Stay alive

The reduction of rural hospitals and doctors' salaries has become a threat to the population of the Far East

Special courses “help yourself” or “learn to heal” were developed at the Khabarovsk Institute for Advanced Training of Doctors. This simple know-how is a desperate way to teach the local rural population to provide medical care to themselves in the face of a catastrophic shortage of professional doctors. And the shortage itself was a consequence of the too literal implementation of the national project “Health” and the 131st federal law on local self-government.

A specialized educational institution, which was initially aimed at retraining people with higher or secondary medical education, now enrolls ordinary citizens as its students. As the vice-rector of the institute, Valery Volovik, told a Vremya Novostey correspondent, Khabarovsk professors did not decide to go among the people and teach basic medical skills to the rural population because of a good life .

The national project “Health” is producing positive results in providing medical care in cities and large towns. The increase in salaries of local doctors and junior medical personnel has led to the fact that in Khabarovsk alone the number of therapists has increased by a third, and the staff of nurses in city hospitals and clinics has doubled. In small villages and taiga settlements, notes the rector of the Institute for Advanced Training of Doctors Salavat Suleymanov, the shortage of medical personnel at all levels has become threatening to the health of residents.

Residents of dozens of villages do not have the opportunity to see a doctor or receive qualified assistance. For example, in the village of Chelny, located just 80 kilometers from the regional center not far from the Khabarovsk-Komsomolsk highway, a paramedic station has been standing with boarded up windows for ten years. According to local residents, the paramedic moved to the city, but there were no people willing to go to the rural wilderness. Then the rate was reduced, and the villagers managed exclusively with self-medication.

During the year, existing rural hospitals and outpatient clinics in the Khabarovsk Territory underwent optimization. According to the head of the health department of the Nanai district, Valery Melnichenko, the main goal of this event was to reduce the number of beds in the village hospitals, leaving only a day hospital and a clinic there. According to recommendations issued from the federal center, there should be one local therapist for every 850 rural residents. But while in densely populated areas of the country these figures may be justified, says Liliya Kile, former head physician of the district hospital in the village of Naikhin, for the Far East such standards are completely unrealistic. There are too many villages with a population of just over a hundred people, which are scattered hundreds of kilometers from each other.

The head of the Nanaisky district of the Khabarovsk Territory, Alexander Kurochkin, said that in the territory under his jurisdiction three district hospitals were cut. They were transferred to the status of outpatient clinics. Mr. Kurochkin explains this decision by the need to save budget money. “There is a hospital in Troitsky, we have it well equipped, but in the villages there is no such equipment. And there are few qualified doctors. Now residents will be able to receive good medical care, and our expenses will be sharply reduced - we will save 3.5 million rubles on staff salaries alone!” - assures the head of the district.

However, practice has shown the opposite. Currently, patients in need of hospitalization wait months for planned operations at the only regional hospital. And in order to undergo the necessary examination or tests, says Marina Konchina, an elderly resident of the village of Mayak, you have to spend time and energy on the long journey to the medical center. And, most importantly, a lot of money for a pensioner.

The regional Ministry of Health explained that there were no direct instructions to reduce the number of hospitals and medical personnel in the districts. The optimization carried out was dictated by the need for municipal authorities to meet the criteria of Federal Law 131 on local self-government. Nevertheless, a wave of closures of medical centers swept across all rural areas of the region. “If in the same Nanai region the villages and villages are connected by good roads, then such medical optimization in hard-to-reach areas of the north of the region looks like a mockery of ordinary people,” says Nadezhda Russkikh, head of the administration of the village of Takhta in the lower reaches of the Amur. A ten-bed hospital serving the population of four small villages was closed due to the transition to per capita funding as part of the national Health Project. There is no such road network as in the south of the region in the Ulchsky district. For several months a year, when there is ice on the Amur, and the taiga routes become completely impassable due to mud, the residents of the local villages are completely cut off from the outside world.

It is in such settlements, “unpromising” from the point of view of inpatient medical care, according to the vice-rector of the Khabarovsk Institute for Advanced Training of Doctors Valery Volovik, that it is necessary to organize first aid courses. In these villages, medical teachers go to the homes of elderly people and give lectures on how to stay alive if there is no doctor nearby. So far, mostly women - employees of village administrations and schools - are signing up for free medical courses. Training includes theoretical knowledge and practical skills - first aid for a heart attack, hypertensive crisis, the ability to apply a splint and stop bleeding, basic pharmaceutical information. Doctors call specialists from the people by the fashionable word paramedics. In Far Eastern villages, in order to minimally satisfy people's needs for medical care, at least one out of ten villagers must take this first aid course.

Ilya SERGEEV, Khabarovsk region