End the Potemkin Villages

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Early in the morning on September 21, my friend and colleague Leonidas Donskis stepped out of the Vilnius airport hotel for a short walk to the airport building in order to catch a plane to Saint Petersburg. His wife Jolanta had gone ahead of him because he had to finish a few e-mails before flying off. When Leonidas did not appear after some time, his wife went back into the departure hall looking for him and saw a group of people huddled over a person who evidently had collapsed in the airport building. The person on the ground turned out to be her husband, who had a heart attack and was dying. The people around were in shock, paralyzed and unable to move, and instead of trying to resuscitate him they watched him die. By the time the ambulance came eight minutes later, Leonidas could no longer be saved. He died at 54 years old on the airport floor.

His death came as a shock to everyone: his wife, mother, and other relatives, but also to his many friends and colleagues. Leonidas was an amazing bundle of energy. Being a writer, a thinker, a historian, a journalist, a diplomat and a politician, he was always on the road, always somewhere in Europe and beyond, always engaged in projects focusing on the horrors and dark pages of the past and attempts to have a better and truly democratic future. He was a liberal in the perfect sense of the word, and a European in heart and soul.

Donskis stood tall within the Lithuanian academic world, hovering at an intellectual level hardly any of us could attain, and his productivity was beyond anything I ever saw before. One book after the other, articles, conferences… It was impossible to catch up with everything he did.

The reaction in Lithuanian society to his death was overwhelming; people who never knew Leonidas lamented his passing away as a huge loss to the country. His funeral was a solemn and impressive ceremony, lasting two days and attended by two former Lithuanian presidents and the Prime Minister, while the current President Dalia Grybauskaite sent flowers. It ended at the Kaunas cemetery of Petrasiunai, where between the graves and towering pine trees hundreds of grieving people gathered, cried, and listened to speeches, ending with a speech by a Roman Catholic priest followed by the kaddish sung at his graveside by the well-known Lithuanian-Jewish opera singer Rafailas Karpis. The funeral not only revealed how important Leonidas had been, but also how many people he inspired and empowered. I was only one of many people, from all walks of life, for whom he had always been there, helping, stimulating, pushing to do more and better. All of us had felt important, not knowing how many of us were really there.

The tragedy of Leonidas’ death is the fact that he did not have to die. The fact is that Vilnius airport has three defibrillators and none of them was touched. As I said, none of the airport staff tried to resuscitate him, and instead waited until the ambulance arrived–too late to save his life. In all major airports and public buildings in the civilized world, there is not only adequate equipment around, but airport staff are also carefully and repeatedly trained to act in times of crisis. One cannot really blame the Vilnius Airport staff that was present and did not act, as no one had taught them to do so. However, one can blame the authorities that, like in so many other cases, created a facade by buying equipment and putting it up on the wall, without any procedure in place to use it in time of need and without teaching all personnel to do what they were supposed to do.

Alas, this situation is not unique. Ten years ago, Lithuania had a young and progressive health minister, Zilvinas Padaiga, who decided to prioritize mental health as one of the four priorities for E.U. structural funds. A unique step, that could have led to tens of millions of E.U. financial support going into the development of community mental health care services. Soon everything was ready, and detailed plans had been drawn up. Alas, Padaiga was sacked after less than two years in power, on basis of a ridiculous pretext, and succeeded by a former Soviet-style hospital director who changed the allocations and instead carried out reconstructions of buildings and bought a lot of often unnecessary equipment. Money that was supposed to go into consumer-oriented modern mental health care went into maintaining old Soviet-style services, and probably into something else as well.[1]

For Ukraine, the Lithuanian experience should be an important lesson. If all goes well, the country will finally embark on a health reform program, catching up with the rest of the world and trying to fill the gap of many decades with international health care standards. Many health care managers and civil servants will oppose the reforms, because it upsets their lives, positions, and their way of making money. Yet some will be more clever and go along, understanding that it is better to join the movement when it becomes hopeless to resist. Yet I can assure you, the push will be for buildings and equipment, rather than health care services that serve the clients, that are community-based, that focus on keeping people in society, rather than ostracizing them and marking them for life. And thus instead of changing attitudes and keeping people in the community, money will be spent on renovating institutions, where the walls may be painted and the stench may be gone, but the system remains the same and people are ostracized from society instead.

True, changing attitudes and systems will not bring Leonidas back. Alas, he died because of a typical aspect of post-Sovietism, about we so often talked and debated: you put up a “modern façade” but below it the old remains the same. However, if his case can be a lesson, and a trigger to do different, to do better, then his death will at least serve a purpose and maybe save the lives of others in the end. It is time to end these Potemkin Villages of reconstructed buildings with nice equipment and no trained staff. It is time to focus on real reforms, where the patient is central and everything is focused on helping persons to return to normal life. It is time professionals are empowered and adequately trained and paid for work on which lives depend. It is time de-Sovietization becomes real and not a form of window-dressing.

 

Robert van Voren is Chief Executive of the Federation Global Initiative on Psychiatry and professor of Soviet and Post-Soviet studies at Ilia State University in Tbilisi (Georgia) and Vytautas Magnus University in Kaunas (Lithuania).

Published on December 22, 2016.

 

References

[1] See the journal Mental Health Reforms, issue 1-2, 2011: Mental Health Challenges in Lithuania.

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