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Doctors call Kolyma good conditions
Minister of Health of the Magadan Region Irina Larina on positive changes in the region
Irina Larina, Minister of Health and Demographic Policy of the Magadan Region, told EastRussia how the personnel issue of medicine is being addressed in the region, and what is being done to reduce mortality and increase fertility.
"WE HAVE RESTED TO SAVE AMBULATORIES AND HOSPITALS" - Irina Evgenievna, what changes are taking place in the healthcare of the Magadan Region today? - At the moment I can give a positive characterization of the healthcare system in our region. Of course, not without problems. But despite the difficult times, we experienced them. Thanks to the governor of the region, Vladimir Petchenich, we managed to preserve the whole structure of public health, to do without closing hospitals. And this is justified. Because the Magadan Region, despite a small population (146 thousand), is huge in area. And we have 0,36 person per square meter. Many sparsely populated villages are located at a great distance from the regional and district centers. Somewhere live 50, somewhere 100, 300, 800 people. In such settlements medical facilities are not provided for by any standards. But we managed to keep small dispensaries and hospitals.
Yes, they are not easy, because the entire health care system is financed through compulsory medical insurance. Work in the MHI system does not involve direct financing for needs, but earning money: how many patients healed, so much money you will get. This is the trouble of our small medical institutions: when there are only 300 people living in the village, and according to the standards it is necessary to fulfill the so-called "state task". That is, all residents must come to the clinic every day for an inspection. This is an absurd situation, but, nevertheless, it is so.
- How do you cope?
- We are looking for solutions. Now medical workers are actively inviting the population to preventive examinations, medical examination, immunization. The second side - we did a great job when we adopted the regional program "Cadres" and from the regional budget began to allocate funds to attract specialists.
- You invited people from Ukraine, even before the war. I remember the news story, in which doctors from Lugansk talked about favorable conditions in the Magadan region, which they would never have received at home. - Not only from Ukraine, but also from the central regions of Russia, where the salary of a doctor is often 8,5 thousand rubles. First, we give big preferences. Those who come by invitation, we immediately pay extra wages, an allowance in 300 thousand rubles, we provide travel payment, office apartment. In 10 years, a person has the right to privatize it.
Secondly, as part of our program, we allocate funds for advanced training at the best clinical departments, for internships abroad. Those who want can always achieve a lot and move up the career ladder. We are frankly talking about it and everyone knows about it perfectly.
- What is the salary now for doctors of the Magadan Region?
- According to the May decrees of Russian President Vladimir Putin, with 1 October the salary of doctors should make 180% of the average salary in the region. We have already implemented this decree in most institutions. But you need to understand that the decree determines the average income for the industry as a whole. But according to medical institutions, of course, the salary will be different.
For example, our salaries are higher in such structural divisions as surgery, gynecology, anesthesiology and resuscitation, neurosurgery, cardiac surgery. Naturally, the salary of a surgeon or anaesthesiologist is different from that of a therapist working in a sanatorium. Now the doctor should receive 96 thousand rubles, but there are specialists who receive 130, and there are those who receive - 45 thousand. It all depends on where and by whom they work.
- Two years ago, the issue of providing emergency assistance to the region with a suitable transport for the local climate was raised. Then on the ONF forum the ambulance driver from Magadan complained to the president that people were driven by cars not fitted for the cold and off-road. Can you comment on this situation?
- Driver Sergey Zelenkov raised the question in such a way that Magadan does not purchase insulated specialized machines. In fact, no one has previously produced such cars in the northern version. After that broadcast, we agreed with the Izhevsk plant to produce such a vehicle. Zelenkov himself worked at the city emergency station with excellent equipment. And we buy ambulances and ambulances every year. They need to be updated in any case.
- Then maybe for the best was this situation? - There is no thin without good. But, I know that when a driver gets a car, he maximizes it. I 22 year worked in the district hospital for 500 kilometers from the city of Magadan. On sanitary UAZs, we with patients went from Berry to Magadan, and I never faced with the fact that the car was not insulated.
