Veronika Skvortsova: Drink up the Sea, Xanthus!

— What’s troubling you, Doctor?

Nothing. I try to be thankful for everything Heaven sends. When you spend a lot of time at the side of seriously ill people in an intensive care unit, you start realizing that you are lucky if you have a chance to wake up in the morning, see the sun and talk to other people. I dealt with strokes for many years and my patients literally lost the ability to speak, they suffered since they were unable to express their thoughts. They tried to say something but others failed to understand them and sometimes patients did not understand what others said to them. It is agonizing.

One needs to value the very fact that we are alive and in good health, we can see, hear, speak and fulfill our ideas and plans.

— Often times, people who are on the brink of a catastrophe pray to God to save them, swear they will lead a righteous life, give up smoking, drinking and cursing, but as soon as the danger fades, they forget their promise and return to their devious ways.

A person has to keep his word. I find that my willpower helpful, which connects me with basic human values. In fact, this is how my day usually starts. You can create a space around you and remain inside for some time. That includes a morning conversation with yourself and even the music you listen to on your way to work.

— What music do you like, Veronika Igorevna?

It depends on the day I have ahead of me and for whatever things that I have to get ready. For instance, there is music for the brain's left hemisphere. Mozart and Vivaldi frame things by creating an emotionally smooth and spiritual atmosphere. Rachmaninoff and Tchaikovsky suit the right hemisphere more, they set a different tone.

Sometimes I listen to jazz music, especially if I need to relax on the eve of some serious events…

Life always gives you little joys. In particular, communicating with other people brings joy because everyone is an interesting person in their own way. The most important thing is not to let your day-to-day routine overwhelm you. Someone who is not well prepared sometimes has difficulties in dealing with the daily routine of life. It seems that you have reached a dead-end, you are facing a wall and see no way out. You get swamped with negative feelings instead of positive ones, which makes matters even worse.

No matter what happens, from time to time I hold some sort of psychotherapy meetings with my close staff. Such gatherings make it possible to work in tough settings for a long time and draw positivity from your own inner world.

— How does it look in real life? Like an open lecture or a session with a shrink?

More like the latter. There is an oval table in my office where 10 to 12 members of the Health Ministry's central team can sit - my deputies, aides, department directors - there are 17 of them at the moment.

I gather personnel who deal with an issue currently under discussion. I try to help them get their minds right to solve the task they are facing and warn them that they should not expect the press or social media to show any immediate positive response. There are other things to be concerned about. Everyone needs to have an inspiration from the inside that would make them believe in themselves. Otherwise, it is impossible to cover a difficult road and achieve the desired goals.

— Where and how did you get your inspiration for medicine, Veronika Igorevna?

I consider my job to be a service and I know why I came into the world of medicine.

— Since you have four generations of doctors before you, from you grandfather Pyotr Avraamov, a professor at the Military Medical Academy in St. Petersburg, to your father Igor Skvortsov, a professor, an MD and a renowned neurologist, I don’t think you even had a choice.

In fact, there is always a choice. I was a very creative child, I have a great ear for music, I played piano since I was four, I studied at the Gnessin School and thought about going to a music college…

I went to a math school, I was a fan of mathematics, won various math contests and graduated from school with a gold medal.

In short, my life took many turns. Sometimes, I thought long and hard about my further development.  Medicine was not the only option. However, at some point I came to realize that I am mostly interested in the human brain, in the way that it works, controls our bodies and connects the body and the spirit.

By the time I graduated from school, I had concluded that I want to study the brain and it was the reason why I went to the Second Moscow State Medical Institute.

— You chose to specialize in pediatrics…

In my view, the Pediatrics Department offered the broadest and deepest knowledge. You study things from the standpoint of age-related changes, starting from the moment of conception. I have always been fascinated with how the brain is formed, how things first develop and then fade with time. These mysteries were my guiding light.

In my second year of studies, I engaged in research and published my first scientific article, which was included in a compilation dedicated to a national immunohistology congress. The prostaglandins had just been discovered and I studied their influence on the human body.

In my fourth year, I delved into neurology.

