[000:00:00;00] to the blood center in your city to find out about the need or register on the online platforms donor.ua or healthy me and schedule a donation today documentary trilogy military intelligence of ukraine at sea in the sky on earth the most remote patch of ukrainian land in the middle of the black sea zmiiny island is a strategic item as special forces of military intelligence disembarked and stormed the snake understood that it was a complex operation, we on intelligence took part in it, did a lot to return this island and eventually returned the russian cruiser moscow, which was sent to three letters on the radio station, and then to the seabed of the black sea with neptune missiles

. there is nothing for such a ship to do . 21:15 we do not know how long the war will continue, we all want our victory to come as soon as possible, but the longer we live in a stressful situation , the longer we will see the horrors of the war of horrors this is inhuman shelling by russian terrorists , and the effect on our health will be worse and worse, mr. minister. i welcome you to the first channel of public broadcasting and thank you for visiting us today. congratulations. i wish everyone good health. thank you to each other for over a year.

the full-scale invasion of russia into ukraine and at the beginning of this invasion you voiced the message that, unfortunately, the state of health of ukrainians will deteriorate and at the end of last year, the sociological group rating conducted a study and 32% of respondents said that they felt a little worse, it had significantly worsened well-being of 21% of respondents in general, if you count it as more than half of the population. so, the first question for you is what are the consequences of the year of the great war for the health of ukrainians and for the health care system in general, and to what extent these figures voiced by me correspond to reality. thank you for the question and when we talk about the war, we can talk about direct losses and the direct impact of the war on the state of health and life of ukrainians, as well as the mediated recently met with international prosecutors and also told them

to record the facts not only of the direct impact because there will be a huge amount of mediated impact of the war on the state of health. now we are polling - this is a person's well-being, how he evaluates his state of health, unfortunately, 2022 is not the year when people thought about preventive medical examinations, about screening programs, about immunopro programs, that's all - the fact that we did not get tested can have negative consequences later, because now everyone's agenda is safety, their own safety, the safety of their loved ones, and after that, there are health issues and possibly some worrying symptoms how does a person feel to go to the doctor and not to miss or detect this or that disease at an early stage and unfortunately this is what going to the doctor is not a priority today for certain reasons or in june of last year after

five months of war you said that the seven months of the war led to the fact that we ukrainians aged by 10 years, at least by 10 , that is, the diseases that occurred in our 60s will now be among people 45-50 years after the year of the war . how much have we aged? we have grown old because heart attacks and strokes have occurred and what used to be at 60-65 is now at 45-50 and we do not know how long the war will continue , we all want our victory to come as soon as possible, but the longer we live in a stressful situation, the longer we will see the horrors of war, horrors, inhuman attacks by russian terrorists will get worse and worse . and the impact on our health, again , when we talk about problems, this is also the

early detection of oncological oncological diseases. for other reasons, the later the stage of an oncological disease is discovered, and the more difficult it is to treat and the longer the treatment will be if you consult a doctor late, therefore i urge everyone who has such an opportunity not to postpone visits to the doctor for preventive examinations for screening programs, but to find time now for in order to rebuild ukraine with healthy ukrainians. well, all the more so it can be done by the place of residence. well, we do, but we understand the conditions in which people live who are now somewhere near the front line. there are problems with territories where russia is trying to establish an occupation regime, there are problems with de-occupied territories or the indirect influence of ukrainians was felt already when we were talking about the ilitka, there was a crisis with fuel for cars, along with this inflation , everything became more expensive to leave a remote settlement to the nearest district center or hospital

where can you go these examinations have become many times more expensive, and those who do not have their own transport cannot get there in order to carry out diagnostics only when there is one. i say to ukrainians when it burns, then we are already going to the doctor , this is a problem. and this is the indirect effect of the war on the state of health of ukrainians. we see the same thing, and now and after paying off the prescriptions from the available medicines program , they did everything to make it work during the war . state, but we see a smaller number of appeals and repayment of prescriptions - this is one of the reasons that many people left the country , at the same time, many cannot get there in order to repay the prescription, and now we are developing a number of measures to bring e-medicine from the affordable medicine program closer through various mechanisms, mobile pharmacies through the help of paramedics, nurses who work in remote settlements , so that they have a supply and they can fill out these prescriptions

