Heidi Alasepp: New brooms sweep better

What is your take on events in Afghanistan?

The situation today is very difficult to watch, while it makes sense if you’ve been there. I believe we need to learn to respect other religions and nations, while helping where we can.

Perhaps we should go back further. Visiting Afghanistan in 2007 was a turning point in my life. I felt great respect for life even before I studied as a doctor, and it only became stronger there. I remain a pacifist at heart and would end all aggression in the world were it in my power. However, my mission is to deal with the aftermath of war.

Wars have done a great deal to change medicine over the years. I learned how to handle it compactly and in a short time. Military medicine starts with health protection and goes right up to high-tech. My trip to Afghanistan also led to close cooperation with the Estonian Defense Forces (EDF) and wounded soldiers. Achieving good results on a journey can be inspiring.

By this journey, do you mean the creation of the East Tallinn Central Hospital Rehabilitation Center?

Yes. We opened the center in 2014, while it will never be finished as science keeps developing.

Rehabilitation is among the least prioritized fields in Estonian medicine. How did you manage to set up what is a modern center?

There was a lot we needed to prove at first, it took five years to open the center. But knowing you are moving in the right direction, that a lot of people need help lends strength. Broadly speaking, modern rehabilitation manufactures more health and joy.

Talking about money, I am very grateful still to the U.S. Embassy in Tallinn as opening the center took a lot of American and Estonian taxpayer money. We eventually managed to sign a contract with the Health Insurance Fund and start offering modern prostheses.

I believe that the passion to help people is what made it work in the end. Working with allies, I realized that what we could offer our servicemen in terms of rehabilitation could be of much higher quality. Once you achieve that new level, it will soon make its way from military into civilian medicine.

How does the center benefit the ordinary citizen?

There are several aspects involved. Firstly, having more patients makes it possible to employ specialists and a full team. Not just surgeons and nurses but also physical therapists and psychologists. Around 500 amputations are done in Estonia every year, which is several times what is required in the field of military medicine.

Secondly, I saw right away how soldiers’ attitudes and better rehabilitation inspired other patients who had been hurt in accidents. Restoring functions and using medical aids requires effort from the person. One cannot learn to walk or run with a prosthesis and keep that ability while lying in bed.

Thirdly, because Estonia is a very small country, we need to stick together and make use of existing resources to be stronger.

Where did you get the idea to run for deputy secretary general of the ministry?

I had come to a standstill in my current job to some extent. Major milestones had been hit and I was thinking about challenging myself abroad. I decided to give it a try when it became clear Maris Jesse would not be pursuing another term.

I saw that help was needed and felt I could offer it, while I was surprised to be picked. Some of my friends have seriously asked me whether I realize the difficulty of the path I’ve chosen, while I see my new office as a mission.

You know the ministry from 15 years ago when you worked as head of its healthcare department. What was the order of the day back then?

To be honest, I see many similarities between the periods. We were also putting together a public health development plan in 2006-2007 and organizing the Pandora international crisis exercise. The latter had to do with preparing for a major flu pandemic.

Could the old plan be of any use today?

Curiously enough, it could. I first dusted it off when I started monitoring the pandemic in Wuhan and Lombardy. The rehabilitation center has a good working relationship with the latter.

While the Covid situation is somewhat different, the framework is still useful and helps one stay grounded, courtesy of having done the mental exercise before.

Talking about teams, how did you get on with [Secretary General] Maarjo Mändmaa back in the day?

Maarjo was secretary general back then too. Our cooperation began even earlier, when he headed the government crisis committee and I was a member of the national crisis regulation team (2002-2004 – ed.). You get to know people in complicated situations, and our cooperation was smooth already back then.

What is your opinion of University of Tartu Rector Toomas Asser and Chancellor of Justice Ülle Madise’s criticism according to which restrictions are too universal and force people to spend time and money on regularly getting tested? Asser finds the obligation disproportionally severe when weighed against the effectiveness of random testing in slowing the spread of the coronavirus.

I have kept an eye on these decisions over the past 18 months. What I could say is that it would sometimes be possible to think measures through and explain them in greater detail.

As concerns testing, the accuracy, choice and availability of tests has changed a great deal in the past year and a half. Therefore, I deem it useful to review relevant regulations and adjust them as necessary.

Unfortunately, testing and masks come with the pandemic, while we also have an effective tool against measures – vaccines. As a doctor, I am very grateful we got a high-quality vaccine so quickly, while it is no coincidence – mRNA technology had been studied a long time before the coronavirus exploded and demonstrates our biotechnological prowess and reserves. We know from history how many lives flu pandemics claimed because there were no vaccines.

Doses of Covid vaccines line the shelves and are not being administered – the ministry once again lacks a plan. Instead of nationwide vaccination coordinator Marek Seer, we will have regional coordinators. Responsibility becomes more fragmented, while we are offered no explanation in terms of why it is necessary. What is your opinion?

I believe we will review these decisions in September. My crisis management experience suggests orders and the responsibility of teams need to be more concrete. I believe we can improve management and explain future decisions better.

One thing is for certain: everyone who wants to get vaccinated must have the opportunity. My colleagues and I have long discussed why people opt out of vaccination.

Real life experience shows that the reason, in most cases, is not poor health or principled opposition but various fears. The ordinary citizen often cannot find the advice of asking a doctor or a nurse in the mainstream media and vaccination websites.

Doctor’s visits are short – no more than 20 minutes usually.

Ask again and again. Doctors in our department also said that people come with back pain but end up asking about vaccination. I’m sure these conversations also reach the offices of psychologists. I encourage people to broach the subject, whereas time needs to be taken to do so. I saw the same effect in our team this winter. Not everyone is a doctor and answering every question proved effective. I believe we need to talk to people about vaccination openly and calmly that will allow them to make a knowledgeable decision.

I’m glad most people in society have realized that vaccination is not the doctor or nurse’s problem but a way to keep their job, meet friends and family and protect the weak. Employers are becoming increasingly active, whether we’re talking about vaccination buses or vaccination at the workplace, including employees’ family members.

In the end, overcoming the crisis is everyone’s business.

How do you feel about third doses?

I have kept a close eye on countries that have greater research capacity than we do.

Third doses will come because they reduce the likelihood of severe Covid, hospitalization and premature deaths. We still need to determine which vaccine to use and its effectiveness as an additional dose. I hope third doses will be free as they help keep society open. I hope we might have clarity in the coming weeks.

State Secretary Taimar Peterkop’s report decimated the Health Board’s handling of medicines and vaccines. Was the board victimized?

I do not think so because the damage was considerable. There needs to be very close monitoring whenever a new thing is developed in healthcare. When we were creating post-amputation rehabilitation, procurement and renovation of the ward was done with the help of top specialists from the U.S. I nudged people from the administrative service to visit the site and learn how to use what had been built. Work processes need to be constantly updated. Only a foolish nation fails to learn from mistakes.

How will you leave the East Tallinn Central Hospital? Hospital manager Ralf Allikvee left this summer and took a lot of experienced doctors with him. Is it the beginning of a downtrend for the hospital?

Definitely not. I know I will be leaving behind a functional and professional clinic its new head will develop further. As my mother puts it, new brooms sweep better.

Will new brooms be sweeping through the social ministry?

Sweeping will take place in the spirit of cooperation, and perhaps more in the sense of activities than people. Every executive has their style and I have mine.