Leonid Roshal: Children’s Doctor, Not Health Service Organizer

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 Professor Leonid Roshal, MD/PhD, Doctor of Peace; honorary member of Russian Children’s Surgeons Association; director, Moscow Research Institute of Urgent Children’s Surgery and Traumatology of the Russian Academy of Medical Science; Executive Committee member, Union of Russian Pediatricians; member of Board of Directors, World Association for Disaster and Emergency Medicine; president, Children and War Foundation; expert, World Health Organization; health commission head, Public Chamber, Russia. National Hero of Russia, European of the Year, Star of Europe, Nobel Peace Prize nominee, etc., etc.

Dr. Roshal’s titles and awards are not half so important as the work that earned them. That is what RIA Novosti talked to him about.


Below is a list of dates and places where he rescued children in disasters:
Mongolia, 1980; Armenian earthquake, 1988; Ufa-Chelyabinsk train derailment, Russia, 1989; Romanian revolution, 1990; industrial blast in Usk-Kamenogorsk, Kazakhstan, 1990; Gulf War, Israel, 1991; Georgian earthquake, 1991; Yugoslav war, 1991; San Francisco earthquake, USA, 1991; Georgian war, 1991-92; Nagorno-Karabakh war, Armenia-Azerbaijan, 1992; Egyptian earthquake, 1993; Japanese earthquake, 1995; Chechen war, 1995; Sakhalin earthquake, Russia, 1995; Afghan earthquakes, May-July 1998; Turkish earthquake, 1998, Yugoslav war, 1999; Indian earthquake, 2001; Afghan earthquake, 2002; Intifada, Israel, 2002; Kaspiisk terrorist attack, Dagestan, 2002; Dubrovka hostage tragedy, Moscow, 2002; fire in deaf-mute children’s home, Makhachkala, Dagestan, 2003; Algerian earthquake, 2003; Transvaal aqua park disaster, Moscow, 2004; Beslan school terrorist attack, North Ossetia, 2004; Pakistani earthquake, 2005; Indonesian earthquake, 2006.

“It is my duty to help everyone on the battlefield. You can put me before the firing squad later” – Dr. Roshal on disaster medicine

Question: You have been a physician for fifty years now, Dr. Roshal. Your disaster medical team was established twenty years ago. What matters most to you in your eventful life?

Answer: Beslan comes first. Hundreds of agonized parents and relations were ready to rush to their hostage children’s rescue—I coaxed them out of it. If they had, the casualty list would be several hundred names longer. Zurab Kekilidze, Russia’s Chief Psychologist asked me to visit them in a club where they had gathered. I knew what a nightmare it would be—the terrorists would have shot them like ducks. I think that was my greatest achievement. True, I saved many lives as a doctor, but the Beslan survivors matter most to me.
Then, I brought up a son. That comes second in importance. Third comes an institute I organized with the help of friends. I don’t blush for it, and Russia can take pride in it.

Q: You think it is your duty to work on disaster sites?


A: I don’t know. I think I was just made this way. When terrorists seized the Dubrovka theater center, many merely gaped and shuddered—but others thought what they could do to help. I was among them. Many came for talks with the terrorists. I got Mayor Luzhkov’s aide on the phone and said I wanted to be there. “Why? There are enough ambulances there,” was the reply. I said that wasn’t what I meant. I wanted to be with the hostages as doctor.

Q: Did your institute colleagues go to Dubrovka with you?
A: No! I’m the boss, and I have to do some things single-handed. I cannot endanger others. I can risk my own life, but how can I place other lives at stake? Terrorists mortally wounded two hostages the night before the theater was stormed, and called me to operate on them. I said I could not bring a surgical team—nurses and all. It was something different to operate on a terrorist’s hand, which I did in the ladies’ room. Major surgery was something different. I said the patients had to be taken to the hospital next door. The terrorists agreed.

Q: You never make any distinction about who to help?

A: That’s the Red Cross law. It’s my duty to help everyone on the battlefield. You can put me before the firing squad later.

Q: That’s a law to you—but not to terrorists. Aren’t you afraid?

A: I am unaware of danger in emergencies. I see it only when I look back. When, let’s say, I fly by helicopter or travel by car in Afghanistan, and blasts start all of a sudden, I see I am hair’s breadth away from death—the people who shoot don’t know there is a harmless doctor inside. Now, when I entered the Dubrovka theater, I merely knew I had to do something to get the children out, bring the hostages medicine, and all that. I made several such trips then.

Q: You established the world’s only pediatric disaster medicine team in Russia, and have been travelling all about the world for twenty years to help children during wars and calamities. Who funds your trips—the Emergencies Ministry or the Health Ministry?

