State Duma creating law on school medicine

Not comforting facts

Russia’s consumer rights protection watchdog said a year ago the number of absolutely healthy children in Russia didn’t exceed 12%. Of course, some doctors claim healthy people don’t exist –people who aren’t diagnosed thoroughly do exist. But this sad joke has big and unsightly truth.

More than half of schoolchildren have chronic diseases. The frequency of children’s health issues has increased 1,5 times in the last 10 years, while the number of chronic diseases has doubled. Russia’s consumer rights protection watchdog provides specific data too: children have problems with the digestive tract, anaemia is often diagnosed, metabolic diseases are frequent (obesity, first of all), cases of manifestation of diabetes have become more frequent. And this has reasons.

Gastritis among schoolchildren isn’t uncommon: it is a consequence of irregular food intake while they are at school. Fast food or junk food for lunch in a hurry don’t help stay healthy. The curvature of the spine develops in a lot of children by the secondary school — it is a consequence of the wrong position at the table. While there is neurology too (due to mass nervousness because of Unified State Exams, many eleventh-year students are ready patients for neurologists or at least clinical psychologists).

What to do?

As I already repeatedly said, one of the fundamentals tasks of our medicine is not to let the disease develop, prevent it. Prevention is no less important than treatment.

Children spend most of the day at school, this is why school medicine must become a front to save their health. But now it is organised in a way that the doctor (a nurse in most cases) stays in her room for just several hours a day, and not daily in some schools.

Moreover, if a paediatrician goes to a school, he has to cancel appointments in hospital — hence the deficit of doctors in polyclinics, which is already serious. It turns out to be a vicious circle. But the problem has to be solved. And we offer to solve it by creating a new edition of the project of federal law No. 426529-7 On Amendments Made to Some Legislative Acts of the Russian Federation on Children’s Health in Educational Establishments. This is the so-called law on school medicine.

This document is assumed to fix the state’s commitment to providing children’s health conservation at school. While parents will be obliged to tell teachers about a child’s health issues and inform them what regime he needs to study, how much sport he can do and how to rest. It is discussed that a health worker might go back to the school on a permanent basis: he will take care of schoolchildren’s health and teach them how to lead a healthy lifestyle as well as to provide first aid if needed.

Another important moment: now a health worker at school is an auxiliary worker. My colleague, Chairman of the Duma’s Committee for Health Dmitry Morozov pays attention to it. He offers to up this status and make sure the status of the health worker at school is approximately equal to the deputy principal’s position (participating in staff meetings and other administrative activities of the school). In fact, the offered system will resemble the past: the work of school doctors in the Soviet Union.

By the way, this document isn’t created from scratch: School Medicine pilot project has been implemented in Rostov, Smolensk, Tambov Oblasts, the Republic of Sakha (Yakutia), Yamalo-Nenets Autonomous Okrug since 2016. The experience of these regions was the foundation of the bill.

Where can there be difficulties?

I see one very difficult moment in this good-looking scheme. Now the health worker at school is appointed by a local children’s polyclinic. But he doesn’t have a doctor’s social preferences, corresponding preferences and statuses working as a health worker. At the same time, he is devoid of a teacher’s preferences too working at school. This issue has to be resolved so that it will defend the health worker’s interests as much as possible. Because he is still a health worker even sitting in his room at school. Moreover, it is necessary to determine what medical advice the school doctor must provide and its order in the law or by-laws. For instance, if his duties include an educational activity about health, it is necessary to develop corresponding standards, the way it will be done. If it will be regular lectures, classroom talks, if there will be individual work with children from health risk groups — all these forms need to be envisaged by leaving the school health worker some freedom for creativity.

How to do preventive, anti-epidemic work at school, how to organise the control of pupils’ health — all these specific moments will make up the general picture. I think initiatives of the Association of Paediatricians who could offer the professional standard for a school health worker, a list of equipment in the room, functional duties of the health worker and similar regulations will be important to us in this issue.

I consider it is huge room for work. But it is necessary to do it because we should stop losing children’s health, and we can do at least a part of this task.

How’s it abroad?

As a rule, such an occurrence as school medicine is not generally widespread in European countries. There is an insurance system, and in case of health issues, the patient sees a doctor.

At the same time, the focus is made not on occupational check-ups but annual screening whose list is established depending on the patient’s age, his health, the spread of some diseases. Such a screening model is created by paediatricians and help detect a disease early.

I think it is also important to work both on prevention and actively detect diseases in our country. The more we will work in this area, the healthier our children will be.