Bulgaria's Health Care - Terminally Ill?

Lingering around the National Transfusion Centre, a group of a dozen gypsies looks like any other Roma men who roam the suburban streets of the capital. Only their eyes and remarks give a clue to their real purpose there: trading blood for money.

A woman, accompanied by a young girl, apparently her daughter, passes by on her way to the centre's entrance. The gypsies ask them once and again whether they need blood.

Once inside the center the girl's hopes to lend a hand to her mother by donating blood suffer a blow. Very slim and with low blood pressure, Kalina, 23, does not meet the requirements for a blood donor.

"The major part of the Bulgarians who undergo planned operations ask their relatives to donate the needed blood," she says, obviously learning the rules of the game as she goes along.

As she is the only one to accompany her mother during the operation in the capital and with no friends or relatives to turn to for help here, she is doomed to fall an easy prey to the black market dealers. The operation could be delayed once and again unless she presents a note that so one has donated blood for her mother.

This some one could be any one - very often the gypsies that shuffle around the centre or look at you expectantly in hospitals. They would charge you from BGN 300 to BGN 600 for the priceless document that proves one of them has donated at least 450 ml of blood.

The black market for blood has recently seen some upgrade with the dealers starting to do business online, which only cemented their status as a staple, though stark, example of health care reminiscent more of a third world country than an EU member state.

These days, after years of lumbering reforms in Bulgaria's health care system, hospitals across the country have suspended planned operations and reduced admission of emergency cases. Some have even switched into a war-time regime, tapping into the reserves, meant to be used in case of natural disasters and wars. Why? Lack of cash, of course.

At the same time the European Union is offering BGN 300 M in funds for equipment and repair works at hospitals, but it takes good projects to absorb them. Meanwhile expenses are constantly on the rise and both the state and the patients are forced to dig deeper into their pockets. A number of governments have failed to implement reforms. Not a single health minister has managed to plug the holes in the system.

The best we can say about the previous Health Minister Anna-Maria Borisova, who, thank God, gave in to calls for her resignation last months, is that she failed to make a difference.

What the new Minister Stefan Konstantinov inherited is a huge load of problems - understaffing, supply shortages, braindrain, bribes to doctors and nurses to ensure better treatment, high debts and chronic lack of money.

Is it that bad because of the lack of cash or the rampant corruption and funds siphoning? Or both?

In recession-battered Bulgaria, the government spends just 4.2%  of its GDP on health. All employed and self-employed Bulgarians are obliged to make monthly health insurance contributions of 8% of their income to the Health Insurance Fund, but it has been plagued by corruption and funds siphoning is no exception there. Combined with the meager health insurance contributions that the state pays for the people under its wing, small wonder we have reached a dead end.

As a result Europe-wide polls show that the lowest levels of satisfaction with health care are reported in Bulgaria, which even lags behind Albania and Macedonia.

Yes, Bulgaria is a unique European country. Take for example the lack of options for hospitalizing heavily and terminally sick people. The health system just rejects them, unless of course they pay.

Unlike other European countries, whose health care systems do their best to fund extra services to support these people and their relatives through the darkest of times, those who have been diagnosed with cancer and HIV in Bulgaria have been left without the support they need to cope with the physical and emotional turmoil of the illness.

This year, once again, hundreds of cancer and HIV-positive patients faced a shortage of life-saving medicines because of a delay in tenders for their purchase. A check in the hospitals across the country showed that a bun, a slice of bread and 300 grams of yoghurt are all a heavily sick in-patient gets as his daily allowance.

When struck by a severe condition, Bulgarian nouveaux riches regularly go abroad for treatment. The less fortunate have more sinister stories to tell.

"My father, one of 300,000 ill-fated Bulgarians diagnosed with cancer, waged the toughest battle of his life - the battle against the disease - only to lose it. Now I see my mother going through all this and me, again, trying to help the best I can," says Manuela.

"It was only until recently that all I could blame for the suffering was crossed stars and karma. Now that I am forced to go through this nightmare again with my other parent, it is becoming more and more clear that life could have been worth living again was it not for a doctor's oversight, lack of funding or I-don't-give-a-damn attitude."

"One has to buy medicines, bandages, syringes, surgical thread and antibiotics and fork out more cash for the operation and subsequent treatment. It is close to a crime."

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