U.S. physician's dream of helping Ukraine goes sour (10/15/00)

U.S. physician's dream of helping Ukraine goes sour

by Roman Woronowycz
Kyiv Press Bureau

IVANO-FRANKIVSK - In 1992, when Dr. William Selezinka decided he wanted to help Ukraine in the best way he knew how, he expected much the same success he had experienced in his nearly 30 years in the medical profession.

He believed his expertise and the contacts he had made during his years as an eye surgeon and chief of residents at the University of California-San Diego and St. Louis University gave him the tools to help the western Ukrainian city of Ivano-Frankivsk re-establish itself as one of the leading eye care centers of Ukraine.

The Ukrainian Eye Project that Dr. Selezinka founded had considerable success initially, most notably in October 1996 when the Ivano-Frankivsk City Eye Clinic opened - a project that he pushed forward with support of the local mayor.

Unfortunately, the 76-year-old retired ophthalmologist from San Diego could not have foreseen that, even as his dream to establish the eye institute as the best in the country moved slowly towards fruition, there were forces at work that would move his primary goal of helping to save or restore the sight of Ukrainians into the background and bring politics and personal ambitions to the fore.

Standing in a supply room amid the medical supplies he had gathered for the Ivano-Frankivsk Medical Academy Hospital, the bespectacled and slightly hunched elderly doctor with a voice that belies his age, said on September 8 that he had come to Ivano-Frankivsk to do charitable work - not to become embroiled in controversy and political tests of will.

"They keep looking at the 'legal side,'" explained Dr. Selezinka. "I only care about the human aspect."

Any American with limited knowledge of the bureaucratic jungle called Ukraine and no understanding of the back-door manner in which business operates here - even if it is the charitable business of helping people and saving eyesight - eventually would have run headfirst into the same insurmountable wall that confronted Dr. Selezinka when his effort of simple compassion crossed with personal ambitions and the misunderstandings that can arise when cultural expectations don't mesh.

After eight years of annual promotion and fund-raising efforts in the United States for his program in Ukraine - the last two years with much support from Lions Club International, a non-governmental organization dedicated to the prevention of blindness - and yearly visits to Ukraine to deliver equipment and materials, and offer consultations and training, a deeply disappointed Dr. Selezinka left Ivano-Frankivsk on September 13, perhaps for the last time, his project unfinished and verging on collapse.

He had become embroiled in a seemingly unresolveable conflict over who owns and controls the medical equipment he had gathered almost single-handedly for the Ivano-Frankivsk City Eye Clinic through contributions from U.S. hospitals and corporations, as well as the Ukrainian diaspora. The dispute left him frustrated, disillusioned and dismayed, mostly over how his best intentions were greeted by what he perceived as political manipulation for personal gain.

But, there are two sides to every story and, as frequently happens in these types of controversies, the parties involved in the dispute view the issues from widely differing perspectives.

At the center: a diode laser

The disagreement, essentially a struggle about whether to keep the 21 pieces of medical equipment at the Ivano-Frankivsk City Eye Clinic or move it to the Ivano-Frankivsk Medical Academy Hospital's eye center, revolves around a complicated piece of machinery with a $40,000 price tag. Called a diode laser, it allows doctors to perform vitreoretinal and cataract surgery on patients.

The diode laser was a gift from the Lions Club International Foundation and the local San Diego chapter to the Ivano-Frankivsk Lions Club in mid-1999. The Ivano-Frankivsk chapter was established by Dr. Selezinka in January 1999 and headed by Bohdan Borovych, an ex-mayor of Ivano-Frankivsk who served in 1994-1998. Mr. Borovych also provided key municipal government support for the creation of the city eye clinic. As the head of the Ivano-Frankivsk Lions, the ex-mayor signed the necessary customs paperwork and accepted all the equipment and supplies sent from the United States through Dr. Selezinka's efforts, including the diode laser.

Mr. Borovych said all the equipment was turned over to the local eye clinic as had previously been agreed and, therefore, is the property of the city. But Dr. Selezinka claimed the diode laser was leased to the hospital for a three-year period, an assertion supported by the clinic's director, who happens to be Mr. Borovych's partner.

While Mr. Borovych explained he had the paperwork to prove the diode laser is city property, Dr. Selezinka said he was not surprised. "Maybe he had his people put something together recently," Dr. Selezinka said.

The U.S. eye surgeon said he was pleased, initially, that Mr. Borovych had become involved with the humanitarian aid project because the mayor brought the weight of his office and the contacts to the project that helped move donations smoothly through customs and the city administration to the hospitals that were to receive it. However, he now believes Mr. Borovych had volunteered to help organize and run the local chapter of the Lions Club in order to control the flow of the gifts for his own benefit.

