Translated material
Unprofitable people
Why the Russian authorities deprived the qualified medical care of residents of small villages
The policy of the Russian Ministry of Health on Centralization and Optimization of Medicine led to the elimination of paramedic points in small and inaccessible Russian villages. Instead of professional medical care, the so -called “responsible households” are now being created in the villages: from among residents they choose the most responsible one, teach him to provide first aid in accidents or poisoning, presenting a first -aid kit and a cell phone, according to which, if necessary, you can cause an ambulance from a nearby city. But how quickly can she come?
In recent months, many people have learned about the problems of the residents of the small Khakass village of Dekhanovka: in the republican government, the prosecutor's office, the State Duma, the administration of the President of Russia. But it is not the fact that the authorities will decide them. And the problem, in fact, is one - 103 residents of Dekhanovka have been living in virtually without medical care for two years. People write about this to all instances, but so far to no avail.
In 2015, the only feldsher-midwife point closed in the village. Faps closed at that time (and are now closed) not only in Dekhanovka and not only in Khakassia, but throughout Russia. The reason is the lack of medical personnel, first of all, of the average medical staff, and the course taken by the Ministry of Health to the centralization and optimization of healthcare. Its meaning is that it is better not to “spray” in small hospitals and concentrate good specialists and modern equipment in district centers so that residents of the districts can receive quality medical care there. And FAPs in the villages, where less than a hundred people live, maintain both unprofitable, and it seems to be pointless.
It is difficult to say how often high -tech medical services are required for people in small villages. But the fact that in the end they were left without the help that they might need at any moment is an already accomplished fact.
There are single people, they just have nowhere to go at their age, they live their age here. Such grandparents need a paramedic who, if that, would put an injection and competently knock them down
“We have mostly elderly people in Dehanovka, most of the 60, and there are those for 90,” says Vera Suturikhina , the elder of the village. - Here, for example, Baba Nina Motanova, she is 92. She has good children, prosperous, her name is to move, but she herself does not want to. He says that next to the village is a healing source, I only live at the expense of this water. And there are lonely people, they just have nowhere to leave at their age, here they live their age. Such grandparents need a paramedic who, if that, would put an injection and hit the pressure correctly. And now they need to get to the Bey district center for all this.
Moreover, only a minibus went between Dekhanovka and Bey, but this year we achieved that at least sometimes the Gazelle would carry people there. Her schedule is not very convenient: she goes to that direction to eight, but returns to two, and after all, you never know how the procedure was assigned to a person. And not every day she walks: it all depends on whether the head of the village council has money for gasoline or not. For example, yesterday the Gazelle did not go to Beyu, and will not go tomorrow, and the day after tomorrow ...
If you urgently need to a doctor, the locals now call a taxi: 200 rubles in one direction, the same amount back. If the course of procedures is designed for 10 days - that’s the half -pensy of the rural pensioner, says Vera Suturikhina.
But the most important thing is that if something is serious, there will be simply no one to help people.
My pressure here somehow jumped for 220, I called an ambulance, and they say to me: "You drink a tablet, and after half an hour, death again." I am recording this conversation when I got to the Internet, I sent to the presidential administration. Apparently, they read there: I was called to the Beyan Central District Hospital, they processed a long time - they say, stop complaining
“We have only 4 ambulances for the whole Beysky district, and at the same time only two are on duty,” says Vera Ivanovna. - We are 7 kilometers from Bey, Budyonnovka - ten, Sabinka - twenty, probably. In total, on the "our" ambulance, seven villages. While they will reach the call in one direction while they are in the other, but while they are in time with the patient - how long will it take? Call useless. My pressure here somehow jumped for 220, I called an ambulance, and they say to me: "You drink a tablet, and after half an hour, death again." I am recording this conversation when I got to the Internet, I sent to the presidential administration. Apparently, they read there: they called me to the Beyan Central District Hospital, processed for a long time - they say, stop complaining.
Heal himself
The closed feldsher-obstetric points in the country found an alternative-the so-called house farms . The bottom line is that of among the inhabitants of small or inaccessible villages they choose the most responsible and, if possible formed (medical education, is not necessary), teach first assistance in accidents or poisoning, hand a first -aid kit, a cell phone with the necessary numbers. If anything, it is to this person that fellow villagers should turn in emergency cases. And then - as it turns out.
Please understand: not a single health worker will go to a settlement where less than 100 people live. And we cannot force a person to go where he does not want. Therefore, households are at least some kind of exit
- Previously, there were 300 inhabitants in Deukhanovka, and there was its own FAP. Now there are 100 left, and keeping your own feldsher-obstetric center is simply financially disadvantageous in such a village, ”says Mikhail Malgin, assistant to the Minister of Health of the Republic of Khakassia. - And this is a problem not only Khakassia, in all of Russia the villages are slowly dying. And the faps are closed everywhere. And households are also created not only with us, just Khakassia was one of the first. Now there are 46 villages with a population of less than 100 people in the republic where there are households.
How are they organized? We are looking for a person among active inhabitants (preferably more developed - a former teacher or an agronomist, for example), he once a year is a retraining of first aid. I emphasize - not specialized medical, but the one that the driver of a passenger bus or a train conductor has the right to provide, for example. He is given medical styling, a cell phone, on which he can contact a hospital or emergency services. The housekeeping housekeeper works on a voluntary basis, people do not receive money for this. Please understand: not a single health worker will go to a settlement where less than 100 people live. And we cannot force a person to go where he does not want. Therefore, households are at least some kind of exit.
