ATYPICAL HEALTHCARE

MEDICINE

What lies behind the definition of the health of the nation, no one will tell you, even the now living Minister, Mr. Zurabov. A vague concept, because the criteria to go into is to undermine the state budget. But if you come to any - point your finger at ...

What lies behind the definition of the health of the nation, no one will tell you, even the now living Minister, Mr. Zurabov. A vague concept, because the criteria to go into is to undermine the state budget. But if you come to any - poke your finger on the map - regional center, then the local children's hospital will explain a lot. “We are firmly average, typical in Russia,” Alexander Chislin, head physician of the regional children's hospital in Bryansk, told me.

Strongly average in Russia - how is it? This means that in a typical project of the 1980s, designed for 300 beds, 420 children were treated at the beginning of June, and it also means that due to a shortage of space, the department of pediatric oncohematology here had to be combined with the department of gastroenterology.

This has a distant relationship to sanitary standards, directly to financial ones.

Surname of the head of the oncohematological department of the Rakov hospital. Coincides with the main profile specialization of the doctor. On June 1, Rakov was in Moscow at a charity evening at Sovremennik, where we did not meet, because we did not know each other personally. I ask about my impressions, and Rakov replies: “It’s a good thing, and the concert is good, but it’s a disgrace that they collect money for sick children around the world ...”.

When Mikhail Aleksandrovich says “in the world”, he also means German charitable organizations from the city of Hameln, which have become attached to Bryansk children since the time of the Chernobyl disaster, and since then they have been taking medicines and equipment to the hospital. Constancy, it should be noted, is absolutely not characteristic of Russian charitable traditions.

Three oncohematological wards in the hospital were repaired with German money last year. Rakov leads the show. Rooms with double-glazed windows, washable plastic panels on the walls - everything is as it should be for a department that must be disinfected daily. Every penny was spent on the decoration of the wards - there was no longer enough for furniture, and Rakov angrily knocks on the door of a metal bedside table standing in the corner. “Look - here is rust and here, it's all “mushrooms” (fungal infection. - N.Ch.). And here, too... This is incompatible with the treatment of leukemia... Categorically.”

Incompatible, here he is right. But the rusty bedside table and the withered chipboard cabinet in the corner are not from a treacherous oversight - from criminal poverty, for which neither Dr. Rakov nor Dr. Chislin bear responsibility. How it is possible in this department to achieve almost 70% cure of malignant blood diseases - a percentage that is standard for Europe - the question is all the more mysterious because through the wall of this sterile ward, in the neighboring gastroenterological one, there are children with constipation, sick intestines and related procedures.

“We have the same procedural sisters working for two departments. And enemas are given, and blood is taken. It is God who keeps us, I say for sure.

God, apparently, also protects Rakov himself, taking him away from the temptation to throw everything to hell and not travel from the regional city of Karachev every day to work in Bryansk for 20 years in a row, earning 5 thousand rubles a month in budget terms.

Last year, 83 children with hemoblastoses passed through it. Only a few, the most severe ones, he sent to Moscow to the RCCH to Rumyantsev, he coped with the treatment of the rest himself. “Rumyantsev helps us a lot with medicines, there have never been any problems with consultations. I can call Moscow doctors at least at night - they will listen ... "

Rakov pulls his Moscow colleagues, to be honest, without any hesitation. He does the right thing, because he has children's lives here, and there is no other information resource. There is one computer with Internet connection for the whole hospital. It's in the main reception area. And he connected long-distance calls to telephones in departments a couple of years ago, because "it's a shame to say - there was no money."

Why should Chislin be ashamed of the lack of money, maybe someone in the government will tell you, explain, so to speak, the measure of social responsibility personally.

Fighting terrible childhood diseases in such conditions (I note, the best in the entire Bryansk region) is like playing “Russian” roulette: a daily risk, which has not turned into a routine for Dr. Rakov. In September, as soon as he heard the president's report on the prospects for national projects, he immediately came to Chislin with the idea: he should ask the Ministry of Health for money for a children's oncohematological center in Bryansk, a very small one with 40 beds. It's quite a national project.

Asking, as they explained to me in Bryansk, it turns out, is also necessary in a high-tech way - with a project and budget drawn up in accordance with all standards, otherwise they will not consider the petition. Chislin spoke in the local press and on television - he asked fellow countrymen for money for the project. They raised money - one million seven hundred thousand rubles. Again, the Germans participated - 100 thousand from them, the same amount - from several Bryansk companies. And in total - a little more than 500 donors. Chislin sheets, written from top to bottom, showed, opposite the surname - the amount. There are 500 rubles, and 700, and 100. This is money torn off from pensions. In a word, in the capital, in the outback - for children it is necessary to collect around the world.