I graduated with honors, I had never gotten a single B, and so I was a straight-A student if you will. I didn’t get my grades by cramming or sitting and studying endlessly, I liked to learn. By the end of my medical residence, I was already working at a hospital headed by my teacher Academician Yevgeny Ivanovich Gusev and had already collected enough information for a thesis. I got my master’s degree ahead of time, in 18 months.

I continued to work under Yevgeny Ivanovich. In 1989, I managed to help a patient in a coma, who had been admitted to a general intensive care unit. That night I was on duty as a neurologist. Though I was a very young doctor, I tried my best to use all the knowledge I had to help people. As a result, the patient awoke in the morning. When Academician Gusev learned about it, he suggested that I set up a neurointensive care unit. This is how I took the helm of a new unit at the age of 29 and created it from scratch. This happened at the City Clinical Hospital Number One...

For several years, I only went home to sleep and then returned to work. I pulled people out of various comas. The knowledge about non-specific brain structures that I got interested in while at school, allowed me to unlock certain mysteries. I introduced a multidimensional system to monitor the functional activities of the brain, these methods were new back then. It was not a simple electroencephalography but a full examination involving spectral and coherence analysis, as well as topographical mapping. The evoked potential and magnetic stimulation methods also were a new thing. Vertical chains were studied separately. We could see how various brain regions responded to damage and interacted with each other.

The most important thing is that we monitored the condition of patients for several days, starting from the very first hours after the stroke, which allowed us to detect the most interesting patterns. For example, in the first three to five days, depending on which part of the brain had suffered damage, there is not a single structure that would work normally. It is possible to use the malfunction to make the unaffected parts of the brain take over the job that is usually done by the those currently damaged and thus offset their weakness.

This was the issue I tackled and this is what my MD thesis was dedicated to.

— You became an MD at 33.

I was extremely excited about my work. Depending on monitoring results, we started to use various neuroprotectors – substances that protect the brain. In fact, we created customized cocktails for each patient. It produced good results.

— Did you count the lives that you have saved?

I never kept count but we can estimate the number right now. About 1,500 patients went through my unit in a year, when I headed the Russian National Research Medical University's Neurointensive Care Unit at the City Clinical Hospital Number One for eight years, until 1997.

— What was the most severe case?

We once brought a patient out of a coma on the 91st day… What is ‘severe’? Cases are different. Sometimes, if the brain is still alive, even cardiac arrest does not mean death. We saved many such patients. Clinically dead patients can and should be cured. But when the brain cortex ceases to function and the encephalography device shows a straight line instead of a curved one, it is indeed the end.

Today’s intensive care methods make it possible to turn almost any form of coma into the so-called vegetative state, when only deep brain structures and the brain stem continue to function. Such patients are unable to fully wake up, they only retain the sleep and wake cycle. If we don’t mince words, it is a vegetable existence. 

However, the task has always been different – to help the brain recover in full. In most cases, we were successful. Moreover, we could give a head start to almost all of our foreign colleagues.

In 1993, I completed my MD thesis and focused on the development of methods of neuroprotection. It was when Academician Igor Ashmarin initiated the extensive medical use of peptides, special molecules that live in human body for only a few seconds, but kickstart a chain of cascade reactions that have prolonged and versatile effects.  We were the world leaders in choosing effective methods to neuroprotect the brain though the term ‘neuroprotection’ was invented later.

In 1994, I delivered a long report about metabolic protection of the brain at an international scientific conference in Germany. Judging by the response of my colleagues, it was received well. During the very first interval between sessions, I was offered three employment contracts to choose from: at a Massachusets neurology center near Boston, at The Charite clinic in Berlin and at a large Spanish clinic. I thanked them for the opportunities, but I didn’t sign any contracts.

— Why?

Because I was really into my work in Moscow. Besides, I understood my responsibility to the team that I worked with. In 1997, I was entrusted to head the independent Department of Basic and Clinical Neurology at the Russian National Research Medical University, where medical and biological students studied – biophysicists, biochemists and medical cybernetists. Time showed that I was right when I decided to stay. I started to get invitations from the world’s leading neurology clinics as a visiting professor.

— What about your knowledge of foreign languages?

