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Chukchi doctors are not afraid of frost
Vice-governor of Chukotka on social issues Yevgeny Podlesny - about how much money "flies" to sanitary aviation and why in Chukotka get on reception to the governor - not a problem
Photo by chukotka.org
- Before the elections, a lot was said about the fulfillment of the May presidential decrees, about a real increase in the salaries of state employees - doctors, doctors, teachers, social workers. Voting took place, the reports were handed over, a new cycle began. Are there goals and guidelines now?
- Generally, elections have nothing to do with it. We were faced with the task of achieving a number of specific indicators in 2017, and we have achieved this. But who said that now the work has stopped and everyone will relax? It was necessary to bring earnings in the social sphere, healthcare and education to the average level for the economy of the region of the Federation. Withdrawn. Let me explain: it must be borne in mind that in the industry and, for example, the banking sector of Chukotka, incomes are quite high, and when we put in considerable figures in the budget, it turns out that we are constantly forced to catch up with ourselves. However, this is not a big problem. A forecast indicator is established, it is approved by the Ministry of Economic Development of the Russian Federation and we are guided by these figures, increasing the amount of wages. For 2018, the average figure for Chukotka is 86 rubles. In 864, it was 2017 rubles. We were not able to bring the earnings of junior medical personnel to this level, they amounted to an average of 85 thousand. This is the task of this year. Our doctors now have a salary of 075% of the average regional in the economy, that is, about 64,7 thousand. The medical staff in the feldsher-obstetric points (FAPs) receive about 200 thousand a month.
- Do the doctors have enough, the staffs of hospitals and FAPs are manned?
- In the Chukotka Autonomous Okrug, there are 10 doctors for every 60 thousand of the population (310 people per 50 thousand of the population of the district). On average in Russia - less than 40. But direct comparisons give little. If all our 50 thousand were concentrated in one place, it would be possible to count “like everyone else”. But in Chukotka there is Anadyr, where 15 thousand people live, and the remaining 35 thousand are scattered in regional centers, in small settlements. There may be at most 100-200 inhabitants, maximum a thousand. Such villages are deeply isolated from the “big world”. The climate is unsuitable for human life, there are no roads, air traffic is highly dependent on the weather - and you yourself know what the weather is. Therefore, every such village must have a medical worker. Not a single hospital is left without medical care, except that sometimes one specialist is missing. For example, there is no pediatrician in Markovo - but by and large, with their population there is enough general practitioner. We are constantly reviewing the schemes for the provision of medical personnel.
"But what if the only doctor suddenly decided to quit and leave the remote village?" Where and how to search for a new one?
- We have a territorial principle of serving the population. A district hospital, a FAP or an outpatient clinic is a structural unit of some larger hospital. Hence, from there, for the first time, another doctor comes to the village, so that "white spots" are not created without access to medical care. And then we are looking for a new one. How? As always. On personal contacts, through resources on the Internet, trying to interest people primarily financially. In addition to wages, we will not forget about the "Zemsky Doctor" program, when a visiting doctor receives a million rubles a one-time payment. We now have all the settlements in the district, even Anadyr, in this program, since the population in it is less than 50 thousand. The program is implemented on the principle of co-financing, 60% of the money is given by the federal budget and 40% - region. By the way, payments are not limited to this one million. Depending on where the doctor went to work, from his treasury Chukotsky AO pays him another 100 thousand (in the center of the district), 150 thousand (in district centers) or 200 thousand (in the most remote villages). If he works well and copes with his duties, plus the same annual premium.
- And where such a zemstvo doctor to live?
- Of course, a person can not go to work anywhere. There are, of course, objective difficulties with housing in Anadyr or in Lorino, but in other places this problem is solved more or less successfully and the municipal housing from the specialized fund is allocated to doctors.
The departmental hostel in the capital of the district is now crowded. To relieve it, we introduced (primarily for doctors) compensation for hiring or sub-housing. A person can rent an apartment or a room, and we compensate him 15 thousand (for a family - 20 thousand). This is not a 100% payment, but quite a substantial help. Now, the mortgage lending support program for medical workers has also been put in place - the first installment is paid from the district budget: 30% of the cost of the apartment, but no more than 1,5 million rubles. Then it is compensated up to half of the monthly payment, but no more than 10 thousand. True, we track - did the person try to consciously worsen their conditions for the last three years. You can not sell an apartment, go to a rented apartment, and then get a new home from the budget. But if the doctor really needs housing, and worked for some time in the hospital, he can count on help. If my memory serves me well, since last year one such apartment has been purchased in Anadyr and five people have submitted documents, they are waiting. The most difficult thing is to find an apartment to buy, because in Anadyr with housing in general is tense.
- Is the new not built?
- In the plans, as far as I know, it is. With the current market value of housing, investors are finally showing interest in building homes for sale, as in other cities. By the nature of my position, I deal with not only health problems, but also social protection, employment, etc. I can say that the municipality constantly buys apartments for the most needy. First of all - for orphans. We consider it our sacred duty to provide them with housing, if it was not assigned to them. There is a list, there is a plan, so in a sense, we also warm up the market. It's just that there is not a lot of place in Anadyr suitable for housing. But if the municipality allocates land and several apartment buildings are built, I think the apartments will be populated quickly.
