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Tender point. Why do we go to healers?

The attempt of the health care officials to close the so-called medical center in the capital's urban district Kok-Zhar which is working without a license, has failed. Last Saturday, the deputy director of the Health Care Department Tilek Zhantaybekov once again went to the place to talk with patients.

 "But they again flatly refused to be transferred to the National Center of Oncology. And then came the healer himself, he was indignant and asked how I have entered the private property, scolded the security. The healer was called in for questioning, but the center is still operating. Moreover, there appeared two new patients," he told 24.kg news agency.

Questions without answers

"Everybody demand from us to close the center, but how can we close the object which was opened without a permit? Tilek Zhantaybekov wondered. - I have a question for law enforcement agencies: why do not they close the facility that exists without a license, which is illegally healing the people? It means that the person does not take a license and does not pay taxes. We can only offer changes to the legislation to take at least some action in such situations, but it will take time. Working group is being just created now."

 During an inspection, representatives of the Health Care Department stressed that patients of the illegal center get infusions of unknown origin. "Liquids that are used for infusions have bright color. I by myself can not confiscate them, otherwise I will be accused of theft. I suggested the policemen to seal the solutions, confiscate them and hand over to us for the examination. I do not know whether they did it or not," he said.

Reason for change


It is not clear whether there is a will to close the private center. But the case has helped the officials to see the trouble places in the health care system.

"According to the anamnesis it is clear that patients get powerful painkillers, because in the last stages of the disease people suffer from pain. And important is the fact that there are no capital's residents among patients of Zaynaliev. All of them are from the regions. What does this mean? Bishkek has a set system: there are doctors and pharmacies," Tilek Zhantaybekov said.

"Once a person was diagnosed with the 4th stage of cancer, the National Oncology Center sends notification to the family medicine center at the place of residence of the patient. From there the signal goes to a group of family physicians. Doctors perform nursing at home, give medications. If the drug no longer suppresses the pain, he is prescribed another stronger medicine. There are few drugstores working with morphine in the regions, patronage is not provided, as a result, the people suffer from pain," the deputy director of the department said.

"Therefore, patients have plenty of reasons to go to a healer. I talked to every patient and understood that Zaynaliev does not cure, but carries out palliative care, relieves pain, talks to them," Tilek Zhantaybekov said.

Right to live without pain

Quality of palliative care in the country is being actively discussed in the last few years. According to the director of the program Public Health Care of Soros Foundation- Kyrgyzstan Aibek Mukambetov, until 2011 not a single law on health care included the concept of "palliative care", including Health Protection Law. "It's not anyone's fault, just a situation. In March 2012, the Ministry of Health Care has developed and adopted a Program for development of palliative care strategy for 2012-2016. Just in this period, pilot projects on the provision of outpatient palliative care have been launched with our financial and technical support," he told to 24.kg news agency.  

This approach helps to provide outpatient palliative care. It is recommended by the World Health Organization, the World Alliance for Hospice and Palliative Care and stipulates the work of multidisciplinary team of physicians, nurses, social workers, psychologists and lawyers.

"There are only three teams, one of them works in the city of Osh, and two - in Bishkek. They do not work in other regions. The government is interested in the development of these projects. It is planned that in 2017 the state will take part of the funding upon itself," Aibek Mukambetov said. 

He stressed that the gold standard for pain relief in palliative patients worldwide, according to WHO recommendations, is tableted morphine. "We used only the injections before. Tableted form has been registered in the country in 2015 with the support of different parties. In order to deliver the first batch of the drug in a limited number, we together with the partners collected the money at the charity events. Morphine through oncology centers was given for free in Osh, Jalal-Abad and Bishkek to patients, who particularly needed it. 

In parallel, the MHIF included the tableted morphine into the program of state guarantees, in which the state reimburses up to 90 percent of its value to the patient. But the problem is different: we can not solve the problem of the regions with this drug. The fact is that all pharmacies are private. It is good that business is developing in the pharmaceutical sector, but few of them want to deal with problematic drugs that belong to opioids. Pharmacy owner must have a license, to comply with a number of conditions for the security and storage of medicines. There is fear of the auditors, bureaucratic obstacles," Aibek Mukambetov voiced the problems. 

"Patients' rights should not be infringed. Those who have seen a person, suffering from pain, will understand it immediately," he stressed.

... As long as the state can not provide adequate conditions for all patients, this niche will be occupied by those, who loudly call themselves doctors.