My English was not good back then, I only studied it at school and university. When the need arose, I bought a wonderful four-volume teach-yourself book by Carl Eckersley with cassette tapes and started to study thoroughly. At the same time, I watched films in English with English subtitles, which helped to understand spoken language.

I also began making short trips – which lasted between a week and a month – to work at leading neurological clinics in the US, Great Britain, Germany, Austria and other countries… I met my foreign colleagues and established good personal and working relationship with many of them.

In 1996, I was elected Secretary General of the European Stroke Council, while I also entered an international group of top experts on neuroprotection. We actually outlined major development directions in this area of medicine. In 2001, I became Executive Director of the World Stroke Organization.

— And where did you head to, Veronika Igorevna?

Our neuprotection research was widely recognized in the world, but in 2001, I realized that there are significant obstacles preventing the use of our effective medical technologies here in Russia.  In order to introduce them, there was a need to establish an entire healthcare system for patients suffering from acute cerebrovascular disorders. Neuroprotection methods help achieve the best results in the first three to four hours following a stroke,  before the brain faces permanent damage. Such damage can be prevented, or minimized through pathological processes.

In order to get access to patients at the early stage of a stroke and effectively use the 'therapeutic window,' the whole medical treatment process should be arranged differently. It is important to explain to people how little time we have to save the brain. And patients certainly need to be brought quickly to a facility where they will get timely expert assistance.

My Department of Basic and Clinical Neurology was initially based at City Hospital Number 20 but in 2001, I made an agreement to set up a neurology clinic at City Hospital Number 31, which was headed by my classmate Professor Georgy Golukhov, a talented manager who later became a minister in the Moscow city government. He allocated two floors for our clinic and allowed us to establish a model stroke unit, which had a patient reception service, an intensive care room, as well as a room for early rehabilitation, kinesiotherapy and occupational therapy.

In two years, we attained unbelievable results, as mortality rates among patients with all forms of brain strokes halved or even declined by more than two-thirds. This made it possible not only to introduce neuroprotection methods but also for the first time in the history of our country to conduct a systemic thrombolysis in an ischemic stroke case, which took place in 2005. In the 1970s and 1980s, Soviet doctors attempted to do that but with no success, because they used wrong thrombolytics at the wrong time so it all ended in brain haemorrhages. However, such a process conducted at the new center during the 'therapeutic window' proved to be successful. Brain clots now were dissolved, vessels cleared up and people suffering paralysis down one side of the body were capable of moving again and went home on the second week following the stroke. It seemed to be a miracle.

Our center gained phenomenal experience and we started thinking about setting up vascular health centers throughout the country. The task seemed impossible at the time. In 2007, there were only three CAT scan devices in Russia that operated 24 hours a day, and those sometimes were out of service. It seemed impossible that a patient suffering a stroke could receive medical care in the first if not three, at least six hours, in any part of the country.

Nevertheless, we began working on a document based on a three-stage system. The first stage was aimed at preventing vascular diseases at primary outpatient healthcare facilities. The second stage stipulated the establishment of interregional vascular health centers where patients could be delivered in less than an hour (this is when the term ‘the golden hour’ emerged). Logistically appropriate locations were to be determined in every region. It was no less important that patients must be brought right to the computed tomography devices without passing through usual patient reception units.  So, a medical nurse would get blood for testing while a neurologist would examine the patient. CAT scans take 15 minutes, and test results would be ready by then.

The third stage included the setup of regional vascular health centers equipped with hi-tech neurosurgical, vascular and endovascular tools to do surgery not only on intracerebral hematomas but also on vascular aneurysms and malformations, perform clot extraction and vascular stenting. Such a center needed to have telemedicine links to interregional (primary) vascular health centers so that it could provide consultations on a round-the-clock basis. In fact, large-scale telemedicine consultations began within this vascular health program.  

We completed it at the end of 2006 and I went to the Russian Health Ministry. Department Head Ruslan Khalfin received me. On the very next day he and then Health Minister Mikhail Zurabov were to present a report to the government concerning the ‘Health’ National Project. It just happened so, it was a coincidence – one of the many in my life. Ruslan Khalfin asked: “Can you shape your initiatives in accordance to a form I will give you?”

