January 2017 theguardian; Rising mortality rates, an increase in life-threatening infections and a shortage of staff and medical equipment are crippling Greece’s health system as the country’s dogged pursuit of austerity hammers the weakest in society.
Data and anecdote, backed up by doctors and trade unions, suggest the EU’s most chaotic state is in the midst of a public health meltdown. “In the name of tough fiscal targets, people who might otherwise survive are dying,” said Michalis Giannakos who heads the Panhellenic Federation of Public Hospital Employees. “Our hospitals have become danger zones.”
Figures released by the European Centre for Disease Prevention and Control recently revealed that about 10% of patients in Greece were at risk of developing potentially fatal hospital infections, with an estimated 3,000 deaths attributed to them.
The occurrence rate was dramatically higher in intensive care units and neonatal wards, the body said. Although the data referred to outbreaks between 2011 and 2012 – the last official figures available – Giannakos said the problem had only got worse.
Like other medics who have worked in the Greek national health system since its establishment in 1983, the union chief blamed lack of personnel, inadequate sanitation and absence of cleaning products for the problems. Cutbacks had been exacerbated by overuse of antibiotics, he said.
“For every 40 patients there is just one nurse,” he said, mentioning the case of an otherwise healthy woman who died last month after a routine leg operation in a public hospital on Zakynthos. “Cuts are such that even in intensive care units we have lost 150 beds.”
“Frequently, patients are placed on beds that have not been disinfected. Staff are so overworked they don’t have time to wash their hands and often there is no antiseptic soap anyway.”
No other sector has been affected to the same extent by Greece’s economic crisis. Bloated, profligate and corrupt, for many healthcare was indicative of all that was wrong with the country and, as such, badly in need of reform.
Acknowledging the shortfalls, the government announced last month that it planned to appoint more than 8,000 doctors and nurses in 2017.
Since 2009, per capita spending on public health has been cut by nearly a third – more than €5bn (£4.3bn) – according to the Organisation for Economic Co-operation and Development. By 2014, public expenditure had fallen to 4.7% of GDP, from a pre-crisis high of 9.9%. More than 25,000 staff have been laid off, with supplies so scarce that hospitals often run out of medicines, gloves, gauze and sheets.
In early December Giannakos, a nurse by training, led a protest march, which started at the grimy building housing the health ministry and ended outside the neoclassical office of the prime minister, Alexis Tsipras. At the ministry, hospital technicians erected a breeze-block wall and from it hung a placard with the words: “The ministry has moved to Brussels.”
Few advanced western economies have enacted fiscal adjustment on the scale of Greece. In the six years since it received the first of three bailouts to keep bankruptcy at bay, the country has enforced draconian belt-tightening in return for more than €300bn in emergency loans. The loss of more than 25% of national output – and a recession that has seen ever more people resorting to primary health care – has compounded the corrosive effects of cuts that in the case of public hospitals have often been as indiscriminate as they are deep.
Pressure to meet creditor-mandated budget targets means that in 2016 alone, expenditure on the sector has declined by €350m under the stewardship of Syriza, the leftist party that had once railed against austerity, said Giannakos, citing government figures.
More than 2.5 million Greeks have been left without any healthcare coverage. Shortages of spare parts are such that scanning machines and other sophisticated diagnostic equipment have become increasingly faulty. Basic blood tests are no longer conducted at most hospitals because laboratory expenditure has been pared back. Wage cuts have worsened the low morale
“The biggest problem is shortage of staff because people are retired and never replaced,” said Dr Yiannis Papadatos, who runs the intensive care unit of one of the three paediatric hospitals in Athens. “Then there’s the problem of equipment and, periodically, lack of supplies like gloves, catheters, and cleaning tissues.”
Small acts of heroism have done much to keep the broken system afloat: doctors and nurses work overtime, with donors and philanthropists also helping.
Papadatos said: “I was brought up partly in Kenya by parents who emphasised the virtues of helping others. These days I spend a lot of time going round asking friends, or the private sector, for help when our hospital runs out of supplies. The monitors we use to track heart rhythms, blood pressure, that sort of thing, were all donated. People like to give. It makes them feel good.”
Unionists argue that healthcare is an easy target because successive governments have refused to properly tackle tax evasion, the biggest drain on public coffers. In a rare public admission, the International Monetary Fund recently conceded that cuts had been so brutal “basic public services such as transport and healthcare are being compromised”.
But at a time when the Greek debt crisis has flared again, after Tsipras’s controversial announcement of a series of welfare benefits, there are many who fear worse is to come.
One of them is British-trained Dr Michalis Samarakos, who believes that while the health system is in need of further reform it also runs the risk of running out of specialists and clinical trainees. Already there has been a massive exodus of doctors abroad, mostly to Germany and the UK, as a result of lack of opportunity.
“The best are leaving because their potential cannot be developed here,” he said. “I can see it teaching sixth-year students at Athens University, everyone wants a reference, everyone wants to go.
“It’s become a growing problem. We don’t have nephrologists, for example, because there are no prospects for specialists, either in or out of the system [in private practice].
“Trainee doctors are the backbone of any hospital – without them hospitals can’t function. Unless there is a big change, I worry greatly that things can only become worse.”