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Iurii Herman is a Medical Doctor of the highest category, Deputy Chief Physician for Obstetrics-Gynecology Help at Kherson Oblast Clinical Hospital; a truly outstanding doctor and scientist that has a track record of numerous current implementations into Kherson medicine. Though, pretty soon his post is planned to be made redundant, or be optimized if to be precise. We spoke to Iurii Herman about the kind of threat it is posing to the hospital and obstetrics in general.

There is a photo collage with new-born children in Iu. Herman’s office. “They are all “my” children” – Deputy Chief Physician for Obstetrics-Gynecology Help at Kherson Oblast Clinical Hospital Iu. Herman says proudly with a smile. He has been holding this position for 16 years already – and within this period of time there has been an incredible move ahead in this sphere of medicine. Although, the perspectives may stay as blessed memory: one of the leading lights in medicine, Iurii Herman, was informed that due to the optimization his position was going to be made redundant, and he was suggested to work at the Department.

-How will the staff reduction influence your work and midwifery in Kherson and Kherson Oblast?

-The matter is that the position of Deputy Chief Physician for Obstetrics-Gynecology Help at Kherson Oblast Clinical Hospital is an important administrative position that allows coordinating work of several departments. Pregnancy care, child’s delivery, follow-up care is meticulous work of specialists from several departments, and sometimes of several institutions, if it comes to a birthing mother from oblast regions. As neither a medical doctor, nor even the Head of the Department have appropriate credentials and even time for such kind of work. As of today, we have managed to organize our work in such a way that we haven’t got maternal mortality for the last 5 years (God grant it, we won’t!). And it’s a substantial accomplishment! We wouldn’t have it without coordination between the doctors of different departments and of different spheres. That is why, to my mind, the reduction of this position is a step back, and, probably, not safe one.

Thanks to the implementation of new technologies, Iu. Herman’s practice includes loads of modern midwifery and obstetrics methods. The scientist that constantly works on the advancement of his knowledge and skills, Iurii Herman, together with his colleagues, implements methods that allow modernizing medicine in Kherson Oblast.

- If earlier, by tradition of Soviet time maternity hospital reminded more a

prison, than a place where a new life was born, now we try to do utmost for a woman to be comfortable. We have been practicing epidural anesthesia since 2000, as the pains of childbirth are very strong. A woman’s wish to be anesthetized is a ground for doing it.

• A number of myths are being all over as for insecurity of epidural

anesthesia. How would you comment on it?

• Each pregnancy is a separate case, as every woman has own constitutional

peculiarities. That is why, of course, executive checkup should be performed each time. But in general, modern epidural anesthesia, if it is done by a professional, almost doesn’t have aftermath, except for a headache that may be felt after delivery.

• Pregnancy becomes older. What’s your attitude towards a woman’s wish

to deliver later, than it was before?

• Pregnancy, definitely, has become older. But it’s a worldwide tendency. It is

common for the societies of the developed countries firstly to receive education, get a decent job, and only after that think about children – when there is a good ground for their upbringing. Of course, growing older a body doesn’t become healthier – neither female, nor male. But conditioned upon healthy way of life, health care and attentive pregnancy care, I don’t see anything bad in the fact that women give birth to their children later than it was common at Soviet times, for instance. A child delivery should be deliberate decision.

• Actually, you have a medical family, moreover – a dynasty of obstetrics-

gynecology doctors. How did you treat the choice of your son Oleksii, who has also become an obstetrics-gynecology doctor?

- I think Oleksii just didn’t have that choice (he is laughing). But to be serious, I

am immensely happy that my son has chosen mainly this profession. It is really a great joy for father to understand and see that children follow their occupation and gain success. I am happy.

• Midwifery in the regions of Kherson Oblast: what problems can you

outline and what can be expected in the near future?

