Economie & Finance Géorgie Guerre du Donbass Histoire Kyiv Politique Santé Société Ukraine

Minister Kvitashvili: I leave at peace, yet this the last chance for reform

Interview with Ukrainian Health Minister Oleksandr Kvitashvili, conducted in Kyiv, on 4th July 2015.

He seems good to go. On Saturday, 4th July, Oleksandr Kvitashvili appears surprisingly relax as he walks through the corridors of an empty Ministry of Health, in Kyiv. Voted as Health Minister by the Verkhovna Rada on 2nd December 2014, he tendered his resignation on 2nd July. Earlier, the Bloc of Petro Poroshenko, the main parliamentary faction in the Parliament, initiated his dismissal. 

A former reformer Minister of health in his native Georgia, Oleksandr Kvitashvili came to Ukraine as a “hired help”, as he likes to describes himself. At the head of one of the most notoriously corrupt ministries in the country, “Sandro”, as his employees name him, initiated some structural reforms of the healthcare system, tried to simplify its regulations and procurement rules, and restructured the functioning of its administration. In doing so, the Minister faced the resistance of several political and financial interests, which had benefited from the deficiencies of the healthcare system for the past two decades. Under strong criticism from political parties and representatives of the civil society for a dramatic lack of results in the course of his seven-months in office, Oleksandr Kvitashvili insists on the huge efforts he and his team made and the lack of unity between the executive and legislative branches of the state authorities. A 130-page package of structural changes and reforms is pending for approval in Parliament for a few months already. 

There are mixed opinions. According to Vitaliy Shabunin, head of the « Anti-corruption Action Center » in Kiev, his dismissal was « long overdue » because of his lack of results. Dmytro Sherembey, head of the « Patients of Ukraine » association, has repeatedly accused the Minister of perpetuating the corrupt and inefficient schemes of the past, which led, for example, to some tense moments in the supply of HIV/AIDS and TB treatments. Some of the Georgian reformers now in Ukraine, Kvitashvili’s former colleagues in Georgia, praise him as a very pragmatic and efficient reformer and manager and an apolitical technician. Yet this is not necessarily a compliment, as Mikheil Saakachvili, Georgia’s former President and new Governor of the Odessa oblast (region) stresses: « I was calling him over the past several months to be more efficient, to be more radical. He started to behave like a perfect old-style Ukrainian civil official. He is a good guy, but not taking bribes himself is not enough when everyone else around keeps taking bribes. He had to be more radical, that’s why he lost his job ». 

Whatever the reasons for Oleksandr Kvitshavili’s departure, his case is quite symbolic: he is the first of the « foreign reformers and experts » invited to reform Ukraine to leave his position. He still does not consider leaving Ukraine though. He keeps his Ukrainian passport and assures that he wishes to find new ways to help the country. 

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How long will you stay Minister of Health? 

It depends on how long it will take for the Parliament to vote me out. I assume it‘s early next week. I Hope it will be early next week because I would like to hand over things to a new person. Create a precedent that one person leaves without lawsuits and scandals and organise a proper handover.

I have no idea of who will come next, no clue. There are some rumours about 6 or 7 people but I don’t know how true that is. I don’t think anyone actually thought about a replacement because the situation went hectic in the Parliament in a very short time.

And my decision was motivated by a very simple fact: if the faction that had supported me to be appointed is questioning my tenure here; it’s better to leave than to start fighting and create some kind of really heavy atmosphere. That’s not what the country needs; the country needs some quiet time and proper handovers continuation with the reforms. that was a decision based on that.

If the faction that had supported me to be appointed is questioning my tenure here; it’s better to leave than to start fighting and create some kind of really heavy atmosphere.

Have you had any contact with the faction of the Bloc of Petro Poroshenko, which initiated your dismissal? 

Yes, of course. There are some members who have always been interested in what’s going on and they have a clear understanding of where we stand. But considering that my dismissal was initiated by the head of the faction (Yuriy Lutsenko, ed.), who hasn’t really contacted me or enquired about the state of affairs at the ministry, I considered it was a political decision.

