Tatyana Kusayko: "It is important to convince people to get vaccinated"
Can compulsory vaccination of children be introduced in Russia? What patients will qualify for pain relief? And why is diabetes growing younger? Member of the Council of the Federation Committee on Social Policy, Honored Doctor of Russia Tatyana Kusayko discussed this and other issues with Vestnik Kavkaza.
- On April 1, the additional measles vaccination began in Russia. The situation in the world is currently turbulent - every day we read about the epidemic in Ukraine, then about the outbreaks in the regions of Russia, even in some elite districts of Moscow. In New York, at the end of March, a state of emergency was declared because of measles, unvaccinated children were barred from visiting public places. In Italy, the law on introducing compulsory vaccination of children and not letting unvaccinated children to public places was adopted. What is the situation in Russia? Can the law prohibit unvaccinated children to visit schools and kindergartens? Can parents be legally required to be vaccinated?
- This is a serious problem not only for our country, but also for Europe and the countries of the former Soviet Union. The infection flow to the Russian Federation has increased. Measles is a dangerous and highly contagious disease. By the degree of transmission by airborne droplets, measles is more contagious than flu. The national calendar in our country involves vaccination against this terrible disease in the early stages, in childhood, and later - up to 55 years.
In recent years, we understand how important it is to convince parents that measles is an infection and it is possible to be protected from it. Any vaccination does not imply the disappearance of the disease, but prevention of complications is necessary. Moreover, complications of measles are very dangerous - pneumonia, meningitis and meningoencephalitis.
Unfortunately, there have been many refusals to vaccinate recently, not only against measles, but also against other diseases. This creates the danger of reducing the immunological layer: if the number of vaccinated people is less, the possibility of spreading the infection is much higher.
Today, the focus is on vaccination of migrant workers. This will provide an opportunity to prevent the ‘flow’ of infection to other countries. In addition, there is a possibility of receiving measles vaccination for 72 hours, if you know that there was a contact. This is one of the protection measures.
Rospotrebnadzor monitors the situation in various regions. An increase in the incidence is noted in the Vladimir region, in Novosibirsk, in some schools of Moscow. We can prevent unvaccinated children from attending schools, but I think that it is much easier to prevent a disease. It is necessary to consciously approach this issue. The issue of introducing vaccines against chicken pox and rotavirus infection on the national calendar is now being considered. In many countries of the world, vaccination against human papillomavirus is carried out, which is important for the prevention of cancer. Cervical cancer is only cancer that can be eliminated by vaccinating human papillomavirus. In countries where vaccination has been administered for 10 years, the incidence of cervical cancer is much lower. It is necessary to use all the levers in order to reduce cancer incidence.
- Another important topic is the provision of high-tech medical equipment to the regions. It was you who drew the attention of colleagues to the shortcomings of the financing mechanism and gave an example with an angiograph, which costs 70 million rubles. Regions which are under the state financing program for several years have money to purchase such medical equipment, but they cannot be spent at once. How to solve this problem?
- Our budget is calculated for three years, and sometimes the acquisition of expensive equipment, which is necessary for some particular region, causes difficulty. It is necessary to conduct monitoring throughout the country about the financial resources allocated for the implementation of national projects so that there is an opportunity to pool the funds allocated to the subject in two years and acquire what is really needed. For example, Kalmykia was allocated 24 million rubles for 2019 and 36 million rubles for 2020. If you combine the funds allocated for two years, this amount would be enough to get an angiograph. We are talking about the possibility of rational use of financial flows from the federal budget, which are allocated to the regions.
It is necessary to eliminate the prejudice that if the money allocated for the year are not used, they will be taken away. This is an important point. So we can improve the material and technical base. Monitoring will allow you to buy what is really necessary. After all, it often happened so that the purchased equipment was not used, because, for example, there were no relevant specialists. The implementation of the national Healthcare project will depend on the extent to which the region can correctly calculate both the acquisition and the possibilities for improving the availability and quality of medical care.
- A few days ago, the amendments came into force, guaranteeing the terminally ill high-quality medical care - the amendments on palliative care. We are talking about a large number of patients - these are children and adults, about one million people. Palliative care also applies to field services, and hospital stay, and the purchase of high-quality painkillers. Can we say that in Russia before there was no palliative care? How will this mechanism really work now? What will change?
- I would not say that we did not have palliative care at all, but for a long time, representatives of public organizations and the professional community said that this assistance requires rethinking. The amendments that have been made are very important. This is a law for each of us because no one is immune to the situation when this help may be needed. The law expands the concept of palliative care, reflects the creation of a palliative care system in our state. First of all, it is an interdepartmental orientation - medical, psychological, spiritual and social care. Alone, the Ministry of Health cannot implement all these innovations.
The main point of the innovation is that now palliative care is closer to a person. A person who is at home can receive high-quality medical care. In addition, we are talking about care, the skills of which should be taught to family members. The availability of narcotic drugs for home use is also regulated by this law. There used to be a sad case when a doctor, guided by some regulatory documents, could not prescribe a narcotic substance. Now the regulatory documents will clearly regulate the rules for issuing prescriptions, the duration of the prescription: if it was 15 days earlier, now the prescription can be used much longer.