A: Neither. The Emergencies Ministry has its own hospital chain, one of the world’s best. The Health Ministry also has a good disaster medicine network. As to my team, it is manned by my institute personnel, and it is the only one of its kind. We are ready to go to any part of the world at any moment to help children. It all started during the Armenian earthquake of 1988. It occurred to me after it that disasters demanded special pediatric teams. I was right, and proved it many times in natural calamities Algeria, Egypt, Turkey, Georgia, Afghanistan, Iran, India, Pakistan, Indonesia, Japan and the United States, and during the Yugoslav, Chechen and Azerbaijani-Armenian wars. The presence of a special pediatric team reduces mortality and disability by half.
As for funding, that is up to the Children and War Foundation, an international charity whose president I am. It has no money to speak of because we have no commercial branches, and we act as volunteers. We start looking for money the instant we hear something is wrong somewhere—and we always find donors. Aeroflot, for one, carries us free to any point of the globe. Russian legations never leave us without help. Every country notices Russian doctors’ proficiency and selflessness.
My team works in hospitals, where it treats the worst patients. There is a shortage of children’s doctors in every big disaster. This is so in every country. We occasionally come to places where there is prejudice against Russians—but local people are always grateful afterwards.

Q: How do you assess world disaster medicine?


A: There is no well-knit system of children’s disaster medicine—either global or regional. I am on the Board of Directors of the World Association for Disaster and Emergency Medicine. I am working now to establish a global medical system to help children in disaster and related personnel training. Currently, doctors have to fly to the other end of the world if need be. That should not be so. Then, we must know what specialists and medicines are necessary in a particular place. That’s essential!
I think this new structure must work under WHO auspices, and we are ready to help because the Red Cross has no pediatric teams, UNICEF limits its work to humanitarian aid, and children’s medicine is somewhere in the margin.

“We must not be tight-fisted when it comes to health services, if we really care about the future” – Dr. Roshal on his work.

Q: You are a physician. Does your community and political work interfere with your medical commitments?

A: Sure it does. I never thought five years or so ago that I would ever pay such great attention to work outside my profession—but then, I see that community work is no less necessary. I was long pondering whether to go to the Public Chamber for a second term. My doctor colleagues, and they are not alone, think I can do something there, and I cannot let them down.

Q: Have you any time at all for surgery?

A: I really seldom operate now—only on very bad patients, with whom my assistants cannot cope. But it is not my duty to make a hundred or three hundred thousand operations. I must train my team to work in my absence as it would in my presence. I want it to be friendly and efficient. This is not a simple thing to do—the institute is quite new, and with a huge staff. We have much new blood, and people are not always mutually compatible. Still, we must have the spirit of mutual assistance, reliable teamwork without which we cannot treat children well. We must preserve the air of kindness to children and parents, for which our institute is known.
There is something even more important—to avoid surgery whenever we can. I start every workday with a morning meeting, as which we discuss every new patient. Teams on duty make daily reports, after which I go to the intensive care ward and to other wards where a council is necessary.

Q: There is a widespread belief that administrative routine demands huge efforts and hinders doctors’ work. Is this true?


A: Not quite. Take Dr. Davydov, the president of the Russian Academy of Sciences. He is also the director of the world’s largest cancer center and one of the best Russian surgeons. True, it’s all a huge burden. But then, my administrative work is part and parcel of my duties as a doctor. It is meant to improve medical work, and so does not impair it—but I really have to work like mad! My workday finishes at 1 or 2 a.m.

Q: When does it start?

A: I usually come to the institute at half past eight in the morning.

Q: Where do your patients come from?

A: Mainly Moscow, and there are children from other parts of Russia—usually bad cases. We have just opened a new surgery and resuscitation ward, one of the best in the world for equipment and personnel. Ours is the world’s only institute specializing in emergency surgery for children’s injuries and neurotic traumas.
Some patients come from other countries. I remember two little girls from Algeria, injured in the earthquake. French and Swiss doctors said they had to undergo amputations. We said no. We took them to Russia with us—and they have healthy limbs now. There were also children from Egypt, Abkhazia and elsewhere.

Q: Is treatment at the institute free? If not, how much do you charge?

A: It is free. We take in any child who needs it. Insurance companies pester us to obtain privileges for certain patients. We can only offer better rooms. As for diagnostics and treatment, all children are equal whether they are treated free or for money. But then, the free, standard rooms are also comfortable enough.

Q: Has the institute received any grants under the national healthcare project?


A: Not a ruble! We are funded from the municipal budget, and never get anything from federal projects. Nevertheless, we are a model hospital, the kind Russia needs—with powerful computer systems and other excellent equipment. We must not be tight-fisted when it comes to health services, if we really care about the future. The Public Chamber has done something in this respect—we have awakened Russia.

Q: Do you mean “red-tape Russia”?


A: Right! Billions of rubles for grants is not what the national healthcare project is about. Its main goal is to make local officials turn an attentive eye to health services. Another stage is starting now—to put the entire healthcare system on the footing of a national project, and increase allocations. We must double them to at least 6% of the gross domestic product.

(Interview taken by RIA Novosti commentator Yelena Zagorodnyaya)


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