Experiences of an American woman who was married to a Serb.

Tuesday, August 31, 2010

Not-So-Fun Adventures in Serbian Healthcare

Just as I arrived last week for my vacation in Serbia, a close friend fell seriously ill and was taken to the Sombor hospital. From the outside, it looks like the setting for a Dr Who TV show, or perhaps The Jetsons. Futuristic design a la 1965, that probably belongs in an architectural tourbook, proving that while Communist Europe was building concrete monstrosities, Yugoslavs had a more creative soul.

Get a little closer and it looks like the setting for one of those "After the Apocalypse" movies, where it's a generation after the atom bomb fell and everything's been untouched and falling apart since. Large plants growing out of gutters, siding falling away in chunks... an abandoned building in the process of turning into rubble.

We push through the only remaining working door to find a huge dark lobby. The reception desk has been pushed to one side because there is clearly no reception anymore... you wander in and find your patient on your own. There's only one sign of life, a small shop in the corner where you can buy, among other things, rolls of toilet paper and bottles of water to bring your patient, because these are apparently not provided by the administration.

I learn you are also supposed to bring cookies, chocolate, fruit juice, or bags of coffee. These are not for your patient but meant for leaving in the nurses' lounge in hopes that they'll pay your patient a bit more attention. But doctors often apparently require studier fare, perhaps a very good bottle of whiskey for a quick in-office consultation or a wad of cash for more significant services. Unfortunately for us, there's just been a medical corruption scandal in Serbia that led to actual arrests, so all the corruptible doctors are a bit shy right now. It seems you need good personal connections to be able to bribe someone! So even corruption is not on a level playing field here.

Sitting by my friend's shadowy bedside (there are very few lights in the rooms or hallways either), I'm appalled to see the food she is served - a large bowl of boiled potatoes in a sauce that smells like Vegeta and chicken fat. I'm pretty sure it's all-wrong for her condition. It's also the same exact meal everyone else in the ward is served, no matter what their condition is. (This is not unusual for the Balkans, in Croatia, my Father-in-Law had the same experience, albeit with spaghetti.)

I remember when my own father was in his local US hospital recently for a knee operation. He was a bit dismissive of the four-page room service menu, so he called us from his private phone to ask us to bring in some of his favorite foods from home, while he surfed the Web using the room's excellent WIFI and the nurses came in to "pester" him every 15 minutes. All courtesy of Medicare.

There are no private nurses or medical services we can find to help our friend in Sombor. Or that we know of in Novi Sad either. But yesterday, due to a complete coincidence, I was in Belgrade to visit one of Serbia's first private hospitals with a different friend who needed a quick chat with a doctor. It's in one of those shiny, glossy new buildings in the business center of Novi Beograd. The enormous hospital lobby is glistening with marble and decorated with huge flat-screen TVs and an official-looking security guard. We perch on Italian leather sofas with chrome legs waiting for the Doctor. The beautiful receptionists, who all wear medical-looking white scrubs, assure us the Doctor will come at 8pm. 8pm? Well, it seems the doctor may also have a day job at the military hospital close-by (where services are free even for civilians, but you must get on a wait list to enter, and presumably there is no marble, chrome, or flat screens.)

At last the doctor is ready to see us. She does look a bit tired, in her also-enormous white room. But she has the latest US medical technology including MRIs at her command.

I sit there, in my comfortable white visitor chair, observing the detailed discussion, which I haven't 1/100th the Srpski required to follow. She hands over, without our asking, copies of the MRI plus a detailed diagnosis memo, so we can take it to another doctor if need be. But, it seems everything is fine. Then we walk out past the security guard into the night. I think, this is what a millionaire feels like.

If they had this in Sombor, I would pay for it in a heartbeat for my friend there. But they don't. And my frustration is intense.


Anonymous said...

I have heard about similar - but unprosecuted - bribery scandals in Croatia.

I was in the midst of trying to establish my residency there when I needed an MRI for a long-term condition. As a non-resident, I had no choice but to go to a klinika privatna and pay out of pocket, but it was a quarter of what a hospital MRI costs in the US. The scanner was state-of-the-art, and images were emailed to my doctor in the US; I was told to return immediately. What I really needed was a PET scan. Croatia has one PET machine in Zagreb and a very long waiting list. People in dire condition wait months for the one machine. Someone suggested I could bribe my way up the list, but that didn't sit well with me. I left the country and had no problem getting a PET scan in New York.

