Patrick Le Tréhondat
One of the most troubled sectors in Ukraine is that of hospitals. Since the start of the Russian aggression, according to the Ukrainian Health Centre, more than 1,900 attacks have been recorded against health infrastructures. The Ukrainian health system (medical establishments and other health infrastructures) has suffered around two attacks a day. 400 health workers died as a result of the bombardments. What's more, healthcare workers have had to cope with a huge increase in workload, both at the front and in the rear, to care for the victims of the war, both civilian and military. Unfortunately, this dramatic situation was compounded by the neo-liberal counter-reform of the healthcare system, which led to the closure of hospitals, brutal redundancies and the reduction or non-payment of nursing staff salaries for several months. The example of the Derazhnyanska maternity hospital illustrates this ongoing anti-social policy, which is also damaging the interests of the population, particularly women.
Ruslana, President of the health workers' union at this maternity hospital, answered our questions.
Can you introduce yourself to our readers?
My name is Ruslana. I started my career in 2004 in a departmental medical establishment that provided care for railway workers and pensioners. I worked as a nurse, then as a senior nurse. In 2008, I was transferred to Derazhnyanska Hospital to work as a nurse in the trauma unit, where I still work today.
What is the situation at the Derazhnyansky maternity hospital? What are your demands?
The Derazhnyansky maternity hospital has been closed. Its closure had been planned for several years. There are three maternity units in the town of Khmelnytskyi, which is a regional centre, but the number of births has fallen sharply in recent years, so the question of closing one of the town's maternity units arose. The regional administration has a health department that determines the capacity of the hospital network. And in order to preserve the Khmelnytskyi maternity unit, it has started to close the district maternity units, arguing that they provide poor quality care. The district maternity units had been operating for decades, and it is not known exactly when they began to malfunction. The Derazhnyansky maternity unit was saved every year because the hospital management was committed to preserving it.
But there came a time in the life of the hospital when it was discovered that the director had begun to violate the terms of the collective agreement by changing the working conditions of the employees for the worse, in violation of the laws of Ukraine. During this period, the maternity hospital's employees became activists in the fight for their rights. Last year, the director decided to get rid of the most militant of them all and began implementing a plan to close the maternity unit. The situation was similar to this year: a winding-up order was issued because of the risk of not signing an agreement with the NHSU (National Health Service), even though no one had yet seen its terms and conditions. A winding-up order has been issued for the maternity unit http://www.medryh.com.ua/wp-content/uploads/2023/11/photo_2023-11-08_17-02-28-768x1024.jpg). The community then mobilised and, under pressure, the regional administration relented and we were authorised to submit documents with a view to signing a contract with the NHSU for the 'Maternity' package [subsidy]. Ukrainian law provides certain ways for a director to protect himself against breaches of labour law, such as sending employees on leave or temporarily closing the maternity unit. In this context, it can be said that truly temporary measures are decided, but when someone wants to liquidate, they immediately use other measures whenever possible. Previously, on 13 September 2024, an order was made banning deliveries due to the absence of a neonatologist, and on 18 November 2024, the service was wound up.
So why a liquidation? It's quite simple. On 13 September 2024, the NHSU set out the conditions for entering into a liquidation contract, which were that there had to be a certain number of births during a certain period, namely from March to the end of September. This information was not classified, but is usually published at the end of November. This year it was made public earlier, because we receive letters with information about health care facilities, so the management was informed the same day. And seeing that the conditions would be right, since the number of births during this period would have increased, the director decided to ban deliveries. You should know that this was due to the absence of the neonatologist, who had gone on maternity leave, but if she had been asked to work until the end of September in order to contribute to the number of births needed to sign a contract with the NHS for next year, she would have agreed. The staff started to look at and analyse the situation later and found out about the conditions [for obtaining funding] too late, when it was impossible to remedy the situation.
How is the public reacting? Are you receiving support?
Of course, the population is against the liquidation. But the situation in the country does not allow demonstrations to be organised. That's why the outrage is only being expressed online. The local authorities have the experience of last year and therefore repress the most active demonstrations. That's why the event didn't get much coverage this year. I'm afraid to speculate, but maybe people have accepted the situation, because everyone has a lot of other problems, like every family in the community, and we're at war.
Tell us about your union. How was it set up and what is your relationship with Be like Nina?
As I said, there came a time in the life of the hospital when it was discovered that the director had begun to violate the terms of the collective agreement, changing the working conditions of the employees for the worse, in violation of the laws of Ukraine. It was at this point that the activists started looking for help and found Be like Nina on Facebook and turned to them for help. Be like Nina activists came to our town for a meeting. They gave us lots of different advice, and we got legal advice. On the girls' advice, we set up our own independent union. In 2019, the former director, using his influence over the head of the union in place, who was his deputy, liquidated the union that had been present in the hospital for many years. Our independent union was created in 2023 and registered in July. Management was duly informed, but the director was very unhappy. At every meeting, the creation of the union was discussed as something bad and against him personally. To this day, he sees the union and its members as enemies.
