ONE YEAR AFTER: Residents of Lviv, in western Ukraine, reflect on Orange Revolution
by Zenon Zawada
Kyiv Press Bureau
"One Year After" is a four-part series examining the lives of Ukrainians one year after the Orange Revolution. This final installment features Olha Boyko, a 23-year-old Lviv resident completing her last year of medical school. (Previous articles in this series took a look at life in Alchevsk, eastern Ukraine; Yevpatoria, Crimea, in southern Ukraine; and the capital, Kyiv, in central Ukraine.)
PART IV
LVIV - The Orange Revolution defined her generation, said Olha Boyko, 23. That's why she'll fondly remember the events and never regret taking part.
Yet the revolution did not change the fact that the Ukrainian government will choose her medical specialty and require her to work, likely by herself, in a village for her medical internship.
"I talked to the interns who work there," said Ms. Boyko, who is in her final year of studies at Lviv National Medical University. "There's no medicine, no tools, no instruments. In these conditions, you can't treat or help people."
One year after, most Ukrainians who took part in the Orange Revolution realize that it was the first step in what will be a decades-long process in creating a civil society in Ukraine.
It's a challenge that makes a two-and-a-half week revolution pale in comparison. Those graduating, such as Ms. Boyko, are bracing for the task, admittedly with reluctance and concern.
Ms. Boyko believes the government should have already set as its priority creating minimal working conditions for medical interns, the nation's future doctors.
Instead, upon graduation in June she faces a three-year internship that will likely pay $80 a month, requiring her to work at least two jobs, "if not three," just to make ends meet, she said.
"This is not what we fought for"
Not all Ukrainian medical students are forced to accept medical specialties and a designated assignment.
In April 2004, the Ministry of Health led by Andrii Pidaev forced Ms. Boyko and all medical students on government scholarships to sign agreements requiring them to perform their internships, typically three years, where it needed them most. More than likely, that meant a Ukrainian village, a destination no other doctor wanted to go because of the meager conditions.
In theory, each Ukrainian village is supposed to have an "FAP" ("Feldshersko-Akusherskyi Punkt") or a Medical-Obstetrics Center. However, many lack even one of those. Those FAPs that do exist are typically dilapidated buildings that often lack plumbing, furniture and windows.
For water, a doctor or medic would rely on a well that could be as far as 100 meters away. Most FAPs offer no tools or medicine for the doctors to work with. On their paltry salaries, some doctors have to obtain equipment themselves.
Some villages offer no place for a doctor to live, while others offer a very meager home.
Imagining her internship, Ms. Boyko has already begun to imagine the hardship. "Working on enthusiasm alone is very difficult," she said with a sheepish laugh.
The Ukrainian government was able to force its scholarship students to accept such conditions because these people had no other choice. Those students who paid their own tuition had no debt and couldn't be forced into the villages.
According to the decree, if Ms. Boyko refused, she would have to repay the government her entire tuition at once.
When she commenced her studies in 2000, annual tuition at Lviv National Medical University was about $850 a year. It has risen every year since then to about $2,000 a year, Ms. Boyko said. Refusing now would require a $12,000 payment - an astronomical sum for students such as Ms. Boyko.
As if that weren't enough, the Orange Revolution brought in more restrictions for medical students.
Within a month of his appointment, the new health minister, Mykola Polishchuk, issued a decree cutting the number of medical specialties in Ukraine's universities from 54 to 16.
In the same decree he increased the length of internships by two years. Therefore, an internship would last between three and five years.
Dr. Polishchuk had good intentions, most authorities believe.
Students graduating with narrow medical specialties, such as ultrasound diagnostics or infant neurology, are unable to find jobs in Ukraine's large cities because these positions are already filled. Meanwhile, small towns and villages are desperate for family doctors, the type that could offer broad, basic medical treatment.
Nevertheless, scholarship students were furious that the new government - supposedly more democratic and pro-Western - was limiting their freedom of choice.
