A View of Health Care in the Ukraine


I got to spend 9 days in the Ukraine this summer. When I was first invited to join the group traveling from Des Moines to the Ukraine, I didn’t have great expectations that I would come home saying what a great time I’d had and recommending the Ukraine as a travel destination. But, much to my surprise, I had a great time and would recommend the Ukraine as a travel destination to anyone looking for a pleasant trip in Europe.

I was part of a group of 6 from Des Moines who went to the city of Cherkassy and the region (called an Oblast) of Cherkassy to support the Centers for Disease Control’s efforts to encourage the people of the Ukraine to fortify flour with Iron and Folic Acid.

I was invited to join the delegation by my friend John Shors. John is an attorney representing the corporate interests of the Mercy Health Care System, and John and I belong to the same Rotary Club. Our trip was sponsored and supported by Rotary and all of the contacts we made in the health care system of the Cherkassy region were through the Rotary connection.

The Cherkassy Oblast is a sister community to Des Moines, Polk County. It has been identified as a region that is similar in demographics, population and natural resources to this region of the United States. This area of the Ukraine is the “Bread Basket” of Europe. The fields produce wheat and corn to make flour and grain for most of Europe.

Our group was made up of six people from Des Moines. Myself, John Shors, Mark Snell who is a local businessman specializing in State and City Management and business management, Doreen Chamberlain who is a director of Health Care Access for the Iowa State Department of Public Health and is also a Registered Dietician, Elizabeth Edwards a former teacher of nutrition science and home economics at Lincoln High School, and Ann Olson Schodde who is a businesswoman in Des Moines who specializes in training programs for international business and education. Bob Mickel a retired community planner who has worked in Des Moines for many years and Mike Kaiser a Fellow in Nutrition and Physical Activity at the CDC joined us in Cherkassy.

Prior to our visit, several of the citizens of Cherkassy have visited Des Moines and the surrounding area. Some have come here to study small business and entrepreneurship, to learn about educating the public in AIDS awareness and prevention. Others have come as part of the water improvement plan for the Oblast of Cherkassy.

In fact, the director of the water plant in Cherkassy has been working with the director of the water plant in Des Moines for some time. Together they have improved the quality of water in that region of Ukraine. While we were there, we saw the award that was given to the water plant for the “Best Quality Water in Ukraine”.

I was initially curious about why the United States Centers for Disease Control would have any interest in the nutrition of the people of the Ukraine. It was explained to me that the most common cause of disease is poor nutrition, and that disease anywhere in the world impacts on the rest of the world.

The CDC has been working in multiple regions around the world to improve the world’s nutrition to decrease the underlying causes of disease and birth defects. In the Ukraine, neural tube birth defects have been linked to a folic acid deficiency. The same was true in the United States and the United Kingdom. Studies done in the late 1970’s and early 1980’s that showed a dramatic (more than 30%) decrease in birth defects when folic acid was supplemented in the diet, led to folic acid fortification of the processed flour in the United States.

To support a grass roots effort to fortify flour in the Ukraine, the Community Partners Program and the US-Ukraine Foundation works with local groups from demographically similar regions in the United States and the Ukraine.

Secondarily, iodinization of salt is part of a worldwide effort of the CDC. Particularly in the Ukraine, where large regions and large numbers of the population were exposed to excessive radiation and large doses of radioactive Iodine, iodine in the salt is critical to decrease the incidence of thyroid disease. In 1986 when the Chernobyl nuclear disaster occurred, much of the Ukraine and Belarus were exposed to high levels of radiation and in an attempt to counteract the effect of the radiation, people with known exposures were treated with near toxic doses of Iodine. That has created a lot of thyroid disease in this area.

Through the Rotary Clubs of Cherkassy, I was able to meet the physician directors of the local Maternity Hospital, a Children’s Sanatorium, the City Hospital and the Oblast (Regional) Hospital. These doctors arranged for us to tour the hospitals and the Children’s Sanatorium.

At the Maternity hospital we learned that regional maternity hospitals are dedicated to obstetrical and gynecologic care. They have sections for Family Planning (what we would refer to as infertility), 6 bed wards for labor and delivery, and sections for gynecologic surgery and their own Pathology Laboratories. Only in the recent past has the birth rate in the Ukraine started to rise, until recently women have been fearful of the after effects of the 1986 Chernobyl disaster and the potential for related birth defects, and the country has been independent of the Soviet Union for only 7 years, now opportunities are available for education and success that weren’t there before.

At the City and Oblast hospitals we learned that every hospital has a unit dedicated to providing care for survivors of Chernobyl, and each physician is required to take special training in treating the after effects of radiation exposure and its treatment. The hospitals have all the technology available here in the U.S. Some of the machinery is out of date, or of a lesser quality than ours, but all treatments are available. Hospitals don’t advertise to try to attract patients. Patients are assigned to hospitals and doctors based on the areas where they live. This is similar to the way students are assigned to school systems in the United States. Although patients can apply to go to hospitals outside their region, it’s easier to go to the assigned hospital for care. The hospital facilities are comparable to the VA facilities in the United States. The buildings and infrastructures are only now starting to be updated and remodeled. Privacy is not closely guarded as it is in the United States, but all health care needs are met.

Health care is universally available in the Ukraine and is paid for by the government, but like our Medicare system, patients must pay for medications out of their own pockets. This is often financially impossible, so some diseases go untreated. One example is AIDS. Although treatment is available, the cornerstone of therapy is medication and the medications are far too expensive for a majority of the people.

One of the most memorable of my new friends in the Ukraine is the director of the children’s sanatorium. He is a Pediatrician who was one of the first responders at Chernobyl in 1986 and had an amazing history to share with us. I found these physicians to be great patriots, working long hours and attending to keeping their skills updated, despite a very low salary and little in the way of social benefits.

At the Children’s Sanatorium, we found a camp and school like atmosphere where children suffering from chronic illnesses like AIDS, TB or heart disease were receiving health care as well as education and socialization. Many of the children are orphaned by parental death or from economic loss if their parents have to leave the Ukraine to work in another country and send money back to the family. They don’t have the opportunity to have their health supervised by parents, and so come to the sanatorium for care. Some of the children were rehabilitating after corrective heart surgeries. They have to travel to Germany for the surgery and then recover at the sanatorium.

During our official visits with city, oblast and hospital officials there would always be an exchange of gifts. I took pens and lapel pins from Polk County Medical Society to share with the local physicians and key chains from the AMA to give to the Chief doctors at each hospital. I had mouse pads with the Hippocratic oath printed on them to give to hospital personnel. The most impressive gift I brought to exchange was a silver jewelry box imprinted with the PCMS name and logo that I gave to the Mayor of Cherkassy. The Mayor of the region would be the political equivalent of our state Governor. We had a very nice meeting with him and he was very pleased to receive the gift from the health care community of Polk County. The Mayor has visited Des Moines in the past and has several community connections here.

Through the local health care systems here in Des Moines and through the Rotary Club of Des Moines, we hope to be able to send some of the instruments and supplies that cannot be used here or are surplus and cannot be returned or recycled, to the hospitals and care centers in Cherkassy. They are particularly in need of fetal monitors for use during labor, baby blankets, microscopes, EKG machines, and ultrasound equipment. I am also hopeful that some books and toys can be donated to the children’s sanatorium, so that children who don’t have families to supply those things will be able to have some childhood fun.

I’m looking forward to an opportunity to visit my friends in Cherkassy again and hope to host some of them here in Des Moines.