UMANA discusses advances in medicine, health care in Ukraine (07/11/99)

Joint Conferences of Ukrainian American Organizations

UMANA discusses advances in medicine, health care in Ukraine

by Adrian Baranetsky
Special to The Ukrainian Weekly

ARLINGTON, Va. - More than 100 health care specialists from the U.S., Canada and Ukraine met under the auspices of the Ukrainian Medical Association of North America (UMANA) during the first Joint Conferences of Ukrainian American Organizations in metropolitan Washington on June 23-27.

The UMANA, established in 1950, is the largest Ukrainian medical organization outside of Ukraine, uniting health care professionals in 18 chapters throughout North America in its mission of serving the Ukrainian community.

The UMANA provided much of the leadership to make the Joint Conferences such a defining event, fostering closer fellowship among the disparate organizations that make up the Ukrainian American community.

For its part of the conference, the UMANA presented a scientific program that was split into two full-day sessions: a scientific conference and the First International Conference on Health Care in Ukraine. On the third day, the UMANA held its biennial organizational meeting and elections.

The UMANA's 35th Biennial Scientific Convention held on Thursday, June 24, was titled "Advances In Medicine." The program was accredited by the national Accreditation Council for Medical Education for Category 1 CME credit toward the AMA Physician's Recognition Award.

UMANA President Maria Hrycelak, M.D., opened this session. Zirka Kalynych, M.D., chair of the UMANA Scientific Program Committee, moderated all of the scientific presentations. The program reflected the depth and scientific intellectual diversity of the Ukrainian medical community; it featured UMANA members, many of whom have academic appointments in U.S. medical teaching institutions.

Speakers and their talks included Orest Boyko, M.D., Ph.D., - "Advances in Medical Imaging"; Victor Hrehorovich, M.D., "Health Care Trends: HMOs and The Government"; Vassyl Lonchyna, M.D., "Minimally Invasive Coronary Bypass Surgery"; Mark D. Bej, M.D., "Frontiers in Seizure Diagnosis and Treatment"; Marta Lopatynsky, M.D., "Laser Vision Correction and Glaucoma Surgery" and Andrew Iwach, M.D., "Future Role of Computers and the Internet in Medicine."

Dr. Iwach also spoke on "Ukrainians and Glaucoma: Should you Worry?" A potentially blinding disease of the eyes, glaucoma can be readily treated if diagnosed early enough. Dr. Iwach noted that, with the increased recent immigration from Ukraine, American physicians have seen a higher incidence of certain types of glaucoma endemic to Ukrainians that have not previously been described in the medical literature. It is paramount for the North American clinician to be aware of this condition in Ukrainians and to treat it in a timely fashion.

During the midday, the biennial UMANA awards luncheon was held with Roman Goy, M.D., M.B.A., UMANA president-elect and Joint Conferences coordinator, conferring individual UMANA Achievement Awards on Dr. Maria Hrycelak, outgoing UMANA president, and Larissa Iwanetz, UMANA executive administrator. Dr. Goy, Dr. Hrycelak and Mrs. Iwanetz, along with others, selflessly dedicated countless hours of planning over the past two years to make the Joint Conferences a reality.

The keynote speaker at the luncheon was the president of the Lviv Medical Association (LMA), Yuriy Hawryluk, M.D., Ph.D., who summarized the achievements and programs of the LMA since it was reincarnated in 1989. Dr. Hawryluk invited physicians to attend the eighth congress of the World Federation of Ukrainian Medical Associations (WFUMA) that will be held in Lviv on August 16-20, 2000. (For information: WFUMA, PO Box 3605, Grosse Pointe, MI 48236; website, http://www.lma.org.ua.)

Health care in Ukraine

On Saturday, the UMANA held its First International Conference on Health Care in Ukraine, featuring American, Canadian and Ukrainian experts currently involved in health care reform or medical assistance in Ukraine.