It’s not my first time in government, I understand how it works. The only regret that I have is that there so many things that are ready, that need a final push – and I am pretty sure the final push is going to happen – my only regret is that I won’t be me pushing that. My logic is that if I am some kind of barrier towards moving forward, then, I would rather remove this barrier myself than of creating a crisis which no one really needs here.

Several Members of Parliament complained that you would not communicate enough on your reforms and not show up to parliamentary committees… 

We did have a working communication. There were several very active deputies who would come here and offer their help. Some of them traveled with me several times to meet with oblast administrations and demonstrate that there was a support from the Parliament for reforms. It’s a very eclectic coalition in the Parliament. some groups are genuinely interested in changes. The Samopomich faction as a faction in general is very progressive and determined to make a good change. They have a very good agenda, they are young and ambitious and they have been very supportive.

But again, it’s a coalition with 5 subjects. Coalition governments are always very ineffective in pushing hard changes. Not just in Ukraine, pretty much everywhere. There is always a certain level of populism and without a strong vertical of executive power – pushing not popular reforms is very difficult. You saw the dynamics the other day on the issue of the law on deposits, which is a disastrous decision and is going to ruin the financial sector of the country that stands. When you have a Parliament with more than 400 MPs, which rules the country according to the Constitution, it’s very hard to push for hard changes.

You said that your dismissal was a political decision. Do you believe it was motivated by some financial interests you countered during your time in office? 

We started to dismantle the system that has been building on its own and with the help of different interest groups over the past 25 years. We are talking about several hundreds of millions of euros in procurement, not just for drugs but also for equipment and other financial matters. the way the procurement of medicine was done in the past was completely untransparent. It is very hard to understand the logic why some pharmaceutical groups were selected over the other. Sometimes the budget was split 50% for the brand and 50% for the generics. Obviously the brand drugs are 4 or 5 times higher. So we attacked that, we changed the way the procurement is done, we removed all those different groups that were formulating the need for the country.

Ironically, for the past few years, Ukraine was buying pharmaceuticals based on the amount of money that is available rather than calculating the needs. The only two programs that have more or less decent statistics are Tuberculosis (TB) and HIV/AIDS, only because there is strong invvolment from the Global Fund, USAID and other international donors that actually made sure that the lists of the patients are, if not 100%, with a high probablity, accurate. But if you look at the other 17 state programs, there are serious issues with the number of patients who were anything for. There was never a time when someone actually calcuted the actual needs. Which we did.

Everybody focused on the tendering processes. But there are two even more important components in it: how and by what means is the list of pharmaceutical companies determined? And what is the distribution vertical? That was two big black holes.

What did you do to reform the state procurement system? 

I kept saying that there is no country in the world, including the US and other wealthy countries, where the state buys 100% volume of very expensive medications for the patients. It’s always a combination of state funds, private funds, international organisations, individuals and so forth. For us to determine that, we need to know which are the numbers that we need. People kept asking me how is it possible that in one oblast there is a surplus of something and in another there is a deficit of something and that we have to manually move things around. That’s because proper calculations were never done. There are no electronic registries of patients, no electronic database whatsoever, apart from TB and HIV/AIDS. Which is one of the changes I tried to push for.

There was a lot of criticism of the state procurement for those communicable and incommunicable diseases. Everybody focused on the tendering processes. But there are two even more important components in it: how and by what means is the list of pharmaceutical companies determined? And what is the distribution vertical? That was two big black holes.

There is a state agency that ensures the distribution across the country: We discovered last month that they had a beta version, a 99% operational system of an electronic supply management system that has never been used. This is a system that traces the pill all the way down to the last consumer. The biggest part of it was done, all we had to do was to start registering people that were getting it. And nobody thought of pushing it last year. We finished finalising that program and the new procurement which will start in a week or so will be based on this software. They have 25,000 distribution points across the country. It’s a phenomenally well done program but no one was using it. Because it’s easy to manipulate the numbers when you don’t have an exact understanding of what is the end need.

