PRINCETON, N.J. – Ihor Kurilets Jr. is a neurosurgeon from Ukraine. He looks younger than his years and someone would be forgiven for thinking he was an undergraduate at Princeton University on the day he stood behind the lectern in the renovated Gothic building that houses the Princeton Institute for International and Regional Studies to deliver a lecture hosted by the Slavic Studies Department and Razom on September 25.
Dr. Kurilets and his father, Ihor Kurilets Sr., work at a specialized clinic in Kyiv which they founded. They treat patients with spine and brain ailments, but their work extends beyond brain surgery. They are creating an island of a different sort of medical care in Ukraine. They aspire to show by example that the vestiges of the Soviet-era medical care can be dismantled by providing quality care with transparent pricing. They treat patients and reduce corruption at the same time.
The younger Dr. Kurilets demonstrated his understanding of economics as well as his passion for improving the opportunities for his professional peers and for his patients. Dr. Iryna Vushko moderated a conversation with Dr. Kurilets and Dr. Luke Tomycz, who spoke about the Co-Pilot Project, an initiative of the volunteer organization Razom for Ukraine (this writer serves on the board). The event was sponsored by the Program in Russian and East European Studies at Princeton University.
Below is an edited version of Dr. Kurilets’s remarks – a voice from modern Ukraine.
Give a man a fish, and you feed him for a day. Teach a man to fish, and you feed him for a lifetime.
We have all heard this saying before. Its authorship is attributed to various people, including the ancient Chinese philosopher Confucius. But for what I will tell you now, it is of a key value.
When doctors from the U.S.A. come to the average state-run Ukrainian hospital where most patients receive treatment, they are usually amazed by how neglected these hospitals are. They see a lack of equipment, low staff qualifications, lack of medicines and supplies, no renovation of premises. On top of that, the constant need for patients to buy everything at their own expenses and pay bribes to doctors out-of-pocket. And this is happening not in a Third World country, but in a country in the center of Europe.
At first glance, it may seem that the situation is easy to change, for example, by attracting a charity fund that will allocate funds to renovate this hospital, to buy the necessary equipment and even to arrange internships for Ukrainian doctors abroad, so that the hospital will become a modern medical center similar to those in the Western world.
After the fall of the Soviet Union, in 1990s and through the 2000s, that’s exactly what happened. Millions of dollars from communities in the Ukrainian diaspora in the U.S. and Canada started to come to Ukraine. It seemed that we just needed a few years for medicine in Ukraine to change significantly. However, despite all the above-mentioned efforts, no big changes happened.
Why? Why did the funds sent to build medicine in Ukraine have such insignificant effect?
I have had a front-row seat to witness this process. I was 5 years old when my father first took me to work with him and I saw the operating room. I was amazed and hooked on medicine from that moment. Later, I remember visiting his patients in the wards where they would often try to give me chocolates. But I was more interested in the surgeries. I entered medical university in 2005, became a resident in 2011, and I have been practicing as a neurosurgeon since 2014. Today I work alongside my father every day.
We have seen aid flow into Ukraine and not make a difference. Why?
In my opinion, the answer is rather simple. Imagine you meet a homeless man on the street and give him $1,000, or even $3,000. What is the probability that in a month this person will be not homeless again? There have been a couple of studies of people who won millions of dollars in the lottery. The results of these studies show that 80 percent of these people in five to 10 years sometimes live even worse than before winning the lottery.
So the problem is of another kind.
It may seem that Ukraine is a poor country, so it is obvious that its hospitals are poor. But that is not true. People who visit Ukraine today will confirm that hotels, shopping malls and restaurants in our country are not worse than those in the U.S. There is a great number of good cars on the streets. Thousands of modern residential complexes are being built in the cities, and their apartments are sold out before the construction is even finished. Access to high-speed Internet and to mobile communication is available even in remote places of the country. Young people have access to higher education, people travel all around the world. Maybe we are not a very rich country, but for some reason hospitals are several decades behind the development of the country as a whole.
I find only one explanation: the main problem is the outdated, imperfect and corrupted health-care system in which these hospitals operate.
