“Three Thousand Children and They Are All Mine!” (Paternal Country Report by Lyubov Chervyavskaya 1/29/01)

From a Local Periodic Magazine
Paternal Country Report by Lyubov Chervyavskaya
1/29/01

The emergency ambulance and taxi more often than not stands right by the gate to the Volzhsky hospital grounds, where a large five story building houses the center. As of old it is still called the regional birthing clinic. Its new name is not a tribute to the current fashion. Primarily, as distinct from birthing clinics, this medical establishment was set up by a group of enthusiastic and innovative doctors and is not just known in Volzhsky, but is known beyond the borders of Russia. Its head is Mikhail Kirichenko, candidate of medical science and honored doctor of the Russian Federation.

Young looking and agile, with a dark head of hair that harmonizes with the whiteness of his doctor’s coat, he speaks softly, and with precision as he does not know how to raise his voice. But his countenance is penetrating, forever compassionate, the countenance of a man who hears more, than you might tell him. After a minute one begins to understand why woman, without a second thought, bring to him their doubts, their alarms, their pain. And their hopes. The fact is that here in the perinatal center come basically those women for whom the birth of a child is a question of life and death, not only in the human sense, but in the medical sense as well. Heart defects, kidney problems, sugar diabetes- but just the same these woman want to have a child. And to this center they turn literally as their last hope. To grant them this is not only a complicated and grave task facing a doctor. Not to grant them this is completely impossible.

The birth of a child is a sacred matter. For some women it is enough to stand beneath some icons, and they approach birth in a completely different mood, without fear, with faith in the outcome.

Still before the trip to Algeria, he managed to work in an old Volzhsky birthing clinic and as head of the department took part in the building of the current perinatal center. This happened when, no one was yet aware about such a center, and the birthing clinic was built namely for Volzshky, for those five thousand children who were added to the population each year. Curiously it was built by means of ‘Communist volunteers”, on what was then called “people’s money”. Was it perhaps for that reason that there came about as a result such a needed, effectively working, medical establishment? The first chief doctor was Lyudmila Ushakova, a wonderful specialist, candidate in higher learning. She now works at the center in the capacity of doctor consultant.

Here Mikhail Nikolaevich returned after his work in Algeria. Since 1989 the former regional birthing clinic has operated as a perinatal center. Much experience has been accumulated. But officially that status was awarded to it, only lately, when in the medical legislative acts, appeared the corresponding juridical designation.

The perinatal centers, relates Mikhail Nikolaevich, for a long time have worked fruitfully around the world. It is impossible to get along without them, because too many women are unhealthy, and require serious observation, constant supervision, so that each of them can become a mother. They need help from a time long before the birth of the baby. Certainly, is this not as it should be? The woman comes to the perinatal center for consultation; they follow her progress, make recommendations. She is treated, if that is necessary and only after that is it possible to allow her to carry a child. The road sometimes is a long one, but for that reason there is hope that she will have a desired, healthy and valued child.

We note that this, of course, is not the only, but a very significant difference distinguishing the perinatal center from a simple birthing clinic. But the former birthing clinic was transformed not by happenstance. Dr. Kirichenko and his associates expended not a little effort to prove that the oblast, with hardly a high birth rate, needed an institution which would respond not only directly to the care of new-borns but also to the problems of every period, connected with the birth of a baby and called in medical parlance perinatal.

In the office of the chief doctor, in a conspicuous place is displayed the perinatal award. This is the designated golden plaque of UNICEF, which was awarded to the center as Baby Friendly Hospital. The Children’s Fund, UNICEF, as part of the World Health Organization, pursues the goal of maintaining the health of the children on this planet. Several birthing clinics in the Volgograd region are designated as Baby Friendly Hospitals and have been awarded the golden plaque.

It is strange now, it seems, that they award this for what 100 years ago was in the natural order of things: nourishing children only through breast milk, the joint sojourn of mother and child after birth. It was the chief principle of the old Russian school of childbirth. But this principle actually departed from the pseudoscientific approach, extensively practiced for a long time during the period of Soviet medicine, when children in birthing clinics were kept separated from their mothers, in children’s wards, and at feeding hours, were exhausted by being carted to and fro around the hospital. The specialists at the center decided that another system was needed, more nearly compatible with the physiology of the infant. Incidentally, the dissertation of M. Kirichenko is also tied in to the physiological norms of childbirth.

The establishment, at the center, of a systematic, critical care facility with consultation for new-borns was a real innovation for our oblast, but its need cannot be valued too highly. The department works around the clock. It is furnished with contemporary equipment, a mobile resuscitator, which is connected directly to the center as well as all that is needed for critical care. Let us suppose that somewhere in an outer district is born a pre-term infant, a fragile life who is in danger. The mini-clinic on wheels together with a team of doctors leaves immediately. Its task is not only to bring the new born to the center, but along the way to render the needed care.

The center has regional status, but serves only nine districts: all part of the trans Volga area plus Kalach, Dubovka, Gorodishe.* This is the official jurisdiction. Practically any woman from the farthest sector will be accepted at the center without an argument. But just the same territorial ties have their significance.