Later, when we walked around the hospital corridors, stumbling over the patched linoleum and the unbearable smell of the paint that was used to paint the ceilings, caustic to the point of pain in the eyes: “we don’t have the right to buy a good one ourselves, we are obliged to use only the one that the supplier sent - this is the year such a law came out”; when it became obvious that those three hematology wards, refurbished with German money, were the best in terms of conditions in the whole hospital; already sitting in the office of the chief, I asked: “Do you believe that it will be possible to build a center? That things will go beyond the project? Chislin and Rakov, without saying a word, began banging their fists on the table, "so as not to jinx it."

There are no other guarantees.

If what he prays for, trusting in God's will, the believing doctor Rakov, will come true, then there will be more children cured of cancer in Bryansk. Not everyone will be saved, but most. “You understand, “chemistry” is not the most difficult thing, the most expensive and technologically advanced is nursing, and conditions are needed for this.”

The thought is nowhere more obvious, and it is relevant in all pediatrics, even treat sinusitis. And in the "strongly average" Bryansk regional children's hospital, what is there for this?

There is the chief physician Alexander Chislin, who has been carrying this responsibility for twenty years and represents the entire resource perfectly. The equipment, as he says, is practically everything. This is a plus for the hospital. If you clarify what kind of equipment, then it, that is, a plus, will automatically turn into a minus. For example, two X-ray machines are 20 years old, and in a year such a machine wears out by 15-20 percent. How many extra lives such a unit has already lived is easy to calculate. What if this contraption of the last century will give out at one moment an increased dose of radiation to the next child being examined?

Chislin believed that all the medical equipment of the hospital was worn out by 80 percent. If you believe the report for the last year of the Department of Health of the city of Bryansk, he can still treat children on this resource for some time, because in other medical institutions of the city this wear is 90-95 percent. And last year, according to the department’s report, medicines cost 82 rubles per bed, and 27 rubles for food. The head physician of the children’s room looks quite prosperous against this background: he spent 45 rubles a day on food, as much as needed on medicines.

The answer to the question why, among others, the children's regional one looks like “the patient is more likely to be alive” must be collected from various sources. One thing is clear: not because from the center they are somehow loyal with a special ruble to the regional children's hospital in the city of Bryansk.

For more than 10 years, the hospital has received equipment and funds under the program to support children's health care in the Chernobyl zones. This year it was closed, probably considering that the children who fell under the iodine attack in 1986 became quite adults in 2006, and those who still live in the zone were not completely affected. Chislin fundamentally disagrees with this conclusion: “We regularly examine children from there. They endure all diseases more severely, recover more slowly. Immunity is undermined seriously. Part of the expensive equipment was brought by the Germans from Hameln. If not for these investments, then how to treat at all?

How and to whom, to be more precise... Even 10 years ago, 15-20 graduates of medical universities took internships in the regional children's school. Many stayed to work. In recent years - three or four. “All my ophthalmologists are pensioners,” Chislin states. “A third of the hospital’s specialists are missing.”

Paradoxically, but with all this, the chief himself believes that the most difficult times are behind him: “There was a time, five or six years ago, I came to work with horror, there was a catastrophic shortage of medicines.” If the current situation of the Bryansk Regional Children's Hospital can be called stable, then how to evaluate the effectiveness of this medical institution in terms of civilized standards?

Virtually any Moscow clinic treats children from the provinces. Very often, not because the diagnosis is too severe, but because time has been lost. It was possible to cope at home, but there was not enough elementary equipment for modern diagnostics and thoughtful specialists who do not grow professionally on provincial salaries below the subsistence level. Moscow meets sick children with its own rules, in which living with a mother’s child in a hospital in a day sometimes eats up a third of her monthly salary - travel, meals, often a rented apartment. If this money is spent on local health care, then you will definitely have to come to Moscow in really emergency cases.

On June 1, Sovremennik collected money for sophisticated equipment needed in provincial hospitals. For Bryansk, they collected it on a bacanalyzer - a device that allows you to accurately and quickly determine the state of the body for the presence of various kinds of bacteria. Often it is the speed of obtaining such information by a doctor that determines the outcome of treatment. But two-year-old Natasha from the Zlynka district center in the Bryansk region with a diagnosis of leukemia, who has been in the hospital for the second week, will be treated without a bacon analyzer, that's for sure.

When they said goodbye, Mikhail Rakov asked: “When you write a note, sharpen the problem. Then it will be more efficient.

Dear doctor, I wrote everything as it is.