Ukrainian Healthcare and the Inept Reforms of New Ukrainian Westernizers

After Ukraine became independent in 1991, a former ideologist of the Communist Party of Ukraine and the first president of Ukraine, Leonid Kravchuk, declared that the country was taking a course towards integration with the European Union. What other alternative there was after the socialism of the Soviet Union crumbled? Neoliberal democracy was the only way to salvation, it was argued. Also implied, if not outright stated, was that the Ukrainian nation had always been part of European civilization and should return there after hundreds of years spent first in backward, paternalist, tsarist Russia and then in the cruel, totalitarian Soviet Union.

The conversion to capitalist democracy would require painful restructuring of practically everything, according to the postulates of the post-communist transition. Reform and you will be saved. The good aunts and uncles of the International Monetary Fund will give you money to do it, if you behave. Cut those ridiculous compensations for all kinds of needy people – retired people can pay for the public transportation from their miserable pensions; abolish free lunches for all children in schools (parents will pay for that); dismantle the free health care system – people bribe doctors anyway, so why not introduce private medical insurance? Let the people pay.

Oligarchs cannot be touched because they belong to the circle of the chosen one per cent of the richest. Capital is sacred for neoliberal gurus. Enter private property! What socialism? Let’s privatize what was collective, destroy public parks and green spaces, cut the state financing of culture, reduce the number of free university programs, reduce the financing of science – who needs all of that? Let ordinary people pay the price of the painful road to the bright European future.

All of the governments and all of the presidents of Ukraine reiterated their aspirations to join the European Union. And all of them were reforming, or at least they reported to the IMF and the Western donors that they were working hard at reforming. The West grew tired and frustrated. Reforms were not advancing fast enough and were not radical enough. The Ukrainian leadership seemed to sabotage radical transformation being demanded by those who disbursed credits. Ukraine was sinking deeper and deeper into international indebtedness, but it was getting closer and closer to the promised European bounty world with the European values. Or so the ideologues said.

And then in late 2013– boom! President Victor Yanukovych decided to freeze the signing of an association agreement with the European Union because it would threaten Ukraine’s existing, close economic ties with Russia. By November 2013, when the Euromaidan protest movement erupted, foreign trade with Russia constituted 27 per cent of the total foreign trade of Ukraine. In 2013, Ukraine exported the largest amount of its export products to the countries of the Commonwealth of Independent States (CIS), 35 per cent, followed by the European Union with 27 per cent. In the import share of Ukraine’s trade, the European Union and the CIS states had almost the same share: 37 and 36 per cent, respectively. These figures clearly show that Ukraine needed to consult with Russia on matters. Yanukovych asked the European Union to hold trilateral consultations with Ukraine and Russia. The Europeans refused, stating that the signing of an agreement is strictly between Ukraine and Europe. Russia had nothing to do with it.

Yanukovych was squeezed between Europe and Russia. His fault, in addition to being a greedy oligarch, was that he was a poor communicator. Instead of explaining to ordinary Ukrainians that signing an agreement with the European Union would harm the export of heavy-industry products to Russia and threaten the agriculture of Ukraine by opening Ukrainian markets to subsidized agricultural products from Europe, media in Ukraine held sway with its message of rejoicing: we are finally joining the Promised Land! Clean streets, honest judges, polite salesmen and bureaucrats, decent salaries! How could the ordinary citizen not revolt in favour of such a beautiful dream when the dream is suddenly yanked away by an arguably unpopular, if not criminal, regime? And so the Euromaidan erupted.

Now the West is punishing Ukraine for being too naïve and believing that Ukraine could belong to the civilized world. The IMF is withholding a new tranche of credit because Ukraine is not doing the homework of “reform”. Again, not fast enough, not radical enough. Four months have passed since the new Parliament was elected on October 26. How could the Parliament do in four months what the previous governments could not do in 24 years? The previous governments did not engage in radical reforms because they knew that it would cost them their political power. Ordinary Ukrainians would revolt in response to any attempts to privatize the health care system, cut social benefits, reduce state financing of education and culture, and so on. In short, the population would not easily let the remains of the socialist order that Ukraine has kept since Soviet times be dismantled any further. Indeed, Ukrainians are protesting right now. Here is one shining example.

Health care in the new Ukraine

The new “European” leaders of Ukraine decided to invite foreign experts to come and “reform” the Ukrainian economy and service sector. Apparently there were no minds sufficiently bright among Ukrainians to take on the task. The new minister of health care is a Georgian, Olexandr Kvitashvili. His efforts at reforming the health system in Georgia produced mixed results, to say the least. The most problematic of his measures was the introduction of private medical insurance, which led to further stratification of Georgian society into rich and poor. Many could not afford to buy the new, private insurance. Experts criticized the reforms because the health system shifted its focus from the health of patients to their capacity to pay for care or not. Kvitashvili got his inspiration from the U.S. health care model, the most expensive and costly in the world. He does not have a degree in medicine, but he is an effective manager, trained in the U.S.

Kvitashvili promised Ukrainians a “painless” reform. Here is how painless it is. Since the Soviet times, Ukraine has kept a well-developed network of medical institutions specializing in certain types of diseases. These institutions are called ‘institutes’ and they conduct research and develop advanced medical technologies. At the same time, they act as hospitals, treating patients from all over Ukraine. The institutes have been funded by the state. They are autonomous self-governing entities with the authority and capacity to manage their finances, draft collective agreements with their staff, and elect their heads.

