Vladimir Vavilov: ‘We will be overwhelmed by a wave of fighters who need hospice support soon’

More than 25,000 cancer patients are on the waiting list

Mr Vavilov, your hospice opened for children in 2014, for adults a year later, and just a year ago another hospice, Natasha, was opened. What is the current situation in these facilities, and what are the most pressing problems?

We have been providing care to seriously ill patients with chronic incurable diseases for 10 years now. During this time, more than 5,000 patients have received assistance. Last year, another hospice, Natasha, opened near the Republican Clinical Hospital with 80 beds — around 800 patients have already passed through it. We operate within the framework of a public-private partnership: the state covers the public order, while we bear the bulk of the costs ourselves through charitable donations. At present, a bed in the hospice costs around 9,000 rubles per day, while the state pays only 3,500. And although we have 80 beds, we were only allocated funding for 50. There is a need for far more beds — the waiting list is very long, especially for adult wards. The coronavirus pandemic played a negative role here. At the moment, more than 25,000 cancer patients from all over Tatarstan are on the waiting list.

So the state support, this public funding, is frankly insufficient?

Proper care for a sick person is always expensive. For example, a caregiver today costs 4,000 rubles per day. And a hospice is far more than just a caregiver! We pay 700,000–800,000 rubles a month just for electricity. On top of that, we need heating, medicine, food. Under the state contract, the food allowance is 160 rubles a day — that’s not even enough to cook porridge, let alone put anything on a plate. Meanwhile, we provide full meals five to six times a day. Fruit, specialised nutrition, juices…We do have enough medication, but that only covers pain relief therapy. We also need Heptral for liver support, expensive silver-infused dressings to prevent bedsores.

We need massage therapy. We need psychological support. We need high-quality hygiene products — the same diapers, for example, which are expensive and used in large quantities. But it is essential to provide all this to our patients: a person, even in their final days, must still feel like a person. We also have a large payroll fund: a hospice is a facility that must employ professionals — doctors, nurses, care assistants — because the majority of our patients are bedridden. All of this costs money, and we receive no benefits or exemptions.

“Relatives don’t know what to do with these patients”

Your hospices still haven’t seen any state-run “competitors”?

Not only in Tatarstan — there are none anywhere in Russia. And yet it’s not just cancer patients who need this kind of care — there are many others. For example, those with acute cerebrovascular accidents, with dementia, with Alzheimer’s disease. Open 100 such facilities with 100 beds each in Tatarstan right now — and even that wouldn’t be enough. And unfortunately, relatives don’t know what to do with these patients.

In your view, how fair is the opinion held by some that placing such patients in care facilities is equivalent to betrayal?

What is a bedridden patient? It means that someone of working age has to stop working and provide round-the-clock care — 24/7 — without earning money, without supporting themselves or the patient, without paying taxes. The patient needs to be fed, cared for, provided with medication, hygiene products, access to emergency services, a doctor. Finding a caregiver for 4,000 rubles a day today is pure luck — they usually cost more, and prices keep rising. And that caregiver still needs to be provided with meals and living conditions. All of this places a heavy burden on the family budget, and unfortunately, 98 percent of our population have incomes below the average. They simply cannot afford proper care. These families need help!

“A closed circle — that’s what I see for now”

The Special Military Operation is ongoing. Can wounded soldiers with severe injuries count on hospice support?

Today, most people do not grasp the seriousness of the situation. They don’t understand what is happening out there on the front line, or in the country as a whole. They go on living as if nothing is happening — and only begin to realise the scale and consequences when it touches their own families. Soon, we will be overwhelmed by a wave of fighters who will also need hospice support.

Doesn’t this mean that the state must increase public funding and begin building state-run hospices?

I studied how this work is organised abroad — and there are no purely state-run hospices there, even though the hospice network is well-developed. In fact, there are hospices that are funded entirely by charitable donations — even in major cities like New York. And I must say, people’s attitude toward charity is much better there — significantly so. People genuinely take pride in knowing they are contributing to a worthy cause. Charity is developing here, but not as fast as we would like. Unfortunately, there are also many fraudsters here who are only out to deceive or steal something — and this attitude is even reinforced in our films and TV series. Tax evasion is seen as a kind of virtue, and getting paid under the table is considered normal. But the country will be richer if everyone pays taxes on all income — and those taxes will return a hundredfold. In Germany, for instance, they introduced a tax for old age — just one percent of income, I believe. People were opposed at first, but now they see the value: when someone dies, the state covers all funeral expenses. Here, what I see for now is a closed circle, where everyone looks for a way not to pay — and somehow, that circle must be broken.

“A waiting list to work with us”

A hospice is a place where people come to the end of life. Ideally, working there should be psychologically difficult. Yet your staff are cheerful, radiating kindness and good spirits. How do you manage to combine what seems incompatible?

I am very pleased that I have been able to build strong teams in both hospices. A hospice is our home — a home without pain. That is why there is a waiting list to work with us. Sometimes someone comes and realises, “This is not for me,” and honestly tells me before leaving. But we have very little turnover; most stay with the team.

Is this connected to decent salaries?

No, our salaries are average for the sector. As for everything else… it all depends on leadership — how a manager treats their team, so the people work. From the very beginning, I said I would organise things so that people come to work with joy — and I have achieved that. People’s eyes shine; when needed, they stay for an extra shift without persuasion or unnecessary words.

“Amendments are still being made”

People speak very warmly about your staff in conversations with journalists. But they also complain about their limited resources. For example, palliative care teams arrive only to provide pain relief. Yet situations vary, and sometimes a patient needs a sleeping pill, a sedative, or another type of medication.

Yes, our main focus is pain relief therapy. For anything to change, the law must be amended. I once spoke in the State Duma advocating for changes, but the situation remains the same. By law, for example, we are not allowed to administer intravenous infusions at home. Neither nutrition nor Heptral can be given this way. We have to take a patient — who might weigh 180 kilograms — carry them down from the fifth floor, bring them to a hospital for the infusion, and then return them home. And since this is legally impossible, palliative care across Russia operates in violation of the law, but for the benefit of the patient.

You are a deputy of the State Council of Tatarstan and are known in Moscow. Have you taken this initiative to the very “top”?

I raised this proposal in the State Duma when Tatiana Golikova was still Minister of Healthcare. She said the amendments would be made — and they are still being made.

There is also a category of patients who do not fit the “criteria” for hospices. They are stable, they will live, but they cannot care for themselves — and their relatives cannot bear this burden. Is this problem solvable in principle, considering that paid care is unaffordable for their families, and they do not meet the “conditions” for placement in nursing homes because they have family?

For these patients, nursing care units need to be opened. I have a dream to open such a unit, but there is no funding for it yet. I even approached the land committee, hoping to acquire a plot near the hospice to build a facility for long-term stays for patients who need nothing but care. But so far, that opportunity does not exist.