American revolution in Ukrainian health system: New appointed Health Ministry head tells how and when it will happen

American revolution in Ukrainian health system: New appointed Health Ministry head tells how and when it will happenEvery Ukrainian should have a personal doctor, the work of hospitals should follow the American standards. The new Acting Minister, famous volunteer Ulyana Suprun, explains how to bring closer the "Soviet" hospitals to the international standards and who will pay for it.

From now on the Head of the Ukrainian health system, Ulyana Suprun was born in the American Detroit. She went to the Ukrainian church, in the childhood she was an activist. Then she mastered the profession of the doctor-radiologist, lived and worked in the USA till the fall of 2013.

After moving to Ukraine in the heat of Dignity Revolution, she and her husband were engaged in public work, they entered the Medical Hundred of Maidan. Subsequently, Suprun created the organization "Defence of the Patriots", which helps the fighters in ATO zone and trains the Ukrainian doctors along the western protocols and practices.

A year ago Suprun and her husband obtained the Ukrainian citizenship. From now on, the 1st of August, 2016, the American Ukrainian begins to fulfill the duties of the Minister of Health and promises to submit - in a month's period -the changes’ plan of one of the least effective spheres of the Ukrainian life - medicine.

We met Suprun for the first time in the middle of July, at the office of the organization "Defence of Patriots", where people were continuously dragging the boxes with equipment, and on the walls there were patriotic posters. Then still the candidate for Deputy of Minister of Health met us with the pizza from a box, and her husband Mark offered us water.

In several weeks we came to meet Suprun for the second time: after the news about her sudden appointment as the Acting Minister of Health, we had to update the interview.

"Why not a Minister's position at once?" - we ask just for fun from the threshold. "Only Verkhovna Rada can appoint Ministers, and there is no time to wait for them coming from holiday, it is necessary to start working since Monday", - Suprun answers, inviting to the tiny room near the study.
American revolution in Ukrainian health system: New appointed Health Ministry head tells how and when it will happen

In the interview, the new Head of the Ministry of Health tells how she will change the medical sphere, which "became famous" for juicy corruption scandals, how she will block corruption streams, how the system of work of hospitals will change and why Ukraine extremely needs medical professions which do not exist in the country yet.

- News about your appointment appeared almost right after the scandal with detention on a brib e of the Deputy Minister of Health Vasilishin. Why did you agree to this position and why are you sure that you will manage to split a corruption ball in the Ministry of Health of Ukraine?

- First, they began to speak about possible appointment prior to his detention. Then there were several meetings with the Prime Minister, then with the President. And they assured me that I can come into the Ministry only on condition of appointment as my deputies those people, whom I will find necessary. I will not speak about them, I will not disclose their surnames or other details, because everything is still in process.

Secondly, the National Anticorruption Bureau of Ukraine, the State Office of Public Prosecutor and police have to fight against corruption. They have to come into the Ministry, trace corruption streams, arrest those involved in them and try to obtain their condemnation. And it is necessary to carry out all the procedures in such a way, so that these people will not be able to avoid the punishment through the court or will be even restored at work.

Personally, I am not involved in these schemes, I am not going to take part in them and I am categorically against the idea of working with those who are involved in them. My task is the establishing work of the Ministry and reforming of the health system. Appropriate authorities have to be engaged in fight against corruption, and in every possible way I will promote them.

American revolution in Ukrainian health system: New appointed Health Ministry head tells how and when it will happen- What are you planning to begin your work with?

- In a very short time (approximately until the end of August) we have to come up with the development strategy and the actions' plan: what we will do in a month, in three months, in half a year, in a year, in 5 and 10 years’ time. We already have the Strategy-2020 - it is quite good, now we have to put down the action plan and to move forward.

The most important thing is to begin the process of changing of the financing of health system. It is a key issue and it is not limited only to one bill. We will begin with the primary link of doctors, we will give to each citizen the chance to have his (her) own doctor.

Each person has to have a family doctor instead of being attached geographically to policlinic. It can be made quickly enough. Last year in Ukraine 63% of graduates of medical schools went to work in hospitals of primary link. There are a lot of them in the country, we simply do not use them effectively.

The second thing concerns the emergency medical care, which can be reformed quickly enough. It is the bill on which I worked as a part of the working group. The essence of reform consists in the fact, that police officers and firefighters will know more about the effective first aid, because, in fact, they are mainly the first, who arrive to the emergency site. The crews of ambulances will have emergency medical technicians who will serve at the same time as drivers and provide the minimum necessary medical care on site. In the ambulance, paraphysicians will be responsible for looking after the person on the way to hospital.

- What will be the function of paraphysicians?