Disagreements between the two over the equipment culminated in July when Dr. Selezinka decided to move all the donated equipment from the city eye clinic to the neighboring Ivano-Frankivsk Oblast Hospital, which houses the regional medical academy and had been competing with the city eye clinic for the humanitarian aid donated by Lions Club International. The decision led to a confrontation between Dr. Selezinka and the director of the eye clinic at the city hospital. It also brought strong protests from Mr. Borovych, whose political contacts and close relationship with the eye clinic director virtually assured that the equipment would remain there.

Dr. Selezinka stubbornly maintains that the humanitarian aid in question belongs to the Lions Club of Ivano-Frankivsk and should remain under his control as the appointed agent for the non-governmental organization. He showed documents in which the club specifically names him as its representative in Ukraine. The U.S. eye surgeon also insisted that the equipment was not properly transferred to the city eye clinic because there are strong suggestions the Ivano-Frankivsk club did not fulfill international requirements for its existence and thus had no right to accept the donations. Lions Club International, according to a letter in Dr. Selezinka's possession, has threatened to remove the Ivano-Frankivsk charter because the club has shown no evidence of any charitable activity and was delinquent in its dues until Dr. Selezinka paid what was outstanding.

Mr. Borovych, on the other hand, says the equipment is the legal property of the city because the Ivano-Frankivsk Lions Club signed it over to the city-run hospital.

July visit reveals problems

The problems between Dr. Selezinka and Mr. Borovych began in July, when the ophthalmologist arrived for his annual visit, ready to train and consult doctors and perform surgery with other U.S. doctors on hand. He noticed from the outset, however, that things were not as he expected.

First of all, medical and training equipment, including a teaching microscope, stood idly in storage rooms, obviously rarely used, even though the neighboring oblast medical academy, which was trying to raise the standards of its own eye clinic, had repeatedly asked for the microscope.

Dr. Selezinka also found that medical supplies provided by Lions Club International were being stored at the home of Mr. Borovych and not at the hospital, where they would be accessible to all. According to Dr. Selezinka, when he confronted Mr. Borovych about the matter, the head of the city Lions Club replied that the hospital lacked storage space. But the retired doctor believes that Mr. Borovych simply had made other plans for it.

Meanwhile, Dr. Selezinka remained displeased that operating rooms and surgical wards at the eye clinic still failed to meet Western standards of cleanliness and sterility. "It is absolutely a nightmare," stated Dr. Selezinka.

He said he had complained earlier about the need to block direct access to surgical rooms from hospital corridors but had received assurances only that the problem soon would be resolved. Dr. Selezinka's concern was that surgeons were soon scheduled to begin performing vitreoretinal surgery with the diode laser, which would require a much higher standard of sanitation.

But Dr. Selezinka was most galled by his discovery that Dr. Halyna Holovchak, appointed head of the eye clinic in April, had made plans to train herself in the use of the diode laser in order to be able to begin doing complicated and delicate retinal and cataract surgery. According to Dr. Selezinka, however, the clinic has neither the facilities nor equipment to properly train her.

"I will not allow her to gain experience at the expense of losing a human eye," said Dr. Selezinka. He explained that Dr. Holovchak would need to spend hours training on eyes from pig corpses in approved medical training facilities before he would agree to allow her to use the diode laser.

Earlier, Dr. Selezinka had provided training on the diode laser for the first director of the clinic, who spent a part of 1999 in the United States learning the procedures. Tragically, the woman, Dr. Oksana Holovchak, who ia Dr. Holovchak's mother became ill with cancer after returning from the United States and died in May. The younger Dr. Holovchak was appointed by city officials to take her mother's place just prior to her death. With no doctor on staff who was capable of using the equipment, the diode laser was used only when U.S. doctors arrived at Dr. Selezinka's invitation to do specialized surgery and train their Ukrainian counterparts.

The conflict, with Dr. Selezinka on one side and Mr. Borovych and Dr. Halyna Holovchak on the other, has taken on such emotional tones, that the latter have even accused the former of ensuring the death of Dr. Holovchak's mother by not obtaining medical treatment for her in the United States.

Friction between the director of the city eye clinic and Dr. Selezinka increased when the U.S. doctor realized that the only other local eye surgeon trained to use the diode laser repeatedly had been refused access to the equipment at the city eye clinic. The surgeon, Ihor Konoval, who works at a neighboring army hospital, had received training in Mexico through Dr. Selezinka's efforts and had agreed to help out at the city eye clinic but was not allowed to work there, explained Dr. Selezinka. Dr. Halyna Holovchak "used every excuse in the book," he said to keep Dr. Konoval away from the diode laser.

Mr. Borovych and Dr. Holovchak, however, claim that is an outright lie, that the army doctor currently treats patients at the city eye clinic regularly on Thursdays.

Disagreements intensify

The disagreements and discussions reached an apex on July 18 when Dr. Selezinka, without previously signaling his intention, unilaterally decided to move the equipment stored at the city eye clinic. While Dr. Holovchak scrambled to contact Mr. Borovych, Dr. Selezinka and a U.S. colleague began carrying equipment to waiting vehicles.

