“It's me, postman Pechkin, coming to cure your boy” — Russian postmen becoming paramedics

“With a thick shoulder bag”, with a stethoscope in his hand

The purpose of the experiment is presented on the official website of Russian Post. Deputy director general of the postal business and social services department Yaroslav Mandron said that within the framework of the pilot project in eight Russian regions, with the participation of local ministries of health, the postmen are involved in providing first aid, collecting data on the health status of the population and educational activities in the field of healthcare.

Mandron justified the idea of combining, at first glance, incompatible duties of postmen and paramedics by that in the post has remained the only institution representing the state in the almost extinct Russian hinterland. And it's true: rural hospitals have long and without a trace been “optimized”. “In addition to infrastructure, Russian Post has the unique resource that is impossible to build or buy: people's trust to the postman,” the website of the department quotes Mandron. “The Russian postal operator has all the resources and opportunities to provide balanced social services and medical care at home for elderly and people with disabilities... The use of the Russian Post platform will significantly save budget funds, since it will not be necessary to create a solution from scratch, and the implementation of the project will improve the level of targeted assistance in the most remote and inaccessible settlements, which will favourably affect the life expectancy of the population and its quality.”

The need to transfer the functions on collecting information on health level of citizens to postmen was justified by Head of Russian Post Nikolay Podguzov when speaking at the Russian Investment Forum in Sochi. He noted that when conducting a medical examination of the population in the villages, it takes 30-50% of the time of the mobile health team for the primary survey of the patient and expressed the opinion that part of the survey could be undertaken by the postmen.

“I assume that the initiative is implemented in order to save”

“The post has a number of advantages,” doctor-psychiatrist Boris Mendelevich, who is concerned about the innovations not only as a physician but also as a deputy of the State Duma, objected to the management of the department in their absence in conversation with the correspondent of Realnoe Vremya. “Postal workers are present in all, even the most remote settlements, which, of course, is a huge plus. But I believe that this advantage can be used as a logistics resource. For example, mail employees can deliver certain medications, pass tests, etc.”

But the collection of medical data and rendering first aid are the functions that, according to Mendelevich, must be performed only by health workers — for special reasons:

— In matters of health, there is no primary and secondary — everything is in the first place. For doctors, medical secrecy, along with the quality of medical care — is one of the integral parts of the work. It is very difficult to predict what medical care provided by postmen can lead to: it all depends on a specific situation, the characteristics of the body and many other factors.

— But in the West, primary medical care is provided, for example, by police officers, — the correspondent reminded.

— Each of us should have the skills to provide first aid. But it is one thing when you wait for an ambulance and help while waiting, and the other — when you become the only participant in this process. If to compare with Western analogues, yes, there is a similar functionality partially assigned to the police, but only because of that it is often the police are the first on the scene. Besides, they undergo special courses to provide medical care. This should also be remembered.

In addition, the interlocutor of Realnoe Vremya stressed, today the domestic healthcare needs narrow specialists and high-tech equipment most of all:

“As far as these tasks will be solved by this project remains questionable.”

Boris Mendelevich expressed doubts about the legality of the actions of postmen who will be involved in the implementation of the project:

“When postmen collect information about the health status of the population, two questions arise: who will be responsible for the quality of the survey and who will be responsible for the confidentiality of the data? Postmen themselves are not medical workers, so they are not obliged to keep medical secrecy.”

Boris Mendelevich also pointed out that Russian Post is going to work, apparently, with the elderly population, who especially needs comprehensive medical care, including computer tomography and biochemical analysis, and these tasks “cannot be solved through just surveys”.

Finally, he has great doubts about the legal aspects of the initiative:

“According to my sources, Russian Post is not licensed to provide medical activity, and all issues related to healthcare, including prevention, imply the presence of a corresponding license.”

“Why do you think such a strange turn has happened? Now paramedic-obstetric stations are under active construction — do we need to duplicate their activities?” the reporter asked.

