Contemporary Polish Voices: The Problem of Medical Care

edited by Aleksei K. Zolotov

NOTE: THIS WAS to have been a half-hour taped discussion of various areas of putative material advantaged by East Bloc citizens as partial compensation for the absence of political liberties. On each of these points the participants considered their situation to be far less satisfactory than is generally believed by Western radicals. As it turned out, the discussion of medical care alone took some forty-five taped minutes, and many more minute “off the record.” The names have been changed, and I have rearranged some items and smoothed the translation.–AKZ)

Klara: To understand the degree to which free medical care really does constitute a right enjoyed by the citizens of the socialist state, we need to look at the details of how it works out in practice. It’s very far from the ideal that is described officially.

We can begin with the hospitals where children are born into a socialist society. In most cities, those hospitals lack the most basic equipment. They lack, too, any kind of proper antiseptic conditions. They are just simply dirty because they are overcrowded. There is no way out. Given the situation, it is impossible to make them clean.

We know what we are describing, because my friend Jadwiga here and I have both given birth to children in Poland. My children are twelve and ten and her daughter is about eight. Nothing has changed in the last decade for the better. Conditions now are, if anything, worse. You give birth to a child, and because of the demographic boom in Poland, you are likely to end up as one of sixteen women giving birth simultaneously in the same hall.

When I gave birth, no doctor was in attendance at any time. After I gave birth, a doctor came, which was a stroke of luck because I had lost a great amount of blood. If he had come a moment later it would simply have been too late. As it was I was down to something like Z7 percent Hematocrit after massive blood transfusions.(1)

It’s not his fault; he had to work fast. But he started saving me without his gloves on, unprepared in any way for sterile work. So, later I developed an infection, a very severe one, with staphylococcus aureus, which is generally endemic to all Polish hospitals,(2) especially to those where infants are. The infants become infected and many of them actually die. We have one of the highest rates of infant mortality now; we are above Albania.

My mother-in-law is a pediatrician and urged me to leave the hospital as soon as possible after giving birth, despite my own condition, because of the child. They tend to release mother and child simultaneously, so for the baby’s sake, she wanted me to get out. Accordingly, on the fourth day after this massive blood transfusion, I left the hospital to take the child away.

Luckily, my baby was not infected. But a friend of ours gave birth to a child quite late in life. She was over forty, delivered by Caesarian section, and it was quite obvious from the start that it would be her only baby. Her child did become infected with the same staphylococcus in the same hospital. And nobody noticed it! In no way was a check made by the hospital for this sort of infection. I was not informed, and she was not informed about the situation with her child. It’s for you to discover on your own that you are infected. It is not monitored because it would give a bad mark to the hospital Infection is generally played down, and no figures are published.

Jadwiga: This is true, the figures are played down. But privately, any doctor or biologist will tell you what sort of infection you are likely to get in which hospital. In that part of town there is staphylococcus, in another there is some other kind. You’ll be told: ”oh! – that one is relatively free, go there. Try to give birth there, maybe you will not be infected with anything.”

There’s another problem. Everybody in the hospital is underpaid, so most of the staff expects you to provide some sort of side payment There are some exceptions- people who are honest, and as a result, very poor, who will extend their care to patients freely. Call it a bribe if you want, but the situation is so difficult you can’t really differentiate between what is a bribe and what is simply job compensation for someone who can’t live on the nominal wage payment.

Also, hospital people work such hours that they can’t get out to buy many things that are difficult to obtain. So sometimes the payment is in the form of things, for example, coffee. In a hospital, where you are up all night on duty, drinking coffee is important, and when there is no coffee in the shops, patients are expected to bring some from home.

It isn’t that the doctors or nurses are at fault. They are in a situation where they can do nothing. First of all, there are far too few of them. And they are underpaid. Generally, the health services workers are the worst-paid workers in Poland. The average doctor, not just the young doctor, is paid less than a cleaning woman. But of course, our government is very eager to say something about the Hippocratic duty of a doctor, about saving human life independently of compensation.

Tadeusz: The salaries in the health services are so low that it is difficult to get qualified nurses to stay in the profession. To give just one example of the overwhelming absurdity of this: One of our cousins just quit the mental hospital where she had been employed as a highly qualified nurse for fifteen years. She now makes her living sewing bags.

Klara: A major problem is multiple-use hypodermic needles. It’s now official policy of the Ministry of Health that in all hospitals, including pediatrics and infants’ wards, it is compulsory for doctors and nurses to use multiple-use needles, because of the lack of single-use needles (a part of the general lack of disposable equipment). It’s incredible, and as a matter of fact many doctors will in many cases just not respect this policy. In fact even our official media are protesting, but still this is the regulation.

As you know, we don’t have the sort of AIDS statistics as in the States, but still there are already some cases. The main problem with needles here is hepatitis. There have been a lot of cases of infant death and a lot of miscarriages caused by the use of such needles. And as you know, there is no way to make the multiple-use needle really free of the hepatitis virus.(3) For years hepatitis has been a near epidemic in Poland.

Jadwiga: There’s another problem, really unbelievable – quite unpleasant and hard to talk about. But it’s connected with health care and at the same time with feminism.

Would you believe that there is a country in the world where it is a major problem for a woman to buy anything even resembling surgical cotton or its substitute for protection during menstruation? Tampons are long forgotten; they haven’t been produced for years. They once were produced in Poland!

Klara: Women continually haunt all kinds of places trying to find something, some substitute, even some very primitive substitute. Working women – 80 percent of women work in Poland –getting ready to go to work, must somehow deal with this problem. There is a discussion of what is being done, even in our official press. We hear “in the next two years” – always this “two years”- “the situation will be changed.” And nothing changes. In fact, if it changes, it changes for the worse.

