The fanatics at the forefront

Despite the health crisis in Russia there are medical centers that provide assistance on a global level. Key to their success — a charismatic leader, a stable government funding and the rate of high-tech services to multi-

Putin once joked at a forum "South of Russia": do well here — there is always something to eat and drink. In Adygea, say, cheese, produce, and in the Krasnodar region — wine. Then I stood up and said, "You know, here you can not only drink, a snack," — Vladimir Porkhanov, chief physician of the Center of Thoracic Surgery in Krasnodar, excited in earnest. — Our surgery — one of the best in Europe! What I hear: went to Israel to Germany with the spine, did not help. And you try to treat back in Krasnodar! Foreigners who are not getting results, and we are going to recover. Incidentally, I saw the screws that Plushenko set in Israel — they are bad! They should "kissing" — the angle should be at an angle? "

The medical director of the Center of Thoracic Surgery of the Krasnodar Vladimir Porkhanov combines the features of the Soviet surgeon and the modern manager

Zador head physician understandable. Regional Clinical Hospital № 1 of Professor SV Ochapovsky, which was created on the basis of Thoracic Surgery Centre — one of the best in Russia. Here spend minimally invasive surgery, organ transplants, grow cells and tissues organs. Each year, doctors KKB spend more than three liver transplants, heart and lungs, tens of thousands of heart operations. Moreover, the clinic doctors have made a breakthrough in the medical world for the first time transplanted artificial larynx and trachea grown from patients’ own cells.

The advanced technology used and other regional clinic — Novosibirsk Research Institute of Circulation Pathology (NNIIPK) named Academician ENMeshalkin. By the way, with the help of its experts was formed Thoracic Surgery Centre in Krasnodar. Under the guidance of a heart surgeon Alexander Karaskova Novosibirsk clinic in terms of medical care has overtaken the absolute industry leader — Moscow Scientific Center of Cardiovascular Surgery of the ANBakulev. Today NNIIPK works at the level of advanced hospitals in Europe and America, and has its own know-how, which foreigners are learning, for example in the treatment of arrhythmias.

The director of the Novosibirsk Institute Alexander Karaskov trains to medical institutions across the country

Both clinics determine the trend of the development of national health care. However, against the background of the overall unfavorable situation in the industry, their example is unique. Over the past twenty years, the domestic health care system dramatically degraded.

In Soviet times, the industry has been a world leader in the coverage of the population and the availability of medical care, but today it is not able to meet the needs of the population.

Because of underfunding almost lost whole areas — diagnosis, prevention, rehabilitation, rural medicine. Deterioration of the health funds exceeded 70%, the shortage of doctors close to one third of total employment.

Demographic indicators in the country leaves much to be desired. For example, the life expectancy is 58 years Russians, while in developed countries — at least 70-80 years. Our country — the leader in the number of complications in the course of treatment, the level of mortality, as well as the number of cases of the advanced stage of the disease. Started a few years ago, the former Minister of Health Tatiana Golikovoj reform because of its formal dogmatic nature only exacerbated the negative processes: led to the growth of bureaucracy, an increase of queues and reduce access to care for patients.

Against the background of such a depressing picture of the experience of the Krasnodar and Novosibirsk center looks unique. Over the past five years, mortality from cardiovascular diseases in the Krasnodar Territory and the Novosibirsk region decreased by 50%, the number of post-operative complications — 70%. We visited Krasnodar Center of Thoracic Surgery and Novosibirsk Research Institute of Circulation Pathology, to understand how they manage to be at the forefront.

The case, which serves as

A key factor in the success of health centers — the charisma of their leaders. Vladimir Porkhanov combines the features of the Soviet doctor and the modern manager. One of the strongest in the country of Thoracic Surgeons, the disciple of the legendary Nicholas AMOSOVA, Porkhanov just ten years has created from scratch an advanced center of chest surgery at the regional hospital. The idea to develop the center was risky — with cardio-vascular disorders in the province had not worked. But Porkhanov understood that it is necessary: such disease — the main cause of death in the country. Center helped form qualified professionals, such as Italian transplant Paolo Makkiarini or the same Alexander Karaskov from Novosibirsk, student academic Eugene Meshalkina, one of the founders of Soviet cardiology. Technical mind (as a child Karaskov wanted to be an engineer) makes it regularly to study the global medical know-how. As a member of the European Association of Cardiothoracic Surgery (surgery and cardiology, working with abnormalities of the cardiovascular system), Karaskov initiated exchange programs between clinics in Novosibirsk, Germany, Italy and the United States.

