Programs - Round Table

Lev Roitman:

Winged axiom: it is better to be rich and healthy than poor and sick, does not yet give reason to draw a conclusion that in society he is certainly more patients than in a prosperous one. The whole thing is probably how social public healthcare is set, and this is the problem and task of the state, its medical organization. If today in Russia, especially children and adolescents, are sick more often than 10 years ago, there is reason to blame the state. This is what Moskvich says, Marina Katys talked with him:

"The fact is that all these diseases, which are now widespread in large quantities not only in Moscow, but throughout the country - this is a direct connection with the state’s attitude to patients, these diseases, that is, people are not protected by the state, social protection is very weak, there is not enough medicines. And, in the regard, we must try to protect their children in the first place, but of course, from the possibility of such diseases."

Tuberculosis has returned to Russia, the growth of drug addiction among adolescents over 10 years of the latter increased by 10 times, the incidence of syphilis - 70 times. These numbers are terrible. Who to blame? What to do, how can you help? With these issues to the participants of today's program, they are in our Moscow editorial office, I will present them: Alexander Chapkovskaya - coordinator of the program to combat tuberculosis of the Moscow Representative Office of the New York Institute of Health; Alexey Nikiforov - the head of the program for the help of the homeless, organization "Doctors without borders"; With them, our Moscow correspondent Marina Katys. With the first question, perhaps, to Alexander Chapkovskaya, questions, in fact, are posed, Alexander Igorevna, I ask you.

Alexandra Chapkovskaya:

I would like to first answer the question: how to help and what to do. But, of course, the disease must be treated and prevented. And to do this is not so difficult and not so expensive. This is especially true for tuberculosis, where the course of treatment of one patient costs $ 50 for the entire course. And who is to blame is the question is already more complicated, which you definitely cannot answer. Now it would be worth it to forget why it happened, and I would like all departments to join their efforts.

Lev Roitman:

Now to Alexei Nikolayevich Nikiforov - we will stay in the channel of the conversation that Alexander Chapkovskaya asked us: what can be done now to help, without having to shift the blame on anyone?

Alexey Nikiforov:

I think that the problem could be solved if, in fact, as Alexandra said, to unite, and so that everyone who must fulfill their duties performed them as expected. Unfortunately, we, public organizations, sometimes have to fight precisely with misunderstanding in state structures of what they should have already done. That is, unfortunately, often budgetary funds that could benefit the patients are not spent on, and one who, let's say, say, the Ministry of the Interior takes more money to protect prisoners than to help the same prisoners. The same thing in help, say, with tuberculosis for both homeless and syphilis patients, gonorrhea and other sexually transmitted diseases. That is, here, in general, resources could be found.

Lev Roitman:

Alexey Nikolaevich, you mentioned, in particular, the Ministry of the Interior. Well, now the places of imprisonment, the places of correction have been transferred from the Ministry of Internal Affairs to the Ministry of Justice, so that the Ministry of Justice is inherited, probably flaws, guilt, and defects of the Ministry of the Interior. It is in places of imprisonment that the outbreak and the prevalence of tuberculosis are now especially high. What does not get in order to deal with this? Alexandra Chapkovskaya says that the treatment of tuberculosis patient is, in the end, no more than $ 50.

Alexey Nikiforov:

Well, these 50 dollars are not there either - this is time, and then - does not get elementary things: X -ray films, and drugs, and in general, often a misunderstanding of those bosses who should decide on the treatment of patients. That is, unfortunately, old approaches to the treatment of patients, costly approaches often dominate. And our organization, in particular, is trying to convey to the leadership of the current Ministry of Justice, which could somehow solve the problem, less costly using the diagnosis and treatment methods tested by the World Health Organization system.

Lev Roitman:

Who is included in your organization, in its Russian branch "Doctors without Borders"?

Alexey Nikiforov:

In this case, I represent the Belgian branch of the organization "doctors without borders", and we directly conduct a program for helping patients with tuberculosis in Mariinsk, the Kemerovo region. So far, this is only the Belgian representative office.

Lev Roitman:

Well, do you still meet some kind of support at the local level?

Alexey Nikiforov:

At the local level, among those directly people who work with patients, those who are responsible for the implementation of the program, we meet very good support. But, unfortunately, at a high level, it is often necessary to prove, in general, things that should be clear the first time. But you have to go through and prove things through it, completely kind of axioms.

Lev Roitman:

Thank you. And again to Alexander Igorevna Chapkovskaya: does support, say, in the Ministry of the Interior earlier, now in the Ministry of Justice your program to combat tuberculosis, in particular in places of imprisonment?

