NOT TO BE BORN A PATIENT

The strength of a state is measured by three key factors: a stable economy, a successful healthcare system and effective education. Other components of a country's stability derive from these factors. We must acknowledge that Azerbaijan is at the stage of development in these areas. We cannot yet boast of the best healthcare and educational systems of the FSU countries. While the first years of independence saw the country lacerated by political cataclysms and Azerbaijan was in no position to think of economic development, let alone develop its healthcare and education, the present economic situation enables the government to turn its attention to other spheres as well. The realization that the social policies of the state are a crucial element in its development gives the country the opportunity to tackle problems which have accumulated over the years. This holds true for children's healthcare.

For several years Azerbaijan has been among those countries with a high rate of maternal and infant mortality. UNICEF has recently published its annual report on the plight of the children of the world, in which Azerbaijan is ranked 46th: 88 deaths under the age of five per 1,000 children born. The statistics are not very impressive - shocking in fact. Even economically backward Tajikistan was ranked 57th: 68 deaths per 1,000 children born, Turkmenistan is 67th with 51 deaths, Uzbekistan is 69th with 43 deaths, Georgia is 86th with 32 deaths, Armenia and Ukraine are 101st with 24 deaths each, Russia is 125th with 18 deaths, Estonia is 157th with seven deaths per 1,000 children born etc. 

As we can see, these countries have not achieved much in economic terms, while their rate of child mortality is not as frighteningly high as in Azerbaijan. The day after the data were released the UNICEF Baku office introduced some corrections to it, saying that child mortality in Azerbaijan had declined in previous years. In 2007, there were 34 cases of child mortality per 1,000 infants and children under one year of age and 39 deaths for children under five. According to official data, 44 per cent of deaths among infants occur in the first month of their lives. Of them, 91 per cent of deaths occur in the first week after birth.

UNICEF believes that the reason for such a high child mortality rate in Azerbaijan is the lack of vitally important medical equipment in some parts of the country. Also, many mothers have limited access to health information. "As part of the fourth millennium development target, whereby child mortality is to be reduced by two thirds by 2015, Azerbaijan has good indicators. However, much still needs to be done to achieve progress," says the acting head of the UNICEF representative office in Azerbaijan, Gillian Wilcox.  

UNICEF calculations show that child mortality in the world has reached a record low level. For children under five the total number of deaths has reduced from 13 million in 1990 to 10 million. The best figures are returned by Sweden, Singapore, San Marino, Liechtenstein, Iceland and Andorra (all ranked 189th) where three deaths occur per 1,000 infants.

Causes and consequences 

The problems of children's healthcare should be tackled as a whole. Further, the research of international organizations should not be trusted unreservedly, Azerbaijan's honoured doctor and professor of the department of children's diseases of the Azerbaijan Medical University, Surxay Musayev, told R+, "It is quite frustrating that an organization of UNICEF's calibre should conduct such serious research in Azerbaijan without engaging local specialists. This is why there are often discrepancies between official data and the data of international organizations. I don't remember the UNICEF Baku office inviting Azerbaijani doctors to discussions on various problems. No joint discussions, projects or visits are being carried out, although this organization has, beyond doubt, contributed a lot to the development of Azerbaijan's healthcare. I would very much like UNICEF to take into consideration the desire of our specialists to work in cooperation with each other. We can achieve even more that way," said the specialist.

Paediatrics has several disciplines. It is wrong to point to problems in one area without saying where they originate, Surxay Musayev thinks. "There are prophylactic, clinical, scientific and ecological paediatrics. These areas are closely inter-connected. I can say that almost no problems remain in prophylactic medicine, i.e. the inoculation and vaccination of children. The late Heydar Aliyev devoted much attention to this issue. Great assistance has been provided to Azerbaijan by the great maestro Mstislav Rostropovich, who was originally from Baku, through his foundation. President Ilham Aliyev is also highlighting the importance of preventive medicine. Prophylactic activities are being carried out; most children are invited to clinics to receive the necessary inoculations depending on their age and the time of the year," Musayev said.

However, problems in prophylactic paediatrics do exist and they concern children's parents, rather than the government or healthcare system. Many parents are reluctant to have their children inoculated, following the advice of well-wishers who claim that this is bad for the children. Despite all the effort and persuasion of doctors, parents refuse. Some say their child is allergic to drugs, others have other excuses. "However, these decisions should be made by doctors. If the child has counter-indications, we will be the first to know. Inoculations up to the age of 18 are a necessary procedure. If such problems with parents exist in our country, we need to improve our work on public awareness", said the specialist.

Problems pertaining to social paediatrics are observed mainly in refugee children, because most of them have lived in unfavourable conditions for a long time. "We have been conducting surveys among this section of the population. According to statistics, 40-45 per cent of refugees and IDPs are under 15. They have problems related to stress. To relieve them of these conditions required lengthy treatment of their nervous system and somatic condition. We have encountered all types of problems, from rickets and pneumonia to very virulent illnesses. Only a small fraction of refugee and IDP children can be described as healthy. We have raised this issue with the Ministry of Health and the government and have worked for a long time in tent-camps in Sabirabad, Imisli, Aqcabadi, in towns and in hostels, i.e. in all refugee settlements. Even today, although tent-camps have been completely eliminated, the Ministry of Health is giving special importance to this category of the population. Medical teams are being sent to refugee settlements. We are helping however we can, including with medical supplies," Musayev said.

