The New Year

Living in Ukraine and being from the USA, one must reorient ones thinking regarding the celebration of holidays, particularly those holidays with special traditions such as Christmas.  In Ukraine December 25th is just like any other workday, with Christmas not celebrated until January 7th according to the Orthodox Calender.  New Year’s Day is sandwiched in between but allows two full weeks potentially for reflection on what it means when “unto us a Savior was born.”

This time of year is indeed full of reflection of what we have done and what we plan to do.  All too often my focus is look and see what I have done.  God offers His perspective on our reflections in Jeremiah 9:23-24.

This is what the LORD says, “Let not the wise man boast of his wisdom or the strong man boast of his strength or the rich man boast of his riches, but let him who boasts boast about this: that he understands and knows me, that I am the LORD, who exercises kindness, justice and righteousness on earth, for in these I delight, ” declares the LORD.

So as the New Year approaches let us use God’s  measure of the past, present and the future.  Let our focus be on Him!   Retrospectively, we can marvel at what God has done through us.  Introspectively, we are thankful for all God is doing in us.  Prospectively, we can look forward to what God has planned for us. 

 Finally, we can ask ourselves two questions.  First, do we understand and know God better this past year and do we have a plan to accomplish this in the coming year?  Second,was, is and will God be delighted in how we exercise kindness, justice and righteousness?

May God grant us the grace and the ability to follow Him.

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. 

A Haunting Question!

Our medical bible study is gleaning nuggets of truth from the Book of Daniel.  Last night we discussed how Daniel and his friends responded when faced with the decision to maintain their personal integrity or bow to the idol constructed by Nebuchadnezzar.

 The discussion soon turned to personal application.  At least 98% of Ukrainian physicians  work for the government and are paid an average monthly salary of $300.   At least 60% of the doctors take additional payments from patients either as bribes for more prompt or attentive service or as gifts of appreciation for services rendered.

 Now the question came.  Should doctors accept these payments knowing that if they don’t they will not earn enough to support their families?  Does God hear those in need?  Why do the wicked prosper?  Where is the justice?  Should we not expect God to bless His children?  The silence for a moment was almost deafening.

As we discussed the issues we did come to some conclusions.  We needed to clearly define what is right and what is wrong.  We needed to decide in advance to do the right thing.  We needed to help each other be accountable.  And we needed to ask God daily for His assistance.

This morning the question was still haunting me.  My daily scripture reading led me to examine Psalm 73 which revealed God’s response.

Surely God is good to Israel, to those who are pure in heart, Ps 73:1.  God does care about His people.  May we seek each day to examine the motives of our hearts and seek the purity only He can provide through Christ.

My feet had almost slipped.  For I envied the arrogant for their prosperity, health, strong bodies, free of common cares and human ills, (Ps 73:2-5).  Who are we to judge because we too are sinners, with the same idolatrous concerns.  Are we truly more righteous.  Is it right to ask God for our reward now?

The arrogant are filled with pride and clothed in violence.  Their evil knows no limits.  They threaten oppression.  They lay claim to heaven and take possession of the earth.  Ultimately, they say “How can God know and ask does the Most High have knowledge.” (Ps 73:6-11)  These people deceive others and deny the power of God.

Surely in vain have I kept my heart pure.  What do I earn for having steadfast belief in God, being plagued all day long, punished, oppressed. (Ps 73:13-16)  God will not care.  My needs are obvious.  I must survive.

How far will I go to satisfy my own desires?  I would have betrayed your children. (Ps 73:16)

But when I seek God, I find understanding.  The destiny of the arrogant is made clear.  They are on slippery ground.  They are cast down to ruin, destroyed and swept away. (Ps 73:17-19)

I also understand my position before God.  I too am senseless, ignorant and a brute beast leading to grieving heart and embittered spirit. (Ps 73:21,22)

But how shall we proceed?  With humbleness that comes from knowing God, we acknowledge His constant presence.  He takes me by the hand as a father with his son.  He guides me with His counsel.  His counsel is found in His word.  He assures us that His final reward awaits us and will be everlasting.  He is the strength of my heart.  How wonderful we do not need to rely upon our own strength.  We need to go to Him and He will be our refuge.  Nearness to God is spending time with Him every day and enables us to do what is right in His eyes.  We only need to tell of His work in our lives.  

