NONTRADITIONAL METHODS FOR THE DIAGNOSIS AND TREATMENT IN THE REPUBLIC OF BELARUS Aliaksandr P. Sivakou*, Anna V. Volotovskaya**, Sergey Vasilevsky, Svetlana Mankevich, Larisa Podsadchik Belarusian Medical Academy of Post Graduate Education, Minsk, Belarus * Head of Acupuncture Deaprtment, Head Specialist of non-traditional methords of treatment and acupuncture Ministry of Health of the Reppublic of Belarus, Professor, MD **Head of the Department of Physiotherapy and Health Resort Therapy; Associate Professor, PhD, MD Due to the high therapeutic effectiveness and profitability the methods of reflexotherapy are being widely introduced in the practice of public health. Nowadays reflexotherapy is one of the most forward-looking and actively developing tendency of the contemporary medicine. The majority of the reflexotherapy΄s methods belong to the nonmedicamentous therapy and are
successfully used for treatment of different diseases, that in some cases permits to reduse the dose of the pharmacologic preparations, terms of the hospitalization and temporary disability to work. Thus, it is necessary to note the profitability of the given methods of treatment, in a classical verse of their application, not demanding utilization of the expensive equipment. The amount of patients, that are willing to be treated by the methods of the reflexotherapy, is constantly growing and the basic part make patients at the age from 30 till 50 years, to be exact the most ablebodied part of the population. Modern lines of development of public health services in the Republic of Belarus focused on introduction of new, highly effective and economic technologies, development of the extra hospital medical aid to the population, promoted in due date to the creation and development of the reflexotherapy service. According to the order of Ministry of Health of the Republic of Belarus from 14.06.96 № 101 the speciality and a post "doctor-reflexotherapist" were led in.
Nowadays the work of reflexotherapy servise is regulated by a number of decisions and orders of Ministry of Health RB from 28.12. 2007 № 128 «About the statement of common norms and specifications of material and labour expenses (time, the expense of the basic and auxiliary materials) on paid medical services in reflexotherapy, manipulative therapy and diagnostics, rendered by legal bodies of all patterns of ownership and individual businessmen when due hereunder», from 14.12. 2007 № 03-02-07/4144 «About perfection of the organisation of the outpatient-polyclinic aid». According to the given standard documents the post of the doctorreflexotherapist from 13.20. 2008 № 36 «About the statement of the price-list of services in reflexotherapy», from 22.12. 2007 № 186 «About the statement of approximate regular specifications of medical and other workers of regional, central, central city, central regional, city, regional and local hospitals» can be entered in hospitals from calculation one post on 200 cots, and polyclinics - from calculation one post on 40 posts of the doctors, conducting ambulant-polyclinical reception. During last 5-10 years in Belarus the method of the hirudotherapy actively takes root into the medical practice. Most accurately therapeutic effects come to light at patients with the diseases of peripheral nervous system and diseases of the internal organs. In year 2009 some difficulties with the deliveries of leeches from the Russian Federation appeared. The Ministry of Health of Belarus has given the commission to the republican enterprise "Belfarmacia" to consider the problem connected with resumption of the official deliveries of leeches through the drugstores that are in submission of the given organisation. It is necessary to carry in to the clinical treatment reports and patients΄ examination the reflexotherapy΄s methods, that will promote the wider introduction of the given method into the medical practice ( observance of treatment reports is obligatory by rendering medical aid in State institutions).
