photo: Rade Prelić / Tanjug
Healthcare facilities in Serbia look either like a spaceship or a Polish hospital, there is no middle ground. Expectant mothers do not have to bring only the delivery table to the maternity hospital. There aren't enough doctors, but that's why there are 22.000 non-medical personnel in the healthcare sector. And that's just the beginning of the list of domestic health problems
The feat of Niš surgeons who worked for 100 days non-stop to reduce waiting lists was met with praise, but also with criticism of the system in which someone has to make sacrifices in that way. Long waiting lists are only one of the problems of domestic healthcare. Truth be told, it has never been great, but both doctors and patients will agree that in the last few decades, the healthcare system of Serbia has gone mostly downhill. Then came the new corona virus pandemic and served as a magnifying glass under which all problems only became even more visible. If they could somehow be categorized, the problems of domestic healthcare are first of all divided into two groups: those that torment healthcare workers and those that torment patients, i.e. citizens.
HEALTHCARE INSTITUTIONS
Health institutions in Serbia are contradictory. It's a strange choice of words for buildings where people are treated, but here's an example from Niš: the new part of the Clinical Center looks like the most modern healthcare facility in Europe. The old part, which still has a large number of specialist clinics, is frozen in time, because no investment has been made in it for more than three decades. It is similar with the clinical centers in the rest of Serbia: it is enough to walk around the Clinical Center of Serbia and see how much difference there is between the two buildings located next to each other. Kragujevac, whose clinical center recently received the word "university" in its name, has a dermatovenerology clinic building that is literally falling apart both inside and out. Someone will say: well, they just prescribe ointments and ointments, not knowing that in dermatovenerology clinics there are a huge number of patients with completely harmless diseases, and that their conditions require impeccable hygiene, which is impossible to achieve where the walls are spherical from moisture and spores molds fly in all directions. Therefore, one of the biggest and perhaps the strangest problems of Serbian healthcare is that the clinics look to us either like spaceships or like field hospitals. There is no middle ground.
TECHNICAL EQUIPMENT
In terms of equipment, it is similar to the situation in institutions. Somewhere there are state-of-the-art scanners, magnetic resonance machines, while somewhere there is none - gauze. For some unknown reason, this is most often the case with maternity hospitals. Every woman in any part of Serbia who is preparing to give birth knows this, and from the maternity ward she receives a list of what to put in the famous "two big bags". Personal items and hygiene items are the smallest item. Postpartum wound care products, povidone iodine, mesh pads, and similar items that one would think would be more abundant in a maternity ward than anywhere else, are the most important items that mothers must bring themselves. Serbian maternity hospitals seem to have only delivery tables, medical staff and sutures. Everything else should be brought.
Rough estimates say that even where a newer diagnostic device occasionally arrives, it is not a big help, because, for example, one scanner is designed so that 10.000 patients are examined during its lifetime, while in our reality 12.000 patients pass through it annually. and those who manage to get their turn.
When it comes to radiation machines, in Serbia there is one for every 250.000 inhabitants. In certain clinical centers, oncology patients often know which is the latest, so when they come for radiation, they insist on being on it.
SHORTAGE OF HEALTHCARE PERSONNEL
In 2020, there were 2.700 fewer doctors working in state health institutions than in 2015, according to data from the Institute for Public Health of Serbia "Dr. Milan Jovanović Batut".
According to the latest data, there are 13.700 specialist doctors working in state healthcare, which is 1.200 less than in 2016.
The number of doctors without specialization also decreased, from 5.100 to 3.600, and only the number of nurses and technicians increased, from 38.600 to 42.800. Most of the mid-level professional staff was employed in the first year of the pandemic, so in 2019 there were close to 37.000 nurses and technicians in state healthcare, so that their number would increase by 2020 at the end of 5800. It was precisely because of the employment of nurses and technicians that the total increased number of healthcare workers. On the last day of 2020, 105.200 people worked in state healthcare, which is 5000 more than in 2019, and 1200 more than in 2016.
At the end of 2020, which is the latest available data, more than 105.000 workers with indefinite contracts worked in the health care system. Of this number, 22.000 are non-medical workers, which is almost identical to five years ago, and in addition, the huge number of non-medical personnel in health care is another problem awaiting a solution.
The Medical Chamber of Serbia annually issues around 800 certificates of good practice, which doctors need to work abroad. Half of them return to the country after professional training, while the other half remain in the countries of the European Union due to better conditions, faster job finding and higher salaries.
WAITING LISTS
If you enter "why are there long waiting lists in Serbia" into the Google search, pay attention to the dates of the media announcements that the search engine throws up on the first page. The oldest posts date back to 2008 and seem like they were written today. The basic criteria for determining the waiting list, for cases that are not urgent, are the patient's health condition and the date of reporting to the health care institutions. They can make changes in the lists, but there must be precise reasons for this, and they are obliged to inform the patients of each change. Patients come here as well: back in 2018, the magazine "Nova ekonomija" published the story of a woman who was supposed to be operated on in 2021. She went to a smaller place in Serbia, registered a new place of residence there and managed to arrive for the operation long before 2021.
"We have to make it much easier for general practitioners to communicate with secondary and tertiary centers. The patient's path from when he feels the first symptoms to diagnosis and finally to treatment must be much easier and simpler," said Minister Grujicic for "Politika" recently. She added that she is aware that it is necessary to solve the problem of "a bunch of unnecessary procedures" because of which citizens sit in the corridors for hours and wait for several weeks or months for some basic things.
