Articles about hospices and palliative care
«The House of Mercy»
The official name of the Kharkiv hospice is the Regional Center for Palliative Medicine. Palliative is when not the disease is treated, but its manifestations. And the worst of them is pain, doctors say. They themselves call the hospice "The House of Mercy". Doctors explain: this is one of the few places where medicine and religion do not enter into an argument, but work in tandem. In a clinic where cancer patients are living their last days, faith becomes the best medicine.
“It was back in the Middle Ages,” says the head physician of the Kharkiv hospice, Vitaly Ekzarkhov. “People went to holy places. On the way, some fell ill, some died. And these so-called hospices were created for them. They were created both at monasteries, and simply at settlements. People were cared for, fed, treated ...
- And under the Union?
- Under Soviet power, these questions ticked away ...
- Why?
- Death! Scary!..
Chief Physician - Vitaly Aleksandrovich Ekzarkhov
The idea to create a hospice in Kharkiv came to Vitaliy Ekzarkhov in 1999, when the doctor was in charge of the intensive care unit in an emergency hospital. For more than twenty years, Ekzarkhov literally dragged people out of the other world. At the same time, the physician first began to think about how to alleviate the suffering of those who could no longer be helped. Articles from The Times and The Guardian about the history of hospices came to hand.
Massively similar establishments began to appear all over the world in the seventies of the last century, says Ekzarkhov. The only country that ignored the problems of the terminally ill was the Soviet Union. Communism denied the existence of God. And hospice and religion are inseparable, Ekzarkhov is sure. He himself, already in adulthood, went to study at the theological seminary. Today Vitaliy Ekzarkhov has not only the title of Honored Doctor of Ukraine, but also the spiritual order of a deacon. On his initiative, a year and a half ago, the throne of an Orthodox church was consecrated in the hospice - it is located on the first floor of the clinic.
“Even for the bedridden, we broadcast the service on the radio,” says Ekzarkhov. - Especially for this purpose, a radio and a TV set are installed in each ward. And it has such a phenomenal impact! We have precedents when a simple baptism, communion or confession led to the fact that a person completely refused painkillers. After that, he starts to behave in a completely different way. He invites former work colleagues, friends ... That is, he begins to live a normal life. The patient's psyche is rebuilt. Values are being reassessed...
The Help the dying
Hospice patients die almost daily.
- It's really hard, says Ekzarkhov. - Although it all depends on how a person relates to death.
- It’s not hard for me personally, — says Alexander Goncharenko, head of the organizational and methodological department. “Because my worldview is such that I do not separate life from death. Life, death - these are all natural processes, and there is nothing to cry over them. We need to help people. Help the dyings...
Despite the fact that hospice staff have to see the death throes of a person every day, rarely does anyone leave the clinic of their own free will. More often, doctors are pushed to such a decision by management.
- We are hinting that it is time to leave, says Ekzarkhov.
- Why?
- Because we see that a person here (rubbing his fist around near the heart) cannot work with the dying ...
For many families with an elderly person requiring round-the-clock care, hospice becomes a lifesaver, says Ekzarkhov, head physician. Relatives, in order to look after a dying or paralyzed person, have to sacrifice work, leisure and, at times, personal life.
Hospice is not an opportunity to get rid of a dying person, doctors say. On the contrary, doctors say, here a person feels even better than at home. There is no feeling that you are disturbing someone, the patients agree. Those who are bedridden watch TV. To whom health allows, they walk around the territory of the clinic (although most patients move in wheelchairs). “They communicate with each other, find some activities,” say the clinic staff.
And indeed, walking with the head doctor around the clinic, on the porch we met two elderly women who, with genuine excitement, played cards. Two meters away, sitting in a disabled carriage, an old man was making something out of wood. Coming closer, we understand that the man is making a cutting board. The patient's name is Alexander Podlesny. He says he can't sit idly by.
- I’ll make a board for someone, a mop, a bedside table. Some nanny will ask: Do it!. Well, I will do.
