Stanislau Salavey: The Belarusian Healthcare System is Destroyed, and It Needs Treatment

Stanislau Salavey. Krakow, Poland. April 14, 2024. Photo: Karolina Nowicka / Belsat

In 2021, Stanislau Salavey left Belarus and worked for two years as an obstetrician-gynecologist in Ukraine, then moved to Poland and joined the United Transitional Cabinet, where he is responsible for the healthcare block and a project for reforms during the transitional period.

Stanislau Salavey — a graduate of BSMU. Since 2016, he worked as an obstetrician-gynecologist and ultrasound diagnostics doctor at the 3rd Clinical Hospital in Minsk, previously undergoing an internship and working at the RNPC "Mother and Child". In 2019, he received an award for scientific activity. During the pandemic, he sought fair COVID payments. In 2020, he participated in solidarity chains and protest actions, was arrested twice, and was part of the independent medical trade union "Panacea". After the chief doctor of the 3rd hospital suggested he "resign amicably", Stanislau made it public.

From the Conveyor Belt of Cruelty to Hospital Pressure: How the Big Repressive Machine Reached Everyone

— Looking back at 2020: what surprised, scared, or impressed you the most — as a doctor and as a person?

— The election results were not a surprise to anyone. Everyone understood perfectly well that there would be no fair elections; falsifications were expected. It was also no revelation that the security forces in Belarus are capable of brutality.

But the scale of what happened after the elections — that was a shock. The fact that violence became widespread, conveyor-belt style, that detention centers were effectively turned into torture camps, that this was done demonstratively and on such a scale — I think no one could seriously imagine that. The scale of repression, the attempt to suppress the first wave of protests — there was nothing like it in the modern history of Belarus.

And even that was not enough to quickly break everything. It was necessary to activate a long, sticky repressive machine: a year of methodical pressure until public forms of protest were completely suppressed, which then re-erupted in the context of the war in 2022. The country de facto entered a semi-military state — with censorship, legalized torture, and blatant disregard for laws. And this, of course, greatly changed the internal perception of reality.

— What was most painful for you about leaving the 3rd capital hospital: the dismissal procedure itself, the pressure, the feeling that the system breaks those who don't keep silent?

— It's harder to talk about it now; so much has happened since then that the dismissal no longer seems serious in that context: two emigrations, life in a country at war.

Even then, it wasn't perceived as the "end of the world." Of course, it was unpleasant: the 3rd hospital is where I developed as a specialist. "Lived at work" — that was me. I truly came in at night when needed, even outside my shifts.

But looking broader, it all looked like a circus: the country has a chronic shortage of doctors — yet the authorities do everything to exacerbate this deficit. They expel dissenting students, push out doctors who dare to have opinions. The team that formed in our department, in my opinion, was one of the best in Minsk in terms of skill and volume of operations. And this team was quite quickly disbanded: more than half of the core staff resigned within a year. Formally, the department was not closed, but the level and volume of work noticeably decreased.

Павялічыць

Stanislau Salavey. Photo from personal archive

The question is — who was hurt more in the end? The system and the patients. This is very indicative of the authorities' approach: the key task is to squeeze out dissenters, even at the cost of destroying functional structures. First, people are practically pushed out of the country, told: "get out, you're not needed here," and then when there's no one physically left to work, they start talking about "hundreds of thousands of migrants" who supposedly will come and save everyone.

Ukraine as a "Here and Now" Salvation, Which Later Turned into Life Amidst War

— When you were choosing where to go, why did you choose Ukraine?

— You have to understand my emotional state. From the realization that I would have to leave to the final decision, it took literally a couple of days. Ukraine was in the category of "quickly get out to where they can't reach me, and then I'll figure things out definitively."

I had an intermediate level of German, theoretically I could have looked at Germany. But in Germany, that would have meant a long period without work: language training, exams, bureaucracy. In Ukraine, it was much easier for a Belarusian doctor to enter the system then: the language is similar, documents are processed through clear schemes, and the medical work culture is closer.

I must say honestly: I never dreamed of "leaving forever." The most I ever thought about before was working abroad for some time. Friends and colleagues played a huge role. While I was recovering, I simultaneously sent out resumes based on the principle of "I'll try and see." Thanks to friends from Odesa, an offer came with very good conditions, and at some point, I thought it would be strange to refuse it.

I think the feeling of temporariness also played a role. It seemed like it was about a year or a year and a half of work, not an irreversible intention to change country and life. Ukraine at that moment looked like an option where one could quickly return to familiar work and not fall into a multi-year bureaucratic pit.

Павялічыць

— You lived in Odesa for two years under full-scale war conditions. What were your daily life like: work, routine, fears, communication with patients? What was the most difficult?

— I remember February 24, 2022, very well. The day before, I was still convincing a colleague that there would be no war: it's a war that cannot be won, there's no logic to it. I learned about its start essentially from the arrivals: the first strikes on Odesa were in the morning, quite close to us.

Odesa was bombed from the very first days. The city emptied, checkpoints appeared, queues, limited shop hours. The usual picture of life rapidly disappeared: bank accounts, logistics, everything that seemed stable. For foreigners, especially Belarusians, this added to the challenges: cars could be scratched, tires deflated, official structures treated you with conscious distrust — these were everyday, but very telling details.

The planning horizon sharply narrowed. You live from today to the end of the week. When there are intense shellings for several nights in a row, you simply exist during the day in a "I want to sleep" mode. There was a moment when, after a long series of night alarms and "Shahed" drone strikes, I went to bed thinking: "Just land and explode already, just let me get some sleep."

