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| The entrance to the National Cancer Institute in Kiev, Ukraine. Photograph: Joel van Houdt for the Guardian |
Musy said a key front in his campaign for reform was the Cancer Institute. On June 26, he announced the results of an investigation into the hospital, detailing 43 alleged violations of the law. Among them were claims that patients had been forced to buy expensive medicines, even though those medicines had already been paid for by the state, and that equipment costing around UAH 42 million, bought in 2011, was gathering dust in a store cupboard, never used, with the warranty expired.
“This is the personal responsibility of the director,” Musy claimed in interviews with reporters. He said the details had been passed to police, who would interview Shchepotin in his capacity as head of the institute. He believed that the suspicion alone was grounds to sack Shchepotin, although that could not happen just yet, because Shchepotin had gone on sick leave. Under Ukrainian law, that meant he could not be dismissed for four months, not until October.
In brief comments to the Guardian, Shchepotin stated that claims of criminality at the institute were “lies”. He refused to comment on further questions about widespread corruption at the institute. In a television documentary broadcast on 20 December, Sergei Kaplin, a populist member of Ukraine’s parliament, who presents a weekly investigative series called People’s Prosecutor, challenged Shchepotin over corruption allegations. In one scene, Kaplin burst into Shchepotin’s office with a camera crew. Shchepotin repeatedly refused to talk to him, unless he produced a search warrant.
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Most patients come to the Cancer Institute via regional hospitals, so relatives caring for them need to find accommodation in Kiev. A charity called Zaporuka, which helps children with cancer, provides rooms for six families, in a large, detached house on a winding suburban street not far from the institute. Zaporuka’s budget is about €500,000 a year – most of this comes from European donors – and it pays the salaries of two psychologists and two physiotherapists who work at the Cancer Institute. Natalia Onipko, who heads Zaporuka, is slight, with her blonde hair in a bob that falls onto her shoulders.
The patients are scared. Any complaint would have them sent back to their regional hospital – a death sentence
“I often think about how much easier it would be for the doctors to work if they could just do what they are supposed to be doing,” she told me. In a decade of working with parents, almost all of whom had paid bribes so their children could be treated, Onipko had never known anyone make an official complaint. “They’re scared, of course they’re scared,” she explained. “Any scandal would end with them being sent back to their regional hospital. Do you understand what that would mean?”
Facilities are basic at the institute, but children coming there receive care from the country’s top specialists, something they could not hope for in the provinces. Doctors have total discretion over which patients to admit or discharge, so it is not surprising that parents are anxious to keep them happy: giving them gifts, paying the amounts suggested, never speaking out. There are more cancer patients than there are beds – being sent back home would be a death sentence.
We walked through to the kitchen, where six women sat around the table, chatting over tea as if they were old friends rather than strangers brought together by the awful coincidence of their children having cancer. At first, when I spoke to them, it seemed the mothers were reluctant to admit to breaking the law. It soon turned out they were simply struggling to understand what I was asking. Bribes were so ordinary that it seemed bizarre someone would have come all the way from Britain to ask questions about them. Eventually, however, one woman, who was from eastern Ukraine, explained how her doctor had extorted money: “He wrote 100 on a piece of paper, then pointed his fingers upwards. That meant dollars.”
That prompted another woman to recall an encounter with a different doctor: “I remember the first time I saw him, he was winking and nodding his head, and I thought he had a tic or something; that he was mentally unwell. But actually he was catching my attention. Then he held out two fingers.” Here she placed two fingers on her arm, as if she were playing charades. “That meant 200.”
“Hundred?” a third woman asked, “you mean thousand.” They all laughed.
As we walked out, Onipko explained that one of her most important jobs was to keep these parents’ spirits up. They were not only struggling to support their children through a terrible illness, but also trying to navigate a health system apparently determined to exploit their desperation for financial gain. “I try not to criticise the doctors in front of the parents, because they have to trust their doctors,” she said.