At the feet of Podlesny lies an old boxer. He appeared in the hospice several years ago, doctors say. The dog belonged to one patient, a man in his nineties. When the man died, the boxer did not leave the hospice. The dog is treated like a patient, says Vitaly Ekzarkhov.
- We feed well, we look after ... He is also of advanced age, - the head physician smiles.
Three whales
... on which, according to Dr. Ekzarkhov, any hospice should be based - this is palliative medicine, outpatient care and social services.
Palliative care "requires physicians of the highest quality."
Kharkiv Hospice has them.
At the service of patients are a therapist and a physiotherapist, a surgeon and a neuropathologist, psychotherapists and a radiologist. This selection of specialists “allows you to engage in palliative care in full force.
First of all, "remove the pain syndrome." And it is “removed” - patients experience almost no physical pain. But the price of such anesthesia, unfortunately, is very high: with the introduction of narcotic analgesics, the patient literally in a few weeks turns into an avid drug addict. This issue is of great concern to the hospice staff, and therefore Dr. Ekzarkhov invites all specialists involved in the development of new methods of pain relief without the use of narcotic substances to cooperate.
But back to palliative care.
The conditions of the hospice allow, if necessary, "to carry out minor surgical operations - to remove necrotic tissue in case of bedsores, to amputate a gangrenous leg, etc." In the case of more complex surgical interventions, there is a mutually beneficial agreement with the Institute of Surgery: the Institute serves hospice patients. The hospice, in turn, takes incurable patients from there.
In addition to nurses, there are also junior nurses in the hospice, who, like in Western clinics, are mainly engaged in “courting” patients.
As for the psychological and spiritual aspects of patient care, this issue is dealt with not only by psychotherapists, but also by clergy. Many patients on the verge of death accept baptism of their own free will and, having found peace, leave life in full harmony with themselves and the world around them.
So with the "first whale" things are more or less well. Except for the fact that the medical staff has only a 15% bonus to the rate (for comparison: in moscow and st. petersburg, hospice employees receive a 60% bonus to the regular salary of doctors for the specifics of their work). In addition, this year the funding for the hospice has been "cut" by a third, and for this reason, the project's expansion to 120 beds is being postponed indefinitely.
The second pillar is the outpatient care service, the main link in the work of any hospice. In the Kharkiv medical and social center, it is practically absent, all for the same reason of lack of funds.
In order to expand the outpatient care service in full (ie, serve 300-400 patients at home), only 2-3 cars are needed. So far, only one is promised, but in the meantime, in order to consult a patient at home, doctors have to make do with their own vehicles.
The third whale is social service. This service is represented by a single lawyer working on a voluntary basis (that is, free of charge). And he has to deal with a variety of things - from protecting the property rights of the patient (which, the way, are often encroached upon by some "loving" relatives) to issues of burial of the dead.
Features of Kharkiv Hospice
Kharkiv hospice, being a state institution, serves patients regardless of their financial situation. (For comparison: you can become a patient of the American hospice only if you have a sufficiently large medical insurance.)
Among the sixty patients, you can meet representatives of almost all age groups - from 17 to 95 years. More than half of them suffer from severe neurological diseases (interestingly, some patients can be "put" on their feet). A significant part of the contingent is made up of cancer patients, among whom, unfortunately, quite a lot of young people.
To date, we have assisted over 1,700 families whose members needed constant care and medical attention.
In fairness, it must be said that a high percentage of neurological patients is a distinctive feature of the Kharkiv center, since the traditional purpose of the hospice is to care for patients with advanced cancer.
In the US, for example, cancer patients make up 80% of hospice patients and only 20% are neurological and HIV-infected patients.
The second feature of the Kharkiv Medical and Social Center - a relatively large number of beds - is due to the conditions of our life. For example, the Berlin Hospice has only 12 beds. But since the standard of living there is much higher, the Germans, if necessary, can "organize an intensive care unit with highly qualified medical staff at home." Our people, for obvious reasons, do not have such an opportunity. In addition, the structure of the Kharkiv hospice "has undeniable organizational advantages."
