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EDITORIAL

Medical crisis nourishes new crop of myths

A financial crisis which began in 1998 is wreaking havoc with the national health care system, reducing the services that doctors and hospitals provide and increasing the cost of many drugs and treatments.
The crisis has added a whole new chapter to the country's rich lexicon of medical myths and folklore. Comprehensive medical care, the new wisdom has it, is provided only to those who pay a thumping bribe for it, while 'gifts' such as bottles of whisky and boxes of chocolate are required to secure even the most cursory attention of a physician.
These new beliefs have clear roots in the current financial situation in the health care sector. As state employees, doctors are wretchedly paid - six years of university studies followed by a two year internship make young doctors eligible to earn a miserable 7,000 to 8,000 Slovak crowns ($200 to $230) a month, almost 25% less than the national average salary. Small wonder, then, that doctors are showered with presents by patients eager to secure the full attention of their harried and aggrieved physicians.


Vladimír Mečiar's scuffle with journalists last week was only a warm-up for his return to...

A financial crisis which began in 1998 is wreaking havoc with the national health care system, reducing the services that doctors and hospitals provide and increasing the cost of many drugs and treatments.

The crisis has added a whole new chapter to the country's rich lexicon of medical myths and folklore. Comprehensive medical care, the new wisdom has it, is provided only to those who pay a thumping bribe for it, while 'gifts' such as bottles of whisky and boxes of chocolate are required to secure even the most cursory attention of a physician.

These new beliefs have clear roots in the current financial situation in the health care sector. As state employees, doctors are wretchedly paid - six years of university studies followed by a two year internship make young doctors eligible to earn a miserable 7,000 to 8,000 Slovak crowns ($200 to $230) a month, almost 25% less than the national average salary. Small wonder, then, that doctors are showered with presents by patients eager to secure the full attention of their harried and aggrieved physicians.

The conviction that decent care must be paid for is so strong, however, that many patients believe the success and even the scheduling of a simple operation hang on a bribe of 5,000 to 10,000 crowns. More complex procedures, or those involving plastic surgery, can range in the public mind up to 50,000 crowns. Older patients who require more frequent attention or more specialised diets say they take bundles of 50 to 100 crown notes into hospital to hand out to the nurses who care for them. Pregnant women who wish the attention of an obstetrician rather than an intern during birth also believe they have to fork out a hefty bribe.

Even doctors are not immune to the mythmaking process. Newly qualified interns who wish to practice at a reputable, well-situated or popular clinic say they have to pay a large bribe to the director of the clinic to secure employment there, no matter what their qualifications and despite the fact that the clinic will only pay them the statutory 7,000 crowns a month in return.

It is notoriously difficult to determine what relationship myth bears to fact, and just because many people say that bribery is rampant in the health care system don't make it so. Think of other popular Slovak medical myths - that men who drive with their left arms hanging out the window are more subject to swollen joints in that limb; that women who drink red wine are subject to heavier menstrual periods; that drinking carbonated beverages will exacerbate a sore throat, or that wrapping a scarf around one's neck will improve the same condition - consider these beliefs, and the tenuous body of scientific evidence that supports them.

On the other hand, as French cultural anthropologist Claude Levi-Strauss showed, myths say a great deal about the fears and stresses of the societies which spawn them. Beliefs regarding joint-swelling winds and magic scarves may seem ludicrous now, but for the poor agricultural society which existed here hundreds of years ago, even the simplest diseases could have tragic consequences. The fact that such illnesses were only dimly understood only increased the fear they caused and the myths that surrounded them.

Modern Slovak society may have different fears and stresses, but these are proving no less potent as generators of myth. Many people fear that in a free market economy, which they only dimly understand, the cash-strapped state will be unable to provide them with acceptable levels of medical care, police protection and legal representation. These insecurities, and the stress that accompanies them, are reflected in the popular conviction that doctors have to be bribed to do their jobs.

In the end, of course, the Health Ministry will sort itself out and the sector will return to normal. But the conviction that one standard of medical care exists for the rich and quite another for the poor may be here to stay.

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