By vocation but without recognition

The international Golden Otis Prize for outstanding achievements in surgery has been conferred on the All-Ukraine Association of Pediatric Surgeons. The sad fact remains that even after developing the most advanced diagnostic and treatment techniques for a variety of complex ailments, these surgeons have not received any government awards in their own country.

They are not complaining. What is important is that the Okhmatdit Special Clinic now has a new device that will save the lives of many Ukrainian children. The equipment was purchased with money that was awarded to the Ukrainian surgeons in Warsaw.

The Day interviewed Prof. Danylo KRYVCHENIA, the president of the All-Ukraine Association of Pediatric Surgeons, about the achievements and problems of modern Ukrainian surgery.

Dr. Kryvchenia, the Golden Otis is a Polish award and little known in Ukraine. Would you tell us more about it?

D.K.: This is the most prestigious Polish award conferred on physicians and pharmacists in recognition of their outstanding achievements. It was founded in 2004 by the president of Media TV Plus, Pawel Krus, and no one outside Poland has ever received it. This year a special international prize was instituted and awarded to foreigners for the first time. The prize is a five-kilogram bronze symbol and a sizable cash award (almost 7,000 euros). We spent the money on a very sophisticated and much needed cystourethroscope that allows us to diagnose and perform surgery even on infants with complicated urogenital malfunctions. Unfortunately, this pathology is rather widespread, and it is difficult to operate on children. So, tiny patients do not get the necessary medical help. We applied for the purchase of this costly device. No one had it in Ukraine and we needed it badly.

How did Ukrainian surgeons manage to receive this prestigious international award?

D.K.: The Poles invited us to take part in the competition. We submitted our data and publications, including those carried by foreign journals. Our articles on topical aspects of pediatric surgery are published in leading medical journals in Poland, Hungary, Germany, Austria, Switzerland, and the United States. In 2000, a US journal carried our paper on the surgical treatment of a complex pathology: the absence of a lung in a child. It was based on the results of a surgical procedure that had never been performed. We operated on a four-year-old girl, who was brought to Intensive Care Ward in critical condition. She is older now and is showing excellent physical progress. This was a unique event in world medicine.

Have they started performing these operations abroad?

D.K.: We haven’t heard or read about any. Our foreign colleagues asked many questions, and a serious international discussion was launched on the pages of scientific periodicals. We performed another operation like this and studied 10 children with similar pathologies. This is the largest follow-up study in European and world practice because there are few children with such disorders. The Poles recognized the value of our work, as pediatric surgeons performing on the European level, and decided that we deserved the award.

Have our Ukrainian pediatric surgeons developed any other groundbreaking techniques?

D.K.: We have developed several new approaches to the treatment of intestinal ailments; we have upgraded diagnostic methods and developed a new surgical technique. Its uniqueness has been confirmed by publications in Ukrainian and foreign journals. In 1982 our surgeons made progress in the diagnosis and treatment of aorta arch failure, which is actually a cardiac disease. Ukrainian physicians boast Europe’s richest experience in treating this disorder. Such infants are born hanging with a noose around the airway in the thorax. Before 1982 no one had ever made this diagnosis on our continent and no operations were performed, of course. Infants died and their doctors were convinced that the cause of death was pneumonia or lung insufficiency.

How prestigious is the profession of pediatric surgeon in Ukraine? What problems do medical professionals face?

D.K.: Acquiring modern equipment is still a big problem. We have to get lots of devices through personal channels. For example, I received an electric cutting probe from London and a device known as a “stimulator” from New York. This is a device that ensures high quality surgery involving intestinal distal areas. It costs more than 5,000 dollars, and we were fortunate enough to obtain it through humanitarian diplomatic channels. We have to rely on our own resources to get surgical thread, including absorbable kinds. A length of surgical thread costs 30 hryvnias. We have no alternative. Physicians are trying to help each other, getting bits and pieces of equipment, mainly working on pure enthusiasm, with personnel trying to do their utmost to make up for the lack of adequate technical facilities. In order to cure sick children, they often work on weekends, report for work earlier, and leave later.

Lately, the problem of what we know as “medium personnel” has become very acute: we lack trained nurses to assist our surgeons during operations, the ones who hand them the required tools and help with anesthesia. Few are prepared to cope with these hard jobs in return for token remuneration. Physicians, especially those in charge of intensive care and resuscitation wards, are quitting for the same reason: backbreaking work and poor salaries.

As for the prestige of the surgeon’s profession, I don’t think it is high in Ukraine. Otherwise topnotch professionals would not seek employment with private firms and better paid jobs abroad. What we are encountering in the medical field now is a typical brain drain.

What are the specific features of pediatric surgery?

D.K.: The main feature is the type of patient. Unquestionably, treating children is unbelievably interesting, but there is also a much greater degree of responsibility. You keep thinking about your patients at work, at home, wherever you are. There are two nagging thoughts: what you have done and what else must be done to help the child. After all, there is a whole social stratum behind every tiny patient, including parents and grandparents. It’s common knowledge that child patients are treated with special care.

Another specific feature is the need to go on business trips abroad. We don’t go there as tourists for pleasure. We have to communicate with our colleagues abroad, share our experience, exchange ideas, and boost our professional skills. If there is no professional exchange, you end up thinking you know how to do everything and you know all there is to know. That’s the end of progress! True, we have to pay for trips abroad out of our own pockets, because there are no government funds for this. For a true surgeon, education is an inviolable priority.