No matter how many charity funds are invested into the system, the result will be negligible. You will make renovations of the hospital premises, but no one will maintain them, and after five to 10 years the hospital will be destroyed again. You will buy new equipment, and it will break down over time and no one will find the money to repair it. You will teach your doctor to do some new surgery, and he will not share this knowledge with anyone. Instead he will defend his Ph.D. dissertation and attribute the authorship of this new surgery to himself, thus monopolizing any profit gained from this knowledge. Unfortunately, this is exactly what our health-care system stimulates doctors to do.
I would like to point out that when I say medicine in Ukraine is in a terrible condition, it does not mean that there are no modern clinics or high-quality specialists here. We do have modern clinics with good equipment and specialists. However, in general, I am referring to the average hospitals that serve the majority of citizens, because it is these hospitals that determine the health-care system of the country.
So the question is: What can be done in this situation? Is there a possibility to improve Ukrainian medicine?
Fortunately, it is not as hopeless as it seems. But before any of you say you would like to help, answer this: Do you really want to change anything? Do you really want to give a person a fish and satisfy his physiological needs for one day, or would you rather teach a person to fish?
Since I have been studying and practicing medicine, I have met a number of Western doctors who visited Ukraine. They came, consulted a dozen patients, assisted with several surgeries and left. Of course, we will always be grateful for such visits, as will the patients that we cured. However, unfortunately, such visits do not change anything fundamentally, and the gap between our medicine and Western medicine has not been narrowing very much.
When Luke Tomycz and Maria Soroka came to Ukraine, I immediately noticed that these people had a different purpose. Of course, Luke and I went to the operating room immediately and did not emerge for a week: we performed five complex brain operations. But that is not the end. Luke and Maria immediately started to carefully study the features of Ukrainian neurosurgery. They became acquainted with dozens of neurosurgeons from different cities. It was clear that they had asked themselves the same question that I asked you a couple of minutes earlier. Why is medicine in such a condition in Ukraine?
I remembered Luke’s words during his first visit. He said the following: “I do not have to come and do complicated operations here all the time. Step-by-step you should do all these operations yourself. And that is not all. You have to gather young doctors around you and share with them knowledge and skills that I share with you right now.” I will never forget these words.
Let me tell you more about the place I work. Our clinic is called the International Neurosurgery Center. First of all, I would say that this is a non-governmental clinic, one of the first in the country that supported the privatization of medical services. This clinic was created in 2001 by doctors without any business investments. The idea is very simple: a group of doctors wants to work legally and provide quality medical services. All the funds remaining after taxes, bills for medicines and supplies, utility bills and staff salaries are invested in the development of the clinic and new medical technologies. In the U.S., you would call it a not-for-profit-private clinic. Of course, our clinic has a profit, but those funds are completely spent on the development of the clinic. What is very important is that the cost of treatment in our clinic is affordable for the average Ukrainian citizen.
Since 2016 we have partnered with Razom for Ukraine to create the Co-Pilot Project.
What did we achieve in three years?
1. All consultations and operations at our center are conducted according to the protocols and standards adopted in the European Union and the United States.
2. We have greatly deepened our activities in brain tumor treatment. Starting from one operation per month, we now perform one operation per week. And the number of operations on brain tumors continues to grow.
3. We have started a training program for young neurosurgeons, and now we have three young specialists doing their training. All of them are doing an internship in the U.S. and the EU with the help of Razom for Ukraine.
4. We have created a training club for young neurosurgeons, interns and students called: Saturday Brain and Spine club. After two years of studies at this weekly group, knowledge of brain and spine anatomy of our members is no worse than the knowledge of U.S. residents.
5. We are completing the construction of a new campus of the International Neurosurgery Center Clinic that began in 2012. It will become the first hospital in Ukraine built by doctors without external investment.
So, what is our recipe for improving medicine of developing countries?
I would like to note that we were looking for a realistic recipe to improve the situation. Realistic means you do not have millions of dollars, or you cannot make a significant impact on the government or senior health officials. So how can an ordinary citizen really help?
In our opinion, if the whole system cannot be changed, then we need to create a small alternative to a system where we can implement fundamentally new approaches and ideas in the health care. We need to create something like our own little system that can inspire changes to a bigger system.
