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Monday, November 20, 2017

The Baltic States were deprived of medicine because of the flight of doctors


The population of Latvia and Lithuania actually lost access to healthcare – both countries are experiencing an acute shortage of basic professionals. The reason – indiscriminate flight of doctors to other EU countries. Situation is called catastrophic, but the authorities shrug: extra money in the budget, and the priority now is the protection against Russia. Desperate patients are resolved on extreme measures.

The origins of the situation in the Latvian medicine, you need to look for in 2009, when the Latvian government, having experienced the first blow of the global financial crisis, began urgently to cut social spending, including medicine. The cuts to the sector made in that year, 62% of the existing level and rolled down to the days of 2005. The situation is exacerbated by the fact that the financing of hospitals have dramatically reduced just at the time when the growth of the VAT has risen in price utilities, medical materials and tools. It turned out that some medical institutions were deprived of even the opportunity to carry out elective surgery, not associated with emergency care. It is not surprising that within six months after that, the number of patients in Latvian hospitals decreased by 15-20%.

The great Exodus

“In Germany and in France a doctor in a public hospital receives per month at least 7-10 thousand euros, in Latvia – 1,1–2 thousand euros”

In Latgale – the Eastern province of Latvia, slightly less than half populated Russian – medicine in those days she resembled a seriously ill patient, a moribund. Began the phasing-out of hospitals, and patients it was decided to bring in Daugavpils. In fact, the whole Latgale with its 330 thousand inhabitants there are only three full-fledged General hospital in Daugavpils, rēzekne and preiļi. Often, to bring in the patient to a place where he could make a difference and help, the ambulance has to overcome over hundreds of kilometers. But even in Daugavpils (and this, incidentally, is the second largest city of Latvia) a critical shortage of physicians observed so far, and for even the most simple operations many have to travel to the capital (about four hours drive one way).

The situation in other regions of the country a little better – qualified nurses literally ran from a small state, and the flight is still going on. “Over the past four and a half years the clinic, which I direct, has had to part with more than twenty nurses qualifications. Went best, with the greatest experience. The quality of the services is directly related to how much people are satisfied with the conditions and remuneration for their labor. But the trouble is that to earn sufficient for the maintenance of the family the amount of money people are forced to work on several jobs,” complains the head of one of Riga’s hospitals.

The President of the Latvian society of doctors Peteris Apinis confirms the diagnosis: “We are losing a lot of nurses due to the fact that we have all the time there is active recruitment. Daily to him in the mail of different email offers to learn a foreign language in six months – for example, the Norwegian – and to leave to work in another country. Rich countries may be reluctant to invest in training of young specialists. They just buy the finished product. Unfortunately, it’s not like in football, when we can train young striker and sell it to England for a million. Here, on the contrary: our professionals we give for free.”

And there is nothing surprising, if we recall that, for example, in Germany or in France a nurse in a public hospital receives per month about 3-5 thousand euros (in Latvia – 350-550), and the doctor at least 7-10 thousand euros (in Latvia – 1,1–2 thousand). Shows the patient the Latvian hospital: “the Situation in the wards is now reminiscent of war, when the walkers cared for the bedridden, the sisters will not do anything unless asked to”. Today, one sister is often caters for 60 people instead of the law of eight. And the fact that the medical staff is faced with a similar overload, of course, seriously affects the quality of his work.

In the priority – Russia

Family doctor Andris Baumanis believes that it will only get worse: “it is now 1370 from the Latvian family doctors of more than 200 say they will not work in this mess. They’ll just retire, because every fifth doctor we are retirement age. Some will go abroad. And the rest will have to divide the vacant patients. The number of graduating doctors have a very small, and half of them leave the state within six months after graduation. And another 25% in the next year.”

For example, over the past 25 years in the hospital Kraslava does not add any new specialist. “During the period of independence since 1991, to work in Kraslava hospital came no doctor,” – said in the air of hospital chief of staff and Deputy mayor of Kraslava Alexander evtushok. Member of the Board of municipal LLC “Rezekne hospital” Marita. complains to the press that magnetic resonance patients are waiting on average for 145 days (now over a thousand people), computed tomography – 140 days of the study of the circulatory system – six months. In the province sorely lacking ENT-specialists ‘ offices, surgeons, urologists, gynecologists, infectologia, trauma, orthodontists, pediatricians, obstetricians, neurologists. As a result of growing number of accidents, the number of untimely dead of a stroke.

Director of Ekabpilssky hospital Ivars zvidrins recognizes that many citizens simply are not at risk to languish in the queue for two or three months and choose paid visits. And recently Ekabpilssky doctors put forward the noble initiative: during the week, the poorest citizens had the opportunity to be examined and to obtain advice free of charge. It is a pity that the services of physicians required people not in one week, but constantly.

