The Medical System in Ukraine

The world is a much smaller place than it used to be thanks to instant communication via the Internet. Yet, as individuals living and working in different countries we tend to focus on our own problems where we work and live.  We don’t do this in a vacuum but within the context of our individual cultures.  Each culture has the same basic needs, but our thought process and how we meet those needs are different.

Often I am asked what is the Ukrainian medical system like, how does it function, how is it similar and different than our system.  Recently there have been two articles published that accurately describe the Ukrainian medical system from what I have experienced after living in Ukraine for seven years.  The links to the two articles are Ukraine’s Hybrid  Healthcare System, http://news.bbc.co.uk/2/hi/europe/7484095.stm, and Healthcare Deteriorating, Physician Shortage likely to grow, http://alisterandsarah.blogspot.com/2008/06/more-on-medical-situation.html. 

Therefore, as an Americian living in Ukraine, I tend to look at the Ukrainian medical system through a different set of cultural glasses.  Native people often accept their culture and traditions as correct giving little thought to how the same task is accomplished in another country.  But once exposed to a different culture, the question becomes which perspective is correct, maybe both are invalid.  It is here that a belief in a God who is sovereign and the author of absolute truth is a blessing.  Either God is the God of all cultures or He is not God.  May we all look to God who knows all and His wisdom to answer how we should provide the best medical care drawing from all cultures he created. 

The Healing Ministry

Physicians are called to care for the sick.  Some physicians claim to heal the sick.  John Stott offers some insight and puts into proper perspective the ministry of healing in his daily devotional, Through the Bible, Through the Year.

“The gospel writers describe Jesus’s ministry as threefold: teaching, preaching, and healing.  Teaching and preaching are not hard to grasp or to imitate, but how are we to understand the ministry of healing?

Perhaps the place to begin is to affirm the goodness of God’s creation.  that is to say, disease was no part of God’s original intention for the world, and it will be no part of his ultimate purpose either.   In the new universe there will be neither sickness nor pain nor death nor tears (Rev. 21:4).  Since, then, disease and death are alien intrusions into God’s good world, doctors and nurses are reight to wage war against them.  Moreover, all healing is divine healing, since God has put into the human body remarkable therapeutic processes.  For example, no sooner has an infection appeared then antibodies are created to fight it.  It is this conviction that led Ambroise Pare, the Huguenot physician, to say, “I dressed the wound, but God healed.”  The words are inscribed on a wall of the Ecole de Medicine in Paris.

The Gospels make it plain, however, that the healing ministry of Jesus belonged to a different order.  Like changing water into wine, multiplying loaves and fishes, and walking on water, Jesus’s healings were supernatural demonstrations of the kingdom of God.

In trying to understand them, we will be wise to avoid opposite extremes.  On the one hand, it would be absurd to put the creator in a straightjacket and declare that miracles can’t and don’t happen.  On the other hand, we have no liberty to say (as some do) that performing miracles is the normal Christian life.  for however we define miracles, they certainly belong not to the normal but to the abnormal.  If we claim to be able to heal the sick like Jesus, we need to remember tht he healed without the use of medical or surgical means, without delay, degree, or remission, but immediately, completely, and permanently, and that even hostile eyewitnesses said, “We cannot deny it” (Acts 4:16).”

So You Want to Go Swimming!

As physicians, we generally encourage our patients to participate in regular physical activity.  But, when does such activity become unhealthy for both body and soul?

We often take for granted the transparency of life in America.  While this is true, we do have corruption, but just better at hiding it.  Adapting to life in a foreign country provides many interesting situations to learn about the true nature and thought process of the nationals with whom we live and work.

One such situation arose when my assistant decided to find a place to exercise and swim.  During the Soviet times many sports halls were constructed with swimming pools.  Like many other things during that era admittance to these halls was free.  Now, with independence, there is a fee, nothing is free.

In the past, as well as now, in order to use the pool a person needed to provide a “Spravka” or certificate of health.  Obtaining this certificate, required a visit to the local polyclinic where you are registered to live.  You were examined by a dermatologist, gynecologist and an internist.  You stood in line for an hour typically for each of the doctors.  When you were finally seen, you were not examined, just asked to pay a small amount and the doctor would sign and stamp your spravka. 

This was very frustrating because you wasted a day of work or more for a piece of paper that really does not mean anything.

