The problem of the fourth stage. Daria Starikova, who complained to the president about poor medicine, has died

Daria Starikova, a 24-year-old resident of the city of Apatity with stage 4 oncology, addressed the President of the Russian Federation during the “Direct Line”, in short phrase diagnosed our healthcare system: “We want to live, not survive.” Her story, alas, is typical and tragically highlights systemic problems today's Russian medicine. Which ones exactly, Ogonyok found out.

Natalia Nekhlebova

If Dasha had not been caught on camera during “Direct Line” with Vladimir Putin, she could easily have been called a collective image of a not-so-prosperous girl from a small Russian town. Orphan - mother died early (father is unknown), raised by older brother. She graduated from 9th grade, at the age of 18 she gave birth to a daughter, the child’s father refused to take part in his fate. Dasha worked as a bus conductor, then as a salesperson, her aunt helped with her daughter - life is no worse, but clearly no better than most. The context is fitting: the regional center of Apatity next to the world's largest deposit of the mineral of the same name (apatite - a raw material for the production of phosphate fertilizers), the Belaya River, shabby five-story buildings, Lenin Square, a processing plant, the Arctic, hills...

Disease history

One day the girl had a back pain. Then the pain began to recur. I made an appointment with the doctor. 55 thousand people live in Apatity. And like in the vast majority of small towns, the hospital has been optimized here since 2013. The departments of gynecology, surgery, traumatology, cardiology, and the maternity hospital were closed. All that's left is the clinic and Women's consultation. “We fought for this hospital as best we could,” says Dasha’s friend Anna Tikhokhod, “we wrote letters to the Ministry of Health. There was no point.” There are queues at the clinic. Crowds of elderly people stand behind coupons.

Daria was diagnosed with osteochondrosis. For further examination we were sent to a hospital in Kirovsk (20 km from Apatity). They confirmed it, prescribed massages and ointments. When bleeding began after six months of treatment, the girl was taken to regional hospital to Murmansk (five hours from Apatity). There it turned out that she had stage 4 cancer. Dasha is 24 years old. How will events develop further? Even non-specialists are in the know: waiting for hospitalization, examinations, tests, obtaining medications...

"Exist installed by the program state guarantees“Standards defining how much help a cancer patient should expect,” Nikolai Dronov, chairman of the executive committee of the “Movement Against Cancer,” tells Ogonyok, “but here they are often exceeded. From diagnosis to the start of treatment, it can take two or three months. We had a case where a person waited a year. The fight is for every free pill, for every free hospitalization. People achieve prescribed treatment through the courts." Daria managed to speed up events - in live contact the president.

Her appeal was seen by the whole country: “Everything has been closed here. There are not enough specialized specialists, thanks to whom it would be possible to diagnose people on time. necessary examinations sent to Murmansk. Ambulance, sometimes he doesn’t have time to deliver..." Immediately after the broadcast, Dasha burst into tears, and the regional authorities shuddered and showed miracles of activity.

Marina Kovtun, the head of the region, rushed to Apatity, promptly visited Aunt Dasha, promised to send her daughter Sonechka to a good summer camp, then received the population at the hospital and listened to complaints. A day later, the regional Minister of Health Valery Peretrukhin was already sitting in Apatity along with his deputies - they received people for two days. Then the baton of welcoming the population in the “exposed” city passed to the deputy head physician of the Murmansk Oncology Center. And the Investigative Committee opened a case of “medical negligence”, and chief physician hospital in Kirovsk resigned. Who else is to blame?

But here important detail: even before submitting his resignation letter after this whole story, the chief doctor of the Kirov hospital (we remind you that he also serves Apatity) confirmed that he medical institution only 62 percent staffed with doctors. There is no regional oncologist in the states: all tests and examinations are 200 km away, in Murmansk.

And one more piece of evidence for understanding the picture.

