345 



were added to the practical public health system of Yakutia, but 754 physicians and 1762 

 paramedical personnel departed the system. 



This explains why the Yakut Republic of Sakha (Yakutia) has 3,894 doctors and 

 11,467 paramedical personnel i.e. 70.9% and 84.5%, respectively, of the authorized 

 positions in its pubUc health system. 



It must be noted that during the last few decades the country as a whole has 

 arrived at a very critical situation in the training of specialists, especially in the area of 

 public health. This is also true for our republic. Evidence of this is provided by the fact 

 that physicians in the highest skill category make up only 5.3% of the total number of 

 physicians working in therapeutic and preventive care institutions of the republic, 

 physicians of skill category I make up 10.0%, and those in skill category II make up 

 5.8%. In other words, 78.9% of physicians in the public health system do not qualify for 

 any skill categories. , 



In this regard we are plarming to develop a program for training public health 

 persoimel and instructors for the purpose of maintaining the appropriate level of s]pUs 

 and upgrading them in accordance with the requirements of the national strategy of 

 providing health care for everybody. Thus, the Yakut Republic requests the WHO to 

 provide assistance in training management personnel in the public health system. 



At present, therapeutic work in northern regions of this country is conducted 

 without adequate regard for the specific northern conditions through poorly equipped 

 and poorly staffed therapeutic and preventive care institutions. Investigation of the 

 nosological pattern of Yakutia emd the specific background against which diseases occur, 

 indicates that the gigantic, extreme, natural region of Yakutia is characterized not only 

 by v!irious forms of cryopathology, infections and parasitoses, diseases of the 

 cardiovascular, pulmonary, digestive and nervous systems, but also by pathological 

 processes connected with biochemical factors. Conditions of hypoQuorosis, hypoiodism 

 and iron deficiency are very common in Yakutia. While the entire picture of their 

 clinical manifestations has yet to be investigated, they cannot be merely reduced to 

 caries, endemic goiter and the so-called polar anemias. 



No less important are various forms of pathology caused by an imbalance of the 

 quality in the diet, especially among children (mono- and polyhypovitaminoses, 

 hypoproteinoses, underestimation of the importance of various lipids, and the prevalence 

 of caimed food in the diet). 



A special place in the nosological picture of Yakutia is occupied by the regional 

 pathology: Vilyuy encephalomyelitis, cancer of the esophagus, tuberculosis, ischemic 

 cardiac disease, and hypertension. Yakutia has the world's only natural focus of Vilyuy 

 encephalomyelitis of unknown etiology. It is a very serious inflammatory degenerative 

 disease of the nervous system found in many agricultural areas of Yakutia. Vilyuy 