- Suppose, the doctor received in Chukotka his million and extra charges to him, allocated him housing. How many years must he work without leaving?
- Not too little?
- Practice shows - who worked here for five years, then does not hurry back. "Anchor", as we say. A friend of mine, a doctor, a "senior comrade" told me when I was young and had just started working in Chukotka: "We all came here once for a color TV. And then we work for twenty years, thirty times ... "So it happened with me.
- And where are you from?
- From the Donetsk region, Konstantinovka. He graduated from Donetsk Medical Institute. And honestly I will say: in 1994 year, when I moved here, it was better in Chukotka than in Donetsk. There were prospects here, but everything was falling apart. The idea was given to me by my relative. I immediately after graduating from the institute began to work in the district hospital of Anadyr by a trauma doctor. We were only three traumatologists for the whole of Chukotka. Worked a lot, and it was an unforgettable permanent drive. And the year in 1999-th I was summoned to me by the head physician and suggested to enter into the personnel reserve for his position. With the condition: if he leaves, I fulfill his duties. His deputies of all kinds, of course, were, he simply believed - to prepare a young specialist so to cook, without discounts. I was then 27 years old. I did not feel a special desire to go on the administrative ladder. Probably, it is a question of happiness and harmony: from work as a traumatologist, I received a colossal return and did not want to change it to a "cabinet" service. For four months I was acting as head physician, I was invited to the district administration, I did not like it very much, and I went back to the hospital. And quietly worked there until 2003 year. While Deputy Governor for Social Affairs Victoria Grigorievna Anisimova did not invite me to become the head of the health department. I was still not enthusiastic about the ability to administer something, but I wanted to break down the old system and create a new, logical and effective one. We were just five people in control, we began to work on the sly. Since then everything has gone.
- Do you regret leaving the practicing doctors?
- First, I'm used to it. Fifteen years have passed since then. Secondly, I see the fruits of my, our work, and this is very important for a person. Even if something is not done - I understand what could be worse. This is a colossal experience from the point of view of organizing the health care system. In Chukotka, we were not afraid of experiments, we were the first to create a rigidly centralized system and a vertical management with one hospital and a network of its branches throughout the region. Nobody has gone over to the same level as we, to single-channel financing, at the expense of the OMI funds. It's very interesting when nobody is ahead of you and you are the first to experience it. Naturally, all crises also hit us, we had to make cuts, sacrifice something. But within reasonable limits. Therefore, today we have preserved the "medical presence" in all villages - there is at least a FAP. By the way, in some places the hospital was first removed, leaving only the dispensary, and now we return again. For example, in Omolon. This is a large village, it has about a thousand people, there is a boarding school for reindeer herders' children. Special attention of physicians is necessary.
- Still, it's terrible to live in a remote village, where there is only a paramedic point. What if the person has appendicitis or has he broken his leg?
- Call Sunrace. Medical aviation works for us. The federal authorities began to develop it, set requirements for helicopters, and they fly. Another thing is that this is a very “financially intensive” thing. The helicopter, which we received last year, is on lease (the contract was signed by Chukotavia). We have been allocated budget funds - 150 million rubles, lease payments are 60 million, so we are able to pay for flights. Our co-financing is small, only 8%. But the total cost of a flight hour on such an aircraft is much more than on a conventional one.
- How many?
- In Chukotka - 400 thousand. This counts with take-off-landing, meteorological report, airport expenses, etc. On an ordinary aircraft, the cost is about 300 thousand per hour, and we also have the cost of leasing and depreciation to them. When the funds allocated from the federal budget are over, we will pay extra from our own. This will happen, most likely, in the middle of the year. Last year, we flew to 150 million in about 4 months, for a year, 350 million flew to sanaviatsia. But then the cost of the flight hour was more expensive - the value of the first lease payment affected. Now recalculation, depreciation has also become smaller. All this is very expensive. But without sanitary aviation, we - and in other Far Eastern regions - nowhere and in any way.
"But what if the weather is not flying?"
- The paramedic will stabilize the patient until he can be evacuated. A well-trained paramedic is able to do this, but, naturally, they will help him, give recommendations on the phone, they will not leave without support.
Taking into account the vagaries of the Chukchi weather, we usually try to take, for example, women in the 32nd week of pregnancy to the district or district hospital so that they can calmly prepare for childbirth. In general, even if the expectant mother is feeling well, we usually try to place her in the district hospital, more than half of the children are born there in Chukotka. This is a good medical institution, its infant mortality rates are at the level of European clinics. Over the past year, we had only six cases when doctors failed to save the baby, and this was due to serious complications during pregnancy from the mother herself. The rest 443 new residents of Chukotka were born safely. May they continue to grow healthy.
- What diseases are most annoying to the inhabitants of Chukotka?