What do women use? I’ll show you. [She holds up an object that is a cross between a roll of toilet paper and a roll of paper towels; the material is about 1/8” to 3/16” thick and resembles matted toilet paper.] But this is available only by prescription! It’s meant for people who are incurably ill with cancer.

This shows all the care that the state has for women in general. Of course, any woman in her senses, traveling abroad, will buy a thousand tampons.

Jadwiga: The whole family all over Poland looks for such items for women. At times pads might be available, but you’re restricted to five or ten pads, so the whole family queues up to buy them. It’s something that a boyfriend would buy, or a husband for his wife. Sometimes there are funny things that happen while queuing. Three or four years ago, they used to throw men out of the line. They would say: “You will not get it,” and the man excluded would protest “but my wife is ill,” or “mother is old,” or “you see, my daughter is embarrassed to queue for herself, she is so young …”

Klara: We are also short of drugs. Most of the drugs that are on the official list as absolutely essential are missing, and some antibiotics are unobtainable. At present there is no form of penicillin available at our drugstore.

Remembering the doctor who saved me without his gloves on ten years ago, it occurs to me now that gloves are unobtainable, so hospitals fight among themselves for them. And they lack thread for sutures, so sometimes they use ordinary sewing thread. There is not enough modem equipment-for instance, we have one Cat scan here for three or four million people, so there is queuing for it.

Jadwiga: In our oncology wards, people must wait a month after being hospitalized before having access to the equipment, and you know that with cancer, time is very important. People who need surgery immediately often have to wait for months. And yet in those wards, the doctors are quite good. If they had some equipment-antibiotics, beds, and Cat scans – they could perform quite well. They try to do their best, but although they make really superhuman efforts, due to the circumstances the results are disappointing. They have certain successes, but still, how frustrating it is for them to work in such conditions.

Klara: I remember how shocking it was for me to visit our medical academy in 1981. I was the interpreter for a group of French doctors who were trying to find out what sort of equipment was needed at the academy. From the list given them by the Polish doctors, they had little idea what was required and wanted to see for themselves.

That day at the medical academy was one of the most frustrating of my life. The French doctors said at last: “Now, we know what you need. You just don’t have anything. We don’t need your list; stop writing it. Now we know.” They had seen the children’s leukemia ward, with children who need dialysis.

Jadwiga: The children need this dialysis daily, and there is a shortage of apparatus for the procedure. All of the children need dialysis, and many of them are condemned to death because of the shortage. This is admitted even in our official press. The doctors are forced to decide which children to choose for dialysis. The doctor has to think how far the child lives from the hospital, how often he or she can come. He has to choose which one is to live and which one is to die, because he has no other choice.

Another problem is the treatment of old people. There is an unofficial rule that the ambulance will not come to take to the hospital people who are over seventy. Because of the lack of beds in the hospital, they would rather bring in younger people. If the family makes too much of a fuss, sometimes they will take the person for a very short period of time. The condition is not important; the important thing is that the person is too old. They prefer to let him or her die at home – it’s quite horrid.

Klara: Nobody can really feel secure as far as medical care is concerned. Everything depends on luck. For example, whether an ambulance comes or not is a matter of luck.

Jadwiga: You can’t be sure, because of the lack of telephones, especially in the new districts of town. You can’t be sure that you can get through, that the telephone booth a hundred meters  from your flat will be functional. You don’t know that you will be in any condition to get all the way to the phone booth and call for help. And if you do get through and call the ambulance, there is the problem of how soon it will come. There is only one intensive-care ambulance here for more than two million people.

Klara: Central planning has a lot to do with this, as with our other shortages. The distribution of vehicles for ambulances is set in the plan. And in fact, the ambulance service is among the last agencies on the list of priorities for the motor vehicle industry. Silly and sad things happen because of this. For example, they received a Fiat that was rejected by the British: thus we have a left side driving vehicle actually in use as an ambulance. That’s what the health service finally got – the bottom of the list.

Jadwiga: And then finally, if you happen to get to the hospital, there is the lack of equipment for diagnosis, the lack of drugs and the lack of single-use needles. You have no idea what will happen to you. You may be lucky. You may not get infected with hepatitis. You may get the kind of blood transfusion that you need. There’s no central blood bank and even the types of blood that are generally available might not be present at your hospital. They might not have the right drug. It’s a matter of luck.

Klara: You also have no right to choose a hospital. You have to go to the one that is on duty. We were very lucky when my child had an accident. He had almost lost a finger, and they wanted to take me to the same hospital where I gave birth and was infected with staphylococcus because that hospital was on duty.

I started begging: ”Please don’t take me there.” They said, “Okay, we’ll try to take you to another hospital, but they might reject us.” We went to the other hospital, and they put me through by phone to the director, quite a concession. I begged him to accept my child. He asked how old my son was, and I said he was twenty-two months, rather than two years, so he would seem more of a baby. Finally he admitted the boy. This was extremely fortunate, as I learned later, because in that hospital they were able to sew his finger back on. If we had gone to the original hospital, they certainly would not have tried to save the finger.

So it was just a matter of luck, and it’s the same with everything.

Notes

1. According to an American medical school professor, whose remarks are the basis for the other notes as well; this is a serious situation, involving the Joss of nearly half the red blood cells in the body.
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2. Unfortunately, staphylococcus aureus is endemic to U.S., British and French hospitals (among others) too.
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3. Actually, several decades-old standard procedures exist for sterilizing quite adequately multiple-use needles. They require considerable care, and their availability has not prevented the transmission of hepatitis B via needles as a world-wide problem.
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July-August 1989, ATC 21