Daugavpils regional hospital had to declare that it no longer helps people with diseases of the ear, nose and throat – due to a complete lack of otolaryngologists. Also no specialists for jaw surgery, are able to provide round the clock care (which is why the author of these lines had broken right nasal septum in Riga), and treat acute injury to the eye is possible only during standard working hours. The local press periodically publishes a dreary story about the ordeal of patients who have to stand in long queues, but in the end still to go to Riga or Riga. In the same Daugavpils true celebrity was Leonid Kremplewski – it is possible that he is worthy of inclusion in the Guinness Book of records as the oldest practicing audiologist: he is 84 years old. Leonid Kazimirovich love to have gone to rest, but not a sense of duty – other ENT-specialists ‘ offices in the city.

The government of Latvia explains that now the large funds need to invest in the army: over the Eastern borders is “aggressive Russia”, which is, one never knows, will attack. In this regard, the former Director of DRB INTA Vaivode, said the newspaper VIEW: “of Course, defense is important, but also attention to the problems of health should be among the main priorities of the government. I want to refer to a telling example: it often happens that people with suspected cancer have months to wait for a free examination. We could have a CT scan very quickly, but the state simply does not allocate to us a sufficient number of allowances! Absurd! I was recently in the Netherlands, so there is annual funding of hospitals, comparable in scale with our activities, is 480 million euros. Then, as we state on all the medicine in the highlights in the year 700 million of this money, our hospital receives about 18 million here, and compare”.

“I think – agrees Daugavpils Deputy Yuriy Zaitsev, consisting of the Duma budget Committee that the state is considering medicine purely financial angle. Give them the will, they would have tried to close most medical institutions to reduce “superfluous” spending. But since from a political point of view, it is very difficult, just trying to give as little money as possible. The division of Ministerial portfolios whenever it appears that no one wants to contact the Ministry of health. We are happy to give on defense, on the culture, but not on health. So maybe “there” a little cut “here” to add? We have the same people die… From colleagues in Preili I know they have a question about the possible closure of the maternity ward. This is what, women will start now again to give birth, as of old, in the baths? The only way to carry pregnant women or in Rezekne, or to us in Daugavpils”.

The doctors are kind of bondage

Last year Latvia has stirred up the scandal, law enforcement authorities began criminal proceedings against forty-five men, threatening to open fire in the building of the Ministry of health. The story of the man largely typical, except that he, unlike many others, decided to take extreme measures. His daughter in need of assistance, consistently blew first in Jelgava hospital, and then in Riga hospital “gaiļezers”. The last institution shortly before he “scored” advanced – they refused to hospitalize the patient-core with pneumonia and a high fever, the story hit the media.

The representative of the criminal police later said on television: “family doctor daughter went straight to “gaiļezers”. There for a few hours no, it has not worked, even abused, sent back to Jelgava. She contacted the father.” After that, the office of the head of the Ministry of health Guntis Belevich phone rang – the caller reported that he had a gun with a telescopic sight and he’s going to use it against officials of the enterprises. While the men of the special forces battalion in a hurry in order to take the Ministry of health under protection, the police developed a feverish activity in search of the caller, and two hours later he was detained in the town of Vangazi. Any weapons he found, moreover, until the man was completely law-abiding. The police man said that he had called to the Ministry in despair. Say that in the same hospital “gaiļezers” a few hours after the opening of the record on the various surveys over all paid by the state quotas for the month. Physicians complained that there were moments when the registry is simultaneously trying to reach 400 patients and the system crashes. Those who tried to obtain medical assistance in the mode of a queue, had been found in the first rows below it to wait.

Of course, if the money is there, such questions can be solved faster (so, a CT scan of the brain cost the correspondent of the newspaper LOOK in the 42 Euro, a free alternative would have to wait two months). But what about those who do not have the required amount, and there are many, because Latvia is a poor country? Especially if we are talking about life and death, a matter of days, and even hours?

On the solution of urgent problems of the healthcare industry by increasing the budget deficit, the government has allocated an additional 34 million euros. The money they promise to spend on reducing queues, speeding diagnostics of oncological diseases and the availability of compensated medicines. Doctors, however, enthusiasm does not show, calling the measure “another patching up holes”.

I should add that the deplorable situation with health care services was not only in Latvia but also in Lithuania. To such an extent deplorable that those responsible for health and food safety, European Commissioner Vytenis Povilas Andriukaitis (former health Minister of Lithuania) proposed to introduce for physicians who have received higher education at public expense, the duty of mining in the province. “Coming from the very first course should be offered such contracts, if you study the means of all taxpayers, they have the right to know that in Rokiskis and Nemunelio-Radviliskis and Victimise sometimes need doctors,” – said Andriukaitis. We must assume that sooner or later the idea of a forced distribution of physicians will come to Latvia.

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