Speaking about medicine in Abkhazia, I would like to focus readers on the three most popular problems, from my point of view: 1) health care for people; 2) medical errors; 3) paid and insurance medicine. All other problems of modern Abkhaz medicine, which are well known to everyone, can be solved in the conditions of state institutions’ systematic work based on the rational use of budget funds.
Over the past 25 years, the Abkhazian state completely forgot about such a concept as care for the nation’s health. It is clear that during the war, in the post-war period and especially during the period of political and economic blockade, our state and society were focused exclusively on survival. But today we must seriously think about our people’s health.
To take care of people’s health, to develop a plan aimed at this goal is a state task. If this task is not one of the most important tasks for the leadership of the country, then citizens have to find opportunities for disease prevention, treatment by themselves, spend a lot of efforts and money. And today our country is in a poor condition, the treatment is problematic and very expensive for the citizens.
So I will share my vision of solving this difficult issue.
Probably it’s worth starting with promoting a healthy lifestyle, our climatic conditions are very suitable for the development of a healthy lifestyle activity.
In Abkhazia many people don’t swim in the sea and don’t spend even a few days in mountains during the summer season. It is difficult to believe these facts but it is true. And if we try to count how many people walking on foot or riding bicycles on the embankments of Abkhazian cities (except Sukhum, of course!), alas, there will not be a hundred even. These are amazing facts and this is our reality! It is the first thing.
I have already talked about the second thing above in the section of “Economy” and I emphasized that the health of our citizens directly depended on the development of domestic agriculture. It is not a secret that most imported food products in Abkhazia have a poor quality and consuming them, we harm our body.
The third thing: how many of our children have visited summer camps at least once over the past 25 years? And how many adults rested in rest homes and sanatoriums?
I am sure if our state wants, it will be able to find funds to create at least several summer camps for children and rest homes for its own population in the mountainous part of Abkhazia and on the sea coast. It seems to me it would be right to involve religious organizations registered in our Republic in the implementation of such projects. This is a well-known international experience: in many countries of Europe (for example, Italy and Greece), churches organize summer camps for children.
Since 2004, the New Athos Monastery and the Holy Metropolis of Abkhazia have been “fighting” in order to preserve the former building of the “Vodopad” (Waterfall) Holiday House in New Athos for children of Abkhazia, located behind the Church of St. Apostle Simon the Canaanite. We want to found a summer camp for children in this holiday home. However, we cannot implement this project by ourselves.
Perfect places for children’s vacations and foundation of summer camps are Auadkhara and Ambara (Myussera). In Soviet times, there was a summer camp in Ambara (Myussera).
By the way, in 2005 summer holidays were organized for children from remote villages of Abkhazia in the New Athos Monastery. The project was not continued, because the living conditions and catering in the monastery were not the most suitable for children.
“Even an ancient doctor,” writes Werner Jeager in the work I have already mentioned, titled “Paideia. The education of the ancient Greek”, – cared more not for the treatment of diseases but for maintaining health than our contemporary doctors. The part of medicine corresponding to this activity was called hygiene. Primarily it consisted of a “diet”. For ancient Greeks, diet was not only a special form of nutrition, but the lifestyle of a person which included exercises and regular meals”.
In the above sections I have repeatedly emphasized that strong personalities play an important role in solution of problems which our society and the state face to. It concerns Medicine too.
Werner Jeager, in the section of his book on ancient medicine as part of the educational system, notes that the highly developed medical science of our days, which is characterized by strictly professional isolation, is not like its ancient progenitor.
“A doctor,” writes Werner Jeager, “not only had deep knowledge, but he was also an example of high morality, he showed other citizens an example of the relationship between science and ethical requirements.”
What about the present time? Dean of the Faculty of Economics of Moscow State University – Alexander Auzan, (I mentioned him in one of the previous sections), wrote in one of his books: “Once Swiss doctors were asked which medicines they used to treat their family members and which ones they recommended to their patients. The lists were different”. Here is the answer.
Werner Jeager also wrote: “in the days of Hippocrates, for the first time medicine began to attach great importance to the personality of the master.” In addition, in the works of ancient physicians, qualified people, good specialists are often contrasted with “ignoramus”, that is, incompetent people in their craft. It is not attached great importance to the personality of a professional in modern Abkhazia and in modern Abkhaz medicine this approach is also rarely used. As a result, a lot of “medical errors” are made by our doctors and the staff of our medical schools. Ordinary people suffer and lose their health because of such ignoramus. But not only health, many people perish because of medical mistakes, these are our citizens, our neighbors, relatives, friends and colleagues.
When some accidents happen, we often ask ourselves: Why? Why did it happen?
Meanwhile, this is inevitable if our doctors do not care of deepening into scientific knowledge, improving practical skills and consider that the only goal of their activity is to earn money. Thus the doctor loses the sense of responsibility and does not realize it anymore! Such doctors are no less dangerous for society than criminals!
The following question can be raised: what are the reasons to state that the medical community of our country has little interest in self-development, improvement, deepening into our scientific and practical knowledge? It is very simple: the updating of scientific medical books is completely absent, that is, most of our medical specialists do not update their knowledge. There is not even a desire to change at least something in this direction. I will repeat what I have already said once: there is a huge number of office workers in our country (surely the profession of a doctor is an intellectual activity) and almost none of them has a study at home. That is, people do not want to devote their free time to self-development, to the development of their professional skills. Someone will object that nowadays everyone can get knowledge in the Internet at least in Russian (though English is the language of modern science). But people who are constantly interested in specialized publications know that the first thing in this business is to be subscribed to scientific journals. Free publications on the Internet is not the best way of getting systemic knowledge. It is very important, especially when it comes to medicine, the life of people depends on the competence of doctors.