The first speaker was Myroslaw Kohut, Ph.D., a Canadian international health care consultant who advises the Ukrainian government in its health care reform efforts. His talk on the "State of the Health Care System" succinctly outlined the health care situation in Ukraine. Dr. Kohut reported on Ukraine's shrinking demographic base, with mortality exceeding the birth rate. Since independence, the population of Ukraine has dropped from 52 million inhabitants to 49.5 million, and by 2002 Ukraine's population will drop to only 48 million. Currently the average life expectancy in Ukraine stands at 62.3 years for men and 73.2 for women, approximately nine years behind Western nations, according to official figures.

Meanwhile, government health care expenditures fell by 1997 to 43 percent of its 1992 level. There has been a lack of adequate resources and of leadership commitment with a turnover of six ministers of health since 1991, along with a loss of central control over the quality of medical care provided to the populace.

At present, health care reforms appear to be declarative, "on paper," with only minor structural changes in the Ukrainian health care delivery system, Dr. Kohut said.

Danylo Hryhorczuk, M.D., M.P.H., director of the Great Lakes Center for Occupational and Environmental Safety and Health of the University of Illinois, moderated the first panel discussion, "Principal Ukrainian Public Health Challenges."

Jaroslav I. Dutkewych, Ph.D., Ukraine country director, U.S. Peace Corps, recounted the current difficulties in raising health awareness in Ukraine via public health education programs.

Daniel A. Hoffman, Ph.D., associate dean for public health at the George Washington University School of Public Health, reviewed the last 10 years of World Health Organization (WHO) data of health status indicators in Ukraine, focusing on major causes of morbidity and mortality. Dr. Hoffman emphasized that all health care indices are plummeting and considerably lowering the average life expectancy of Ukraine's citizens and further deterioration of its public health.

Ivan M. Solonenko, M.D., Ph.D., director of the School of Health Administration in Kyiv, provided an insider's account of the major health care problems in Ukraine. He emphasized that 80 percent of the Ukrainian government's health care budget is currently taken up by hospitals and institutes (as compared to 40-50 percent average in developed countries). Also, only 20-25 percent of all physicians in Ukraine work in primary health care (50-70 percent average in developed countries) while most (80 percent) are involved in administration or teaching and research. The average length of stay for all hospital beds is 16 days (eight-12 days average in developed countries). Due in great part to Western influence, Ukrainian government budget allocations are being diverted from hospitals and institutes towards direct patient care which more closely approximates international models.

The next panel discussion, "Health Care Assistance to Ukraine," focused on Western humanitarian assistance and was moderated by Dr. Dutkewych who concentrated on the activities of the Peace Corps in Ukraine from 1993 to 1999, emphasizing its grassroots approach to fieldwork and introducing Western methods of health education to empower the public in preventing disease.

Bernice Bennett, senior program officer, American International Health Alliance, outlined the AIHA Health Partnership Program and announced the formation of five additional new partnerships between U.S. health care institutions and their counterparts in Ukraine, including Donetsk-Pittsburgh, Kharkiv-LaCrosse, Wis., Kyiv-Philadelphia, Lviv-Cleveland and Odesa-Boulder, Colo. These new programs are geared to foster more efficient and effective health care delivery in Ukraine.

Orest Kozicky, M.D., co-founder of the SUM Emergency Medical Relief Fund, then spoke on the "mom and pop" approach used by the Ukrainian American Youth Association (SUM), which has targeted small but highly successful individual start-up projects, providing Western medical techniques and equipment at select hospitals in Ukraine.

Afterwards, Alexander Kuzma, J.D., project coordinator for the Children of Chornobyl Relief Fund, emphasized the need for the diaspora to develop a much more aggressive health care strategy with a much bigger financial commitment than the community has yet made, and with more creative coalition-building with American hospitals, corporate donors and non-Ukrainian organizations.

Wladimir Werteleckyj, M.D., of the Ukrainian American Birth Defects Project finished the session by commenting on that program, which is modeled on the U.S. March of Dimes program, and its introduction of a birth defect surveillance system in Ukraine.

