Download HEALTH HAZARDS OF POSTSOVIET MEDICINE

QUALITY HEALTH CARE in
COUNTRIES of FORMER
SOVIET UNION
Malkhaz Jalagonia, MD
Association Esculapius
GEORGIA
PROBLEM STATEMENT
After breakdown of Soviet Union
the state of public health has
deteriorated significantly in
some postsoviet countries due
to various reasons, but even
before collapse of communist
system public health was
plagued with different problems.
Learning Objectives
• What is quality health care?
• Identifying some problems with
quality health care in FSU
countries
• Main causes of these problems
• How to overcome the obstacles?
What Is Quality Health
Care?
"Doing the Right Thing at the
Right time in the Right way for
the Right Person and Having the
Best Possible Result" – US
Agency for Healthcare Research
and Quality. This is one definition
of quality health care, but there
are many others.
Appropriateness of
Health Care
Appropriateness means that
required care is provided and
unnecessary or harmful care is
avoided, so appropriateness is
linked with safety.
When does a Postsoviet Person
Meet with Inappropriate and
Unsafe Health Care?
You could expect
the following
answer: soon
after BIRTH,
but in fact the
correct answer
is: before BIRTH.
VACCINATION SAFETY
Vaccines are frequently
injected into the buttocks and
not in the antero-lateral part
of the thigh in children. The
injections in the upper outer
quadrant of buttocks in
children cannot guarantee
safety of sciatic nerve.
PREVENTIVE MEDICINE
There is very low priority for
preventive medicine in the
region. The attention of the
policy-makers as well as of
the population itself is more
directed to curative services.
Surgical Interventions
Minor surgical interventions
could be more dangerous than
major surgery, because they are
mostly performed in primary
health care clinics. These
facilities are underequipped and
also have poor access to electric
power needed for proper
sterilisation.
Surgical Interventions
(cont'd)
Due to shortage of surgical material
it is not rare that disposable items
(endotracheal tubes, scalpel blades,
etc) are reused after cleansing with
alcohol. Multiuse Lidocaine bottles
are also dangerous because the
doctors can insert used needles
into them.
Modes of Transmission For
Hepatitis B in Georgia
35
32.4
33.6
30
25
20
15.7
15
10.8
10
5
0
6.6
0.9
Modes of Transmission For
Hepatitis C in Georgia
60
54.67
50
40
30
21.3
20
9.7
10
2.33
0
12
Safety of Blood Transfusions
Blood is misused. Most doctors
think that if blood is HIV, Syphilis,
Hepatitis B and C negative, then it
is microbiologically safe.
Sometimes even blood untested for
infectious diseases is used in
emergences due to lack of blood
bank refrigerators.
Safety of First Aid
Some first aiders, including
doctors, during CPR press not
on the sternum but on the left
side of the chest close to the
sternum.
Many first aiders use tourniquet
instead of direct pressure to
stop external bleeding.
Diagnostic Procedures
Upper gastrointestinal endoscopy
and sigmoido/colonoscopy are
not safe because the
fiberscopes are not usually
properly disinfected.
Due to shortage of speculums
prenatal and gynecological
examinations are also unsafe in
some places.
Diagnostic Procedures
(cont'd)
The diagnostic centers often do
not ask if the procedures were
ordered by the doctor. So the
patients can undergo tests and
investigations on their own will.
The patients often do not receive
proper information about
diagnostic procedures.
Diagnostic Procedures
(cont'd)
Due to poor qualifications and
limited experience of X-ray
technicians, poor quality of
X-ray films and power surges,
the X-ray examinations
sometimes need to be
repeated several times.
Prescribing Habits of
the Doctors
• Preference for nonessential
and nongeneric medicines
• Many drugs at one time
• Expensive ones
• New ones
• Antibiotics
• Vitamins
• and of course, injections
DRUG SAFETY
Pharmaceutical market is
flooded with counterfeit and
poor quality drugs. Only in
few CIS countries MOH is
willing and able to address
the problem adequately.
DRUG SAFETY (cont'd)
The doctors like to prescribe
drugs, which "boost"
immunity. Some of them are
of animal or human origin.
DRUG SAFETY (cont'd)
To decrease health-related costs,
patients often bypass doctors
and go directly to drugstores,
where almost everything could
be bought without prescription,
except maybe control drugs.
DRUG SAFETY (cont'd)
The outpatients rely mainly on
Metamizole (Analgin), NSAIDs
and Paracetamol for pain
relief. Metamizole has been
taken off the market in many
countries due to fatal cases
of agranulocytosis.
Illness and Family Budget
A 1999 World Bank report
identified the illness of a family
member as one of the main
causes of impoverishment in
Georgia (source: "Health Care
Systems in Transition:
Georgia").
The Main Causes of Problems
• Development in isolation
• Low priority for health
• Shortage and inappropriate use
of resources
• Shortage of new reliable medical
information and refresher
courses for health professionals
• Widespread use of ineffective
diagnostic procedures and
treatments
The Main Causes of Problems
(cont'd)
• Unrestricted dictatorship of
pharmaceutical companies on
the market
• Well-developed black market
for pharmaceuticals
• Lack of consumer orientation
• Frustration, lack of motivation
The Difference between
Postsoviet and Western Medical
Concepts Does Also Matter
Due to this gap health
professionals in FSU often
refuse to accept ideas of
western medicine. The main
difficulty arises from rejection
of evidence-based medicine.
Is Everything in Postsoviet
Medicine unacceptable?
Of course, not. Some ideas of
postsoviet or Eastern European
medicine are getting acceptance
abroad. We can give two examples:
use of Neostigmine for Acute
colonic pseudo-obstruction
(Ogilvie's syndrome) and
considering the role of probiotics
in the management of Irritable
Bowel Syndrome.
How to overcome the obstacles?
First of All We
Should Reinforce
Education:
• Refresher courses
for health
professionals
• Health education
for public
This should change
POLICY-MAKERS
Once More about
Quality Health Care
Definition of quality health care
by US Institute of Medicine:
"The degree to which health
services for individuals and
populations increase the
likelihood of desired health
outcomes and are consistent
with current professional
knowledge".
Acknowledgments
I'd like to express deep gratitude
to my colleagues and friends
(listing is alphabetical)
for their help:
Botsvadze Eteri (Georgia)
Cunningham Fiona (UK)
Fry Catherine (Australia)
Jalagonia Maka (Georgia)
Jones Terry (Canada)
Krebs Verena (Switzerland)
Malone Teri (Australia)
Revel Jean Pierre (France)