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If coronavirus hits Ukraine, we won't conduct major anti-epidemiological measures, - cardiac surgeon Todurov

Author : 112.ua News Agency

Respondent : Borys Todurov

Source : 112 Ukraine

Interview of Ukrainian cardiac surgeon, director of the Kyiv Heart Center clinic
18:39, 4 February 2020

Ukrainian cardiac surgeon
Open source

Today our host is Borys Todurov, Ukrainian cardiac surgeon, professor, honored doctor of Ukraine, director of The Heart Institute, public figure, and blogger.

- Mr. Todurov, let's start with the coronavirus issue. Should Ukrainians panic now? If not, what to do?

Todurov: I think panicking is not worth it anyway. It is necessary to approach this problem very carefully and systematically. It is clear that today there is no effective antidote to this virus, there is still no vaccine, and there is no serious method to combat it. And, of course, the virus will come to Ukraine. Judging by the trend observed in the world today, sooner or later we will face the fact that this virus will come to Ukraine. And the epidemiological situation will be quite serious.

- As a doctor, do you see that we are preparing for the coronavirus in our country?

- Now we are preparing to identify it in a timely manner, but some serious anti-epidemiological measures, I think we are unlikely to be able to organize today in Ukraine, since the sanitary-epidemiological service has been destroyed. There are no people responsible for epidemiological measures. And there are no structures and forces that could organize it today at the proper level.

- Why do we have neither structures, nor powers?

- The managerial vertical in medicine, which was responsible for the sanitary condition, was destroyed several years ago. When cholera arose in Odesa in the 70s, city was isolated from the outside world, quarantine was declared, the city was closed, and the epidemic was suppressed. In the same way as other epidemics were suppressed, when there was a centralized and well-organized medicine in Ukraine. Today, unfortunately, there is no such medicine, so I have serious fears that if this virus comes to Ukraine, we won’t be able to organize any large-scale anti-epidemiological measures.

- The President said that it is necessary to develop a national plan to overcome this coronavirus. Do you see Ukrainian specialists who are ready to face that virus and do something?

- Undoubtedly, we still have these specialists - very competent epidemiologists, very competent infectious disease specialists. But the system that I am talking about is quite expensive, it requires large material and human resources.

- So you are hinting that we won’t be able to build a hospital within a week if the virus suddenly enters Ukraine?

- Naturally, we will not build a clinic, our clinics have been built for decades. And I am not sure that the capacities of the boxed rooms that exist today are enough to somehow localize this infection so that it does not become mass.

- Is there any expectation of political speculation on this coronavirus, and what about ordinary speculations?

- We live in such a world that political speculation takes place on every issue, including diseases. Everyone is already used to it and do not pay much attention. As for speculation in masks, vaccines and other things, then you need to be vaccinated against influenza and other diseases. All vaccines that are required by standards must be done. And if there are effective vaccines for viral diseases, of course, it is better to be vaccinated. In many ways, such vaccines have cross-immunity, and this is one of the elements of protection.

- We got questions. Dmytro asks: China introduced responsibility for the deliberate spread of the virus. Are such measures needed in Ukraine? And why were the Ukrainians who arrived from China not isolated if the incubation period was up to 14 days?

- As for someone to infect someone, we have such a law on AIDS - the criminal liability for intentional infection. As for a viral infection, it is unlikely that anyone intentionally walks and coughs on others. As a rule, people do this unconsciously or from a lack of some information. And it will be very difficult to prove any responsibility here and somehow punish people. As for general protection, we are now talking about a coronavirus, but it could be any other virus. It can be massive defeats, technological disasters. I can say that the destruction of the managerial vertical in medicine entails simply disastrous consequences.

Today, this destruction of the vertical, with the privatization of clinics, with the destruction of many district hospitals, the so-called decentralization, caused irreparable damage to the epidemiological protection as a whole, across the country. If today something serious happens in Ukraine that requires the mobilization of state hospitals, it will be very difficult to do this. And tomorrow it will be even more difficult, because this notorious decentralization, which provides that hospitals become state enterprises and earn their own money for bread, salaries, utilities, will lead to the fact that hospitals cease to carry out some kind of state, social mission, function and begin to think about how to survive, how to earn their salaries, utilities, and medicines. This process is quite destructive in our country, and it continues.

