Global Independent Analytics
Radostina Schivatcheva
Radostina Schivatcheva

Location: Bulgaria

Specialization: Sustainable development, International relations, Comparative European politics, European integration, Eastern European politics and EU-Russia relations

Healthcare Bulgaria Ltd. Baby, do not cry ...

The Bulgarian Ministry of Health has just received an open letter, which reads: "The Hell of Dante is a pastoral picture compared with the Bulgarian health care system and its 101 ways of torturing people".

The reason for this dark comparison is the newest fee levied on the Bulgarian patients. Now mothers, who wish to remain in the hospital with their sick children must pay between 2.50 and 75 euros per day. Many parents, who receive the average monthly salary of 150 euros, can not afford the 'luxury' to accompany their children during the time of hospitalization, so the infants are left alone. The Deputy Minister of Health Dr. Boyko Penkov admits: "It is sad, but it is legal. A mother, as a companion to the child, is billed as an uninsured person and every hospital has the discretionary power to introduce a fee for the mother's stay."

The fee varies, depending on what kinds of 'services' the mother chooses to access while accompanying her sick child. For example, a fee of 7.5 euros per day allows the parent to access the following hospital 'services': hot and cold water, electric lighting, bathroom and toilet, as well as heating. If a parent wants to sleep beside her / his child in the hospital, she / he will have to pay more. The mother of a child, undergoing a treatment in Pirogov, the biggest emergency hospital in Sofia, testifies about the conditions that paying the 'companion' fee entitled her to: "The general ward room is 4x5 m with 5 beds for small children. If there are mothers present - the women have to squat or even sleep on low children's chairs between the beds. After the lights are turned off, some children start to cry; this is normal, because they are small children, some of whom have undergone surgical procedures. The other children can not sleep because of the crying and the whole experience becomes a nightmare. Furthermore, in the darkness brazen cockroaches begin crawling on the walls, and the bugs even crawl on the beds, so this is something, which I have also been doing throughout the night - killing the cockroaches before they would wake up my son ".

Die Hard on the road to Gattaca

The health care system has little compassion for the adult patients as well. The succession of post-socialist health care reforms have meant the creeping privatization of health care, which has entailed greater funding cuts and smaller financial support for the suffering sick. The latest 'successful reforms' of the early winter of 2015/2016 have put in harm's way the diabetics, the cancer patients and once again, the newborn babies. The newest funding cuts are so severe, that even if the sick have made regular contributions to their health insurance, medical help may be out of their reach at the time of their greatest need.

Now the National Medical Insurance Fund (NMIF) will no longer fund the medications of 15,000 diabetic patients. Financially, this measure will save the government 750,000 euros per year. The personal and social impact of these 'savings' will be harsh and even deadly. Now pensioners, suffering from diabetes, whose pensions could be as low as 75 euros per month, will have to pay 25 euros per month only for one particular medication. The medication, which is deemed non-essential by the Bulgarian Ministry of Health, helps ensure the correct blood circulation in one's arms and legs. A diabetes' sufferer grimly explains the implications: "One must take these medications for life, if one wants to keep one's legs and arms. So, if you have money you will live, if you do not - you will die ".

Cancer patients could also be left without medications. According to the new directives of the Health Ministry, NMIF will not reimburse medical expenses, exceeding a certain limit. This means that if the limit has been reached, either the hospitals or the patients have to cover the costs of the treatment. Frequently such treatments cost thousands of euros per month - a sum well beyond the means of the average Bulgarian.
 
Yet 'control of the expenses' rather the affordability of the medications is the goal of 'fingerprint testing' - the new administrative measure to be implemented by the Ministry of Health. Patients who are to be hospitalized, and those who purchase subsidized pharmaceuticals, could access medical care only if their identity is confirmed by their fingerprints. Dr. Komitov, head of NMIF, approves of the 'fingerprint testing', because "We can control the hospitalization and the de-hospitalization of the patients with greater probability". According to the Health Ministry, this new measure will make it easier to control the issues of the "NMIF monetary drain and the sale of drugs under the table". Consequently, now every hospital and pharmacy must buy devices for fingerprint identification by the end of April, after which the device must be connected with the software of the NMIF.

Accessing healthcare, which is a human right and part of the United Nations Charter of Human Rights, based on fingerprint identification raises serious ethical issues, which are not only personal but also social. These issues should be a matter of public debate in which the Ministry of Health communicates honestly with the citizens on the matter, weighing in favour or against the fingerprint testing. Regrettably, the concerns that the Ministry is voicing are about money, rather than about the health and well-being of its citizens.