I said ‘yes’ and spent the night harmonizing everything with the ministry’s standards. To my great surprise, I was soon invited to the Health Ministry’s board meeting, where I delivered a report. Our program was approved and in a little while, financial issues were also solved. Clearly, the program did not engulf the entire country at once, so we decided to choose 12 pilot regions.

At the end of the summer of 2007, Tatyana Golikova was appointed as health minister. I once again spoke at a board meeting following which Tatyana Alexeyevna suggested that… I take up work as her deputy.

It was quite a shock for me. I never saw myself as a government official, I had been engaged in research activities my entire life and valued the opportunity to implement my ideas. But it was what Tatyana Alexeyevna said – that being a health ministry official would help me fulfill my plans.

— Did you think long about Golikova’s proposal?

We had our first conversation at the beginning of 2008, met several times after that and I became a deputy minister on June 15, 2008.

Certainly, I could not imagine what my work will be like when I agreed to join the ministry staff. It is totally different from everything I did before. It is a completely different dimension!

In my first year, I often thought that tomorrow would be my last day there.  It required exerting willpower and achieving unprecedented concentration.

The lack of positive feelings weighed heavy in me, as well as… I don’t know how to explain it… the lack of fast results. Do you remember the Aesop story? ‘Xanthus, drink up the sea!’

I came to realize that I can dedicate my own life and the lives of many wonderful people working with me to the cause, but I will not be able to break or change the system. At least, at once. It is too stagnant, it has accumulated too many faults. Changes require time and patience.

First, there was a need to determine a location scale and a starting point, to develop some criteria. This is the strategic task that I set before myself. At the same time, every day brought numerous problems, from some small issues in certain regions to large problems such as the lack of doctors in hospitals and ambulance services, as well as the lack of nationwide healthcare rules. There also were no quality criteria for medical care and medical workers’ skills!

Nevertheless, it was then – in 2008-2009 – when the groundwork was laid for the Russian healthcare development strategy.

— When you were appointed as health minister in 2012, the medical circles welcomed the news, saying that at last the industry would be run by one of them, not an economist or a cyberneticist. Has the optimistic sentiment subsided over the past six years?

I am indeed one of them. I have always been. And I still feel support from the top professionals in Russian medicine.

In 2012, the team of the Health Ministry’s major freelance experts went through major changes. It currently consists of more than 80 people, including the directors of federal centers, heads of professional communities and associations. We also established the positions of chief district and regional specialists.

This, for the first time, allowed us to outline a set of national clinical recommendations approved by consensus.

We also set out quality criteria for medical assistance, all medical workers are now being included in a new occupational clearance mechanism. It had been under consideration since 2012 and we started to gradually introduce it in 2016. All medical college graduates have to receive primary accreditation to practice their profession.   

If you ask me whether there are any issues left concerning Russia’s healthcare, I will answer in the affirmative. Some pressing issues will be resolved in the near future, yet others will require time.

Nevertheless, I can say with confidence that because of our six years of work, healthcare has started operating in accordance with clear and comprehensible rules. It concerns everything. For instance, we created and introduced a geographical information system, which makes it possible to timely respond to changes in the number of people living in certain locations and their healthcare needs. This leads us to fieldwork, mobile complexes and the rapid development of airborne medical services.

Most regions now have access to telemedicine and control centers equipped with GLONASS navigation devices.

Personnel policies have totally changed. Methods are employed to determine the need for various specialists. A federal portal has been created, dedicated to continuing medical education, which offers a large number of training courses and master classes, as well as an opportunity to undergo tests and get certified in specific education modules.

Meanwhile, science remains something that allows me to remain efficient and optimistic. I continue to supervise my subject. Two years ago, we created an innovative development-oriented cluster, once again reformed a center for strategic planning and health risk management, established a network of national medical research centers.

— How many of them are there in the country? 22?

As of now, yes, but the number will grow a little. In fact, medical research centers came to be at the end of the Great Patriotic War (WWII) and after the Victory.  It was a pivotal to the development of healthcare in the Soviet Union.

Not only did we strengthen these centers, re-equip, renovate and finish their construction, but we also set up head offices that now guide specific tracks throughout the country. Each of the centers – no matter if they cardiological, oncological, preventive medicine or any other centers – is provided with around-the-clock telemedicine links to specific medical facilities in all the 85 regions.

