As at War: Ukraine Fight with Influenza by Efforts of National Security and Defense

The president of Ukraine Victor Yushchenko entered the Minister of Health and chief public health physician into the structure of National Security and Defense Council. "As per decision I enter posts of the Minister of Health and chief public health physician of Ukraine into the structure of National Security and Defense Council", - Yushchenko said. At the same time, Yushchenko considers that situation with flu/ARVI is extremely difficult in Ukraine.

Now the post of the chief public health physician is occupied by Alexander Bilovol, Vasily Knyazevich is the Minister of Health in the present Cabinet.

In the meantime the number of the diseased in Ukraine already came nearer to a half-million, the number of died yesterday was 86. The president and the prime minister already recognized that Ukraine is not capable to cope wit it by itself - not with epidemic of flu but with seasonal flash of various cold diseases, it addressed for the international help. Even to NATO... It seems that activity of the authorities has chaotic character.

From editorial board: Strangely enough, the decision to enter the Minister of Health and the chief public health physician in National Security and Defense Council is absolutely sensible, though at the same time is absolutely senseless. Now this decision is already late - that is one thing. This decision is purely bureaucratic (plus good PR) - neither minister, nor the chief public health physician have in the submission any operative means to correspond to the status of member of National Security and Defense Council.

Let's imagine that tomorrow there will be epidemic of foot-and-mouth disease - should chief veterinary officer be entered into National Security and Defense Council? If a vessel starts sinking - to enter the minister of water transport? If there's an accident on the atomic power station - the representative of atomic engineering? Probably, the structure of National Security and Defense Council should be more flexible as in United Nations Security Council - there are constant members and there are temporal ones and, likely, there is no need to keep in structure of National Security and Defense Council branch ministers and the more so chief experts of the directions all the time.

But it just not the most important thing actually, they will cope somehow with bureaucratic structure.

The main thing is that public health service system appeared to be not ready to elementary seasonal splash of ARVI. Now this system will not react - it has nothing to do it.

There's in medicine some part which is possible to name emergency medicine - it's a service of "first aid", emergency surgery, resuscitation, sanitary aircraft and a number of other services. There is a sanitary-and-epidemiologic service - important structure which is recollected always after all the others - is a little bit aside.

So, all medicine, both in Russia and in Ukraine, as well as in the former USSR as a matter of fact is decentralized, the main structural link of the system of public health services is district (city). All that's above - region, republic, the state as a whole is already superstructure which often practically does not have sufficient resources - all is concentrated mainly in regional link. And if it's justified for most part of medical branches, for emergency services - it's not so.

Let's admit, there's epidemic in one district and there's no epidemic in the neighbouring but you cannot send brigades of "first aid" from one district to another because each district has own station of first aid, absolutely independent structure.

Once - long time ago, being still very young doctor, I worked on "ambulance" in Moscow region and that discrepancy became evident to me at once. For example, the quantity of brigades of "first aid" is being calculated at the rate of 10 thousand people and the number of brigades - at 100 thousand and more. Population in Moscow is about 10 million, there's uniform city Station of the first aid which possesses, except necessary quantity of linear brigades, decent number of special ones. While in Moscow Region where there's almost the same quantity of population - 7,5 million, things with special brigades are not good. Region is divided into 50 districts, each of them has independent Station of first aid (thus any substation in Moscow in comparison to any regional station - a palace) - there are no towns in Moscow region with population more than 200 thousand, so there's practically no special brigades - it is not due by calculation. Also it turns out that 7,5 million people occupying territory larger, than the city of Moscow in tens, are provided by "first aid" 10 times worse.

But it's not the main thing. The main thing is that each regional station has dispatching service, as a result if ambulance car of the neighbouring district is in kilometre from you, all the same you will wait for brigade from "your" district which will go to you, maybe, 20-30 kilometres. Even if it kills you.

In due time (long time ago) I wrote a note and then published something in "Medical Newspaper" about necessity to centralize "first aid" service at least at the region level, to have uniform resource base, uniform dispatching service. It was necessary to deduce "first aid" from regional submission long time ago and ideally to generate certain semi-military structure with rigid discipline and, on the other hand, great volume of powers on its base. Roughly speaking, in case of emergency situation - to make decision on place. Partially these reasons later were realized in frameworks of "medicine of accidents", in structure of the Ministry of Emergency Measures but it is far not general system of public health service, it is a drop in a ocean.

I'm speaking about system in Russia but there's the same in Ukraine, the same structure inherited from the USSR and almost not reformed. Here, there's epidemic now in the country and to send brigade of "first aid" from the neighbouring region - is almost unsolvable problem. The lay of things with reserves is also bad - the role of reserve could be executed by those special brigades which are not present now as they are being calculated at the rate of 100 thousand, that is only in big cities and population of small cities and villages where the basic majority lives doesn't have them.

The same situation is with Health Inspection Service being connected, as well as all medicine, to the distrcit. According to resources at the district level - regional Health Inspection Service also has almost nothing. Simply to reach some place - is a problem.

What's the reason of submission district Health Inspection Service to the region? On idea, it should put district heads constantly in a certain position - otherwise there is no sense in it, only continuous corruption. The same way regional Health Inspection Service - it should put problems before provincial heads, while they should not have the tool of pressure. Only then the post of chief public health physician in National Security and Defense Council will have any sense, if there will be real structure independent of local bureaucracy under it.

Then - information about placing of additional beds in military hospitals. In fact there are specialized infectious disease ward with boxes and half-boxes for placing of contagious patients - to place influenzal patients in the common bulk of the hospital means to have infection generalization the next day, including surgery and in resuscitation... Have they gone mad? Chief sanitary officer keeps silent - he has no info from places, everything's "good" there. Though after all there is a decision registered in every textbook on Civil Defense - to use for placing of temporal hospital premises of schools, kindergartens, etc becoming available. All the same there are no school for 3 weeks. Why they do not do it like this? Well, there's nobody to be engaged in it! It does not enter into any functional duties! Not to mention the fact that beds and other accessories from warehouses of the Civil Defense which were stored in the USSR in case of war, most likely, are plundered long time ago.

I write it because in Soviet time I had to place temporal hospital at school (mass defeat of children by fighting poison gas) - it's familiar problem which hardly began to be solved better a quarter of century later. But if to try to solve it - it will be solved. 

It seems that it is only the question of PR...

Аnatoly Baranov

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