Operating surgeon Ismail Haji-Ismail receives a patient
The Chief Doctor of the Minsk City Endocrinological Dispensary — Natalia Karlovich — describes the type of assistance rendered to endocrinology patients, the medical institution’s approaches, foreign internships and training courses.
The City Endocrinological Dispensary has a head office in Minsk to provide outpatient care for patients with such disorders. At present, over 100 thousand Minskers are registered in need of help, with around 10 percent of them seen by our specialists, this group is growing by around 5-10 percent annually. Last year, the number of patients rose by 8.3 percent. However, our specialists work not only with dispensary patients: but with others from all over the city, although they will only accept onto the list only those with the most severe pathology cases. Simple cases can be handled at district polyclinics.
Ms. Karlovich, what diseases are treated by the dispensary endocrinologists?
Of course, thyroid disease and diabetes are the most common. Out of one hundred thousand dispensary patients, 60 percent suffer from diabetes (mostly type 2), 35 percent — thyroid disorders and 5 percent — a rare form of endocrine disease (or more complicated diagnoses). Sadly, the number of our patients is increasing every year — mostly on account of diabetes. After all, it’s no secret this is a disease of modern civilisation — one of the most dangerous non-communicable diseases.
What is seen as being responsible for the development of diabetes?
This disease is related to heredity, excess weight and age. Our population is ageing and the predisposing genes are being accumulated. Moreover, excess weight is also common for Belarusians. Around 4 percent of Minskers suffer from this disease.
What triggers the development of thyroid disease?
Naturally, the 30-year-old consequences of the Chernobyl disaster play their role. However, this is no longer the most significant factor. Thyroid diseases are also caused by iodine deficiency. Overall, the country copes with the problem fairly well and prevention plays a significant role, such as salt iodising on an industrial scales and its use in food. This might seem insignificant but actually produces results. Doctors have recorded that the number of patients with thyroid iodine deficiency diseases has fallen in recent years.
Gathering population data is also beneficial…
Definitely. The possibilities of identifying the disease at an early stage are also growing. Thyroid ultrasound can be done today in almost any medical centre and clinic. If an abnormality is detected, then a patient sees the endocrinologist who comments on changes in the thyroid gland and explains the degree of danger and ways to treat it. Without boasting, I must admit that our clinic employs Minsk’s best endocrinologists. We use the same technical equipment as Western clinics. The dispensary possesses the newest equipment for ultrasonographic imaging of the thyroid gland. If the examination is conducted with the use of high quality equipment, then a half of the problem could be solved; doctors’ qualifications are another important aspect: it’s necessary to have experience to properly interpret what they see. Frightened patients often come to us: they’ve independently tried to ‘interpret’ images and thought the worst, but actually their images demonstrate almost normal variants. Apart from thyroid ultrasound, we quickly and accurately make a puncture biopsy of the thyroid and hormone blood tests (results are ready in 2 to 24 hours).
Does this mean that young alumni of the Medical University can’t join you after their post-graduate distribution?
We do not employ beginners: our specialists have experience. This is really important. We bring all complicated cases to discussion and exchange views. Moreover, our doctors participate in all professional events in Minsk and Belarus. Annually, experts travel to major international conferences in the field of endocrinology. After our colleagues return, our dispensary organises seminars to share the obtained knowledge.
Who are your patients?
As regards Minskers, a clear system is applied: a patient visits a polyclinic with a complaint and if the organisation cannot help, then this person is sent to us. We also offer paid services and, in this case, no special application is needed. We are attended by patients from different regions of the country. Contracts have been signed with insurance companies to render private services.
Can foreigners consult the dispensary?
Of course. We also treat foreigners, who basically come from Russia and Ukraine. It’s necessary to note that rendering assistance to patients suffering from abnormalities of the thyroid gland is not something extraordinary; moreover, it is not expensive. Therefore, people who come to Minsk on business or those who can easily get here come to us. Some patients also come from beyond the CIS. In most cases, these are our countrymen who prefer to receive consultations and treatment at home.
