KIEV (Reuters) - Family doctor Dmitriy Rozumiy struggles to bridge the gap between what his patients in rural Ukraine need and what the country’s cash-strapped healthcare system can provide.

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His clinic in the village of Ivankovichy, 35 kilometers outside Kiev, uses Soviet-era medical equipment and lacks basic supplies. Life expectancy in Ukraine is on average five years shorter than the European average, according to the World Health Organization.

Rozumiy, 51, has worked as a general practitioner since 2014. Before that, he worked as a cancer surgeon but he gave up because budget cuts were causing late diagnoses and leading to lower survival rates.

His current patients are mostly children and pensioners. Many working age adults choose not to be treated because they often cannot afford the medicines that are available.

Recently, Rozumiy said he has seen some improvements since the start of a Western-backed reform drive.

“There’s a desperate need,” he said, expressing a hope for faster change. Patchy implementation of the reform drive has raised questions about Ukraine’s ability to modernize after a pro-European uprising in 2013-2014.

Last October, parliament approved a long-delayed overhaul of the health system following international pressure to speed up reform.

“I hope ... this will give us a chance but if this turns out to be yet another bluff, well then we’ll lose everything,” Rozumiy said.

He said recent positive changes include the launch of programs to improve treatment for military veterans and help pensioners gain access to certain medicines.

But times remain tough, forcing Rozumiy to consider halting some home visits as he cannot afford the petrol costs for his car on a salary of around 6000 hryvnias ($230) per month.

His clinic’s decrepit central heating system occasionally fails in the middle of winter, prompting parents to keep their children bundled up in snow-suits during consultations.

Ivankovichy is far from unique. Hospitals across the country of 42 million are crumbling, underpayment of medical staff has prompted many to quit and Ukraine’s vaccination rate is one of the worst in Europe.