“It is clear that there is a shortage of personnel in medicine. Especially in those sectors that do not bring great economic benefits. I assume that the initiative has been introduced because of this. But personally I have a lot of questions to it. I believe that it is possible to attract the postmen to inform the population, but everything that relates to the relevant activities, including primary inspections, must be performed strictly by doctors. For this purpose, it is necessary to expand not the postal network, but the activities of mobile brigades and paramedic-obstetric stations.”

“No more than five methods”

“The basic methods of first aid and resuscitation in Europe are taught to almost everyone — police officers, postmen, taxi drivers, and this is the right thing,” chief physician of the Kazan ambulance station Farid Galyautdinov explained to Realnoe Vremya his position on the difficult issue. “There is nothing difficult in this, we teach students and teachers how to do this. I believe, every person should know and be able to do this today, and these five techniques can be taught just in 72 hours: how to put a person, how to clean the mouth, how to make mouth-to-mouth ventilation, closed chest cardiac resuscitation. One can save human life while you are waiting for the ambulance to arrive.”

It is useful to know and be able, for example, to fix a fractured hand, Galyautdinov says. But these simple manipulations, in his opinion, must be performed only by medical specialists so as not to harm the patient. Especially trying to provide medical care to a person who has a heart attack or stroke, it is, according to the expert, is “just absurd”.

He is categorically against non-specialists trying to help with drugs because any, even the most harmless as most may think, drug, if it is “prescribed” by a person ignorant in medicine and pharmacy, can cause serious harm.

Survey — strictly against signature

As it turned out — and this is for the better — caution is peculiar not only to physicians but also to postal workers in the pilot regions. The head of the public relations group Tatarstan Pochtasy, Evgenia Doronina, told Realnoe Vremya that in our republic the experiment begins from Kukmorsky district, and in “a very mild form”:

“The branch of Russian Post, Tatarstan Pochtasy (Tatarstan post office), and the ministry of healthcare of the Republic of Tatarstan signed an agreement on cooperation aimed at preserving and strengthening the health and well-being of elderly citizens, disabled people living in rural areas. Its main purpose is to raise awareness of citizens in matters of health.”

According to Doronina, so far it is only about carrying out rounds and surveys of the population, identifying single citizens in need of help by rural postmen. The postmen will transmit the information about such people to the polyclinic and social protection authorities at the place of residence. Along the way, postmen will inform villagers about medical examination and professional examinations, help to make an appointment with doctors or to make a house call of a doctor.

“How will confidentiality issues be resolved?” the reporter asked.

“Data collection and transmission will be carried out with the written consent of citizens.

However, the Tatarstan experiment is still at the very first stage. According to Doronina, now the working group Tatarstan Pochtasy is discussing the ways of interaction with the republican ministry of social protection.”

They promise to pay extra

Yevgenia Doronina found it difficult to answer the question of Realnoe Vremya whether they are going to pay extra to the Tatarstan postmen for excess “medical burden”. She even did not answer how many postmen in the city and in the village earn on average, she only noted that some additional payments to them already go for non-core for the post but everywhere introduced the sale of products and consumer goods — from pasta to soap and ware. Meanwhile, the question of money is more than timely.

In Kazan, postal workers work without raising their heads. Moreover, the queues at the post offices at peak time are huge. Besides, post workers more and more often snarl at the complaints of visitors that they move slowly, “Go and work there yourself for a song!”

The postman in the “native” department told the correspondent of Realnoe Vremya in confidence his rate — 8,000 rubles, and the salary with surcharges — up to 12,000 rubles a month.

In Kazan, postal workers work without raising their heads. Photo: Maksim Platonov

In the village of Minger, Sabinsky district, that may not be considered a backwater, at least for the reason that from year to year it holds one of the most famous in the region and widely covered by the media Sabantuy festivals, the postman, in her words, does not earn even 8,000 rubles. The plot is small, it is enough only for a part-time salary by the number of people served. The woman delivers all correspondence and pensions from the neighbouring village once a week for 4,000 rubles. What is more — because of the great kindness, she wanted to leave, but the people convinced her to stay. The postman receives 8,000 for serving two villages — this and the neighbouring one. In such a situation, the main thing is not innovation, but that the postmen in despair did not become like the crooks in the Kazan logocentre of Russian Post, who compensated for low, by their standards, earnings by large thefts.