Into the void: some thoughts on the Ukrainian healthcare system

This is a personal account of some experiences with Ukrainian healthcare system“You are really French? Oh, my. I cannot believe I have a Frenchman for Christmas Eve. For me and me only. Take off your coat. Such a nice present. Are you a real one, a real Frenchman I mean? Where do you come from? Please lay down on this table. How is it, there, in France? I dream about it since I am a little girl. Open the mouth”. The nurse is ecstatic as she prepares me for the X-Ray. In her fifties, she sounds joyful and romantic - she probably is. Her machine seems antiquated and rusty - it definitely is. I look sick and tired - I really am. Yet it mostly feels like I am bewildered and passably annoyed.Earlier that day, I had come to this hospital to check with a specialist on a kind of sinusitis-bronchitis I had not managed to cure back in France. It all developed in a nasty way on the flight back because of the cabin pressure in high altitude. My friend insisted on me going to check by her friend specialist in a Ukrainian public hospital. That kept me from calling to a private clinic to ask for them to come over and give me a home consultation. Fair enough. Anyway, as this was obviously a sinusitis with early signs of a bronchitis, I was just expecting to go and see the doctor, get checked, receive a diagnosis, buy a few medications at a nearby pharmacy and run back home to cure myself.I should have known better: Ukrainians see it differently. After the initial check-ups, I was directed to two different heads of departments. One woman was about to go on a lunch break when she saw me coming in. Hence she hurriedly butchered my finger in order to get some blood samples. Another nurse proved more tender. She resolved to give the Frenchman the X-Ray of his life. For a sinusitis. Nothing was done about my bronchitis as we were not in the proper hospital department.It was not the first time I witnessed the Ukrainian healthcare system turned into such a festival of tests and check-ups. I do consider myself a very obedient patient and I have been taken care of in quite different countries. I try not to criticise the Ukrainian system from a French point of view, as a lesson-giver and "I know better" person would do. People survive here as they do in France. Who am I to judge a healthcare system that seems to suit the majority of the population…? Yet on this specific occasion, being sick and dizzy, I couldn’t help myself thinking that, where I come from, a sinusitis is usually diagnosed after a 10-minute consultation. Every other Westerner I would later tell the story would be very surprised with such impressive measures. But ok. Better being checked and not say anything. Anyway, all it had to come down to was a set of pills and pain-killers. I would be home soon. That’s what I thought.In Lviv, this time, doctors hardly prescribed any pills. Instead, they ordered daily injection of antibiotics by way of dripping and a whole set of shots. Which basically forced me to come back to the hospital every day for five days, lay down for over an hour and spend the rest of the day weakened and dizzy, that is to say physically unable to perform any job or social activity. It was extremely annoying and demeaning. But ok. If that’s what it takes to get better, let’s do it. Plus, the staff was extremely polite and patient and competent. As I had to come in during the Christmas period, the hospital was generally empty and some nurses took time to act charming and cute. And professional. So if that’s what it takes…5 days passed. I showed up to the doctor for a check-up after a long Ukrainian Christmas weekend, she went on to check one of my ears - only one - and ordered three days more of drips and shots.  With no further explanation, a nurse took me to a “palat” (common hospital room, in Ukrainian) and I was shot, again. No one ever checked my lungs. I grew seriously depressed because of the very perspective of further inaction. My friend undertook to discuss my case with her friend doctor. She came back a few minutes later all smily and shiny. "We toasted to Christmas with 50 grams (millilitres) of cognac. We haven't seen each other for a long time, you know. What about you? Just stand still, there is nothing to do but to wait".And then it all came back to me. All these anecdotes I had heard of over the past few years I spent in Ukraine. All this data I collected in the course of my interviews and researches. “I have a lot of friends who simply ‘disappear’ and stay in their local hospitals for a week or so, just because the doctor ordered it”, one foreign friend told me once. “Ukrainian patients don’t really ask why. It’s just like that”. His Ukrainian girlfriend actually refuses to