Navy Loses Medicine

To a sailor, taking the sea is rather desired event than a sad one. However, speaking of Irtysh, the feelings are not so unambiguous. For two years the ship has been delivering young sailors to the islands and taking "demobees" out of there. Not the best job for the excellently equipped floating hospital, right? Of course, one could hammer nails by microscope, but is it worthwhile?

Nonetheless, Pacific Fleet command can be understood. Irtysh is just another victim of reform taking place in military medicine. A pebble on the beach. Here come the proofs…

Opinion

Jason Demeyev has been heading the floating hospital not for the first year. In the past a Colonel of Medical Service, now he is a civil doctor. You're welcome, Jason Artemievich.

- In my opinion, military medical staff could have been reduced but not in a way it happens now. Military medicine has a number of particularities different from civil medicine. We had been trained and drilled for years; our medical officers sailed the seas, served in military units, and accumulated experience. To me, it is simply irrational to deprive the Navy of such skilled professionals. There used to be up to hundred men of medical staff at Irtysh, now remained only half of them; by the way, all are civilians. Those who decided to stay haven't leveled down in money, since most of them draw a pension. However, for some people new environment cause difficulties in housing or career perspective. What a shame, we prepared our proposals on staff reductions, but when the decree was issued it seemed that nobody even had a look on what we had proposed! Those guys in Moscow did not consult with anybody. Not talking of myself, they ignored even opinion of the fleet medical service director. They did it in a way they saw fit. It seems like some bosses wanted to keep their chairs, so they fired us. Have you seen a hospital without admission department? Formerly there was a preventative clinic on board; now everything is hung in the air! We had to assign a man in charge for that preventative clinic to unestablished post. No mess-room, no cooks, no mess staff. Physiotherapy department disappeared, so did admission office. Apparently, it was an amateur who made that reforms; it is perfectly seen from the ship's readiness to perform major mission. There were 100 hospital beds and they remained without changes. But the staff has been reduced in half! It's impossible to reduce staff without reduction of hospital beds, as it implies definite amount of doctors, nurses, and medical assistants. Consequently, we have to reshuffle our staff from one department to another. Things don't look good. Speaking of the ship used for other purpose… I think that's correct. If Irtysh has no another job, let her do this one. Ships are built not for staying at the quayside. We don't afraid of that job; last year we had carried out such cruises and did the work well. Doctors, nurses, crew are engaged, and that's great. The longer a ship stays at the quayside, the faster she dies. Irtysh has barely run 15% of service life. Formerly, the ship used to perform its primary tasks; Irtysh had been dispatched to islands and provided medical checkup of distant bases and servicemen families. Now… Don't even know where this ship could be used in present environment. Perhaps, it'd be wise just to keep her ready as EMERCOM rescue vessel. God forbid, if an explosion, heavy fire, earthquake, or tsunami occurs, Irtysh could be used as a floating shelter. This plan firstly appeared after Neftegorsk earthquake; we hosted 500-600 people out of 2,000 bereft of home. Presently, EMERCOM has not such vessels; we can approach seashore and drop cutters to reach places even where there's no runway. That's about it.

Reasoning

Strong words and expressions used by military medical staff talking of past reforms are anything but material for publication. Meanwhile, military officials refuse to give any comments and stay mum. Their silence is understandable, since it is a piece of cake to lose epaulets while such large-scale staff reductions. That's why only Yury Tarlavin, the head of Far East branch of Russian Guild of Servicemen agreed to chat about military reform using "clean" words. There is no telling that his perception of the reform differs from the "public mind", Yury Alekseevich is simply best in expressing his thoughts without the f-words…

As for Yury Tarlavin, reform in military medicine has two trends. The first one implies total liquidation of medical institutions. There is a rumor that even Main Medical Department would be disrated to the level of a bureau and moved to St. Petersburg. It's hard to estimate authenticity of this rumor, but it looks like truth taking into account the general course of the reform. It met the heaviest resistance in Northern Fleet, when Murmansk Military Hospital was shut down. They tried to provide health service for naval veterans in Severomorsk, although it is closed administrative territorial unit and located pretty far. Northern Fleet managed to carry its points, and Murmansk hospital remained as in-patient clinic for 150 patients and became a branch of Severomorsk hospital. Nevertheless, military hospital in Vologda was liquidated after all, though servicemen of the whole Northern Fleet aviation took treatments there! Speaking of other fleets, it's hard to say anything definitive about Black Sea Fleet. Baltic Fleet faced the largest reductions; even BF Medical Department has gone. In contrast to other fleets having misfortune to be based closer to Moscow, situation at Pacific Fleet (PF) is relatively satisfactory. Only one hospital has been shut down – in Lazo (Dalnerechenskiy), although other four hospitals were closed "before Serdiukov"... PF main hospital has been has been shrunk to nothing (it used to accommodate 900 patients prior to the reform, now only 650), but survived. Presently, all remained hospitals are branches of PF main hospital. As of today, they are three – in Vladivostok, in Fokino, and in Petropavlovsk. Why this trend of the reform is so problematic? Medical institutions are withdrawn from small garrisons where most of personnel have been reduced but some objects remained like depots or command posts. In case of disease, active and retired servicemen of these garrisons will have either to find their way to the nearest "branch" or to be treated in civil clinics. Retired personnel can obtain the policy of obligatory medical insurance, but active servicemen do not have such opportunity; they have to resort to fee-for-service medicine unless their military command has settled all accounts.

