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1 September

Seeing the obvious

Why Ukraine's healthcare system needs to change

“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.

RELATED ARTICLE: Deputy Minister of Health Oleksandr Linchevskiy on the reform of Ukraine's medical system

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 half-year, 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.

Translated by Lidia Wolanskyj

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