Medical leaders apparently do not like. Karaskov — technocrat, it is clear that a child was interested in mathematics and physics. He had a loud confident voice, he quickly and clearly pronounces every word. Clinic Karaskova literally filled with various technological innovations: for example, it is set in the famous robot "Da Vinci" — four-armed machine that performs the operation. His actions surgeon operates by remote control: he sees on the monitor operable area in 3D-image c multiple increase. "Bridging the hair was no time to ask any questions, tell you everything," — says Karaskov, flying to the reception in a surgical gown, a cap, taking off from the face of the mask. Now the lunch, the director of the Novosibirsk clinic has just completed a complex operation. He operated at night to six in the morning. Half an hour later Karaskov should be at the presidential envoy. So he invites us once again to come to the clinic at half past eight in the evening to continue the conversation. It is absolutely unclear when that person is asleep and whether he sleeps at all.

Porkhanov more humanitarian warehouse — very artistic, loves colorful figures of speech and good looks. About this talk: the perfect PR. "Today I will not say much: just open doors for you surgery, intensive care, laboratory cell. I will give you a phone Paolo Macchiarini, let him say what we have achieved over the years. Sam will not say: do not praise the man himself. "

Strategies of medical luminaries similar. Both managed to obtain from the authorities tolerable funding to attract the best staff, to move from narrow specialization to versatility, to develop their own unique approaches to the treatment and a gradual system of medical care.

Entrepreneurship in Medicine

In the Novosibirsk clinic is in full swing repair. The old seven-storey building was constructed Meshalkin Academician in 1973, this year completed the first phase of reconstruction of the complex. In most clinics — cleanliness and order. In this case, attention is drawn to
the quality of the service that was already all the details — even the taps in the water dispenser — very soundly.

"At the time, Alexander Karaskov realized that the effective development of medicine in the modern world is impossible without the introduction of innovative technologies, and it required to change the format of the scientific center. Including create a comfortable environment for patients and physicians, "- says Artem Puchalski, Advisor to the Director Research Center. According to him, now in line for the upgrade is the operating unit — the clinic operating 12 for open surgery. Despite the renovation, the clinic for one day did not stop the work. There are no patients who are in the hallways, and there are no doctors without the staffroom. In the future, the number of applicants to be treated in the clinic can be increased by 25%, but this requires additional hospital beds.

The annual budget of the Institute of Science in Novosibirsk is 4 billion, which provides the federal budget. It was not easy to achieve. In the 1990 Institute nearly closed, managed to survive only thanks to the clearing, with the help of which was purchased by the bare minimum: breathing apparatus, monitors, angiographic complex. "We had to get out: somewhere helping regional authorities, somewhere — sponsors" — says Alexander Karaskov. Then he decided to increase the volume of high-tech care. In addition to the cardiac surgery center began to develop the most complex areas of medicine: neurosurgery, treatment of associated pathologies (eg, cardiovascular diseases and neoplastic processes) transplantation. This allowed the center to reduce the losses, for example, due to the turnover of beds in the intensive care unit and hospital — high-tech surgery allows patients to recover as quickly as possible. And the waiting list for surgery declined. "The effectiveness of clinics has increased dramatically, and this allowed us to get more funding from the state — says Artem Puchalski. — Act now provides for a system of payment of medical work, built on account of efficiency: the salary is about 14 per cent of the wage fund, the rest — the premium. The more we get the quota, the higher the premium amount. "

There were difficulties. Oncologists warily embraced the idea of the center of Novosibirsk to develop this direction: it seemed that the cardiologists went to another man’s field. "They said, why are you doing this, we are not doing heart surgery. We tried to explain we do not want to work on the cancer market, we have a new segment — a segment of particularly complex clinical cases of mixed pathologies. In their treatment of the huge pent-up demand. We have provided additional options available equipment and started working, "- say the doctors at the clinic.

And had to take risks. Thus, the institute developed an original method for the treatment of cardiac rhythm disorders. But guarantees its effectiveness was not: in medical science it is difficult to predict the outcome. Many have abandoned the idea, Karaskov the Ministry of Health has made a supplementary funding of this project. Thus was created the largest Arrhythmology center in Russia, and the technology has become the first domestic treatment for heart disease, which entered the European Society of Cardiology guidelines. "Despite the fact that health care is a market that is not, entrepreneurial initiative is very important. It also makes the clinic leader, "- says Artem Puchalski.

