Professor Vyacheslav KAMINSKY: "Reforming does not mean that everything you have to do must be destroyed"

The population of Ukraine is catastrophically rapidly shrinking. A few of our hulks, in search of a smaller share, emigrated to other lands, or they wandered over the cordon just to earn a penny, and there, it seems, “God willing.” Mortality has increased in succession, even if it may be, the place is obviously more old-fashioned. Another significant factor is the decrease in the number of people, the number of children in wealthy homelands. This fact is particularly disturbing, because behind it is a threat to the renewal of the nation's gene pool. Why so vіdbuvaetsya? How to work, how to change the trend, improve the situation? About ce — Rozmov correspondent of the “Voice of Ukraine” with the doctor of medical sciences, professor, head post-employment specialist of the Ministry of Health of Ukraine in the specialty “Obstetrics and gynecology”, corresponding member of the National Academy of Sciences of Ukraine, director of the Kyiv City Center for Reproductive and Perinatal Medicine Vyacheslav Kaminskiy (na) .

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Illness does not matter

— To Vyacheslav Volodymyrovich, what is the truth about childlessness in our country on a menacing scale?
- Family, like a century-old show, mothers of children can, but not to wash, in Ukraine one million, in fact - skin patches. Ale, the problem is trohi shirsha, nіzh "mother of children, do not mother." To the homeland, in some rich children, if you want to bring three, our setting is ambiguous - if it’s not judgmental, then it’s brutal, ironic. Notwithstanding the fact that earlier richness was considered a normal phenomenon. For this reason, the tradition should be revived, for that number it is necessary to bring together the distinguished homelands.

— Well, why are you less likely to be unacceptable in the succession of wealthy homelands and in these ostentatious primordial ones? See, singly, like nothing else, observe, for example, the role of state policy and stagnation in it, zokrema, and equal nationality.
— Tsya staleness is already great. I will illustrate on the butt of a visible medical and social phenomenon, connected with the reversal of pregnancy. The number of such types, thank God, has changed dramatically in Ukraine. Let's say that in 2005 the won was worth 800 thousand, then none of the abortions could be worth about 150 thousand per river. Ale, everything is the same in the social aspect, it is enough rich. Deyakі hot head proponoyutcho legislator to introduce a fence on abortion and early doctors, yakі rob such operations. Mіzh tim, as a result of analysis, 80% of women are surviving the vagіtnіst for the vlaznym bazhannіy zvіzku zі their innocence — in the daytime of life, work, through financial strife, family negativity, the unstable situation in the future, the future.

— How many patients should go through the clinic to the center?
— We take an average of 1,200 cases per day, over 1,500 surgeries are performed, including supra-surgical interventions of “one day”. I’ll say that until the last fate they survived with the remaining forces, even if they were satisfied with modest security, they had to accept hundreds of women without proper funding. And as you can see, a friend knows in bidi - the axis here I am and having balanced the right position of the hromadyanska bagatioh kyan. They came before us, proclaimed a podtrimka, and so, that they bought money for money, they gave money for resuscitation, for perinatal diagnostics. It's worthless! And then give us hope and faith in the future, even if everything starts from the sowed grain. Think of the wisdom of the people: what you sow - you will reap. And baiduzhіst often turns against the quiet, who її manifests, because they don’t call ailments for statutes, they don’t care about well-being, they do good to sanctify. Vaughn can come to anyone, moreover, raptovo. I can’t help noticing the understanding of our problems and the importance of our sphere by the lower Kiev government: the salaries of doctors have increased, and, in fact, the quality of personnel has stuck; more cats are seen on faces, stained glass materials; rozpochali reconstruction of part of the budіvl, closed in radyansky hours. The staff warehouse of the center is saturated but in the wind of modernity, so that it is possible to start the presence of scientists and high-class doctors, so that you are always ready to give help to everyone who needs it. І robitimut tse, even as long as they do not grow up, as officials say, European cadres. I don’t know what to invest in, I don’t know, because there were few Ukrainian specialists who know that kindly, whispering the best share beyond the borders of our state, and they are willing to take them from out-of-the-way clinics. From May: 192 thousand doctors in the country lost 140 thousand.

