How children are born in the Czech Republic: hospital experience for Ukraine to use
A nurse from Vinnytsia talks about everything that distinguishes the Czech experience from the Ukrainian one, and how the Czech Republic can inspire Ukraine to carry out medical reform. Some things are quite unexpected: for example, the Czech hospitals do much less disinfection!
Marina Efremenko
The level of the health care system can be described in just two words: quality and safety. The medical reform in Ukraine is aimed at increasing the assessment of these indicators. In search of inspiration and motivation, we have a sneaky peek at our neighbors on the continent: what's the usual life of Lithuanians, Czechs, Poles? What result the reforms in Ukraine have? What changes are yet to be made? What have they achieved over the years?
Undoubtedly, the development of European medicine, which we set as an example, results from the development of society as a whole. Today in Europe, where human life and health are the fundamental values not only on paper, they pay attention not only to disease control but above all to health protection and improvement, preventive measures, and a rational combination of modern scientific advances in medicine and pharmaceuticals. And most importantly, this concern begins on the birthday of a new EU citizen.
Fortunately, Europe isn't just flaunting its achievements but is ready to share its experience with us. Thus, for two years, as part of the House of Europe program, the Czech Center in Kyiv has been organizing study tours for Ukrainian physicians. The first trip was to an internship in the neonatal department of the Faculty Hospital in Olomouc. Here, Czech doctors and nurses acquainted Ukrainian specialists with the peculiarities of the work system of perinatal centers in the Czech Republic, conducted training on care, nutrition, and first medical and post-resuscitation care for premature babies.
Ukrainian physicians on an internship at the Faculty Hospital in Olomouc, Czech Republic
House of Europe is a program funded by the European Union, it was created to support professional and creative exchange between Ukrainians and their colleagues in the EU. The program focuses on culture and the creative sector, education, medicine, social entrepreneurship, media, and youth work and sponsors more than 20 areas: internships, networking, residencies, and other forms of professional exchange. The British Council, the Goethe-Institut, the Institut-Francais, and the Czech Centers are partners in the project consortium. In particular, the Czech Centers provide professional training trips of Ukrainian doctors and nurses to EU countries in the healthcare field. They also organize seminars with European doctors in Ukraine. Now, due to the threat of coronavirus, study trips have temporarily moved to a new format, online courses for doctors and nurses.
Not because they need to, but because they want to
Maryna Yefremenko, a nurse from Vinnytsia, was one of the first participants on a short-term study trip to the Czech city of Olomouc. Five days of an intensive course in the maternity hospital and neonatology department of the Faculty Hospital became a unique opportunity for the nurse of the ordinary state hospital, where Maryna worked at that time, to see the work of European doctors, to be able not only to compare with Ukrainian reality but also learn something new.
The first thing that surprised the Ukrainian delegation to the hospital in Olomouc was the directness and openness of its employees, their positive attitude to life, and the desire to share their experience with others not because "they need to," but because they really want to. This, according to Maryna Yefremenko, was felt even in their movements, gestures, intonations. From the first day, Ukrainian and Czech doctors established friendly contact, and communication and training were held with mutual joy.
"It was very nice to watch the teamwork," Maryna recalls. "Support and friendship were felt at a distance. But personally, I was impressed by local doctors' approach to problems. They soberly assessed their situation, because they also hadn't always had everything as wonderful and stable as now. However, they have always looked for ways to change the situation for the better. We're currently only on the threshold of new changes and implementations, but after what we've seen, we want to believe that medical reform will work in our country as well."
Less disinfection and more rationality. How babies are cared for in the Czech Republic
In the Czech Republic, fundamentally, newborn care is no less different from our standards. However, Ukrainian doctors still noticed the differences. Yes, Czech doctors and nurses don't touch the baby without a need, and the fact that they don't change the diaper every three hours is not so important. If the baby is asleep, they can do this procedure later. Weighing is also not performed daily, but only if necessary. And besides, it takes place directly in the incubator. Maryna Yefremenko says it's a shame that even such bits aren't real for us because the Czechs use innovative "Giraffe" incubators, which not only have built-in scales, but the entire design works to provide the baby with maximum comfort for fewer stimuli to disturb it. One such "bed" is expensive, more than 60 thousand dollars, it's not affordable for most Ukrainian hospitals.
In the Czech Republic, the baby is bathed by the mother under the supervision of a nurse. Premature babies are also bathed directly in the incubator. To do this, they use sterile distilled water. Such water is bottled and comes from the pharmacy. Intravenous infusions for individual purposes also come ready from the pharmacy, which greatly facilitates the work of the manipulation nurse.
The department is fully equipped with disposable sterile materials. Disposable means sterile and individual, literally everything! Ukrainians were surprised when they saw the Czechs didn't use disinfectant solutions to treat disposable materials (needles, gloves, syringes, cotton wool, napkins), even if they were contaminated with biological materials. According to their protocols, they're forbidden to wash and disassemble them, as this increases the risk of infection of medical staff! All such products are simply sorted into dry, labeled containers and sent for disposal. This approach has eliminated the huge need for disinfectants, which, according to Czech experts, kill not only harmful microflora but also a useful one.
In feeding, preference is undoubtedly given to breast milk. However, if the mother doesn't have it, donor breast milk can be used with her consent. The donor woman is checked for diseases and bad habits, and the milk is pasteurized and frozen. This milk retains its qualities for several months. Feeding containers are also disposable and sterile, as are pacifiers.