• Each region differs from the other. There are such regions where midwifery is

being developed not badly: doctors add to their experience, visit conferences. But there are such where situations are close to catastrophe. The matter is that a doctor needs to have practice all the time not to lose qualification. For obstetrics-gynecology doctor it means 200 deliveries per year: the more, the better. Thus, a doctor that is ready for any situations knows what to do in every complicated case. If there isn’t such an experience, he/she loses skills and doesn’t know what to do in complicated cases and as a result makes a mistake. And mistake in our work can be very expensive. That is why, on one hand, we have positive experience of some regions, and on the other there are regions with few deliveries, and as the result doctors don’t have enough experience and because of that delivery becomes a risky matter. But we try to monitor and help with everything we can in such cases. By the way, it is an extra application of my position: if it is made redundant, I am afraid to think of the consequences.

— As we have touched too close to home, let’s get back to it. The

representatives of authority constantly emphasize that there is a lack of doctors. What do you think of that?

• I totally agree with this position: doctors are lacking – it is a fact. Moreover,

medical practice becomes much older: there are almost no young doctors that can worthy take over the elder generation. There should be succession of generations in any profession – it is natural and normal. Unfortunately, we (in Kherson Oblast – editor) have such a situation that less graduates of medical higher education institutions remain in the profession. To become a good doctor is a deal for not one but several years of meticulous work that should be spent on studying. Not every person is ready for sacrifice, so to say. And after all, doctor’s salary is far today from motivating. That is why, we really have a problem. In addition to this, midwifery is getting older in Kherson and Kherson Oblast. On one hand, it is great as we have very experienced doctors, but on the other – we have a little number of young specialists that will take over their place.

And in this context reduction of Deputy’s position?

• Unfortunately, yes. It seems to be cost-effective and according to the results of

auditing, job duties of a Deputy Chief Physician for Obstetrics-Gynecology Help totally duplicate job duties of a Deputy Chief Physician for Treatment. It’s not for me to say how much the conclusion of the State Auditor Service is correct, but I understand that this demand can negatively influence to a great extent the obstetrics-gynecology help of the entire Oblast. From “saved” at the cost of post reduction 385,000 uah. per year, our oblast may receive much bigger problems that will cost a fortune; and life, as it is known, is priceless.

• Let’s try to end our meeting on an optimistic note. I think our readers are

waiting for the advice from the awesome doctor. What would you recommend to women that decided to get pregnant?

Firstly, to plan. I would highly recommend to consciously treat the decision to

give birth to a child. It requires planning, at least half a year ahead. For everything to be ok, it is better to get ready to pregnancy, thus, the possibility of some problems will be less. For example, a course of folic acid will highly decrease risk of child’s deviations. But all prescriptions are better to be done under the care of a doctor and only upon his/her recommendation. Hence, secondly, take care of your own health. Regular check-ups, questions that wouldn’t go amiss, when it comes to health, - all this are of high importance. And thirdly, pregnancy means not only woman’s health, but man’s health as well. That is why it is important to get ready together.

For the period of Iu. Herman’s work at Kherson Oblast Hospital the following new and perspective measures of obstetrics-gynecology help have been implemented:

• usage of epidural anesthesia in childbirth;
• performance of childbirth with family and partner;
• processing of breech delivery in an upright position;
• multidisciplinary cooperation of obstetrics-gynecologists, neonatologists and

children’s doctors when helping fetuses with birth defects (processing of cesarean section at Children’s Oblast Clinic Hospital for immediate help: omphalocele, fetus’s diaphragmatic hernia).

Iu. Herman has published 7 scientific articles in scientific, pedagogic and specialized editions of the Ministry of Education and Science of Ukraine since 2017, which have become the ground for doctors’ medical practice. Instead of it on December 24th an outstanding scientist and one of the best oblast doctors can lose his post, which is of high importance for the normal condition of midwifery in our region.

Today, when Kherson and Kherson Oblast is provided with doctors up to 67%, there arises a significant problem not only with the staff supply, but with a qualitative composition of this staff. And in spite of the fact that Oblast Administration promotes the program of doctors’ support in regions (with lodging, bonuses, etc.), specialized and known doctors are made redundant in oblast center …due to cost cutout. What is the cost of local stimulations in regional centers, if there is no one to share experience in oblast center because of the lack of this stimulation here?