Download 16.82 Mb.Pdf ko'rish
- Bu sahifa navigatsiya:
- ISBN 0-902322-39-7
THE UKRAINIAN REVIEW
former Soviet republics is Russia. Consequently, Ukrainian leaders have
sought other sources of assistance and support to improve their country’s
economic situation. When visiting Iran, the Ukrainian speaker o f Parliament
stated that “cooperation between Iran and the newly independent Central
Asian republics and Ukraine will help consolidate the independence of
those stales”, and that Tehran should help Kyiv “further consolidate its inde
Such statements confirm the views of the present Iranian leadership who
warn the former Soviet republics to avoid falling into the “trap of the West”.10
Tehran is pleased that ideology and oil wealth are acting to extend its
influence in the former Soviet territories. However, in the case of the
Christian Ukraine, only the second factor applies.
Both Ukraine and Iran are concerned about Russia’s ambitions in the
newly independent states. Russian military intervention in Tajikistan (a
country with a Persian-speaking population), and Russia’s dispute with
Ukraine over the Black Sea Fleet and the Crimean peninsula, provide a com
mon ground for Kyiv-Tehran consultations.
In appraising Iran’s relations with Ukraine, the Turkish factor should also
be taken into consideration. Turkey and Iran share an interest in the Central
Asian and Caucasian republics, which has been interpreted as a competition.
In view of Turkey’s lead over Iran in the Black Sea region and the Turkish ini
tiative in setting-up the Black Sea economic zone, Iran’s intention to find a
foothold in this region, through Ukraine — and Georgia — is understandable.
Finally, Iranian leaders are pleased with Ukraine’s humane treatment of
the Crimean Muslim Tatars who are willing to return to their homeland in
the Ukrainian territory.
' Tehran Times, May
T H E STATE OF TH E U K R A IN IA N HEALTH S E R V IC E
Prof. B.H. Iskiv
Providing national health care is a complicated and complex issue, which
includes economic, ecological, socio-psychological, public health, financial,
demographic, educational and strictly medical aspects.
It is widely believed that it is principally medics who are involved with
health care. In actual fact, their work caters for only about 10-15% of health
In the broad sense of the word, health care is an issue which touches the
life o f the individual, society, and the nation.
The last few years have been fruitful in concepts, doctrines and health
care programmes of the Ukrainian people.
I should like, first of all, to expound the following concept as the basis
for a contemporary doctrine on health care of the Ukrainian people.
1. The basis of the health care system must be the principle of multilateral
improvement of the physical and psychological strength of the Ukrainian
people as a whole, as well as every individual citizen regardless of his or
her material status.
2. To implement this principle, the state, community and private sectors
have to work together in harmony to build and operate the health care system.
3. The health care system in Ukraine must include measures to:
a) improve the general health of the population;
b) strengthen the physical and psychological health of the nation;
c) prevent disease, reduce the morbidity and mortality rates, increase the
birth rate, increase life-expectancy, and raise the capacity for work of the
d) organise public health and prophylactic services;
e) organise health-care and treatment centres;
f) provide the Ukrainian armed forces with the best possible medical ser
vices of all kinds.
4. Measures for the health care of the population, that is health care legis
lation, public health and prophylactic programmes, general planning of
health care, the establishment of a network of public health, prophylactic
and treatment services, and monitoring of the whole health system, and in
particular medical care, must be, basically, within the competence of state
power and guaranteed by the state budget.
5. To avoid the bureaucratisation of medical care in Ukraine, primary, that is
non-hospital care, should be based on a network of general practitioners.
6. Medical establishments, the pharmaceutical industry and retail pharma
cies can be run by state, community or cooperative institutions and private
THE UKRAINIAN REVIEW
individuals. All these institutions and businesses will be monitored by the
state health care organs.
What is the current programme of Ukraine’s official organs of power regard
ing the health care of the Ukrainian people? On June 9, 1992, a bill “On health
care”, drafted by the Ukrainian Health Ministry, was published, debated and
enacted as a law by Parliament. This bill evoked justified criticism, and (in the
case of certain articles) outright indignation among medics. Under the terms of
this bill the I leallh Ministry would retain a strict centralised control over the
health service, allowing no administrative autonomy. The preamble and intro
ductory paragraphs of the bill were ideologically unsound and confused.
A parliamentary commission on health care then drafted a new bill, enti
tled" “The Fundamentals of the health-care legislation of Ukraine”. This bill
was passed on December 15, 1992, after a one and a half hour debate, with
out being published beforehand. The preamble and introductory paragraphs
o f this law have a more democratic character than the first bill, and the pri
ority o f health care in the activities of the stale is stressed. The President is
stated to be the guarantor of the right of citizens to health care.
