The country is taking the first steps in implementing the system of rehabilitation of patients. Since the beginning of this year, the main principle of the reform of the medical sector ‒ the money goes to the patient ‒ got a real sense in the organization of the sanatorium stage of rehabilitation of the patients. The government has proposed a scheme that first takes into account the wishes of a person. In a trilateral agreement, the patient is in the first place, then the Social Insurance Fund, through which the state provides the patient with the reimbursement of medical expenses, and the sanatorium, in which there is a corresponding rehabilitation department. Opinion learned whether the resort industry is ready for such innovations.

Let the headline of these notes not to confuse those, who are well aware of the curative power of the Morshyn waters: the resort remains the leader in the treatment of the liver, biliary tract, pancreas, intestines, stomach, diabetes. But today’s respectable 140-year anniversary it meets with the next step, creating several rehabilitation departments. Including cardiologic.

Doors in such innovations were opened by the decision of the Social Insurance Fund on the reimbursement of expenses for provided social services for the treatment of insured persons and their family members after the transfer of diseases and injuries in the rehabilitation departments of sanatorium and resort institutions, which came into force from January 1 this year. Therefore, if after consultation with the doctor, the patient says: I want to treat the heart in Morshyn, no one denies him or her, and money will “follow a patient”.

After surgery ‒ rehabilitation

What does this mean in general? This is a real revolution in healthcare. Because we, in Ukraine, don’t have just a problem with rehabilitation ‒ it’s a catastrophe. Everyone knows: even after a successful operation, other difficult states of a person, a person needs a long time to return to normal life. And this is certainly not the case of the district therapist, under whose supervision a patient is usually passed along with the discharge.

Meanwhile, the chief doctor of the sanatorium and resort complex “Morshynkurort” Oleg Melnyk notes: “In Poland, the Czech Republic, Hungary, whose experience we studied, immediately after the operation the patient is given a direction for rehabilitation in a sanatorium”.

On what, for example, should people with diseased hearts count? The conditions should be created that allow the heart, which is functioning poorly, to be restored. In particular, to provide psychological rest, give minimal procedures, observe pressure and pulse, to take care. By the way, mineral waters, especially rich with calcium ions, magnesium, potassium are useful to them. It is these microelements in large quantities that Morshyn water contains. And the most important argument: a person does not feel thrown at the will of fate.

“More people from certain regions are sent to us to cardiology instead of the formerly specialized sanatoria, thanks to the fact that we provide quality services”, says Oleg Melnyk. “Because now it is different times, and the people are different. After all, there is a situation: conditionally, the pioneer camp was turned into a sanatorium, primarily on paper, they launched an advertisement, 500 people came to them. What they did there was unknown. Now the patient agrees on the issues of rehabilitation with the medical doctors, and those, in turn, consult with our doctors. We note that people are already coming for their money, and our departments were advised by the patients, who were here for free. So, for 8 months of this year, we had 1800 people, who had the course of rehabilitation. Of course, most of all ‒ with traditional, for this resort, diseases, in particular, diabetes. This is not uncommon for us, we care about such patients for a long time, only this was called in a different way. Let’s say, after the removal of the gallbladder, the body adapted much faster to function without it. We were pleased that nearly 300 patients with cardiological pathologies chose us, as many as with the neurological ones. Another 300 ‒ with traumatic problems, although the department was created only 8 months ago. This is a real jump ‒ another word, it seems, does not match here, an indicator that we are standing on the right path.

Innovation is not a problem when there is a medical base

So why for Morshyn it turned out to be very easy to get acquainted with innovations? Another 10 years ago, the then chief physician of “Morshynkurort”, the ideologist of his modern renovation, Bohdan Aksentiychuk, told us, journalists, looking far ahead and convincing of the benefits of insurance medicine: “According to the statistics, 40-50% of the expensive stationary bed fund is occupied by people, who do not need such treatment, but could be more effective for them to get the rehabilitation in the departments of our sanatoriums. Morshyn ‒ a resort of this level”. Therefore, he managed in a short time, that he was left in this world, to begin the radical reconstruction of a balneotherapy clinic, to bring medical units into one structure, previously dispersed in all five sanatoria, entering into health resorts. Now, going into a separate 7-storey building of the treatment and diagnostic center, the patient can learn, it seems, everything about his body. And this is, above all, the merit of the chief physician of the institution Nina Polovynko. Her model is exemplary, not only thanks to the latest equipment, about the replacement of which she constantly cares, staffing, but also because it functions as an impeccable mechanism.