Under Ukrainian law, all the institution's decisions must be taken jointly with the trade union committee or be the subject of an agreement. Today, our union is completely ignored, we are not invited to any meetings and all decisions and instructions are issued by the director alone, without any approval, which is against the law. People are afraid to join the union because they are immediately ostracised by the manager. And what can we say about the fact that even our several requests for premises to be made available so that the union committee can work in accordance with Ukrainian law have not been met with any response. For more than a year, the laws have been broken, but in Ukraine, trade unions are generally associated with gifts for the holidays, not with protecting workers' interests. To prove violations against a trade union in court, you need to gather a lot of evidence and show that the violations are causing significant damage. For the leaders, all they have to do is issue an order and invoke martial law in the country, which is what our director is doing. He knows that, whatever he invents, there will be no sanction, because under martial law, audits are prohibited only in the event of non-payment of wages. He acts astutely, issuing an order changing the essential working conditions of the female employees, according to which they receive lower wages. And that's all there is to it. And it takes a long time to prove that he acted illegally.
What do you think of the current state of the healthcare system in Ukraine? What needs to change, especially at a time of war?
The current healthcare reform was supposed to improve the standard of care, but the result is that we are sliding towards the abyss at a dizzying speed. Patients are no better off, only the number of conditions to be met in order to obtain an appointment has increased. Free care? Not at all. It is true that there is a national list of medicines that should be available in hospitals and given to patients, but it is very limited and the medicines it contains are not very effective, so patients often buy medicines from pharmacies that are really useful to them. Surgery is no longer free. Healthcare workers are the ones who suffer most from the reform. There are no working standards, particularly as regards workload, and the managers are saving everything and setting up conditions so that each employee works for three. Many can't take it any more and are quitting. Young graduates often don't even go to work in their own speciality, seeking instead to work abroad or in private clinics. And if there's a shortage of doctors, there's no one to provide quality medical care, even though the aim of the reform, let's not forget, was to raise the standard of care. The result is a vicious circle.
What needs to change, especially at a time of war?
In recent years, the work of healthcare professionals has become particularly important. First of all, the coronavirus pandemic and the war have set the main priorities: human life and health. It's hard to imagine any other profession being in such demand during the war. Care workers face extremely high demands, both physical and moral, and they often sacrifice their own lives to save their patients.
Despite the war and the daily confrontation with the enemy, Ukrainian medics continue to work and strengthen Ukraine's medical front line.
In these hostile conditions - with missiles or drones overhead, or during explosions, and in basements, without electricity or water, under enemy guns - it is extremely difficult for military and civilian medical personnel to work. They provide medical care and save lives. Their work is an example of the greatest moral strength.
It is extremely important that today's healthcare workers feel the international support and assistance of Ukraine's foreign partners and friends. After all, many foreign doctors are still coming and helping to provide medical care to people affected by the war. Supporting and fully facilitating the work of healthcare professionals should have been one of our country's essential and priority tasks.
But our government has chosen a different path and has reduced social guarantees for healthcare workers. Deprived of security at work, they are victims of arbitrary and unfair treatment by employers, moral harassment, and social guarantees have been reduced under the pretext of war. Hospital managers have acquired considerable power over employees, simplifying mechanisms such as dismissals, pay cuts and deprivation of benefits. This situation has considerably exacerbated the shortage of qualified staff. In addition to the mortal threat to their lives, many doctors fear for the future, feeling constantly disenfranchised, insecure and emotionally drained.
You can write a lot of recommendations and ideas here, but when the government is corrupt and, at a time like this, turns its back on everyone, especially carers, and won't listen, then the changes will only get worse. Before the reform, medical staff used to "provide assistance", and now we "provide services", we have become service staff. The attitude towards the profession has to change, we have to pay attention to the working conditions and salaries of medical staff, the level of workload... We will always be on the battlefield, whether it's war in our country or peace. Our battlefield is also in the hospitals, we are always fighting for people's health and lives.
How do you see the future of your fight for the Derazhnya maternity hospital?
Fighting for the Derazny maternity unit? It's become impossible, because without a contract with the National Health Service, no one will benefit from the maternity unit. The local budget won't last, they say. It's just that people understand perfectly well that a lot of women on low incomes won't go to the city, because there's no one waiting for them there... And that's why the children will be born at home, and we mustn't forget: there can be complications and, consequently, consequences: deaths of newborns and deaths of mothers, as well as other consequences during childbirth and, also, a handicap for the children. Because no matter what anyone says, all this will happen soon, in a few years' time.
Notes:
- In 2023, there had already been mobilisations in defence of the maternity hospital. NdT.