— More than half (60.9 percent) of health workers believe that their professional workload has increased in 2016 and the first quarter of 2017, and cite optimization as the reason for this medical organizations(77.5 percent), says the director of the Independent Monitoring Foundation to Ogonyok. medical services and protection of human health “Health” Eduard Gavrilov.— At the same time, the absolute majority (92.7 percent) of health workers believe that the increase in the professional workload assigned to them negatively affects the quality of the services they provide medical care.

The right is there. No money

Numbers

Free help for cancer patients - paper declaration. In fact, almost half of the regions of the Russian Federation are reducing the cost of medicines for them. This is the list of entities with the largest decrease in funding (%)

Sakhalin region 47.9

Khanty-Mansiysk Autonomous Okrug 47.9

Magadan region 39.0

Kalmykia 38.5

Saratov region 35.8

Kemerovo region. 33.2

Udmurtia 32.2

Ingushetia 29.7

Primorsky Krai 29.1

Tula region 27.8

Source: Research Institute of Healthcare Organization and Medical Management

No one responsible

“Incorrect diagnosis is not a mass phenomenon, but it cannot be called a rare exception,” says Nikolai Dronov. “In the conditions in which we have to work medical workers today, I would not make all the claims to the doctor who treated Daria. Questions should be asked to the Murmansk governor, his deputy for social issues, and the head of the health care organization department in the region. For example, where are the district oncologists in their region? They should organize the work of doctors of other specialties to identify the risk of cancer in district hospitals, in places. And this question can be asked in many subjects."

However, it is not only regional officials who need to be called to account. It's no secret that oncology is the most expensive branch of medicine. Colossal amounts of money are required. Tablets can cost from 500 thousand to 10 million rubles. And here the federal Ministry of Health washes its hands. Because legally he's not actually... responsible for helping cancer patients. The Federal Ministry of Health simply issued an order according to which all patients with oncology must be provided with free treatment. And the regions must do this. The directive is wonderful. But it’s paper. It does not contain recommendations on what to do if a region has money problems. But the majority have a deficit budget. And even treatment prescribed in federal hospitals can be canceled in the region for a trivial reason - because there are no funds for it.

Exemplary punishments will not change anything. We need a national systemic plan to combat oncological diseases

Instructions real life It’s not regulated in any way, it just exists – in fact. And one can only be surprised that in Ryazan, for example, there is no surgical department in the oncology clinic and operations are performed by general surgeons in a regular hospital. It's like a dentist operating on a broken jaw.

Now let’s get back to the specific subject: why wasn’t Dasha from Apatity sent for examination to Murmansk? The reason may be this: “The more patients, the more expensive it is for the state,” says Nikolai Dronov. “And in a number of cases we are simply faced with the fact that the diagnosis is not specified. People are not sent for further examination. This has happened even in Moscow.”

The situation when you have to fight for treatment, which according to all instructions is due to citizens of the Russian Federation and should be free, is typical not only for oncology patients. According to the Movement Against Cancer, the Union public associations patients" thousands of requests a year are received by the Federal Ministry of Health about the fact that the regions do not provide free treatment. The Federal Ministry of Health regularly responds: it sends complaints to regional departments. And the regions answer: there is no money. Patients also go to court (they usually sue the regional Ministry of Health), but even when they win the case, they hit a wall: there is no money... And so this bureaucratic gimmick continues with an inevitably tragic ending: departments point at each other until until the person dies. And there is no one to blame either.

“Exemplary punishments will not change anything,” says Dronov. “We need a national systemic plan to combat cancer. We have been writing about this to various authorities for several years now.” Apparently they will continue to write.

And Dasha was taken by a special plane of the Ministry of Emergency Situations to the Institute named after. Herzen in Moscow. According to her friend, she is cheerful and does not lose hope. There is no doubt that they will now do everything possible for her, and there is only one thing left: to wish her recovery.