— The canopy policy is becoming a liberal liberal, fashion has canopies in the presence of relatives. What is your setting up to what?
— More positively: I am an absolute hanger-on for the presence of close people on the canopies. In the first place, less stress for a woman who is a people, in a different way, a chain of additional control over the actions of the staff, and thirdly, it is important for the future child: high out once again to lean in the number of people close to her. But, obviously, the canopy chamber cannot be a passable yard, it is not guilty to disturb a lot of people there, it is only to take care of the birth of the medical staff, and such presence is not to blame for being overwhelmed. Obviously, the curtains are a natural, physiological process, but at the hour of the break, they can be blamed for the aggravation, for the doctors of the goiter, it’s easy to breathe, and for them there can’t be a reshkod. Before everything else, you can’t learn about those people who live at home. If you want to do homework, wash in a canopy booth is definitely necessary. Therefore, we are talking today about individual family sloping halls, blocks, fireplaces, etc., so that the whole family can feel calm at once. The course for demedicalization in the canopies is a current light trend. I pragnemo promoted in Ukraine. From the point of view of the medical profession, it can be said today that the safety of the baby during the half-birthday is the task number 1. In this regard, we are 100% responsible for our professional qualifications, the state for the stilts is social support.

 

Not a foolish prophet

- And what is the situation with obstetrics in the country? As the head specialist of the Ministry of Health, you are in a melodious voice and oppose her.
- I respect that we do not give enough respect to the vagrants on the sovereign level. In its time, the garni was roared, like on me, the project is the creation of perinatal centers in regional centers. Tse giants, yakі could b - there, de stink є, - take on yourself all the women, yakі require special respect. Think about the fluctuations, if you suspect that you are not born, if you have problems, if you can blame the people for the future child, as well as situations that imply the complexity of professionalism and total security. But, unfortunately, such centers are not in the skin area, and the equipment of some of them has not yet been brought to the necessary level. If there is a need for reforms in obstetrics, then, looking at the professional background, I give priority to the regionalization, if a woman is highly qualified medically, she can help and can take care of the cost of living, regardless of the complexity of the diagnosis.

- Will there be no problems with personnel with such an approach?
- I constantly draw the attention of the leadership of the ministry to the urgency of this issue. For example, in 2005, when I won the competition for the position of Chief Specialist of the Ministry of Health of Ukraine, there were about 12,000 obstetricians and gynecologists in the country. Today, according to official data - about 9 thousand. I agree, it is necessary to provide primary care - family doctors, who are also in short supply. But completely reoriented to building a system of these specialists, we lost what we had. Today there are even districts, first of all, in Sumy, Chernihiv, Kirovohrad and some other oblasts, where there is no obstetrician-gynecologist at all. The level of training of doctors also suffers greatly. Moreover, we have already heard statements that we do not need the Academy of Postgraduate Education. I am categorically against such sentiments. In our department alone, where 12 professors and two corresponding members of the National Academy of Medical Sciences work, for example, 400 anesthesiologists from different districts are retrained during the year. They master advanced methods of analgesia during childbirth and surgery, get acquainted with new equipment for respiratory support, and more.