I heard the same stories throughout the institute: there was little money for maintenance, medicine or salaries, little interest in the patients, or in the medics doing the work of keeping people alive. One morning, I visited one of the institute’s laboratories. Apart from some microscopes – given by donors eight years ago – the equipment in the department had not changed for two decades, according to one person who worked there.
While he was health minister, Oleg Musy embarked on an ambitious reform programme. Photograph: From the facilities you would never have guessed this was one of the institute’s most important departments. Patients’ biopsies were stored on their original slides, between cardboard dividers, and kept in an index, like in an old library. These slides are crucial for diagnosing cancer. Doctors look at them through microscopes to determine the type and virulence of a patient’s condition. Examples have to be stored in case the patient suffers a relapse. To prepare the biopsies, the lab workers drip purple dye onto slides suspended over an enamelled basin, which was once white but, after decades of use, is now dark purple.
* * *
Months passed before I next saw Oleg Musy, in a canteen in central Kiev, in one of the battered and dirty buildings that had been used as a headquarters for the revolutionaries. It was November and he wore a black leather jacket against the cold. He looked paler, and tired. The previous month, on 1 October, Prime Minister Arseniy Yatsenyuk had suspended Musy from his duties. Musy had, he said, failed to buy the medicines the country needed. It was a tough time, with the Ukrainian army at war with Russian-backed separatists in the east, the economy contracting, the currency plunging. The government needed competent officials, not revolutionaries engaged in quixotic ideological crusades.
Over the previous few months, many of Musy’s supporters had turned against him. Patients of Ukraine, a charity that campaigns vigorously against corruption, accused Musy of conducting his battles at the price of sacrificing sick Ukrainians. It was urgent that the ministry buy drugs, they said, even at the cost of making deals with the businessmen who got rich from corrupt deals with the old government. That was not a point of view Musy shared.
“I will tell the truth,” he said. “The prime minister sent people from his own team to watch what was happening in the health ministry. I did not agree with their schemes, specifically with them maintaining the old … schemes during the health ministry tenders.”
After Musy was suspended from his position, the old networks had re-established themselves, he said, as if nothing had happened. Musy claimed that some of the officials who ran procurement under Yanukovych were back, because the new government had failed to find anyone else with the expertise to navigate the ocean of paperwork required to buy medicine. Musy said this left the system open to the same kind of abuse the revolutionaries had promised to end. “It’s right that the west doesn’t want to give us money, that they say we’re not fighting against corruption. There isn’t a fight against corruption,” he said.
And what about the Cancer Institute? On 2 October, the day after Musy’s suspension, Shchepotin returned to work. Had Musy kept his powers for three more days, he claims he could have sacked Shchepotin, whose four months of sick leave was almost spent. “He was ill for four months, and had only three more days in which to be ill. But I was suspended, and he came back to work.”
* * *
The next evening, I visited Semivolos in his 13th-floor apartment on the edge of town to find out how his battle with Shchepotin was going. Semivolos made us tea and we sat in the kitchen. His wife kept us company and his son came in occasionally to give them both hugs. It was a cosy scene, the fridge covered in colourful magnets from foreign cities, cakes on the table, but he was gloomy.
He began our conversation with a 20-minute overview of the last millennium of Ukraine’s history. The basic message was one of survival against catastrophic odds. “How many revolutions did the French have? Four? And only then did they get their republic,” he said. “We have total corruption – it couldn’t be more total. Cleaners don’t clean if you don’t give them money; ministers won’t govern if you don’t give them money.”
The personal clash between Semivolos and Shchepotin is now playing out in court. Shchepotin has sued Semivolos for defamation for his Facebook posts, claiming that “the negative information causes me great moral suffering and concern over my honour, my dignity, and my good name. People have lost their trust in me as a doctor, and now are unwilling to come to me for help.” The hearings are ongoing.
Semivolos laughed it off , but the issue is serious – Ukraine’s courts can be unpredictable.