Wen I would ask at the beginning of my started my career here – what is the coverage of the Hepatatis program? The answer would be: « we procured 95% – 95% Of the needs? – « No, of the budget ». It is very hard to make sense of such a figure especially considering the dramatic devaluation this year. So we tried to change the way we do these things. Now it’s easier to go to international organisations and say that we will have a deficit here and there.

And yet there is still a risk of an outbreak of polio epidemics…? 

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The polio vaccination is a very good example. Ukraine has less than 30% coverage of the polio. Which is not only a threat to the country but also for the whole continent of Europe. The polio had been eradicated for so long, but now with the situation in the East, on non-controllable territories, we are at risk. We have done contact with the  UNICEF and the Canadian government and we presented our numbers: there no proper vaccination since 2009; these are the numbers that we need to cover the newborns until the end of the year and this is the number we need to go back six years and revaccinate everyone. Since the numbers appeared, our partners were quick to respond, the Canadian government gave 3,5 billion Canadian dollars and Unicef did the procurement through Sanofi. On other vaccines, the Polish government is helping us according to the same tools.

No one had ever done a proper calculation of current needs and future needs, and definitely not of how to go back and revaccinate. The country had been taking commitments on increasing the number of treated patients in HIV for example, which is a commitment to the Global Fund. However, no one has allocated any money. No one has actually identified whether the 25% increase is only on paper or corresponds to a real need. Of course, one has to focus on treatment, on the existing cases. But one has to also fund prevention, early diagnostic, diagnostic in general. And if you look at the way Ukraine has been handling the portion of the state programs on HIV and TB compared to the procurements made by the Global Fund, you see major differences in the numbers. For example, per one patient, Ukraine pays roughly 83 dollars per year. Considering there are 40,000 patients, it is a lot of money. and its very difficult to trace because the end result is very vague and unclear. As for the HIV test devices, which need to be done twice a year per patients on average, the average market price in Europe is about 9 euros. Ukraine buys them for 42 dollars. Questions arise: why?

After 7 months in office, you probably have some answers to this question? 

Of course. The everlasting fear of corruption is a big part of it. Plus some regulations were made to counter it which made corruption even more possible.

Also, because of excessive regulations, the state does not have the discretion to use the best way to buy medication. Let’s consider the example of Holland, which does not have the same problem with corruption at least at the level of Ukraine. The government has multi-year contracts for vaccines for example. 75% are supplied by Glaxo and 25% by Sanofi. It’s a 3 to 5 year program. I initiated this in Georgia, and I tried to initiate it here. Why? because you agree on 3-year plan, the manufacturer has clear figures of the needs and they don’t loose ressources on storaging or anything like that. You agree on the price, which base remains the same during the contract. it’s a win-win situation. Unfortunately, current procurement regulations and laws in Ukraine do not allow that. we have to go through tendering processes. That was also on the agenda to change.

State registration of pharmaceuticals is also a very strong tool to manipulate pharmaceutical and procurement markets. You may register or not register something or may not re-register something and that puts this particular product on hold. To register a product, the manufacturer has to go through a process which is lengthy, corrupt, disgusting. No one would want to do it. Another initiative was to give the ministry a discretion to register the life-saving medication on its own. The way we did it in Georgia was just to say that if it is on the list certified by WHO and UNICEF, then it is automatically registered in Georgia. Period. That makes everybody’s life easier.

Regulation in Ukraine has gone way beyond protecting consumers rights.

You keep talking about the things you tried to push for. Is there any concrete results you achieved? 

You have to do things in waves here. The first wave was this 130 page changes in laws that completely reforms the healthcare system. It has yet to be voted by the Parliament. The second step was to do the deregulation: removing all barriers for the pharmaceutical companies and medical equipment to enter the market. One of my favorite examples is a « certificate of appropriation », something like that. Basically it means that a liniar accelerator for the treatment of cancer would have to get this certificate upon coming to Ukraine, in order to prove that it is not a washing machine. 

