This is the appraisal of new MARCO (Medical Amateur Radio Council) member, Dr. Oleksiy (Alex) Gavva, UR4LL.
"Health is not a high priority ---. Human life cost nothing (as recently) as 40-50 years ago ---- millions people died in prisons, due to absence of food."
This is not a description of East Africa. It is not a description of Uganda, or Rwanda. It is not even a description of Zaire, Zambia or Zimbabwe. What it is, however, is a description of present-day Ukraine barely six years after the breakup of the Soviet Union.
"Now we don't have totalitarianism but we are living in a democratic state with all political freedoms. But this state is in deepest economic crisis now. The population - - - - has gone from 52 to 50 million."
(A whopping 4% population decrease in six years)
"Ukraine is not a third world country but I think that we'll be near Africa level soon."
This is the appraisal of new MARCO (Medical Amateur Radio Council) member, Dr. Oleksiy (Alex) Gavva, UR4LL.
Alex is the 41 year old Medical Director of the 280 bed Zolochiv Central Regional Hospital (CRH) in Kharkiv, an oblast on the Russian-Ukrainian border. In addition to those duties, he is Chief of all regional health services that also includes five rural satellite hospitals, and other emergency and 'first aid' stations.
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Reaction to receiving medical and hospital equipment in Ukraine Hospital Project: Equipment and funds to support Dr. Alex Gavva's urgent request for medical supplies is being provided by approximately 84 (unduplicated) MARCO members - or 19% of the total membership. The two largest individual donations by far to the Ludin Memorial Fund which supports MediShare, have been provided by individuals who are not hams, not MARCO members and not in the medical field. Dr. Alex Gavva reported that the shipment consisting of several large containers of medical supplies arrived by truck in Kharkiv City via Hamburg, Germany, Poland, Russia, and finally in Ukraine on May 13, 1998. Although Ukraine Customs had given tenative approval prior to shipping, there were substantial delays at the border. Finally, after about six weeks, the shipment was accepted as 'Humanitarian Aid', and thereby free from import duty. Dr. Alex reported recently that according to customs officials, this shipment was the first consignment of humanitarian aid received in Ukraine.
"On the next day the truck was unload in presence of the Custom officer and all items were placed in separate room of hospital's drug store and after checking procedure shipment was sealed for custom cleaning ('clearing'). It was necessary to recognize this shipment as humanitarian aid for clearing from different import taxes. We sent documents to Kiev and special State commission recognized this shipment as humanitarian aid. I must say that we had no experience with a custom and next two weeks I worked hard for custom clearing. During this period I had very close contacts with 'Smitty' (W6CS) and Direct Relief Internationnal Senior Program Manager, Katherine Poma. Every morning we received additional necessary documents from Santa Barbara by fax. I remember the round eyes of our customers (custom officials) when I appeared by morning at their office with new papers. On May 29 all custom procedures were completed and the room was desealed and opened. All Heads of hospital departments were invited to our drug store and all items were divided between hospital departments and rural hospitals. Since June 1 we started to use humanitarian aid. On Jun 2 first operations with vital functions monitors were made. Our doctors and nurses were happy to receive such help from the opposite part of the Earth. I prepared a few articles in the local newspapers about help from USA. But news about this help run before newspapers. For many peoples it is very hard to ('imagine') about such things. After WW II our peoples heard every day Communist propoganda that USA is our greatest enemy. Such propoganda finished at Gorbachov's time but many people continue to trust in old legends. For breaking of such legend your help means significantly more than simply medical aid. Now all people know that our ICU and Operation Unit have equipment from America (we rarely use 'USA' in our terminology).
I am really happy to be MARCO member and cooperate with MARCO. I want express my cordial thanks to all MARCO members, MediShare, DRI, Dr. R. Smithwick, Mrs. Katherine Poma and all people who supported us in this dramatic period of our way from Communist regime to democracy and free market economy. I trust that these grains will grow a good crop in the future."
