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Өвчин худалдаж авах зуршил
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Хаа газрын эрүүл мэндийн салбар гэж олон хүүхэдтэй эх шиг олдсон жаахан төсвөө олон тийш нь хуваадаг нүсэр бүтэцтэй.  Харьяа газрууд нь ч хэрэглээ өндөр, “хэрэглэгч” олны хэрээр төсвийн хөрөнгийг өм цөм зарцуулна. Манай оронд эрүүл мэндийн салбар дахь үйлчлэгч, үйлчлүүлэгчийн харилцаа нэг зүйл дээр урвуу хамааралтай явдаг. Энэ нь манайхан хамрын ханиад мэтийг өөрөө оношлоод, дур мэдэн эм уугаад, эцэст нь эмнэлэгт ханддаг. Зүй нь бол эмнэлэгт эхэлж хандаад, оношоо тогтоолгож, жорын дагуу эм авч  зааврын дагуу хэрэглэх  учиртай. Чухамдаа өвчтөн битгий хэл, эмч нь ч, эмнэлэг нь ч тоож үзэхээ больсон эмийн энэ замбараагүй хэрэглээ эрүүл мэндийн салбарын хэтэвчтэй шууд холбоо­тойг мэдэх үү. 

Эмийн зохисгүй хэрэглээ ганц манайд ч биш дэлхий даяар бодлогоо хандуулах асуудлын нэг болжээ. Учир нь антибиотикт дасах нь чи­мээ­гүй аюул хэмээн тодорхойлж байна. Өөрөөр хэлбэл, эмчийн жоргүй­гээр антибиотик хэрэглэх нь мөнгөө төлж өвчин худалдаж авч байгаагаас ямар ч ялгаагүй гэсэн үг. Тухайлбал, дур мэдэн антибиотик уух нь биед байх ёстой бактерийг устгаж, улмаар тухайн эмэндээ дарагддаггүй шинэ төрлийн нянг үүсгэдэг байна. Энэ нян нь тарвал нэг хүний биш нийт салба­рын асуудал болж хувираад, эмчил­гээний зардал тэр хэрээрээ өсч, манай аль ч эмнэлгийн коридорт байдаг өнөөх дуусч өгдөггүй дараа­лал уртасч байна гэсэн үг. Одоогоор антибиотикт дарагддаггүй сүрьеэ, бэлгийн замын хэд хэдэн төрлийн халдварт өвчин шинээр бүртгэгдээд байгаа гэсэн. ДЭМБ-аас гаргасан судалгаа­гаар бактерийн эсрэг эмүү­дийн 50-иас илүү хувийг зохисгүй хэрэглэж байгааг тогтоожээ. Тус судалгаагаар эмч нар антибиотикийг онцын шаардлагагүй байхад өвч­төний хүсэл сонирхолд автан ихээр бичиж өгөх нь түгээмэл байгааг дурдсан байна. Антибиотикийг жо­ронд бичих хэмжээ Африкийн улс оронд 29-60, Латин Америкийн улс оронд 27-30, Азийн улсуудад 75 хувь байдаг бол Монголд томоохон клини­кийн эмнэлгийн дундаж 48.5 хувь байгаа судалгаа гарчээ. Энэ нь хувь хүн төдийгүй эмч нар ч антибио­тикийн хэрэглээнд хайхрамжгүй хандаж байгааг харуулж байна. Өөрөөр хэлбэл, эмч нар өөрсдийнхөө гараар өвчин “тарааж” байна гэсэн үг. Энэ нь эргээд л өнөө салбарынхаа санхүүг сэгсэрч байгаа хэрэг болно. Хий мөнгө хэрхэн урсгаж байгааг Бельги улсад гаргасан судалгаанаас харуулъя. Тус улсын судлаачид мэс заслын хүндрэлээс сэргийлэхэд зориулсан антибиотикийн хэмжээг зохистой болгож чадвал эрүүл мэн­дийн систем нь нийт 6.1 мянган ам.доллар хэмнэх боломжтойг но­тол­жээ. Зөвхөн хүнд өвчтэй хүмүү­сийн тоон дээр гаргаснаар шүү. Тэгвэл антибиотикийг өдөр тутамдаа хоол шиг хэрэглэдэг манай улсын хувьд ямар их зардал хэмнэх боломжтой нь харагдаж байна. Үүний тулд эмтэй холбоотой өнөөгийн бод­лого, хууль эрхзүйн орчин рүү өнгийж харах хэрэгтэй болж байгаа юм.