Good medicine can not be cheap

Vladimir Porkhanov kept his word. We were shown inside the clinic: diagnosis, resuscitation, and, of course, the very surgery. Clad in a special one-off costumes, suits, my photographer like pioneers on the moon. We are invited into the operating room. Going coronary artery bypass surgery, the patient is now — a man in his forties — will stop the heart. "Tell me something," — suddenly asks the surgeon who is working on the opened chest. The operation is long, a lot of manual work, and the anesthesiologist assistants in silence follow the instructions surgeon. "What are the current trends in bypass surgery?" — I asked at random: the form of the body is torn embarrassing. The surgeon nodded, obviously, happy to talk. "This is such open abdominal surgery gradually taper off. Now in Western countries commit operations robots, minimally invasive treatment. This allows you not to open the chest — all manipulations surgeon performs with a catheter, which is inserted through a pair of punctures, and the operation takes thirty to forty minutes, not five or six hours as open surgery. In addition, non-invasive intervention has far fewer side effects than abdominal surgery, for example, the patient is not formed fistula. "

Krasnodar Hospital intends to increase the number of minimally invasive operations — today they make up a third of the volume of medical care. We are a photographer in another operating. This is quite a common room: yes monitors young people behind them. It soon becomes clear that they direct the course of the operation, which is seen on the screen. "Well, you see, the patient was brought at night with a suspected stroke — casually said one young man in a sweater draped over a white gown — a vessel in the thigh at the mouth of the affected vessel introduced a special catheter through it held a thin metal wire with a stent. We are watching him move through the screen of a special X-ray machines. "

In contrast to the center of Novosibirsk, financed from the federal budget, the technological level of the Krasnodar Territory Governor clinics provided Alexander Tkachev, which removes one-third of the regional health budget. This is an unprecedented event for Russia. "Alexander Tkachev believes that good medicine can not be cheap — says Vladimir Porkhanov us. — If we want to be treated qualitatively, we have to be clever technique. We are well equipped with diagnostic and surgical equipment. "

The introduction of high technology has increased the profitability of the clinic and get a new niche. Appeared transplantation, followed by cell laboratory, where organs are grown from the cells of the patient. For these experiments, the regional budget was not enough, and the center had to seek other sources of funding. "We set the goal to grow artificial trachea using a patient’s cells, — says Mr. Porkhanov. — For such experience required huge amounts of money, and we, along with Paolo Macchiarini have applied for megagranta Government for the project in the field of regeneration of the respiratory tract. The project was grown artificial trachea, which successfully transplanted to two patients injured in the accident. "

Money is still not enough

It is noteworthy that the share of market services in both centers is negligible. In Krasnodar clinic does not exceed 3% of the Novosibirsk Institute — 4%. This clinic provides services to residents of other regions and countries. Both leaders believe that inhumane to take a patient’s money for high-tech surgery. Yes, and co-payments will not allow patients to clinics to develop in full force. "Unfortunately, our funding scheme is that the free services we provide only the residents of our region. There have been cases where patients from other regions prescribed in the Krasnodar region, we have to get help — says Porkhanov. — I would have treated all free. Even in the United States commercially oriented medicine that is generally valid. If there is, for example, suffer from a Mexican showdown without insurance, it still prooperiruyut for free, using the most modern medicines and equipment. "

Alexander Karaskov also believes that the government order — the only way to make high technology available. "Doing serious things in the global commercial medicin
e is unreal, funny, forget about it," — he said.

Despite the fact that the financing of high-tech medical centers are much better than other hospitals, and it is often not enough. "The quota for heart surgery does not change for many years. It is 200 thousand rubles. These funds cover only the standard operation. If there are complications, the costs can increase up to a million. Take them nowhere ", — Says Alexander Karaskov. Problems creates the 94th PPL, which requires hospitals to buy cheap domestic supplies. "Seam made by the domestic yarn can not be trusted, blood pulsing out of holes, often have to redo the operation, — Hot Karaskov — because we buy a bit of foreign fibers. Every thread I use more than once, and ten. The same situation is with the others. As a result, a foreign colleague spends operation parts for 40,000 euros, and our surgeon — only five. And he gets paid ten times less. "


High-tech help, the development of which today is worried about the state requires expensive original drugs, and not cheap knock-offs. "In the transplant is not possible to use generics. People who have had such surgery, you need a lifetime to use the original immunosuppressive drugs that can prevent rejection of transplanted organs, "- said Vladimir Porkhanov.

Obviously, the further development of medicine in Russia is impossible without an increase in funding. "If for the operation, which costs 40,000 euros, the state would not have smacked five thousand, as of now, but at least 15, then we would be operated in two or three times as many people. We would have solved all their problems, including social, built to house employees would increase the bonus pool training. Do it today, but with difficulty: it is necessary to ask foreign experts to enter our position, so that they learn to give our employees free of charge or for a token money " — Says Mr. Karaskov.