, by the way , according to the medicine. certain nomenclature positions sometimes reveal one or another problem , what kind of position is it? on the global market, these are the so-called thrombolytics of this group. when a drug is administered that dissolves blood clots and helps prevent complications during heart attacks and strokes, unfortunately, there were none of them in the world. our cooperation with the german minister of health and the german ambassador to ukraine allowed us to prioritize ukraine. increased the quotas of deliveries to us , now there is no such problem, periodically at the beginning of january there was a problem with access to oncological drugs, this

issue was also closed again, everyone turned on different at the political levels, they accelerated the delivery of drugs to ukraine at the beginning of the war, there were problems with bonus substitute drugs with insulins, operational measures were also taken well, i would say in manual mode in order to react promptly to it and yes, in principle, the range of drugs is sufficient, as in the pharmacy network, yes and in medical institutions there is a plus, a large number of drugs arrived as humanitarian aid and were distributed in the regions in order to give them to people who need them, in general, what is the situation with health care institutions throughout in ukraine, and where the most critical situation is, we can say there are two directions, we see significant damage and destruction, we see that more than 1,200 institutions were damaged. and recently , the prosecutor's office and the security service of ukraine discovered in kherson directly a gunner who

directed fire at doctors, and we this fact again they still handed it over to international prosecutors so that they could clearly see the violation of the geneva convention, which clearly says that during hostilities, buildings with red crosses are hospitals. they are, as it were, outside the limits of shelling russian terrorists don't care about it as much as medical evacuation vehicles, because the main goal is destruction, and we can see that there is destruction. now, about 200 hospitals have already been restored, and the center for primary medical care has already been built from scratch in some settlements because they were completely destroyed. it was not possible, but there are still a large number of damaged hospitals in large numbers. we cannot even begin to restore them because they

are constantly under fire and this affects access to medical care, at the same time where it is possible, the health care system of hospitals is modernized, a large number of institutions are modernized, innovative equipment is supplied, both with the funds of the state budget , the funds of the national health service of ukraine are saved, and a large number of international partners have supplied us with expensive equipment, including angiographs, which they help us with perivascular pathology and also remove thrombus from blood vessels during heart attacks and strokes computer tomographs now there will be supplies of linear accelerating in anesthesia equipment, ventilators, that is, changes are taking place, institutions are being modernized, if it were not for the war, there would be something to brag about. and so we see that somewhere we manage to develop a little better, but we understand the large amount of resources that we need in order to completely restore what after our victories was damaged and destroyed, by the way, today

i saw the news that from march 1, the health care facility must be built , reconstructed, restored, and that it must be repaired already in compliance with the new building regulations, you will observe them, so we specially made them with the opportunity so that grain state building regulations appeared in us, which are completely synergistic with european regulations, so that when we launch a large program of recovery of companies that come and help ukraine from the countries of the european union from great britain, the united states of america, so that they do not have a barrier of those former soviet regulations, which in fact migrated to the ukrainian dbn in 2005. now we have changed it, launched a new dbn, and it is really progressive and we will adhere to the fact that our main postulate of recovery is that the hospital should be equally comfortable

for both the patient and the medical worker . why work, again, in each region differently when we are talking about the kyiv region, the zhytomyr region, the chernihiv region, it worked to the full and everything works when we talk about the kherson region, we cannot say what worked, everything starts on the field to work as much as the current situation allows, because it is not possible to open all hospitals in the city of kherson now, because they are constantly under attack, and we have opened the number of health care facilities and the number of medical workers that is necessary for the specific situation, and we are also helping field teams on rotating shifts because, for example , neurosurgeons from odesa come to kherson , field teams of the disaster medicine center

of the ministry of health work in populated areas of the kherson region, and they pass through in all settlements and well, as such a mobile rural dispensary, a large number of partners help the red cross, other international organizations and ukrainian public organizations, which also travel around the villages and provide both social support and first medical aid, the first diagnostic procedures that can be carried out on the spot in order to then tell the person that he needs to go further, if hospitalization is needed , well , let's say we are talking about the kherson region. left, continue to work and continued to work in the occupation and work under shelling, for which a big thank you to the medical workers, are they in the same number as there were , but not the same number of people who continue to live now or have returned to kherson, so it can be said with a stretch, but the number of doctors is adequate to the situation

that exists there in case of some critical situation , if we see that there are gaps , the health care departments of the regional military administrations report to us, and we, through the mechanism that was launched last year, can to send any employee to another hospital on the territory of our country on a business trip with the preservation of wages, it is clear that people fleeing the war moved, some were forced to move inside ukraine to safer regions , some went abroad, did this internal and external migration of ukrainians lead to a lack of personnel of medical personnel. in particular, i mean, for example, junior medical personnel, nurses, orderlies, mostly women. is there a shortage? if so, where the situation is not more critical, is there a shortage? after all, the closer to the front line or

where there is shelling, if we are talking about ukraine as a whole, so we see a decrease in the number of medical workers, we monitor the number of workers who left their jobs and left ukraine, but this number is not critical for our health care system because a large number of medical workers have moved from those territories where russia is now trying to establish an occupation regime and are quietly working in health care facilities in safer territories, burdening those who remain who did not leave? it must have increased. well, you have to compare where and how the workload really increased, as well as on family doctors, and especially in the first months of the war, when a large number of people transited through certain settlements, since after all, kropyvnytskyi , so many people went for a week or two remained in kropyvnytskyi, then moved further to the west of our country and the question is how they all