We arrive at 7 am along with a blood sampling assistant. Surprisingly, I do not feel any discomfort, when the assistant takes it from a vein. I make a compliment to the medical sister. “Consider the fact that we have German system”, she answers. “And such quality disposable materials are everywhere. Another, especially important for the nervous patients, is the following detail: there is no usual hospital smell here, which usually encourages to bypass such institutions.

In general, the laboratory in the early hours can serve up to 150 people. Everything is adjusted so that the vacationers have time to drink some mineral water and have breakfast. Meanwhile, 40 of its employees are engaged in biochemical, clinical, immunological, cytological research. Here, even skin, hair and nails are taken for analysis to find out if there are fungal diseases.

Again, they are trying to learn as much as possible here about the visitors, and then monitor the state of the human body. After all, from the very beginning, the resort was positioned as medicinal ‒ the local water is highly mineralized and has to be drunk only under the patronage of a doctor, Nina Feliksovna emphasizes. Therefore, the patient must do an ultrasound scan, exclude gallbladder and kidney stones, make partially biochemistry, that is, determine the activity of the process in the liver cells, and the doctor must also know the situation in the pancreas and kidneys. For your information: a stone is formed in the gallbladder for six months, in a kidney for a year.

“We are engaged in the diagnosis of cardiovascular diseases”, Nina Feliksovna says in the next room, where the new apparatus takes the cardiogram. “Because people come with pacemakers, after heart attacks, shunting, stenting. Unfortunately, they deceive us, they want a lot of procedures, but there may be a heart attack in the bath, because the thermal procedure is incompatible with that. They think they have made diseases for 30 years, and here they will cure them in 10 days. Sometimes we do a cardiogram a few times. An experienced doctor and equipment allows you to make a diagnosis at a difficult level.

At the same time, we rejoice with the attitude of foreigners towards treatment, and there are more and more of them. “I have such patients, which changed Karlovy Vary, Baden-Baden to Morshyn, they even come from Australia, Canada, Germany, the Emirate; Bulgarians, Czechs, Slovaks visit us. They listen to every word of the doctor and follow all his instructions”, he says.

The constant increase in difficult patients encourages workers to improve. 22 doctors and almost 90% of nursing staff have the highest categories. “A doctor cannot be good, he must be qualified,” Nina Feliksovna likes to repeat.

In total, 15 narrow specialists work in the corps ‒ from a psychotherapist to a dentist. No one is sitting without work; sometimes a visit to one of them attracts several others to consult.

“There are such patients, who have not yet visited an endocrinologist or a general practitioner, but complained to an oculist about blurred vision. For the first time we see changes in the vascular fundus and then we refer them to these specialists”, they tell us in the ophthalmologic office. “Some patients are on the verge of neurology and psychiatry — difficult situations at work, in a family, lead to loss of vision, and we deal with this and refer to a neuropathologist or psychiatrist”. Here, they even pick up glasses not blindly, by changing glasses, they have long since abandoned such an old-fashioned method, but on the most modern apparatus, which makes no mistakes. I know for sure: in the capital, many patients have never heard of this.

Conference checked the clock

Therefore, it is natural that the scientific-practical conference, which “Morshynkurort” organized during the celebration of its 140th anniversary, was devoted to the issues of medical rehabilitation. And Morshyn personnel had something to say on it, and whom to listen to. Foreign experts came to share specific developments, and our scientists, who did not stop research on the effect of resort factors on the recovery of the body, and those few colleagues from the sanatorium complexes, who were able to survive in difficult times, fight off the raider seizures, repurposing to trendy spa facilities with Thai massages and weight loss programs. Unfortunately, there is no help for one million cancer patients, 49% of whom are of working age. I do not intimidate ‒ these figures were voiced from the tribune. And, for example, the sanatorium “Roshcha”, in the Kharkiv region, which gives hope to patients not to perceive this disease as a sentence, is only one in the country. Meanwhile, the head of the Department of Oncology and Pediatric Oncology of the Kharkiv Medical Academy of Postgraduate Education, the full member of European and American specialized societies, Professor Oleksandr Dudnichenko needed years of walking around the cabinets to create a department of therapeutic oncology and rehabilitation. And only now such activity is licensed. And on the whole, humane things were offered ‒ the scientist defended the idea of drug treatment of cancer patients in sanatoriums, caring also about the quality of their life.