— Undoubtedly, priorities are important but how do they relate, say, to a letter that Olga Andreitseva, a doctor at the Vishnevsky Surgery Institute, wrote to President Putin and you, saying that the unique national center lacked basic medications and equipment, and that staff members received low wages and were fired in large numbers – all in all, a total disaster.

Yes, there was such a letter. The Health Ministry’s integrated commission went there and looked at financial and other documents. Practical conclusions were drawn, including those concerning some personalities; there was a meeting with the center’s staff. The situation has improved. Each facility – be it a national center or a district hospital – sometimes has to deal with misunderstandings. A wise manager must get to the root of the problem and resolve the issue. I hope that Academician Amiran Shotayevich Revishvili, a brilliant doctor and researcher and a good manager, has already taken the situation into account as part of life’s experience and it will help him avoid such conflicts in the future.

— Meanwhile, the letter’s author was fired…

All disputes must be resolved in strict accordance with rules and laws. I think the incident we are talking about occurred because Amiran Shotayevich only came to the Vishnevsky Institute from another federal center a short while ago and did not have time to detect certain dangers brewing within the team…

— Veronika Igorevna, you speak about trying to build a healthcare system in Russia but frequently someone who’s standing on the peak can’t see what’s going on at the foot of the mountain. Are you not forgetting the public while making all those plans and projects?

And who are we doing it all for? Certainly, for the people!

Unlike the federal ministry, which is formally separated from regional healthcare institutions reporting to governors and not to us, Roszdravnadzor [Russia's healthcare watchdog] is vertically organized, it has offices in every Russian region and constantly monitors the situation there. This is the first thing.

Second. We manage the system through an off-budget funding mechanism - the compulsory health insurance. In the past two years, rules have changed for insurance companies joining the mechanism and as a result, the number of market players more than halved. Only the largest and most reliable companies are still there, which took on additional obligations. This makes it possible to actually evaluate the quality of medical services, as the army of thousands of insurance agents in fact protects a major human right – the right to life and health. 

Besides, we have been boosting medical volunteer movement, so around 20,000 volunteers inform us about everything they see and face.

In addition, the All-Russia People's Front has been instructed to keep an eye on the situation.

We welcome any kind of inforatiom from medical treatment and preventive care faciities. We assess it impartially. There is a hotline for that purpose, the ministry's special unit.

— You know as well as I do that negative incidents stir a particularly strong response. Be it an incident in Kaliningrad, where personnel in a maternity home refused to give a premature baby some expensive medicine and it died, or another incident, when a disabled person was told to climb to the second floor to see a doctor… People judge the system by such incidents.

You are right. One rotten apple spoils the barrel. It is easier to criticize things, to say that the situation is bad.  However, there is a positive trend and it can't be ignored. For instance, the amount of hi-tech medical services grew by 12.5 times in less than ten years, while the mortality rate from vascular diseases halved, the mortality rate from tuberculosis declined by more than 70%. Maternal and infant mortality reached an all-time low, and life expectancy hit a national high.

— Have you seen Boris Khlebnikov's movie Arrhythmia? It won a bunch of awards last year.

I don't watch TV, I just don't have time for that.

— Then, in short, it is a story of a brilliant emergency doctor who wants to help everyone but cannot do that because of restrictions such as the rule to spend no more than 20 minutes on a patient.

Let us clear some things up: there is no federal requirement putting limits on the time doctors spend with patients. A visit to a physician should last as long as needed. There are only some estimated timeframes to help managers plan staff schedules. Perhaps, regions still facing staff shortages are forced to introduce some rules so that doctors receive more patients.

Conditions are being created to address staff shortages. It doesn't only include rising wages and one-time payments in accordance with various programs. An effective targeted training system has been set up in medical colleges so that university graduates take up jobs created for them for at least three years. If regional authorities do address staff shortages, the issue starts to get resolved.

But we are not in the army. I don't have vertical management tools that would reach down to midwife centers.  We have to create a system, outline methods and rules, train regional managers. In 2019, we will legally establish a 'two-key' mechanism so that the federal authorities will need to approve all the regional programs concerning free medical assistance.