As Dr. Holovchak argued and pleaded with Dr. Selezinka to stop, two individuals claiming to be security personnel appeared and forcefully told the U.S. doctors they were to leave everything behind, said Dr. Selezinka. He maintained that he was imprisoned in a room, but it appears that his incarceration was self-imposed to a large extent because he had the key to the room in which he was asked to remain. The only reason he wouldn't leave, he later explained, is because the security officials had taken his personal instruments.

"They told me that I could not leave the building with my instruments," explained Dr. Selezinka. "This equipment is like my suit, it goes where I go."

According to Dr. Selezinka, the radical efforts by Mr. Borovych and Dr. Holovchak to keep possession of the humanitarian equipment, and especially the diode laser, are quite clear.

"I know that they want to begin their own business, to start charging patients for treatment," said Dr. Selezinka, who also noted that Mr. Borovych's daughter was soon to enter medical school and had plans to study ophthalmology.

Mr. Borovych flatly denied the allegation and said the elderly Dr. Selezinka simply had succumbed to pressure from the oblast hospital medical academy to turn the equipment over to the eye clinic there and had developed all sorts of rationalization to support his decision.

"Why did Dr. Selezinka not explain to us his concerns about the need to improve the cleanliness in the surgery wards earlier?" asked Mr. Borovych in an interview conducted in his office on September 8. He explained that several floors of the hospital were currently being remodeled and that the eye clinic level would be done next year.

Later, Dr. Halyna Holovchak contested her U.S. counterpart's assertions that the eye clinic did not meet normal standards of sanitation. She explained that the surgery wards including pre- and post-op rooms, contain special sterile lamps and are sanitized regularly.

"If the conditions weren't sanitary we would have patients with eye infections," said Dr. Holovchak. "We haven't had a single incident."

Mr. Borovych explained that Dr. Selezinka was not allowed to leave the hospital on the day he abruptly decided to take what he deemed to be under his care only because he was about to break the law. He said neither he nor Dr. Holovchak had ulterior motives in their insistence that the medical equipment stay with the city hospital and that their only concern was to save the clinic.

Mr. Borovych added that the tragedy he and Dr. Holovchak are trying to avert is that the impulsive and emotional reactions of Dr. Selezinka could result in the closing of the city's eye clinic and a loss of eight years of planning and work.

"I believe that he succumbed to pressures and influences to move the eye center to the oblast hospital," said a weary-voiced Mr. Borovych. "He caved in. All this work, all this time expended, and now to close the city eye clinic. He needn't have bothered if he had such plans for the end."

He explained that when he became involved in the project it was because Dr. Selezinka convinced him there was a need to get away from the mentality of monopoly and to develop a second eye clinic in the region that would allow for competition and be a model for Ukraine.

Mr. Borovych said that, as far as he was concerned, the matter as it now stands is a legal issue and should be resolved through the city council because that is who has control of the property today. Dr. Selezinka later replied: "Of course, he wants the city council to decide - all his friends are there."

With the two sides unable to reach a mutual understanding, Dr. Selezinka turned to the Ivano-Frankivsk Oblast Administration and the region's chief doctor for support in resolving the issue. The head doctor for the Ivano-Frankivsk Oblast ordered an ad hoc medical commission, chaired by the head doctor of one of the city's districts to look into the matter and allow both sides to present their case in a public hearing following which it was to make recommendations.

A decision is handed down

Even though Dr. Selezinka found solace in the impression that the committee chairman seemed to be a level-headed, understanding sort, he only obtained only partial satisfaction when the oblast's chief doctor issued an order on September 4 based on the commission's recommendation to turn over all the equipment, except for the diode laser, to the medical academy hospital.

It seemed to be a victory, but Dr. Selezinka was far from satisfied. The diode laser, the equipment that could help diabetics and children with cataract problems and retinal deficiencies, was the key piece of equipment, according to the U.S. doctor and the one that Dr. Halyna Holovchak and Mr. Borovych most wanted to remain at the city eye clinic. They had won.

The head of the commission, Mykola Oliiniichuk, went on vacation the day the decision was handed down. The action mirrored a common practice of Soviet leaders, who hid from scrutiny on controversial issues by claiming they were sick or on vacation. Dr. Oliiniichuk also failed to show for an interview with The Weekly at the medical academy, even though his wife had assured this reporter that he would most certainly be there.

Dr. Selezinka said he is sure that Mr. Borovych utilized his contacts, called in past debts and pulled some strings to make sure the diode laser remained at the city eye clinic. However, as he himself admits, there is no clear proof.

He explained that another thing that irked him was that the proceedings of the commission, which consisted of doctors, became bogged down in legalese and legal processes, at which point he realized the issue was not sick patients and bad eyes.

"They keep missing the point," said Dr. Selezinka. "Morally, is it fair to have this thing standing there?"

Then, shaking his head in regret, he added, "I'm not coming back, that's sure as hell. And they will not be getting any more donations from the Lions Club International Foundation through me."

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