With regard to clinical paediatrics, i.e. the treatment of children, problems largely stem from changes in climatic conditions. But there are more prosaic causes as well. "Whether this is a problem of attitude, or something else, children are quite often brought to us at a critical stage. We can't understand this. If the child is ill, why not have him examined in good time? Sometimes we discover medical errors, when a child has been treated wrongly for a long time. As a result, we have a serious case and have to act immediately," the expert said with some impatience.

The most frequent illnesses are lung problems, bronchitis, pneumonia, asthmatic conditions, kidney and liver disorders. "Unfortunately, neurological disorders have often been observed lately. This involves problems with the central nervous system. All issues pertaining to children's health are inter-connected. For instance, the health of most young mothers is causing concern, but in order to give birth to a healthy child, the mother has to be in good health herself. The point is that many families practically ignore the health of girls, thinking that they should grow up without medical care. Many forget that girls are future mothers. They will become pregnant and their bodies have to be able to withstand this pressure. To our regret, parents don't always remember this. As a result, the first child usually has problems. Sometimes doctors even joke between themselves that it is not a child but a patient that is born. We must remember that the female organism forms, not after marriage, but long before it," Musayev stressed.

Much is being done  

The doctor agrees that the hospitals of Baku have to take on the biggest workload in accepting young patients, while in the countryside there is a crisis of personnel. The competence of rural doctors leaves a lot to be desired. The government is doing its best to resolve this problem, continued the paediatrician.

"Medical and diagnostic centres are being opened in the districts. President Aliyev has recently inaugurated one such centre in Lankaran. Similar medical and diagnostic institutions already operate in Naxcivan and Mingacevir. It is gratifying that the development of rural health institutions, their renovation and reconstruction, is carried out both through the government and upon the instruction of the President and the Ministry of Health. The Heydar Aliyev Foundation is making a large contribution. Of course, if there are good hospitals and clinics in the districts, and if we staff them with qualified personnel, I think that the flow of patients to Baku hospitals will soon be reduced. This tendency is already in evidence. For instance, heart by-pass surgery is already being done in Naxcivan. Several years ago such operations could only be carried out in Baku. Our doctors travel to Lankaran and other districts to provide consultations and participate in such operations in the districts. However, the situation in remote places needs to improve," said Musayev.

There can be only one way out - to resolve the personnel issue. The specialist believes that the level of training at the Medical University cannot be compared to that of 15-20 years ago. "University departments are well-equipped, which allows us access to the latest information and technology. All the conditions are in place for the training of qualified doctors. Therapeutic and surgical clinics are being established under the Medical University, following a presidential decree. It is common knowledge that the best clinics in the world are those established within universities, because they have the best combination of academic and practical potential. I hope that new progressive methods will be used in training personnel for these clinics. The clinics will be fitted with state-of-the-art equipment, i.e. they will combine the latest equipment, training of personnel, scientific research and healthcare for the population. At present, the Medical University has only two clinics - dental and oncological. I think 2009 will see the opening of more of them," Musayev added.

A further option can be used to resolve the personnel problem in the country's remote regions. "It is necessary to encourage young specialists to work in the districts. I am aware that this issue is already under consideration at the Ministry of Health, particularly as successful examples of such experience are already available at the Ministry of Education. Villages in mountain districts must be supplied with doctors on a priority basis, and appropriate conditions must be created to interest doctors in working there. Let me say that on the instruction of the Ministry of Health, 70 per cent of our graduates have been sent to work in the districts for three years now. This is a very good indicator. Only those unable to go to districts for family reasons stay in Baku."

According to Musayev, it is not impossible that child mortality in mountain districts is not always registered, due to the lack of medical personnel there. "It is possible that there are no paramedic or first aid stations in villages." As for the reasons for child mortality in Azerbaijan, Musayev said that this problem is observed throughout the CIS. "Yes, the problem of maternal and child mortality is one of the most important areas of the healthcare system, not only in Azerbaijan but also in other countries. There are a host of reasons for this. What kind of child can a young woman give birth to after living in a tent-camp for years? Quite often in remote villages women deliver babies at home with the help of home-grown obstetricians. Hospitals are near-by, but women deliver children at home. As a result, an injured child is born. Children quite often die due a lack of basic care," the paediatrician said.

"Of course, our country cannot be compared to the USA or Europe in this respect. Let me repeat that a lot is being done in the country to reduce child mortality. Many out-patient clinics have been built and renovated in the capital and in the country. Why am I talking about out-patient clinics? Because this is the first line of healthcare work with the population. Good conditions have been created for children and doctors alike. The rate of attendance is quite high. And this is only through the Ministry of Health. Much is also being done by the Heydar Aliyev Foundation, and on the instruction of the President through the State Oil Fund," Musayev indicated.

The specialist also pointed to the work being done by UNICEF, which is implementing a project to reduce child mortality in Azerbaijan by establishing European-type pilot maternity hospitals in the country. The World Health Organization has conducted a detailed analysis of the maternal health system in Azerbaijan, and its key provisions are reflected in the new national strategy on reproductive health, developed with technical support from the WHO and its partners. "This strategy was approved by the Ministry of Health in January 2008 and will cover the period between 2008 and 2015. Most problem cases occur in groups which have not had prenatal care, or have benefited only once. Thus the WHO will help Azerbaijan to develop the healthcare system, enabling quality prenatal examination. Standards of emergency obstetric aid are yet another issue where the WHO can be of help. This organization, jointly with UNICEF, will provide assistance in developing standards for neo-natal examination," Musayev concluded.