The subject of children's health becomes traditionally central at the beginning of every school year. The disease does not spare even the smallest Ukrainians - every year five thousand children are born with cardiac defects. Some children require immediate operation in the first 24 hours of their lives. ForUm had an interview with one of the best pediatric cardiac surgeon of Ukraine Vasyl Lazorishynets to learn about how doctors save little hearts and why the number of Ukrainians decreases.

Child's heart condition depends on ecology and life style of the parents

At what age are children diagnosed with heart diseases?

- As of today doctors can diagnose cardiac defects of a future child at 12-14 week of pregnancy, when a woman undergoes the first prophylactic medical examination. The cardiac tube (which grows into heart) is formed and starts beating at 19th day of pregnancy, and at 72nd day the heart is fully formed and can be examined for defects. At 20-22nd week another examination is usually held to specify diagnosis.

Earlier, when a newborn manifested four signs - heart hurry, pulseless legs, cardiac murmur and blue - doctors could diagnoses a cardiac defect in 80% of cases. Now we have developed recommendations on prenatal examination and detection of heart diseases. There are nonsurvivable defects, which bear risks, and pregnancy must be terminated.

Why does such small children have cardiac defects?

- There are plenty of factors influencing child's health. The main ones are ecology, life style and bad habits of parents. Then there is hereditary background and various infectious diseases, almost every person had: the so-called TORCH infections, a group of diseases that cause congenital (present at birth) conditions if a fetus is exposed to them in the uterus. There are also factors affecting the heart directly. If a pregnant woman has had measles, for example, the child will have a cardiac defect in 100% of cases.

You were talking about hereditary background. Whose health influence the child more - mother's or father's?

- Chromosomes are equally divided - 23 paternal and 23 maternal chromosomes. But there is an interesting point. We once held the research on certain cardiac defect together with Americans. They said: we do not need to examine fathers, but only mothers and children. It turned out that in US the biological paternity is confirmed in 60% cases only. That's a serious scientific fact.

As known, the Jews take nationality after the mother, and there is certain logic in it. It looks like they thought of it five thousand years ago.

Does the child fully recover after the operation or are there certain limitations?

- In 80-90% of cases the child becomes absolutely healthy, but there are certain defects, as univentricular heart for example, when we do not a possibility to make it physiologically healthy. There is also hypoplasia syndrome, when we have to form a ventricle and to perform two more operations. In general, if the operation goes well and in time, these children will be absolutely healthy.

How much does this operation cost to parents?

- Since 2003 we've been making these operations free of charge.

Does the number of your patients change from year to year?

- According to the statistics, the figures are approximately the same. We can manage 800-900 operations annually, Professor Emtsa's center makes 1300-1400 operations per year. There are other eight centers making such operations. Heart center in Kyiv makes 150, Lviv center also can manage 150, Donetsk center has been gathering pace lately. In total, we make 2-2.5 thousand operations annually, while there are about five thousand children born with cardiac defects every year. 

So, you always lag behind, don't you?

- For now, yes. However, the situation is improving within the time. There are 24 centers in Ukraine, making heart operations. I am very proud that in 2012 we have finally opened a cardiosurgical center in Transcarpathian region, where I am from. There are my students working there, who can make up to 200 operations annually.

How do you decide who has to pay for treatment and who is treated at the expense of budget means?

- We conclude a memorandum with the governor, which stipulates for patients' order. Regional head of the healthcare department decides on the order, and patients are sent to us accordingly.

So, there is a certain queue for small children, isn't there?

- No, there is no queue for anybody. Decisions on emergency cases are taken immediately. There were cases when ambulances brought children with already stopped hearts. In these cases, we start reanimation, plug in artificial lung ventilation, take other necessary measures, and children live.

Do you make intrauterine operations?

- No, we don't, but such operations exist in the world.

Why aren't such operations available in Ukraine?

- We do not have enough time to operate those already born... However, we are making progress. I spoke before about hypoplasia syndrome. The first successful operation was made in 2010. Successful...because we'd been trying since 1990ies, but children did not survive. There are about 200-250 children in Ukraine being born with this defect annually. They live up to 10 days maximum. Since we started making operations we've had 12 survivors. There is a girl who has undergone the second stage of operation and is doing well.

How many children do you manage to save?

- When I first came to the center in 1993, the mortality rate after the operation on certain defects was 27%. As of today, it makes 1.8% per 900 operations. The difference is huge, but still there is a child's life behind these figures. In total, the fatality rate in our institute makes 1.3% per five thousand operations.

Healthcare system's share in keeping people healthy is only 10-15%

How well is financing of the Ukrainian cardiac surgery department?

- 3.2-3.4% of GDP in Ukraine goes for healthcare. WHO says that if a country allocates less than 5%, the population of this country is doomed to extinction. That's exactly what we observe now: Ukraine's population has decreased by 7 million.

