FROM THE DAY’S FILES: Hennady KNYSHOV, director of the Amosov Institute of Cardiovascular Surgery, full member of the Academy of Medical Sciences of Ukraine, corresponding member of the Ukrainian National Academy of Sciences, Meritorious Scientist and Technician of Ukraine, state prize winner, professor, doctor of medical sciences. One of this country’s leading heart surgeons. Was the first in Ukraine to put coronary bypass into clinical practice. Author of over 300 scholarly publications, including six monographs. Supervised 30 doctoral and postdoctoral dissertations. President of the Ukrainian Association of Cardiovascular Surgeons, member of the US Society of Thoracic Surgeons and the European Association of Cardiovascular and Thoracic Surgeons
THE INSTITUTE
Anyone who has ever been at the Mykola Amosov Institute of Cardiovascular Surgery before will not notice any sweeping changes there today. A bust of Mykola Amosov in the vestibule, with a bouquet of fresh-cut flowers underneath... Your eye catches a wall clock in the institute director’s office: surgeons turned Jacks-of-all-trades and put scalpels in place of the hands. On the whole, the surroundings are as in a popular joke about a “new” Ukrainian: “poor but clean.” What remains after the last Soviet-era renovation is carefully looked after by junior medical staff.
What leaves you truly impressed is that last year the institute performed 3400 operations. If you take into account that there are approximately 220 working days in a year and do some simple arithmetic, you will find an average 16 operations a day, 18-20 on very heavy days.
An operation with artificial blood circulation at the Institute of Cardiovascular Surgery costs about UAH 4,000 for a child and a little over 8,000 for an adult (last year 124 underprivileged patients were operated on free at state expense). Incidentally, this only covers the cost of medicines and expendables, such as artificial heart valves and lungs. Conversely, Western clinics charge $10,000 to $45,000 for an artificial blood circulation operation and $90,000 for a heart transplant (in Germany). As to the success rate, incidence of postoperative complications, for example, infectious endocarditis, is 20% in the West and a mere 4% here.
In 2002 the Institute was allocated 338,000, instead of the planned 495,000, budgetary hryvnias. With this year’s target being 700,000, 180,000 have been received over the five past months, while the operations performed already cost UAH 260,000.
On top of all this, a department chair, doctor of medicine, professor earns 394 hryvnias (roughly $74) a month.
Television has recently told us that a certain Swedish charitable organization collected $200,000 for a Ukrainian girl to undergo open-heart surgery. The child was saved. This is wonderful, of course: there also are good specialists abroad, who, unlike their Ukrainian colleagues, are adequately rewarded for their efforts. Ukrainian TV viewers saw the pretty little lady thank the foreign sponsors with tears in her eyes and must have concluded that this is the only way to solve the problem. Do many Ukrainians know that treatment at the Institute of Cardiovascular Surgery is more effective, in many respects, than in the best European clinics? This raises the question: how many of our children can be saved in the West? And how many could be saved in Ukraine if the state addressed this problem in earnest? Why do Western benefactors, instead of paying for expensive operations there, not allocate much smaller sums to fund similar operations here? They refuse because they have noting to gain.
There is a shocking gap between the sophisticated technologies employed by Ukrainian heart surgeons, their highly commendable representation of our country at international symposiums and conferences on cardiovascular diseases, etc., and the modest, if not miserable, conditions in which our specialists work wonders for such a salary. Moreover, private health care does not seem realistic either. Where is the way out?
THE ACADEMICIAN
The reception room is full of commotion and confusion, then the door is flung open and the institute director strides confidently into his office. Any psychologist will say that an individual is best of all characterized by his eyes and hands. Dr. Knyshov’s eyes are calm and penetrating, his hands are big and strong but at the same time surprisingly soft and free of calluses, ideally adjusted for surgical accuracy. He is simple and witty in dealing with people and can explain everything in clear terms.
THE OPERATING ROOM
The operating room is the holy of holies of any hospital. It is nothing but a pipe dream to gatecrash the Institute’s heart. Duly attired, I timidly step behind a heavy iron door. A high ceiling, tiled walls, implements, people swaddled from head to toe in sterilized smocks, with only their eyes visible.
I am perplexed: people, with whom you have just shaken hands, talked, and drunk coffee as an equal, undergo an astonishing metamorphosis as soon as they take up the scalpel... The operation is in progress; the case is acute. Dr. Knyshov listens attentively to a colleague of his and comes up to the table. What comes then is like a movie, “Scalpel! Swab!” The only difference is you are standing half a meter from a man whose heart has stopped, and it depends on the people bending over him whether he will live or die.
Each of the medics in charge of a particular thing — anesthesia, artificial heart, blood, cardiogram, drip, surgical instruments, lighting — does his/her job calmly, with no unneeded fuss. In brief, you see that these people are just doing their daily work.
It is difficult to photograph — mainly because of a plethora of hoses, wires, and equipment: you are afraid, God forbid of accidentally catching on or breaking something. The mask also irritates you: it keeps slipping over your eyes and makes the viewfinder fog up.
At last, the most critical part is over. It is a fleeting, almost mystical, moment: the all-pervasive tension has suddenly eased, the people relax and begin to move more freely. “Suture,” Knyshov seems to be smiling with his eyes and invites me to go further.
The first operation room was followed by a second and a third. In all surgeries were being performed at a different stage. An interesting detail: when Knyshov comes in, a light wave of joy sweeps over his colleagues, a far cry from the syndrome of fearing the boss. A piece of advice from an experienced surgeon is very much to the point when you begin a difficult stage of the operation, and when the operation is drawing to a close, the physicians do not mind cracking a joke or even discussing political problems.
AFTERWORD
Dr. Knyshov and I spent almost half a day in operating rooms. After what you have seen you begin to take a different view of many things and reappraise the values of life. Seeing me off, he said, “I’m responsible for everything.” and firmly shook my hand with his, the hand he keeps, literally and figuratively, on the pulse at all times.
