Transformations of the healthcare system headed by Ulana Suprun have made medical issues one of the most relevant in Ukraine. Some Ukrainians support the direction of changes and actively use them, others criticize the methods of reforms, but almost everybody discusses the reforms of the healthcare system.
In an exclusive interview for Opinion, Ulana Suprun told about the changes in the culture of healthcare and medical education, about her conscious choice to come back to Ukraine and develop the country.
The Healthcare Reform is being much criticized in Ukraine. It is said to have destroyed the healthcare system. What is the world community and international partners’ attitude to these transformations?
When I go abroad and tell what we are doing now, I am invited to present our activity in Ukraine to other countries. Because we are one of the best examples for them how to do everything right when the healthcare system is being changed. We are building a universal network for every citizen to have equal access to medical aid. This is one of the WHO, the World Bank and the UN’s goals by 2030 – to provide access to healthcare facilities to all countries, to all citizens, to ensure the financial and physical ability of everybody to get medical aid. Our international partners tell the world community about Ukraine’s progress as an example of how things should be done right. We started from the primary issues. We develop fair and transparent rules of effective spending of even that little money we have to get the highest effect of health, living standards improvement and death rate decreasing. We want to guarantee a person aid in case of illness so the person won’t worry physically or financially, or about quality of service. It is very important.
Our partners from USAID, the World Bank, the World Health Organization, all embassies invite us to their events to speak about transformations of the healthcare systems in Ukraine as about the biggest and the most successful reform which is taking place in Eastern Europe. We tell other countries how we have done it and how they can do it.
The medical community of Ukraine is suspicious about everything new. Ukraine has a so-called “special national healthcare system”, national treatment protocols. Many people say that we can’t have the treatment they have in other countries. Students worry about international exams and say that our educational program differs much from the international one. Are there any national medical schools in other countries? Are any changes in students’ training and doctors’ development expected?
All people homo sapiens across the world have the same anatomy, biology, biochemistry, physiology, everything is the same. That’s why no separate treatment protocols can exist. Sometimes, there is some cultural difference in a treatment approach. But it doesn’t matter whether a person is from Ukraine or Great Britain, or India – if they have lung cancer, there are only a few variants: either operation or chemotherapy, or radiation therapy – it depends on a kind of tumour. We understand that there is a treatment methodology which works and has been proven by evidence-based healthcare.
Because of some reasons, Ukraine has separated itself from the world healthcare. During Soviet times, foreign specialists weren’t allowed to come, their western treatment methodology, the history of healthcare weren’t allowed to be read. However, Ukraine has been independent for 28 years so far, and it can easily enter the world community.
There is a reason which doesn’t let Ukraine do it. Many doctors don’t speak English. As Latin used to be a medical language, English is a medical language now. Almost all international conferences, almost all medical magazines are written in English. It is a fact. Today, doctors have to learn English to be able to work as they had to learn Latin in the past. And this is a new demand for our medical students. In their 3 Year, they have to take an English test to prove they have enough knowledge to read medical magazines, take part in conferences, have access to the most advanced textbooks.
The next thing is a cultural change in healthcare. Some Ukrainian doctors don’t want to change because they think knowledge they got decades ago is enough and they don’t have to learn anything new. Vice versa, there are new changes in healthcare almost every day, there are new inventions, new ways and new combinations of treatment, new diagnosis, new equipment. We have to change the culture in medical universities and in the community in general. Doctors have to study constantly. We’ve changed conditions of constant professional development of doctors. Every doctor has to gain 50 points every year. We will establish a professional licencing for doctors, and it will motivate them to constantly study. This cultural change will take some time, after the law on professional licencing is adopted, doctors will have a five-year transition period.
The third thing to be done is to raise the level of medical education. We have started with doctors, but we are also working with nurses – we are changing their training. New medical professions have appeared – paramedics, physical therapists, ergotherapists. We are widening professional opportunities for our employees so they could provide that medical service our country needs.
Our medical universities are autonomous, the Ministry doesn’t even approve their programs – they do it by themselves. The only way how the Ministry can influence the education quality is admission demands and licence tests: a single state professional exam, standards and demands for doctors obtaining medical education, and internship (practical postgraduate education).