Cardiac surgery department does not make enough despite the fact that the number of operations has increased significantly for the past five years. Before there were about 6900 operations, made per year, while this year we have made 17 thousand. There is a progress, a significant one, but still it is only half of what the country needs.

This year our institute has received sufficient amount of means for equipment and medical products. What we lack is drugs. For parents to buy a drug for 400-700 hryvnias is one thing, but to buy a valve for 8 thousand or an oxigenator for 6 thousand is another.

Last year, the academy president ordered to work out a quota system. Every institute must conclude agreements with 27 regions, which have now a possibility to send patients for free of charge treatment.

All our institutes treat 150 thousand people annually, and 44 thousand out of them are treated at the budget expenses. This is according to the quotas, agreed with the minister. Hence, the medical care becomes more available for regions.

According to the Healthcare Ministry statistics, Ukrainians mostly die of heart diseases. Why?

- Yes, 66% of deaths are caused by heart diseases. However, with 680 death cases last year, only 250 thousand autopsies were performed, which is 25% of the total. Moreover, only 45% of the autopsies confirmed heart diseases as the cause of death. If we carry out statistics more carefully, we will have different figures. All people die because the heart stops, after all.

Ukraine's problem is that people do not undergo diagnostics and come with advanced cases. People simply do not want to be treated.

Population of Ukraine decreases and people get sick more often. Is our nation disappearing?

- Health of Ukrainians is determined by various factors: ecology (40%), lifestyle, nutrition, hereditary background. Healthcare system's share in keeping people healthy is only 10-15%. The rest 85% depend on the above-mentioned factors. Bad habits are also included.

Pirogov once said that the future belongs to the preventive medicine. First, people need to balance lifestyle and nutrition and must come regularly for diagnostics. If a person has hypertension, he must know about it and the risks it bears. Thus, he must take medication to prevent any failures.

In general, with our life expectancy rate we hold one of the last places in the world, but I would not state that our nation is disappearing.  In 2006, 360 thousand people were born and 780 thousand people died. In 2011, however, 541 thousand people were born and 680 people died. As you see the situation gets balanced.

Whose qualification is better, in your opinion - Ukrainian doctors or foreign doctors?

- Doctors' qualification is more or less even all over the world. There are differences in technological capabilities. In Germany, for example, 80% of operations are made with mini-invasive techniques.

From the standpoint of an experienced doctor, do you think our universities prepare good specialists?

- No, education process is poor. Pregraduation education is more or less at proper level. We reform everything under Bologna process, but Bologna process is a way to brain drain. Post-graduate practice is absolutely unacceptable. A surgeon after three years of practice comes to work in a hospital and is incapable to do anything, as during practice he was not allowed to the table.

Operation every morning

How often do you make operations?

- When I worked as a department chief, I made two-three operations per day, and 300-350 operations per year. But since 2004 I've been holding the post of the department head of the Academy of medical sciences, and in 2008-2010 I worked first as a deputy health minister, then as the first deputy health minister, thus I make less operations than before, but still every day. My morning starts with an operation.

Being a practicing doctor you worked as the first deputy health minister. Was there an inside conflict between the doctor and state official?

- No, not really. Our work was focused on doctor's rights. Unfortunately, doctors are less protected people, both financially and legally. We worked out 5-6 draft bills, which were successfully implemented by the authorities. However, the salary still leaves much to be desired. How can a person live on 900 hryvnias per month?

Going for an operation you realize you hold person's life in your hands. How do you deal with such pressure and responsibility?

- I am used to this pressure. Besides, it's my job, and if my hands are shaking I won't be able to do my job properly. A surgeon is like a band-master. We have 9 people participating in every operation and the surgeon must see and control everything and everybody. We all pass certain stages of training. I have the youngest department in the institute - 34-35 year-old team.

Have you made wrong decisions in your practice?

- There is always a certain percentage of mistakes. But if you fully realize the responsibility you know there is no room for a mistake. Besides, a surgeon must believe in success till the end. I had a case once, when a heart was cut in two during the operation and the operating surgeon gave up. I was operating on the second table. I immediately washed my hands, changed clothes and came to help. We made everything necessary and saved the child's life.

How do you de-stress?

- I have two hobbies - sport and hunting. I play football and tennis. When the season starts I go hunting.

Note: Vasyl Lazorishynets is a leading scientist in cardiac surgery field and known as the pioneer of creation and development of the newborn cardiac surgery school. He was the first to apply the practice of experience exchange with foreign leading specialists in cardiac surgery. He was the first to perform successful operation on a patient with hypoplasia syndrome.

Tetyana Hryhorieva, photos by Viktor Kovalchuk


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