In years 2008-2009 under the basic indications and contra-indications for reflexotherapy the order΄s project according to МКБ-10 was prepared. Nowadays its coordination is being discussed with the main experts of the Ministry of Health. The medical aid to the patients, that uses reflexotherapy΄s methods, is normally provided by the doctors – reflexotherapists, working in the reflexotherapy offices. In most cases those doctors are a part of medical rehabilitation and physical therapy departments. In managements of public health of regional executive committees and committee on public health of the Minsk municipal executive committee the work of the reflexotherapy service is supervised by the main untenured reflexotherapy experts. In order to check the work of the reflexotherapy service and advisory – methodical help by the main untenured reflexotherapy experts systematic visits to the regional public health’s organizations are carried out, the work of the reflexotherapy offices is constantly controlled. In the first table the main indices of the reflexotherapy service for the last 5 years are presented. Table 1. Activity indices of the reflexotherapy service in the organisations of Ministry of Health (2004-2008)
patients who have procedures finished treatment
procedures for 1 patient who has
finished treatment 2004 2005 2006 2007 78 172 62 276 64 639 65 084 701, 6 631, 5 655, 4 632, 2 9, 0 10, 1 10, 1 9, 7
For 07.07.2009 according to state’s statistics in the system of the Ministry of Public Health there were registered 145 regular medical posts of the doctors –
reflexotherapists ( out of them 130 doctors are occupied), taking into account the departmental medical services – regular medical posts – 161. The greatest amount of the regular medical posts were led in in Minsk area – 22,75, Vitebsk area – 19,25 and Brest areas – 18, Gomel area – 14,75, Grodno area – 14. 66 % of the doctors – reflexotherapists have a qualifying category ( 6 % - supreme category, 40 % - first category, 20 % - second category) and approximately 60 % medical sisters have the same qualifying category. The main indices of the reflexotherapy offices΄ activity correspond the recommended standards. Almost in every area of the republic and of course in Minsk the amount of medical posts for the reflexotherapy and the amount of the medical sisters – reflexotherapists should be equally increased. As a whole the percentage of the doctors – reflexotherapists who work in combination is pretty high. Exactly this fact negatively influences the development of the reflexotherapy methods in the republic. In the second table the main indices of the reflexotherapy service activity are presented. Table 2. The main indices of the reflexotherapy service activity
Year Index 2008 2008 (6 months) Number of the patients who have 63 212 finished treatment, including paid 12, 8 basis (%) Quantity of the procedures Quantity of the reflexotherapeutic procedures for 1 patient who has 9, 7 finished treatment 9, 2 10,4 612, 2 32 158 12, 9 296 678 2009 (6 months) 30 764 14, 2 321 158
The fact, that the percentage of rendering the paid service strikingly differs among the areas of the republic, cannot be omitted. If in the Gomel area it makes 28 %, in Brest - 12,5 %, in the Mogilyov area - 9 %, and in Minsk - 5 %. As compared with the year 2008 the quantity of the patients, who have finished the treatment, has decreased, but at the same time the quantity of the procedures has increased by 5347 procedures. It can be probably explained by the wider use of the new reflexotherapeutic methods according to the standards of the aforesaid ministerial decree from 28.12. 2007 № 128. It is visible from the presented table that the greatest number of patients were treated in Minsk and Minsk area and they were rendered more than 300.000 reflexotherapeutic procedures. The smallest quantity of patients was treated in Grodno and Mogilev areas. In public health organizations, subordinated to the Committee on public health services of the Minsk Municipal Executive Committee, the nontraditional methods of treatment (mostly the reflexotherapeutic methods) are used in 56 medical institutions ( in 16 public health organizations, rendering permanent medical aid, and in 40 out-patient – polyclinical medical institution). In the public health organizations, that are situated on the territory of Minsk according to the commissions of the President of the Republic of Belarus, given straight after the visit to the Chinese National Republic and Socialist Republic Vietnam, were created:
Department of the traditional Chinese medicine in the Republican Center of the medical rehabilitation and balneotherapy;
Clinical center of the traditional Vietnamese medicine based on the department of the medical rehabilitation of the public health service “№10 clinical hospital”, Minsk. The stated centers function according to the modern demands, that have to
be reflected in the reflexotherapy offices; those centers are also fitted out with the modern equipment; all the doctors – reflexotherapists are attested and have the supreme, the first or the second qualifying categories. The aforementioned medical