went to the family doctor, they did not renew the declarations, but from the first days of the war, an order was issued by the ministry of defense health that if a person applies without a declaration, then the doctor has the right to form a referral, write a prescription, provide him with all the necessary medical care, this is signing without signing a declaration. so, this led to additional burdens on the doctor, but everyone understood that this is an additional burden, it cannot be compared with the burden where there is a doctor on the territory of constant shelling in the bomb shelter, we are with a smaller number of people to whom we provide medical care, but in much worse working conditions, and this is the way it is, if only by mutual aid to each other, the system health care has persevered and continues to provide medical care, i will not say that everything is perfect, everything is smooth, there are cases, but we all respond to these cases together with the salaries of medical workers, everything is fine thanks to

international aid, in particular, the government of the united states of america, which allocated grant aid for the budget of ukraine, which is aimed at for the repayment of the gap that arose in the budget of ukraine under the program of medical guarantees for the salaries of medical workers and the purchase of necessary medicines we managed to fully finance the program of medical guarantees in the 22nd year. and now , in the first months, we also have money in a single treasury account that allowed the national health service of ukraine to make transfers to the accounts of health care institutions . last year, all institutions were required to maintain a minimum salary of 20,000 uah for a doctor and 13,500 for a nurse this year we switched to

the balance sheet and say that if you have, for example, 85% of the income and health insurance is spent on the wage fund, you are obligated to pay the wages adhere to this minimum level, you spend everything else on medicines and consumables so that none of the patients buys anything in a hospital that works with the medical guarantee program. in general , are there any allowances for doctors, well, medical personnel who work in the front-line territories, or is something provided for them, see the front-line territories we have made separate packages of the medical guarantee program, because we understand that there are several issues, they do not have the same number of patients as before well, as before and it can lead to a decrease in the receipt of funds from the national health service of ukraine, which in turn leads to a decrease in wages, that is why we fixed them there with the so-called combat package, which provides for the preservation of funding at the level of 2021, so that they can

be ready to respond to any challenges have separately preserved the salary package for those hospitals that continue to work in the occupied territories . remembered and knew that ukraine is with them ukraine will fight to the end to expel the russians from the territory of our country. diseases, mental health is becoming the main problem of health care in ukraine, this is the statement of the special adviser of the world health organization, michel kazachkin, what will we do with mental health and what is being done already, we are already doing it, so we understand that really

the war has a significant impact on the psycho-emotional state of every person, even if we do not recognize it. this does not mean that it does not affect us, and the first months of the war, if we remember , we saw everything live on the air: the movement of a convoy of heavy weapons from russian terrorists , shots, the destruction of residential buildings, rocket attacks, all this it was broadcast and even a person who lived in the wrong place where the rockets flew by, she saw all of it and was just as worried as the people who lived near the destruction, that everything will not be have a negative impact and in order to assess the consequences we even used the data of the shelling or terrorist act in new york on september 11, almost everything there was also live, and then the researchers assessed how much and what kind of impact that terrorist act had on our psycho-emotional state of health much more, we understand that

the impact will be greater, we calculate somewhere on the figure of 15 million plus or minus which well, in principle, every fourth of which will have changes in the psycho-emotional state but in order to cope with this challenge, we we have already done an audit of the systems we have for psychological support and an audit of the resources we have, we have identified the problems we have, and we are now directing our maximum efforts to these specific problems because what is working , well, for example, the problem is that psychology - these psychological changes are not only a medical problem. in our medicine, this is already psychiatry, and when we talk about the fact that we do not detect changes in the psycho-emotional state in the early stages , and then we already see the consequence of psychiatric three psychiatric diseases that are treated, then we are somewhere you should look at what the person applied for and where adequate help was not provided in order to work it all out and we in medicine

have a flagship project, we started to retrain family doctors on the problems of vozov such as identifying changes in the psycho-emotional state , a program such as mhgap shows the vozov techniques the key changes that one should know each family doctor so that when communicating with a person who has asked for a consultation and someone else has some question to the doctor, he must detect changes in the psycho-emotional state and recommend or exercises for self-help or referral to a narrow specialist who will already help specifically cope with this or that issue. whom did you recommend to turn to if people feel that the psyche is now disturbed? the family doctor is the first thing there is a hotline where you can talk to professional psychologists who can then tell you where to go. the closest to a person's place of residence is

a psychologist who provides psychological help free of charge; the centers of vitality will be developed further, which are under the care of the ministry of social policy, the ministry of education is retraining its psychologists who are in the education system near schools so that they can also work with the trauma that is received as a result of the war. three years ago , the first case of coronavirus disease was recorded in ukraine during the entire pandemic . almost 5.5 million ukrainians fell ill with covid-19 over 111,000 died, what is the situation with the corona now, the second half of february 2023, we see an increase in the number of cases, an increase in the number of hospitalizations, but the situation is not critical and the same as it was in november 21