But what can we wish for the people who remain to live in Apatity? That everyone will be returned to them necessary doctors, even after the scandal they no longer hope: “They’ll talk and forget,” they comment doomedly on social networks. And we’re not just talking about the residents of one regional city. There are many such addresses in Russia, where thousands of people with “complex” diagnoses - oncology, HIV, Hunter syndrome, mucopolysaccharidosis - cannot wait for treatment or wait six months to see a specialist. What do you wish for them? Is there really no other way out than the one that Dasha Starikova fortunately had - to get to the microphone on the next “Direct Line” of the president?..

Daria Starikova from the Murmansk region died in one of the capital's hospitals. The girl had stage four cancer. As Daria said during a direct line with Vladimir Putin due to a shortage medical institutions It was in her hometown of Apatity that she was first misdiagnosed.

“We do not have enough specialized specialists, thanks to whom it would be possible to diagnose people on time. Our maternity hospital was closed, closed surgery department, cardiology, everything was transported to a neighboring city. We have to go and seek help there, and also for difficult operations, for the necessary examinations, we are sent to Murmansk - this is a five-hour drive from us,” Dasha then said to the head of state.

Vladimir Putin promised to help Starikova and kept his word. The doctor began treating the 25-year-old girl medical sciences, Honored Doctor of Russia, Academician of the Academy of Sciences, Head of the National Medical Research Center for Radiology of the Ministry of Health Andrey Kaprin. An operation was performed to remove the tumor. As experts reported, it was successful. “Before and after the operation there were courses of chemotherapy, first to reduce the tumor, and then to consolidate the success after its removal. We used both imported medicines, as well as Russian generic drugs,” said Kaprin.

Dasha had no metastases or tumors after surgical intervention. A few months later she was allowed to return to hometown to see my daughter. People from all over the country were worried about Dasha. She thanked those who cared during a press conference, which was broadcast on television. “This is very important in this life, when you are not alone in fighting your illness. This life is very hard and scary. I wish everyone who is fighting to fight to the end,” Starikova noted.

As you know, on the recommendations of doctors, Dasha returned to Moscow for another examination. It has not yet been reported what exactly provoked the death of the resident of the Murmansk region. The administrator of the VKontakte group, which was dedicated to Daria, confirmed that the cancer patient had died. “It’s true,” Anna wrote in the comments. Netizens are wondering who her six-year-old child will now stay with.

Afterwards it became clear that Dasha’s appearance on television was, let’s say, not a simple accident, but one of the acts of a political game in which a dying person was used. She was diagnosed 4 years ago, and Starikova did not receive any refusals for treatment - because she did not go to the doctors. And in the end I only got to them by ambulance, when it was almost impossible to do anything.

There is absolutely no need to dance on the bones, this is how her life turned out. Sometimes doctors do the impossible - the best doctors in the country fought for Dasha for a year. But they couldn't save her. The seven-year-old daughter was left in the arms of her aunt. The girl will be given a pension with an additional payment up to the cost of living - 12.5 thousand rubles.

Last year's TV story about Starikova did not become a sensation - it was about her depressing condition cancer care not only in the Murmansk region, but almost everywhere, those who have encountered such a diagnosis are well aware. But, as usual, instead of a thorough investigation and real attempts to change the situation, a demonstrative flogging of the head doctor of the Kirov Central District Hospital, Yuri Shiryaev, who wrote a letter of resignation, began immediately. at will(Kirovsk and Apatity are twin cities, 15 km between them, the central district hospital is located in Kirovsk). The doctor’s patients defended him: after campaigning for Shiryaev’s return, he withdrew his statement.

However, as Novaya was told in Investigative Committee, a criminal case under the article “Negligence”, initiated at lightning speed after that direct line, is still being investigated. There are no real plans to build the unfinished hospital in Apatity, promised by Putin on live television. And thank God - a multibillion-dollar budget, if any, more than expected, will fall on Murmansk medicine, it would be much more important to invest in the reconstruction of the regional oncological clinic - if we are seriously talking about helping cancer patients. This year, amid a scandal, one of its buildings was renovated. But the radiological equipment there is still from the 1980s and periodically breaks down.