“Our patients need such condition so that they do not feel doomed. In a cancer hospital this cannot be done. They begin to vomit only from the looking of such a hospital, from a white coat. In the sanatorium, they are deprived of such emotions, because they are among different people, including healthy ones, around beautiful nature.

In the rehabilitation department, I try to take patients with concomitant diseases. For example, one of my patients, a violinist by profession, suffered a stroke 10 years ago, as a result of which, the right upper limb did not function. And this year he had lung cancer. He found out about our sanatorium and asked if it was possible to undergo chemotherapy here. I say: we do that. A week later, his wife told me: “A miracle happened: for the first time in 10 years, my husband took a fork in his right hand”. And there was no miracle, in fact. Just after chemotherapy, we immediately rehabilitate. This suggests that if our patient had been rehabilitated 10 years ago, the arm would have recovered. I will note the following: chemotherapy for patients with comorbidities ‒ a stroke ‒ no one performs, it is contraindicated. We undertake, we have a team ‒ a cardiologist, a rehabilitation therapist, who deals with oncology patients, and an instructor of exercise therapy, who deals with the rehabilitation of cancer patients only.

By the way: to recruit such a command is not a simple formality. After all, only two years ago, a medical specialty was introduced to medical universities in the country. This implementation was possible due to the Ukrainian Society of Physical and Rehabilitation Medicine and its Chairman Oleksandr Vladymyrov. Now, thanks to the efforts of this organization, the so-called “White Book on Rehabilitation” is being translated into Ukrainian, where the actions of a specialist in each particular case are described in detail.

I ask Oleg Melnyk how they overcome the personnel shortage in “Morshynkurort”.

“Previously, rehabilitators graduated only from the Institute of Physical Education, ‒ he responds. ‒ This is a little different, but still. The paradox is that they could not find a job anywhere, because the profession belonged to the field of social security. But what is social security, when a person needs to return the ability to work? This is a healing process. Therefore, we also had such graduates, only registered in other positions. We sent them to one training, other. And this year we introduced the post of rehabilitologist. Although we will not see the “correct” diplomas soon: this year Ivano-Frankivsk University got bachelors, and Lviv Catholic University ‒ masters.

Subsequently, the hospitals will be waiting for such specialists, where the rehabilitation departments will be created. In any case, one of the reports at the conference cited successful examples of the application of early rehabilitation from the moment when a person regained consciousness and anaesthesia ceased to operate.

It is not so bad

Another misfortune called diabetes mellitus, the prisoners of which are already one million patients, and two more are in the risk group, another one of our glorious health resorts, “Myrgorodkurort”, is struggling in every way. Here, for more than 15 years, the basic in the country school of full-fledged life with diabetes and the Sanatorium and Resort Rehabilitation Center for Children and Adolescents have been working, as well as departments for adults. Even the European partners of Myrgorod personel admit that such a complex of modern equipment and effective techniques is not often met. And here the rehabilitation direction began with the opening of the first such department for the liquidators of the accident at the Chernobyl nuclear power plant. Now, Natalya Butenko, Deputy General Director of “Myrgorodkurort” for medical issues, tells me that there are already 18 of them. Among the latter, for the recovery of ATO participants. “The presence of a solid medical base (here is also a powerful diagnostic and treatment center ‒ author) It gives us the opportunity to individually approach each patient, despite his diagnosis, to monitor the state during the treatment, and also to make individual treatment programs. The cardiology department is in special demand because for a long time we have been working with the capital institutions named after M.M. Amosov and M.D. Strazhesko”.

Unfortunately, there are few such complexes that have built a medical base over the years. However, there are scientific developments of resort treatment, there is the experience of the best, there is support from the relevant ministry, and, most importantly, the interest of practitioners. They just say: the rehabilitation of patients is not cheap and the government should take this into account.

Text by Natalya Lishchynska

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