KYIV – Dr. Ulana Suprun, a trained radiologist of Ukrainian descent from Michigan, is slated to be confirmed as Ukraine’s deputy health minister on July 22. According to the Detroit native, Prime Minister Volodymyr Groysman offered her the job earlier this month, after which she held a publicized meeting with President Petro Poroshenko on July 12 who also supported the high-level appointment.
After meeting with the physician, Mr. Poroshenko equated the “health care situation” with “national security” in a statement published on the presidential website.
One reason is that Ukraine’s population declines by 82,000 to 110,000 each year, according to statistics cited by Dr. Suprun. If the trend continues, Ukraine’s population will shrink to 35 million by 2050 reverting to levels not seen since 1950. Ukraine has the world’s second highest death rate, according the Central Intelligence Agency’s World Factbook. More than 14 people per 1,000 population die yearly.
Thus, the quality of care is the medical system’s main inadequacy, according to the 53-year-old physician.
“We’re doing this for future generations. It’s going to be hard, nobody is saying this is going to be easy,” Dr. Suprun told The Ukrainian Weekly on July 19.
Although Ukraine spends about the same per person on health care as a percentage of gross domestic product as its European counterparts, it spends far less in monetary terms. Despite having more than 3.5 physicians and nine hospital beds per 1,000 people – much higher than the U.S., Great Britain and Canada – average life expectancy at birth in Ukraine is 66.1 years for men and 76 years for women, lower than European averages.
Other deficiencies include the state not having the fiscal means to fulfill the nation’s Soviet legacy promise of providing all medical services free of charge.
“Money doesn’t follow the patient, medical institutions get money for the number of beds they have, not for the number of patients doctors and nurses treat, so medical workers get a base salary if they treat one or 1,000 patients,” Dr. Suprun said, who took Ukrainian citizenship last year together with her husband, Marko Suprun, a native of Canada.
Clinical protocols, sets of procedures that are evidence-based and written by physicians and professional associations, are outdated and medical schools still use books from the 1980s.
“And we all know that medicine has drastically changed since the 1980s. Protocols that are done are enshrined in law rather than changed every year based on how medicine is advancing,” Dr. Suprun explained.
In addition to updating protocols, Dr. Suprun wants better treatment of doctors, who are paid a monthly salary of only about $110. This encourages corruption and bribe giving, she added. The idea is for money to follow the patient, where the best doctors make more money because satisfied patients keep coming back.
Dr. Suprun will also push for giving more “power, freedom and choices” to the regions so that they could make decisions on their own.
“We understand that in the U.S., medicine in New York is different than in Michigan,” she said. “Same thing in Ukraine. Medicine is different in Odesa than it is in Kyiv and Rivne. When you have a very top-heavy centralized ministry that tries to control these many different things, it doesn’t make for a very reactive system.”
Other factors that adversely affect the quality of care are ineffective public health policies. Preventive medicine programs, such as those whose goal is to lower people’s blood pressure or to ensure that immunizations are almost 100 percent across the board, are absent.
Evidence of this came as recently as October, when the Zakarpattia Oblast, the country’s westernmost region, suffered a polio outbreak, prompting the World Health Organization to urge parents to have all children under the age of 10 vaccinated.
Dr. Suprun also would like to encourage patients to have their own doctors as opposed to being randomly assigned one geographically at their local clinic based on whose shift it is. “There’s no appointments for patients, no emergency rooms in hospitals, no walk-in clinics… Patients don’t feel like they could go to someone when they’re ill,” she said.
Backed by what she sees as the political will of the president and the prime minister, Dr. Suprun is confident the Verkhovna Rada will pass the needed bills to enable the reforms she’s envisioned. Coupled with an electronic public procurement system and plans to introduce electronic documentation at the Health Ministry, this should also mitigate kickback schemes from which so many corrupt health officials have benefited in the past, according to the physician.
“However, there’s still a lot of vested interests and one way of changing it is to take power away from the state at the top and spreading it around to the regions and to other agencies who might do things better,” Dr. Suprun said.
She added that she’ll rely on ministerial orders to make the changes that don’t require parliamentary votes.
Dr. Suprun and her spouse moved to Ukraine in the fall of 2013. They came to Kyiv on November 29, 2013, the same day that riot police brutally beat a group of university students in the capital’s central Independence Square, or the Maidan. Both ended up volunteering during the ensuing Maidan Revolution, with Dr. Suprun eventually becoming director of humanitarian initiatives for the Ukrainian World Congress in March 2014. As Russia’s unprovoked war against Ukraine escalated, Dr. Suprun used her medical background to start training soldiers in May 2014 to administer tactical medicine on the battlefield. Her group, Patriot Defence, also started distributing first aid kits to soldiers based on NATO standards.
“Even if you have the best hospitals and best evacuation vehicles, if you didn’t save the soldier’s life in the first five minutes after there was significant bleeding or a problem with their airways, they would die before they ever made it to the doctor,” she said.
Her organization then began training Ukrainian instructors in tactical medicine. The group has since trained 26,000 Ukrainian soldiers, distributed over 21,000 first aid kits, and taught about 4,400 cadets at military academies in tactical medicine.
Next, the group started to train combat medics to keep soldiers alive long enough to reach the hospital. To increase survival rates, hospital doctors were also trained in trauma care.
Ulana and Marko Suprun had always dreamed of living in Ukraine after getting married in 1991, the same year that the former Soviet republic gained independence.
“I was born in a Ukrainian family; we spoke Ukrainian at home. We went to a Ukrainian school, went to a Ukrainian church. My friends were Ukrainian; I belonged to Ukrainian organizations,” she said. “As I went through life, I felt closer to being a Ukrainian than as being an American.”
She feels that everything she’s done in life up to now has led her to Ukraine.
“I feel I’m at the right place at the right time. The experience that I have has led me here. Marko and I had planned on moving to Ukraine at various times… and what we’ve done over the last 2.5 years, I don’t know if we could’ve been doing that had we already been living in Ukraine (earlier),” Dr. Suprun said.