go to hospitals unless she really has to. “If I check in to the hospital, I will come out in after looooonnnng time, and maybe even in a worse condition…”The story echoes with what Health minister Kvitashvili told me once during an interview. Namely that Ukraine’s healthcare system has oversized nominal capacities, which are inherited from the Soviet tradition of “let’s have as much as we can in terms of quantity even if it does not translate into quality”. “Ukraine has 9 beds per 1000 population. Sweden has a much more developed welfare state is a much more socially oriented state, has 2,7 beds per 1000 inhabitants. The average length of stay is 13 days in hospitals in Ukraine, 5 in Sweden”, the minister told me. I myself was almost taken in because of the sinusitis. I assume now that no one wanted to bother with a Frenchman in the midst of the Christmas break.It may be fun to think of it in the way that I am just a spoiled foreigner who criticises everything that he does not fully understands. Yet my forced inaction for most of the first two weeks of the year got me thinking. I would be fine. But what about other cases, other diseases, other treatments? The Ukrainian tendency to over-hospitalise may have dramatic consequences in the sense that it totally disrupts lives. A friend at the WHO was very eloquent on this one. “The patient has to adapt to the system, not the other way around. It is extremely rigid and not adequate. In most of the countries in the world, the system aims at keeping you active and socially responsible. In Ukraine, the patient is supposed to stop everything he does to comply with the treatment doctors ordered".My WHO friend continues: "I remember the case of this businessman, very active and employer to some 30 people. He was diagnosed with a benign form of tuberculosis. Doctors ordered him to stay in the hospital for three months. After a few weeks in, he decides to leave and go back to work. His situation worsens. Then he comes back. Doctors first refuse to treat him because they accuse him of non-compliance with the treatment. His situation worsens. Eventually they admit him and keep him in. He develops an intra-mural infection. Now he has a multi-resistant form of tuberculosis, his business is down and his employees are jobless. It's absurd to follow such a rigid approach. It is all the more so frustrating that the technology does exist to produce a proper diagnosis and to treat the patient in a way that he would not be contagious or weak after a few weeks! If this businessman was correctly diagnosed, he would have received a proper treatment while being still active”.But then it turns out that the system is both extra-rigid and very much not understandable. In normal time one would get barked at for not leaving one’s coat in the "garderobe" (coat room) or for not wearing "bacils" (medical blue plastic shoes) in specified areas. When I came in over the Christmas weekend, I was waived away and blessed to do pretty much anything I wanted. Coats on me, dirty shoes on the floor, melted snow in the "palats". Hygiene? We will deal with it after Christmas.I remember one of my former flatmates in Kyiv suffering from an infection in a sensitive spot: she had to stay in quarantaine in one of the hospitals in downtown Kyiv for a few days - that means one of the best hospitals in the city. That meant laying down on a Soviet-looking bed with overused sheets. That meant having hot water just a few minutes per day. That meant buying her own toilet paper and soap. I am still not sure it was the best environment to cure such a sensitive infection.Long story short: I am not sure my treatment was all necessary. I believe it could have been more precise and more efficient, without it keeping me from active life for so long. But again, what do I know…? I have no medical qualification, I cannot understand the doctor's logics. Am I being over-critical in writing these lines? Impatient? Ungrateful? Childish? Dunno. I would go over all these thoughts everyday - I had nothing better to do. During one of the dripping sessions, a nurse approaches me. It’s time for my shut in the butt. This nurse is new, I have not seen her before. It turns out that she also really enjoys me being French. "Say something in French", she kindly asks as I take my pants down. "Merci Mademoiselle, d'être aussi gentil avec moi", I answer. "Oh, it sounds so nice. But I did not understand anything but 'Mademoiselle'. Anyway. Stand still". Shot. "Please put it back on. Take your time and you can go home whenever you want. Ah, it's so good. For just a couple minutes, I was a 'Mademoiselle' again. It's been a long time. Look, what can I tell you? I know". "O Revouare, Mossieur!" I am so dizzy from the shot I don't even realise she is gone.