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Article in thePozvunete & Novini (Call Us & News) Newspaper of 13-Nov-2003 |
Bulgarian Version | Back to chronology |
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[Headline on 8th page:] Director of Varna Regional Commission of Health: Medicine is Risk. It is always available. The treatment conditions in the HD unit of St. Marina Hospital are better than anywhere in this country with the exception of Plovdiv and Sofia. Those whose diagnoses have been confirmed are treated on separate machines. All machines are disinfected after each procedure, says Dr. Veselin Balkanski - Dr. Balkanski, how would you comments the ex HD nurse Reneta Stoyanova's opinion that there is risk of infection in the HD unit of St. Marina Hospital? - I cannot agree with most of what she wrote in her letters or said in Reneta Stoyanova's interview. She worked there for 15 years and suddenly, last year, she began to worry as to what would happen to the foreign citizens under treatment in Bulgaria. I asked myself why Mrs. Stoyanova did not think all these 15 years about the Bulgarian citizens who had been treated in the unit. I believe the conditions there are better than anywhere in this country with the exception of Plovdiv and Sofia, maybe. This leads me to the thought that she had another motif or another problem. Based on the standards which hold in Bulgaria and the difference from the international standards, can we expect that a hospital which is indisputably qualitative does not function well or the standards and epidemiologic requirements are not properly observed? She alleges that both our and foreign patients are exposed to risk. There is no logic in this. Up to this moment we have not had any complaints from the patients under treatment in the HD unit. Moreover, we have many letters of gratitude from foreigners. In Stoyanova's letter, it is written that they paid along certain contracts and there was possibility for someone to benefit. According to the international agreements in force and the oaths we gave, if these foreigners had come in Bulgaria not having concluded a contract and they needed hemodialysis we should have done it all the same. This is a heavy condition and life-saving. We are obliged to do this work If a patient goes, say, to Afganistan and he has no contract but needs hemodialysis he would be served there. Every one patient is expose to risk and every one manipulation in medicine goes with its risk. - Is everything being done in the HD unit of St. Marina Hospital do limit this risk? - What has been done as investigation, control upon activities, monitoring of the patients in the HD unit of St. Marina Hospital, has been put down in the report of our inspection. There is the opinion of the medical team working there as well. Therefore, control is being carried out and what I have checked is in my report. I cannot say more because everyone id responsible for and acts according to his authorities. Mine are to watch and control how healthcares develop, how medical establishments function, how statutory documents are observed, whether the standards given by the Ministry of Health are observed, and if there are any lapses. Wherever we find any lapses in following the standards in a given field of activity, it will be deleted from the license of this medical establishment. - What are there standards? - I cannot say exactly how many they are but most of the standards are ready and they regulate the hospital activities. I think, the standard of clinical laboratories is ready, of surgery wards. - Are there any standards for virus carriers in HD units and what are they? - I do not know all the standards by rote. I have my subordinates who perform their duties. As for the standards for virus carriers, there are, most probably, regulations as to how often or over how many months testing of the staff working in a risky environment should be made. Those standards I was talking about are about carrying out the activities: availability of the necessary equipment, whether it complies with the requirements, with the standards established in this country, whether disinfection is carried out and other things which are needed to maintain the machines on a good level so that there is no risk for the patient. These standards are introduced by the MH. There is another standard, about the qualification of the staff. We watch this. As for the concrete activities, they are responsibility of the medical establishments which directly perform them and they are obliged to observe them. - Did you find out whether there was a physician's report of 24-May this year where a "clean" patient was reported to have been dialyzed on a machine devoted to virus carriers? - There is no information on this question in my report. You can get information from the hospital. The medical records are there. - I asked them but they denied. Moreover, they have no right to show some of the documents. - My information is public. I am alerted about a problem and I appoint a commission. It performs a check and reports to me. I submitted it to the authorized bodies because parallel to this a check was performed by the Economic Police. Their check did probably not differ much from what was assigned to us. In this connection, we do not dare take a concrete stance because the possibility of making a mistake is very big. If certain patient gets infected, who can say whether this happened in the medical establishment or while he was somewhere on holiday? No one can guarantee or take a definite stance. - You, as Director of RCH-Varna, can you guarantee that in the HD unit of St. Marina Hospital all normative and hygienic standards as observed? - You ask me if I can claim that everything in the HD unit is perfect. Well, I can hardly say even about myself that I am completely perfect. - Was everything perfect during