But then, at the forum, the question arose in this way. They began to find out who was being taken out on the floor in winter, who was cold. Two names of patients who have left for the mainland have been named. That is, we are talking about the events of ten years ago, which once were possible to be.
- But the noise was done all over Russia ...
- Honestly, it was terribly unpleasant. Because such issues must be resolved on the spot. But nobody addressed me or the governor.
"WE PROVIDE BENEFITS ON 100 PERCENTAGE" - Magadan Oblast has shown low mortality rates in recent years. And now what data?
- Indeed, we have one of the lowest rates of total mortality: 11,3 at 1000 population, which is lower than the RF and DFO indicators. There are subjects in the Far East, in which the indicator reaches 16-ti! We also have the lowest infant mortality rate: for 2016 year the figure is 3,7 for 10 thousand births. For the current seven months, this indicator is equal to 4,6, but so far there have been few births, it is necessary to speak about the results at the end of the year. For example, in Chukotka, 16 children die from 10 thousand births. The most common cause of death is congenital malformations, intrauterine infection.
I note that over the past two years we have opened a children's intensive care unit and a surgical department in the regional children's hospital, a department has appeared in the maternity hospital where babies with extremely low body weight are nursed - from 500 grams.
- And what about the mortality rate of the adult population? - More often we die able-bodied, if we look at this criterion, because the region is mainly characterized by a young population. There is at us such feature: the person left on pension and leaves on continent. Among all causes of death, oncological diseases rank first. On the second place - cardiovascular diseases. But the figure is much lower than the national average. In general, we reduced the death rate compared to last year by 8%.
- Does the region have doctors of narrow specialties - oncologists, hematologists?
- Such doctors are enough and our regional institutions are almost all staffed. An important task now is the early detection of oncology in the population. Last year, with the participation of federal co-financing, we opened a modern diagnostic center in the oncology dispensary. I am confident that this center will help us achieve better indicators in the detection of cancer in the early stages.
- Oncology, cardiovascular diseases ... What is in third place?
- Mortality from diseases of the digestive system. This is the trouble of the whole DFO. At the forum VEF-2017, Russian Minister of Health Veronika Skvortsova said that the Far East from all over Russia is different in that alcoholization here is twice as high as in other districts. Cirrhosis of the liver is one of the causes of death in the Magadan Region. It can develop both from alcohol dependence and from hepatitis. In the second case, we began to pay more attention to the treatment of this disease: we began to buy more drugs, vaccinate, prevent liver disease.
- Need to be vaccinated against hepatitis?
- Required. In general, hepatitis should be taken very seriously, it's not just jaundice. Hepatitis B and C are serious diseases that are treated long, hard and very expensive. The rate of treatment per patient costs in a month from 100 to 300 thousand rubles in the framework of our program. Usual resident is simply beyond his powers. And so the quality of treatment for hepatitis in all subjects is different. There are subjects where they really allocate good financial means, expensive drugs are purchased, patients receive them for free.
- At what level is the availability of soft drugs in the Magadan Region?
- At the level of 100 percent. We provide patients with all drugs under the list that is provided for the benefit recipients. If there is an appointment, which is not included in this list, the doctor writes a corresponding application to the Ministry of Health. The drug is immediately ordered, and after 2-3 weeks it is already in the patient.
- And what about the birth rate?
- Unfortunately, the birth rate is low and this is a sick subject for us. We have few women. The outflow of women is greater than that of men. In many ways this is due to the fact that men have a place to work (we have a mining industry), so there are more of them. Of course, social conditions are also determining when deciding whether to give birth to a child or not. Therefore, the Ministry of Labor and Social Policy is developing various support measures. We were among the first to introduce regional maternity capital, when the payment takes place at the birth of the first child up to 25 years. The law came into force on 1 January 2015. At that time, matkapital was 100 thousand rubles, every year it is indexed.
- And yet there is no natural increase?
- Natural increase appeared immediately after the introduction of payment for the first child. Last year, the figures were slightly lower than in the previous year. Let's see how it will be this year. I really hope that the indicators will go up.