The silence of the state and the 'medicinal liberation theology' of Revd. Fr. Nikolay

The Ministry of Health clearly has forgotten the Hippocratic oath: "I will apply, for the benefit of the sick, all measures which are required". Meanwhile, it falls on the medical professionals to both treat the sick and to stand for their social rights. Dr. Kalin Kalinov is a director of the oncology clinic in the city of Plovdiv, the second largest Bulgarian city. He states: "The Bulgarian medics want a dialogue with the state and with the institutions, but such dialogue has been lacking". Dr. Kalinov has been alarmed by the new administrative procedures which he qualifies as 'deadly.' The doctor assured that no patient has been returned, but cautioned that the patients are under the truly grave threat of being refused treatment, since the hospitals, which are now Limited Trade Partnerships, are incurring very large monetary deficits. The doctors pleaded for help from the state in order to ensure the availability of vital medications for Bulgarian citizens. Dr. Kalinov states: "We have not been invited to a discussion, in spite of our numerous letters".

Under the 'care' of the right-wing government, the Bulgarian health care system is increasingly failing the sick, yet the opposition parties, including the center-left Bulgarian Socialist Party (BSP; also a member of the Party of European Socialists), have been shamefully silent about the issue and its potential cures. It fell on Reverend Father Nikolay, the bishop of the city of Plovdiv, to denounce the troubling situation. "The lack of medications for the Bulgarian cancer patients is a genocide", the bishop said.
 
Father Nikolay led a prayer for health in the oncology clinic in Plovdiv, and the words of his 'medicinal liberation theology' sermon should have been expressed by the BSP's oppositional party-leaders from the parliamentary tribune. The church Father stated: "Our society has endured reforms for 25 years now [since the fall of Bulgarian socialism], but we are getting worse off as a result of these reforms. The educational reform made the people illiterate; the economic reform resulted in the privatization of factories for 50 cents, the healthcare reforms made the people more ill ".
 
The ailing condition of the much-reformed healthcare system is illustrated by another very recent scandal. The Bulgarian National Television recently aired the first part of a documentary movie by the investigative journalist Valya Ahchieva, which traces the exchange of two vaccines between Bulgaria and Turkey; the exchange took place in September 2015. The Bulgarian government received from Turkey a donation of 100,000 units of the 5-valent vaccine "PENTAX" and donated to Turkey 5 million BCG (anti-tuberculosis) vaccines. The vaccines imported from Turkey were not authorized for use in Bulgaria, as their adherence to the European standards has not yet been proven. Moreover, the importer of the vaccines had not adhered to the necessary administrative procedures. Similarly murky is the way that the Bulgarian BCG vaccines have been exported to Turkey. The export has taken place before the process of the vaccines' testing and their appropriate quality control have been successfully completed.

'Guns, germs and steel'

While the Bulgarian sick have to resort to prayers, the Bulgarian Consultative Council for National Security has made the decision that in 2016 the national defence budget will be 2% of the national GDP. In this case the center-left parliamentary opposition clearly expressed its disagreement, especially in light of the 8 million euro loan which the government has recently taken.

The leader of the Bulgarian Socialists Michail Mikov stated that: "There is no way we are not worried, when the President advocates that Bulgaria will be forced to pay from the country's taxes 2% of the GDP for arming and rearming. It is a strange request, since we remember the assurances that the 8 billion euro loan will not be used for the purchase of military equipment ... And why to use this money for fighter radars, and not for education, health care, to increase pensions and salaries, to stimulate the birth rate and to integrate excluded groups? ... It does not matter how modern is the tank in which you conduct military exercises, if you do not have enough money for your child's education or for ensuring the health of your parents ... "

As for the Bulgarian social media - it is indignant, claiming that it is a crime that the poorest EU state gives billions for weapons, but not for healthcare, education and pensions. Yet even the most powerful social indignation needs the leadership of a political party in order to achieve a lasting change. While the most influential center-left political force, BSP, is only timidly making small and inconsistent half steps, it has fallen on the medical professionals, and even on the church to sound the alarm. Journalists asked Dr. Kalinov, the director of the oncology clinic in Plovdiv, what will happen with the patients if the situation continues to develop in a similar manner. The man of science and medicine answered unambiguously: "If things go on like that - God help the patients!"
 

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