Drop calling

Doctors at both clinics on standard gray-haired surgeons are not similar. These young people are very much more like kakih-nibud programmers — perhaps because the monitors they have to spend more time than at the operating table. Today, Russia is missing nearly 200 thousand doctors in different directions, despite the fact that most doctors in the country of 600 million. "Fool, whether that young person today to go into medicine, when the oil industry is? You can draw pictures, just giving them a dignified existence, — the flutter — the salary should allow the doctor to take a mortgage or rent housing. Drop calling. We should not focus on the fanatics! It is necessary to build a system where profits are competing with the trade, from raw materials. " In Krasnodar clinic average nurse salary is around 50 thousand, surgeon — more than 100,000. In addition, in the Krasnodar region governor’s program is subsidizing bank loans for physicians. It’s quite good conditions, especially for the region, so the lack of specialists in the Center of Thoracic Surgery no.

Embedded in the frames and the Scientific Center named after Academician Meshalkina. "We give employees the opportunity to study at leading hospitals abroad — says Artem Puchalski — it attracts us experts from different regions: we have doctors from Tyumen, Barnaul, St. Petersburg. I recently lured surgeon from the St. Petersburg Institute of Neurosurgery named after Academician AL Polenov. "

"I arrived in Novosibirsk two years ago — says" peremanenny "team leader endovascular angioneurology Cyril Eagles. — In St. Petersburg, five million inhabitants, there are several endovascular clinics, and here our direction — in the central Siberian region and covers about 40 million inhabitants. The average age of a doctor in the center of Novosibirsk — 30-35 years old, while the average age in the industry as a whole — about 50 years. In the 35 years of our doctors is a mother, because that is the intensity of labor. When technology changes frequently, the physician must constantly learn, analyze, and apply new knowledge. Older people cope with it worse, they are less mobile. "

Novosibirsk Clinic — source of manpower for the industry. "Today in Russia opens a lot of Cardiology Center — in Tomsk, Krasnoyarsk, Irkutsk, Tyumen, Perm. We call out and ask: Who can you give? Because experts in the country — one, to prepare them takes a lot of time. If the doctor we have — the right hand of the head and wants to career development, we offer it to move to the new center, where there is a real opportunity to make a career. So the industry is integration — due to flow rate. The success of our partners — is our success ", — said Puchalski.

Novosibirsk feature clinics — a close relationship of doctors and scientists from neighboring Akademgorodok. "I used to work at the Institute of Nuclear Physics and more engaged in theoretical research, and now I can in practice to realize their ideas," — says medical physicist Igor Poor.
In favor of such cooperation, he cites other facts: for example, work with modern technology often requires technical expertise of physicians, physicists therefore help to cope with it.

Poor Igor, a medical physicist working at the Novosibirsk Institute, is an expert in the modern equipment

Restore the system

Another factor in the success of both clinics — vertical integration. Often, doctors can quickly provide high-tech care because the patient is not a correct diagnosis. In addition, many clinics are unaware of the possibilities of high-tech medical centers, and therefore does not send patients there. "We have seen this very often and finally decided to develop its own diagnosis," — said Alexander Karaskov. In the Novosibirsk Scientific Center appeared receiver-ray department, where patients are examined, and then send the documents to the region of his residence to get a referral for treatment. But as regional clinics in Russia are ineffective, the institute sends back a consultative and diagnostic teams of specialists who are receiving patients with complex cases.

In the long term NNIIPK and plans to open a rehabilitation center. "Since we got the diagnosis: the patient is now somehow finds us. But we do not know anything about the patient after surgery. As in this situation, you can evaluate the quality of treatment? State at the time of discharge insufficient indicator — says Artem Puchalski — so we’re going to build a large rehabilitation center, we already have the land under it, very close to the institution. But will he be financed by the state, we dormancy and not know it. "

Develops medical care related steps and Krasnodar clinic — there is formed ray department, which give direction to the cardiologists clinics edge. "We have good relations with the boundary clinics. If a local cardiologist sees that conventional therapy does not work, it sends a request to our clinic, and we call the patient to himself. During the day we put him to an accurate diagnosis, and then the patient is sent to observe the attending physician, or — for operation in our center, "- says Vladimir Porkhanov. He plans to develop and rehabilitation center, while also working with health centers on the Black Sea coast.

A total of Novosibirsk and Krasnodar clinic willing to increase medical care by 25-50%. "While the demand for high-tech services in Russia many times greater than the supply, — says Artem Puchalski — we’re doing a year 14 000 operations, and the daily requests for clinic site today — about half to two thousand."

Lily Moskalenko

In preparing the material participated Sophia Inkizhinova

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