According to current estimates, about half a million to one million Ukrainians will soon live in the Czech Republic. Since almost half of the people who have come to us so far were not yet 18 years old, this means that there will be around a quarter of a million Ukrainian children in the Czech Republic. The problem, however, is that pediatricians are the oldest medical profession, and in some regions it is difficult to find a doctor and parents of Czech children. It is already clear that GPs for children and adolescents will not be able to care for all refugee children without help (we have also covered this here). At present, so-called UA points are already operating in some hospitals, but they are likely to increase in the future. Hospital paediatricians, for example, should facilitate the practice of children, but the involvement of other specialists is also under discussion. At its meeting yesterday, the House Health Committee addressed the issue.
“The original scenarios worked with completely different numbers than the current ones – at first we were working with around 50,000 refugees, but today we are at around 300,000. At the same time, studies have been published which map the movements of the Ukrainian population in Ukraine, where there are about 6.5 million people on the move. So far, it is internal migration, however, the crowd is moving to border states, it is i.e. Poland, Slovakia, Romania and Hungary. 10-13% want to end up in the Czech Republic. So if we look at the numbers with simple calculations, there may be an estimate of 600,000 more people The scenarios we are working on are half a million to one million refugees in the Czech Republic in the coming months,” Deputy Health Minister Jakub Dvořáček said, adding that if the crisis lasts longer , 60 to 70 % of refugees in the Czech Republic The Republic can expect the host country to stay.
As the Czech Republic is one of the countries most affected by the migration crisis, it will be able to draw on a special EU fund for the provision of health care. At the same time, the Czech vision aims to ensure that this money does not only go to the transport of seriously ill refugees and the provision of basic care, but also to the provision of expensive health care. It must be taken into account that there will also be those who will need financially demanding care, such as the treatment of cancer or cystic fibrosis.
Refugees with a tolerance visa are insured by the state and therefore have paid care to the same extent as any Czech citizen. On the other hand, there will likely be a different approach for rare disease patients treated with the more expensive drugs. “Usually it is Zolgensma (used to treat spinal cerebral atrophy). Yesterday we signed a bilateral agreement with the German Minister of Health according to which, in the case of expensive patients, an immediate transfer to Germany is prepared, which they will arrange. I asked Professor Štěrba to coordinate this with Dr. Šebková on selected diagnoses, and in rare diseases, we asked for translations in time. Some children with blood-oncological diseases we were transferred because we said that we had free capacities. On the other hand, Ukrainian children are already being transferred to us, Austria or Germany, and the Germans have also offered us to send their paramedics to our establishments for help”, describes the Minister of Health Vlastimil Válek.
But there is another special group of patients. As a number of clinical trials have been conducted in Ukraine, it will also be necessary to ensure that patients have continued their treatment with us. SÚKL provides information on how to contact the company that conducted the specific study and secure the medicine through them. “The vast majority of companies conducting the studies lead to this and connect with patients where they left off in Ukraine,” adds Jakub Dvořáček.
UA point care will likely need to be expanded
In any case, given the number of new arrivals, the huge burden on GPs, who are now trying to help, is clear. “We are expanding primary care to handle the greatest onslaught. Therefore, so-called UA points are being created, which are low-threshold outpatient clinics that are currently in university hospitals. We have spoken with the Governor of Cuba and the Association of Regions, where we also explained the regional hospital regime. Based on the feedback, we are preparing a manual, but it is up to the regions to decide whether to follow it or go their own way. I think that we are waiting for the expansion of this service, because people only seek treatment in the weeks or months after their arrival,” Dvořáček points out.
Care should be provided at UA points more quickly than in normal outpatient clinics, as translation is provided and a coordinator is available. At the same time, we are negotiating with other countries, the WHO or UNICEF, to have enough vaccines and medicines. Children who do not have a vaccination schedule or a copy of one will be considered unvaccinated and will follow our vaccination schedule.
The biggest problem can be expected in the field of primary child care. “General practitioners for children and adolescents constitute a segment of outpatient medicine, which is probably the worst in terms of capacity in the Czech Republic. The average age of these doctors is almost 60 years old, and in many regions they are facing a capacity in terms of working hours at a very late retirement age. I cannot imagine that two generations of children will enter this network in an uncontrolled way. About 110,000 children are born each year, and s ‘there are more than 200,000 children from Ukraine more permanently, the network will only absorb it if it is centrally controlled. It can be assumed that the children will not be massively chronically or seriously ill, but even routine care is something that the network cannot handle,” says IHIS Director Ladislav Dušek, who recalls that unfortunately the regions where the greatest influx of children can be expected from from UK raine are also wrong, such as Prague (which also deals with the Central Bohemian region) and the South Moravian region.
Assistant and pediatrician Romana Bělohlávková (KDU-ČSL) also confirms that children’s practitioners are not able to handle so many children. “We already have big cities, like Jihlava, where Czech children are not enrolling. These older colleagues are exhausted and it is impossible for them to take care of dozens or hundreds of Ukrainian children. Our colleagues from hospitals will have to help us UA points are a good idea, but in my opinion it will also have to be implemented in lower type hospitals After the training, colleagues from children’s services will have to help us with children , including preventive care and vaccinations,” Bělohlávková points out.
In gynecology, ambulatory care can support care
The problem, however, is that the ministry currently has limited information, both on the capacities of practitioners and on the care needs of refugees. “Let us realize that, unlike covid, when all records were kept by the Ministry of Health and therefore Colonel Šnajdárek, this is no longer the case now – everything is handled by the Ministry of the Interior”, underlines the Minister Valek. For everything to be managed, according to Válka, health insurance companies need to map the republic much more in terms of free capacities, and at the same time inform where care can be provided in a given locality.
In all cases, the effort is to help those working with the children as much as possible. According to Válek, the discussion is, for example, whether internists could not help children from the age of 15 (after all, adult practitioners can deal with adolescents today). But as MP David Kasal (YES) pointed out, teenagers who have preventive checks every two years are not such a burden – a lot more work is done with young children where there are checks every couple of years. month.
The good news, however, is that it is not necessary to do UA points in women’s hospitals or gynecological care. “The president of the gynecological society, Vladimír Dvořák, assured me that it is easy to cover the care of 100,150,000 women in gynecological clinics. So the situation is different in different areas,” Minister Válek adds.