Reporting to the regional Duma, Governor Marina Kovtun recently announced sharp decline mortality from neoplasms: by 7.3% in 2017. True, if you look at the data from Murmanskstat, you can see that at the beginning of 2018, 10% more people died from cancer than in the same period of the previous year: 236 people versus 216.

In addition, the mortality rates do not include deaths outside the region - and more and more northerners are diagnosed with cancer in the late stages, and they are last hope go for treatment to large medical centers. The FlashNord news agency, citing its sources in the regional Ministry of Health, reported 150 patients who died as a result of incorrect diagnosis. According to the agency, their cancer was “overlooked” and was discovered only at stage 4. The department does not comment on this information in any way. However, several similar stories gained resonance this spring. In particular, the regional Ministry of Health is conducting an investigation into the improper treatment of Nadezhda Vorobyova, who was diagnosed with cancer on late stage. Previously, the woman was treated for migraines, osteochondrosis and anxiety.

Recently, a criminal case was opened regarding the improper provision of medical care to another Murmansk resident, Sergei Pavlov, who was “treated” with vitamins without noticing oncology.

Severomorsk Alexander Smirnov was treated for an ulcer until he, on his own initiative, did an ultrasound that showed a tumor. The tumor turned out to be inoperable. Metastases in the liver and abdominal cavity. According to the man, when he asked why the ultrasound was not done on time at the clinic where he initially went, he received an answer: the institution was fined by insurers for “extra” procedures. And it’s true: in the Murmansk region, contrary to federal legislation, the Territorial Medical Insurance Fund dictates to doctors how, whom and how much to treat. Sometimes you can only get what you are owed for patients who have already been treated through the courts.

To end next year The regional government promises to invest 238 million in the cancer clinic. Given the depressing state of the institution, this will not solve all the problems.

I met with Daria Starikova at the Herzen Oncology Research Institute, where she was hospitalized after the Direct Line with the President. Dasha's condition is serious. Although after starting treatment I felt a little better. My blood test results have improved and my appetite has appeared. It’s just that I can’t give up cigarettes. And it’s hard to blame Daria herself for this: after everything she’s suffered, it’s hard to give up overnight addiction- at least some kind of outlet.

The studies carried out and the tests taken showed that Daria advanced cancer cervix. Severe pain in the spine in this case is a common occurrence. It is known that cancer, especially in initial stage, has no clear clinical manifestations. And the patient goes to the doctor with complaints about symptoms, not knowing that they are a manifestation of the underlying disease, and not the disease itself.

So Daria developed cervical cancer. The tumor was pressing on the spine, and the woman was tormented by pain in the spine. Standard therapy was carried out at the place of residence. In Murmansk, Daria underwent ten sessions radiation treatment. It didn't get any better. It was getting worse. Even now, when they managed to feed her in Moscow, she weighs 46 kilograms and is one meter 63 centimeters tall. And my six-year-old daughter Sofia is at home. No close relatives. And that means you simply have to live. And, Daria tells me, they told her: “We can’t help. Nobody will help!” She asked for a quota for treatment in St. Petersburg or Moscow. In vain. Daria told how her search for help turned into sheer agony...

After the incident with Daria, most likely, the problem of the same quotas will be removed. In those parts. And everywhere? Or is it still: we have everything, but not for everyone? But when it comes to health care, then “not for everyone” is not the fourth stage of the disease, but lethal. Do the specialists Daria contacted have low qualifications? Maybe. But where else can we come from if there is a growing shortage of specialists themselves? According to Rosstat, at the end of 2016, the shortage of therapists working in primary health care was 27 percent, pediatricians 18 percent, doctors general practice 23 percent.

Daria, of course, is lucky: she is now in one of the best modern oncology clinics. She is being treated the best specialists according to the newest, most modern protocols. But Daria's story is evidence of the inaccessibility of medical care. More precisely, accessibility is not for everyone.

