Modern medicine and health care on the territory of Ukraine
Formation of modern Ukrainian medicine
An important stage in the formation of Ukrainian medical history is connected with the formation of modern Ukrainian medicine in Galicia. From the end of the 19th century historical descriptions of various problems of medicine, individual diseases, methods of treatment and prevention of ailments appeared, the first Ukrainian modern medical-historical publications were published. The works of E. Ozarkevich published in Lviv contain the first information on the history of the study and prevention of infectious diseases (from Hippocrates). V. Shchurovskyi (1890–1969) was the chief of the sanitary brigade of the Ukrainian Sich riflemen, later a doctor of the Ukrainian Galician Army (UGA), published his memoirs about medicine in the UGA. V. Bilozor (1890–1969) — a doctor of the Ukrainian Sich Riflemen and UGA, commandant-centurion of the hospital in Kamianets-Podilskyi, published essays about the medical service during the years of liberation struggles. Professor-microbiologist M. Muzyka (1889–1972) — the article “Development of medical science and literature in Ukraine in 1917–1918.” (1920).
In 1919–1939, in-patient medical care in the western Ukrainian lands remained paid and inaccessible to the vast majority of the population. There were no county public hospitals in 25 counties. Medical assistance to the population in Poland was managed by the Ministry of Health. It was carried out by the health care departments of the voivodships and district doctors, through health insurance funds that served workers and employees, with the help of a network of private medical institutions and private doctors. Some medical institutions were maintained by charitable societies and religious communities. Compared to Austria-Hungary, the health care system in Poland was better organized: there was state labor protection, certain categories of social insurance, and pension provision. Sick funds were maintained by highly qualified medical institutions (polyclinics, hospitals, and even sanatoriums). However, all of the above did not apply to Halychyna, Volhynia and Western Polissia, which did not have a sufficient number of medical institutions, and a high incidence of tuberculosis and infectious diseases was observed on their territory. Mortality among children was especially high, sometimes reaching 30%.
The shortcomings of the state health care system on Ukrainian lands in Poland were tried to be eliminated in a certain way by Ukrainian doctors and the public, who founded medical associations to provide medical assistance to the population. Among them were the medical sections of the Ukrainian Citizens’ Committee (which performed the functions of the Ukrainian Red Cross) and the Ukrainian Society for Helping Emigrants from Central and Eastern Ukraine. A significant contribution to the health care of the Ukrainian population was made by the Ukrainian Hygienic Society (founded in 1929 in Lviv), headed by Professor M. Panchyshyn, which existed until the Second World War. The society organized its branches in the seven largest cities, had medical clinics, tuberculosis dispensaries, and an anti-tuberculosis people’s sanatorium. The members of the society carried out extensive medical, educational and preventive work with the help of a sanitary and educational exhibition, popularization of medical literature and publishing activities (they published a monthly hygiene magazine, printed popular articles in the Ukrainian press on medical topics, etc.). Society “Narodna Lichnytsia”, founded in Lviv by doctors S. Drymalyk, I.-T. Kurovtsem, T.-E. Burachynskyi, created its own well-equipped polyclinic and built the Ukrainian hospital named after Metropolitan Andrey Sheptytskyi in 1937. The polyclinic and hospital provided free medical care to thousands of patients for several decades. The “Renaissance” society, founded in 1909 in Lviv under the leadership of Professor I. Rakovsky and Dr. S. Parfanovych, fought against alcoholism and smoking. The society achieved the almost complete elimination of pubs in Ukrainian villages, carried out extensive educational activities: participants conducted anti-alcohol courses, gave lectures, published educational products and distributed them among the rural population.
In Transcarpathia, health care was built in the same way as in Czechoslovakia, of which it was a part. At that time, workers’ insurance and medical assistance through sickness funds were common. Medical care for the peasantry was insufficient. The lack of Ukrainian doctors in Zakarpattia prevented the deployment of proper public medical assistance to the population. In Bukovina, which was part of Romania, medical care for the Ukrainian population was provided mainly by private doctors and remained at a low level.