Maryna stresses this feature: the access to the department with babies is open to all interested relatives and friends of the child. Parents can also be present during any manipulations. So, with enough sterile consumables and competent actions of the staff, "microbes from relatives" aren't so scary for babies.
There was a lot of talk about psychological services, namely, work in neonatal wards with parents and medical staff. Everything can happen in life… "One of the toughest points they managed to implement in the Czech maternity wards," says Maryna, "has become for us the concept of 'the last minutes of a child's life in the arms of parents.' Let's be honest. Neither our parents nor the medical staff is ready for this. In general, psychotherapists have been working successfully in Europe for a long time. As a result, people are less aggressive and more satisfied with their own lives. Therefore, there's hope for quality and highly qualified help of psychologists, which must be in our maternity hospitals."
Another shock for our doctors was to realize how much the Czech Republic values its medical specialists. "I don't think anyone will be surprised to hear that the salaries of Czech medical workers are almost five times higher than ours! It's shameful and horrible to realize that your work in one of the most difficult departments is valued at an unfortunate 180-250 dollars!" the Vinnytsia woman is outraged. "A job that involves not only caring for newborns but also saving a little life! After all, our children don't differ from others. They also deserve the highest level of medical care, and our staff a decent salary! This question is probably the most painful of all!"
How did the Czech Republic do this and how can Ukraine repeat this success?
Significant changes in the Czech health care system had taken place since the early 1990s. Within a few years, health care facilities and their management system were completely reconstructed, a health insurance system was created, which became the primary source of funding, a General Health Insurance Fund was established, and then other insurance funds. Both public and private medical institutions increasingly began to conclude contracts with insurance funds, payment for services was made depending on their number. For easy payment, a detailed list of medical services has been developed and is constantly updated through negotiations between officially authorized partners. In the mid-1990s, there were 27 insurance funds in the Czech Republic, but now their number has tripled. The most popular company is VZP (Všeobecná zdravotní pojišťovna České republiky — General Medical Insurance Company of the Czech Republic). Almost seven million Czechs trust this fund to take care of their health.
The health insurance system in the Czech Republic is based on the principles of equality and unity of society. Every citizen regularly makes deductions and can use the insurance if necessary. The tax on medical care is 4.5% of the monthly salary. Medical care is provided to everyone in the standard amount; for non-standard services or medications, you need to pay extra. The system is funded by insurance contributions from individuals, employers, and the state, which pays for the unemployed, pensioners, children and dependents under the age of 26, students, women on maternity leave, service people, prisoners, and those receiving social assistance, i.e. about 56% of the population! The state is also the guarantor of the insurance system.
The Czech Republic now has one of the lowest infant mortality rates in Europe. It is health insurance that has allowed patients and physicians to get rid of the problems of providing a sufficient amount of medical equipment, materials, and medication. Parents whose children are being treated in the neonatal intensive care unit are provided with high-quality and comprehensive psychological support, which greatly facilitates cooperation with them. The people's trust and respect in medical staff are also fostered by promoting medical care in the media. Involving parents in caring for their own child is easy psychologically and physically. Free access to visits to the intensive care units for relatives, the possibility of a video broadcast of the child's stay in intensive care only reinforces the parent's belief that in the Czech hospital, everyone without exception is trying to help, not harm. By the way, the institution where Maryna Yefremenko did her internship has the status of a "child-friendly hospital," which, as the Ukrainian woman was convinced by her own experience, is confirmed not only in words but also in deeds.
Everything seen in the five-day intensive course could be implemented in our hospitals as well. But, as Maryna Yefremenko acknowledges, the efforts of doctors alone are not enough. For actualizing their knowledge and skills in providing the most effective care, there's a catastrophic lack of financial support that could provide health insurance, as has happened in the Czech Republic. Currently, only voluntary health insurance exists and works in Ukraine, and compulsory state insurance doesn't exist yet. "We have a lot of care funds that provide hospitals," says Maryna, "but I know from personal experience that, unfortunately, such care is not enough. In addition, other 'Soviet' attitudes and methods are still sometimes felt in our work. I hope that by joint efforts we'll be able to overcome outdated stereotypes and reach the level of professional activity we saw in Olomouc."
Vinnytsia doctors brought a lot of advice and suggestions to their home institution. It's a pity that it was practically impossible to embody them in a state institution. And it's not about the management wanting to leave everything unchanged. The reason for forced inaction is the same, insufficient funding. There's simply no money to buy innovative incubators, noise meters, special window blinds, pasteurizers, freezers, the right amount of harmless disinfectant solutions, and disposable materials. Public hospitals are on a very modest budget, and in Europe, insurance medicine works for that.
The poor medical policy of the Ukrainian authorities has its results; the most qualified medical personnel leave the country or go to private medicine. Since April of this year, Maryna Yefremenko has also changed her place of work. Now she works in a modern maternity hospital of European level "Innomed," which recently opened in Vinnytsia. Her position is the same: a neonatal nurse in the neonatal intensive care unit, but the working conditions and salary are much more pleasant. In private business, her knowledge and skills, acquired during ten years of continuous work in the specialty, were evaluated better than the state was able to do.
Photos provided for publication by Maryna Yefremenko