Maybe oh free medicines we must forget, as well as about ourselves free medicine? Recognize that being treated for nothing is being treated for nothing?

This is not the first year I have been covering health issues in the media. There is not a day when the editor does not receive letters on this topic. Usually the ratio of such letters was 50 to 50. Half were thanks to the health service and its employees. Half are complaints. And this is natural: nowhere in the world is any department so intertwined with people’s destinies as the one protecting our health and life. And nowhere in the world can you probably find an example where everyone would be satisfied with this service. But I don’t remember that there were practically no letters assessing medicine positively. A bad sign.

I chose two letters from the last mail. One from Samara from Mikhail Nikolaevich Dobreli. The second from Rostov-on-Don from Mikhail Andreevich Rzhakinsky. I chose it because both relate to the treatment of eye diseases. The author of the first entitled his letter: “Where do the drops flow?” Mikhail Nikolaevich has glaucoma. And in the 6th clinic, where “in accordance with the place of residence (I quote the letter. - I.K.) I am being treated, 2 days a week are allocated when the ophthalmologist sees only glaucoma specialists... You can only get a coupon for an appointment with an ophthalmologist for a glaucoma specialist on the day of admission. The number of coupons is limited. The quantity of medicines is even more limited. And they are not always available. All pharmacies always have it for money, but in clinics there is only sometimes and in limited quantities... I assume that the budget pays for the entire annual requirement, that is, 12 vials per year for each patient. In 2016, I received 4 vials at the clinic, and 8 vials leaked somewhere. I didn't receive any in 2017. I make do with the pharmacy... I would like to know who feeds on our drops? Where are they going?"

Everyone would like to know this. Or should we admit that it’s time to forget about free medicines, just like free medicine itself? Recognize that treatment for nothing is treatment for nothing, and direct your search for health to private institutions, as Mikhail Andreevich Rzhakinsky, a resident of Rostov-on-Don, did five years ago? It was then, on March 22, 2012, that he turned to the private medical center "Hippocrates" for a consultation. Next, the author talks about his search for effective treatment. The search, judging by the letter, is useless. Despite appeals to local and non-local authorities asking for help, asking him to figure out why he paid a lot of money.

The note was already in the room when the patient from Kursk called. According to him, he was diagnosed with liver cancer. Where to go with your problem? I name clinics where they can help. A resident of Kursk calls again and again: how to get there? How to get a quota? But is this a question for the editors? Is the story with Daria doomed to exception?

At first, her messages were completely hopeless; it seemed that she did not believe that anything could help, Maria recalls. - But after surgery before the New Year, it seemed to me that she had hope for recovery. She wrote that she began to gain weight, felt better and even began to make plans. I kept thinking about how she would come to her daughter for the holiday with gifts... The last time a message came from her was at the end of December, she then wrote that a lot of people were calling and writing to her and she simply did not have time to answer everyone, she said that perhaps the doctors would allow she should go home for the holidays.

Apatity resident Daria Starikova (she complained to Putin about problems with medicine in the city) died of cancer. As the Mash telegram channel found out, the 25-year-old girl died in one of the capital’s clinics. Dasha had an incurable stage.

On June 15, 2017, 24-year-old Daria Starikova from Apatity, who at that time already had the fourth degree of oncology, during a “Direct Line” with the President of Russia, said that doctors initially gave her the wrong diagnosis of “intervertebral osteochondrosis.” Because of this, time for treatment was lost.

Obviously, the last straw for the girl was an appeal to the president of the country. What most struck those who heard Daria Starikova’s appeal was that the girl was asking not for herself, but for other residents of her region who might find themselves in a similar situation. The girl’s appeal was recorded against the backdrop of the hospital’s unfinished surgery building, which was supposed to be operational back in the 90s, but eventually became a refuge for the homeless.

Dasha's first appearance in front of television cameras after surgery and a course of chemotherapy. There is a barely noticeable smile on his face. At an impromptu briefing, doctors from the Moscow Herzen Research Oncology Institute do statement: the disease has subsided.

