Health & wellbeing

 
Audrius Simaitis

VilNews invites you to participate in a discussion about Lithuania’s health care system.
Introduction by Audrius Simaitis,
Consultant Cardiologist at Royal Cornwall Hospital, UK.

One of the things that strikes one the most in Lithuania is the fact that management’s mentality in the health care system has undergone little change since Soviet times. This is out of proportion in comparison with other fields like education and business.

Any outsider would immediately ask: why?
The answer most probably could be found comparing the State owned medical field with the predominantly private sector of odontology.

The State owned medical field is ineffective, tarnished by corruption. National and European surveys reveal the public in general is significantly dissatisfied. Physicians are happy neither with salary levels nor with working conditions. The emigration rates of the doctors are increasingly in worrying proportions.

To read more and comment, go to Section 3 – CHAT AND DICUSS!

Text: Audrius Simaitis

My efforts to change the outlook of the Lithuanian health system started in January 2009 when I created the very first plan for how to bring about the change, long before the Ministry of Health started the current reform for this sector. Mr. Žilvinas Beliauskas was a wonderful partner in this enormous effort at that time but government institutions paid little attention, if any.

When in autumn of 2009 the Ministry of Health started the current reform it was obvious that the suggested changes, although important, will not bring a long term ongoing success as much deeper changes tackling the main underlying issues were required.

I have created a concept that is called "Health Care Reform Based on Values". The main idea of this concept is to create 3 medical regions in Lithuania with university centres as the main coordinating institutions in each of the region. Vilnius and Kaunas already have such an institution and Klaipeda does not.

One of the obvious problems that are the main source of underlying current problems, such as corruption, is the fact that the directors of the hospitals have too much power. Indeed their powers could be compared to the Kings of the middle ages. There is no control and accountability for their actions, as many Boards in the hospitals do not have any decision making powers. To compound the issue, six years ago Parliament issued a law that the there is no retirement age limit for the heads of the hospitals. They are the only category in the country to have such indulgence.

These are just a few examples to illustrate the fact that there is too much power concentration in one hand. This led to the situation where doctors and nurses are very passive and over the years they never learned to express their concerns or opinions publicly purely due to the fear. The fact that doctors accept unofficial payments also contributes significantly to the stagnation in the system.

Therefore we need to create an institution that will tackle these issues and will release the potential currently suppressed by existing structures and fears.

This leads to the next idea described in the "Health Care Reform based on Values". Each of the 3 regions should be governed by the elected/appointed Boards that would consist of the doctors, nurses, directors of the hospitals, representatives of the public and representatives of the patients' organizations. In this way the balance of the power between the directors of the hospitals and doctors will be achieved. The Regional Board will be responsible for the strategic decisions and the hospitals will be responsible for the implementation of these decisions.

And the integral part of this concept is the New Physician's contract that would encompass all the modern aspect of the physicians’ role in today's society. The concept also foresees significant change in the role of nurses as the current role of the nurses in Lithuania is well beyond the times.

Since autumn 2009 I have made multiple presentations of "Health Care Reform based on Values" to hospitals, various organizations, including presentations to the Speaker of the Parliament Mrs. Irena Degutiene, to the Health Care Minister Mr. Algis Caplikas, to the health care team of the President Dalia Grybauskaite. Various national mass media outlets published a lot of my articles reflecting these ideas.

In the continuation of these efforts to bring about the change, I organized a Western Lithuanian group of doctors and patients. This group in collaboration with Klaipeda University organized a Conference on the 15th of January 2010. About one hundred representatives of the doctors, patients' organizations and nurses in Western Lithuania took part in this Conference. The Resolution of this Conference fully supported the idea of establishing Klaipeda’s University Hospital with the idea to create the Association of all three Hospitals in Klaipeda as an initial step. The Resolution also supported the idea of establishing a Board of the Association with the thought to bring about balance between the administrators of the Hospitals. This also would enable the implementation of modern methods of health care management.

Basically there was no reaction from the government institutions to this Conference, and there two main reasons for that. Firstly, Vilnius and Kaunas University Hospitals do not want to loose their dominating status, as this obviously is associated with the finances. They have a lot of power and influence on the Ministry of Health to a degree that some of the prominent figures state that health care in Lithuania is governed by them and not by the Minister. Secondly, is the very important reason that most of the directors of the hospitals in Klaipeda do not want to have the University Centre as their own role could be different after the Klaipeda’s University Hospital is established.