- Still, the standard remains: children are not accepted into kindergarten now without vaccinations. Already there is a level of protection. A flu epidemic has begun - schools and kindergartens are being closed. There are measures that work according to the circuit. And now we find out how much our citizens trust Ukrainian medicine and how they evaluate it - we have the results of a survey in our audience. We asked: "Are you satisfied with the level of Ukrainian medicine?" 90% are not satisfied, and 10% are satisfied. How do you rate such results in our studio?

- I am surprised at 10% who are satisfied, because the general level that we have reached is clearly not even 10%. The problem, as I see it, is that we are all taxpayers. And of these taxes, we have the right to demand medical care from the state, as it was before and as provided for in our Constitution. At the same time, some people who decide on the distribution of our taxes, for some reason decided that we should get only 2.8% of our taxes on medicine. Worldwide, less than 7.5% is thought to be a dying medicine. And in most European countries, 7.5-12% is allocated from the country's budget for medicine.

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- We have a Minister of Health, who should defend those 7.5% or 8% allocated to medical purposes. And there are MPs who voted for this budget.

- It was they who voted? It turns out who is to blame. We have been screaming about this for several years now, we are practicing doctors. We are talking about the fact that the funds that are allocated today for medicine are barely enough for meager salaries. According to experts (we had the Accounts Chamber), which examined our rather successful clinic for a rather long time, the state allocates only 29% of the necessary amount of funds for supplies, medicines, oxygenators, valves, etc. today we have less than a third for the treatment of patients.

- The Ministry of Health plans to fight with underfunding of medical institutions. 72 billion hryvnias (2,8 billion USD) for medical care will be provided through contracts with healthcare institutions. Is it a lot or a little?

- 72 billion hryvnias. In Ukraine, about 100 000 doctors and approximately 200 000 nurses. If you multiply this figure by 12 months, then you get about 10 000 hryvnias (400 USD) only for salaries. The tariffs offered by the National Health Committee as compensation for medical services make up 10% of their real cost. For example, our heart surgery costs about 300,000 hryvnias (12 000 USD) at cost, including a meager salary of 3,500 hryvnias (140 USD) for sisters, and a surgeon with a 15-year experience, Ph.D., is receiving 7,000 (280 USD) today. So, these 72 billion are enough only for a small salary. And instead of 300,000 for a heart operation Health Committee gives us 30,000 (1200 USD). This is a lie, deceit, untruth. And those laws that were adopted last year, on autonomy, on state guarantee of medical care - in fact, these are laws on the bankruptcy of medical institutions. Because the law on autonomy assumes that all medical institutions had protected under the Constitution salary items, even miserable ones, for utilities, after they switched to state-owned enterprises, they would be forced to earn their salaries themselves. With the meager 10% of the tariffs offered by the National Health Committee, this means that in the near future, many hospitals (a significant percentage of these hospitals) will simply go bankrupt. I will give an example at our clinic. We are very hard pressed to become a state-owned enterprise.

- By whom?

- By the Ministry of Health represented by Ulyana Suprun. There was just unprecedented pressure. I still wonder how I was able to defend our clinic. Like some other doctors, who were able to defend their right to be called state enterprises. So, in our case, the salary fund along with medicines and utilities is about 120 million hryvnias (4,8 million USD). 102 million (4 million USD) is the salary of the thousandth collective per year, and 18 million (800 000 USD) we need to pay for utilities. In the event of a transition to a state-owned enterprise, we are offered to earn 120 million on our own. I ask them: at the tariffs that the National Health Committee gives (supposedly guaranteeing state payments), will we be forced to take these 120 million from the old people who don’t even have money for a bus ticket? It turns out that we are forced to either take this money from patients, or go bankrupt. It's very simple - to bankrupt any medical institution.