We have set 150 points as the lowest passing score. It was a big struggle because now universities show that this year’s freshmen have evidently better knowledge. Besides, we are establishing additional exams in the third and sixth Years. Krok 1 and Krok 2 and additionally an international exam on the IFOM basics which will be held to equal our Krok to the international education standard. When our students write these exams as an average student in the world, we will understand that we gained the international level. Now we are establishing a clinical exam OSCE (objective structured clinical exam), then we will begin working with postgraduate education. We will widen the internship to make it longer.
A general surgeon has a three-year internship, while in the USA these are 6 years of postgraduate education. I am a doctor-radiologist, and my specialisation is women’s disease. I studied mammography, biopsy, MRI, and everything connected with women’s disease and specifically with breast cancer. I had a one-year general internship for all specialisations, then 4 years of radiology, and one year in women’s disease. After six years, I became a junior doctor. Having worked for some years, gained some additional experience, you have to pass an exam to confirm the specialisation of doctor-radiologist. Now, I belong to the American College of Radiology which requires a certain level of medical knowledge from me. Every year, you have to apply for the membership and confirm that you are constantly studying, because the level of requirements is very high.
I would like Ukrainian doctors to have self-administration. To have a possibility to control each other independently and demand a very high level of medical service, responsibility, ethics, behaviour from each other. Until Ukrainian doctors take such responsibility on themselves, the Ministry and licencing commissions will require these from doctors.
After young doctors spend some years at their positions, they will understand that they should unite because educated ones will want to see changes, enter the medical community. To achieve this, they should create their community and present it. This is how they will be able to achieve the international level and introduce Ukraine in the healthcare community.
Because, unfortunately, these days, healthcare in Ukraine is decades behind the modern international level. We have to jump over these decades and enter another, almost the third decade of the 21 century.
I believe we will manage to do it. A good example is mobile phones. Years ago, we had to wait for years until our house was connected to the phone network. I had friends that lived in a remote district of Kyiv, they waited five years to get connected. Now, everybody has a mobile phone, even old ladies in remote villages. In this regard, we jumped over the years very quickly unlike other countries.
I guess we can do the same in healthcare. We have to support young doctors and become closer to the world healthcare. But to achieve this, we need old managers not to disrupt changes as they do now. When an average worker of the National Academy of Medical Science is 77 years old – it disrupts. Those who are in office, please resign, let’s change something – and this is what we should do. Young people who are more advanced understand the evidence-based healthcare, they are ready to do clinical study, elaborate new protocols, implement new things, they need more room to do it. The Ministry has done it because most of our employees are 35 years old or even younger. Many of our experts are younger than 40 years old. They are modern and English-speaking, they attend international conferences and not only take part but give lectures. Ukraine has such specialists but the old community does not give them a chance to perform. Some of them rarely give a chance but it must be so in most cases.
You studied and worked in the US. When the Revolution of Dignity started, you joined the volunteer movement in the Euromaidan, and then the volunteer movement at war in Donbas. After a while, you headed the Ministry of Healthcare of Ukraine. Please tell how and why you came to Ukraine and started transformations?
I wasn’t born to an immigrant family who migrated to earn more money or something like that. My grandparents and parents were forced to migrate after the Second World War. For my whole life, I was growing in the community of people who were waiting for a chance to come back to Ukraine. I wasn’t an average American girl, I was Ukrainian who happened to be in another country, in exile. We were to come back to Ukraine given the opportunity.
I was 11 when I first came to Ukraine. It was 1974, Brezhnev was the leader of the USSR. I was growing in the equal democratic country, that’s why when we came to the USSR, I saw the prison of our people, of our nation, the prison that country was. Our family couldn’t even visit us. And when we came, the KGB was chasing us and didn’t let us come to the village where my mother had been born.
The only possible flight was through Moscow, no direct one to Kyiv. When we arrived in Moscow, all our baggage was opened and all the presents we brought for our family were taken away. Our relative who came with us was a priest. He brought Bible copies. What impressed me the most was that they took them and then they forced him to sign the paper telling he gave them voluntarily. Otherwise, they wouldn’t have let us cross the border. I also didn’t understand why they laughed at a doll I brought. I had other clothes for the doll. They asked what those were. I said that was a doll and clothes for it for my cousins. The customs officers laughed and grabbed them for their children.
