Yurii Poliachenko: “A diagnosis for the nation”

Nearly one million people in Ukraine are addicted to drugs or alcohol. These are people who in one way or another have ended up in medical or law enforcement institutions and declared their special needs. The real number of alcohol or drug addicts is unknown. Health ministry officials say it is 2-2.5 times higher than the official one.

In order to determine how the struggle against addictions is progressing, Ukraine’s Minister of Health, Yurii Poliachenko, has opened a new national social institution, an observatory for gathering information on the consumption of drugs and alcohol in Ukraine, and analyzing trends in this social sphere.

“One cannot say that we have an epidemic today,” Poliachenko said during a press conference held at Kyiv’s Sociotheraphy drug abuse clinic. “Certain trends exist, but the state does not know the exact numbers and cannot fight this evil. The monitoring center will provide a real picture of socially dangerous diseases. This will be a diagnosis for the nation.”

The new observation center will introduce programs to help curb these negative processes. People in the health ministry and hospitals are certain that there are no weak links in the medical services provided to these special types of patients. “There is a lack of money and institutions, but everyone who goes to a hospital is treated,” the health minister explained. “Drug and alcohol addictions are socially dangerous diseases, and such people need not only medical but social rehabilitation.”

Assistance provided by medical personnel is not enough for drug addicts. Anatolii Viievsky says that doctors are already doing their duty to people who need treatment for their addictions. Now we need the healthy part of the population to start fulfilling its rehabilitation duty. With this goal in mind, the Ministry of Health is planning to hold a national public forum on medical-social questions early in 2007. Concerned members of the public and representatives of the state will discuss such problems as the struggle against AIDS, tuberculosis, drug addiction, and alcohol abuse. The national monitoring system will present the first results of its study, which was launched on Dec. 9, 2006.

100 HRYVNIAS EVERY TWENTY-FOUR HOURS

The Sociotherapy Clinic spends 100 hryvnias on drugs for every patient. The treatment is free of charge for the sickest individuals, who are not obliged to provide even a single syringe. On average, nearly 5,000 people with drug or alcohol addictions visit the clinic. This hospital is one of a handful of medical establishments fully engaged in implementing rehabilitation measures for their patients.

Everyone is accepted here: people who have been brought from the street by ambulance or their relatives, and individuals who come on their own. The average age of drug abusers is 18-20, and that of alcohol abusers — 30. “The more intensive development of society, the higher the incomes, the higher the urbanization level, the higher the consumption of substances that cause addiction,” Dr. Iryna Zvershkhovska explains. “Today we see the maturing of addictions. If more sedative substances were taken in the past, now there are more stimulants. Our youngest patient is 15 years old.”

The average hospital stay is difficult to define. Most patients need their psychosis — delirium tremens — instantly eased. Depending on the individual and how long s/he has been having problems, stabilizing the patient’s condition may take anywhere from two or three days to several months. After completing a course of treatment, the patient has a choice: to continue treatment or return to his or her former life. Doctors have to satisfy both wishes. The former are offered an additional course of detoxification and rehabilitation, while the latter are offered a switch to a substitutive therapy. There are no guarantees that a patient will be completely cured: everything depends on the patient.

Street people pose the majority of problems. They arrive at a hospital in serious condition and require more efforts both in terms of treatment and social rehabilitation. A man without documents, family, and permanent residence may stay here for months while social workers find a job for him, renew his documents, and generally help him adapt to normal life.

The hospital administrators have no reason to complain of a lack of money: there is a minimum of necessary equipment, but repairs are sorely needed. For the most part, it manages. While 100 hryvnias are spent on each patient, hospital staffers earn an average of 500 hryvnias a month and a 25- percent bonus for “dangerous work.” A female doctor asks: “Where would I go from here? I have been here since 1986, and I can’t imagine myself working anywhere else.”

BETTER NOT TO RETURN?

“Here we have a pressure chamber, especially for people in especially bad shape,” Viievsky explains during the tour. “Ninety percent of our patients stay here no longer than 48 hours. The rest stay for more than two weeks with a high probability of death.”

Across the corridor is an intensive care ward with four beds. The oldest patient here is 71. He has been addicted to alcohol for 30 years, and he arrived at the hospital 8 days ago. “This is a case with the most severe pathologies, when almost every organ is affected,” ward doctor Serhii Terletsky explains. “The constant use of alcohol causes pathological, dystrophic changes to the internal organs — the cardiovascular, nervous, and digestive systems, and the liver. Encephalopathy sets in: total pathological changes in the brain.”

Patients lie motionless, wrapped in blankets. They do not speak, smile, or react. Are they conscious or just sleeping for a long time? “They are not sleeping,” the doctor explains. “This is a normal state for them — an ordinary one in their case. They are conscious, but their consciousness is different.” Doctors do not know how long they will stay in the intensive card ward or whether they will be able to return to an active, conscious life. They say that everything goes case by case — nothing can be predicted.

The hospital has no special equipment, cone/tubes, or drugs. The main service is care: to turn the patient on time, feed him if he does not eat, and calm him down if he gets nervous. Decades-long alcohol abuse causes irreversible changes in the body, and such patients need daily intensive care. In most cases, family members have no desire to do this. Sometimes they bring in a relative and instantly say that it would be better if he did not come home.