Homer, author of the epic poems The Iliad and The Odyssey, claimed: “An experienced doctor is more precious than many other people!”
The leadership of our country and the Ministry of Health are still not ready to dismiss non-professional workers from their subordinate institutions, including those people who have a retirement age, hence the quality of medical care will not change. Meanwhile, the lack of vacancies in medical institutions of Abkhazia is a serious obstacle for the emergence of new competent personnel in them.
Paid and insurance medicine
Discussing the question of what medicine should be in Abkhazia, paid or free, it is worth remembering the fact that in our Republic (including the Soviet period), medicine has never been absolutely free!
I remember when I was a kid, once (in the early 80’s) my mother took me for examination and treatment to the Gudauta Resort Clinic. At the end of the treatment procedures, she put money on the doctor’s table. But it was a doctor who worked in a modern Soviet clinic at that time and received decent wages. Nevertheless, he took money from his patients!
Don’t forget the features of our mentality as well. I have talked about this for many times, but I will continue to repeat it, because it is the only way to make it understandable for people.
Now I will give an example from my own experience as a clergyman.
I am very offended when people offer me remuneration for performing the Sacraments or religious rites, for example, baptism, funeral services, etc. I consider, my vocation is serving to people and the duty of a doctor is also serving to people.
To tell the truth, for 18 years of my ministry I have never taken any money for my service. During this time, I baptized up to 10,000 people.
Some people persistently try to pay me for the sacrament, I tell them: “Go to the church and donate how much you wish”. The logic of these people (majority of them) is completely obvious to me: anonymous (hidden from human eyes) donation to God (we don’t see him) in the church is not necessary, but to give money to the priest, and moreover a considerable amount, is a completely different matter. After all, you never know when the priest will be useful for you. None of them thinks that a priest does not mean anything without God! It is not by chance I give this example. The same logic works when people go to doctors. They think they don’t need to pay regularly for their health insurance (in order to use it when they need it), because medicine must be free. But they think they need to give a doctor a large amount of money. Who knows when the doctor will be useful for them again? Therefore, I have no doubt that in our country medicine should be officially paid! In this case, our hospital will be required to offer services at prices set by the market and insurance companies. The medical community, including doctors, managers and medical staff of various levels, will have to determine the cost of the services provided, in accordance with world standards, create catalogs of medical services and medications, including comprehensive information for the Ministry of Health, tax and insurance services and for consumers of services – patients as well.
As for the qualifications of doctors, they should be determined not only by a diploma thesis, but also by their professional experience and continuous improvement of knowledge and professional skills. If we follow this approach, then an unqualified doctor will become a burden and even a threat for our medicine. After all, an unqualified doctor is not only a stain on the reputation of a medical institution. This is also a serious obstacle or even the inability to receive money from insurance companies, patients and banks. In this case the task of insurance companies is expanding. They will have to not only insure, but also control the medical community and determine the catalog price of services. Meanwhile, banks will offer more favorable credit conditions to medical institutions with qualified personnel and first-class equipment and as a result, this will create the following scheme: the patient pays to the insurance company, the insurance company pays to the medical institution and banks finance the development of promising medical facilities. Banks get the income from insurance companies and medical facilities. Tax collection will also improve, it will be good for our society.
I hope the above scheme helped me to convince readers that a private medicine market should be developed in our country. Competition of state and private clinics will allow patients to choose the clinic they want to be treated in, new job opportunities will appear and the state will receive an increase in tax revenues. Georgia has taken this path, although it is clear that their financial and institutional capacities are much wider and besides, there is an opportunity in the country to choose the best medical services in a variety of professional and high-quality medical facilities. In my opinion, this approach will allow us to get rid of the humiliating situation when the state-medical facilities must be free, but in reality patients have to pay for everything, run after doctors and medical staff. Let me remind you of incidents when patients have to buy unnecessary drugs in pharmacies, prescribed them by some doctors which have mutually beneficial agreements with pharmacies and officials. There are also incidents when funds are allocated from the state budget for the purchase of medicines and the staff of state medical institutions sells the purchased medicines to patients, although the government allocated them for patients free of charge.
Let me remind you that medicine is also a systematization of statistical data on the health status of each citizen. Regular medical examination and recording of its results in the medical history of each citizen should be stored in the databases of medical institutions and patients should have access to them. In several medical institutions of Abkhazia, such databases already exist. Patients know that it makes life much easier. Regular medical examinations of citizens should be recorded in the databases of insurance companies as well. This system will encourage citizens to take a more responsible attitude to their own health (for example, smokers can be offered less favorable medical insurance conditions and preferences for people who undergo regular medical examination and take care of their health).
At the end of the medical topic I would like to speak about another important aspect, in my opinion. In the section of “Economy” (see above), we have already discussed the importance of sustainable use of natural resources (water, timber, coal, inert materials and continental petroleum) for the benefit of our country’s people. In particular, we need to build “people’s funds”, similar to those ones which work successfully in Norway. The budget of such funds are used for social needs and increase of the citizens’ salaries and pensions.
In my opinion, one of the ways to change the quality of medical care in Abkhazia can be replenishment of the budget of the Republic’s healthcare system, based on the benefit from the production of the above natural resources.
As we have already noted, according to the Constitution (Basic Law) of the Republic of Abkhazia (Article 5), they belong to people.
(To be continued)