This was very well demonstrated during the latest debate /forum which was initiated by the Mayor of Klaipeda and myself on the 26th November 2010. Only one Director of Klaipeda's three major Hospitals was present during this debate. This debate was about the future of the Klaipeda’s Hospitals and the unanimous decision of the forum was that there is the obvious need to establish Klaipeda’s' University Hospital. A representative of the Ministry of Health, Mr. Martynas Marcinkevicius who gave a presentation during this event supported this idea. There have been no developments since then.

The “fight” continues.

Text: Gene Emmer
(from his travel blog www.lithuania-travel.net)

Unfortunately, Vilnius Lithuania does not rank high on any list of wheelchair accessible cities. We rarely see any wheelchair users in the city. When we do, they are invariably manual wheelchairs. We have yet to see a power wheelchair or a mobility scooter in Vilnius.

Several problems plague Vilnius in terms of accessibility. While it is not difficult to find accessible accommodation in Vilnius, it is difficult to get around. Like many European old towns, the streets are cobblestone. Old town shops usually have steps, and rarely have ramps or lifts. Restaurant toilets will sometimes be a flight up or down, with no alternative access. There is little in the way of disabled parking. The good news is that the Vilnius old town is pedestrian friendly. So, with some patience and a bit of assistance, a manual wheelchair user will manage in most places.

In the newer part of the city, such as shops and restaurants located on Gedimino Prospektas, things are a bit better. For example, the shopping mall located on Gedimino 9 is wheelchair accessible. Some of the newer mega shopping centres, such as Akropolis, Ozas, Panorama will offer few problems for wheelchair users. However, the vast majority of the buildings in Vilnius were built without elevators or ramps and there has been little in the way of retrofitting to accommodate people with disabilities.

Services for wheelchair users are also limited. It will be difficult to locate wheelchair accessible vehicle rental or wheelchair rental in Vilnius. While the Vilnius Airport will present few problems to a wheelchair user, access to the train station will be quite difficult. There is ramp access at the train station to one of the doors at the train station. However, getting onto the trains is challenging as there are no ramps to the train platforms and getting onto the train usually requires a very steep climb up steps built into the train cars.

While Vilnius is a beautiful city and certainly one to be enjoyed by everyone, a trip to Vilnius, Lithuania will present challenges to many wheelchair users. With adequate planning, many of the challenges can be overcome. But wheelchair accessibility of Vilnius, Lithuania leaves much to be desired.

Having worked in the Pharmaceutical industry for over 15 years, I have seen and gotten to know more doctors than most. I know that there are many doctors who are good at treating the disease but not so good at treating the patient. There are other doctors who are very good with patients, but are sometimes lacking in their medical skills. To find a doctor who is good at both is unfortuately rare.

I have a found a doctor who is not only good at both, he is perhaps the best doctor I have ever met. His name is Dr Cervin.

It is not just me. I have mentioned Dr Cervin to my friends and I know that some are seeing him. Most express their gratitude for the referal. This guy is that good.

Dr. Cervin studied medicine is Australia. His passport maybe Lithuanian, but his medical approach is very much western. He is that GP who you just feel confident in and comfortable with. He offers old-fashioned patient care with modern medical treatment. The ideal mix that you rarely find anymore. Needless to say his English is perfect Australian English.

Dr. Cervin's assistant is pure Lithuanian. She is very kind but her English is limited. So, if you call and speak English, she will probably connect you through to Dr. Cervin directly.

The other nice thing about Dr. Cervin is his location near the Cathedral Square. For many expats and visitors to Vilnius, this is very convenient.

All this comes at a reasonable price. At the moment the cost of a consulation is about 150 lta (approx. euro 50) plus the cost of any exams or proceedures. However, Dr. Cervin always consults with his patient before ordering any of these. So, you will not be suprised by the bill.

So if you are looking for the best GP in Vilnius, call up Dr Cervin and say G'day.

Text: Gene Emmer
(from his travel blog www.lithuania-travel.net)