"I agree that villages need doctors, and students agree," Ms. Boyko said, reflecting the position held by most students. "If the government created acceptable conditions to work as a doctor, then we would go and work there."
Shy and gentle to an extreme, Ms. Boyko doesn't seem like the protesting type. However, it was the Orange Revolution that gave her and other medical students the inspiration to challenge the Health Ministry's February 2005 decree.
"Before, we wouldn't have even had the idea to strike," Ms. Boyko said. "Until the revolution, we weren't taught to do such things. The Orange Revolution gave us the inspiration."
Students from all over Ukraine descended upon the Ministry of Health in April to protest the decree.
At Lviv National Medical University, Ms. Boyko and others wrote a letter to the minister and gathered signatures demanding that he rescind the order. They refrained from a student strike because the Ukrainian government forbids doctors from such taking part in such acts because they threaten the public welfare.
During the last week in April, Ms. Boyko and 30 classmates traveled to Kyiv. The boldest demonstrators set up a tent city at Mariinskyi Park and staged a hunger strike. Some protesting students arrived wearing orange scarves, symbolically taking them off and throwing them onto the ground in protest.
"This is not what we fought for!" some shouted.
Eventually, Minister Polishchuk confronted the students, essentially telling them that the government was working both in their best interests and in the nation's interest, Ms. Boyko said.
President Viktor Yushchenko also greeted the students, assuring them he would help them reach a compromise.
However, there was no compromise. Only after Mr. Yushchenko fired his Cabinet of Ministers on September 8, 2005, did any change take place. The new minister of health, Dr. Yurii Poliachenko, canceled all the provisions of the February 2005 decree the very same month.
The students had their victory, but it was moot to a large extent.
The April 2004 decree remained in place. Students such as Ms. Boyko still face the likelihood of working in the village.
"We'd have to work until death
to earn that kind of money"
To Ms. Boyko's parents, Volodymyr, 50, and Tetiana, 49, the system makes sense.
Sitting in their 64-square-meter (689-square-foot) eighth-floor apartment, warmly defended against the frigid, minus 6 degrees Fahrenheit weather outside, the Boykos reflected upon their Soviet upbringing while discussing their daughter's situation.
If the Ukrainian government paid for her education, Mr. Boyko figured out loud, then, in return, it has the right to ask her to serve where it needs her help most.
Incidentally, when Mr. Boyko had completed his degree in hydro-technical studies in 1978 at the Ukrainian Institute of Water Management Engineering in Rivne, he faced a situation similar to the one his daughter faces.
The Soviet government had assigned him to Cheboksary on the Volga River to plan, build and improve hydro-technical structures and dams. "It was my duty," Mr. Boyko said. "There was no 'want to or don't want to.' We had to go. There was no choice."
"Just like I'll have to go!" Olha Boyko said, then laughing at the irony.
After 10 years in Cheboksary, the Boykos decided to return to western Ukraine to be closer to family. They traded apartments with a Lviv family; no money was exchanged.
Fifteen years after Ukrainian independence, the Soviet mentality remains ingrained in the Boykos, despite their upbringing in the village of Kryliv, Rivne Oblast.
When beginning the interview, Tetiana Boyko apologized that they were going to speak Ukrainian (instead of Russian). They didn't want to comment much on politics.
However, Mr. Boyko participated in the Orange Revolution. Currently working as a professional photographer, he proudly displayed thousands of photos he took during the first days of the revolution in Lviv, and then in Kyiv when he was there for three days.
His reasons to join the revolution were simple. He went "to defend our freedom." As for the current divide in the Orange forces, "Let them sort it out," he says.
After living in Russia, he said Ukraine is better off having an independent economy and military.
Both he and his daughter Olha stayed at her brother Anatolii's single-room apartment in Kyiv, where he is working as an economist in the Metro supermarket chain and raising a child with his wife. Olha slept on the floor alongside a friend from Lviv.
Like most residents of Halychyna, the Boykos are satisfied with the revolution and thankful that it happened. Ukrainians have more freedom now, and at least there's more truth in the media, Mr. Boyko said.