, march 21, when there were crazy peaks in the number of detected cases and in the number of hospitalized patients, and then in the number of deaths, now there is no such thing, that is, the number of vaccinated people, the number of sick people today allows us to go through this increase in the number of cases of covid, as before we went through the increase in the number of cases of influenza and acute respiratory viral infections , i do not i will say that the disease has already completely, well, become a common banal because you voice it . and deaths from covid continue to be registered, and there are people who die in intensive care are on oxygen therapy, but there is no overcrowding in health care facilities , they calmly continue to provide medical care to everyone who needs it, including for the coronavirus. there are vaccines, everyone vaccinates but do people get vaccinated? are they vaccinated? not in the same quantities as before. before, we talked about

millions. we did 10 million vaccinations in the summer . now it is already tens of thousands per week, it is hundreds of thousands. well, somewhere on average 200-250 thousands of people are vaccinated, are there many who haven't done much , and we recommend that you recommend them to get vaccinated , there are no problems, consult a doctor, the vaccine is available and a children's vaccine has also appeared, so there are no problems with this at all. and what about monkeypox in ukraine? there were several cases , an investigation was carried out, and the european union last week gave us 10,000 monkeypox vaccines for certain risk groups so that we could use them to prevent the spread of this risk disease in the first place

in turn, these are men who practice sex with men, since the previous cases were precisely in this cohort of people, this is one of the groups of people , or is it a group, but it is the most at-risk group that now gives professional contacts , that is, these are infectious diseases doctors, medical workers, doctors, laboratory workers who work there in your profession, you can meet the pathogen. therefore, they will be able to protect themselves in the event of something. where can you get vaccinated? yes, there is already a vaccine. you must contact the regional department of health or the center for disease control and prevention and ask the place by location in which vaccinations are carried out against by the way, according to the calendar of vaccinations, preventive vaccinations, children's vaccinations, what kind of situation do we have at the moment , is it a disaster or more or less, see for me as a person who also has the experience of the chief

state sanitary doctor so everything that is below 95% of coverage cohorts is a disaster yes, but i personally expected that there would be more of a failure in 2022 because of the war, right now we see that the coverage level is 60-75% depending on the country that was before the full-scale we from 2018 to this was already a disaster, and after that we already reached the level of 90% for certain diseases . 85 and now we asked for 10-15%. we have not completed a full-fledged company, an additional such cleaning company for poliomyelitis, we understand that the 23rd year is a year of five-year cyclical increase in the incidence of measles, and every 5 years there is an outbreak and every 10 years there is a large outbreak, so once again we urge everyone

to review their vaccination status, and everyone who needs to be vaccinated must make up for it. and who needs to do that must be done well, all adults must also make their contribution to the victory and prevention of the spread of infectious diseases every 10 years diphtheria and tetanus is done because diphtheria is one of those post-war infections and it can spread quite quickly in the kitchen of unvaccinated people another topic about who wanted to talk about reforming the medical system, however, it was stated that the ministry of health is starting another stage of medical reform, however, there is the issue of reforming such systems that operate in health care, which in my opinion, what is being discussed around

is more timely. and it is not the first day, not the first month, it is the reform of the system of medical and social expert commissions , military medical commissions of the lkk, etc. what is being done now so that we do not see more posts on social networks about what people that were injured as a result of the war , received mutilations, servicemen who were injured, that they go through the nine circles of hell in order to stand in queues of kilometers for several hours, get a certificate, then get a conclusion, and the conclusion should be objective a lot is being done and is being done, but you understand that it is a system. well, it has been developed since soviet times. it is necessary to separate the issue of the vlk of military medical commissions and medical and social expert commissions . disability in ukraine, what is it related to? the first stage is

the launch of a full-fledged rehabilitation system in the field of health care, as it is declared by the best countries of the world, this rehabilitation is not focused on the fact that a person has been somewhere she recovered there, was treated, and upon return and resocialization, a person understanding the pathology, physical rehabilitation does everything possible to ensure that a person comes and is physically active and employed in accordance with his functional capabilities , a new rehabilitation system was launched in ukraine , this was facilitated by the law on a separate law of ukraine on rehabilitation in the health care sector i and a number of normative legal acts are the instructions of the president of ukraine to launch a new rehabilitation system in the country, and we have already done, well , a large pool of what should have been done, and it's not only on paper. well , first of all, any reform and changes are being prepared on paper, it's already in practice. now we're