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!

Reality for Young Ukrainian Physicians

Today I met with Vita, a very bright young Ukrainian physician who just finished his residency a year ago.  Our initial meeting was at the Christian Medical Association of Ukraine annual meeting about two years ago.  Then he was full of excitement for his profession and to serve his God through the practice of medicine.

 As we continued to catch up on what has transpired in each of our lives since then, it became obvious that he no longer practiced the profession it took him so long to learn.  He currently is the sales manager for a company dealing with dialysis machines.

I could not help wondering why this intelligent young doctor had to throw in the towel so early in his career.  He said, “It is impossible to make a living as a Christian doctor.”  He went on to describe how the paperwork was going to kill him.  The salary just did not allow him to support his family.  He just got married 2 1/2 months ago.

He was not complaining of the amount of paperwork even though everything is hand written but about being able to write the truth about his patients and their diagnoses.  Once again it was an issue of trust.  He said as a physician he does not know why any one would go to a doctor in this country.  In addition, he said the state of technology in this country does not enable you to make a diagnosis with any reliability.

The reality for young Ukrainian physicians is in this current system it does not take long before they just stop caring.

What is the answer?  Building Christian clinics and hospitals, evangelizing and discipling  health care professionals, modeling compassionate and competent care are all part of the solution.  I pray to God how long must your people suffer.

Milk Cartons

Living in another culture one tends to notice differences in how simple common occurrances in both cultures are handled.  One such difference is how you buy and store milk.  When I was a kid, milk was delivered to your house by the milkman in glass bottles put in the milkbox on the porch.  I remember when the milkman was replaced by 7-11’s, Shore Stops and other chains that sold milk from a refrigerated shelf in plastic containers or waxey cartons that had a built-in spout for easy pouring.

 After moving to Ukraine, we were surprised to learn that milk is sold in cartons, in stiff bags lined with aluminum, neither are refrigerated.  There are also thin plastic bags that are kept cold.  None of these options are easy to pour, particularly when they are first opened with the milk usually pouring down the sides and all over your counter.

The theory for why this happens is interesting, maybe to someone.  When the carton is filled the milk coming out doesn’t allow any air to enter the carton at the same time, thus the milk comes out in spurts.

 Well a few years after we arrived in Ukraine some cartons started having a built in plastic spout.  This was a significant improvement over pulling back the corner of the carton and cutting the end to fashion a spout.  Often we punctured the top of the carton to allow air to enter the carton when the milk was poured.

This past week we noticed another giant step forward for mankind in the evolution of the milk carton in Ukraine.  The little plastic spout on top of the carton now has two holes.  Unfortunately, when I pour milk, it still dribbles down the side.  Maybe when I grow up I will be able to pour without spilling.

House Calls

It is often difficult for young mothers in Ukraine whether they are nationals or foreigners.  Often I receive a call for medical advise to just help people through the medical system in Ukraine.  A young missionary family e-mailed me two days ago to ask for help.  Their nine month old was ill with respiratory distress, they had already seen five different doctors and still were not certain what was wrong with their child and if he was receiving the correct treatment.  Now they would like me to come to their apartment to examine their child.

The story started at the beginning of the week when the child developed a cough and a fever.  The child’s condition became progressively worse through out the day.  They called for a doctor who administered an injection and said she would return later in the day to check on the little boy.  If he was no better he would have to be admitted to the hospital.  The doctor did not say what was wrong with the child but left just after writing six precriptions.

As the day progressed the child became worse.  The parents were now faced with the decision of where to have their son admitted.  They took him to a private clinic called Boris.  They agreed the child needed to be admitted but would not admit him to the private hospital because he had diarrhea.

Well the child eventually was admitted to a government hospital for one night, but the parents took him home the next day because they thought their child was being treated no differently than what they were doing at home.

The child seemed to have a combination of acute asthma and croup.  Fortunately, by the time I examined the child he had significantly improved.  Thank you God for designing our bodies to be able to cope with many illnesses despite our attempts to practice medicine.  In Ukraine, nebulizers are not routinely available.  Albuterol and racemic epinephrine are not available at all. 