- What is the purpose of this?

- It’s very simple: further privatization of bankrupt medical facilities. This process has already begun. There are funds that operate in Ukraine and which have already begun this privatization process. Now they are developing and buying up private clinics. But later they will have those state clinics that go bankrupt as a result of the transition to state-owned enterprises.

- Now everyone cares about the coronavirus and that it does not come to Ukraine. They write to us: "How can immunity work? Are there any cases when people do not get sick, being in the focus of the disease? Is a medical examination of Ukrainians who returned from China established?

- Even in the center of the epidemic there are people who do not become infected. And when there was a plague in Europe, not everyone suffered from a plague. There are people who have immunity; there are people who are not prone to such diseases. As for coming of the virus to Ukraine, only one thing scares me: a high mortality rate. If there are 200 dead for about 9,000 patients, then this is a very serious situation. 200 people died from a common virus out of 9,000 cases. Therefore, we must be prepared. In America, smallpox vaccines are available for the entire population, although it is believed in the world that smallpox has been defeated and no one has been sick for more than 20 years. And these vaccines are updated annually to be fresh, because we live in a world where there are bacterial weapons, when there are various experimental laboratories that create some kind of viruses. There are countries that engage in biological terrorism. And Ukraine does not live somewhere outside this premise: planes fly to us, tourists come to us, and sooner or later this virus will come to us. Another question - how sensitive is our population to it? How much cross-immunity does our population have from those vaccines that we received from the flu before? Do we have a sufficient number of vaccinations against this virus, and what percentage of the population is vaccinated and will receive guaranteed protection against what will come to Ukraine? And people should be prepared for this. God grant that this does not catch us. But we must be 100% ready.

- There were reports that we shouldn’t buy bananas now, since it is through them the coronavirus can be transmitted. Do you take this into account? And how do you protect yourself and your family?

- I eat bananas. I do not think that this will be the main source of transmission of any infectious diseases, including viruses. In addition, bananas are immersed in such disinfectant solutions before being shipped so it is unbelievable that something remains on them.

- A question from Volyn: “We have a guarantor of the Constitution, and there is article 49 of the Constitution, which says that every citizen has the right to free treatment, and the state must ensure this right. There is article 16, where it says, that citizens living in the Chernobyl zone have the right to appropriate assistance, and there is article 3 of the Constitution, which says that the life, honor and dignity of a citizen is a social value. Does Mr. Todurov support that the government should provide citizens with everything that written in the Law?

- Undoubtedly, everything that is written in the Constitution, while nothing has changed, we must all fulfill.

- One way or another, there is no free medicine in Ukraine. So why not to do everything legally and make it paid? Then more taxes will go to the budget. Is this possible?

This is one question, and now another question from a pensioner from the Kherson region: is it likely that we will have insurance medicine in Ukraine?

- The head of the parliamentary committee, Mykhailo Radutsky, has already announced that we are proceeding to insurance medicine. For this, certain laws and regulations are adopted. And in a year we will receive insurance medicine. In the world, this system has existed for more than 100 years, in different forms. Insurance medicine can provide us with a fairly high level of medical care and security for those people who are insured. At least those working people who can afford monthly insurance fees will be served free of charge. How much budget money is enough under the insurance system in order to provide socially disadvantaged segments of the population: children, pensioners, people with disabilities - this is a big question. Is there enough budget money today to insure at least 60% of Ukrainian population who cannot earn their own insurance payments? This question is not for me - I am not the organizer of healthcare for today. As for me, for today I would keep most of the state clinics in state ownership. Any private clinic aims to make money. Private clinics will not take seriously ill patients who need high expenses. They will not care for extremely severely dying patients who need monthly high expenses. They will not even hospitalize such patients. Such things are possible in large university public clinics. The development of new methods is a large university state clinic. Therefore, my personal opinion: the correct ratio of public and private clinics today is 80% of public and 20% of private.

- Have you filled a contract with a family doctor?

