Cancer patient in Sofia reports on:

Health care crisis in Bulgaria

Zornitsa Dermendjiewa was diagnosed in 1997 with Hodgkin's Disease, a form of cancer of the lymphatic system. A young man in his early 20s, Zornitsa lives in Sofia, the capital of Bulgaria. His correspondence explains the very difficult and often tragic circumstances confronting cancer patients in the countries of the former eastern bloc.

Since the collapse of the Stalinist regimes in the late 1980s, conditions that were already bad have now become impossible as patients are confronted with the realities of the capitalist free market.

Worldwide, cutbacks in spending on health resources and the orientation of governments toward a 'user pays' health policy has lead to a serious deterioration in all aspects of health care. The conditions described by Zornitsa are by no means exclusive to Bulgaria and are in fact becoming a universal standard, including in the advanced capitalist countries. We encourage readers to write to us about the health issues they face in their own countries.


I live in Sofia, which is the capital of Bulgaria. With me I hope that everything is okay. I try to live as if I have beaten this disease.

In ex-communist countries like Bulgaria the health system is in a very bad condition. Hospitals do not have enough money because, until now, treatment was free. The doctors are really good but there are no drugs. It is a complicated situation.

I am sorry that I cannot sound more optimistic but for the past few years I have had so many problems because of our health system and because of the socialist regime we had.

For about 45 years, we had the right to free medical treatment. In the beginning, the governing Socialist Party seemed to be okay. The government built many hospitals. As you know education was also free of charge, so there was a great opportunity for anyone who wanted to study medicine.

The system worked a little bit like this: there was a state budget in which the government decided how much money would be needed for the hospitals and the salaries of the doctors. As you probably know, the salaries for everyone at that time were fixed. Everything sounds nice, but only sounds that way.

The real problem was that there was no real 'fresh' money in the health system at all. You know how expensive everything is. The result of the lack of spending began to be felt by the 1980s. Hospitals had bad conditions which you cannot even imagine. I mean really awful. In each room, there were about five people. There were no toilets in the rooms, no television, no telephone. The food was more than terrible. It was clear to people that the country was bankrupt.

The most terrible thing of all was that people in the high society of the Socialist Party and the government always went to some other country for their medical treatment. They did not do anything for their own people but went to the West to help themselves. There was enough medicine for them but not for me or anyone else.

But the thing that I can never forgive them for is the explosion at Chernobyl (1986) in the Ukraine. Now the government has the strength to tell people what the real danger and real conditions are and how much radiation is in the air. When it happened the socialist government knew but did not say anything. They, the officials at the time, drank water and ate food delivered from special places just for them. This is a crime against all society. After Chernobyl the cancer cases in the hospitals increased, many of them babies.

What is happening now?

The pollution is terrible. The air is dirty because of the old Russian cars in the streets. The streets are dirty because there is not enough money to clean them. There is no money, no medicine, no food for hospitals, no money for repairs. Today I was in the hospital and my doctor said that in European countries there are repairs in the hospitals every year. In many of our hospitals there have been no repairs from maybe ten years. In many hospitals in the country areas you must get food brought to you from home when you stay in hospital.

In Sofia there are, I think, only four machines for computer tomograph (CT scanners are used to examine the body's soft tissues). In many other large towns, there are no such machines. In 1997, there were 205 hospitals in Bulgaria; in Sofia for every one doctor there are 389 patients. For Plovdiv, the second largest city in Bulgaria the ratio is one doctor to every 477 patients.

I will describe my case to explain the condition of our health system. When I understood that something was wrong with me I went to the Medical Academy, Thorax Chirurgy. For the operation and chemotherapy that I needed I had to pay for everything. The hardest thing was that a big part of the operation required drugs that were very expensive. For example, the post-operative drugs cost 36,000 leva ($US20) for just 1 gram. I needed 30 grams of that drug which cost me 720,000 leva ($US400). An average monthly salary in Bulgaria at that time was about 100,000 leva ($US55.55).

For the chemotherapy I needed, I had to get a loan to go to Austria. In my country, the conditions in the hospitals are terrible. To be sure that everything would be okay with me, my family decided to send me there. There are no drugs readily available for chemotherapy in Bulgaria. You must wait for them and in many cases, when you get them, they are old. That is why I went to Vienna for chemotherapy.

It was difficult for me there because my family was in Bulgaria, and only my sister came with me to Austria. I missed my friends and family. The hardest thing in Vienna was that I had to find out everything about the treatment by myself. There was no one to explain to me about the effects of the chemotherapy.

In Bulgaria it is impossible to pay for your medical treatment without help from somewhere, because of the low salaries. In Austria I paid about $US17, 000 for my treatment, which is about 28,800,000 leva in my country. This is about 250 weeks worth of my salary. Because of the lack of money, it is very hard for a cancer patient in my country. I am giving you my personal account for a month so you can understand how difficult it is:

  • One $US = 1800 leva
  • My salary = 150,000 leva a month ($US83.33)
  • Electricity = 20,000 leva a month ($US11.11)
  • Hot water & central heating = 40,000 leva ($US22.22)
  • Telephone = 25,000 leva a month ($US13.88)
  • Transport = 30,000 leva a month ($US16.66)
  • Total costs = 115,000 leva a month($US63.88)
  • These are the main costs. From this you can calculate what is left for food, monthly 35,000 leva ($US19.44), and food is very expensive. In other words, I work for about $US84 a month. After this I think you can imagine how hard it is to be a cancer patient here or to be ill.

    I am speaking like this because I am very angry. My family sold almost everything because of me, and now we must return the money that we spent on my treatment. To return $US17, 000 in my country you must pray for miracle. All my family are working night and day for that money.

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