Translated material
Operation
This was only at the front. And now it happened in Vladivostok. Without waiting in line at the oncology center, the young mother operated on herself. Why a state that cannot provide essential services?
At the end of August, a shocking story happened in Primorsky Krai. A resident of Vladivostok, a mother of two children, removed a breast tumor herself, fearing that a month and a half before her appointment at the regional oncology center, they could become ...
At the end of August, a shocking story happened in Primorsky Krai. A resident of Vladivostok, a mother of two children, removed a breast tumor herself, fearing that a month and a half before her appointment at the regional oncology center could become fatal.
Already in September, together with TV reporters, a mammologist from the Federal Far Eastern Regional Medical Center Grant Gulyan came to visit Marina (that is the name of this woman). The specialist examined Marina, praised her and said that the woman acted very professionally - she performed the operation on herself no worse than in the hospital, and wrote her down for further examination. (Now she was examined in the oncology dispensary. Oncological pathology was not found.)
Will the position of cancer patients in Primorsky Krai and in the country change after this egregious incident? Or, as before, officials will report not saved lives, but rubles swelled into the next program?
“Come in, come in,” Marina meets on the threshold of her hotel. - The place is small, but cozy and neat. The cupboard is lined with books, most of them on medicine. On the unfolded sofa, her daughters are drawing in the album: Katya and Polya. Marina quietly shares her pain:
- A lump appeared in my chest, quite small, but palpable. I called the regional oncology dispensary to make an appointment for an initial appointment. I was told that for this I needed a referral and a bunch of tests from a regular clinic: a blood test, an ECG, a fluorography ... I collected the tests for a little less than a month. I work, I feed two children by myself. And there are queues everywhere, somewhere you have to pay. The next time I called oncology in early June, when all the necessary papers were on hand. I was signed up for the next month, before the appointment I had to wait another month and 10 days. My bump was already the size of a cherry, I didn’t know if it was a benign tumor or not. I didn't know at what stage. I know that in the third stage - metastases. Most likely, by the time of admission I would have been on the second ... I graduated from the 4th course at the medical faculty of the medical institute, then I had to leave. Long thought and decided. I chopped with novocaine, disinfected with an antiseptic. I made an incision with a scalpel and “torn off” my tumor. It was, of course, unpleasant. But no pain. It was sewn up, perhaps not as beautifully as professional surgeons would have done. But firmly. She sent the girls to the kitchen, but Katya saw and stayed to help.
And now she's around. He hugs Marina: “I saw, and my mother told me not to be afraid. And then asked to bring a towel ... "
“I would not bother the newspaper,” says Marina, “but I know that the situation among oncology patients has not improved. My friend needs urgent hospitalization, but she was booked in for an appointment a month later.
Lyudmila Gurina spoke about the difficulties of patients, and. O. Chief Physician of the Primorsky Regional Clinical Oncology Center:
— We have a planned maintenance program. Everything happens as follows: the patient comes with a referral from his clinic, registers, and then, if necessary, waits for a call for hospitalization within a month or two. Whatever stage the patient is at - the second or even the fourth - the order is the same for everyone. We are currently experiencing a shortage of beds. The program of state guarantees for the provision of free medical care is not implemented in our country. Patients simply have nowhere to put for treatment. We have been waiting since June. If only my desire were here, I would have put everyone and cured them. But, unfortunately, nowhere. There is also a queue for a paid service. I also want to note that 70% of patients come to us at advanced stages. Because of this, additional problems arise.
Many, having heard this story, twisted their fingers to their heads. Andrey Svinin, mammologist-oncologist of the Regional Clinical Center for Specialized Types of Medical Care for Motherhood and Childhood, says:
- It is not clear what exactly she deleted herself. Tumors are of different types: benign and malignant. As a specialist, I would say that the patient did not have an entirely adequate reaction. But, from a human point of view, it is worth considering how desperate a woman must be in order to cut her chest while sitting in a home chair. The worst thing is when at such moments a person cannot get professional help. By the way, we have been advocating for the creation of a separate mammological center for several years, but so far to no avail ...
In her story, Marina complained that it was difficult to make an appointment. We have carried out our experiment. It was possible to “get through” by phone to the dispensary, but she called for a long time and persistently for two days. By phone, I was advised to go with my problems ... to the nearest clinic. Everyone there will tell you which doctor to see and for which tests, and then, if necessary, come and make an appointment for an initial appointment.
It is also not easy to get a coupon for an oncologist at the dispensary registry. The reception window opens at 7.45, the queue is already at five. Arriving at the beginning of the eighth, I was 60th. “After seven, you don’t have to borrow: it’s still not enough,” the woman next to me sympathizes. While we are waiting, a talkative woman advises what to do next: “If you need an operation, go to the manager, she can speed up the process.” Remuneration is a separate issue: "How will you agree." I learn that paid single rooms cost 1000 rubles. And if for two, then 500 per person.