- No. For several reasons. Until recently, the entire registry of family doctors for which millions of dollars were spent was not protected (the personal data - passport data, identification number were open to various kinds of fraudulent activities). And to be honest, I don’t need a family doctor yet - I am a doctor myself.

- In Ukraine mortality exceeds birth rate twice. Ukraine ranks first among European countries in terms of mortality among newborns. According to the Ministry of Health, 7.5 deaths per 1000 survivors. In EU countries it is 3.4 people per 1000 Why?

- This is a social situation. If five years ago half a million babies were born a year, today this number is less than 300,000. This means the insecurity of young people in the future, low salaries, domestic, social disorder. This is the mass emigration of young talented people. Nurses are leaving our successful clinic. There is a medical college near our clinic, from which half of the nurses leave within a few months after graduation. And these are young girls who must stay in Ukraine and have children. According to statistics, it is believed that if the birth rate is less than 2.3 in the country, then the population begins to decrease. Today we have 1.1, if I'm not mistaken. We have already laid a time bomb: according to mathematical calculations, by the 2050th year in some regions of Ukraine there will be no population at all. As in the Chernihiv region, for example. So this is a social, economic problem, the problem of emigration of young people. For 6-7 years, the number of pensioners decreased by 2 million. These are not emigrants, but these are people who simply died. This is a huge social, medical problem. We do not treat these people.

- According to the latest sociological studies that were done using electronic devices, Mr. Dubilet said that about 6 million old people now live in Ukraine, according to their preliminary data.

- According to the latest statistics, men die in Ukraine aged 62 years. I don’t understand why they pay pension contributions.

- WHO said that since 2030 our demographic situation will improve. We either put up with it and wait for the year 2030, or we demand some plan from the government. How do you see a way out of the situation?

- Looking at those people on the TV, I don’t even know from whom personally this can be demanded.

- A question from a pensioner from the Rivne region: what should be in the first-aid kit of a simple Ukrainian, in order to protect you from the usual virus?

- I'm not an infectious disease specialist, I'm a cardiac surgeon. I can only say as a doctor: try to contact with infected people as little as possible. This is the easiest way to protect yourself from infection and diseases.

- After the appointment of Zoryana Skaletska to the post of minister, employees of the Ministry of Health complained that the new leadership was not going to continue the reforms. How do you rate the work of the new Minister of Health?

- I am impressed by what Zoryana Skaletska does. I do not envy her position today, because she was between a rock and a hard place. On the one hand, they demand the impossible from her - to improve the situation in medicine, which she personally cannot provide for objective reasons, although she is trying very hard, and we see this. We have full communication: we communicate on all technical issues that interest us, she helps as much as she can. In those directorates that were outraged, there were employees of Suprun, grant-eaters. It was a big surprise for me why she did not fire them immediately and did not replace them with normal, adequate people. And these people complain about her efforts to change something for the better. Although this is the executive branch, and if certain laws of the Verkhovna Rada are adopted, especially from the previous convocations, the executive branch must fulfill them. And what is required of the minister today is an absolutely impossible task. She needs to preserve the remnants of medicine that remained, to somehow fund them, somehow support doctors and nurses, somehow organize a personnel policy so that there are no such personnel losses that Ukraine incurs today, but she does not have an instrument for this. As a minister, she cannot simply raise our salaries, improve our working conditions, and provide us with full funding. We are sympathetic to her efforts and support her for today, because we see that she is doing this sincerely and frankly. God grant that she had enough strength to do at least what can be fixed today.

- There are news that some officials received high salaries, including the Minister of Health in December received 95 000 (3800 USD). Her average salary last year was 42 000 UAH (1680 USD), and the surgeon in Ukraine on average receives only 4 500 UAH (180 USD). Did you talk to her about salaries?

- I looked at this table of people who earn from the budget today. Minister of Health is the most modest of all ministers. Her salary is the smallest. She does not set this salary on her own. She is a very competent lawyer, and I see nothing provocative in this.

- Thank you for the dialogue. Borys Todurov, Heart Center clinic director, was our interlocutor.

Related: Medical masks not to protect against coronavirus, - WHO

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