Patient odyssey: Veles via Skopje through Stip

Veles - Seventy-year-old Rodna J. from Veles got psoriasis last spring. She lives in Kojnik, on the hill on the right part of the town and she came to the Health Center in the town center on foot, so that a skin doctor to see her. But at the specialist clinic instead of a doctor she was met by a nurse explaining that the clinic was not working as the specialist had retired

By Ubavka Janevska

- The fact that I was walking from the hill in vain was not so terrible compared to the information that I needed a sub-specialist examination in Skopje. But for there I had to have a referral from a doctor specialist in skin diseases. As in Veles there was not any they told me to go to the family doctor, and he to send me to the skin doctor in Stip and onwards to get the referral for the Skopje Clinic. That is what I was supposed to do so I went from Veles to Stip, then after a few days I went to Skopje. It was not easy at all at the age of seventy to walk this path, said Rodna.

"Veles via Skopje through Stip", this journey has been overcome by several people from Veles in the past nine months while the town was without a skin doctor. Retiring of the only specialist happened at the time when the doctor who was to succeed him failed to promptly specialize since married, became pregnant and gave birth to a child. For this reason the clinic for skin diseases in the Health Center was closed for a few months. The director of the General Hospital Veles, Dr. Atanas Vasilev said that as soon as the doctor had retired, he began looking for a solution to the problem. But the hospital in Veles waited for several months for the Dermatovenerology Clinic to give a written response for hiring a replacement.

- The clinic has been reopened. The hospital has signed a contract with the Dermatovenerology Clinic and once a week or every Friday a specialist from Skopje comes to the skin clinic in Veles. If there are more than 40 examinations we will then pay for twice a week engagement of the doctor, which means to come some other day too and to examine the patients in Veles, said Dr. Vasilev.

Patients in Veles are now faced with the consequences of the period 2002 - 2006, when in the general hospital no doctor was employed and no one was sent to specialization, although the staff of the public health organization was pouring out. Apart from naturally, for retirement, 20 specialist doctors suddenly left the hospital moving to private clinics. All doctors specialized at state expense. Specialization generally lasts 5 years, at the time the state paid 2,5 thousand Euros per semester for a doctor. And instead of all to return and work 10 years as a legal obligation, most of them immediately after specialization left in other clinics. 

The skin clinic remained without a doctor and the transfusion station in Veles works with one specialist doctor. Nine months ago it worked with two transfusionists and 10 years ago there were three. But both are retired and now it is a real chaos. Queues of patients in the region, waiting for hours because the only doctor does not arrive at the same time to examine those with venous thrombosis, pregnant women, people who take the driving test and blood donors. Moreover, this doctor transfusionist is obliged to provide blood for hospital operations. So once a week a doctor from Negotino came.

- I cannot know read the blood results myself. Now they tell me to visit my family doctor, because there is no one to see the results here. It is hard for me, I have been waiting for hours, and I have four built-in bypasses, said Mile S.

- I have deep vein thrombosis and I have to take medicine according to a pattern and come regularly for control. A doctor needs to examine me and tell me how to take them. But there is no doctor, said Vera M. from Veles.

- I have been coming from Rastani three times. I do not know what this is, I have had a surgery and cannot stand. There is neither a bench nor a chair to sit. At the clinic the conditions are very bad, there is damp everywhere and the hygiene is bad, said Gjore T.

Apart from the patients, there are also complaints from blood donors. They also return home because of the crowds and it directly affects the amount of voluntary blood units gifted. Veles was always first on the blood donation list but now unfortunately it is not so, said the president of the Macedonias Red Cross, Dr Milcho Trajkov.

"Blood donors feel the lack of a doctor. It is a problem but we cannot influence this situation. The solution should be sought in the State Institute for Blood Transfusion", said Dr. Trajkov.

However, in Veles there are no prospects of hiring a second transfusionist, the director of the Institute for Transfusion is categorical. Dr. Emilia Velkova believes that Macedonia should introduce the telemedicine method by which laboratory assistants will take blood and send via Internet the results to doctors in regional centers. They will read and give therapy to the patients.

- This is how transfusion in Europe works. We should also apply this model. We will slowly introduce it, said Dr. Velkova.

She said the state now has 70 transfusionists and in the next 5 years 14 of them will retire. In the same period only two transfusionists will specialize. And it will be enough, said Dr. Velkova.

The patients from the Vardar region cannot understand it. They wonder who will choose their treatment without any examination if transfusionists from other centers in the country read their results on the internet.

The transfusion department is not under the jurisdiction of the Veles hospital but the Institute in Skopje. It only uses the space within the hospital in Veles. It is located on the ground floor of a century-old building, with moldy and ruined walls and on the floor above it works the department for physical therapy. It will be renovated, said the director of the Veles hospital.

- The project is ready for soon we expect the procedure to start. Once the renovation is completed we can say that almost all units will be in good condition, said Dr. Vasilev.

Once this project is completed he will be up to the problem of shortage of staff. Now the hospital works with 52 doctors, specialists and according to the director 28 more are necessary to be able to meet the needs of all patients. Seventeen general practitioners, employed since last year until now got specialization but they will fill the place of only half of those who will retire in ten years.

The Veles General Hospital with an annual budget of 3 million Euros and 52 doctors specialists provides health services to 133,000 patients in the Vardar region. This amount of money covers all annual income and expenditure of the public health organization from procurement of medicines, medical supplies and appliances through the payment of salaries, water and electricity bills. The initial impression that for Macedonian conditions it is not a little money, falls into water because the program that the hospital has shows that it still needs more money and more specialists. The annual budget would welcome another 200 thousand Euros, says director Vasilev. The Veles hospital is not the only one facing such problems.

The Ohrid General Hospital provides services to 150 thousand patients, has 72 specialists and an annual budget of 243 million denars. According to the director, the hospital would work better if it got another 20 million denars and 20 new specialists. Dr. Ljuben Arnaudov, like his colleague in Veles, says that most of the budget money is spent on procurement of medicines and utility bills. He claims that the hospital needs additional money because in the first half of the year it gave 20 thousand health services more than last year.

But we have not managed to find what the plans of the Ministry of Health are. From there we did not get an answer to the question whether they save at the expense of patients if hospitals are working with smaller budgets than the reasonably needed and fewer specialists.

Unlike Macedonia, Slovenia, a country with approximately the same number of people and regions, annually allocates 3 billion Euros of the budget for the needs of all public health institutions, which is seven and a half times more than us.

The directors of hospitals in Macedonia have begun to plan how to improve the working conditions and patients’ services. They just need more money. And while the state sees their real needs, patients will have to be content with what Macedonian health currently offers them.

Meanwhile, the deputy minister of health Jovica Andovski came in the Veles hospital. He announced restructuring of the department for physical therapy and rehabilitation, which will cost 140 thousand Euros and procurement of medical equipment. According to Andovski, the department of transfusion is likely to be renovated next year. Then the director of the hospital, Dr. Vasilev said that another doctor for the skin unit has already been hired.  

"The investigation is supported by CIN SCOOP MACEDONIA within the project Raising awareness about corruption though investigative report"

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