During my time in the institute, I only saw Shchepotin once. He was at the end of a corridor, walking away from me, and was gone before I could get close. He agreed to talk by telephone, but refused to answer any questions about the specific allegations made against the institute and him. He insisted that he really had been ill and rejected any suggestion that the health ministry investigation had uncovered anything serious.
“There are a few facts, but they are not cause for an investigation, a probe, or anything,” he said. When I asked him about the defamation case he had brought against Semivolos, he said I was an “unserious person”, and “interested in gossip, rumours and the rest. These are the kind of things you find in the tabloids, and I don’t give interviews to the tabloids.” Then he put the phone down.
I sent a list of further questions via his secretary, but she returned it with the words “no comment” scrawled on it above his initials and the date – 27 November. I sent further requests for comment, detailing the allegations in this article, but they went unanswered.
That same day, Ukraine’s new members of parliament took their seats, including Oleg Musy, who had been elected to represent a constituency in western Ukraine’s Lviv region. I watched the proceedings on a television in a small Kiev cafe called Mon Ami. It is near the administrative quarter, and I was due to meet a source who has worked as a senior official in various ministries since the days of Yushchenko.
He was late, bustling in and excusing himself with a wave in the direction of the television, where a succession of deputies were giving interviews and explaining how important it was to combat corruption. My source looked exhausted, and started explaining the situation before he had even removed his coat.
“It’s really difficult to beat these people. They control everything. It is like a hydra. They have secret service officers, prosecutors,” he said. “We are fighting real guys, you know. I would make a parallel with Colombia and the drugs cartels. They look fine, they look respectable, but behind the curtain there is blood.”
He ordered a filled croissant, and I had mushroom soup. We sat watching the deputies on television milling about: many of them in uniform, others in the embroidered shirts that are a nationalist symbol. Yatsenyuk and President Petro Poroshenko appeared together in a show of unity. There was a brief glimpse of Musy on screen, his handsome face turned towards one of his fellow members of parliament, listening patiently.
“It’s a real problem,” my lunch partner said, nodding towards the dethroned health minister. “Who do you want? A patriot but a disastrous manager, or an effective manager with questions hanging over him?”
I ate my soup and we discussed how businessmen who had got rich under Yanukovych, had quietly returned to Kiev in recent months. “We took away Yanukovych and his guys but it’s another matter replacing all their schemes,” he said. “Everyone is ready to carry out reforms, to make everything open, except for things that affect themselves.”
On 2 December, parliament approved a new health minister – Ukraine’s third in the year. He was Alexander Kvitashvili, a Georgian given Ukrainian citizenship especially for the job. Officials hoped that the fact he was foreign, and unconnected to any existing power structures meant he would be able to shake up the country’s hospitals in the way no Ukrainian could manage. Georgia is one of the few countries in the old Soviet Union that has managed to restrict corruption, if only at lower levels of officialdom.
The day after his appointment, the Kiev Post reported that Kvitashvili was confident he would be able to carry out genuine reform to Ukraine’s healthcare system. On 21 January, he confirmed that although the current health care funding system will remain the same in 2015, he would also begin introducing new funding mechanisms for hospital treatment. On 3 February, the latest stage in Kvitashvili’s reforms was announced: the health ministry stated that it will not renew Shchepotin’s contract when it runs out on 11 February.
Commenting on allegations of corruption within the healthcare system in a statement to Patients of Ukraine, Kvitashvili said: “Sadly, owing to imperfections in Ukrainian legislation, dishonest managers can’t be dismissed even for abuse of power.”
He continued by stating that the health ministry would conduct an “open and honest competition” to find a new director for the institute. “I really hope the police will finish their work and,” he added, “if any employees of the institute are found guilty, they will be held responsible for profiting from human misery.”
http://www.theguardian.com/news/2015/feb/04/welcome-to-the-most-corrupt-nation-in-europe-ukraine
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