A separate presentation was made by a U.S. Agency for International Development (USAID) representative, Paul M. Holmes, who spoke on "U.S.-Based Efforts in Ukraine." Unexpectedly for his audience, Mr. Holmes emphasized the unique role and dedication that Ukrainian Americans bring to humanitarian efforts to Ukraine.

Dr. Kohut moderated the final panel discussion on "Directions for Future Medical Assistance to Ukraine."

In this panel, Dr. Hryhorczuk spoke on the potential of building the capacity of Ukrainian health institutes through research and training partnerships. One such example is the National Institutes of Health's Fogarty International Center-funded program at the University of Illinois School of Public Health in environmental and occupational health, which is based in Ukraine.

Zenon Matkiwsky, D.O., co-founder and president of the Children of Chornobyl Relief Fund, emphasized that community-based efforts are the future for real change in Ukraine's health care. Dr. Matkiwsky spoke on the necessity of providing technical and material medical aid directly to progressive primary care physicians, thereby completely bypassing the apparatchiks who have gotten Ukrainian health care into its current dismal state.

The above panelists plus Dr. Dutkewych, Daniel A. Hoffman, Ph.D., and Ivan M. Solonenko, M.D., Ph.D., then summarized their positions. There appeared to be a general consensus that public health projects, including the control and prevention of epidemiological conditions, including infectious diseases such as HIV, diphtheria, TB, and drug use, are arguably the most cost efficient way to assist Ukraine. More critical selection of effective equipment and technical aid needs is essential, rather than dumping of costly medical equipment or near-expiration medications that end up in the back rooms of hospital directors' offices.

Better information access and gathering for good public health data on which to base health care policy changes are needed. The provision of current medical information via various media, including textbooks, journals, video, telemedicine and the Internet to Ukrainian health care providers is essential. The maintenance of data banks on the countless ongoing programs would go a long way toward coordinating and maximizing limited humanitarian aid efforts.

In conclusion, the panelists agreed that the Ukrainian health care system must radically change its outlook and proactively evolve rather than rely on the band-aid approach of receiving Western experts and equipment that cannot be successfully integrated or employed in Ukraine. Most of the human and technical resources needed to provide medical care to Ukraine are already in place, but Ukraine has to undergo a complete metamorphosis by resetting priorities and rebuilding its current health care system based on international models of reform. Ukraine must realize that the wheel need not be reinvented in setting new local standards on the provision of health care, but it does need to open itself to reform.

Assembly of UMANA Delegates

The 28th Assembly of UMANA delegates, consisting of an organizational meeting and elections, was held to propel UMANA into the next millennium. Myroslaw Kolenskyj, D.D.S., presided over this section.

First, however, Dr. Hrycelak presented the 1999 UMANA Lifetime Achievement Award to Mykola Deychakiwsky of Brecksville, Ohio, retired surgeon and civic activist, for his many years of contribution to the community.

A new UMANA executive committee was elected for 1999-2001 consisting of: President Roman Goy, M.D., M.B.A., Baltimore; President-Elect Ihor Voyevidka, M.D., Reno, Nev.; Vice-President Bohdan Iwanetz, M.D., Lansing, Ill.; Secretary Andrew Browar, D.D.S., Hinsdale, Ill.; Treasurer Andrew Iwach, M.D., San Francisco; Chapter President Representative, Ihor Zachary, M.D., Middleburg Heights, Ohio; and UMANA Foundation President George Hrycelak, M.D., Elmwood Park, Ill.

Following the general assembly, the new executive board met to outline a schedule of meetings and program goals for the next two years.

In the immediate future, the UMANA is planning to commemorate its 50th anniversary next year with formal celebrations planned in Chicago and New York City, and with an UMANA family outing in the Caribbean during the winter. For further information contact: UMANA, 2247 W. Chicago Ave., Chicago, Ill. 60622; telephone, 1-888-RX-UMANA; fax, 1-888-558-6262; website, http://www.umana.org; e-mail, umana@gateway.net.

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