Alexandra Chapkovskaya:

Briefly, I would say - yes, finds support, including at the leadership level, before the Ministry of Internal Affairs, and now the Ministry of Justice. I would even say that the leadership of the prison system is much more preoccupied with the state of health of prisoners than the Ministry of Health, oddly enough. As if society as a whole shares people, it seems that prisoners are not the same people who live with us in the same territory, and as a result, it is better to close them in prison and forget about it. This prevents, as it were, these social diseases, because: let's forget about the people of patients with syphilis - they themselves, they say, are to blame for this or about prisoners - they are still criminals. And no one thinks that these people will come out, and will walk here with you and with us, and that this is the same problem, there should be no departmental approach. In addition, of course, $ 50 costs treatment, but if you consider that in all prisons in Russia, at the moment, scurvy is no less than every third person is sick with a clinically pronounced scurvy, that is, a deficiency of vitamins to this level, then, of course, if you put them so badly, then even if you treat them, this, in general, will not help very much.

Lev Roitman:

Thank you, Alexandra Igorevna. Well, for the sake of the fact: in Russia, more than a million people are in places of imprisonment and in investigative insulators. According to European norms, this is a monstrous figure.

Marina Katys conducted her mini -cap for Muscovites on the eve of this program, and we will now listen to an excerpt from her conversation with another Muscovite.

Marina Katys:

Now diseases such as tuberculosis have spread, especially in a teenage environment. Are you worried about such an increase in the incidence?

"Well, in principle, yes."

Marina Katys:

You have children, they drive by public transport - do they have a chance to become infected?

"Therefore, we carry them in our car."

Marina Katys:

In general, you heard how many people are sick with tuberculosis now in Russia?

"There are no such data. But rumors are that many are sick."

Marina Katys:

And you yourself are not afraid that you can pick up such a disease like that?

"Everything is possible. I'm afraid what will you do?"

Lev Roitman:

An excerpt from the conversation of Marina Katys, she participates in our program, with a Muscovite on the street. Marina, you naturally not only talked, but also did your own research.

Marina Katys:

Moscow, in general, is a kind of city, and it is not a reflection of the state of affairs in Russia. Nevertheless, a large number of people do not think about such so -called socially determined diseases. They believe that this is really behind the fence of the zone or behind the fence of their prosperous life and will never touch them. On the other hand, given that a huge number of people poured into Moscow without a certain place of residence, as they were previously called, and the number of patients and cripples in public transport, who simply ask for alms - this is a very tangible population of the city. And people come across them every day, and many of these people who get on Moscow streets are really sick. And it is they who lead Muscovites to the idea that they really are not somewhere in somewhere, but very close and easy to get sick. And, indeed, statistics show that now such a disease as tuberculosis has ceased to be only a belonging to socially dysfunctional sections of the population, quite prosperous teachers and doctors were also prone to, simply because they have a very low standard of living, and they, roughly speaking, are not known, but it is known that tuberculosis is associated with this problem. But in general, people try not to think that they can get sick.

Lev Roitman:

But, if you still think that you can get sick, then, probably, in especially disadvantaged, in the particularly poor layers of the Russian population, this probability of getting above. Alexey Nikolaevich, you are the head of the program for the help of the homeless organization "doctors without borders", in this environment the risk of sick diseases that we determine in something socially determined, what? And what are the chances of recovery?

Alexey Nikiforov:

Among the homeless, a large number of former prisoners are somewhere up to 35%, and this determines that among them there are many people who have tuberculosis. According to our statistics, up to 20% of the primaryly contacted our first -aid post, doctors suspect the presence of tuberculosis from them. On average, among all our patients, and about 30 thousand passes through our first-aid post per year, somewhere the total prevalence of the incidence of tuberculosis 4%. There is still an opportunity for these people to recover, and state structures still make efforts, and this program, thank God, works. In Moscow there are several clinics in which homeless people can be treated for free of tuberculosis. And if we suspect the patient with tuberculosis, then through the anti -TB dispensary we direct them for treatment, and people, if they want to recover, they can undergo a full course of treatment. So there are positive shifts here, and I hope that you can still fight this if you actually come from all sides: from a social point of view and from a medical one.

Lev Roitman:

Alexandra Igorevna, how do you compare the situation in Moscow with the situation in other regions of Russia?

Alexandra Chapkovskaya:

I can comment on the situation in prisons in other regions and have only indirect information regarding the situation among the civilian population in other regions. As for the prison, tuberculosis is currently leading the cause of death, and three quarters of patients with tuberculosis in Russian prisons under 35 years old. That is, the chances of dying from tuberculosis, sick in prison, are very large. Nevertheless, most people still do not die from tuberculosis in prison, because they receive treatment, though treatment is inferior. As a result, they become chronic patients and die a few years later. But because of this inferior treatment, they lose their chances to recover forever, because they turn into an antibiotic stable form, and the treatment of an antibiotic stable form costs more than 10 thousand dollars and can’t afford anyone or a prisoner or him when he is released.

