M.D., Ph.D., Academician of the Russian Academy of Science, Director of the A.V. Vishnevsky Institute of Surgery Revishvili Amiran Shotaevich:
Institute of Surgery named after the outstanding Russian surgeon A. V. Vishnevsky is the oldest multi-profile hospital, as well as an educational and scientific center of the country. Traditionally the Institute develops the whole spectrum of cardiovascular, thoracic, abdominal and wound surgery, combustiology, herniology, plastic surgery, urology and orthopedics. Heads of the profile departments are highly qualified and well-known specialists of our country with wide contacts with foreign companies and professionals. Numerous developments and achievements of the Institute specialists are awarded the State Prizes and the Russian Federation Government Prizes. The Institute has modern diagnostic equipment, widely uses all the arsenal of mini-invasive surgical techniques, including robot-assisted surgery. Every year the Institute specialists examine and treat about 30,000 patients and train about 500 students all over the country. The Institute's mission is "to treat, train and develop, keeping the traditions of charity".
Why do wealthy Russians prefer to go for treatment to Germany, Switzerland or Israel, if, as government representatives and the doctors themselves claim that the level of the achievements of Russian medicine are not inferior to those on offer at the best foreign clinics? To answer this question, we turned to the AV Vishnevsky Institute of Surgery, Deputy Director of the Institute, Doctor of Medical Sciences, Professor Alexey Zhao.
Usually, the decision of a patient to go abroad for treatment is due to the lack of understanding that we in Russia use the same techniques, and the results are no worse. No one questions the right of a person to choose, especially when it comes to the most precious of values - that of health. One downside of this is that outsiders are making a business out of it. Agencies specializing in organizing such trips, using the patient's lack of awareness, overcharge the true cost of medical services by two or three times. As far as the treatment processes are concerned, believe me when I say that we have excellent surgeons, quite modern equipment and advanced technology. In our institute, as well as in other leading specialist centers, especially in Moscow, we are famous for our traditions and achievements in the field of medicine. So here you will undergo medical procedure as good as those abroad.
Other clinics perform surgical operations in line with their specific profile. What does your institute specialize in?
We often get asked this same question. Not everyone knows that many of the operations that are now quite commonplace, were developed and performed here for the first time, and then our students spread this unique expertise to other institutes. But we never stand still, and always try to improve and do more than anybody else. It is of no surprise that the most severely ill patients from across the country are brought to us. Here, much more material and tech-nical resources, knowledge and effort are invested in the treatment of each patient, including intellectually. Each department is headed by an academic or a professor - a leading expert in his field. I would say that our Institute is a sphere of hi-tech medicine, and it is not just the technology, but also within the walls of the school itself, there is a special climate formed by professional highly trained specialists.
Can you give at least a few examples to prove that the institute actually works to a global standard?
Take, for example, the Department of Vascular Surgery, where the surgeon Anatoly Pokrovsky works. He is famous all over the world among those skilled in the same profile. At one time he was president of the International Association of Angiology and Vascular Surgery, and remains an honorary member. His department has conducted unique operations, such as malformation of various localized tumors related to the blood vessels of the neck, and inflammatory lesions of the arteries, and here we conduct more of them than any other clinic in the world. We can proudly say that we have the most experience in this field, and we can treat illnesses that others are not yet able to. The Department of Liver Surgery is headed by Professor Vladimir Vishnevsky, author of numerous scientific papers and tutor to all those involved in this field of medicine in Russia. Its direction in its present form was born in our institute, and leading experts in the field of liver surgery were trained within these walls.
At the same time as treating disease, our institute serves as a center for disaster medicine, paying special attention to methods of rescuing people who have been seriously injured. The department of wounds and wound infections, which is headed by Valery Mitish, is the pride of our institute, and one of the best departments in Russia with such a profile. Unique methods for the treatment of purulent wounds, extensive wounds, and serious damage to bone tissue have been developed here, thereby managing to save a patient even in seemingly hopeless cases. Even if there is a need for amputation, it is carried out as gently as possible, providing better opportunities to rehabilitate the patient.
Our burns unit is famous across the country, where we not only save people, but also help them return to normal life. There's a branch of plastic surgery that is mainly engaged in dealing with scars formed after burns, and this treatment is also performed here at the level of world standards.
I have listed just some of the techniques, without going into details and without resorting to professional terminology. Really I could take much longer to respond to this question.
How has it happened that such an unusual medical institute has developed, seemingly without any previous analogy?
Generally speaking, this was one of the country's first scientific medical research centers, and the story of its creation is unusual. A year before the end of the Second World War (in 1944), some medical scientists began to think about the future of the planet, and proposed to the government that it organized an Academy of Medical Sciences. Its structure was to consist of ten clinical institutions, including the Institute of Experimental Clinical Surgery. In 1944, the distinguished surgeon Alexander Vishnevsky became the Director and the institute is dedicated to his memory. Apart from specialist civilians that came here, other specialists came that had paid an incredibly heavy price for their experience - in the midst of battle. They were universal surgeons: they could operate on all organs, and worked very quickly and accurately. From then on, the main departments of the Institute and the direction of its field of activities were formalized. Since then and for all the ensuing years, continuity has been maintained in its inherent traditions, the excellence of the surgeons that have worked here and the impeccable scientific authority of its directors have remained unchanged.
