Back To The Middle Ages

The international and domestic public were recently shocked by photographs taken at the Special Neuropsychiatric Clinic in Gornja Toponica near Nis. Velibor Popovic, the Federal Health Minister, reacted by making it public that 209 patients had died in this clinic since the beginning of this year, which is more by 80 compared with last year. He also added that the situation at the hospital in Nis, one of the five similar institutions in the Federal Republic of Yugoslavia, is most critical, ``since they have accepted the patients who had been ``expelled'' from mental institutions in Macedonia.'' Popovic said that urgent measures had been taken. ``The following day we immediately sent 7 tons of food through the Red Cross, according to the specifications drawn up by the hospital. A package of necessary medicines has also been sent. The hospital's request to have priority in receiving heating fuel was accepted. 120 out of 250 tons, which was needed, has been provided. We've informed the High Commissioner for Refugees, the International Committee of the Red Cross, and other humanitarian organizations about the problem, so that food and medicaments are already arriving in large quantities through them.'' Humanitarian relief has helped the situation normalize of the last several days.

Some employees see this situation as more or less usual, if this is to be judged by the fact that Radomir Popovic, the acting director of the Gornja Toponica hospital and the two of his colleagues had to cut short their trip to a scientific convention on alcoholism in order to meet with Borisav Antic, the Serbian Health Minister, who got alarmed at the news about the death figures in Toponica.

New data pertaining to the number of dead patients were released in the meantime. According to the Belgrade daily ``Borba'' (November 21 and 22,1993), ``only'' 23 persons were officially recorded to have died, while the number stood at 87 according to the list drafted by the clinic's morgue. ``It is believed by and large that the cause of death is to be found in a lack of medicines, hunger and cold, all of which are a consequence of sanctions imposed by the international community. Dysentery, which followed a bout of typhoid and tuberculosis, is still raging in the hospital,'' the paper said.

The quantities of relief supplies which had been urgently delivered are said to be in contradiction with each other. Two tons of heating fuel from ``Jugopetrol'' and a truck of coal from the Soko mines are being mentioned in Gornja Toponica. A more serious intervention by the Serbian Health Ministry is still expected, and the hospital is under its patronage. Talking to VREME, Acting Director Radomir Popovic invited a scandal in a way. He said, ``The problem has been brought to public attention, and the situation has significantly improved since.'' No additional data on the mortality figures may be released because of improvement of the situation in the hospital. ``That's history now,'' he said.

In (what we would really like to believe is) the past, patients killed and maimed each other. They bit off each other's ears and noses, received injuries in fights, starved and froze in dirt over at least past five months. ``They ate soup made of water and flour and little carrot. And, then, tuberculosis, dysentery, and the like followed,'' Nadezda Radic, the head nurse said. She denied that a certain number of patients were released from the hospital and left on the streets of Nis as the ``crisis'' had been anticipated. According to her, there have been attempts to turn their problem into a political issue. ``It has never ceased to happen. Everybody has been trying to use it to their advantage. However, Slobodanka Gruden, the Mayor of Belgrade, was most helpful when she took a film about the hospital abroad. Our hospital was presented as a most severe consequence of sanctions.'' However, unlike this authorized approaching the world, none of the data can be made accessible to the public without the director's approval.

Conditions at ``madhouses'' in Nis, Kovin, Vrsac, Kotor and Belgrade, where some 5,000 patients are treated, are not any different. Tihomir Jovanovic, the former acting director of the Neuropsychiatric Clinic ``Dr Laza K. Lazarevic,'' explained how they manage to get what they need. ``I get the impression that the demand has to be specified by the fifth of the month so that things could function properly. In other words, one has to respect administration, which grew more complicated since sanctions were imposed.''

Medical treatment which lasts more than a month is provided in Padinska Skela. The situation with food is much worse there. ``We here are closer. As far as food is concerned we've always had bread,'' Jovanovic said and continued, ``But, there have been times when patients would get only tea for lunch and for dinner for a whole month at a time.'' The mortality rate is said to be ``usual'': 80 out of 100 patients die annually. 48 patients died from the beginning of 1993 to the end of September. ``The mortality rate has dropped. Actually, it is the number of patients in delirium that decreased. However, we're expecting an increase since the season of making plumbrandy has begun.''

``Madmen'' are dying and winter has only started. Pictures of naked patients and starved faces of ``lunatics'' are a horrifying reminder that we're not alone and that it can be much worse. Of course, on condition one has time to look at the pictures in papers. Mental patients are most often the first to be affected by a social catastrophe. Unable to articulate their right to basic living conditions, let alone realize it, they survive naked in the lap of their fellow sufferer. ``The pictures from Toponica are the first in a series of live broadcasts and reports from the spot of horror we are bound to be watching this winter,'' one Belgrade doctor said.

Social medicine experts claim that quoting sanctions as a cause in such and similar cases is an excuse for many more drastic causes. Both medical and those ``real'' politicians could hardly wait for sanctions, which they would blame for a fall of health care standards over the past few years. They have actually abandoned a problem. Sanctions thus cancel a need to explain why there in no money for health care or where it was spent over the three years of war. It is much easier to deal with ``international antiSerb conspiracy'' and refuse humanitarian aid from ``hostile Germany'' in a dignified way, as it happened before.

Doctors who are making an effort to establish the problems in the national health care on request of international organizations must force usable data from local doctors who by rule welcome them with tirades about the effects of sanctions on the import of medicines. Other valuable data recording the loss of weight of all patients and epidemiological statistics showing that a number of diseases have become more frequent do not seem to matter: increase in the mortality rate from dysentery in the Yugoslav state continues to be regarded as a strategic and confidential information.

The Hospital Scene

The Mental Hospital in Kovin entered the winter of 1992 with debts for delivered food, no heating fuel, the alcoholics' ward shut, the action of fighting an epidemic of white lice and with fears that many will die of lung infections, malnutrition, feebleness, lack of resistance, old age, abandonment and oblivion. ``Gods'' and ``Napoleons'' were eaten by lice (see VREME, February 8, 1993), while directors and staff made statements that ``they obtained and used no less than 12 to 14 per cent of necessary medicaments. We have no idea how we'd make it if there weren't for private businessmen, the Red Cross, the Serbian Orthodox Church and the Soros Foundation.''

Doctor Nada Mokan then disclosed that some hospital wards did not even have light bulbs and described frightening scenes of her trying to reach a patient at night, ``He's lying on the floor. I turn him around and by moonlight coming through the window I make out spots on his chest. I touch him and spots disperse. Those were lice forming clusters on his chest.''

By the end of summer this year patients at the Mental Hospital in Kovin we losing on average 1.7 kilos each month, as according to medical records. In other words, they entered winter without a protective layer of fat subcutaneous tissue, clothes (like in Toponica), blankets, heating, adequate diet or medicines which would calm them down thus slowing the loss of energy. Judging by a harsh beginning of winter they are doomed to freeze to death. They say this is still better than dying of hunger.

The scene in the ward with most serious mental patients could have been painted by Breughel. ``We are wardens, rather than doctors,'' said Doctor Bojana Simic from the psycho geriatric ward where patients sleep on mattresses soaked with urine. Patients who don't take medicines have to be physically restrained every day. This would happen more frequently but the doctors and staff in Kovin are with the patients all the time thus trying to compensate for lacking medicines with communication. That's the strongest impression which one carries out of this hospital. It's perhaps because it offers a ray of hope and optimism. If one takes into account that no medical and legal regulations are being enforced and that no one can remember a doctor being taken to court for negligence, it can be said that medical ethic is at a relatively high level.