Dehanovka in a certain sense was lucky. In this village, the house economy was fixed for a paramedic who worked in the local FAP until it closes - more, in fact, there is no one to consolidate it for it. But since the paramedic point is now gone now, and the physician is still a year before retirement, she goes to work in the district center every day, to the Beach Central District Hospital. Returns in the evening. The household is inactive all day, although according to the law it should work around the clock. However, even if the paramedic was always in place, it is still forbidden to provide a “real” medical care to her in the status of a responsible household.
I have not seen anything more meaningless than house farms. What we are talking about, if a person, behind him, is assigned, even a doctor, has no right to put a dropper or injections
- I have not seen anything more meaningless than house farms. What we are talking about, if a person, behind him, even a physician, has the right to put either droppers or injections, says Innocent Stryapkov , the head of the Beyan village council. - It is clear that to maintain the FAP building is worth certain money, especially in winter. Yes, residents themselves understand that he can work for him all day, and nothing to do. But let it open at least two hours a day when it was necessary to carry out the procedures. If our healthcare came to contact with residents, this issue could be resolved.
But everything is like a wall of peas. We gathered a gathering, called representatives of the district administration and the Ministry of Health. And it seems to have agreed on 0.25 rates for the paramedic, so that she was officially allowed to work. But the WHO is now there, but the village council does not have their own health authority. I asked that gathering: here the budget of the Beyska district hospital is taking shape at the rate of 10 thousand rubles for each person assigned to it. It turns out that the state will be allocated about a million a year on our Dekhanovka. So is it really possible to pay out of this amount at least symbolically extra, especially since there is already a building?
With the building of the feldsher-midwife point, the story is also interesting. Immediately after the closure, he was transferred to the category of housing and seemed to be going to sell. People were indignant - they were explained that the doctor would live here. “But no doctor will go to Dekhanovka for dead, even from the district center,” says Stryapkov. As a result, the former FAP building is idle, and the doctors, if they come to the village, are taken in a local club.
And so they tell me: Vera Ivanovna, prepare the club, the dentist-surgeon will come. Well, we washed the floors, what else? It flows from the roof. And here the doctor in such conditions with people removes teeth
“By the way, we put the club in order, they don’t give us money for this,” says Vera Suturikhina. - Now we follow him, keep in order, try to hold the events. But still, the building is old, the roof happens, it flows, ancient furniture. And so they tell me: Vera Ivanovna, prepare the club, the dentist-surgeon will come. Well, we washed the floors, what else? It flows from the roof. And now the doctor in such conditions removes their teeth ... They are completely holding the people for the cattle. I believe that the generation, which lived and worked here, has achieved everything with its labor, survived the 90s, did not sleep, did not sleep-it somehow deserved two hours a day of normal medical care.
Wait for the increase in mortality
Does Dekhanovka and other small villages have a chance to regain paramedics? The probability is small if only because the numbers are changing all the time, on the basis of which the settlement can have its own FAP. Initially, it was about one hundred inhabitants, now other numbers are mentioned.
“According to our standards, a rural medical site is 1,200 people, a paramedic - from 300 people,” says Mikhail Malgin. - But there are in Khakassia and the village, where from 150 to 300 people live, but the faps are preserved in them.
That is, Dekhanovka, if you follow the logic of the Republican Ministry of Health, at least 50 people are “not enough” to restore the work of FAP. But after the numerous appeals of the villagers to all conceivable authorities, they still had an answer: there is still reason to open the first-aid post.
And from the Republican Ministry of Health I know what answer came? Like, once after the closing of the FAP in the village, mortality did not increase, then there is no reason to open it
- I didn’t write where. And the deputy of the State Duma Maksimova - here we were campaigned for her before the elections, she was only due to the dekhanovka of the voice and recruited. But I did not receive an answer. And Zimina, the head of Khakassia, wrote. I wanted to get to the new Minister of Health - but they did not let me go. And from the Republican Ministry of Health I know what answer came? Like, once after the closing of the FAP in the village, mortality did not increase, then there is no reason to open it, ”says Vera Suturikhina. - But I can read. The law says: FAP should be in the village, where more than 100 people, taking into account seasonality. And next to Deukhanovka there are two recreation centers, and many come with savages. So in the summer we are gaining up to 200 here. But if something happens to tourists, no one will help them urgently either. The prosecutor’s office finally answered me: the check was carried out, the FAP is recommended to open. But that was the case and stopped. I come there again, I say: why don't you follow the execution of your own requirements? And they answer me: you know, in a good way, elderly parents should live with children. They would have dismantled the elderly from here - and all issues would be resolved.
Putin speaks and constantly says: you can’t close fations and schools, if even 10 people live in the village, people, they say, are most valuable. And our officials, when they close something again, are covered by government decrees, which the same Putin signed
- Do you know what surprises? - adds Innocent Stryakkov . - So I sit on the TV, Putin speaks and constantly says: you can’t close the faps and schools, if even 10 people live in the village, people, they say, are most valuable. And our officials, when they close something again, are covered by government decrees, which the same Putin signed. I can’t understand these discrepancies. Yes, they just don’t want to spend money, that's the whole explanation. But no optimization should make people's lives worse and leave them without the most elementary. Moreover, according to the law, everyone has equal rights to medical care.
Now Vera Suturikhina is waiting for acquaintances from Moscow to visit their places: he wants to send all the collected documents with them, the appeals with the signatures of fellow villagers, unsubscribes from different instances - to the government and Putin. He says: Maybe Muscovites will be able to pass all the papers faster. And then by mail how many times I have already sent, and it’s not clear whether it came or not.
Why the Russian authorities deprived the qualified medical care of residents of small villages
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