New hospitals for Ukrainians and why they are not present
Victoria Popovich, Director of Real Estate Investment Company "Obriy", founder of the volunteer project "Babysitters for Medical’s Children"
The story of "barrier-freeness"
Now there is often talk about barrier-free accessibility, requiring to make ramps almost in rural nightclubs. But in a capital's budget clinic children with disabilities had to squeeze for years into a narrow smelly cubicle and use a frankly unsuitable toilet. I learned about it by accidentally visiting my own children's clinic N 1 in Solomyanka with my children.
We put the toilet in order. The management of the clinic immediately "endorsed" it and for young patients it became one less factor of stress. But during the implementation of the project I had to immerse myself in the topic, communicate with a lot of people and find out something for myself.
Among other things, I had to explain more than once why Ukraine does not build new medical facilities and does not modernise existing ones. But, as it turns out, the answer is clear to me as the head of the construction company! For a person who is not involved with construction or medicine, this is a complete mystery. Even if one was asking that question. That's why I decided to write this text.
"Norms" that are "abnormal"
Construction of medical facilities, without which we cannot conceive our existence- maternity hospitals, clinics, hospitals, morgues, laboratories, blood collection stations, etc. - is subject to certain regulations. These rules, of course, are necessary - they are like the rules of the game, which should be obeyed by everyone. Otherwise, in one city there could be built a hut, and in another –a palace, and both will be called, for example, an oncology clinic. Moreover, the standards that are needed for buildings for the sick should be different from the norms of buildings for relatively healthy – factories, restaurants or schools. I think that's obvious to any sensible person, too.
There are such norms in Ukraine. They are called SCS ("The State Construction Standards"), V.2.2-10-2001 "Buildings and Structures. The Buildings of Health System.". As you can guess from the coding above, they were endorsed almost two decades ago. It's been a long time since, especially given the development in construction, medicine, and society.
However, even in 2001, these standards were already outdated. Because they were based on previous ones, established for completely different materials, technologies, and so on, but most importantly, these still Soviet building standards were "slanted" to serve a entirely different healthcare system!
You may have noticed how similar our clinics are in different regions and cities. This is the legacy of Semashko, who created and regimented the system. And a hundred years ago, it was really a breakthrough or, at leastl, definitely better than nothing.
However, all this is outdated, both financially and morally. Now in terms of the basic standards of well-being for an average person, and for a society with modern customs, the "system of corridors with many rooms and only one lavatory" looks just fastidious sadism. Or, take, the electrical wiring: after all, the medical equipment in hospitals is increasing dramatically but the standards of wiring are something from the pre-flood era!
I'm only talking about the most obvious things related to everyday comfort and obvious to the average person. But there are still a lot of more subtle nuances. The importance of many of them is better understood by doctors - for example, norms that relate to ventilation and air recuperation. Others are obvious, rather, to builders: say, the inappropriate dependence of the volumes of certain hospital premises on the dimensions of the standards of building slabs.
However, the fact that the existing SCS are inadequate is obvious to everyone who is concerned with the problem. And it is this problem, in fact, which the building new hospitals or clinics is up against! If there were new rules - it may make more sense to allocate money for construction, otherwise, "we have what we have".
Why the alternative has stalled
A natural question arises: if both to builders and doctors it has long been obvious that the existing SCS are inadequate, why are they still not acting? Has no one ever offered an alternative?
It was offered. Last year, the Ministry of Regional Affairs drafted a new bill on modern SCS.
Yes, this document is not ideal. I don't know what the doctors would say about it, but as a builder I have a lot of complaints about it. However, it would be better than nothing and more accurate than standards outdated more than half a century ago! At least, the bill pays attention to the comfort of patients and staff and takes into account the qualities of modern building materials, etc.
But most importantly, as far as I can tell, the bill was created in step with the global reform of healthcare in Ukraine. This means that these SCS were somehow correlated with the new "rules of the game" from the Ministry of Health - the healthcare system that was offered to Ukrainians and the implementation of which has already begun a year and a half ago!
Now, as we know, something incomprehensible is happening with the healthcare reform. It will, or it will not happen, or will be, but not this one ... And the bill from the Ministry of Regional Affairs, as it is easy to guess, also is a dead letter. As the saying goes, "A coincidence? I don't think so."
Effects of putting on brakes
The impression is that our government is currently at a crossroad. It is clear that it will not be possible to return to the old standards. At least because everything fell apart there, and there is nothing to pick up. To follow the algorithm that was developed without time to implement by a previous government, “the paperednics”, is also not convenient. In particular, because in this case almost all our hospitals will automatically turn out to be non-compliant with the standards, and this will require huge "infusions" in the construction of new buildings. There is no one to create a working alternative from scratch to the healthcare SCS in particular and, to the entire construction industry in general. "Staff shortage," as our president recently lamented.
The consequences of this problem are obvious. At the time when coronavirus patients suffocate in premises with outdated ventilation, doctors have resigned, because it is impossible to organize safe workspaces, and children with disabilities are forced to climb the stairs to the narrow cubicle of the outdated toilet! And all this - in particular, because of the building "norms" that have been "abnormal" for many years.
What you can do: Personal experience
For me, the link between these phenomena is quite obvious. Not as a medic, but as a builder. And I know that until the new SCS are adopted, Ukrainians will not see clinics /hospitals up to new standards. And it is unlikely that I, who is "only" the head of a construction company, can overturn the situation and somehow move the healthcare reform from full stop to the adoption and speeding up of the implementation of new standards.
But I also understand something else. Personally, I can go to the management of my own children's clinic in Solomyanka. And I can say: my company is able and is ready to make your toilet anew and inclusive, so that the use of it becomes not stressful. Because the state of this facility humiliates not so much the children who have already enough hardship in life but the adults who allowed it. Personally myself.
P. S. I encourage fellow builders to follow suit. Because, as we can see, there is no other reasonable way out. Unless, of course, we consider revolution and emigration as an option, which is always fraught and unpredictable.