The third feature of the hospice, according to Dr. Ekzarkhov, is that it "should become an integrated center with a base for education and a base for scientific work." There are two very obvious reasons for this.
The first reason is practical.
We have nowhere and never trained junior nurses and nurses for home care. Experience shows that without these two parts of the medical staff, the normal functioning of the hospice can turn into a pipe dream.
The second reason is no less important.
The fact is that by the end of the second millennium it became clear that the problem of death had not been studied at all. Along with this, somehow unexpectedly came the understanding that, first of all, the study of death as a physiological phenomenon is necessary for palliative medicine. It is quite understandable that the hospice can provide the researcher with very useful information, without forgetting, of course, about its main purpose - to help incurable patients. It should be noted that the position of Vitaly Aleksandrovich found support among his st. petersburg colleagues.
Kharkiv hospice is located in the premises of the former dispensary of the Electrotyazhmash plant. Either because this building was originally intended "for the rest of the workers", or for some other reason, but it completely lacks the painful hospital atmosphere, "complemented" by the usually indestructible smell of the catering department.
Church of the Saint and Confessor Luke, Archbishop of Crimea at the hospice.
In the director's office, you can see the image of the building topped with a small gilded dome. This is how the students-architects saw the future temple, which operates at the hospice.
The temple is located in a former cinema with excellent acoustics and a balcony, as if specially designed for choirs.
However, let us return from spiritual matters to earthly matters.
Patients in the wards lie in twos. At the same time, according to Dr. Ekzarkhov, "couples" are selected taking into account psychological compatibility and, of course, the severity of the disease. But this was not what surprised me, but the fact that some patients came to the hospice with their favorite birds and cats. However, there were no dogs yet. But everything is ahead ...
Ward
Currently, the Hospice includes: outpatient care service, outpatient social service, inpatient service, consisting of an oncology department for 30 beds with intensive care units for 6 beds with a round-the-clock post of an anesthesiologist and a neurological department for 50 beds. The following were also put into operation: a reception department, a clinical diagnostic laboratory, a laundry, a disinfection chamber, a centralized sterilization department, a dental office, an X-ray room, a thermal chamber for storing the dead. The hospice maintains close contacts with representatives of various faiths in order to provide spiritual, material, humanitarian, and voluntary assistance. Thanks to humanitarian support from the United States and Germany, the hospice is equipped with the necessary equipment and items for patient care.
To meet the spiritual needs of our patients, a religious community of St. Luke and Confessor at the Kharkiv Diocese of the Ukrainian Orthodox Church was created at our Hospice. The preparations for the consecration of the altar of the Church of the Prelate and Confessor Luke, operating under the Hospice, are nearing completion.
It's a pity to die
The creator of the Kharkiv hospice, Vitaliy Ekzarkhov, does not plan to retire. Caring for others is the meaning of his life.
- You worry when you are not remembered. When they don’t hope for your help, and you, therefore, are no longer the same ...
More than twenty years of experience in intensive care. Almost a dozen are in hospice.
- Are you scared to die?
- t’s not scary to die, - says Ekzarkhov. “But it’s a pity ... It’s a pity that so many beauties that you see every day will be lost ...
In order to find out about the actual needs of Kharkiv Hospice, please contact the administration of the institution.
The chief physician is Vitaly Alexandrovich Ekzarkhov.
Phone: +38 (0572) 93 91 25 (reception)
+38 (0572) 93 90 93
+38 (067) 272 46 66
Fax: +38 (0572) 93 90 21.
Email: hospice@kharkov.ukrtel.net
Address:
61075 Ukraine, Kharkov, st. Louis Pasteur, 4-a.
The article was prepared based on materials from sites - Kharkov Info, who-is-who.ua, Media Group Lens, Provisor, Orthodox Kharkivshchyna.