Many of the buildings on campus look like they were not built after the war, but more than a hundred years ago...
That's right. This place is based in the old Shchipok district of Moscow, which was once a kind of free medical center. In the 19th century it formed a complex for health charities, where treatment care was provided to all who needed it but could not afford to pay. As you can see, they were not some kind of "economy class primitive structures" but were properly constructed buildings, uniquely constructed by some of the best original Moscow architects, and superbly equipped for their time Among the patrons to donate money to this complex was the philanthropist Pavel Tretyakov, who was much better known as the founder of the most famous art museum in Moscow: the Tretyakov Art Gallery. These days, in a building constructed with his money, the Department of Wounds and Wound Infection is based. Obviously, it has changed in our time and is equipped with the latest equipment. Soon a reconstruction is planned, and this unique building will be restored.
Only the main building is relatively modern, built in the 1970s, but its architectural style has no historical value and it is obsolete. There are no complaints about the diagnostic equipment and the equipment in the operation rooms. Everything is up to date, but we still have to work in cramped conditions. We need to reconstruct the building itself, change the communication systems, and remodel the wards - they need to become more spacious and comfortable for the patients. We hope that we can do this, if we get the funding.
Will it be possible to carry out the reconstruction of the existing clinic without stopping its work, just as is done in industry?
The technologies exist, but it would be very difficult. In order not to disturb the sterile conditions, the buildings under repair must be completely isolated from the rest. Then, once the work is completed, part of the clinic may be moved there. So, the entire reconstruction can be undertaken step by step. It will be difficult and uncomfortable, but we're not able to close the Institute and to postpone operations for months, when the price of human life is often measured in minutes. Another possible option, in principle, is to build another building. A suitable area for development could be found on the territory of the institution itself, but this requires government approval. We are, of course, a public institution under the Ministry of Health and are funded from the federal budget.
What position does the Institute take in the budget priorities?
We exist in the budget system for public institutions, and are certainly not bottom of the list. But I can't say that the money allocated for the maintenance of the Institute is enough. We work on quotas, which are allocated annually by the Federal Ministry of Health. Without investing money, you cannot get results, especially when it comes to high-tech, modern medicine. This is a serious investment. Any additions to the budget can only come from the private business sector. We would be pleased to introduce one model or another of public-private partnership. We have ideas, and if private capital can help solve the problems associated with the lack of medical funding from the state, we will do our best to welcome it.
Are there any models that allow for the partnership participation of foreign capital?
We have foreign citizens that pay for medical treatment. If we talk about private investment, so far there have been no such proposals, but we are ready to consider them, especially in the field of high-tech and high-quality services, where we have really established a strong position.
What might attract an investor?
Every investor wants to make a profit, but we must understand that high-tech medicine is a field that is associated with high costs. Complex operations require expensive drugs, and the best equipment, which is also very expensive. At the same time we can't be guided by commercial interests: we can't refuse to save a person's life on the grounds that it would require too much money. Such a statement would sound immoral. Since we are talking about very complex operations, a high degree of risk is also involved. For example, liver surgery, my specialist field, usually involves cancer patients. The likelihood that private business investment would be interested in such projects is low. However, if we calculate costs carefully, we may be able to involve private insurance agencies, and with their help build a certain segment of demand for such services. Then it is possible that someone will agree to invest funding.
Commercial success is more likely in the development of surgical services which do not involve risk to the life and health of patients, but are in high demand and pay well. This aesthetic surgery, cosmetic surgery, minimally invasive techniques, endoscopic surgery, and so on, are exactly what they do today in numerous private clinics, although they do not always do it well. Since at our institute we have similar departments and highly skilled professional specialists, a good case can be put forward for one day organizing a hospital for in-patients this way. A partnership for profit could well happen in this case. Also, of course, we are willing to accept charitable donations from any organization.
Which international projects is your institution involved with?
We certainly strive to maintain and develop international links, including with so -called multicenter randomized trials. Many of us are certified GCP (Good Clinical Practice), which allows us to participate in such projects, and we are not last in the list there. If we talk about the exchange of experience, we try, despite the limited budget, to allocate funds for trips for young specialists. Last year we sent vascular surgeons to the United States, doctors from the Department of Liver Surgery to Korea, and experts from the Department of Surgery of the Pancreas to Japan. They all return with useful ideas that allow us to make rational improvements in our medical practice. What is especially pleasant is the confirmation that in general we do not lag behind our foreign colleagues, and in some areas (angio-dysplasia, wounds and wound infection, surgery of the liver and pancreas, endoscopic surgery) we can actually teach others.