the check? - What was found during the check, is in our report. - If certain patient is infected, is it possible to prove that this happened in thehospital? - Generally speaking, everything can be proved by experts. I am not such an expert. It is not fatal that someone has said that there is risk of infection for the patients in a hospital. Everyone can say this. When there is really such a case, however, when there is a claimant, then the name of this medical establishment could be denigrated. Then it must be proved whether this happened in the hospital or somewhere else. Let us take the Libya case. The initial accusations were that everything happened by our health workers' fault. But then, after they invited independent international experts, it became clear that the situation was not exactly so. What are we talking about? We are talking about a real fact, we have concrete evidence and possibility of some persons to be accused. It is another point, of course, that Mrs. Stoyanova's allegations could be accepted as a measure of prevention. Nothing wrong. But there comes the next question. For all those 15 years during which she worked there I am convinced that the conditions of work, and control, and disinfecting materials in use have been improving from year to year. - She says that things were in order until recently. They had their patients regularly tested. But for some time, maybe since introduction of the health reform, it is not so. - I cannot take any side because my opinion should be based on facts. Facts and proofs for me are these found by the commission appointed by me. I cannot go out of this frame And I can openly say that since the health reform was introduced, many things in the health care system both out of in-hospital instead of being improved got worse. But these are the risks of the reform. - If all the requirements and standards are observed in a medical establishment, can infection result? - No one can tell you this and no one can guarantee. A hospital is not a closed system with its own microclimate where everything is absolutely isolated and there is no possibility for some virus to be brought from the outside. Nothing alike. If certain patient gets infected with something, there is incubation period during which we cannot catch the virus. There are many virus carriers too, who are not ill, they have not any symptomatics. How can I know whether a patient has not been somewhere on holiday, got infected, for instance, with AIDS, and became a virus carrier. He is on hemodialysis at the same time, but he has no symptoms. - How do they in St. Marina limit the risk? - First, those with proved diagnoses are treated on separate machines. Besides, after each procedure, according to the standards and requirements, all machines are disinfected with best-quality disinfectants. I cannot see what else is there to be done. We cannot be sure about any single patient even if he has been tested. For instance, he comes to hemodialysis today, blood sample is taken from him and sent for tests. But we cannot deprive him of his session at the moment. He is on the machine. Disinfection is made after him and another patient is placed. If the previous has been ill, we cannot know at the moment. That is why I say that there is risk in medicine at any one moment. There is no situation without risk in medicine. There are no strictly regulated standards either, which could give 100% guarantee that in a concrete case there would not arise a problem. Our objective is to solve the main problem of the patient and risks are always available. - In general, how often does RCH inspect the way of work and the conditions in the HD unit of St. Marina Hospital? - At least once per year we visit all the medical establishments and perform our checks. They cover this activity as well. With regard to the epidemiological conditions in the medical establishments, there is epidemiologist in each of them. There are instructions given by Hygiene and Epidemiology Institute and MH and strict regulations about the frequency of controlling visits, materials are taken for testing, tests are made and the condition is watched. This is on the line of Hygiene andf Epidemiology Institute while we inspect whether the statutory documents of MH are observed. The epidemiologist of St. Marina Hospital should be able to give you data about the epidemiological condition of the hospital. - The leadership of the hospital was not willing to give us information to publicize in the media. - I can imagine what Dr. Krasimir Ivanov feels like. Can he be 100% certain, that there will not arise a problem in a unit? St. Marina Hospital has over 1,000 staff and a large flow of patients. The probability for a problem to arise, which would have a negative impact upon the medical establishment he is in charge of, is big. That is why I can fully understand him for his being economical of information. I am too economical of information because I do not dare say something that might turn out not quite the same tomorrow. Risks are many, responsibilities are incredible, and the consequences are for us. First for the patients, and next for us. |