All these little things, including officially fees you have to pay and the bribes you have to produce really hampered the development of new technologies. In Georgian capital, Tbilissi, which is a 1,6 million city, has 11 linear accelerators, which is in the European average. Ukraine, which is a 44-million country, has 17 linear accelerators in the entire country. And Georgia is a lot poorer than Ukraine. 

The reason that I am saying that is that regulation in Ukraine has gone way beyond protecting consumers rights. Because of regulations, there is a staggering number of counterfeit medication on the market. It will not work if we do not deregulate. Even the European Union, which is an organisation that regulates the size of a cucumber, is asking for deregulation.

With such drastic changes you wanted to push, you probably stepped on someone else’s toes, meaning pharmaceutical companies and their middlemen…? 

Those interest groups do not want to change. Journalists ask me: “Who is it?” But it’s not one person, because that would be easy to deal with that. It’s different groups of interests: the pharmaceutical companies, the ones who have created bogus middlemen, the companies involved in the distribution market, etc. It’s a huge system. you have to start removing the regulatory barriers in order for all this to start breathing. Currently the entire country is in a state of coma, you have to give it a chance to breathe. Not just in health but in every direction. That’s why it comes to the point of unity between the executive and legislative powers. Everybody’s interest should be to move forward. We did some analysis, and over the past 7 months: 70% of the legal changes proposed by the Cabinet have been killed at the level of the Parliament. The ¨Prime Minister made that statement a few weeks ago.

I believe this is the last chance to reform the healthcare system in a proper way.

To give you an idea: the ministry of justice has had this big set of changes ready since April, which would enable Ukraine to move up 30 points in the use of doing business ranking. It is estimated that every step up is worth half a billion dollars of investments. So we lost 15 billion dollars simply because the Parliament did not find time to vote on these things. And for the 2016 ranking, we already missed the time to report that those things might be passed.The Finance minister is vivid because a set of laws that are absolutely necessary to be passed to receive about 3 billion dollars from the World bank financing and is a pre-condition for the IMF financing; have not been passed. So without the unity of the Parliament and executive powers, reforms will not happen.

I believe that if Ukraine has to go ahead with those changes, not because I sat down and wrote them with my team of Ukrainian and international experts. I believe this is the last chance to reform the healthcare system in a proper way. Because if this reform is postponed, if we still do not have purchase or provider split, if we still do not have autonomous network of hospitals, if we still do not switch from per-bed financing to paying for the services, the system will collapse financially and infrastructurally. Ukraine has 9 beds per 1000 population. Sweden, which has a much more developed welfare state is a much more socially oriented state, has 2,7 beds per 1000 inhabitants. The average length of stay is 13 days in hospitals in Ukraine, 5 in Sweden. Sweden, in addition to everything, has proper method of financing healthcare. Ukraine’s method of financing is based on the number of beds and the length of stay. Not on the real needs! It does not involve quality control, it does not look at the outcome.

And the money that the state has to finance the infrastructure is only one third of what is required for the infrastructure to be sustained. So ideally to cover 100% of the expenses, you need either to reduce them by 2/3, which is impossible to do at this point. Or you work to allow the system to earn money legally. Nowadays, 2/3 of all the expenditures in healthcare in Ukraine are informal. Meaning money that goes from patient’s pocket to doctor’s pocket. It is estimated by the World Bank that it is roughly 10 billion dollars a year. I assume it is more around 8 but still, it is a very large amount of money, that is not accounted for, not reinvested into the system. It goes into buying smartphones and Porshe Cayenne and that sort of things. The legislative changes we proposed open up the system for the reinvestment of the money. If you don’t legalize the system, the state funds will not be able to sustain it, it shall collapse. The Prime Minister and the President are aware of this, they have been very strong supporters of the changes. So I really hope the MPs realise that too and that they will vote the changes and at least initiate the salvation of the system, which is on the verge of complete collapse.