I thought it was a pity that I was trying to take steps to eventually get their health coverage and was thwarted at Step One (Residency) - but in the end, for me it makes more sense to stick with what I've got in the US.

hipimama said...

Yes, that is the reality of Serbia...everything is opening only in Belgrade! That is why it is overpopulated.... Doctors have their noses up in the sky.
On the other hand, I have no insurance here in The States, I am not making enough to pay it by myself, but I make too much to get medicaid. I am healthy, or at least I have convinced my self I am... Dentist??? Did not seen one in ages...So, yes hospitals here are great but only to those who can afford them...so same like in Serbia!

Gordo said...

The military hospital in Belgrade (Banjitcia) is actually quite nice compared to others I've seen in Serbia. Quite modern in a Brasillia kind of way, with all the modern equipment one would typically need. A little spartan otherwise.

The one in Zemun though, seems a clone of the one you've described in Sombor, right down to the atrocious food. The staff on the other hand are quite dedicated and have some world class talent. Sadly these talents will not stay forever as private hospitals will snatch them up, unless they've already gone off to foreign shores.

My 6 month old son came down with bronchitis while on a visit to Belgrade last year. We ended up going to a local clinic in Banjitcia, who referred us to the Children's Hospital near the Pink TV network building. The staff again was excellent - no bribes were required for the 5 days he and my wife stayed there, receiving full care. Our only worry was that there were many Tubercular patients (mostly Roma).

Ancient creaky metal cots, but the equipment and food was OK. The building again was quite old but not so rundown. Brand new doors and windows installed in 1999, due to yet another American "smart" bomb which blasted the building, killing 3 patients, instead of the barracks about 700m away. (http://news.bbc.co.uk/2/hi/europe/348287.stm) I can only imagine the terror the poor children must have felt that night.

As foreign visitors, we paid cash on our discharge, about 1/10th of what it would have cost in America. With the translated transcript, we sent to our Canadian (Ontario) healthcare system, we were reimbursed for all costs.

Anonymous said...

My heart goes out to you and your friend. Best wishes for a speedy recovery.

How would you compare this to the medical services in Nis (if you are familiar)? I am traveling there next month to visit my husbands family.

Thank you.

Pera said...

I understand you. Health system in Serbia is very bad that even Minister of Health goes to Germany for a surgery. If you are looking for MRI in Sombor I think you can find in 'Consilium' clinic. Place is decent but they are not hospital.

Anonymous said...

My wife just gave birth. The doctor cost us 500 euros in bribe, the nurse that was by her side during the delivery 200 euros. On top she stayed at a private suite, which cost 20 euro / day and came with her own bathroom, and shower, and AC and TV. The nurses barely came to see her all day long, she got served horrible food, and the hospital is in the state it is.

This is Serbia, bribes are mandatory and hospitals are from communist area, falling apart - it doesn't look as if will change anytime soon if ever.

Rosemary Bailey Brown said...

Yeah! A reader just emailed me this link www.somborskenovine.co.rs/e-novine/pdf/br.2912/strana16-17.pdf to information about a private medical clinic in Sombor. Why it never occured to any of the Sombor doctors we spoke with to mention this fact, even when asked point-blank is a mystery. Anyhow it doesn't look bad and includes a doctor who speaks English.

In the meantime, the nurses have now told me seriously to never bring fruit juice or fresh vegetable juice to my friend in the hospital who has had intestinal surgery. Apparently their special Sombor hospital diet of boiled potatoes and baked chicken wings is far better for healing ones intestine. I guess Balkan intestines are different from American ones.

Anonymous said...

I don't think it's really fair to compare the health system of Serbia to that of what a person with enough money (not the majority of the population) can afford in the US - or can't afford, and will be paying off for the next 20 years.

The few times I've had to stay in Canadian hospitals, everyone was fed crappy, identical food, too. Hospitals aren't generally known for their gourmet eating.

Maria said...

I think it's just scary to think about what sort of health care I would have to put up with if I decided to move to Serbia. It seems like even if you can afford healthcare in Serbia, you are not guaranteed it. I don't like the idea of having to bribe doctors to get the treatment I need. That is not universal healthcare. Where is all the tax money going?

Anonymous said...

I agree that hospitals aren't known for their gourmet eating. But in my experience, they at least give you a balanced meal in US hospitals. If you are in the hospital for an extended stay, you also meet with a nutritionist and can be placed on a special diet (depending on your condition). They also always provide toilet paper :)