A patient died of sepsis, she got infected during a routine operation in the Prilep hospital. A few more patients are infected. Blagojce from Bitola died while waiting for the cystic fibrosis “trikafta” drug. We talk about Macedonian healthcare in the 21st century with Dr. Igor Nikolov, chair of VMRO-DPMNE’s Health Committee.

The problems in public healthcare are not from today, but how did we allow people to die during routine operations and from diseases for which there is treatment?

Nikolov: I would look for the reason for these cases in the dysfunctionality of the system. To think about what anomaly led to such a tragic situation, especially to ask questions to the State Health Inspectorate, which controls health institutions. Suggestions for corrective measures should come from it so that such archaic bacteria do not appear in the system. The Prilep hospital is a regional hospital with a serious capacity, and therefore it must be properly investigated what exactly happened. In the Inspectorate, there are newly appointed managers whom we have not seen for almost a year, and to get to know them and see their activity. Unfortunately, we have the impression that management positions are being distributed to which people are appointed who are justified by some bureaucratic procedure for whatever happens.

Healthcare workers staged a protest. Were you at the protest? What do they demand from health bureaucrats?

Nikolov: Health workers staged the protest at the call of the Trade Union to demand the promises that were given to them earlier. It was announced back in November as a warning protest, but due to certain promises made by the Minister of Health, it was postponed. Today’s protest showed that healthcare workers are quite concerned about the conditions in the system and the way in which the payment for health services is managed. We witnessed a delay, promises of motivation, that is, an increase in the personal income of the middle medical staff, nurses, paramedics… who do not believe that this promise will be fulfilled. Today we saw serious protests manifested by several health organizations. Of course, I was with my colleagues.

The heroes in the corona crisis were promised a salary increase of 10% per year. The union says that it was this increase that decided the elections 3 years ago. But you got barely 5%. Nurses are still waiting for the promised 2000 den. Will doctors be anti-heroes in the next elections?

Nikolov: The intimate feeling of healthcare workers is that they are being lied to. Young doctors, interns, nurses, paramedics, technicians, and doctors who were on the front line were declared heroes during the corona pandemic. We witnessed how society relied on these people. We were valued then. We have seen many brave stories, many young colleagues, but also older ones, who uncompromisingly joined the battle with covid-19. But in the post-covid period, the feeling of healthcare workers is that they are no longer needed and from the so-called heroes, they feel they are turning into anti-heroes, people who should demand a raise of 2000 denars in protests.

This protest was held because of the arrogant behavior of HIF. I have to repeat the way it was served to us that we were under attack, but no one wanted to give information about what was happening. This silence has opened doubts among healthcare professionals that this society no longer needs them and the number of personnel leaving public healthcare is increasing.

During the corona pandemic, we saw that nothing works without public healthcare. But it is clear that public healthcare is collapsing. Doctors are leaving for private hospitals or abroad. Who destroys public healthcare and who benefits from it? With these conditions – non-conditions and hotel prices, do people consciously push themselves into private hospitals?

Nikolov: Several thousand nurses and doctors left the country, and it is a serious issue that needs a lot of work. The healthcare system is a complex system that needs a lot of work. The dysfunctionality of this system only benefits private healthcare. We are not against private healthcare, but the percentage of private healthcare in the healthcare system must not exceed a certain number, because then the functionality of the entire healthcare system is threatened. We cannot function without private healthcare, but we cannot function without public healthcare either. A balance is needed between these two systems, which we must make complementary.

It is not possible to work without the residents, but the Fund and the clinics do not have money for them. On the one hand, an ad is issued for residents, on the other hand, clinics tell them that they are just whining and they can do without them. Who plays with the young doctors? Are we consciously sending them to Germany?

Nikolov: Without young doctors, we cannot expect to have a healthcare system. Young doctors need to gain experience, and they can gain it only if there is a system of knowledge transfer. The transfer of knowledge is best when the residents are working and when they are motivated, i.e. adequately paid for that work. Currently, the payment of residents depends on the decision of the Management Board of HIF. Auxiliary medical staff must be further trained. Attention must also be paid to secondary medical schools in order to produce competent staff. Our competent personnel, unfortunately, mostly go abroad. I am afraid that we will face a period when we will not have competent personnel in healthcare.

Patients complain about the food at all clinics and the hygienic conditions at some clinics. The only thing they don’t complain about is the staff, but they are aware that one nurse cannot serve one, or even two, or three departments. On the other hand, in the clinical mazes, the weekend starts on Thursday afternoon. Even if you can’t find a doctor on Fridays, the whole job is done by a few nurses at the clinic. There is security, but anyone can come in and threaten nurses and doctors. All these things will be inherited by VMRO-DPMNE. Are you ready for it? Where will you start? Do you have the capacity to move things from this point in one term?

Nikolov: The future VMRO-DPMNE government will have two priorities. Infrastructural improvement and strengthening of the system and personnel strengthening. About security – it is an open infrastructural issue. Our hospitals are pavilions and security is very difficult when it is not under one roof, when you do not enter through one door. When we don’t have an emergency center at the moment, the dissatisfaction of the citizens comes from the fact that we don’t have an emergency center. To come to a place where the appropriate examinations would be done and then they would be assigned to which clinic they should be treated and to which specialty they belong. In the last year, we have had an excuse for not having an emergency center, which is that the Toxicology Clinic is being renovated. We do not have an emergency center because we have no infrastructure and no new buildings. Investment in infrastructure and personnel will be a priority. The Clinical Hospital in Stip must be completed and the Clinical Center in Skopje must be brought to an advanced stage. Personnel strengthening must consist in stimulating the personnel and those who want to stay, to be retained in the system. You have to invest in education. Without education, the healthcare system cannot progress. In the last five years, all education and trips abroad of doctors have been stopped. We are witnessing that instead of doctors, organizational directors go to training congresses. It is pure abuse.