What pediatric visit would be complete without a plethora of questions from the mom.  This visit was no different.  The questions however concerned information regarding drafts, wearing slippers, and not going outside.  Apparently, one of the doctors who came to the apartment from the polyclinic would holler at the mom for not taking care of her child properly blaming her for why the child was ill.

After seeing the first child the parents asked if I would not mind examining there other two children.  This is not uncommon for pediatricians in America as well.  The twist came when they asked if I would also see two other children belonging to couple who were friends of the parents from two buildings down the street.

What initially began as a 45 minute visit turned into a marathon.  What we are trying to model to health care workers is how to build trust in their patients by providing consistent accurate information based on fact instead of superstition or tradition and to abandon their blind authoritative approach to delivering care.

Chickenpox

It is interesting practicing medicine in two different cultures.  Part of medical tradition is passed on from doctor to doctor, doctor to patient, grandparents to parents. 

Recently one of our office employees asked if she could ask me a medical question.  Her child had recently developed chickenpox.  Her question was when was it safe to give her child a bath.  She had been instructed by her pediatrician not to bathe her child till all of the lesions had crusted over.  There was one pesky spot that had not yet crusted over.

We talked about how different cultures have different traditions.  The traditions are not necessarily based on truth, but are assumed to be.  I shared we do not have this tradition in America.  In fact we encourage bathing to help with itching.

The mom looked shocked and asked if that was really true.  I assured her this was common advise and that millions of children in America survived bathing while having the chickenpox. 

I could not help but ask how long it had since he had been in the bathtub.  Her reply was nine full days.  We both began to laugh hysterically.  I wonder if she had the courage to break with Ukrainian tradition.

Victory Day

In Ukraine on May 9th is celebrated Victory Day.  It is a combination of Veteran’s Day and Memorial Day rolled into one.  This day 62 years ago the Great Patriotic War or World War II officially came to an end.  A good reason to celebrate and a good reason to remember the 40 million people, 20 million from the former Soviet Union alone, who lost their lives in this conflict. 

As you walk the streets of most cities in Ukraine you will quickly come upon a veteran.  They are easy to spot because they are wearing their uniform proudly and usually have a chest full of medals.  Whether in America or Ukraine, I just want to go up to these men and women to say thank you.  I often did this when I lived in the USA.  What unspeakable horrors these men witnessed.  How strange to be living now on the other side and wanting to thank Ukrainians for their bravery. 

America and the Soviet Union fought on the same side during that conflict, but history records our relationship turned cold soon thereafter.  For much of my life, those we now consider our friends were indeed called the enemy.

For Ukrainians the name of this conflict makes sense because they were fighting on their soil, for their homes and their families.  For Americans we were fighting more for ideals.  We romantize our history probably to hide the horror and reality of war.

It is easy to say that freedom is not free but bought at a price.  But are we willing to pay the price?  There is a freedom however we cannot earn, our freedom from sin.  It too was bought at a tremendous price, the death of our savior, Jesus Christ.  On the final day of judgement will you be able to celebrate for eternity the victory won for those who place their faith in Christ?

Having a baby in Ukraine!

You are a young couple and you decide to start your family.  You find out you are pregnant and need to decide where you will seek medical care.  If you are one of the new Ukrainians you can choose to have your baby at a new private hospital.  The cost is only $10,000 and you have to sign a paper saying you understand a healthy baby cannot be guaranteed.  Understandably this is too expensive for most Ukrainians.

 The next alternative is to give birth at a government hospital.  In Ukraine you always have two obstetricians.  One is typically a consultant and the other actually delivers the baby.  When the time of delivery arrives, you call your first choice and pray they are not busy.  Of course, that is why you have a back up.

Mothers and babies usually remain in the hospital for 3 or 4 days for a vaginal delivery and 7 days for a C-section.  For follow-up the pediatrician from the polyclinic comes to your flat after you come home.

I can guarantee this information is up-to-date since our neighbor just above us is the young couple having a baby.  She was very excited to learn that I was a pediatrician.  She said I will be her new best friend.  I told her our twins born 24 years ago by C-section cost about $4,000 and that when I was born the cost was $150.  She was quick to add her father born during the Soviet days cost nothing!