Хаа очиж манайх Эмийн тухай төрөөс баримтлах бодлоготой. Өдгөө түүнийг дахин шинэчлэхээр боловс­руулж байгаа юм билээ.  Мөн Эм, эмнэлгийн хэрэгслийн тухай хууль гэж бий. Гэхдээ манай нөхцөлд эм, архи хоёр шиг хяналтгүйгээр зараг­даж, сурталчлагддаг, хэрэгцээ нь үл тасрах бүтээгдэхүүн ховор. Шинэч­лэлийн Засгийн газрын зорилтын хүрээнд эмийн аюулгүй байдлын бодлогыг тодорхойлсноо салбарын сайд нь хэлсэн. Түүний хэлснээр, “Одоогоор Монгол Улс 40 гаруй орноос 140 гаруй эм ханган нийлүүл­дэг. Жилд 160 тэрбум орчим төгрө­гийн эмийн зах зээлийн багтаамжтай гэж үздэгээс 89 тэрбум төгрөг нь иргэдийн эм хангамжид, үлдсэн нь эмийн сангуудаар дамждаг. Хамгийн сүүлийн судалгаагаар нийт эм хан­гам­жийн 13 хувь нь чанарын баталгаа хангаагүй” ажээ. Энэ оны байдлаар эмийн үйлдвэр 32, эмийн сан 1283 , эм ханган нийлүүлэх 120  байгуул­лага ажиллаж байна. Үнэндээ тэр болгоны үйл ажиллагаанд тавих хяналт байхгүйтэй адил байгаа. Нэг ёсондоо   эмтэй холбоотой одоо үйлчилж байгаа бүхий л хууль унтаа байна. Ийм байхад улсын бүртгэлд ороогүй эм зах зээлд тарж, бараг амьдралдаа жор бичүүлж үзээгүй хэрэглэгчид, арав алхаад л байх эмийн сангаас хэвлэлээр сайн гэж сурталчилсан эмийг авч, өөр дээрээ туршдаг гээд бид хуулийг чөлөөтэй зөрчсөөр байгаа нь үнэн. Энэ онд 190 төрлийн эмийг Монгол улсын эмийн бүрт­гэлд бүртгүүлжээ. Жил болгон шинэчилдэг энэхүү бүртгэлд анти­био­тикийн төрлийн эмийг зохих хэмжээнд хязгаарлах ёстойг мэргэж­лийн хүмүүс хэлж байсан. Мэдээж зөвхөн Монгол Улсын эмийн бүртгэлд байдаг эмийг борлуулдаг болсон буюу хуулиа хэрэгжүүлдэг болсон нөхцөлд дээрх хязгаарлалт хэрэгжиж таарна. Дээрх бүхэн эмийн зах зээл дэх энэ замбараагүй харилцааг бодлогын төвшинд шийдэх цаг болс­ныг харуулж байна.