Specialist examinations are no less of a problem: although since 2016 there has been an Integrated Health Information System (IZIS) through which it is possible to schedule specialist examinations, there are simply no available dates in the near future. Until recently, it was also a problem that patients could only go to their chosen doctor from the 1st to the 5th of the month to schedule a specialist examination, but fortunately, the new Minister of Health, Danica Grujičić, abolished that practice. That procedure really didn't make any sense: a person goes to his chosen doctor for a certain problem, for example, on April 7, the doctor judges that the patient needs an examination, for example, a urologist, but that examination could not be scheduled immediately, but the patient he has to see his doctor again sometime between May 1 and 5, and until then - who is alive, who is dead. Some rough estimates say that Serbian citizens spend between 50.000 and 100.000 dinars annually on specialist examinations in the private sector, although they already pay for these services through mandatory health insurance.
PARALLEL HEALTH SYSTEMS
If they are patients for hospitalization, but have a chronic illness and have money for private specialists, their life looks like they go to a private doctor, pay something they have already paid to a state institution, and everything is easy until we get to the prescribed therapy. Those who are treated in private institutions pay the full price of drugs, wherever they are on the list of the Republic Health Insurance Fund. Only a few of the medicines, if he is of good will, can be entered into the patient's record by the selected doctor and issue a prescription. However, it depends not only on the goodwill of the chosen doctor in the state health center, but also on the type of medicine. Namely, without a specialist examination in a state institution, the selected doctor has no basis and how to issue you a prescription. In this context, patients who are treated privately or in the state system, in their records in health centers are completely healthy even though they may have diseases ranging from psoriasis to heart failure. In this sense, the estimated sum that citizens allocate for private healthcare is much higher when medicines are added to it.
Additional problems that are perhaps the least talked about are occasional shortages of drugs that many patients simply cannot live without, such as sugar regulators, blood thinners or drugs to prevent the formation of fatty deposits on implanted stents in blood vessels. In addition to shortages, the problem is also drugs that are or are not on the positive lists of the RFZO.
We will cite just one example: after a heart attack, everyone, absolutely everyone, in the next year has to drink exactly one medicine that exists on our market and costs 6000 dinars (dose for four weeks). Along with it comes a medicine to slow down the heart rhythm, also the only one on the market, the price of which ranges from 4500 to 5700 dinars. Neither of these two drugs is on the lists of the RFZO. In addition to these two drugs, 4 or 5 others are prescribed, which are not cheap by any criteria.
In translation, if you have decided to get (and survive) a heart attack, save at least a thousand and a half (in numbers 1500) euros for the next year just for medicine. And that's all we need to know about Serbian healthcare.
Serbia entered into civil disobedience, and that brings with it consequences. In the days behind us, it became impossible to count those detained, arrested and injured. It will be recorded that police cars ran into peaceful citizens at full speed and that one man wanted to harm himself, under the pressure of the authorities
What did the protest on Saturday June 28 show? What messages and lessons can the government draw from it - and does it do so - and what kind of students and citizens who demonstrate? Was the manifestation of nationalism on Vidovdan expected, potentially dangerous, or does it represent something completely different? What is the position of the regime now, and what is the position of its opponents
The counting of votes in the repeated elections, at one polling place, in a town of 10.000 people, was personally monitored by the President of the State, Aleksandar Vučić, because he knew that if Kosjerić falls, more than one municipal government will be swayed. In the end, SNS managed to retain the election victory, with the usual repertoire - intimidation, demonstration of force and media smearing of opponents.
The citizens and students are so well organized that the police look ridiculous. They run from street to street, from neighborhood to neighborhood, like some confused children. If this rebellion produces the expected result, that is, if Novi Sad really becomes the local Gdańsk - it will undoubtedly be written in golden letters in the history of the city. It will be talked about with pride, just as it is proudly pointed out that in 1748 it became a free, autonomous city, by decree of Empress Maria Theresa. He paid for freedom then, it is always paid for
"After these seven months," says psychologist Zoran Pavlović, "repression becomes quite clearly counterproductive. Regimes that use excessive force often inadvertently mobilize citizens, because violence delegitimizes the government, and gives people moral clarity and emotional strength to oppose. Repression, in other words, will not only passivize society (which the regime plans), but will only strengthen the border between 'us' and 'them', will strengthen the identity of resistance and strengthen cohesion within the group that suffers injustice. The number of people taking to the streets is not decreasing, but increasing"
With a gesture of pumping at Wimbledon, Novak Djokovic drew curses and insults from the regime of Aleksandar Vučić. He was put in the same basket with "blockade-terrorists" and "anti-Serbs"
And how will firefighters, police and doctors take care of unsafe tunnels? Well, by keeping an eye on the hill and being ready if the hill falls on the bus, for example
Would you sit down with Aleksandar Vučić at the bar table after he pardoned the progressive men who heroically broke the jaw of a female student with a bat? Apart from the loss of basic moral inhibitions, what else is behind this act
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"We wanted that financial moment, if possible, to be excluded from any discussion. One can determine the price of two kilograms of aluminum or the price of a car tire. But who will define the price of human life? I don't know how much we would otherwise be paid for these 24 days. But I'm sure we saved at least one life, and probably more. And that's enough"
Perhaps those who believe that the whole planet "lives in a time of fundamental interegnum" are right, in which there is not much room for compassion, for other people's suffering, for motives to help others. Is there a possibility that the actions of my colleagues from Nis are simply part of what Harare calls "godless ethics", where morality means "a deep understanding of suffering" and the need to "reduce suffering". I sincerely want to believe that it is, especially after the statement of one of them that "it would be hard for them to bear another death waiting for intervention"