- Paraphysicians are not doctors, but health workers with very specific skills. They are responsible for maintenance of patient's life on the way to hospital. Actually these are like current paramedics in ambulance cars, but more educated and capable to give help in extreme conditions.

So, after rendering primary help, the paraphysician with the emergency medical technician will carry the patient to the hospital. There there will be a room or office of medical emergencies. In the West it is called "emergency room". There is the team of doctors on duty who are notified that the ambulance is carrying such a patient who needs such a help. And only from this room the person will be tranferred to the operating room or reanimation.

Now in Ukraine it is possible to count on the fingers of one hand the number of hospitals, which have such emergency rooms. They are called "receptions", but there is nothing there, and each doctor is responsible only for his strict specialization’s sphere. The surgeon looks at a breast, the traumatologist looks whether something is broken, but nobody pays attention to the patient in general.

The office of the organization "Defence of the Patriots" looks as informal representative office of the United Nation in Ukraine: everywhere one can see the flags of the different states, at the same time one can hear several languages, the work does not stop even during the week-end.
American revolution in Ukrainian health system: New appointed Health Ministry head tells how and when it will happen

- Will it be possible - as you told us - to do it "quickly enough", if in Ukraine there is no such medical speciality as a paraphysician?

- For two years - through the organization "Defence of Patriots" - we have been bringing into Ukraine the American instructors, who already actually trained nearly 260 soldiers to the level of paraphysicians. Also we already taught the first respondents in police.

Now we are preparing the program for training of the emergency medical technicians. Two our instructors are passing expert training period in the States, then they will be able to return and begin such training program, for example, in Odessa.

In this way we begin the pilot program for transition of Odessa region to this western system of the emergency medical care.

Coming back to priorities of my work, the third thing is an improvement of quality of delivery of health care.

- It seems to be such a huge problem - it is unclear where and how we should begin to solve it.

- It is quite clear. The first thing is a change of medical education system, bringing it to the level of the Western standards. It will allow to teach new doctors and to improve those who already work.

Last year, by the way, in September, we began the academic program of training at the Ukrainian Catholic University for physical therapists and ergoterapists. These are people, who work in the sphere of rehabilitation. Such professions officially do not exist in Ukraine, this year we carried them out via qualifiers' system and we will begin to train the first experts of these kind.
American revolution in Ukrainian health system: New appointed Health Ministry head tells how and when it will happen

All of us understand that now in Ukraine we need a rehabilitation of ATO fighters. We also lost many rehabilitation centers which were in Crimea. Now we have to reconstruct all rehabilitation system. It is necessary to develop training programs, to train experts, to retrain those doctors who already work, to introduce the western standards etc.

- It turns out, that the Ukrainian medical education does not correspond to modern standards at all, if it is necessary to teach all and to retrain almost everybody?

- The system needs to be improved. It not at that level, as in Europe or in the USA. The best option is to bring one and all training programs to the European standards. And the program which we began in the Ukrainian Catholic University, was created according to the protocols of the World Federation of Occupational Therapists and World Confederation of Physical Therapists. It was initially written in order to be recognized by the European network of higher educational institutions on ergoterapy.

Actually, a lot of things should be changed, but we will begin with two directions: short programs of training or retraining for concrete specialties according to the European and American standards as well as with reductions of already existing university programs to the western standards. A few days ago, I met the students from the National Medical university named after Bogomolets. They said that they want more practice, especially ont he last courses, they do not want to sit in offices; they want the free choice of medical specialty, and not its imposing; they want qualitative doctors with whom they can do practical training.

We do not say that it is necessary to close all educational institutions which work now. Let's do it gradually, specialty after specialty, bringing them into correspondence with the international standards.

The new Acting Minister of Health is sure, that the Ukrainian medicine will be rescued by the international standards in everything: in education, in work of hospitals, in cooperation with police.
American revolution in Ukrainian health system: New appointed Health Ministry head tells how and when it will happen

- Recently the discussion is going on concerning the permission to the hospitals legally take money from the patients. But deputies either do not pass this bill on vote, or they try to make amendments, which just devastate the reform. Is it really necessary to begin reforming with legalizing shadow money, which already exist in healthcare institutions?

- I think that it is the correct and necessary step. The idea is that we should change health system’s financing: money have to go not to medical institutions, but on patients' service quality and fee. And in order to assure that money follow the patients, it is necessary to make medical institutions more independent.

The part of deputies says that this law means privatization or commercialization of the hospitals. But it will not be privatization! Medical institutions will continue to belong to city and regional councils. Only they will have other control system inside. But they will not be privatized or sold.

In the world there are many countries which have normal health systems. Ukraine as the space power which can go to space, can also have normal health system. We have many talented people, there is an enormous potential, now it is necessary to work and receive results.
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