— It is all very well, but you did not answer the question, Veronika Igorevna: does negative information reach you and how do you respond to it?

Every morning, I receive reports about everything that is going on. I receive additional information during the day. The information is not filtered, no one protects me from bad news. What's the point keeping it secret? I will learn about it sooner or later. I instruct Roszdravnadzor to probe into every incident on the ground. I get feedback very soon. If there is a need for an expert assessment, a team of our chief experts goes there and reports about the actual situation. When we see blatant violations of rules and laws or negligence, we hand documents over to the prosecution. It is the only way to make the system work effectively. However, we try to use punishments sparingly as we value the army of medical workers and always try to see the situation through their eyes. But there is no intention to cover up negligence. 

— Are you capable of taking tough measures?

Definitely. Otherwise, I wouldn’t be able to work in the Health Ministry for over ten years. I am firm but not rude. 

— People tend to think that healthy cynicism is a tool doctors use for self-protection because if you die with every patient you won’t live long.

That’s not true. I have told you that I worked for years in an intensive care unit and dealt with people in coma. Strokes, poisonings, cardiocerebral syndrome… Very difficult cases.

You come to realize the finite state of existence and it makes you love each and every person more. None of us is immortal but we should try to put off the end as long as possible. This is a task of a doctor. 

There are no saints among the living, people show their true self in misery and in sickness, when there is no more need to wear social masks. And a good doctor must be merciful.

— Do you still have a medical practice?

I don’t provide consultations to patients in a clinic, though when I was a deputy minister, I continued to head the neurology department and had medical practice. I came there early in the morning, made patient rounds, trained post-graduates and doctoral candidates, held scientific conferences on Fridays. The wheel kept spinning. However, in 2012 I had to give it all up. A minister works on a round-the-clock basis. I never turn my cell phone off, even on rare days off and short holidays. It is always on the standby mode.

— But your former patients still may request a consultation from you?

I don’t turn anyone down. Another thing: I was given a working cell phone in 2012. But I also have a personal phone and its number hasn’t changed since the 1990s. All my past life is in the phone’s contacts. The people whom I used to know back then, and who may need me now know that number. If it is in my power to help, I will do it without a doubt.

— There is a famous story about how you helped a presidential security service member regain consciousness.

Actually, there were a lot of such incidents but I try not to draw attention to them. The public knows only about those that occur in the media’s presence. Two years ago, we were going to New York by plane to attend the UN General Assembly and a woman aboard had an acute disorder of cerebral circulation. I managed to help her. I always carry emergency tools with me, including neuroprotectors. If a patient is given certain substances in time, within minutes, then the brain's level of susceptibility rises and it can survive an ischemic attack.

Some Chinese colleagues, who were on the same flight, made a video showing me standing before the woman on my knees and treating her. The video spread widely and a story about the incident onboard a plane was even told to the UN General Assembly. So the news travelled across the world…

— And what happened to the woman?

We were flying over Finland when it all occurred. It was decided that the plane would return and land in St. Petersburg. An emergency vehicle was waiting on the runway and delivered the patient to the Dzhanelidze Institute. In a week, the woman was discahrged from hospital and departed for America to see her grandchildren.

— What if you specialized in HIV treatment, would we have fought AIDS more actively, Veronika Igorevna? Russia is among the world leaders as far as the growing number of new infections goes. This is hardly something to be proud of…

As for HIV, in fact, the number of infected people started to grow by 2010. The peak was in 2014. The number of new diagnoses rose by 12.5-13% back then. There was a need to reconsider the developments and make a tough decision in order to prevent further growth. We did it by the end of 2014 and spent the next year developing and adopting a state strategy that was put into effect in 2016. The policy has many aspects but it is first and foremost aimed at preventing the spread of HIV/AIDS. It involves an awareness campaign among teenagers and young people but only among them. What is the danger? Infected people often times don't even think something is wrong as the disease may not reveal itself in years, until the symptoms of AIDS become obvious. This is why there is a need to take active steps to inform people about the disease and ways to avoid infection.   

Since 2015, we have been conducting a national campaign dubbed 'Stop HIV/AIDS' together with the Foundation for Social and Cultural Initiatives, founded and headed by Svetlana Medvedeva. We have also engaged the college student community and organized special lectures for high school students.

