Featured Doctor

KOLESNYK, A/Prof Pavlo

Ukraine : family doctor

What work do you do?

I started my practice as a Family Doctor (FD) and a Family Doctors' trainer over 18 years ago participating in the organization and development of the regional health care based on family medicine and FD’s training. In my daily activities I usually combine my academic work as an Associate Professor of the Family Medicine Department of Postgraduate Faculty of Uzhgorod National University (Ukraine) and my FD’s practice at the municipal family medicine clinic.

From the very beginning of my work at the only family medicine clinic in my town, I started promoting the philosophy of family medicine among professionals and the local citizens. Our family medicine clinic is one of the first in the Trans-Carpathian region that is actively promoting the values of family medicine. Due to our efforts, family medicine is getting more and more popular among both the general population and medical trainees. The positive results gained by family medicine in the city was mainly due to the very successful and busy out-patient clinic staff. The clinic where I have been working during recent years is staffed by 10 talented family doctors including 2-3 residents (interns), who are practicing family medicine, and 12 nurses who provide medical care to more than 15,000 patients. We have been trying to promote our clinic's experience offering it as a successful model for a newly organized system of primary care based on family medicine throughout Trans-Carpathian region.

The other very important stage of my life started in 2013 when the Postgraduate Faculty of Uzhgorod National University organized the Training Center of Family Medicine based on the municipal family medicine clinic where I worked. I was allocated a Head of the Training Center for family medicine residents and doctors attending the retraining courses. Annually, over 20 residents and over 50 doctors attending retraining courses spend three weeks training at this family medicine clinic. I consider our greatest achievement is that we have managed to improve the training of the doctors in primary care by having developed a high quality training programme. Additional to the above activities, I continue working as a family medicine mentor-trainer at the city family medicine clinic.

As a recognition of my achievements in the development of family medicine in Ukraine, I have been twice awarded the scholarship of the Oregon Academy of Family Medicine (USA), Montegut Scholarship Wonca Europe, grants of Austrian American Foundation for Internship at Salzburg Seminars in Family medicine (open Medical Institute). Furthermore, I am often invited to speak on the family medicine development and training doctors in Family Medicine before my colleagues not only in Ukraine but also in European countries (Slovak Republic, 2014), Asian countries (III National Uzbekistan Republic Congress, 2016).

What is it like to be a family doctor in the Ukraine?

To begin with, family medicine in Ukraine has a very short history. Nevertheless, since the year 2000, more than 5000 family medicine clinics have been organized all over the country, especially in rural areas. Unfortunately, many of them are ‘ re-named ’ clinics and rural hospitals with poor equipment. Over 33% of them use old buildings that are often more than 50 years old. Only 35% of the rural family medicine clinics are appropriately equipped. Quite a few practices have been equipped by the regional government from the local budget, but most of them do not have such equipment, and it is a duty of the FD to purchase equipment for their clinics. The expences are traditionally made from the FD’ s individual salary (the average monthly salary of a FD is about €80)

The legislative framework for the development of family medicine in Ukraine was founded in 1999 – 2000. According to the Ukrainian legislation, a FD in towns has to provide medical care to 1500 citizens and in the villages to 1200 citizens of any age. To date, more than 7000 FDs have been trained in the country. However, the deficit in FDs in Ukraine is still over 13,400. Currently, more than 6000 FDs are of retirement age. It is estimated that 50% of the trained FDs leave the service every year, often pursuing careers in more lucrative work such as the pharmaceutical industry, other specialties or as FDs in the other countries as Slovakian Republic, Poland, Czech Republic etc.

The economic support of the primary health care system by the state remains inadequate. The state spends only 5–7% of the whole health care budget for PHC, which is lower than the targeted 30%. FDs remain the lowest paid specialty in the Ukrainian health care system.

Sometimes, FDs have problems providing certain services because there is competition with other specialists. For example, health care of children of pre-school and school age is often provided by paediatricians, especially in the cities. In addition, there are many surgeons and gynaecologists in Ukraine competing with the FD to provide minor surgery and obstetric and gynaecological care.

Other interesting things you have done?

Another part of my activites is connected with scientific research. I am honored to have one article published in European Journal of General Practice [ Pavlo Kolesnyk & Igor Švab (2013) Development of family medicine in Ukraine// European Journal of General Practice, 19:4, 261-265 http://www.tandfonline.com/loi/igen20.]

All in all during the 18 years of my career I have published more than 130 articles, brochures and books and several items have been incorporated in the routine work of FDs of the region. My recently published booklets on the management of diabetes, asthma and hypertension in primary medical care became a pocket reference formulary of drugs and guidelines for the FDs. My most popular achievement was a medical record form for children that is widely used not only in the training of the residents but also in the routine work of the local doctors throughout Ukraine.

My second sphere of interest is connected with evidence studies of preventing and screening of the main diseases of Ukrainian population. The goal of these studies is to outline the ways to overcome the crisis of Family Medicine in Ukraine.

Third, I have been a supervisor for over 15 research projects of young medical specialists.

My wife and I being supported by Dutch partners became the founders of the Charity Foundation ‘Family’ that was launched in 2005 (http://cffamilyen.wordpress.com).

In 2011 I was elected the President of “Uzhgorod (Ukraine) - Corvallis (USA) Sister City Association”. In November 2011 at our own initiative and following the previous agreement between the Sister Cities Association and our Charitable Foundation "Family" we became the donor receivers of the American humanitarian aid (cost USD112,000) that has been spread among the people of low income of Uzhgorod. Some of the equipment received from our partners worth USD30,000 is unique and is being used for the primary medical care of our town, and will certainly help to restore the health of many patients of our clinic. In 2014 our Charity Foundation received a grant from a religious organization for eight family medicine clinics in the Uzhgorod region in the form of equipment aimed to improve family medicine development of the city.

In 2015 I was chosen as a coordinator of the Open World program of medical exchanges for women medical leaders involved in maternal and child primary care. I assisted six young women-leaders in getting a fellowship to the US. In 2015 I renewed my membership in EGPRN and became a member of EURACT and been elected as a representative of Ukraine in the Council of EURACT and EGPRN.

What are your interests outside work?

I am a father of three children. I am proud that my elder son Andriy became a student in the medical Faculty of Uzhgorod National University and follows in my footsteps and in my alma mater. My younger daugters are school students.

During my free time I enjoy gardening at my summer house in the countryside. I am fond of swiming and I like travelling very much i.e. I try to use any possibility to visit other countries and to meet different people, to get aquainted with new cultures and traditions. Due to the many grants I've received during my professional life I have had a lot of opportunities to visit different countries of Europe, Asia, US etc.

After my beloved Grandfather passed away in the age of 91 I inherited a unique old apartment in the historic center of my native town of Uzhgorod. The building was built in the late 18th - early 19th century and, of course, requires renovation. Currently no one lives in the apartment and I am responsible for repair of the ''family nest" in which four generations of our family have lived. I hope that one day the renovated family house will become a pearl of the ancient center of my native town. That's my dream - hope it will come true in future.

Раvlo Kolesnyk
Email address: dr.kolesnyk@gmail.com
Website address: http://cffamilyen.wordpress.com