The First World War not only stopped material improvement, medical and sanitary construction, development of a medical network, but also became a real test for the medical and sanitary system of the Ukrainian lands within the Russian Empire. More than 60% of the troops of the Russian active army were stationed on Ukrainian lands. Military operations took place on the territory of border Ukrainian provinces. The resolution of many important organizational issues of medical assistance to the population was interrupted. The mobilization of doctors to the army led to a significant shortage of personnel in Zemstvo medicine, as well as to a significant increase in the number of unregistered patients.
After the establishment of Bolshevik power on the territory of Ukraine, the state of health care of the Ukrainian population in the conditions of a general disruption of life was unsatisfactory. The government of the Ukrainian SSR declared the implementation of health and sanitary measures, including the improvement of settlements, the construction of new residential premises, the development of public catering, the fight against diseases, the organization of labor protection, the provision of free qualified medical care, etc. Instead, the realities for the Ukrainian population became the decline of the medical and sanitary network, the increase in mortality as a result of the war, malnutrition and typhus, and the colossal spread of venereal diseases and tuberculosis. Some improvement came with the introduction of new economic policies. The health care network in the USSR consisted of state institutions, occupational medicine, and charitable societies. State institutions were subordinated to the People’s Commissariat of Health (Narkomzdrav) of the USSR, and included provincial (later regional), poviat (later district) and district health departments. The system included medical care for the rural and partly urban population, preventive, sanitary and anti-epidemic measures. Occupational medicine mainly served the urban population, it was represented by medical institutions of workers’ and employees’ social insurance funds. Among the institutions of charitable societies are the Ukrainian Red Cross, a branch of the All-Russian League Against Tuberculosis, Jewish relief organizations, and a network of private doctors with individual private-cooperative medical institutions (in particular, a polyclinic and a specialist hospital in Kyiv).
The state health care system, the formation of which was initiated by the People’s Commissariat of Health under the leadership of M. Semashko (1874–1949), in many aspects continued the traditions of zemstvo medicine. Elements of city, factory, railway, military, insurance medicine, etc. are involved. The main principles of Zemstvo medicine were borrowed from the free and universal access to medical care, the preventive direction, the unity of science and practice, and the participation of the population in health care measures. In the mid-1920s, the basic principles of dispensation were developed, and later – new types of medical and preventive institutions (LPU): specialized tuberculosis, psychoneurological, narcological, venereological dispensaries; night and day sanatoriums, preventive clinics; dispensary service for workers of large industrial enterprises was introduced. For dispensary observation of women and children, women’s and children’s consultations, advisory associations, etc. have been organized.
In the Constitution of the USSR in 1936, for the first time, the right of citizens to material support in old age, due to illness and loss of working capacity was enshrined. The realization of the right took place thanks to the social insurance of workers and employees at the expense of the state, free medical assistance to employees, organization of access of the working population to sanatorium-resort treatment facilities. The provision of medical and medical care was carried out only at the expense of budget funds, and the right to medical care was given to all citizens, regardless of the availability of insurance. The main network of medical institutions belonged to the state, preventive measures were carried out through the state apparatus. Health care departments had medical and preventive, sanitary and epidemiological, mother and child protection, medical statistics sectors, as well as financial, personnel, and organizational departments. The Department of Education and Science operated as part of the People’s Commissariat of Health. With the help of the state apparatus of health care, with the active participation of workers’ medicine and the Ukrainian Red Cross, a network of medical institutions, as well as scientific research medical institutions, was restored and developed. In 1928, there were 5 sanitary-bacteriological institutes in the USSR: 1 protozoan, 2 radiological, 3 psychoneurological, 3 children’s, 2 venereological, 3 tuberculosis, as well as organotherapeutic, orthopedic and traumatological, occupational medicine, experimental pharmaceutical, and 3 clinical for the improvement of doctors. In addition to scientific institutions, scientific and medical societies continued the traditions of pre-revolutionary medicine.
The main focus of public health management at that time was on preventive measures. Social and sanitary legislation has been introduced, including mandatory two-week leave and leave for pregnant women, prohibition of child labor, regulation of work for teenagers and women, social insurance, laws on labor protection, supplementary nutrition at harmful enterprises, sanitary protection of land, air and water, a number of prescriptions regarding nutrition, residential and communal hygiene, etc. A significant sanitary-epidemiological and preventive apparatus has been developed: an institute of sanitary doctors from various fields of hygiene (housing, communal, food, school, professional, etc.); the training of epidemiologists, doctors of health care for children, adolescents, infants, and pregnant women was founded.