Pensions were tripled, he also pointed out. When asked about the inflation that accompanied that pension increase, "of course prices will have to change a little bit," he commented.
Mrs. Boyko agreed with her husband that the government's policy assigning medical students to villages was fair. "You have to work because that is the law," Mrs. Boyko told her daughter as they talked in their living room. "The state provided the education, and we have to be thankful for that."
But Olha wasn't entirely on the same page. "For three years of my life I'll have to thank them!" she retorted. "It's like the Communist system."
Her mother reminded Olha that they'd have to pay the government $12,000 if she were to back out. "We'd have to work until death to earn that kind of money," she said. "Those are the laws."
The generation gap that has emerged between the current university students and their parents is enormous. The prior generation knew questioning the Soviet government meant trouble, if not prison.
"Our parents were used to submitting," said Khrystyna Didyk, 23, a classmate and close friend of Ms. Boyko who also studied on a government scholarship and faces a similar fate.
The Orange Revolution was a direct result of their generation having grown up in an independent Ukraine, Ms. Boyko said. "Our generation had its identity formed in an independent nation," she said. "We didn't know what a Communist, totalitarian regime was. Without our generation, the Orange Revolution wouldn't have happened."
At least 80 percent of Lviv's university student population was on the maidan (Independence Square in Kyiv) the first few days, she estimated, providing that critical bedrock that later proved vital in launching the Orange Revolution.
Ms. Didyk said she'll never forget the sight when she arrived at the tent city for the first time. "I suddenly realized that people were conscious of what was happening," she said. I was happy that I wasn't alone in this world, and that others felt as I had."
The people on the maidan all had different reasons and causes that brought them there, she said. But they were all united in the desire to change Ukraine. "We all wanted change for the better," Ms. Didyk said.
Ms. Boyko's generation has also quite readily, and rapidly, adapted itself to the principles of free will, individualism and global capitalism.
She estimated that about 50 percent of her classmates won't pursue medicine after graduating.
One sixth-year medical student, identifying himself only as Volodymyr, is considering pursuing business instead of becoming a doctor - a decision quite common among the male graduates.
But the majority of Ms. Boyko's classmates are female. Some are deciding to get married, create fake marriages, or one way or another give birth to a child so that they can't be separated from their family to take a village assignment, Ms. Boyko said. "I can't imagine giving birth to a child just for that reason," she added.
"In the villages, family medicine practically doesn't exist"
Dr. Vasyl Ruden will be the first to admit that the medical education system needs improving. He is Olha Boyko's professor of social medicine.
More importantly, as the director of the Lviv National Medical University's Department of Social Medicine, Economics and Defense of Health he said he's been trying to propose educational reforms for years, but his suggestions draw little response from the bureaucrats.
He even submitted an article to a Ukrainian medical journal, whose editor rejected it out of concern that some content might offend its pharmaceutical advertisers.
When approached by The Ukrainian Weekly, Dr. Ruden immediately launched into a cathartic speech on the problems his students face.
Students like Ms. Boyko aren't ready to become family doctors because the university hasn't adequately trained them for family medicine, Dr. Ruden said. They have been trained as specialists, he said.
"It's nonsense!" he said. "Nothing will come of it. They must start from the first year of study." Such students need more practical experience on live patients, but their studies are limited to pathology, Dr. Ruden said.
Since many of the medical students themselves know they aren't ready to become family doctors, and are aware of the fact that poor conditions await them in the villages, they will find ways to avoid the assignments, he said.
"In the villages, family medicine practically doesn't exist," Dr. Ruden said. "No one has developed it. Financing is miserly."
City and village councils are responsible for funding medical centers in villages, but their budgets are extremely limited, he said. They often can't even provide the doctor a place to live.
"Nobody is talking about offering the doctor a Jacuzzi!" he said. "But he needs a place to live. That's why they don't want to go."
Dr. Polishchuk deserves recognition for being among the few ministers of health to take decisive steps, he said.