[Headline on 9th page:] Patient from the HD unit: There was no disinfection before but things got better I have my tests done when I remember I have to be tested. We are not given medicines of prime necessity, such as for anemia - You called in our newspaper’s office after the interview with Reneta Stoyanova, ex-nurse in the HD unit of St. Marina Hospital. Would you explain us why you wanted to get in touch with us? - Because to achieve some improvements we should attack from all sides. - Are Reneta Stoyanova's assertions true? - Yes. Up to a recent time it was so but there are some improvements already. Everything is properly disinfected now. This is laudable. - And how was it before? - Not everything was as it should be. There were no disinfectants for the machines before. We are not well with medicine supply too. Great difficulties. Whether it is the state that does not provide us or it is something that happens here, I cannot tell you. A few years ago, as soon as I knew there was money for dialysis I asked where is it. Immediately, on that same day, all the patients were told not to buy any more supplies themselves. We are not given medicines of prime necessity. Such are medicines for anemia. An ampule of them costs 17 BGL. [about $7]. Even Analgin [a cheap painkiller] is not available in the hospital. - What if a person cannot buy them? - Well... then he goes to St. Peter. I'd like to tell you something about the food, too. We must receive food during each dialysis. I have been to many HD units and saw that they receive larger rations than here. - You claim they give you less food in the HD unit of St. Marina Hospital than you have right to? - Yes, definitely. Up to a recent time, they gave us a small 'kebapche' [grilled oblong rissole] and a slice of bread – this makes about 55 stotinkas [ab. 25 c.]. Now they introduced a little more variety but still ve don't receive all we have to. - How much is a ration for a patient? - I knew it was 1.15 BGL [ab. 60 c.]. Quite recently, within less than hour, I was told two different prices. First, that it was up to 1.00 BGL, and then that it was 0.75 BGL. I don't know which is true now. They get angry when we raise these questions. Also, they sometimes give us food of less weight than we have right to. - And what kind is the food? - Cheese, apple or yoghurt and a roll. - When did you last have your tests in the hospital? - I have my tests done when I remember I have to be tested. It's the same with the others too. When somebody says, "Hey, is it not time for tests? We have not had them for a long time", they answer, "Well, get a referral from your GP". This should be arranged, I think. They closed down our lab, and now these GP's referrals, I mean the tests, go somewhere else. - Do they tell you here, in the hospital, when or how often you should be tested? - Well, no need to tell us, we know. Up to the New Year they used to tell us. We had our tests every three months. But then these health funds interfered and persons who "gorge"… That's how I explain it to myself. For example, the director of the hospital makes workers redundant, closes down the lab and these notices go to another lab which benefits and so on… I don't know. - In your opinion, do the staff in the unit know which patient on which machine is to be dialyzed? - We ourselves know it. This thing is managed by the technician who is in the unit. He takes, say, the folder for the big room and says, "You here, and you there." - Who is the technician that does so? - The technician of the unit who is in charge of the machines. There are four technicians. - But they are no physicians? - No. One is engineer, and the others have long time of service. - Should not doctors decide on patients' distribution? - I cannot tell you. Perhaps they are the first to decide who should be placed where and then they order the technicians. - Would you explain me the whole procedure? - We go in and everything is arranged. My folder in on my bed and I lie down there. Another man's folder is, say, in room two on machine three. - So, even before you go into your room for dialysis, it is already decide who will dialyze where? - Yes. - Were you here when the Belgian and Israeli citizens were dialyzed in the HD unit? - Yes, here, of course. - Tell me something more. - What to tell you? Reneta Stoyanova told it as it was. What you wrote, so it was. "C'mon, you from this bed go to the other room, and you – with him, and here will be the foreigners." The people were not cared for as much better, and still they were foreigners! We should have shown some attention, to represent ourselves, you know. The doctors came over us more often then. Well, how often – two or three times. He passes by him, and he passes by me. - And do you remember how were the machines distributed then? - Well, perhaps this was the bosses' mistake that they did not consider well and did not distribute the guests in a separate room. They were 15 or 16 people, I can't recall. - Have you signed a declaration for informed consent as a patient in a risky group? - Yes. As soon as we are admitted to hospital, we signed one. - Does it happen very often that a patient bleed? - There are such cases. There are stains on the ceiling, too. - How are the machines distributed now? How many rooms in? - They are distributed in four rooms now. There are no such common things anymore. - And how long is this distribution for? - For two or three months, maybe. - Tell us more about the staff's attitude. - It’s very nice. We don't complain. But they were overloaded up to a recent time. But there are no bed sheets. Everybody brings his from home. - Do you disinfect them yourselves? - We wash them. We bring medical supplies, too. They provide cotton wool and medical alcohol but there are no bandages, no sticking plaster. Not few among us are poor pensioners, you know. - How much do you pay for medicines a month? - It's a bout 50 BGL a month [ab. $26]. If you use iron, you need even 100 BGL because the ampules are expensive. The transport is not all right, either. As far as I know, the state pays about 5,000 BGL now for transporting the people from a region outside Varna. Some time ago, this cost 1,000 BGL for two cars. Now, there is only one. Instead of giving this money to the transport company, they could use it for medicines and other things. - Why do you want to remain anonymous? What are your worries? - Because they will look at me in a different way afterwards. Besides, I don't want to bring trouble to the doctors and the nurses. They worry they too might be expelled from work as happened with Stoyanova. |