The National Cancer Institute in Kyiv is one such institution. It is a leading institution in Ukraine for the on provision of oncology treatment at the national level. It has a research department developing innovative treating methods and technologies. It also has its own educational unit providing professional development courses for practicing oncology doctors, and it provides residency for medical students. There are PhD programs specializing in oncology, radiotherapy and radio diagnostics. The hospital of the Institute has 560 beds. The consultation clinic receives 400 visitors per shift.

The Institute employs 1,063 people, among them 119 researchers and 168 physicians. They are highly qualified professionals with many years experience and expertise in cancer treatment. The head of the Institute, Ihor Shchepotin, is one of the top ten specialists in oncology in the world and is a member of numerous international associations, including the American Association for Cancer Research and the American Radiation Research Society.

In June of 2014, Shchepotin was accused of misuse of public funds by then-Minister of Health Oleh Musiy. The minister claimed that Shchepotin overestimated a budget for renovations and spent too much on costly medical equipment. Musiy also stated that the whole oncology care system is corrupt and useless. “Mafia, headed by Shchepotin, has to be eliminated,” he said. “I will do everything I can to open a criminal investigation and to put this man in prison.”

The investigation was done and the results were sent to the courts. Shchepotin stated that the investigation was conducted with massive violations of procedures and he filed a complaint. He also stated that the accusations were a political persecution whose goal was to dismiss him as head of the National Cancer Institute and replace him with an associate of Musiy. The Institute receives public funds and, in Shchepotin’s opinion, Musiy was seeking direct control of these funds. The employees of the Institute were on Shchepotin’s side.

As the drama unfolded, Shchepotin took a medical leave. Musiy was dismissed from his ministerial post by the Ukrainian Parliament. In December of 2014, the newly appointed minister, Kvitashvili, decided to rewrite the statute of the Institute. According to procedures, the new statute has to be discussed and agreed by the employee collective of the Institute. The first draft of the statute was adopted correctly. However, in January, the new minister, without consulting the Institute, changes the text of the statute. According to the new version, the Institute loses its autonomy and self-governance and the head of the Institute is to be appointed by the minister of health, instead of being elected by the employee collective. Financing of the Institute is to be cut by 40 per cent, which means that over 30 per cent of its personnel will lose their jobs. (See a Ukrainian news report on the drama as it unfolded, here.)

The employees of the Institute and social activists have organized protests. They say that cutting public financing of the sole, national oncology treatment institution in Ukraine is a hidden genocide of the Ukrainian people. “If 30 per cent of the personnel is fired, those remaining physicians will be physically incapable of treating patients”, said one of the doctors participating in the protest. “Mortality will rise. One has the impression that the government bureaucrats do not worry about the sick and weak–fewer patients will mean less trouble for the state.”

“There are two million persons with cancer in Ukraine who need help”, Tetiana Holovko, professor and physician of the Institute, told the UNN news service. “I receive a monthly salary of 2000 hryvnia [which amounts to approximately US$100, given the disastrous fall in the exchange rate of Ukrainian national currency-H.M]. My colleagues and I have devoted our entire lives to this difficult work. We are here to protest”, she said.

This is but one example of the current Kiev regime’s efforts to seize control of public funds and redistribute them to the new rulers of the country. Plundering of whatever is left of state property continues. Financing of culture and education has been reduced; social benefits cut; prices of commodities are sharply on the rise. Public transportation tariffs are climbing higher and higher. The national currency has devalued at an astronomic speed. Welcome to the new, European Ukraine!

But ordinary Ukrainians are protesting against the new draconian measures of austerity. This is the only hope that the country will not crumble completely under the weight of Western reforms carried out in a hasty and non-reflective way. There is an English saying which I like a lot: If it ain’t broke, don’t fix it.

The irony of the situation with the National Cancer Institute is that while its director has been temporarily dismissed, Georgetown University in Washington, DC has offered him a multi-year contract. The job offer recognizes Professor Shchepotkin’s high professionalism and international reputation. How’s that for his treatment in Ukraine being a showcase of misuse of power and of corruption? Or have Washington’s zealots in Kyiv gone overboard in trying to reform what does not need to be reformed?

Halyna Mokrushyna is currently enrolled in the PhD program in Sociology at the University of Ottawa and a part-time professor. She holds a doctorate in linguistics and MA degree in communication. Her academic interests include: transitional justice; collective memory; ethnic studies; dissent movement in Ukraine; history of Ukraine; sociological thought.  Her doctoral project deals with the memory of Stalinist purges in Ukraine. In the summer of 2013 she travelled to Lviv, Kyiv, Kharkiv and Donetsk to conduct her field research. She is currently working on completing her thesis. She can be reached at halouwins@gmail.com.

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Halyna Mokrushyna is currently enrolled in the PhD program in Sociology at the University of Ottawa and a part-time professor. She holds a doctorate in linguistics and MA degree in communication. Her academic interests include: transitional justice; collective memory; ethnic studies; dissent movement in Ukraine; history of Ukraine; sociological thought.  Her doctoral project deals with the memory of Stalinist purges in Ukraine. In the summer of 2013 she travelled to Lviv, Kyiv, Kharkiv and Donetsk to conduct her field research. She is currently working on completing her thesis. She can be reached at halouwins@gmail.com.

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