Together with Russian Railways, for two years we traveled from Vladivostok to Kaliningrad, making stops at every station, meeting with people and telling them why HIV is dangerous. We also offered free HIV testing.

In 2018, we organized a motor rally across Russia together with the GAZ company for the same purposes, testing 40,000 people for free.

— It’s not much for the country.

It was only one campaign. In 2017, we tested more than 34 million Russians, which makes over 23% of the country’s population, so that’s one of the best rates in the world. Everyone should know their HIV status. It is important to make people understand that even a positive test is not the end.  With proper treatment, HIV patients have zero viral load and can live a full life with no restrictions.

We have almost stopped vertical transmission. In 2017, the rate was only 1.7%. In other words, as many as 98.3% of HIV-positive women give birth to healthy children. The few infected kids that are born with HIV are from women who avoided seeing a doctor until it was time to give birth.

Another thing. In 2010, only 19% of HIV patients received antiretroviral treatment. In 2015, the number grew to 26%. In 2018, we already have 56%.

According to AIDS centers that every region has, there currently are more than 880,000 people living with HIV in Russia. Over 80% of them are registered with dispensaries for medical observation.

It is particularly important for us to provide therapy to as many patients as possible. The task for 2019 is to take the number to 75%.

Indeed, we still are first in Europe as far as new infections are concerned. A total of 71,000 new HIV infections were diagnosed in the first ten months of the year. However, the growth rate has declined and we know what to do. As many as 25 regions that make up a drug trafficking route create a negative picture. Their situation is different from that in other regions. By the way, for years, drug needles were the main way the virus was transmitted in Russia, but now the situation has changed and heterosexual relations now take first place.

— What would you say about replacing hard drugs with soft ones for addicts?

I disapprove of this. We managed to achieve positive results in the fight against the drug epidemic in the late 1990s through another strategy, aimed at reducing the demand, preventing drug use and rehabilitating drug addicts. We believed that there is a need to provide comprehensive care to drug addicts rather than replace one drug with another, actually making these people incurable.

The world heard us and now many countries are following in our footsteps. In the early 2000s, a well-known international fund conducted an experiment in northwestern Russia. Syringes and needles were distributed for free. However, experience showed that in 18 months, the number of drug addicts and blood-transmitted infections grew immensely. After that, the practice was abandoned.

— What are your relations with non-profit organizations?

We maintain close ties. They are highly necessary for the fight against HIV. There are closed groups that are reluctant to build contacts with government agencies, including medical ones. It is important to join these communities, not to harm people but to help them. Socially oriented non-profit organizations are very helpful in working with such groups.  We are thankful for their activities, since they conduct anonymous testing and find opportunities for confidential conversations with those exposed to HIV risks.

Our task is not to brand people’s foreheads. HIV is only a sickness and it should carry no social stigmas.

There should be no disgust or fear.  HIV is curable, the main thing is to not lose any time after the infection and choose the right therapy. There is a large number of wonderful and respected people that the country is proud of, who have been living with HIV for ten to 15 years.

— Does it bother you that charity funds sometimes substitute the state healthcare system and save those you are supposed to treat?

There is a ministerial coordination council, which unites about two dozen of the largest funds. We have agreed that they will coordinate their activities with us when they receive cries for help. If a case does not fall into the state program for free medical treatment then charity providers may take steps. However, often times there is no need to raise money. People start spreading the word without finding out first what the law offers. And when it is impossible to get hi-tech treatment at the regional level, there is a point in seeking help at the federal level.

We treat children suffering from various forms of leukemia for free, transplant bone marrow and stem cells either from their family members or from allogenic donors. This is the most expensive hi-tech treatment we offer. A course of treatment costs 3.5 mln rubles ($52,500) but we don’t have resources and time to search for donors abroad. This is when charity providers come in.

We need to fit into the funding we have. We are thankful to the state for allocating far more funds to healthcare than it used to do several years ago. We can’t demand over-the-top amounts of money because we know what the situation in the country is like.

We need to look at reality. Nevertheless, the obvious fact is that the nation’s health has become a state priority. The major aspects of the national project are planned so that real results can be achieved in improving people’s health, increasing life expectancy and developing healthcare.