Lev Roitman:

What is necessary, from your point of view, Alexander Igorevna, to undertake in the criminal punishment system, in the system of investigative insulators so that, at least, tuberculosis does not spread like a forest fire, that's how it is now?

Alexandra Chapkovskaya:

Of course, it is necessary to quickly identify and isolate all existing patients, because the current system of detection and isolation is lags behind the rate of spread of the epidemic. Secondly, of course, you need to provide some minimum power level so that people do not suffer from scurvy and so on. And besides, as long as in the investigative insulators half a meter per person of the floor, the spread of the epidemic will, of course, go very quickly. That is, it is desirable that they are less planted, but this is already as if not a medical problem at all.

Alexey Nikiforov:

I still hope that the problem of tuberculosis and other socially dangerous infections in the coming years will not be like that in our country. I am an optimist.

Lev Roitman:

But, and as for this specific group that you serve as part of your organization "Doctors without Borders", homeless people, homeless people, except for tuberculosis, what do you celebrate in this group?

Alexey Nikiforov:

In this group, of course, in addition to tuberculosis, the number of people who suffer from sexual diseases has increased, also one of these social problems. First of all, for this group of population, the main thing is the solution of social problems. The main solution to the issues of restoring documents, registration issues, the ability to get a job, because for many of them it is the main one, that is, already a employed homeless one is no longer a homeless person, but a person with an unresolved housing problem. And in general, our program now, first of all, makes efforts to solve these social issues, that is, for the homeless this is the most important thing. Not even medicine, not even treatment, because we are treating a person, he returns to the same society, but if he does not solve a housing problem, if he does not have documents, if he is not employed, he again falls to the bottom, and people who descended to the bottom do not live for more than a year, according to our statistics, these people have been dying out simply.

Lev Roitman:

That is, in a strange, and perhaps not in a strange way, the organization "doctors without borders" performs the function of social trains without borders in institutions. I understand you correctly?

Alexey Nikiforov:

Yes, in the Charter of our organization, it is written that we can act as witnesses. And we testify to the state, to the international community that this group of the homeless people, that these are not some dirty creatures, and these are our fellow citizens, these are Russians who could still be beneficial to the state and live humanly if society will think about them as fellow citizens and not something that needs to be concluded for the thorny wire, as it was done before the 91st year. And if the law is adopted that they are free people, so perceive them just like everyone else. They have exactly the same right to medical care and social security. This is probably the main thing.

Lev Roitman:

And how to explain what you represent the Belgian branch of the organization "doctors without borders"? There is no Russian branch?

Alexey Nikiforov:

In Russia, there is no organization "Doctors without borders". Unfortunately, Russian society has not yet matured before, and secondly, the behavior of medical programs is a rather expensive thing, and so far Russian organizations cannot pull this.

Lev Roitman:

That is, the problem of insufficient state support is aggravated by the immaturity of civil Russian society?

Alexey Nikiforov:

Yes, that is how. Due to the fact that it is homeless, they do not have registration, and they do not have access to outpatient medical care, which is why the “doctors without borders” have to work here. And our task is to somehow move this situation from a dead point, and prove to the state that they should still recall these of their citizens, who are young, mostly people, 75% of them are people from 25 to 45 years old.

Lev Roitman:

Thank you, Alexey Nikolaevich. I add to everything that you said - unfortunately. Alexandra Igorevna, but, and your program to combat tuberculosis, you represent the New York Institute of Health, does it have sufficient staff, staff?

Alexandra Chapkovskaya:

We do not have so many staff, because, unlike the organization "doctors without borders", we rely on existing structures, medical personnel in prisons, in civilian society - anti -TB dispensaries, that is, we work with Russian doctors. And in fact, our own staff is 12 people here in Moscow. To fight social diseases, it is necessary to consider these people as the same citizens as all others. Firstly, the discrimination that these patients, especially in civil society, are interfered with the struggle with tuberculosis. That is, when the former prisoner is free and the diagnosis of tuberculosis, this further complicates his life and interferes with obtaining a residence permit, and therefore the place of residence, and therefore work, and therefore food and medical care, and drives these people even more into a hopeless situation. As if society, thus, puts his head in the sand, and the disease spreads because these people do not disappear instantly.

Lev Roitman:

Meanwhile, we read and hear about mercy ...