The turnover of narcotic and psychotropic drugs is now at the revision stage. Regulatory documents must also protect the health worker because there were precedents when a criminal prosecution was initiated against medical professionals. Now the Ministry of Health proposes to make changes to the Criminal Code: if a not very dangerous violation is committed during the circulation of narcotics and psychotropic drugs necessary for the provision of palliative care, then it should be ranked as an administrative violation.
The law on clinical guidelines was also adopted. They are currently under revision. Clinical recommendations for cancer should be reviewed first of all. This will enable the timely implementation of one of the sections of the national project, which concerns the early prevention of cancer. The financial resources that are now allocated for cancer care are unprecedented.
Polyclinic pain centers have been established, where you can get outpatient care, new palliative care departments are opened, which are equipped with modern equipment and enable a person with an incurable disease to live in normal conditions without experiencing pain. There is equipment that can block pain at the ganglion level. These are the methods that were not previously used, and the person was forced to endure unbearable pain.
And we are talking not only about oncological diseases. A lot of somatic diseases are accompanied by severe pains that need to be stopped - connective tissue diseases, rheumatoid arthritis, multiple sclerosis.
As for pediatric oncology, it is especially important to create conditions for a child when he is not experiencing pain. An important point is a psychological mood, how to help both the patient and his family accept the diagnosis. The quality of life of the patient also depends on this. That is, we want to say that terminally ill people have an opportunity to live well, even knowing that they have such a disease.
- Now the Federation Council is developing a unified bill on families with dependent children. You and your colleagues often visit the regions to meet with people, find out what worries them, what they need most urgently. What can the state do for them?
- We regularly meet with representatives of large families and understand that many problems are the same in our country and in the regions. Thanks to this communication, we can create a mechanism that will allow us to make the necessary decisions at the legislative level. On behalf of the Chairman of the Federation Council, Valentina Matvienko, a working group has been created and now it is working to create a law on large families.
First of all, we need to clarify the status of a family with dependent children. In different subjects, there are regulatory documents that define what a large family is. But having left the boundaries of their region, large families no longer enjoy benefits. Benefits that exist on the territory of one subject, people can no longer receive on the territory of another. Determining the status of a large family at the legislative level, I think, will remove many issues regarding large families.
It is also about the fact that the family with three children ceased to be considered a large family when one of the children turns 18. Those two children who remained in a large family no longer enjoy the benefits that are provided for in another subject.
There is a very acute issue with land plots - the situation on the territory of the regions is different. One cannot compare the steppe Kalmykia with the Murmansk region, where there are hills and stones. Therefore, the financial resources needed for large families for the development of these sites differ in different regions. Why should we endow families with territories that have no communications? A large family will have to spend a lot of financial resources in order to bring necessary communications, in order to develop a plot. Sometimes families who receive a plot pay taxes, but they don’t have an opportunity to build something on the plot because they have no necessary financial means.
One of the tasks set by the national demographic project is to increase the birth rate to 1.7, that is, two or three children in the family should become the norm. We also have families who do not have children. There are talks about the tax on childlessness. I am categorically against this because this is the ethical side of the issue because, for completely different reasons, some families cannot have children. For many of them, it is a pain.
We are a modern society. We must help families get out of this situation. There is a possibility of adoption. It is necessary that the adoptees of several children enjoy the same benefits as an ordinary family, which has the status of having many children.
- Do you have any support measures in the region, in the Murmansk region?
- In our region, there is such a measure of incentives as payment for the first child if the parents are under 26 years old. This is an opportunity to stimulate student families. Though its only 15 thousand rubles, the stimulation measure itself is quite significant as it allows young mothers not to lose the opportunity for professional growth. You can carry out various kinds of professional training at home, you can work on remote access, now there are all the conditions for this.
-Tatyana Alekseevna, you are a pediatrician with a great experience, more than 30 years. During this time, tens of thousands of patients have passed through your hands, through your heart. Do you know the fate of at least some of them? Do you keep in touch with someone? Did some of your patients follow your footsteps, choosing a medical profession?
- Of course, I know.
A doctor is not a profession, it is a life. If I had to start life all over again, I would still choose only the profession of a pediatrician. I maintain links with many patients, I was even treating their children.
There are patients who, looking at me, have chosen the profession of a medical worker. And now, my former patients with whom I maintain relations are studying in the universities of Moscow and St. Petersburg. They send their video greetings wearing white coats.
My daughter, Nastya, also became a pediatrician. I always told her that at any course of a medical university, you must be sure that you will never say that you are tired of this. If you realize that this is not yours, it is better to leave earlier. I hope that my daughter will become a good pediatrician, she is committed to this. On March 30, she married. Her husband is a children's traumatologist. I hope that they will be able to work in the Murmansk region and improve the provision of primary medical and sanitary care to the population and will be a part of the program on the elimination of the personnel shortage.
I hope those patients who have followed my footsteps will never regret that they have chosen the profession of a pediatrician. In my former office, there is the whole wall with children's photos. I really love children’s eyes. Sometimes a newborn baby says so much with his eyes that it seems that he has already lived a life. I remember them all, I remember their birthdays, we communicate with mothers, and already with adult children. And these meetings are always very important because when you love your profession, you choose your vocation - this is life.