- In the first place, of course, diseases of the upper respiratory tract. It's no wonder people breathe cold air most of the year. Fortunately, bronchitis and sinusitis can be successfully cured, such diseases are unpleasant, but not fatal. In mortality statistics, as well as throughout the country, diseases of the circulatory system are in the lead (cardiovascular pathologies, heart attacks, strokes, etc.). Oncology is in second place in Russia, but we are out of the general trend. We have the second most common cause of death - "external causes": injuries, poisoning, accidents. Malignant tumors claim lives less. Unfortunately, this is a regional feature. The point is also that the population of Chukotka is quite young. The average life expectancy in the district is 66 years, but this is due to demographics. We have fewer elderly people than in other constituent entities of the Russian Federation, as old people and pensioners leave "for the mainland." Therefore, the calculation of "life expectancy" in our case is done with adjustments for the age structure as a whole. For Russia, this is 78-80 years. For natural reasons, our figure is lower, and it is impossible to raise this figure in a short time. In addition, the mortality rate has to be counted from a population of 50 thousand, it can fluctuate sharply from year to year (doctors will not be able to save three or four newborns - and there will be a collapse in statistics). I will only say with caution that over the past five years, our mortality rate has decreased quite significantly. We are the second in Russia in terms of the rate of its decline. But it is very difficult to compare us with other regions: in terms of population size, and its demographic composition, and in terms of living conditions in a harsh climate, and for many other reasons.
- Is the Federal Ministry of Health able to understand this specificity?
- In general, yes, we find understanding and quite constructively communicate with Minister Veronika Skvortsova. She thinks in terms of the future, it's important. But it's not just about her. In old and not so very "good" times 90, when the Minister of Health was the famous cardiac surgeon Yuri Shevchenko, he and his deputy Vyalkov realized a simple thing: the problem is rooted in how well the head of the Ministry of Health and the head in the subject understand each other Federation. In Moscow, you can build different schemes and offer projects, but so far it will not be understood on the ground, things will not move. So-called "commander's courses" were organized at the Ministry of Health, where the deputy heads of regional government came. Two weeks of intensive pumping the ideas of the ministry plus getting acquainted with new models of technology were useful. Pharmaceutical companies also presented their new drugs at these courses, and with all the pros and cons of such practice, we got an idea of what is happening in the pharmacy market and in the field of medical technology. Maybe Veronica Igorevna should resume the system of such meetings and communication. In the distance, we can not put new ideas into our heads: we live in an insane rhythm, small everyday affairs so much that you just do not have time, attention is dissipated. For example, I flew for the past couple of weeks in remote villages - there are things that need to be constantly monitored so that employees are "in good shape." Already I feel that a lot is under way here. To make a "reset" of local leaders, we must tear them away from the usual turmoil.
- Even the most prosperous regions have recently faced the problem of shortage of prescription drugs for recipients in pharmacies. Is there such a problem in Chukotka?
- In my opinion, the decline in mortality in recent years 10-12 has been achieved before due to the system of preferential drug provision. The commercial sector does not want to go on preferential leave of medicines. Therefore, until recently, we had two pharmaceutical companies - Anadyr Pharmacy (municipal) and Chukotfarmatsia (state). It was decided to privatize both of them with 100% municipal or state participation. Now they have become an LLC and can work not according to the 44 federal law "On the state contract system", which provides for serious restrictions on the time of drug delivery, but on 223-FZ, which allows to react more quickly to requests. Yes, such privatization is in many respects a formal thing, since the state remains the owner of the enterprise, and the performance of the social function does not give an opportunity to get a big profit. In our conditions, it is required to create a minimal assortment list in rural pharmacies, where these medicines can lie on the shelf for a long time. For the commodity credit taken from the wholesaler, it is necessary to be calculated from some other means, because sales are few. At Chukotfarmatsiya now, for example, 23 million of commodity credit is worthless.
As for medicines for the treatment of orphan diseases, we receive them in normal time: the relevant patient registries are being maintained, we submit applications to the Ministry of Health, the Ministry holds an auction and buys everything necessary. Sometimes it happens that generics are bought, and a person has personal intolerance. Then we buy the necessary drug for the money of the district. Recently, by the way, there was such a case. And what if you need to save a person?
We have no problems with sending patients to other cities for treatment, with the purchase of medicines for them. We can choose any profile clinic in Moscow, St. Petersburg, Novosibirsk or Khabarovsk and give directions if they have not yet fully fulfilled the state task and can accept our fellow countrymen. Sometimes this does not work out because the clinic is too busy. And sometimes people prefer, for example, to do heart surgery not in Moscow, but in Novosibirsk - there are excellent doctors and excellent conditions for caring for patients, there is no metropolitan fuss.
- How often do you have to deny people who turn to you for help?
- Rarely. We always try to find a way out and a compromise. You see, what a thing. We have few people in the district, everyone on the account and everyone knows each other. The authorities are close to people, and controlling organizations have the opportunity to check almost everything (especially when entrepreneurs have "check vacations" and auditors are full of energy). We live in a very narrow society, so a person in Chukotka can come literally from the street and say: "I want to talk with the deputy governor or with the governor." He will be recorded at the reception, and with a 100% chance he will get to such a reception. He will say everything that he considers necessary. And will be heard.
This is called the boring term "socially-oriented region". But for us it is a condition of normal work and normal relations with citizens.
Honestly, I like this system. Many things you want to change, but not this.