment of the classical universities right to train medical students, the right that was taken away by the Bolsheviks a long time ago. It was an honor for me becouse after Donezk Medical Institute I studied in the Department of Mathematics and Mechanics in the very University. My decision was supported by my Kharkiv teachers and by world-famous scientists and doctors as well.
Working as a Dean appeared not to be easy. It cost me a lot of blood. And it is understandable why. It was an encroachment to the monopoly. In order to defend the aim of including the medical education in the educational sector I approached the media. My articles were published in the “Medical Newspaper of Ukraine”, “Mirror Weekly ”, “Governmental Courier” and other newspapers. Three of these publications from “Mirror Weekly ” are included in this book. These articles are interesting. They were published before the decision to be the Minister’s Advisor was made. Published several years ago, those articles are still topical.
Two years ago we came to graduation of our first group of doctors, doctors that were trained in our very classical university. The problem we were faced to was minimal. To get permission from the Health Ministry for our graduates to work as doctors. “Dislove” of the “First” was expressed in delaying of the permission. We were pressed by the timeframe of the undergraduate course. We had to hurry…
Good occasion, the “First” is on vacations, and my Minister, at that time the Deputy Minister, performed the Minister duties. The meeting was set up.
It’s nice to remember. The waiting – room was crowded but I was the first one to come in the study.
- What is a problem?
- It’s not a problem… We just need a letter…
- I will help.
She called somewhere: “… will visit you, please help”. Then to me: “No, they will not help”. Then she called again: “I need you in my office”. Another replica: ”For more reliability I will ask them to go with you”.
She did not know that her prediction was correct. The letter was not ready. It was prepared much later. Signed it was, as appropriate, by the “First”, as usually in the bureaucratic sphere. The nonwritten rule of the national bureaucrat.
I was glad to have my first publicist experiences in the approached to reform the sector and the meeting with the future Minister. These were the entrances in the position of the Advisor. If I didn't have them, I would not be ready to accept the offer, which appeared to be interesting and very useful.
I did not ask for that position. I did not predict that in a half a year, I would be in those shoes. For advisor is the governmental employee. Even thought his rank isn't too high.
View from below
It is now the right time to introduce the respectful reader with my understanding of the sector’s problems and the ways to solve them. The understanding that I had three years ago, the time that seems to be far away from me nowadays. When I did not know that I would be in the Ministry and even on the Advisors position. Those thoughts of mine are well reflected in the article “Exit is one – to cut, or the ambitions for the cool position in the shadow Cabinet”, which was published in “Mirror Weekly ” (“Zekralo Nedeli”, 1997, # 27 (143)).
I am making only a small edition of that article in order to make it mach the book. The epigraph taken from Bukmullin “That absolutely dispassionateness can be only the piece of the metal” reflects the authors feelings related to the raised topic.
So, here is the article.
Country is in difficult economic situation. Health Care too. It does not require many words. The media uncovers its bad condition. By “Mirror Weekly ”(“Zerkalo Nedeli”, 1997, #10 (127)). Article # 46 of The Ukrainian Constitution was buried. Looks like now the Health Care will be in the same condition. Mr. A. Mostipan with the sharpness of Nostrodomus predicted ongoing processes in his article “Medicine of Ukraine today and tomorrow” (“Medytsyna Ukrainy” , 1996, #3).
That period had proved that nobody listened to the predictions. There was a lot of talking about reforms. But in reality they are absent.
Having an understanding that alternative programs are needed and supporting the idea of the Shadow Cabinet of the Ministers (SCM), I have enough courage to nominee myself on the position of the Health Minister (HM) in the Shadow Cabinet of Ministers.
Today this branch and the Health Minister are practically managing the Health Care, medical education and medical science. So it would be appropriate consider the reforms in all these directions.
1. Reform of the practical Health Care
Existing system of the practical Health Care is weak: too big, low effectiveness, high cost. The level of the medical help in the whole state sector, excluding several centers, is somewhere in the middle of the century. But the most important thing is failing of the existing system to overcome the limited governmental financial support often only promised but usually not reaching the practical medical institutions. Let us imagine the situation. When the value of financial support of the sector in the whole country is 54% of the one needed. But, this planned sum is restricted in the real life and only half of it is actually provided. All this accelerates only the process of Health Care sector degradation. There are rumors about its complete crash forthcoming. For example, let us look how the institutions of emergency medicine work. Very often the emergency doctors do not have even the most simple medications to help their patients.
To overcome the stagnation in the sector of Health Care one should use the radical for 100% “surgical” actions. Today we do not have any time for reflections. The time of profound restructurization has come. The way to solve the problem is not in restricting the state Health Care network but in stimulating the non-governmental or private sectors of Medical Care. I believe that in today’s reality one should concentrate on the existing state system of Medical Care and on the half of the promised financial support. For this can't be enough for completely solving the problem it can show that some positive changes are possible.
There is urgent need for priorities. First of all, the fundamental rebuilding of the hospital-based medical care. This care should be concentrated exclusively on the urgent “beds” such as surgical, obstetrical, infectious diseases. For so called somatic patients, the “beds” for them should be settled only in case of critical state. The restricted number of hospital beds should be served by highly qualified personal with high moral principals and very serious attitude to the work. The departments should be highly specialized. For their work the personal should receive appropriate reward. Let us analyze situation: in the West countries the ordinary surgeon operates around 1000 times a year, while in our country the ordinary surgeon performs less then 200 operations a year. This is possible because there are more than enough surgeons in our country. Among them are good and not very good ones.
From my point of view the necessary number of hospital beds is around 20% of those existing today. Even more, there is a popular system in Ukraine of so-called daytime hospitals and daytime care in outpatient institutions. Without any doubts, a great part of these beds is devoted to fulfill social functions. But one should remember that social-functioning beds have different goals and should be transferred to specialized institutions. This will be cheaper than to manage them by ourselves.
The emergency medicine should be reviewed. It is very expensive to have physicians and even nurses in the ambulance teams. The functions of such teams should be fulfilled by other structures such as police or firefighters institutions like it is in Western countries.
The existing outpatient medical care should be rebuilt. As an alternative one may propose the family medicine. But this health care institution should be functioning on different organization principles. Otherwise, there will be nothing else, but profanation again.
Today in the big cities the institutions of private medicine are in the process of being established. In Kyiv and Kharkiv, for example, the home-based medical care and private first aid care are quite successfully functioning. One can’t say that these services are completely inaccessible for people with low incomes. In the competition world the costs for this private services are going to become lower. I want to believe that the depression economic will not stay forever. Besides, the low-income part of the population may be received medical care through the system of green cards. For the state today can pay only for some restricted needs of medical care.
Medical care in our country is delivered also by means of the Special Administrations Sector. Different departments created these medical institutions to achieve there special goals. This system does not have to be treated as an anachronism for it exists also in other well-developed countries. It was created in our country in a quite a long time ago before the Bolsheviks came to power.
I would not be rising up this problem with Administrative Medicine, if there were no attempts to “gulp it” completely. As usual there are some exclusions. But, in general, the question with Administrative Medicine should be solved within administration itself. The administration should “survive” and take care of its medicine services.