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His wife, Ludmila, is a pediatrician, and is in charge of the sixty-bed "Therapeutical Department for Adults and Children."
A shipment, underwritten by MediShare International has only recently been delivered to the hospital. It consists of the most urgently needed medical supplies, equipment, pharmaceuticals, and instruments carefully selected by Alex. This material was supplied by MediShare partner, Direct Relief International of Santa Barbara, California. Also included was equipment donated by MARCO members.
Nurse unpacking medical equipment and supplies
In response to his direct and urgent request, the shipment includes very basic equipment, such as EKGs, stethoscopes, sphygmomanometers, autoclaves, and nearly a ton of assorted medical supplies including rubber gloves, gowns, syringes, dressings, and much more. The value of the shipment is just over $32,000 on the wholesale market.
This shipment is another major project of the MediShare - Bush Hospital Foundation International program, which included a recently completed shipment of medical supplies valued at $87,000 to the little rural hospital.
UKRAINE
Ukraine consists of 24 oblasts ("states") and the Crimea Republic. The Kharkiv oblast has a population of over three million and at its center is Kharkiv-city, with a population of 1.5 million. It is the second largest city in the country after Kiev and the largest industrial, educational and scientific center in the country. There are many different medical institutions in Kharikiv City including the Kharkiv Medical University, a Postgraduate Medical Institute, and three colleges for nurses' training.
MEDICAL EDUCATION
In order to study medicine, a student must complete ten years of secondary education, and six years of medical education. The university consists of four sections, "medicine, pediatric, stomatology (dentistry) and 'sanitary-hygienic'." Postgraduate education, or specialties, consists of one or two years of additional training.
As recently as five or six years ago, medical education was paid by the state. Tuition was free to the student and included a living stipend. Now,the state supplies only enough money for about one-half of the cost of education, the student being responsible for the balance, currently about $1000-1300 USD per year.
HEALTH CARE IN UKRAINE
In Alex' opinion, medicine in his country is organized somewhat along the lines of the profession in the US. Private practice is largely absent due to high taxes and low income of the general population. At his hospital, eighteen specialties are represented including dentistry ("stomatology" in the Ukraine).
Medicine does not have the status in Ukraine that it does in the US,
although there are twice as many doctors per 10,000 population than in the
US. It may be characterized as a 'mid-level' occupation. Therefore many
doctors have little interest in improving their education since it "will
not improve their life. It is possible to work very hard or not very hard
and still receive the same salary", according to Alex. For example, Dr.
Ludmila Gavva was formerly head of the 30-bed children's department. Since
last August she has headed up the 60-bed 'therapeutical dept.', yet her
salary is unchanged and Alex, even as the hospital's Managing Director, has
no authority to change it. But despite those circumstances, Alex states
that there are many good educated doctors with a profound interest in their
profession.
Those doctors that live in rural areas grow vegetable gardens, fruit trees, and some farm animals in order to supplement their family's food supply.
THE CENTRAL REGIONAL HOSPITAL (CRH)
The Central Regional Hospital (CRH) is the principal hospital in the region which has a population of 37,000 people in the immediate area of 300 square miles. It is a 'multifield' hospital and is combined with a first aid clinic and ambulance station and includes as well, a number of specialized wards. It consists of 40 'therapeutical' (medical) beds, 35 surgical, 40 neurological, 10 gynecological, 20 obstetric, 20 pediatric, 20 infectious diseases for adults and 10 for children, 20 for trauma, and 6 beds in the ICU (Intermediate Care Unit). There are also the pharmacy, laboratories and other departments normal to a comprehensive hospital. His staff consists of 60 doctors, more than 200 nurses and 150 additional support staff.
The present hospital was built between the years 1902-1969 and has had no repair or refurbishment in the intervening years. The five rural satellite hospitals do not play an important role in the medical service of the area. Alex has recommended that they be phased out for economic reasons, but his suggestions have so far been ignored.
