The city’s best specialists on ailments of the hands and forearms work at Bauman City Clinical Hospital No. 29, where there is a centre for upper limb surgery, which treats hand traumatology, common traumatology and performs surgery on infected limbs. The centre also has a specialised day care service and short-term in-patient facility.
The centre can boast some of the most advanced equipment in the city: a unique machine for arthroscopic surgeries, including a microscope for microsurgery, mobile X-ray equipment and other things. Olga Papysheva, Chief Doctor, told mos.ru about these new opportunities for doctors and patients and how the situation for doctors in Moscow has become better.
Question: The traumatology centre at City Clinical Hospital No. 29 has united the powers of emergency traumatology with arthroscopic and hand microsurgery. What has changed for doctors and patients?
Olga Papysheva: Our clinic has a large traumatology department. There are two traumatology units here, one of which has traditionally specialised on hand trauma, and there is a unit for cases of infections of extremities. In last two years, there has been a tendency to create a full-fledged city service to help patients with upper-limb pathologies.
Patients thus far with serious hand ailments have been treated at various hospitals. For example, one specialised in emergencies, a second on regular treatment and a third on microsurgery. So we can say that there has been no general arthroscopy in the city.
Now all kinds of treatment for upper-limb injuries are at the same clinic
We have combined several kinds of treatment in the same clinic. We work round-the-clock and are ready to accept patients either with serious emergencies or with complicated cases who must be treated routinely. In addition to this, we can perform arthroscopic surgery here. We also accept patients with complications from hand traumas that have become infected.
The main point is that we have established a service of a new format. We run our operation at the highest level possible. We try to help all patients who can be treated as outpatients without hospitalisation. We have day a patient facility for this and a short-term in-patient facility. We also give consultations, and patients come here from all over Moscow. We manage to attract specialists with a narrow specialisation to consult patients; it allows us to make a decision about what treatment strategy will work going foward and to prepare the patient for an operation if necessary.
We have everything: a multi-specialty in-patient facility with intensive care and advanced anesthesiology units, a laboratory, ambulatory service and a diagnostic and consultation centre, which we use as the basis for our day patient facility. It works very successfully: dozens of patients receive help on ambulatory basis, without hospitalization.
We have equipped the traumatology with machines that doctors could have only dreamt about
Question: What equipment has the new centre received?
Olga Papysheva: We have equipped the traumatology with machines that doctors could have only dreamt about. We have a unique machine for arthroscopic surgeries. As of today, I think our hand-trauma specialists here are the only ones to have keyhole surgery equipment of such a level. In addition to this, we now have equipment for hand microsurgery. For example, a microscope that allows us to perform microsurgery operations. This is also a unique case in Moscow. We also have C-arms here, which are mobile X-ray units allowing us to control the invasive procedures in the operating room.
Question: Is it possible to perform operations that haven’t been done here before?
Olga Papysheva: We have an opportunity to help patients with very difficult cases of diseased wrist joints. We can now use keyhole surgery to treat those cases that were once very difficult to treat.
Question: Do these advancements help you discharge patients more quickly?
Olga Papysheva: We have already been discharging them quickly. The in-patient phase takes half the time it once did. We have achieved this by introducing advanced hi-tech treatment methods.
Question: City Clinical Hospital No. 29 organises courses for orthopaedists. Does this mean that the hospital has an educational centre as well?
Olga Papysheva: Our traumatology centre is one of the leaders in this area: we constantly hold events. On 4–5 December we will receive the world-famous German Professor Gabor Salai, who will conduct a workshop, perform an operation and show us his methods. In early November, we gathered trauma surgeons from all around Moscow and shared our latest up-to-date achievements and approaches toward understanding how to treat patients with upper-limb disease, both on an outpatient basis and in our in-patient facilities. Our lecture halls were full.
Question: City Clinical Hospital No. 29 was founded in the 19th century as a modern hospital. How is it different from other Moscow hospitals now?
Olga Papysheva: We are proud of the history of our hospital, it is unique. Princess Natalia Shakhovskaya established a charitable community a Sisters (Nurses) of Mercy congregation Soothe My Sorrows and then, using her own money and collecting donations, she built here what was then the most advanced healthcare facility.
Even now, we are trying to preserve the principles of self-abnegation and dedication on which our facility was founded. On one hand, we follow the hospital’s traditions that are still alive here: we keep documents and photos from the end of the 19th century and the beginning of the 20th. But on the other hand, the hospital has always had the most advanced specialists and most advanced technology. The City Clinical Hospital No. 29 has always had something to be proud of: both our doctors and the methods we use in our work.
Question: Does the hospital provide hi-tech help?
Olga Papysheva: Of course, and in many areas at that: gynaecology, obstetrics, vascular surgery, general surgery, urology and traumatology. We have a new specialisation: neurosurgery, and we also have interventional radiology.
Question: Are these hi-tech operations free of charge?
Olga Papysheva: Yes, we work under the compulsory health insurance system and also receive assistance from the state budget. Everything is available not only for Muscovites, but for all Russian citizens, too. We are proud of this. The number of patients who receive high-tech medical care is increasing. The volume of patients receiving high-tech medical care has grown 64 percent compared with the last year. During 10 months, we have treated 580 patients this way.