Unfortunately, many provisions of the “Fundamentals...” take on a ten-
dencious and assertive character. There arc many inadequacies and faults in
both concepts and wording.
Thus, in article /i, “Fundamental principles of health care” arc staled to
include a "... humanist approach, the guaranteeing of the priority o f com
mon human values over class, national, group, or individual interests...”.
Are national values not “common hum an”? Why stress the “humanist”
approach, so downgrading to national values, and ignoring the very fact of
the existence of the Ukrainian people.
The “Fundamentals..." make no distinction between the two concepts
“health care system” and “medical care system”, and fail to specify the tasks
and responsibilities of the various organs and institutions of the non-medical
part of the health care sector. They stipulate a centralised administration of
the health service, give legal force to the social inequality of citizens (special
medical establishments for the privileged elite), give unlimited power to the
bosses of medical care establishments, and cast doubt on the need for pub
lic monitoring of the management of medical establishments.
A law should take a long-term view, and it is the task of the stale to
ensure its citizens not a minimum standard of living, but a decent one. This
means that the percentage of the national income represented by ihc wage
fund should gradually increase so that workers will have sufficient funds to
renew their physical and psychological forces, and to ensure ihe normal
upbringing and development of their children.
Is a reform of the health service possible without the establishment of an
effective watch-dog system to monitor the management of medical establish
ments? Such a system, working on the principles of independence, impar
tiality and justice, would do much to resolve all the problems which sur
round the provision of health care.
The establishment of the young Ukrainian state is fraught with difficulties.
The catastrophic economic situation is having a painful effect on all spheres
of life, and on the health of the people, perhaps most of all.
One must not forget that Ukraine inherited from her colonial status in the
USSR, the degradation of her soil, forests, and aquifers, as well as the plun
dering o f her mineral resources, outmoded agriculture, disproportionately
developed industry (catering first and foremost to the needs o f the military-
industrial complex), and a very poorly-developed medical and pharmaceuti
cal industry, as the total lack o f production facilities for vaccines can testify.
The main emphasis in the health service was put on quantitative indices:
the increase in medical staff and the number o f hospitals, the construction of
giant medical centres to order and for the party n om en klatu ra. There was
virtually no up-to-date medical technology, and primary health care was
utterly neglected, particularly in the rural areas, and the majority of clinics.
Despite a huge number of doctors (in 1982 — 195,600, or 38,900 per 10
thousand inhabitants) and medical establishments (3,808 with 652,500 beds),
Ukraine did not mange to prevent the process of depopulation. The mortali
ty rale in Ukraine is several times higher than in the developed countries
(from accidents and poisoning — 1.5 to 2 times, from cardiovascular disease
— 50-80%, and from respiratory disease — 30-40%).
The average life expectancy of the Ukrainian population is 70.9 years (66.4
years for men, and 74.8 for women). In western countries the average life
expectancy for men is some 6-9 years greater, and for women — 4-6 years.
In general, the high mortality rate is caused by such factors as the poor
state of the health service, bad working and living conditions, the environ
ment, and individual lifestyles. In Ukraine the mortality rate of men of work
ing age has been on the increase for a considerable time. Men of this group
arc dying more frequently than women from accidental poisoning and other
accidents (4.5 limes), from diseases to the circulation system (1.4 times), res
piratory diseases (2.3 times), and cancer (1.9 times).
The medical-demographic indices of the Ukrainian population are causing
considerable alarm. The dynamics of these indices indicate a drastic deterio
ration of the health of the nation. The overall mortality index has increased
over the past few years and now equals 11.6 per 1,000 inhabitants. This fig
ure is significantly higher than for the countries o f western Europe.
The birth rate in Ukraine, which in 1913 amounted to 44 per thousand
inhabitants, under Soviet rule fell constantly and presently amounts to 12.7
The decline in the reproduction rate is not conducive to socio-economic
In Ukraine only 56% of families have children; every second family has
only one child. Forty thousand women a year have abortions and out of
every 1,000 infants, 14 are still-born.
The decline in population process began in 1979 in the villages, and in the
1990s in the cities. In 1970 the natural increase of the population amounted to
THE UKRAINIAN REVIEW
more than 300,000 a year, in 1980 — 174,000, and in 1990 — 28,000. In the vil
lages the number of deaths exceeded the number of births by 58,000. In 1992
the death rate increased three times, exceeding the birth rate by 120,000.