In 1923, the Kharkiv Research Institute of Labor Hygiene and Occupational Diseases was established (now the Research Institute of Labor Hygiene and Occupational Diseases of the Kharkiv National Medical University). The institute was engaged in the development of leading problems of occupational hygiene and occupational diseases, in particular problems of industrial toxicology, combating pneumoconiosis. Scientists of the institute laid the foundations for the systematic development of occupational hygiene problems for adolescents. Scientific works on social hygiene, theory and history of health care by such scientists as O. Korchak-Chepurkivskyi, S. Igumnov, S. Tomylin, L. Ulyanov, A. Merkov and others occupied a significant place among hygienic research. O. M. Marzeev (1883–1956) was a prominent organizer of the state system of sanitary affairs in Ukraine — hygienist scientist, epidemiologist, academician of the Academy of Medical Sciences of the USSR (1944), doctor of medical sciences, professor, founder of the scientific school of hygienists. On his initiative, in 1931, the Ukrainian Research Institute of General and Communal Hygiene was established in Kharkiv (now the O. M. Marzeev Institute of Public Health of the National Academy of Sciences of Ukraine).
However, the declared program did not produce the expected results (quality improvement of the population’s health, reduction of mortality, etc.) due to insufficient attention to the development of curative medicine. The main reason was the low standard of living of the population: low-quality food, mostly poor living conditions, excessive workload, etc. Morbidity did not decrease, there was a constant shortage of beds in hospitals, and doctors were overloaded with patients. According to the People’s Commissariat of Health of the Ukrainian SSR in 1926, four medical institutes of Soviet Ukraine graduated more than 1.4 thousand doctors, in 1928 the total number of doctors in the Ukrainian SSR was only 10.7 thousand. , Odesa and Dnipropetrovsk (now the city of Dnipro) — 46% of doctors were concentrated, in other cities — 22%, the rest — 32% — served the rural population. According to official data, in 1928 in rural settlements there were 7.4 thousand residents per one doctor; In 1927, there was one hospital bed per 1.9 thousand rural residents. In Ukraine, the assistance of specialist doctors in the rural areas was insufficient: there were 160,000 people per surgeon in the Kamianets-Podilsky District, 220,000 in the Konotopsky District, and 225,000 in the Romensky District. The state of health of the population clearly illustrates the example increase in the death rate from tuberculosis: 1913 — 20.2 per 10,000 people; 1921 — 60.4; 1928 — 18.8; 1933 — 36.8.
Unjustified expectations of the effectiveness of measures in the preventive direction of medicine forced the government to reorient health care to the development of a network of medical institutions, and later to make the treatment direction the main one. These changes coincided in time with the beginning of the dictatorship of J. Stalin, the bureaucratization of life and the concentration of all leadership in Moscow. Public and private medicine, with the exception of a very few private doctors, was largely destroyed. Public health care as an industry has completely passed into state management with a centralized management system. The People’s Commissariat of Health of the USSR/USSR functioned as a branch of the Ministry of Health of the USSR. In oblasts — regional departments of health care, in districts — district. Sanitation was managed by the State Sanitary Inspection. Separate departments operated within the People’s Commissariat of Health Care: higher medical educational institutions, research institutes, health resorts and sanatoriums; state medical publishing house. Some medical and sanitary institutions were departmental and were part of the ministries of the armed forces, communications, state security, internal affairs, etc.
The social stratification of the population had a significant impact on the development of the health care system, which then affected the gradual increase in the number of medical facilities for the privileged sections of the population. For the most part, specialized hospitals and other medical institutions served responsible party officials, state security officials, the NKVD, the military, etc. In particular, the sanatorium-resort network (1940 in the Ukrainian SSR — 21 resort areas with about 35,000 sanatorium beds and 226 local sanatoriums) mostly served the privileged strata of the population. The use of sanatorium-resort treatment as an incentive or reward for workers for record production was practiced.