When the story became public, the governor of Primorye, Sergei Darkin, visited the oncology dispensary. They say that all the curators of the regional health care did not fare well.
Checks, replies and ... promises began. In particular, now we are talking about the modernization of equipment and the purchase of blank products for registering patients. (Perhaps this lack of forms hindered admission?) But in the subprogram "Oncology" of the regional target program "Prevention and control of socially significant diseases" for 2009-2012, there are no reasons for optimism: "In Primorsky Krai, it is necessary to have 740 beds (actually - 396 ). There is a shortage of more than 344 specialized oncology beds<…> Primorsky Krai has the lowest radiological bed availability in the Far Eastern Federal District: one radiological bed for 57 newly diagnosed patients.” “In the Primorsky Territory, more than 6,000 cancer patients are registered annually, and more than 3,000 oncological patients die.”
The equipment has not been updated for more than 15 years. There is no apparatus for immunohistochemical studies - it is impossible to determine in advance how the tumor will behave with this or that treatment. There is no X-ray computed tomograph and gamma camera for preclinical diagnosis of tumors and their metastases. But after a regional-scale scandal, they will buy letterheads.
In Primorye, 22,109 cancer patients are registered. Places are sorely lacking. If only for the initial appointment an appointment for a month in advance, then tragic outcomes are inevitable.
Commentary of the Ministry of Health and Social Development
“Here you can talk about the negligence of the leader…”
We have developed a system for providing medical care to cancer patients, approved by the procedure for providing medical care to cancer patients. If a person who has a practically confirmed oncological diagnosis cannot quickly get a consultation with an oncologist, these problems should be solved by the regions, which are entrusted with all the responsibility for providing medical care by the relevant legislation. But to say that such situations occur everywhere is impossible, this is not a system, this can only happen in those institutions, those regions where the organization of oncological care is poor, and here we can talk about the negligence of the leader.
After confirming the diagnosis and determining the stages of treatment, the patient can be treated as an outpatient at stage 1-2 or can be referred to inpatient treatment, where he will receive the necessary assistance.
As for patients with stage 3-4 disease, however, we have a fairly high percentage of patients with advanced stages of the disease. In order to fix this, we have an oncology program, institutions of the relevant profile are provided with all the necessary equipment, and the procedure for organizing medical care has been established.
It should be noted that since the beginning of the National Cancer Program in 2009, by 2010, for the first time in modern history, we have recorded a decrease in mortality from cancer by 0.9%. Although over the past 10 years, the increase in mortality from oncology was 14%.
The Ministry of Health and Social Development of Russia provided a complete algorithm for managing such patients. Now a high share of responsibility lies with the regions.
Natalya Sholik "Far Eastern Gazette" -
especially for Novaya Gazeta
Regions
Omsk region
“Even if you have an urgent case, you still won’t get an appointment with a doctor before October,” they said in polyclinic No. 2 of the regional oncological dispensary. The doctor will look and give a referral for testing (how long it will take, the registry does not know). Then there is a queue for hospitalization, how long to wait is unknown, those who need to be hospitalized without delay are waiting for their bed.
A well-known case from local practice: retired police lieutenant colonel Elena Moskalenko (see "New" dated May 31 of this year - G. B.) with a cancerous tumor was placed in a pre-trial detention center, after leaving there, the surgeon sent her for treatment in January 2010 years (at that time it was already known that she had cancer in the third stage), and they began to treat her only after 1.5 months.
According to the Regional Ministry of Health, for the first half of 2010, the number of registered cancer patients is 36,495 people, i.е. 1.8% of the population of the Omsk region. How many unaccounted for, it is difficult to say.
In June, the regional government approved the Regional Oncology Project for 2011-2015. It provides for the “construction of a three-story operating building of the Clinical Oncological Dispensary with an area of 12,468 sq. m.
Krasnoyarsk region
In Krasnoyarsk, since 2005, the authorities have “launched” a project to build a new regional oncology dispensary, but nothing has been built yet. The existing dispensary was built in the 60s and does not meet modern requirements. It was designed for 90 beds and 5 operating rooms. Now 480 beds are permanently occupied in it. Operating rooms need at least four times more. People are kept in an overcrowded hospital without treatment: patients are simply waiting in line for an operation.
The head of the dispensary, Andrei Modestov, states that in some departments, the waiting list for hospitalization exceeds 30 days (this violates the state guarantees program). They were given the task that the queue did not exceed a week. But in order to get into this queue, you still need to be able to defend the preliminary ones - bring a card to the registry, then to a specialist, then to a hospital or for an examination. The turn for ultrasound is a month ahead, for x-rays - two weeks. The marginal oncomortality rate is 213.2 per 100,000 population, i.e. above the national average.