- Sometimes it seems that our managers have lost their way in health care reforms. And, probably, it is not for nothing that the head of the profile parliamentary committee Olga Bogomolets has publicly stated: they are still being carried out at random.
- When we talk about the transformation of our system, its turn to face the patient and focus on him - right, the idea that money should follow him - great. That's the way it should be. But this does not mean that everything around should be destroyed. When building a new one, it is necessary to preserve the basic elements of the existing one, all the possessions that should become the foundation of future medicine. This also applies to doctors. In fact, not everyone works as time requires, someone does not know something, does not know something ... This is where the question arises - where to get new, well-trained, young staff? We know the current level of education. How long will it take for specialists with the highest and much-needed level of knowledge and skills to emerge? And what to do with the sick so far? Wait and die? Most of us practitioners understand and see the weaknesses of modern healthcare more deeply than we do - and we cook every second of it. We have reached a practically European level of safety of childbirth. Professors from all over the world come to us and appreciate our work. Today, our association of obstetricians and gynecologists is involved in the development of European treatment protocols. And the Ministry of Health urges to abandon our really working achievements. Those that are recognized in a united Europe and harmonized with European treatment protocols. Isn't that absurd? And whether it is necessary to look for the prophet in "another's fatherland". We have a lot of smart, worthy people. Collect them, listen, determine actions. But no - the current leadership of the ministry abolished the scientific council of the Ministry of Health as unnecessary. And this despite the fact that reforms are only being declared, and the endless pulling in different directions of the medical field leads to persistent stagnation on the ground - it is unclear where to move.

Our reproductive medicine is medical tourism

- Has motherhood become younger today?
- "I wouldn't say ..."

- And yet there are many cases when even schoolgirls give birth?
- In fact, today we have up to 100 births at the age of 14. But in general, a woman gives birth to her first child when she is 26-27 years old, instead of 20-22, as before. That is, now the birth of the firstborn is postponed until the time when there will be housing and appropriate conditions for education. And this is also one of the factors that reduces the total number of births in the country. It happens that the firstborn is born at the age of 35 and 37. Meanwhile, from the point of view of physiology, the first child should be born earlier, when the physical shape is maximum. Especially since the first birth is physically difficult for a woman. Therefore, postponing them to a later period is wrong.

- However, it does not always depend on the woman and the man ...
- That's why my soul rejoices when I manage to help my family become happy. And doubly, if after a long wait, perhaps even despair, more than one child appears in it. For example, it has been ten years since four children were born with our help in a family that has not had children for a long time. Each baby weighed 800-900 g. The parents were over 40. At that time, there was a state program to encourage the birth rate. It so happened that they had four embryos, and they - Mrs. Oksana and Mr. Vasily - said they would not give any. And we did everything to make sure that everything was fine with both mother and children. Now these kids congratulate me on every holiday.

- By the way, how successful is our reproductive medicine?
- There are more than 50 specialized clinics in Ukraine. But, unfortunately, they are not quite accessible to people. Those who need help have to wait long enough. The state program to encourage the birth rate remained within UAH 6 million. This is very little. If at the rate of 5 UAH. for a dollar we could help almost a thousand families every year with state funds, today - about 350 families. For example, in 2008 a municipal infertility treatment program was launched in Kyiv, which provided free assistance to 177 families in the capital, but unfortunately the program was later nullified, and only last year it was gradually restored. Currently, the effectiveness of reproductive care is 40-45%.

- So almost half of those who were considered infertile gave birth?
- So. Under any circumstances, this is a chance for couples who do not have the funds. On the other hand, what do 50 clinics do? Their patients are foreigners, they are mostly treated there. So reproductive medicine is medical tourism. Foreigners come to us and receive help from Ukrainian reproductive specialists at a decent world level. And much cheaper than in their countries. However, it is sad that we cannot do this for our fellow citizens, for families who do not have but want to have children. In these programs, in addition to ours, there are four other government centers. The fifth, unfortunately, remained in Donetsk. We are trying to do something. There is a lot of talk today about the need to buy medicines for people living with HIV. And it is really necessary. As well as to combat diabetes and other chronic diseases. But there is almost no talk about the need to restore our reproductive potential - no one is interested. And we need to shout about it. Activists, who organize various actions-demands, lobby for programs related to big money. None of them ever said: let's help restore the birth rate, women's and men's health, that is, the restoration of the nation. Today, we see that the female and male factors of childlessness have leveled off - 50 to 50. No one is talking about the health of boys. No one is saying that girls who start smoking at the age of 13 or 14 will have huge problems with having children. We need to think about this, we need to shout about it, because without the reproductive potential there will be no restoration of humanity. Consequently, there will be no one to treat or teach, and, ultimately, no one to defend the state.