Fear pervades nation where government is mistrusted, health system is weak
By Philip P. Pan
Washington Post Foreign Service
Saturday, November 21, 2009
KIEV, UKRAINE — One night at the height of the panic over what people here call the California flu, as 24-hour news stations tracked a rising death toll and politicians speculated about a mystery lung plague, Ukraine’s prime minister rushed to the airport to greet a shipment of Tamiflu as if it were a foreign dignitary. Not to be outdone, the president, a bitter political foe, dispatched a top aide to meet the plane, too.
In neighboring Belarus, the government took an opposite tack, accusing drug companies of fanning hysteria over swine flu to boost profit. In Poland, the health minister is under fire for refusing to stock up on a vaccine, while doctors in Hungary are resisting orders to administer the shot. In Turkmenistan, the authorities have been accused of covering up an epidemic, with infectious-disease wards reportedly full and people being turned away.
As the pandemic H1N1 influenza surges with the onset of winter, the nations of Eastern Europe and the former Soviet Union appear particularly vulnerable to the deadly virus. Burdened with weak health-care systems, relatively inexperienced news media outlets and shaky governments that have little public trust, the region also seems ripe for panic and political strife over the flu.
The potential for trouble is already on display in Ukraine, where 1.5 million of its 46 million people have had diagnoses of flu and respiratory illnesses since the start of the outbreak and 356 have died, according to the government. The World Health Organization (WHO) suspects that most of the cases are swine flu, making Ukraine among the hardest-hit countries in Europe, including Russia, Bulgaria, Moldova and Poland.
More telling than the numbers, however, has been the widespread fear the virus has caused in Ukraine, and the outsize impact it has had on the nation’s political landscape.
In the weeks since Prime Minister Yulia Tymoshenko announced measures against the spread of the flu — shutting the nation’s schools and banning public gatherings — anxious residents have overwhelmed hospitals and pharmacies, buying up supplies of medicine, gauze masks and home remedies such as lemons and garlic. Rumors have proliferated that people are dying of a new, more lethal strain of the virus.
Semyon Gluzman, a psychiatrist and Soviet-era dissident in Kiev, said the fear was a rational response in a nation with a dysfunctional health-care system and a corrupt, ineffective government. Hopes soared in Ukraine after the mass pro-democracy demonstrations known as the Orange Revolution, he said, but the five years of political infighting since have undermined the public’s faith in the nation’s leaders and political institutions.
“What we’re seeing is a normal, psychological reaction to the complete incompetence of the state authorities,” he said. “People are scared, and they don’t know who to trust anymore.”
Ukraine’s news media — which gained new freedoms after the Orange Revolution — have provided round-the-clock, often sensational coverage of the outbreak. The nation’s leading politicians, meanwhile, are jockeying for advantage ahead of the January presidential election, accusing one another of exploiting the crisis by doing too much or endangering lives by doing too little.
President Viktor Yushchenko, running far behind in his reelection bid, accused the prime minister of failing to prepare for the outbreak, saying that she left the national flu center staffed with only one employee, put doctors in danger and allowed the H1N1 virus to mutate into a “more aggressive” strain. Aides floated the idea of postponing the election because of the outbreak.
Tymoshenko, who was a Yushchenko ally in the Orange Revolution, fought back, criticizing him this week for blocking $125 million in emergency spending to fight the flu and saying he would be “responsible for every person who is ill today or dies.”
Tymoshenko, shown by the media touring hospitals, issuing instructions and delivering daily updates on the outbreak, has enjoyed a dramatic boost in the presidential race. One poll conducted last week put her within three percentage points of Viktor Yanukovych, the opposition leader and front-runner, after lagging far behind for months.
Ukraine has one of the weakest health-care systems in Europe, being a Soviet relic that has barely changed despite 18 years of independence. Medical care is supposed to be free, but quality is poor, with underpaid state doctors surviving by taking bribes and selling unnecessary drugs. Life expectancy is a decade lower than in the European Union.
The WHO says the beleaguered system has held up fairly well, because advanced equipment or training isn’t needed to fight swine flu. But the organization also identified problems here that could arise throughout Eastern Europe.
Doctors have been reluctant to treat patients with oxygen because medical schools in the region emphasize the risk of oxygen poisoning, for example. Ukrainian hospitals also lack devices to measure blood oxygen levels precisely, making it dangerous to put patients on ventilators, said Simon Mardel, a member of the WHO team sent to help Ukraine.
More broadly, people often waited too long to see a doctor because they tried home remedies first, and hospitals have struggled to care for the severely ill because they admit too many mild cases, said David Mercer, head of the communicable-disease unit in the WHO’s Europe office.
Conveying accurate information to the public is another challenge in the region, he said. In some countries, especially the authoritarian states of Central Asia, officials are accustomed to concealing disease outbreaks, while in others, the free press is a relatively new institution and media outlets dwell on conspiracy theories. “It’s like dealing with English tabloids all the time,” Mercer said.
Yevgeny Komarovsky, a pediatrician and popular author in Ukraine, said the media here so sensationalized the outbreak that “we should also be counting casualties from heart attacks and high blood pressure due to the panic.” He recalled a five-hour television special in which a series of ill-informed politicians were interviewed instead of medical experts, calling it “a concentration of stupidity.”
“I felt ashamed for my country,” he said, noting that one presidential candidate complained about shortages of an ointment with no proven effect and another suggested that the plague had hit Ukraine.
One result of the mistrust in government is deep skepticism about immunization in general and the swine flu vaccine in particular. The sentiment is common in Eastern Europe and Russia, where people express doubts about the safety of state supplies and suspicions of corrupt deals with drug firms. But it is particularly intense in Ukraine, with parents often paying doctors to falsify their children’s immunization records.
Confidence in even the WHO was shaken last year after the death of a teenager who had received a measles shot during one of the organization’s immunization drives. The WHO said he died of meningitis, but the opposition blamed the vaccine. Some Ukrainian experts concurred, and a deputy health minister was arrested.
Many doctors accuse Ukraine’s leaders of refusing to dispel the public’s vaccine concerns. Others say the fears are justified.
“You can afford the luxury of trusting your government and health authorities,” said Natalya Kolomiyets, a pediatric surgeon and leader of an anti-vaccine group. “But here, in this country of constant revolution, we can’t.”
Special correspondent John Pancake contributed to this report.