It was the first thing I saw after the 12-hour flight. They kept us in the airport for 12 hours. It had a huge impact on me, a 12-year-old girl. Then, they chased us everywhere.
When I was elder, I took part in different youth civic organisations. I was a member of PLAST (Ukrainian scout organisation), the UYA (Ukrainian Youth Association), and the Mikhnovsky Ukrainian Student Youth Association. We took part in different organisations, held protests in front of the USSR embassy, demanding to release Yuri Shukhevych and other political prisoners. We attended a Ukrainian school during the week, the Ukrainian church on Sundays, took part in PLAST meetings. Our life was Ukrainian, all my friends were Ukrainians.
The second time I visited Ukraine was in 1990, in 1991, I attended a medical conference – by that time Ukraine had already declared independence. We started to come more often with my husband. In 1992, I brought my grandad who hadn’t been to Ukraine since 1944. Then, he saw his sister-twin for the first time in 50 years, and it was something incredible for them. We came often, but I had a job to do, I was finishing my residentship. In the US, you have to pay for your education, so I had to pay for the loan. Then, my parents got ill. But we came often.
Finally, in 2013, we decided to move here. I had been working in Manhattan for 15 years. I worked in a big prestigious clinic, so I sold my share and we decided to move here. But we didn’t intend to transform the healthcare system, we had another idea. Then, Yanukovych was the president, and we saw that there was revenge taking place in Ukraine, everything was turning back as it used to be. Our idea was to come here and do cultural projects. We believed that changes could be implemented through culture. Through films, literature. We wanted to create independent Ukrainian films, translate Ukrainian authors into Ukrainian to widen the market,
We wanted to buy a three-floor house in the historical centre of Kyiv. It was supposed the first floor to have a coffee shop, the second to become a place for plays, art events, the third to be our apartment. These were our nice ideas.
So, in 2013 we sold everything and moved to Ukraine. We came on the day the students were beaten by the police on the Maidan. The history changed and we started to be occupied with the Revolution instead of cultural projects. We had a very good basis as we spent our young years in PLAST, we realised very well what protests were and how proper assistance for them should be organised. When after the Revolution of Dignity, the war started, we began helping the military with military healthcare. It has two elements: tactical and medical ones. We helped within both directions, the civic organisation “Defence of Patriots” we created still works with the military.
In a year, Prime Minister Volodymyr Hroisman invited me to work for his government in order to change the healthcare system. My only requirement was that I had to start with my own team and nobody would give out positions.
And we started to change the system. To continue changes, we have to provide changes in education. As a doctor, I consult and help my friends who come to me after Ukrainian hospitals. I help them to realise what issues they have, find doctors for them, and I am very anxious about the level of their knowledge, expertise, ethics and other professional values. The level differs much from that they have in the US, Germany to other countries we look up to. Changes in education are crucial. Because it is the only way to guarantee a good quality of medical service and higher dignity of the profession. Besides, we have to return respect to the profession because these are doctors who are guilty in the absence of respect to the profession.
Almost every year, you attend the Book Arsenal (a book fair) in Kyiv. What books have you bought this year, and do you have enough time for reading?
Unfortunately, I almost have no time for reading. For example, today we have our interview, before that, I had 5 more meetings. I come home at 10 p.m., and sometimes we begin working from 8 a.m. So, most of my time I read mostly papers or other related information. Sometimes, I have time when I am in transport going somewhere, then I try to read. This year, I’ve bought different books at the Book Arsenal – from comics to a very interesting for me book of Ukrainian feminists. It is written in English and Ukrainian, they told about their worries. I’ve also bought some prose and poetry of Ukrainian soldiers. The last book I read was a Ukrainian translation of Isaac Asimov’s Foundation and Game of Thrones by George Martin. I’ve read these books in English but I like them in Ukrainian, too.
Healthcare field is naturally one of the key priorities for any country. So every citizen uses its service sooner or later. The Ministry of Healthcare team states that the reform has to be conducted despite any political turbulence in the country. However, as Ulana Suprun summed up, “Real changes is a complicated process where time is the main enemy. Populists and corrupt officials’ hate speech, constant court issues, political turbulence, informational campaigns and strong opposition of healthcare feudalists take much energy and strength, but they won’t stop the changes as it is time for them.
Interview by Svyatoslav Linnykov