Back in Georgia you pursued the privatisation of the healthcare system and the involvement of private investors. Do you recommend such a policy here? 

You cannot compare Georgia with Ukraine, population-wise. Also, it was different then. Because the Georgian healthcare system collapsed in the 1990’s and there was a natural optimisation of the system that happened there. The set of reforms we are trying to push here happened back in 1995-96! so the system started to breathe a little bit better. When we go to the 2000’s, the system was collapsing purely because it was old buildings, no capital investment, nothing. The state would never have that amount of money to save the whole system. That is why decision was made to privatise, so that private money would come in to help the state; and the state would concentrate on service provision only for the population. The state would buy services and investors would invest in equipment, buildings and so forth. There, it worked.

There, we did different kind of schemes. For example, there used to be old hospitals in the ancient part of Tbilissi. They used to be hotels, which communists turned into hospitals. So by no standard, including Soviet, you could have a hospital there. So we would tell a developer or a private company: “Look, you can have this asset, which is valued at whatever price. In exchange, we want you to build a modern, well-equipped hospital in this location, outside of the center, where we develop cluster for help services. Once you’re done and that you have moved the hospital there in a proper way, you can have the asset.”

I don’t believe that it can happen in Ukraine now for several reasons. First , nobody would buy those assets that are hospitals now. The vast majority of them was built in the 1970-80’s, those are massive, huge structures, with 1,600 beds and operational costs going through the roof. If I would have some money, I would never buy such an asset and invest in it. What I do expect is that once the system is open, there will be lots of private money to come in to build new networks of hospitals and clinics. There will be modern buildings with modern services and proper planning. There is an art of how hospitals operate, where physical movement of staff and patients is important. It’s not the case here.

Plus, people have a sensitive attitude toward privatisation in general in Ukraine. Because every privatisation process that happened over the past 25 years was really not what you and I would call fair and transparent… When you don’t have that kind of trust, things don’t go well.

When you improve statistics, numbers get worse.

Ukraine is the only country in Europe with Russia where the HIV/AIDS epidemics keeps growing. The TB epidemics is hardly under control. What do you think should be done to counter these trends? 

I would be looking at this for a long time as I worked as a consultant for the Network of People Living with HIV/AIDS before I came to work in this position. I am preparing the society to the fact that when you improve statistics, numbers get worse. It is true, because once you have better diagnostics, better coverage, better access to help, things are discovered that before were unknown. When we did reforms in Georgia, first two years, every single statistics got worse. Because we started seeing the real picture. The two programs on HIV/AIDS and TB, which are administered by the State, USAID and the Global Fund; they improve the statistics, which is quite contrary to a better understanding of what’s happening! We need to develop proper data.

The second thing is diagnostics. There is no proper system of diagnostics. In Georgia, there has not been a mother-to-child transfer of HIV since 1997. Because there is mandatory testing of blood for every pregnant woman. This is not the case in Ukraine. Having a very weak link, which is the primary healthcare in Ukraine in general also plays a negative role in that. Public healthcare functions are not working properly. The especially weak link of epidemiological coverage in Ukraine also plays a role in that. We do not have any European-looking Control Disease Center and the disease control mechanisms are not working properly. There is a lack of TB diagnostics. There is an issue of cross-diagnostics between TB and HIV. The penitentiary system, I don’t even know what is happening there but I assume that this is a nest of horror stories.

In he complex, you cannot fix all that if you do not have some kind of system in place on the venal use of drugs, on the whole problem of drugs. And this is where you are in close link with police, with prosecuting agencies, border guards, and so forth. There is a complex of problems that were completely overlooked and under-reported in this country.

Isn’t it also because of the level of discrimination against TB and HV/AIDS patients? We know that they are still considered as parasites and social degenerates by some large segments of the society, even within the medical staff. 

