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Culture Shock: Hospitals still shock even most jaded

That the Slovak health-care sector is in crisis is old news not only to Slovaks themselves but also to foreign residents of the country.
The current system of funding - in which working people, firms and the state pay premiums to health insurance firms, which in turn fund hospitals and treatment - is not working, but finding a better way has proven beyond the powers of those in charge. And thus, every six months or so, the price of drugs goes up, another hospital declares a state of emergency, and a chorus of complaints is heard, from citizens about medical care and from medics about their abysmal salaries.
Not that the sector is entirely without income. Bribery in health care is standard: retired patients distribute candies and coffee, pregnant women give obstetricians 5,000 Slovak crowns ($100) and more to 'ensure' proper care during the birth of their children, and richer patients pay into five figures even for non-elective surgery, and of course far more for plastic surgery. Polls carried out by the Focus agency in 2000 showed that Slovak citizens regard health care as the most corrupt sector in the economy.


A visit to a Slovak hospital can be a painful experience, but some doctors go beyond the call of duty for their patients.
photo: TASR

That the Slovak health-care sector is in crisis is old news not only to Slovaks themselves but also to foreign residents of the country.

The current system of funding - in which working people, firms and the state pay premiums to health insurance firms, which in turn fund hospitals and treatment - is not working, but finding a better way has proven beyond the powers of those in charge. And thus, every six months or so, the price of drugs goes up, another hospital declares a state of emergency, and a chorus of complaints is heard, from citizens about medical care and from medics about their abysmal salaries.

Not that the sector is entirely without income. Bribery in health care is standard: retired patients distribute candies and coffee, pregnant women give obstetricians 5,000 Slovak crowns ($100) and more to 'ensure' proper care during the birth of their children, and richer patients pay into five figures even for non-elective surgery, and of course far more for plastic surgery. Polls carried out by the Focus agency in 2000 showed that Slovak citizens regard health care as the most corrupt sector in the economy.

While not so long ago, doctors taking these payments would at least affect reluctance, waving the money off with a "you shouldn't have, please put it away," today doctors often don't even say thanks as they pocket the cash. At least, that's how it was when I gave birth to my son. And having talked to doctors, nurses and friends since, I have every reason to believe my case was typical.

People have this fixed idea that if they happen to find themselves hospitalised, everyone simply has to bribe or pay a 'surcharge', otherwise they won't receive proper care. And so it is that nurses commonly get coffee or flowers, doctors thin envelopes, or not-so-thin envelopes. Every patient who pays these bribes secretly believes that his 10,000 crowns will prevent him from dying on the operating table - much like a lucky charm - or at least will ensure him the kind of care reserved for King Midas.


A photocopier or new sheets? One Slovak purchased bedsheets worth 25,000 crowns for a local hospital, but said the gift was unappreciated.
photo: TASR

A hospital with a difference

The shortcomings in the health service could fill a book; they certainly won't shock anyone, culturally or otherwise.

What does bring people up short, however, are moments when doctors, and hospitals, defy expectation. Such was the case of Karol, a 45 year-old admitted to the psychiatric wing of Fakultná Hospital in Bratislava in January 2001 with severe depression. During the course of his rehabilitation, which included group sessions in front of 20 other patients, Karol related the following story.

Three months before, Karol's wife and two daughters had been standing at a bus stop in the southern Slovak city of Komárno when they were hit and killed by a truck. Karol was left alone. His parents-in-law, with whom Karol and his family had been living, put him out on the street.

Having spent all his money meeting funeral expenses, Karol moved to Bratislava penniless. He says he was even beaten up by a transport cop on a bus, since he was travelling without a ticket and didn't have enough money to pay the fine.

He was picked up off the street one night in Bratislava by an ambulance, suffering from dehydration and mental confusion. Doctors diagnosed his condition, prescribed medicine and treated his black eye. They fulfilled their legal duty to the patient - but to the surprise of Karol, and those to whom he later related this story, their care for the penniless, homeless, 'bribe-less' man did not end there.

On his own steam, the examining doctor got in contact with the hospital's 'social nurse' (who takes care of the interests of patients who are not capable of looking after their own basic needs), and between them they found Karol a job and a place to stay in Bratislava. They did it without payment of any kind, and went far beyond what their jobs demanded.

Hospital on the other side

Just as unsought kindness and generosity can be shocking in the health sector, so can cases of unusual insensitivity and greed.

Alica, a woman who has lived in my block of flats for 40 years, has a lot of money and a seriously ill grandson named Roman. Every month the family has to take Roman to the oncological wing of Bratislava's Kramáre Hospital to have his brain tumour treated.

Roman's parents are from Bratislava as well, and visit him every day he is under care. His mother decided early on that she would sleep at the hospital with her ill son, and that's just what she's done - on the floor, because the hospital doesn't have enough money even for a camp bed.

During one of her many visits, Alica noticed that an 11 year-old boy in a nearby bed, whose parents lived far away and could not visit every day, had spilled tea on his bed covers and had also peed on the sheets. Alica told a nurse.

Two days later she was back, only to discover that the boy's bed sheets still bore the tea and pee stains. She asked a nurse rather crossly to change the sheets, and was shouted at for her pains: "The hospital doesn't have enough money to change the bedsheets every three days!"

When Roman left the hospital about two weeks ago, Alica decided she wanted to leave the children's oncology ward a gift, something doctors really needed to treat such miserably ill children. She went to the head doctor and asked what the ward most needed.

"Well, if you really want to help, you could buy us a photocopier," came the answer. "I don't have one in my office, and when I have to copy something I have to go to another ward one floor up."

"It's just unbelievable that the head doctor of a wing which doesn't even have money to change the sheets on kids' beds, or for camp beds for the parents of the smallest children, thinks that she most needs a photocopier to decorate her fancy office," fumed Alica.

Alica eventually decided to buy the hospital 25,000 crowns worth of bedsheets.

When she revisited the ward a week later, the halls were covered with posters reading "We thank the TV Markíza Foundation for giving us 10,000 crowns". Alica turned to the nearest nurse and snapped, "I guess that went for the photocopier, eh?" And of course, not a single word or a sign in that ward thanked, or even acknowledged, the receipt of 25,000 crowns worth of bedsheets.

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