Иргэдийг эмээс “айдаг” болгох нэг алхам нь мэдээлэл. Өдгөө теле­ви­зээр эмийг уу гэж сурталчилж бай­гаагаас биш уувал ийм аюултай гэдэг мэдлэг, мэдээллийг өгдөг нь бараг алга. Иргэдээ мэдээлэлтэй болгох нь салбарын яамны үүрэг. Түүнчлэн жороор эм уух хэвшил гэх үү, соёлыг бий болгох нь бас л энэ яамны ажил. Өдгөө хамрын ханиад хүрээд, оно­шоо тогтоолгох гээд очиход эмийн зөв хэрэглээг хэлээд өгчих эмч хэр олон байна вэ. Явж явж очиход нь өнөөх л өөрийнх нь мэддэг хэдэн антибио­тикийг бичээд өгвөл тэр хүн дараа­гийн удаа жор бичүүлэх гэж очих уу. Тэгэхээр эмч, мэргэжилт­нүүд энэ талын мэдлэгтэй байх нь чухал. Тэгж байтал эмийн санд суудаг эмзүйч нарын мэдлэг хэр билээ. Үнэндээ эмийн санчдын тухай яривал бүхэл бүтэн сэдэв гарна.

600 хүний дунд судалгаа авахад 45.8 хувь нь эмийг жоргүй худал­дан авдаг гэсэн бөгөөд үүний­гээ тайлбар­лахдаа 41.4 хувь нь эмийн сангаас асуухад хангалттай гэсэн бол 68.5 хувь нь эмийн сангаас жоргүйгээр эм худалдан авахад бэрхшээлгүй боло­хоор тэр гэжээ.  Өвчиндөө юу таара­хыг мэдэхгүй таавар тааж эм ууна гэдэг энгийнээр бодсон ч дэндүү эрсдэлтэй. Өнөөдөр үр дүн нь гарахгүй ч маргааш эмэнд дасал болсны гай гарч ирж л таарна. Үүнтэй холбоотойгоор хуучны боловч баримт дурдъя. Монгол Улсын Эрүүл мэндийн 2008 оны статистикийн мэдээгээр осол, гэмтэл, хордлого нь хүн амын өвчлөлийн тэргүүлэх таван шалтгаа­ны  тавдугаарт, 10 мянган хүн амд ноогдох нас баралтын тоогоор гу­рав­ду­гаарт бичигджээ. Улсын хэмжээнд 2003-2007 онд “эмийн хордлого” оноштойгоор эмнэлэгт хэвтэж эмчлүүлсэн 1588 хүний 211 буюу 13.3 хувь нь өргөн хэрэглээний антибиотик, 393 буюу 24.8 хувь нь унтуулах, сэтгэц нөлөөт эм, 213 буюу 13.4 хувь нь хаана ч ангилаагүй даав­рын эсрэг эм, 482 буюу 30.4 хувь нь амьс­галын тогтолцоо, араг ясны бул­чинд анхлан нөлөөлөх эмэнд хордож эмчлүүлжээ. Үүнээс гадна антибио­тикийн хордлогод гол төлөв 20–44 насны эмэгтэйчүүд илүү ихээр хор­дож, 0–4 насны хүүхдэд эцэг эхчүүд дур мэдэн эм өгөх замаар хордлогод оруулж эмнэлэгт хэвтэн эмчлүүлсэн байна. / “Эмийн мэдээ­лэл” сэтгүүлд 2008 онд хэвлэгдсэн мэдээлэл/

Эм, эмч, өвчтөн гурав Монголд хэзээ зөв хамааралтай болох вэ. Ингэснээр эрүүл мэндийн салбар бага биш мөнгийг хэзээ хэмнэдэг болох вэ. Хамгийн гол нь өвчлөгчдийн тоо бодитой буурах эсэх нь эмийн зөв хэрэглээнээс шууд хамаарна. Эрүүл мэндийн зөв тогтолцоо гэгч эндээс л эхлэх учиртай. Аливаа зүйлийн голдирол зөв болсон цагт аяндаа жижиг сажиг асуудал нь шийдэгдээд явдаг. Үүнийг шийдэхгүй бол хэдий болтол эмнэлгээрээ дүү­рэн гурав,  дөрөвдэх шатлалын өвчтөнүүдтэй, ачаалал, нерв хоёртоо дарагдаж суух вэ.

 

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