In the big cities, the quality of doctors is slightly better. Because at least there, doctors understand they will not get infected with TB if they shake somebody’s hand. But the smaller places you go to, you find some cases of doctors refusing surgical treatment for HIV positives. But this is a very complex issue of the society in general. As long as this issue is tackled by different actors and organisations, it’s a progress. But the society has to embrace these concepts and understand basic things about HIV and TB. I had TB myself in 2002. I was stunned. I never had any symptoms and I was just doing a medical check-up to get a Green Card and the doctor told me I had huge scars… From then I put myself on many public messages and videos to explain. TB is not a social disease, confined to a certain group of people, anybody can get that. People have to understand what are the risks and what are not the risks.

But again, there are some structural problems. Professionals from prevention campaigns complain that it is hard for them to incite people to get test for HIV, as there are running out of testing equipments in several parts of the country… 

Again, everything is about making money, not about good aspirations of public officials. In 2013, they bought a lot of things, something like 120% of the needs. The procurement was done very well, at a very high quality. Although we do know that they stole quite a lot of money, they did buy a lot. After the change of government, my predecessor (Oleh Musiy, ed.) could not do the procurement in June, July, August… and they had to do it in December. The only reason that they system did not collapse is because of the procurement of last year. So it means that they used all supplies that they had over the past year, and there was even some that was used in the first months of this year. When they did the procurement in December, they gave all the companies that were paid in December the ability to postpone the shipment of the medication for 180 days – six months! This is just ridiculous and I really would like someone to prosecute this.

You know, the usual crap.

So we received the legacy that there were no supplies left and that there was a 180-day delay in the shipment of the medication. Now, these things are coming in because the time is up. So we receive now everything that was procured in December last year. There was a time when things were running very thin. And of course, every company had middlemen and the companies that won the tender never repaid the manufacturers and so on and so forth. So we had to deal with it manually: calling up, scaring someone, calling the Ministry of Interior and using their force… You know, the usual crap.

But what about the 30,000 HIV treatments, which the state purchased and activists claim were never delivered to pharmacies…? 

That’s a different story. And by the way, the patients’ organisations knew that very well. But I understand they also need some public relations… There was a « Vector Pharma » company that received money on December 19, 2014. The manufacturer was an Indian company that had manufactured 100% of the pharmaceuticals already. By March, it was labelled in Ukrainian, manufactured, done. The company that won the tender never paid the manufacturer a penny throughout March. In April we learned about that. The deadline for delivery they had was June 19th, and we realised that there is a problem. So we called the manufacturer and asked whether there was no money transferred.

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Then we called this company to ask what the hell was going on. They said that the currency was devaluated and that they could not pay what they owned to the manufacturer. « That’s Bullshit, because we paid you in December and  the devaluation happened in February. So if you had transferred the money in January, nothing would have happened ». Then they went and sued us. They were asking for 8 million hryvnias to be given to them as a difference. But they never showed the proof that they tried to buy currency. They actually never did, they were trying to embezzle the money as I understand. Then I went to the Prime Minister in May and told him “Look we have supplies until the end of June – mid-July. And there is a risk that these guys are going to do something funny. So I need your help.” And for two weeks, the owners of the middleman company would not come to us nor return our calls. So then I told the Prime Minister to give the order to the Ministry of Interior to get involved. When he made the statement, within 15 minutes, the President of the company called my deputy and said he was ready to come and meet us.

Read a post-ed by Dmytro Sherembey, head of the « Patients of Ukraine » association: « I am doomed » (Я обречен)

At this point, they still have 4 million to pay to the manufacturer. And we have been involving the President of the manufacturer company, which is a huge company, covering some 20% of US market; the ambassador in India has been involved… That’s why I am disappointed when Dmytro Sherembey says we have been doing nothing. And they paid the first 10%, that came in, and one of the drugs is covered 100%. Then they paid another 15% and so on… We get confirmations by the manufacturers. They pay in chunks.