The clinic, meanwhile, continued to operate. Patients understood everything; we were all in the same informational field, there wasn't much to discuss anymore — everyone lived with the same level of anxiety. Over time, a person gets used to almost everything. I understand very well the people who continue to live in front-line cities now: there comes a moment when war becomes background noise. As a result, I lived in Odesa for a little over two years under wartime conditions.

— Why did you leave Ukraine?

— The reason is bureaucratic. I didn't manage to renew my passport in time. At the moment when it was time to submit documents for renewal, a law appeared that prohibited changing passports outside of Belarus. And that was it — you find yourself in a legal loophole.

You have a residence permit in a country where a full-scale war is ongoing, and it's supposedly indefinite. On the other hand, it's tied to a document you cannot update. There's no embassy, you cannot go to another country where there's a consulate because your passport is expiring. After some time, you turn into a person with an expired document — and that's a completely different reality.

Formally, applying for asylum remained an option. But I know only isolated cases where people received refugee status in Ukraine. In most cases, it's either rejections or a story that takes many months, if not years.

Poland here is a result of the Dublin Regulation: you must seek protection in the first country you entered or where you have a visa. I had a humanitarian visa on an expiring passport, and I came to Poland to apply for protection and somehow conclude this story. From a practical side, friends and acquaintances helped a lot: where to live, how to open an account, how to talk to officials.

Between Doctorina, Clinic, and UTC: What Stanislau Salavey Does Now

— Where do you work now?

— Currently, I have several areas of work, but my main income comes from the IT project Doctorina — an artificial intelligence-based platform. The idea is to develop an AI-based doctor that can address the medical needs of people who, for some reason, lack access to doctors: to provide a quick explanation of the situation, a second opinion, or advise where to seek further help.

In parallel, I work part-time as an assistant in a Polish clinic. The goal is very simple: to learn the language faster, better understand the system, and adapt. In the future, I would still like to return to practicing as a gynecologist.

I have already confirmed my Belarusian diploma in Poland, but this is only the first stage. To become a practicing doctor, one must pass a language exam, a professional exam, complete an internship, and then a residency. This takes years.

And, of course, there's also work in the United Transitional Cabinet.

— What are your responsibilities in the United Transitional Cabinet?

— My task in the cabinet is, first and foremost, the healthcare block: situational analysis, planning steps for system reform, working with vulnerable groups, and medical expertise for political prisoners.

Павялічыць

Stanislau Salavey. Krakow, Poland. April 14, 2024. Photo: Karolina Nowicka / Belsat

We strive to move the topic of medicine from a mode of heroization, where medical professionals are only spoken of as heroes, to a mode of normal problem discussion. Because the system is destroyed — and it needs treatment. And if reforms are written only by medical professionals, no one but medical professionals will like them. Therefore, we involve economists, lawyers, patients, and people who understand how processes are structured. Belarus is unique in this sense: here, the interests of officials are placed above the interests of both patients and doctors.

Now we are talking not so much about reforms as about "sanitation" — an attempt to stabilize the system in the first hours, days, and months after changes, so that it simply does not collapse. Because "better immediately" will not happen. And bringing doctors back from emigration is extremely difficult: salaries in medicine differ by many times, and people have few objective reasons to return. Therefore, it is important to understand what can be done in the country here and now so that the system does not completely fall apart.

— You work part-time as an assistant in a Polish clinic. If you compare this income with what you earned as a doctor in Minsk, what's the difference?

— When we start talking about salaries, the difference becomes even more palpable. I understand that an assistant in a clinic is not the same as a full-time specialist doctor. But even my part-time work as an assistant here earns more than a doctor's salary in Minsk, if you convert it to raw euros. In Minsk, I worked more than one shift; here, the income level is different. Of course, expenses are also higher: housing rent in Poland and Minsk is chalk and cheese. But when talking about specialist doctors, residents, a Polish doctor can easily afford housing, a mortgage, a car, holidays, travel. For them, it's not "wow, incredible luxury." It's a normal outcome of normal work. Comparing it to the Belarusian reality here is simply painful.

— Would you return to Belarus if such an opportunity arose?

— Now I can honestly say: for now — yes. But I am very cautious about any categorical statements on this topic. Life and war have shown: what a person says does not always coincide with how they behave in a real critical situation.

I saw this with the example of Ukraine. There was a Ukrainian doctor who, before the war, very loudly declared, "If it starts, I'll take a rifle and go," but when it started — a couple of days later, he was volunteering somewhere near Rotterdam. And there was another example — a very calm anesthesiologist-resuscitator who never beat his chest and lived an ordinary life. But when military equipment started approaching his city, he simply sent his family to Europe and started going to work with a hunting rifle. That's why I'm cautious about phrases like "I will never..." or "I definitely will..."

One more thing needs to be understood: the longer a person lives in another country, the deeper their roots grow. Work, language, children, school, social connections... If you already have a stable job in a clinic, duty schedules planned months in advance, colleagues who rely on you, the question "can I drop everything tomorrow and leave" ceases to be abstract. This applies not only to doctors, but for medical professionals, the situation is particularly complex: confirming a diploma and integrating into the system is a long journey, and the further you've progressed on it, the more expensive a sudden reversal becomes.

I understand very well that the return rate among medical professionals will be lower than among many other professions. Even now, I am confident that a significant portion of colleagues with whom we work on reforms will not return. And that's normal; no one is obligated to sacrifice their life and family for a symbolic gesture. Therefore, my honest answer is this: currently, I would like to return if a real opportunity arises to return to a free Belarus and be useful both as a doctor and as a person. But such questions are ultimately answered not in interviews, but at the moment when that opportunity truly arises.

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