To make matters worse, if you are registered to live in another city, you must obtain a medical record book before obtaining the spravka.  This involves much the same process, but you must see 10 or 11 subspecialists.  Then and only then you return to the gynecologist and dermatologist you just saw to obtain permission to go swimming.  You now take your spravka and visit the internist who can then conclude whether you are healthy or not to go swimming.

Now you could avoid this process by paying an “expediting fee.”  You can easily see how quickly corruption can take a foothold.

Imagine how you would feel if you decide to go through the process legally, then go to the pool and realize the majority of people where not examined and just paid for the spravka to be signed.  Maybe it is healthier not to go swimming!

Sacred Trust

Being a physician in any culture means having a certain level of competence and the desire to look after the best interests of your patient.  Recently I was asked to assist in obtaining care for a 10 year old boy who electrocuted himself after grabbing onto a power-line.

 This young boy’s leg had to be amputated and there was concern his arm would require the same procedure as well.  After several clicks of the mouse a telephone number for a burn institute was obtained.  By this connection, Ukrainian doctors where able to discuss the treatment of this young boy with their American counterparts providing an international consultation.

The main concern for the parents of this young boy was whether or not he was receiving the correct treatment in addition to whether the treatment being prescribed was for financial gain.  How difficult to wonder whether you can trust the advise of your physician.

In Biblical times till most recently, people went to the priest or rabbi for teaching regarding health care.  There was a sacred trust rooted in the authority of God and mediated through the priests to do the right thing.  Medicine is a parable of the gospel, maybe more than any other profession, although separated by the world currently from theology.  Therefore, as noted in Hebrews 3:1, My brethren, let not many of you become teachers, knowing that we shall receive a stricter judgement.

As physicians let us not break this sacred trust with our patients so they may believe in our advise, providing care that is competent, compassionate, and Christ-like.

How to treat your patient!

Thomas Syndenham(1624-1689), a famous English Christian physician known for his work in describing the illnesses associated with Group A Streptococcal infections, described the proper role of physician’s regarding the care of their patients. 

Quote: It becomes every person who purposes to give himself to the care of others, seriously to consider the four following things: First, that he must one day give and account to the Supreme Judge of all the lives entrusted to his care.  Second, that all his skill and knowledge and energy, as they have been given him by God, so they should be exercised for His glory and the good of mankind, and not for mere gain or ambition.  Third, and not more beautifully than truly, let him reflect that he has undertaken the  care of no mean creature; for , in order that he may estimate the value, the greatness of the human race, the only begotten son of God became himself a man, and thus ennobled it with His divine dignity, and far more than this, died to redeem it.  And fourth, that the doctor being himself a mortal human being, should be diligent and tender in relieving his suffering patients, inasmuch as he himself must one day be a like sufferer.

Despair turns to Hope

Weekly I meet with a group of Ukrainian physicians who are believers but need lots of encouragement when working in a very oppressive environment.  In most countries physicians are taught a very man centered view of medicine.  If only we could discover the cure for this disease, man could live for ever.  Christian physicians often behave only as doctors Monday through Saturday and Christians on Sunday.  Of course, this is not always the case, but the medical system does not allow them to express there Christian opinions freely without ridicule.

This is especially true in Ukraine where for the past ninty years science and evolution were promoted as the true basis for the philosophy of medicine.  Not only were Christian ideas ridiculed but there were economic consequences for holding such beliefs as well.  Christians were not promoted.  If you shared your faith with your patients you were removed from your position.  Despite being an independent country with one of the highest levels of religious freedom in the post-Soviet era compared to other countries in the former Soviet bloc, things have not changed much in the medical sphere.  Christian physicians are the overwhelming minority, making up only a small percentage, 1 or 2 %.

In our weekly meeting we have been examining how the Great Physician dealt with patients.  Previously these same physicians have been taught  how to share there faith with there patients in a course called The Saline Solution.   We studied how compassionate Jesus was in caring for His patients, as He proclaimed and revealed the truth of their condition to them.  You could visibly see the anguish on some faces and the joy on others as they wrestled with how they could share their faith with sensitivity, permission, and respect within the time constraints every doctor faces.

We ended our time with prayer for God to work in the hearts of their colleagues and for them to be the most Christ-like physicians towards their patients.  May they make the most of every opportunity to be Christians first, who happen to be doctors, seven days a week.  May God use health care providers to relieve the despair we all felt once, providing an everlasting hope to their patients.