The tense moment was when we got to the two-week period time. We do the looking up every week through a video conference with all HIV centres across the country. Last time we talked, they ensured me that everything is covered until the end of this month. Plus the new shipments are finally coming in. And we also have a Plan B, which is the Global Fund: there is a savings of about 7 millions there and it would take about 5 days to get everything down here. So we will not have any shortage or deficit.

You are now about to leave. How can you make sure that this kind of tense moment does not happen again? 

It will not happen again because we changed the regulations. The way things worked was very strange. When I asked the large manufacturers who are based here and who qualify for such tenders why they always rely on these distributors and middlemen; they said they were told in a friendly conversation that it was better not to participate. On July 9, we organise a huge meeting with the top 20 manufacturers, producers and importers of pharmaceuticals here in the Ministry. We are going to show them how we will be doing the tending process, and we will be encouraging them to participate and not to leave us with the middlemen. And of course, we are removing this 180-day postponement…

This is incredibly ridiculous. Of course, « Vector-Pharma’ said that it was a Cabinet of Ministers requirement. But no! It said “up to 180 days”. It was possible to deliver before! Of course, it had to make sense for someone who got something in return… The manufacturer is also in a very tricky position because that product if labelled for the Ukrainian market, it’s in Ukrainian. For it to be sold on other markets, it would take a lot of hassle.

How does the war in Donbass affect the evolution of the TB and HIV/AIDS epidemics? 

It affects everything. The way things are there is difficult. In general, all third level – high tech – clinics are on the other side. So the rest of the oblasts does not have third level clinics and we have to use what is left. It is very difficult and obviously distances are long. As for HIV and TB, the program with the Global Fund actually works there and it can deliver treatment through the separation line. Through other partners such as MSF, the Red Cross and other partners, they can have access to the other side. Medicine is delivered by international organisations only, the state does not do that. There was a lot of migrations out of there, obviously, so we reallocated funds and equipment to zones where people moved to.

The only real problem is with methadone and substitution therapy because we cannot deliver methadone across the line, for obvious reasons. What we do is to facilitate the transfer of groups of people from occupied territories to non-occupied territories. That’s the only quick solution we could find from there. Because for example if you compare to Crimea, since it’s annexed by Russia and Russia does not have substitution therapies at all; pretty much everyone moved out from there (or died or resumed using narcotics, ed.). But its very hard because you have to deal with someone from that side and no one can give any guarantee of safety or anything else.

A hired help

As we come to the end of this meeting, I cannot help but mention that you look extremely relaxed…! 

(laughs)

That’s because you’re talking to me on Saturday. Last Thursday, you would have seen a lot of my frustration and anger. I am a very pragmatic person in general. I try to concentrate on the future, not on the past. That never does any good. I came to Ukraine fully understanding what I was getting into. I told everyone that was interviewing me – the President, the Prime Minister and the Head of the Parliament – that I don’t want to build a political career in Ukraine nor I am going to run for any public office. I know that I am a hired help in this particular case. As long as I will be needed here and I will be useful, I will serve to 100% of my abilities. If any of us decides that I am no longer useful, we should have an open line of communication and we mutually agree that we are going to end that.

Psychologically, it’s very difficult when there are so many things happening and when you cannot get them done. I had a choice to simply come out and tell them: “well, go ahead, I don’t care, vote me out!” It would have been a possibility. But once I am kicked out, there is nothing much I can do, I would not have much power. If they did not vote me out, how was I supposed to keep working in this situation? So I chose to resign and wait for the Parliament to confirm it, I think I am much more helpful from the outside at this point, I can help the new guy if the new guy wants my help. That’s why I am relaxed because I am at peace with the situation.

What’s next for you? 

I have no idea. I only have the Ukrainian passport. I don’t plan to leave the country for the next few months. I would like if not to be based here, at least to have a base here and be helpful. Maybe start some consulting. I used to do that before. I really would like to be useful here. Because I really believe that the success of this country will change the entire geopolitical situation in the world, at least on the Eurasian continent. It is very important for people that really showed their commitment to democratic values and European values to get changes done. If I can help with that I would be very happy to.

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