Illness In The Institutions Of Health

On Monday (June 16) the polyclinic of the Clinical Center of Serbia was closed, and all specialized check-ups and diagnoses were canceled. The polyclinic now only admits patients for dialysis, citostatic users and those with organ transplants. Doctors who wanted to continue working have gone to their mother institutions and clinics and all urgent cases are forwarded to the Emergency Center, where doctors aren't on strike nor can be according to the law.

Chaos in the hospitals and the GP ambulances is overwhelming. The patients, muttering to themselves, make tours of all health institutions only to find they cannot get a prescription nor an appointment with a specialist. Those who have already been admitted to the hospitals or find themselves in a hospital bed as emergency cases are in safe hands up until the moment comes when their therapy demands medicine or specialist equipment which is out of order.

The medical workers, unsatisfied with their wages, block Belgrade's crossroads, threatening to stop issuing death certificates soon. They communicate with the citizens via union flyers pasted all over Belgrade hospitals, trying to explain that not only are they not getting their wages but that they have nothing to treat the citizens with in the hospitals and ambulances.

In the overall confusion, the part of the nation which is currently healthy is speculating about whether the union is working with the government and whether the strike is supported by the government itself while attempting to save on health costs by not treating the population, therefore enabling the entire "free" health care system to somehow survive until the elections.

As far as doubts of "joint" activities go, the situation is this: the union and strikers' leaders whom we spoke to are categorically denying a collaboration with the government whose resignation they are demanding, claiming that the story is being spread by the "powerful" people in the health institutions - their colleagues - who, thanks to corruption and fringe benefits, are living nicely even without their state wages. Dr. Stevan Djordjevic, president of the health unions of Serbia claims that in the impoverished hospitals there are no cuts left to be made and that the government had already tried everything with various half-public decrees in order to reduce the mandatory medical protection to a minimum: "Even if we weren't on strike we have nothing to treat the patients with in the hospitals. They can at least temporarily save some money by not giving us our wages. Operations were postponed even prior to the strike, people had to wait a long time for specialist check-ups, and we issued prescriptions which patients had to buy. Still, this strike wouldn't have occurred if the government had observed the agreement and had paid out our salaries on a regular basis". Djordjevic states that health institutions are literally ill and that 90 percent of the funds go towards the salaries of more than 130 thousand employees and only ten percent towards financial costs. The health system cannot survive with that proportion. As a doctor, he announces that a lot more problems lie in store.

"We are a union and we simply aren't interested in what is beneficial to the government. We have to live off something and we are fighting for our wages. We aren't to blame for the situation in the health institutions, for this poverty, for the long check-up and operations lists. A long time prior to the strike Milivoje Stamatovic, the general director of the Clinical Center, issued orders that we were to reduce our capacities and services by 30 percent and to schedule patients' check-ups every 90 or 180 days. Surgeons keep warning patients that they have to wait five to eight weeks to have an operation due to the lack of funds. The situation is truly alarming even aside from the strike, says Milka Kacarevic for VREME, a nurse at the Clinical Center and member of the Strike committee. She claims the entire Clinical Center is on strike and that the number of employees on the streets does not reflect the true dissatisfaction, since the majority are at the hospitals, maintaining the legal working procedure minimum.

After services had been deleted from the list of mandatory health protection in April of this year by a by-law act, the Serbian government has decided to, according to top hospital officials, "save money" on those who are ill. The medical workers' dissatisfaction (who had been ordered a long time ago not to inform the patients that there is nothing in the hospitals) has apparently come at the right moment for the government. It will postpone the collapse of the medical system and will lay all the blame and focus the patients' anger on the strikers. At the beginning of this week, after the Clinical Center polyclinic closed its doors, the government of Serbia once again, this time officially, threatened the strikers with a new act on the minimum working procedure during a strike in medical institutions, and all with the "goal to protect the interests of the citizens of Serbia". The union reacted noisily, claiming that it was a violation of the collective agreement act and that it would not be observed. As if in passing, the above mentioned announcement informs the public that "the medical workers have been given the first part of their April salaries and are therefore no exemption in comparison with the other public services which are financed from the republican budget..."

All speculations on who's fooling whom in the medical agony of the nation and the medical institutions which had survived war and the sanctions, and on who's supporting and working for whom become unimportant when facing the fact that no funds are allocated for medical treatment. The strikers could possibly be blamed for their gullibility and trust in the undeserving minister and government.

According to official data, in the first five months of this year the "main financier" of the medical sector, the Republican Health Care Fund, had a 1.6 billion dinars deficit. The monthly wages of all employees amount to 448 million dinars.

At the meeting held this week (organized by the parliamentary Democratic and Civil Alliance parties) on the health care system and reform possibilities, Dr. Zoran Vacic, president of the parliamentary health committee, warned that in the last year more than five billion dinars or 7.5. percent of the gross national product was allocated from the Republican Fund to health: "It has been estimated that an additional 4 billion dinars were spent outside of the health insurance system for patients' private clinic bills, medicine and bribes. By adding those two sums we arrive at 12.5. percent of the GDP spent towards health". Economists claim that far richer countries cannot meet such costs. In comparison, France allocates 7.4. of their GDP towards health protection, Finland 8.4. percent, the United Kingdom 6.1. percent leaving us at the top of the list with 12.5 percent. The US is the only country which spends more with 14 percent. Converted into actual sums, a huge percentage of the allocated funds in our condition boils down to 120 dollars per citizen, which is nothing for a country with contagious diseases and a high illness rate - primarily cancer and heart disease, and lately, mental disorders.

Unlike the above mentioned countries, no one answers to the tax officials as to how and on what the funds have been spent. Those close to state health institutions procure expensive clinics for themselves along with medical equipment and appliances. In the Belgrade hospital circle there are three appliances for magnetic resonance, each worth a couple of million marks.

The economist Aleksandra Posarac warns that the government pandemonium is paid by the insurers who have free social protection on paper only: "The rate of contributions which is collected from paid salaries exceeds 26 percent. However, the problem lies in the fact that more than 350 thousand employees don't receive their monthly wages. The same number of people work illegally and have no compulsory contributions. All in all, a small percentage of employees provide the financial backbone for the entire population. Instead of taking the necessary steps, the government is waiting; it isn't facing up to the health problems in a serious manner".

For now the government, at least publicly, isn't mentioning reforms in the overly large health-care institutions, let alone the redundancies. At this moment, they are engrossed with badmouthing the medical workers and inciting the patients against them, promising that in two months time things will be better. If we are to judge by previous experience, things have always been much smoother in pre-election months. Salaries and pensions arrive on time and medicine can be acquired with prescriptions.

We have been informed that no one is working overtime in the hospital morgue. They say that the situation is as usual, and that their activities have been reduced since the strike began. The New Cemetery in Belgrade refuses to issue such information to the media. Comparing this local strike with the one-month-long protest of the doctors in Los Angeles in the sixties sounds consoling as well, says Snezana Simic, a professor at the Medical School: "During the L.A. strike, the mortality rate dropped. We always mention that to our students. It stands as an example that medicine isn't almighty".