services are in great demand among the patients, even though some of these services require payment. Despite the decision of the Committee on public health services of the Minsk Municipal Executive Committee medical aid through the reflexotherapeutic methods is not being rendered towards the patients in some medical institutions, some public health organizations send the doctors – reflexotherapists for the qualification improvement absolutely ill-timed. And again this fact affects the certification terms of these experts. The percentage of the combination is high enough: in hospitals – 41 %, in polyclinics – 74 %, that reduces the quality of the rendered services. Without disparaging the advantages of classical acupuncture, it is necessary to notice, that the modern reflexotherapy is distinguished by the heightened interest to a new direction - the use of physical factors in acupancture points (the given direction is accepted to call physiopuncture). With this particular aim in order to influence the acupuncture points the following methods are used: various kinds of an electric current; electromagnetic rays; magnetic fields; ultrasound; various kinds of laser radiation and the visible light; the combined kinds of influence when two physical factors are used simultaneously, for example, magnetolaserpuncture. It is proved, that the use of the different physiopuncture methods visibly increases the treatment efficiency, more obviously shows such effects as microcirculation improvement, micro relaxation, vessels΄ tonus and body’s temperature control, standardization of various reproductive organs΄ functions, sedative and antidepressive effects, activation of the immune answers of the organism, cupping of the abstinent syndrome, etc. The analysis of the reflexotherapy offices shows that the doctors – reflexotherapists in the Republic of Belarus unfortunately insufficiently supplied by the necessary
modern medical and diagnostic equipment. Therefore the physiopuncture methods are rarely used in the medical practice, that negatively influences the treatment of the patients. In order to improve the rendering of the specialized medical aid it is necessary to provide the possibility for the centralized purchases of the modern concerning inexpensive equipment for the reflexotherapy offices. It should be done with the only aim - improvement of treatment effectiveness. For the knowledge and practical skills perfection the new courses for qualification improvement in laserpuncture, electropuncture, magnetopuncture, bioresonant therapy and other physiopuncture methods in the practice of treatment of nervous and internal illnesses were introduced. Basing on the above – stated information and the indices of the reflexotherapy services΄ activity it is necessary to notice the decreasing tendency in the amount of patients, that have finished the treatment, and the quantity of the procedures. This fact is closely connected with the decrease of the staff posts. On the other hand the index of the procedures quantity for one patient, that has finished the treatment, has increased a little bit. In connection with the limited quantity of the means allocated for the acquisition of the equipment for the reflexotherapy offices, the equipment updating in the reflexotherapy offices is being held very slowly, that brakes the introduction of the new modern and effective technologies of the
reflexotherapy into the medical practice and leads to the reflexotherapy therapeutic decrease. According to the modern demands connected with the rendering medical aid through the reflexotherapy methods the main untenured experts should make and opportunely present the plans offitting out the reflexotherapy offices with the modern equipment. Thus, the reflexotherapy service, using the available material equipment, continues applying the methods of treatment approved by clinical practice. Despite the existing difficulties, the new reflexotherapy techniques actively
take root into the reflexotherapy service. It is important to widen the introduction of such modern and effective reflexotherapy methods as extremely high-frequency acupuncture, shock-wave acupuncture, cryoacupuncture, and also the methods, that were based on the use of feed-back relations, which have proved their high therapeutic effectiveness.
Conclusions. 1. In the examined public health organizations all standard, registrationaccounting and medical documentation is available. The doctors – reflexotherapists competently lead the treatment, control the effectiveness and the endurance by the patients the reflexotherapy methods, the correctness of the procedures carrying out by the average medical staff. Medical techniques, chosen bythe reflexotherapist, corresponds to the character of disease of the patient. 2. The lack of the sufficient amount of the doctors – reflexotherapists in some areas negatively reflects the work organization, indices of the reflexotherapy service activity and brakes its further development. 3. In the most public health organizations the reflexotherapy offices are
insufficiently equipped for the reflexotherapy treatment. It leads to the effectiveness decrease of the reflexotherapy service work. It is essential to introduce more actively the new reflexotherapy technologies into the clinical practice. 4. In the reflexotherapy offices the sanitary-and-hygienic and antiepidemic demands are strictly observed. 5. The state and the activity of the reflexotherapy service are being regularly controlled by the main untenured experts from the Ministry of Public Health. 6. The main indices of the reflexotherapy service activity in the republic correspond the common standarts.