The Health System Has Blocked, Everyone Copes on Their Own

Стойчо Кацаров

Dr. Stoycho Katsarov is chairman of the Center for Protection of Healthcare Rights. He was a Member of the 38th and 39th National Assemblies, District Governor of Sofia District (1997-1999) and Deputy Minister of Health (1999-2001).

Dr. Katsarov, the prime minister has ordered recently that exported stations should open in front of each hospital – both state and private – where the patients are quickly diagnosed and referred to the necessary medical care. Were they supposed to be tents for military-field hospitals?

It’s another idea ad hoc. No clear purpose, no content and no financial provision. Almost all treatment activity associated with coronavirus is loaded on hospitals. Now Borisov assigns them another activity, which is outpatient in its content. At the same time, most outpatient medical facilities are isolated and practically removed from the fight against coronavirus. Anyone who knows at least a little bit about health care organization will see that this is a mistake. The Prime Minister has either to stop meddling in something he doesn't understand or sack his advisers because it will do more damage than the pandemic.

Should we accept for accidents the series of deaths of patients in Sofia, Burgas, Plovdiv, Dupnitsa, who failed to receive medical care because the hospitals refused to accept them, even to examine them – supposedly because of a lack of beds?

The series of uniform cases shows that this is not about individual incidents, but about a systemic problem or, more accurately, for the lack of any organization of processes.In Sofia, for example, 74 hospitals with more than 12,000 beds have been opened. According to the Health Insurance Fund (the interview was taken on November 5) less than half of the beds are occupied at the moment, 41 percent only.

Annually, hospitals in the country carry out over 2 million hospitalizations. And in the last seven months, fewer than 10,000 hospitalizations of patients with coronavirus have been performed, i.e. 0.5% of the total only.

So what is this system in which COVID patients now have to look for beds themselves and which "offers" people access to medical care against negative PCR tests only, that in most cases they themselves have paid for?

Health authorities claim we are short of medical specialists?

In Sofia, 900 general practitioners and over 5000 doctors in the specialized outpatient medical care are registered. Adding to them those working in the already mentioned 74 hospitals, it "suddenly" turns out that nearly 9,000 medics work in the capital alone, plus another 3,500 health care professionals…

However, the government is seeking volunteers for hospitals after the majority of their staff has been idle following the ban on carrying out planned operations. The government is urging students to get involved in the battle, even though hundreds of outpatient doctors are excluded from the anti-coronavirus organization in such a way that they are not even allowed to issue testing directions to their patients.
They were left to fend for themselves without even being provided with protective equipment. And on top of that – today they are paid less than in the days before the pandemic.

What's going on with district health inspection (DHI) employees? Aren’t they struggling as well since no one's talking about them?

There are about 300-350 employees nationwide. They must carry out a local epidemiological study in each case of a positive PCR test, trace contact, issue them with a quarantine prescription and monitor compliance. However, it is unknown why some of them are hanging at border crossings 24/7.

It's a bloody situation. If 2,500 positive PCR tests are registered today, each DHI employee will have to visit between 50 and 100 people to serve them quarantine prescriptions and to monitor everyone's compliance with quarantine at the same time. In addition, they must monitor and control the wearing of masks indoors and outdoors, the work of catering establishments, the curfew of entertainment establishments, compliance with measures in schools…

Let's stop here. This is the picture of a catastrophe that is gaining more and more real dimensions and already has casualties. From March until now, the government had all the time in the world to reorganize the system. Almost eight months later, however, we don't even have a plan. This leads to panic and fear, which instead gives rise to a desire for reinsurance. We see the result – late reactions and poor management decisions at all levels. Poor organization limits the possibilities of response and people are forced to take care of themselves.

What will be the fate of patients with other diseases following the health minister's order suspending examinations and planned operations in hospitals for the areas with more than 120 patients per 100 000  by November 30?

This is another gross mistake. Without constant medical supervision, the condition of patients with chronic diseases can worsen and many treatable diseases – remain undiagnosed. If the ban lasts too long, more people will die because of it than from the coronavirus. Hospitals are not a breeding ground for infections. They have a system and organization to fight infections. Doctors can separate the contagious from the non-contagious patients. That's part of their job. The epidemic in "Pirogov" is the result of bad decisions onsite, it’s not a generalized problem. And therefore it should not be used as a motive for banning all activities in all hospitals.

How will you comment on the lack of epidemiological analysis, bearing in mind it has been eight months since the beginning of the crisis?

The central health administration has proved incapable not only of preparing an epidemiological analysis and a plan to combat the epidemic, but even of making – by their own admission – a short-term prognosis. Since March, the health minister has issued more than 70 new orders rescinding at least half of the orders previously issued. And 95% of the citizens of Bulgaria have probably not read any of them.

The problem is that, in general, the epidemiological analyses and forecasts that the Inspector General prepares by law are kept in a deep secret. Why? Isn't it right to inform everyone – medics, citizens, regional and local authorities?

There is only one explanation for this absurdity – the analyses themselves are not for display because they are superficial, do not contain any essential information, and there is no evidence of the need for a state of emergency. If there's another explanation, let them give it.

The root cause…

For years now, there has been a misguided health policy. GERB created and patronized a handful of health aristocrats, while the orderly medics were consistently to blame for all misfortunes.

In the fight against COVID, however, the anointed cannot help and they do not seem to want to. The health administration is filled with incompetents whose unfitness to propose and implement policies is best seen in the current crisis situation.

The new health minister's desperate attempts to put order with calls for solidarity and threats of sanctions have not yielded much effect both because of the lack of a clear plan and because of the depleted credit of trust in power. That doesn't bode well and the worst is yet to come.


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