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Above: Border of the region of Pskov with Region of St. Petersburg. Below: Pskov countryside

June 28, 2005 - Pskov

The city of Pskov is a pretty little town filled with parks and is situated 265 km southwest of Saint Petersburg close to the borders of Latvia and Estonia. It is the seat of Pskovskaya Oblast, the area surrounding it. Once asked to consider the establishment of a pediatric cardiac surgical center for the region of Pskov, Doctor Paul Pitlick advised against it. “A regional center of excellence (the name given to highly specialized pediatric cardiac surgical centers), requires a population base of about four million people”. Together the city and surrounding region contain just under one million people, too few to support the existence of such a center. It is well established that high-volume hospitals tend to have better outcomes than centers with lower volumes. With that size of population, the numbers of children with heart disease in Pskov would be too few to maintain the skills of the surgical team. Still, the population needs to have a place to send its children who need heart surgery. “In this case, it is better to send the children to a center of excellence that serves a larger region.” Dr. Pitlick responds.

 

In Russia, most primary and secondary care is funded at the local level, with some additional federal funding for more complex procedures. Thus, both the city of Pskov and the Pskov Oblast employ Pediatric Cardiologists, who provide non-invasive diagnostic and medical care. Patients who require procedures which are not offered locally may be eligible for federal funds, which must be spent at a federal institute. Thus, the majority of children in Pskov who need open-heart surgery are referred to the Bakulev Institute in Moscow, a large (performing 2500 open-heart procedures in children/year) cardiac center. However, the federal funds do not support travel between Moscow and Pskov, nor housing in Moscow. Many families simply cannot afford these expenses. In addition, some procedures are not offered at the Bakulev.

 

The Regional Children’s Hospital of Pskov, owns a state-of-the-art tool of modern medicine , an Acuson Sequoia ultrasound machine. “Vladimir Putin himself delivered the machine to us not too long ago.” Doctor Tatiana Schegoleva proudly states. She is the pediatric cardiologist responsible for the children of the Region of Pskov. In the United States such a machine, which is critical for the diagnosis of congenital heart disease in children, would cost about $280,000. To any pediatric cardiologist, it’s a beautiful sight.

 

Doctors Tatiana Schegoleva and Chervonnova Valentina Leonidovna

Dr. Schegoleva considers herself lucky. Just a few blocks away, her colleague, Dr. Chervonnova Valentina Leonidovna , the pediatric cardiologist of the City Children’s Hospital of Pskov, does not have her own machine, but through arrangements with the Regional Administration, she is allowed to study one or two patients each week.

Outside the consultation room at the Regional Hospital a corridor full of hopeful children and families wait to be evaluated by these doctors. The families come in hope that the presence of American doctors means funding will become available for their children’s operations.

Most children from Pskov are referred to the Bakulev institute, but some are assigned to have their surgery at the Medical School of Saint Petersburg State University. The rare family who is able to collect the funds for surgery themselves (equivalent to about $6000 USD) may seek care at Children’s Hospital Number One in Saint Petersburg. Thus, the majority of children with cardiac problems receive the care they need,

 

but there are still those whose lesions are too complex to operate in Moscow, and those who cannot afford the expense of travel and housing. The rest wait.

At the Regional Women’s Hospital , over half of the births in the entire region of Pskov are delivered, 3000 per year on average. According to Dr. Yuri Grom, Neonatologist, up to 60% of these births are considered high risk. Over 30 of these babies each year will be born with heart disease . Some of them would benefit if they received a drug called prostaglandin E1, which is not readily available. This would allow time for the baby to be transported to a surgical center for an operation at the ideal time.

 

 

Pskov Regional Health Administration

What opportunities are available for agencies outside the current Russian health-care system to aid the families and the children who are born with serious heart defects in Pskov? On a general level, the Pediatric Cardiology clinics would benefit from additional equipment, such as simple machines to measure the oxygen level in the blood of children with cardiac defects, and another ultrasound machine. On an individual level, there are still a number of children with cardiac defects in Pskov whose families need financial support for travel to a larger center, as well as a few patients who need more substantial financial support for procedures which are so complex that they fall outside the offerings of either the regional or federal system. Currently for these children, funding from generous donors from more fortunate parts of the world remains desperately needed. – Andrew Maxwell.

 
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