Do other specialists work at the dispensary, apart from endocrinologists?
Yes, we need the assistance of other specialists. For example, diabetes requires inspection by an ophthalmologist once a year. The doctor examines the fundus using the fundus lens — making it possible to learn of the vascular lesions’ state. The neurologist pays attention to neurological manifestations of endocrine diseases, especially diabetic neuropathy. We also run a special room treating ‘Diabetic Feet’; two local surgeons boast diagnosing skills and render medical assistance in cases of diabetic lesions of the legs. This is a unique department which has operated since 1996. Regional doctors come to us to study. It’s a specific branch which has many nuances that an ordinary surgeon might fail to diagnose. Recently, we’ve introduced a paid service for doctors: training in the workplace of the ‘Diabetic Feet’ division. Moreover, CIS colleagues can train here as well. Belarusian doctors intern free of charge as we are interested in ensuring that as many Belarusians as possible receive qualitative medical care. To diagnose the pathology of legs and perform complex manipulations with the skin, treating wounds and nail plates, we have special equipment: a podo-theraupetic chair and a set of tools. We also employ a gynaecologist. Gynecologist-endocrinologists are unique: they are experts in women’s endocrinological health. It is known that a range of gynecological problems exist but the diseases related to hormones are the most difficult sphere. We render specific examinations which are needed in case of endocrine problems in reproductive health.
While walking along the corridors, I notice that the building is being renovated. Do you think it’s important that patients feel comfortable while consulting the doctor?
Definitely. It’s nice to receive a consultation in a comfortable and clean room. Yet the most important thing happens in the doctor’s head. We also have another building — located close to the main office: in 15 Kiselev Street. In the future, we hope the Endocrinological Dispensary will have a separate large and beautiful building and its own hospital. We have goals to develop further. Continuity has been established with all medical institutions of the city. If necessary, we send patients to endocrinological departments of the 1st or 10th city clinical hospitals. However, it would be much more convenient to have all the facilities in one place.
What advice can you give our readers regarding the prevention of endocrine diseases?
It’s naturally necessary to keep a healthy lifestyle, while controlling nutrition and moving more. It’s beneficial to walk for at least 30 minutes daily. Those older than 40 need to test their level of fasting blood sugar at least once in 2 years. Those who have excessive weight and /or close relatives with diabetes of type 2 need to monitor their blood sugar levels at an earlier age. This is the only way to detect the disease in time. Another factor which we, unfortunately, fail to control is that the older you get, the more risk emerges.
It’s possible to determine whether you have an excess weight in two ways. The more complex method is to calculate the body mass index: the weight in kilograms divided by the height in metres squared. If the result is higher than 25, then the excessive weight is present; if it is over 30, then you suffer from obesity. Another method to determine the susceptibility to diabetes is to measure the waist circumference; some people fail to find it. This is especially common for men. In such cases, you should measure the circumference of the body at the level of the navel. Ideally, women should measure no more than 80cm (94 for men). As you can see, this is much more than beauty norms. Actually, these are the criteria for risk of metabolic problems. If a woman’s waist circumference is more than 88 and man’s is over 102, then we can say these people suffer from abdominal obesity. It is likely that they would also suffer from diabetes, hypertension, atherosclerosis and heart diseases. These diseases will plague a long and qualitative life.
I’d wish all your readers health. If you suffer from an endocrine disease, please do not despair. You should not neglect the disease but consult specialists who will definitely be able to help.
The site of the Minsk City Endocrinological Dispensary — http://endominsk.by — presents special complex health programmes and packages of services, in Russian and English. Among them are ‘Thyroid’ and ‘Diabetes’ which have been prepared taking into account medical indications for the initial examination of a patient. There are also several thematic programmes: ‘Men 40+’, ‘Women’s Health’, ‘Women 45+’ and others.
By Yekaterina Medvedskaya