The system's annual budget is approximately $700,000 (USD) per year for all purposes, or an expenditure of $20 per person per year as compared to US health care costs of about $2000 per person per year (Alex' figures). Of this amount, $500,000 is budgeted for salaries. A very modest amount of the hospital's income derives from patient fees, but this source generated only $10,000, or only 1.4% of last year's income.
Typical salaries for health workers are $80-100 per month for doctors, $70 for nurses, $30 for aides and kitchen workers. The rest goes for all other purposes, including all medicines, food, utilities, equipment, and supplies. He has not had the funds to buy any new or replacement medical equipment or money to pay for ambulances and building repairs for many years. The 'fibrogastroscopy unit' had to be closed, due to equipment failure for which there have not been funds available for repair or replacement. Only seven thousand USDollars per month are available to spend on medicines, yet Alex estimates his actual 'bare-bones' needs to be at least $30,000 USD.
HEALTH STATUS OF POPULATION
"Health is not a high priority for our state", according to Alex.
The health of the general population has not improved in recent years as a result of the continuing economic crisis. In fact it is deteriorating precipitously. Six years ago the average life span for men was 67 and for women, 72. The life expectancy has been plummeting and in the five years since the break-up, it has dropped to 61 and 66 years respectively. Officially, child mortality is at 14 per 1000, but "in my opinion, the real figure is about 20 per 1000." Death results primarily from heart diseases, oncological diseases, trauma, and lack of a balanced diet. Alcoholism is a significant factor. There is a high growing rate of tuberculosis and AIDS (for which Alex has very little protective gear for his hospital medical staff). People defer health care until it reaches crisis stages, at which time it is often too late for treatment.
Alex was born in 1956 in Asiatic Russia. His parents were ethnic Ukrainians, but the family moved east in the early 1950's to improve their living conditions. His father worked in the new country as a railroad worker. In 1963 the family returned to Ukraine.
He attended the Kharkiv Medical Institute, and in 1979 after graduating, he began practice at a railroad hospital as an epidemiologist. In 1982 he and Ludmila were married. She was a pediatrician at the same hospital. She had graduated from the Middle "Asiatic Poediatric Institute" in Tashkent, Uzbekistan in 1981.
Upon returning to the Ukraine in 1982, he studied at the Ukrainian Postgraduate Institute in Kharkiv for hospital and health care management. In 1982 twin daughters were born to Ludmila and Alex and he "had to go to work" instead of continuing graduate studies. In 1984 he joined the medical staff of the Zolochiv Central Regional Hospital as Vice Chief of the Health Service. He now is the 'head doctor' and when time permits, he is able to combine his administrative responsibilities with practice in the infectious diseases department.
Ludmila, Alex and their daughters now live in a "separate home", built in 1959, of about 130 square meter, as Alex describes it, belonging to the hospital. Ludmila's mother lives with them. They have no car and depend on transportation using the hospital's jeep or 'service car'. His monthly salary is $200 U.S. dollars, and Ludmila's is $100 U.S. dollars.
Alex began his amateur radio career in 1972 and was active at the local radio club's 2-meter station. He was first licensed in 1980 as UL7KAD but was not active while he was pursuing his medical education. For the past few years and currently, he is active with his good friend, the well-known "EMEer", UR5LX, on 432 EME. Two years ago he finally got his own station on the "magic band" as Alex characterizes it - six meters.
In a recent exchange, I asked:
"Are you optimistic or pessimistic about your and your country's future?"
"I don't lose my optimism. we are not living in desert area. Many nations want to help us. I know my field of responsibility and I'll do all - - - to change situation to better. Ukraine (has) enough good educated and talent peoples ready to work for a better life. With other hand we have enough peoples of old generation (not age) - "red directors". They are not able to accept new situation rules. Many medical directors are "red" and they don't feel OK in this life. I also don't feel OK, but these rules are better for me and I know how I'll be work in future 2-3-5 years."
Alex Gavva
Head Doctor of Zolochiv Central Regional Hospital
Ukraine