"We stood at the doctors for a very long time, for half an hour, for 40 minutes, nothing could be achieved. But now, of course, it’s better,” notes Murmansk resident Irina Osipova.

Dasha about the fight against stage IV cancer in practical conditions complete absence qualified medical care has touched millions of people.

Almost immediately after this, Daria was transported for treatment to Moscow, where the best oncologists in the country tried to save her.

Dasha Starikova addressed Vladimir Putin during Direct Line with the President last year. The girl had stage four cancer. She said that doctors misdiagnosed her and treated her for another illness. And as a result, the disease was started. After this resonant interview, the girl was transported for examination to the Murmansk regional hospital, then to Moscow - the Herzen Research Oncology Institute. Doctors reported in December that the treatment gives positive results, she went home for the New Year holidays.

Daria Starikova last news. All news.

When her daughter grew up a little, Daria went to work, first as a conductor, and then became a salesperson in one of the local stores. Her aunt, Lyubov Tulupova, helped her with the child (it was she who became Sonya’s guardian after her mother’s death). This is how Dasha’s life went on until the girl learned about the terrible diagnosis. “It all started absolutely out of the blue,” says Dasha’s other friend, Maria. - For no apparent reason, Dashka’s back started to hurt. Nothing helped, so she decided to go to the doctor.

That's where they put it terrible diagnosis“cancer”, already stage IV. Naturally, this was a shock for Dasha, but she decided to fight to the end. She always loved life very much, knew how to enjoy little things, things that many others simply do not pay attention to. More than once after talking with her, my pessimistic mood disappeared.

MurmanskAlakurttiApatityVarzugaVerkhnetulomskyVidyaevoGadzhievo (Rocky)ZaozerskZapolyarnyZarechenskZelenoborskyKandalakshaKildinstroyKirovskKovdorKolaKorzunovoLovozeroMezhdurecheMolochnyMonchegorskMurmashiNickelOlenegorskOstrovny (Gremikha)PechengaPolar ZoriPolyarny FurRevdaRoslyakovoSeveromorskSnezhnogorskTeriberkaTulomaFogousUmbaUra-Guba

In our city, like in many others, five years ago the hospital, consultation and clinic were closed during optimization. Both at the clinic and at the hospital in the neighboring city, Dasha was diagnosed with osteochondrosis and prescribed ointments and massages. But a few months later my friend started heavy bleeding. She was sent to the Murmansk hospital, which was 5 hours away.

Daria Starikova Why does the girl have cancer? News for this hour.

- This is very important in this life, when you are not alone in fighting your illness. This life is very hard and scary. “I wish everyone who is fighting to fight to the end,” says Daria Starikova.

She has not been in touch on social networks for the last two months. And today it became known that Daria Starikova died.

When the girl was sent for treatment to Moscow and the first good news, we all hoped for a miracle. They hoped that Dasha could be saved, that her little daughter would be next to her mother again. Unfortunately, real miracles only happen in fairy tales, and even the president is still not an omnipotent wizard.

After Daria's conversion, a lot changed in. New offices appeared there, qualified specialists, comfortable infomats.

The Moscow Herzen Institute reported encouraging news about the health of Daria Starikova. She will meet New Year not in the hospital, but at home. The whole country learned about the fate of a 24-year-old woman with fourth-degree cancer during a Direct Line with the President. Daria complained about problems with medicine in her native Apatity. She no longer asked for herself, but for her fellow countrymen. What has changed in six months?

“Everything was closed here. There are not enough specialists thanks to which It would be possible to diagnose people on time. They are sent to Murmansk for the necessary examinations. Sometimes the ambulance doesn’t have time to deliver... I’m not asking for myself, I’m asking for the city, for our residents, for all the people. We want to live, not survive. We ask you to please help!” - as soon as the live broadcast ended, Dasha burst into tears.