The second trend of the reform is medical staff reductions and replacement of military servicemen with civilian personnel. It should be noted that dismissed military doctors do not level down in money, since those who serve in the Far East receive pension early; retirement pay plus civilian salary at least equivalent to earnings of a military doctor. Yury Alekseevich and other analysts see the threat in another problem – training system of qualified medical officers is being broken down. At present, military medical education is concentrated only within Military Medical Academy (before the reform, three more educational institutions were involved). Formerly, the training of such unique qualified specialists was not limited by studies in academy – that was just the beginning! Then were years of shipborne and onshore service, regular duties in hospitals, transfer to coastal medical institution, enrichment by experience of senior colleagues… Eventually, the armed forces had a 40-year old professional. Today this system loses its "load-bearing element" as staff categories for military doctors are anything but high. Previously, young enthusiastic doctor could count on trouser stripes [Generals' insignia] or colonel's stars at sunset of career; now this perspective has been vanished. To a ship's doctor, transfer to shore is no longer an opportunity to make a career but a chance to lose in money in comparison with shipboard personnel. Indeed, in the nearest future this trend of the reform may lead to sufficient budget savings without apparent degradation of medical services, but some day it may cause dramatic downfall of hospital staff qualification.

What is left?

Basically, the reform has a rational kernel called "optimization of financing". Perhaps, "squeezed" medical service would be easier to equip, provide with pharmaceuticals, and make proper reconstruction of remained institutions. Again, qualification of medical staff won't degrade tomorrow as there is yet Soviet "powder in the powder-horns". However, one "but" has been already emerged …

Army and navy are established not for a peacetime. Their job is combat operations, and all reforms must be aimed to "optimize" it. Makarov's phrase "remember the war" are topical today just like hundred years ago. So will the "reformed" military medicine be more effective in combat conditions than the "non-reformed" one? It is common knowledge that in the World War II Soviet medical personnel was rated best; comparing to Germany's 60% casualties returned to duty, our medicine could provide 80% and even more. Pirogov's traditions used to live and win. The reform's central idea is that only field surgery would be military when the rest of doctors would be replaced by civilians. But the past experience shows that even at the battlefield people have problems with kidneys, sometimes occur infectious and cold-related diseases, traumas, intoxications, and so forth. All those patients are supposed to be treated by civilian doctors, but they are far from the trenches. As it was seen during "peace enforcement operation against Saakashvili regime", even if a civilian doctor voluntarily goes into the action area, commanders will throw sand in his wheels, since nobody wants to be responsible for uninsured civilian. Neither was determined the status of civilian doctors in the group of medical reinforcement who are attached to a task unit while service at sea. What is their travel allowance, where will they live, eat, how will they go ashore at ports? Questions, questions, questions…

Attitude to reforms in military medicine is the same that to all initiatives of the present defense minister. Undoubtedly, after two decades of breakup Russian Army and Navy vitally need radical reforms. Obviously, even the most topical reforms will arouse the wave of criticism, since it is like a surgery on people's fates without anesthesia. Apparently, only completely "civilian" minister not lobbying interests of particular branch would be able to bring those reforms to an end. But why don't reformers defer to opinion of professionals, just once in a while? Contrary to opinion of our reputable minister, by no means all officers are mobs of hunkers and egoists trembling for their posts. Mainly, servicemen who have dedicated decades of life to the Army and the Navy do care of situation in the armed forces. Many of them have more professionalism and expertise than inhabitants of defense ministry's offices. Probably, it is time to hold by what the specialists say instead of issuing premature orders and realizing them by the "iron hand"? To my thinking, the mischief of present big-city reformers lies in the lack of a "feedback coupling". But it's not only the minister's duty to arrange such coupling. For those who have anything to say on this matter, it is high time to stop being afraid. Perhaps, someone's voice would be heard…