Let me explain in detail. The idea is that, in any imperfect system, you can always find people who want changes. And it’s not just the desire for change that is important, but the willingness to change yourself first of all, meaning to study hard and to work hard. If these people are supported, soon they will start to work with fundamentally different approaches, as if creating oases around the desert of an imperfect health-care system. As the size and number of these oases increase, over time they will play an important role in medical care, and then the system will have to change, otherwise it will simply lose in competition with the new medical system.
Of course, in practice, it’s not as easy as in words. I want to tell you about some mistakes, so that you can avoid them and increase the likelihood of success.
Errors you can make when trying to help (What not to do).
1. Assisting people involved in medical corruption.
Such people may say that they want changes, but in reality they do not need legalization of medical services and changes in the health-care system. It is not needed because in the current system they already feel good. Helping such people only strengthens corruption in the country and postpones the time when changes come.
Before you help someone, ask yourself about the person’s visible expenses. Do his or her wages and lifestyle correspond to their legal income? It is rather common in our country for doctors to complain about low salaries while driving luxury cars and living in villas. Only legalization of health-care services, lack of hidden payments from patients, and taxes for doctors can lead to profound changes in the health-care system. I urge you not to support corruption in developing countries. If we are to create a new world, then this world must be based on principles that are universally recognized in your Western world.
2. Helping those who are not ready to help themselves.
In our country, there is a saying: “water does not flow under lying stone.” Helping a person who is not ready to work hard and help himself is not effective. I often see the efforts of foreigners to help the weakest and worst hospitals. Pity is certainly a virtue. However, it is not uncommon for lazy and unintuitive people to work in such hospitals. They are certainly happy to receive help, but they are not ready to learn, develop and work hard. They will always find a reason why they work in such poverty. They will always say, “If I had the opportunity, I would go to study abroad.” But if you ask them to give $1,000 for the training out of their own pocket, they will never agree. So, helping such people has no effect. They tend to be comfortable where they are.
At the same time, people who work hard often look better, and it may seem that they do not need help, so they are often left without any help. However, these exact people are the ones who could really change something in the country.
People who can change something are people who are ready to work harder than others, learn more than others and invest their income into self-development.
3. Help those who want to leave the country.
This is the most painful question for me, but there are many examples. A typical example: foreign doctors visit Ukraine and meet an extremely talented English-speaking doctor. They are ready to say anything in order to get internships abroad. And instead of studying and acquiring knowledge that will help Ukrainian patients, they will look for any opportunity to stay there for a fellowship, and then for the residency. In a few years these people leave Ukraine forever. Dear friends, you have enough doctors in your country, don’t take ours.
4. Helping those who are not ready to help others.
It is also not possible to overlook such an important factor as training young doctors. Because the new system won’t have a future unless there is a transfer of knowledge and experience from senior and experienced doctors to younger and less experienced ones.
So what do Ukrainian doctors who want to change the system, already work legally, pay taxes, invest in development, don’t want to leave their country, and are ready to share their knowledge and skills with future generations need?
1. Assistance in the purchase of new modern equipment.
For example, at our clinic, we are constantly developing and introducing new medical technologies. However, we always strive to remain affordable for average Ukrainians. We want to be a “clinic for the people.” That is why the cost of treatment in our clinic is low. Unfortunately, this significantly slows down the process of purchasing new equipment.
2. Help to attend hands-on courses.
Neurosurgery is a specialty that has a lot to do with craft. And to master a craft, practice is important. When it comes to neurosurgical training, so-called “cadaver courses” are very prominent, since they allow doctors to practice various skills required for surgery. In Ukraine, because of the peculiarities of legislation and the mentality of people, there are no cadaver courses, unlike in the U.S. Ukrainian doctors have to fly abroad for such training, and a three-day course can easily cost several thousand dollars. For a Ukrainian doctor it is a big sum, but without such courses modern neurosurgical training cannot exist.
3. Advice and experience of U.S. specialists.
As you already know, thanks to numerous visits of Dr. Luke Tomycz, we have managed to achieve a lot. Thanks to Luke, Maria and the Razom team, we can talk with you right now. However, we need your advice not only in neurosurgery. We need your experience in other medical specialties as well. Assistance in organizational questions, staff management, nursing care and rehabilitation is also important.
The most important thing that you, U.S. citizens, can give to the world, and to developing countries especially, is your accumulated knowledge and experience. Because it is the most valuable thing. Thank you for your support.