In the birthing clinics tied to us in the 9 districts, explains M. Kirichenko, we are able to work out a system of work with one technology. To this contributes the department of pediatrics and neonatology of the Volgograd medical academy, headed by professor Leonid Gavrikov. Doctors from the region study with us, and become of one mind with us in our medical approach. We follow women according to tested methods, divide up the group according to risk, in time treat or undertake treatments and prevention, and all this yields its results. Let us take for example the morbidity index, the index of infant mortality. Still ten years ago in the trans Volga districts, it stood at a 22-25 per thousand. But when we started to work in one system this index declined to 7-11 per thousand. So this is the thought behind opening other perinatal centers, so that the entire oblast will be covered with qualified medical assistance.

On Mikhail Nikolaevich’s writing desk is opened a book. In it are reported the latest achievements in the field of obstetrics, a book published not long ago in America. The study of similar literature is usually a matter for specialists of a similar level. Without this it would have been impossible to fulfill the realization of the dream of Dr. Kirichenko- to establish here a modern clinic for childbirth. It has happened that he and his colleagues have frequently traveled to far off countries. Then came a time when in Russia it was understood that namely a system of regional perinatal assistance appeared to be the most effective. In reality it was impossible for each district to be outfitted with high priced technical equipment. It was easier to outfit one center, where women in the high-risk category would be sent. This is the way they do it in Japan, France, Germany and America.

Mikhail Nikolaevich remembers the 1990’s as of special interest to Russia and particularly to the young perinatal center in Volzhsky. From trips abroad specialists at the center brought back equipment, medicines, instruments. This allowed the introduction of many improvements. For example, operations with lapa roscopes, saving many women from infertility. The doctors from Volzhsky borrowed methods long practiced elsewhere in the world of anesthetization during birth, the so-called long lasting epidural anesthesia, which allows a woman in childbirth not to have to writhe in unbearable pain, and to feel like a human being. Moreover, they use not a narcotic preparative, but lidocaine {a local anethestic}, which is used even in cases of tooth extraction. And the child is born strong, energetic, not affected by anesthesia.

Of course, given all the possibilities, the outfitting of the perinatal center is far from ideal. For example, there exist diagnostics allowing during early pregnancy the imaging of the embryo that permits detection of illness or defects incompatible with life. Such in our parts, alas is encountered very infrequently. For example consider the underdevelopment of lungs in the embryo: while still in the uterus the embryo is supplied with oxygen from his mother’s blood, but once born immediately dies, because he himself cannot breath. Or the child is born with physical deficiencies or with a deficient intellect. If a woman knows of this beforehand, she can make a decision about continuing such pregnancy. However, Mikhail Nikolaevich has a dual approach to this question. Of course, it is better to give birth to a healthy child. Together with that, perhaps is it not worth it to try to avoid the trials sent from a higher authority? And someone has said that invalids should be in society so that the healthy ones do not lose their compassion.

The ties with foreign clinics are maintained even today, he related, through international conferences, and exchange delegations of practicing doctors. Mikhail Kirichenko is convinced that such contacts not only raise the level of professionalism, but also affect the world outlook of Russian physicians.

You know in America, one incident astounded me, he related. A seventy-year-old woman was operated on by reason of a tumor and they sutured the wound not with ordinary sutures, but with cosmetic sutures. Surprised, I asked: why that? You have saved her life and that is splendid, but she is 70 years old? And he answered me no less surprised: “Why ugly sutures on the abdomen? She is a woman and one must do it aesthetically.” One must treat one’s patients as if they were your daughter. Do you know why? Because in such circumstances you do not let go by a single symptom, and that means you are able to help her with maximum effectiveness. As soon as indifference, or medical snobbism takes over, or even, God forbid, pride, all compassion is finished. And in our profession that is just unacceptable.

The doctors at the perinatal center, as everywhere else, have to decide medical problems. In that sense, the center does not differ from the usual birthing clinic. Here are seen pre-term high school expectant mothers, who still as of yesterday did not know that children could have children. And the doctor sometimes has to expend extra pedagogical efforts to convince the girl not to kill her future child. Mikhail Nikolaevich’s position on this subject is a principled one: by the laws of Christianity and morality, if God has sent a woman a child, she is obliged to carry him, give him life and health. In former times, they excommunicated a woman, who did not want to give birth. That was a cruel policy. But a healthy population and a high birth rate is deserving of such a policy. Even to leave the child in the birthing clinic is less of a sin. Perhaps, he will bring happiness to another family.

Incidentally, sometimes thirty and thirty-five year old mothers leave children. With that problem unfortunately neither Doctor Kirichenko nor anyone else is able to deal. An implacable statistic almost breaks his heart: according to the data of the Children’s fund, since 1989 the birth rate in Volgograd has decreased two-fold, the number of child orphans has increased three-fold. And just the same one must note that in the perinatal center, those women who leave their children are the ones who do not seek care before birth, and therefore do not experience the influence of the doctors.

In the departments of the center everything is quiet and comfortable. The irreproachable cleanliness. The rooms, which more than anything are like hotel rooms, only the cribs with little flowers remind one of the fact that here next to the mothers lie new-borns. At the entrance to the labor section is a small hall. In the corner stand s a piano. Its spirit asks: play me.

* Translator’s note: The Perinatal Center also has, through its affiliate in Mikhailovka, supervisory responsibilities for 9 more districts in the northwest part of the oblast. See remarks of Dr. Alexander Bukhtin of 11/16/01