Question: Several years ago, your maternity ward was completely re-equipped. What has changed since?
Olga Papysheva: We haven’t stopped re-equipping for a second. We are still equipping every unit at our maternity ward with transformer chairs for vertical births. This year, we received a system for induced hypothermia (it lowers the body temperature to decrease the risk of brain damage after circulatory failures – mos.ru). This machine prevents edemas and, in essence, can save a baby’s central nervous system. We have also received additional equipment to treat premature infants and infants with diabetic fetopathy: this is a complication that may afflict pregnant women with diabetes. There is also a centre for interventional radiology in our maternity ward. There we can administer embolas, which stop heavy bleeding, and thus save a woman’s life and prevent her needing a hysterectomy. Hence the blood loss is minimal and we can preserve her ability to reproduce. We have also created an endocrine pathology centre for pregnant women, where we treat diabetes and thyroid and adrenal gland diseases. After treatment, our patients can give birth. Last year, we delivered 8,500 babies, 2,300 of them from women with diabetes. We also can treat women with other complications due to our maternity ward’s being situated on hospital premises, allowing us to solve patients’ problems together.
We have created comfortable conditions for women in labour
Question: How comfortable are the rooms now?
Olga Papysheva: Each woman can stay together with her baby. We have created comfortable conditions for every patient: there is a bathroom and shower in each room… Mothers can visit their babies in a resuscitation ward without warning staff or agreeing the visit in advance. This is very important.
There are infants who don’t need resuscitation care, but are treated nevertheless, for example, if they were born with a low birth weight. They can receive an IV or some other treatment while constantly being with their mums. It was rather difficult for us to achieve this, but now we are already used to this.
Question: Doctors in Moscow can receive the status of “Doctor of Moscow.” Are there people at your clinic who take this exam?
Olga Papysheva: Yes, many doctors have qualified for it, and many have applied for this. I am sure that we will also have such doctors. It may seem trivial: everyone knows that you have to improve your skills. However, it is especially important today, because we cannot stop progress, our lives change every day, and in medicine above all. New methods and new approaches appear constantly, and new equipment, too. Doctors need to know about them and how to use them; they need to know how to organise their work with all these advancements.
Surely we need a system for raising doctors’ qualifications, a structured and continuous one, which will help doctors advance in accordance with all the new possibilities in Moscow, in Russia and in the world. It is also very important that it not be just a formality, but rather that it would bear fruit, such as high-quality healthcare and a friendly working environment for doctors.
Doctor of Moscow Project is a smart mechanism for encouraging doctors
The Doctor of Moscow system being established right now probably meets all these demands. First, this is a smart mechanism for encouraging doctors. Second, it includes a training system, which allows doctors to improve their professional skills while preparing for the qualification exam.
Question: Why have some applicants failed to pass the exam and get the Doctor of Moscow status?
Olga Papysheva: Many people were sure that this is something like regular certification, but it turned out to be much more serious. Those who failed the exam signed up for a second try, which means they will be preparing and polishing their skills to be better prepared. I am saying that even those who the failed to pass the exam have managed to improve the quality of the medial service they provide.
Question: You have mentioned your friendly working environment for doctors. How has the situation changed in this area in the city?
Olga Papysheva: The level of the healthcare has changed for the best in Moscow, and our work conditions are also getting better. There is a very clear upward trend in the level of salaries doctors receive.
We are trying to make working conditions more comfortable for all doctors
As the Chief Doctor, I am trying to take all measures necessary to make the working conditions for the staff, and first and foremost for our doctors, more comfortable. We are constantly working to make the doctors’ work more automatised and less formalised; we are trying to make their work easier by using information systems.
We have implemented innovations successfully. Following the example of Western clinics, a number of which I have visited and have seen how they work, I have hired secretaries and managers for the busiest department at the hospital, and not doctors. This means that several of the busiest departments have someone who does all the administrative tasks, such as filling in documents, calling people, coordinating patients’ logistics (which takes a lot of doctors’ time), and preparing the documentation needed for high-tech medical care, all of which takes a lot of effort. There always is a lot of work that you don’t have to be a doctor to do; you don’t even need an education in medicine. Clever people with very little training can do this work.
We have everything we need to treat patients according to international standards
Question: Can Moscow clinics rival foreign ones in equipment and specialists?
Olga Papysheva: I believe that we have everything we need to treat patients according to international standards. I know many people who have traveled abroad for medical help, and it doesn’t surprise me to hear, especially about child delivery, that “no one cared about us: no one talked with us; we got home just 12 hours after the delivery, and nobody would give us the time of the day.”
Question: Do our patients like it when they are doted on?
Olga Papysheva: But it really works. Compassion has real power. It has medical value and can influence the outcome, because a patient’s emotions mean a lot. We are trying to do everything so that our doctors have this kind of healthcare mindset, and treat their patients with compassion.
However, little by little, we have started to realise that every person is responsible for his or her own health. Doctors can offer cures and help, but it is patient’s task to lead a healthful life, to turn for medical help in time, follow the treatment that was prescribed and cooperate with doctors. I think that this is the next phase of our education.