The reasons are generally known. Today it is not only individual doctors,
scientists, and journalists who are sounding the alarm, and describing the
present tragic situation of the Ukrainian people. There are hundreds o f insti
tutes and committees, although no top-level national demographic commit
tees or institutes, which would be able to resolve the demographic crisis.
What practical measures can be taken to improve the health service, and
where to begin this process so far remain unclear.
The weakest link in the health service is the polyclinics. Are the people
satisfied with the system of. district service by therapists and paediatricians?
Are doctors and nurses themselves satisfied with this system, and do they
receive adequate pay for their hard work? During outbreaks of influenza,
district therapists frequently dish out sick notes to patients without so much
as feeling their pulse. And if a patient suffers from hearing or sight prob
lems, or problems with the nervous system, they are completely helpless. To
improve the health service, judging from the experience of other countries,
the polyclinics need to start training family doctors who would be interested
in good salaries, and thus will know and be able to do a lot. One should
think how to rationally use the huge polyclinics, whose offices can be rent
ed out to individual family doctors.
The cost of hospital care in Ukraine is a huge drain on the state. The
experience of developed countries indicates that the huge hospitals we have
in Ukraine are not cost-effective. The introduction of proper medical and
surgical standards must be deferred. This type of reconstruction will mean
abolishing the obsolete preference indices of medical hospitals.
The introduction o f the standards accepted in the civilised world will
allow the duration of in-patient treatment to be reduced, save money which
can be reassigned to the acquisition of medical technology, release space
and allow the establishment of ancillary services and departments (remedial
exercise, massage, physiotherapy, etc.).
Finally, one should think about payment of doctors, employees of med
ical departments, and laboratory staff in accordance with international
scales, and to improve their working conditions.
One can hardly expect the health of the Ukrainian people to improve
unless the medical sector, and not the state administrative leadership, is
made legally responsible for health care.
The environment and recreational facilities have been extremely neglect
ed, and the holiday industry barely exists at all.
Workers, and in particular teenagers, do not know what to do with them
selves in their free time. Alcoholism, drugs and crime are therefore rampant.
The state has virtually given up building gymnastic and sports facilities. New
housing developments, as a rule, lack public baths, saunas, not to mention
stadiums and health centres.
The anti-alcohol and anti-smoking campaign is a low priority.
The lack o f a responsible medical staff is a major misfortune for the
Ukrainian nation. The party n om en klatu ra and the h o m o Souieticus it creat
ed in medicine and its administrative system has an overtly anti-Ukrainian
and anti-democratic orientation. In words they are for independence, but
take independence to mean an all-embracing permissiveness and indepen
dence from their own people. How else can one explain the disrespectful
attitude to the Ukrainian language, the sabotage of medical supplies, the
theft, including humanitarian aid, and the misuse of positions. For them the
needs of the people and national problems are completely alien.
The system of medical education in Ukraine needs a thorough reform at
all levels, starting with medical schools and institutes.
Some positive trends may be observed — the introduction of three-year
internships, the establishment of new Ukrainian programmes o f post-diplo
ma studies, and the computerisation of the education process.
However, h om o Sovieticus is putting up overt and covert resistance to the
introduction of the Ukrainian language in the teaching process. Some pro
fessors are totally u n con cern ed about the virtually com p lete lack of
Ukrainian medical literature, and the training of medical staff with a sense of
responsibility to the population of Ukraine.
The problems are enormous, and can clearly only be solved by an inte
grated and multi-disciplinary approach.
The Third Reich and the Ukrainian Question.
In this 175-page collection Wolodymyr Kosyk subjects the Third Reich's attitude
towards the Ukrainian question to a painstaking analysis by compiling and com
menting on the crucial documents covering a decade (1934-1944) which encom
passes both peace and war.
This period of German-Ukrainian relations has heretofore been largely overlooked
by Ukrainian and other scholars. Thus, Kosyk’s attempt is a pioneering one. He
draws the materials for his work from such unimpeachable sources as: the
German Federal Archives (civil and military), the German Foreign Ministry, and
the International Military Tribunal in Nuremberg.
Published by the Ukrainian Central Information Service, London
Price: £8.00 ($15.00 US)
Orders to be sent to: UCIS, 200 Liverpool Road, London N1 1LF.
THE UKRAINIAN REVIEW
H IG H E R EDUCATIO N IN U K R A IN E —
IN T E R N A T IO N A L COLLABO RATIO N IN
D E VE LO PM EN T
Higher education means universities and colleges, courses, training, edu
cation, research, scholarship and enlightenment by a variety of different
methods in an infinite number of circumstances. Quite what mix of higher
education institutions and higher educational provision is appropriate for
Ukraine cannot be elaborated yet, and the reasons are many.