— Oncology is also among the priorities, isn’t it?

It is the most important of all our programs. In fact, it is as epic as the vascular health program was ten years ago. We developed it together with the country’s best experts. Apart from oncologists, there also were radiologists, cancer immunologists, chemotherapists, medical physicists and other specialists. If we implement all our ideas, Russia’s healthcare will reach an entirely different level. It includes fast – no more than two weeks – and complex diagnostic procedures, involving tomography, ultrasonic and endoscopic examinations, laboratory tests and morphological methods, so that patients can be sent to specific oncological centers dealing with a particular disease. In the next three years, we plan to create remote reference centers offering a second expert opinion. Special attention will be paid to developing total awareness of oncological diseases and providing additional training to primary care physicians for early cancer detection. We seek to use a special information program to follow the treatment of every patient at every stage of the disease no matter where he or she is receiving medical care. There is a lot of work to be done.

— You are speaking about the future but there is the present with hospices and palliative care issues. Will they receive state support?

Certainly. Our president mentioned these priority projects. Vladimir Putin instructed the government to allocate additional funds to re-equip palliative in-patient facilities, develop fieldwork programs, provide patients with breathing tools they can use at home and resolve the painkiller issue. The government has recently approved and submitted to the State Duma the Health Ministry's bill concerning the development of palliative care, which engulfs not only medical aspects, but also psychological assistance and social support.

In fact, no one addressed the issue in Russia before as there were more pressing problems. But we have already patched the largest holes, got things in order and now we can address the palliative care issue. In my view, it is one of the most humane and noble areas of healthcare.

— You said that during your first year in the ministry you often thought about quitting the job. Do you still have such thoughts?

Well, it was for a reason that I used that quote: 'Xanthus, drink up the sea.' Naturally, I sometime say it to myself. Our field concerns every person and the major human right to life and health. It is a very sensitive area. Clearly, people get used to good things fast and forget what the situation was like only a few years ago. When people are sick, they are more vulnerable, they face stress and fears, so they cannot be expected to be in the right state of mind. 

The healthcare system is far from perfect. In fact, we are going through a stage of active development. Major vectors have been determined, development processes continue in all regions. Their speed and efficiency differ but the movement is headed in the right direction. Nevertheless, overcoming the system's stagnancy and achieving the desired results requires time.

— And you, Veronika Igorevna, where do you and your deputies receive medical treatment? If you have health issues, do you prefer to travel to western countries or go to your Russian colleagues?

- I can firmly state that people from my close circle and I go only to Russian clinics and seek no medical treatments abroad. I don’t remember any such cases, there is no need for that. We have wonderful specialists who can offer exclusive medical care even when foreign colleagues give up. In Russia, doctors try to cure patients considered as incurable in America, Europe, Japan and South Korea, and often succeed. National centers offer unique hi-tech care.

— Do you say that out of patriotism?

It concerns the health and life of specific people. I am happy that more and more Russian clinics are becoming world-famous. And I am proud of our best specialists. The task is to provide everyone with access to high quality healthcare. We are working on that.

— So, returning to what we began with… What music do you listen to when you return home from work? Which of the brain's hemispheres do you turn on?

I sometimes ride in total silence. Sometimes you get so tired of communicating with others that every sound seems to cause hyperacusis, when the smallest noise annoys you.

This is why I rarely turn the TV on. I come home late and have about five hours of sleep. Why waste time watching some movies or shows?

— You don't take care of yourself, Madam Minister!

I would be happy to do it but I am currently unable to change my schedule. A person needs to sleep at least six hours, seven or eight is better. My workload is heavy, it would be foolish to deny it. I try to spend my energy reasonably.

— When do you usually leave the office?

Half an hour before midnight. And my working day starts at nine in the morning. I was brought up to complete all things planned for the day. I never put anything off until tomorrow. Never! There are no exceptions. Once this rule is broken, the heap will continue to grow and will never be done with. As a result, the everyday routine will swallow you and you will never get to the strategic issues.

— You mean you want to get through everything each and every day?

Exactly. Not a single document remains unread by the time the night comes. This is when I go home. To start everything anew in the morning…