I am addressing you with a request for assistance on a case which is of public rather than personal interest. Since May 2003 I have been writing many times to the health and police authorities. My letters have been, in general, about a high percentage of hepatitis virus carriers among hemodialysis patients, weak control and - as an immediate occasion for my first letter - carrying out of undocumented hemodialysis sessions on visiting patients from Belgium and Israel in St. Marina Hospital of Varna.
Checks on local level were made after my first alarming letter; these checks did not find any disorders. I wrote again to argue that the results from the checks did not give a convincing answer to the questions I had brought forth expressing my opinion in the form of new questions. I never received a reply to these questions. Indeed, I have had several replies for all this time, but they are rather strange. The Ministry of Health, for instance, informs me that I shall receive a reply from the Ministry of Internal affairs to my questions concerning hygiene and epidemiology, and the Ministry of Internal affairs denies me a reply on the pretext that I am not a state agency.
As a citizen of this country, I believe that, after I have posed certain questions, I have the right to receive answers to them, too. So far, all I have learned from my personal experience is that only my right to pose questions is guaranteed; then comes humiliation after humiliation: threats with dismissal in my working place and silent disregard or inadequate replies from the higher authorities.
Nevertheless, I think positive. I am happy to see that within less than a year the MH has introduced high accreditation criteria for the Bulgarian medical institutions, HD units included. A standard specifically directed toward the HD centers is going to be published soon as well. All this is making me very content. In order to consolidate and the achieved and move it yet forward, I suggest that available should also be:
A Hepatitis Virus Day, similarly to the AIDS day. Few people realize that the hepatitis virus was identified some 10 years after the HIV, but it already takes 10 times more victims;
Official statistics on the Internet about the hepatitis B and C virus carries in the HD units in Bulgaria, similarly to the Internet statistics on AIDS. The information should be updated two times a year at the least;
Independent control: the authorities controlling the health care must be freed from subjection to the Ministry of Health;
Up-to-date Information:
leaflets for HD patients with brief and clear explanations: types of hepatitis, risk of being infected with hepatitis in an HD unit, when and what kind of vaccination should they receive, how to take care not to infect their families and friends in case of already being infected. By this moment, most patients do not even know what they must know;
detailed instruction for the HD staff, courses and workshops dedicated to the questions of hepatitis, research on the topic Hemodialysis and hepatitis;
detailed information on the Internet about hepatitis, including measures against its spread, specifically directed toward the HD units in Bulgaria. Model: the CDC (Center of Disease Control) site:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5005a1.htm
To the best of my knowledge, the only epidemiological data available on the Internet about the situation in Bulgaria point to about 60% hepatitis infected HD patients. The average percentage worldwide is about 20% ranging from 3% - 9% (the Netherlands, Belgium) to 80% - 90% (Egypt, Brasilia). To clarify this issue to a degree, I shall add that 3% is only a little above the average percentage among the general population.
Since the place of Bulgaria is in Europe, and not in Africa or Latin America, I have a dream: to see how measures are taken and the percentage of the hepatitis infected HD patients in Bulgaria gradually diminishes to the unavoidable minimum. I am determined to commit myself to this noble aim.
I hope you will agree that the task with which I have encumbered myself is really noble and that it is of interest to the whole Bulgarian society.
I also hope you understand that I would hardly be able to accomplish this task alone, Mr. Premier of Bulgaria; that is why I fervently ask you for assistance!
Yours faithfully:
Reneta Stoyanova, an ex-nurse at the HD unit of St. Marina Hospital of Varna