But the mechanism for implementing family medicine was not effective, as evidenced by student outrage. "Several months after the maidan, the same young students came out against the indecisive, thoughtless steps of the ministry," said Dr. Ruden.
Had Health Minister Polishchuk planned his reforms better and reached an understanding with the students, he would have had success, he believes.
Of the 2,500 graduates he wanted to go to villages, between 600 and 800 would have even volunteered, he said.
"They understand what's needed," Dr. Ruden said. "But administrative pressure doesn't work anymore in Ukraine. And that was the problem. You need to talk with people, particularly in the field of medicine. People want changes, but they have to be constructive and wise."
The frustration Dr. Ruden bears for Ukraine's medical system became apparent as he began rattling off a list of the critical problems it faces.
Patients don't have the means to treat themselves. Doctors don't have the ability to earn an honest salary.
Those doctors who don't have the ability to earn a living are forced to seek bribes from their patients in order to feed their own families. Last year's 57 percent increase in doctor's salaries meant nothing because inflation eliminated those gains.
Meanwhile, government officials and hospital administrators lack training in management and marketing, he said.
"Today, here in Ukraine, there isn't a single position as to guiding the family doctor," Dr. Ruden said. "There hasn't been a single program for reforming health care after 14 years of Ukrainian independence."
"I gain strength from the divine liturgy"
For Olha Boyko, Judgment Day is February 20. On that day she will sit face-to-face with representatives from the government commission that assigns graduating students to their internships.
She has already imagined the scenario in her mind. "They will ask me what kind of specialty I'm interested in," said Ms. Boyko, who would have liked to specialize in infections.
She continued in a downcast tone. "Then they will tell me that's not available. And then I will be told to be a family doctor for three years in a certain village."
Once the government assigns a specialty, it's extremely difficult to switch out, Ms. Boyko said.
When asked by The Weekly at a January 25 press conference whether the Ukrainian government had plans to improve conditions for medical interns, Prime Minister Yurii Yekhanurov said he had been working on the problem of accommodating young professionals while serving as oblast council chair.
Programs are under way to build residences and facilities, funded by local city and village budgets, the prime minister said.
In his response though, Mr. Yekhanurov acknowledged that keeping young professionals in Ukraine's towns and villages will be difficult, if not impossible.
Ultimately, "people will decide for themselves where and in which center they will settle and which of those will become centers for future young professionals," he said.
To find peace and hope, Ms. Boyko attends liturgy at Lviv's Dominican Cathedral in the city center. Constructed in the Baroque style, its magnificent altar is adorned with marble columns and robust statues of muscular saints.
On an icy January Sunday, during which temperatures plunged well below zero, she rode the bus for 20 minutes from her apartment complex on the city's outskirts to the downtown cathedral in order to pray.
Frost turned the bus into a roving icebox, forming a thick sheet of ice against the windows that prevented passengers from viewing the street outside. The cold from the metal floor penetrated thick rubber soles and rendered the riders' toes numb.
When she was 16 years old, Ms. Boyko began attending the divine liturgy on a consistent basis, either once or twice a month. At about the same period in her life she realized she wanted to become a doctor, in order to help others.
"We have a closer church, but for me, it's worth a half-hour on the road," Ms. Boyko said. "My soul is calm there and I gain strength from the divine liturgy."
She also enjoys hanging out in the cafes of Lviv, where between classes she sips coffee with fellow students.
On one such occasion, when asked what her ideal situation would be with her career, her face lights up as if she had already envisioned the scenario a hundred times over.
"I am working in my own clinic, which offers qualified, specialized medical help," she said. "And it is outfitted with the newest equipment: computer tomography, ultrasound diagnosis and a lab with the newest methods of diagnosis."
"Wow! You've really asked for quite a situation," said her friend Ms. Didyk upon hearing Olha's dream.
But then Ms. Didyk said she essentially wants the same thing, with one crucial requirement. "I want my work to be appreciated in such a way that my salary would cover my living expenses," she said.
PART IV
Copyright © The Ukrainian Weekly, February 12, 2006, No. 7, Vol. LXXIV
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