In the first place the demand for higher education in Ukraine has not been
reliably modelled, nor can there be any reliable economic forecasts upon which
to propose a new funding mechanism. In the second place the research has not
yet been done into labour market trends, demography, wastage, student
demand, etc., in order to map the existing terrain, which in most countries pro
vides the background for higher education policy. In the third place, it is not
clear who will carry out the economic modelling, or propose a funding mecha
nism, or research labour market trends, or ask the students what they want.
Moreover, it is not clear that the key questions, like the ones above, are really
being asked, or that there is the intention, awareness or motivation to ask them.
The pressure for change in the higher sector is mainly external, in that it
is forced by economic circumstances and the absence o f ready alternatives
to central funding. However, the pressure for change is unplanned and in a
very real sense, change itself is out of control. Unfortunately, nobody seems
to care much about this in the West.
Foreign news teams were agog when the break-up of the Soviet Union
spelled potential civil war between the former republics, at least three o f
which were in possession of nuclear weapons which they might, it was
argued, provoke each other into using. Relations between Russia and Ukraine,
given the bitter dispute over the ownership of the Black Sea Fleet, have been
at times very tense, but with the stakes being so high the most powerful states
of the CIS have successfully resolved their differences by diplomatic and eco
nomic means. Ukraine’s offer to give up her nuclear weapons was a calculat
ed gesture of peace which Britain and France have yet to venture, although
paradoxically, it is the civilian use of nuclear power which causes the greatest
damage, and which continues to threaten and pollute.
Nuclear issues do still make the news because the dangers threaten
everyone in Europe, but the weariness of ordinary people struggling with
David Randall is the East European Development Officer at Kingston University.
the stress, uncertainty and discomfort o f the economic crisis and the day-to-
day trials of the new Ukrainian democracy no longer get reported in the
g en eral m edia. Much hot air and film footag e is still ex p e n d ed on
Kremlinology. The machismo of the leadership battle between Yeltsin and
the parliamentary opposition leading up to the April 1993 referendum com
pletely dominated the “quality” press for months, at the exclusion o f all
other news including the remarkable turn-around in the supply of goods to
The uncomfortable truth is that the struggle for democracy is only really
newsworthy when a blood-bath is just around the corner, and if western
audiences cannot have their blood, then they can be tempted by tasty
morsels which pander to their ghoulishness and desire for self-aggrandise
ment. All that remains of the 1991 Coup-days fascination with “freedom” in
the USSR is quasi-investigative reportage about the rise of organised crime,
poverty and corruption, the collapse of the health care system or the spread
of drug abuse, prostitution and aids.
Somewhat surprisingly, the media seem to have grown tired of churning
out low-brow titillation from eastern Europe. Perhaps the public appetite for
such material was not limitless after all. Nevertheless, it will be too much to
expect' the present vacuum of news from Ukraine to be filled with insightful
reporting on serious change issues. That never was the case, and it is even
less probable now.
The mass media have largely failed to capture either the detail or the
essence of the difficult social challenges which Ukrainians face. This failing
blunts the educative impact of the modern communications media, and at
the same time it diminishes the power of the media to enlist appropriate
overseas support for burdensome modernisation processes.
Yet in spite of the lack of information on life in Ukraine in general as well
as higher education in particular, there has been expanding cooperation
between Britain and Ukraine since the lifting of the Iron Curtain and subse
quent Ukrainian independence. The reasons for this lie in the resourceful
ness of people and organisations and their ability to get on with life on their
own terms. The new initiatives, from business to cultural exchange to edu
cation and training may be motivated by self-interest, sometimes by altruism,
but they are executed by independent agents in pursuit of concrete objec
tivés; objectives beyond the dictates of fashion.
The role of higher education in these cooperative processes has been to
find ways of coping with external pressures for change in Ukrainian educa
tion. The responses are largely locally organised, and are specific to particu
lar universities or other higher education institutions.
Inter-governmental initiatives have, of course, been important catalysts in
cooperation between partners, particularly in the area of market reforms and
inward investment in the private sector economy. However, government
money has tended to favour the private sector, to the detriment of inter-uni
versity cooperation, and the private sector short courses, MBA programmes
Download 16.82 Mb.
Do'stlaringiz bilan baham:
Ma'lumotlar bazasi mualliflik huquqi bilan himoyalangan ©fayllar.org 2020
ma'muriyatiga murojaat qiling
ma'muriyatiga murojaat qiling