Interview conducted by Desislava Pateva with professor Alexander Chirkov – founder of the modern Bulgarian School of Cardiac Surgery and Cardiology. After graduating from the Medical Academy in Sofia, he works for years in Germany, and then specialize heart surgery for babies and young children in the United States. In 1986 he made the first heart transplant not only throughout the Eastern bloc, but even before countries such as Spain and Portugal. In 2003 he performed the first lung transplant in Bulgaria. Prof. Chirkov is the creator of the Hospital “Saint Catherine” in Sofia and for many years was its director. Currently he is working on building a modern cardiac hospital in Varna.
Originally appeared at A-specto, translated by Borislav exclusively for SouthFront
Prof. Chirkov, how do you assess the reforms of the minister of health Petar Moskov? We have seen a number of his blunders, he has completely exhausted the credibility given by the population, yet he continues to enjoy the support of the prime minister.
And what is his reform? Do you know what reform means? That there is some form and that this form is transformed. There hasn’t been a form for 25 years, first we need to build it. In 2002, the Saxe-Coburg-Gotha sent me as his adviser to the Minister of Finance in Brussels to realize the concept of healthcare. I said that we need something like 300 million leva to realize it. The very European Commissioner for Health said: “We have not seen such a concept in Bulgaria, ever!” I’m going back, telling the king of the meeting, and he replied: “Bravo, bravo! We should begin to do what you say.” This is based on experience and not on fabrications. While in this case the minister tries to figure it out. Where is his experience, where did he work, what did he do?
Everyone saw what I did for 4-5 years. At first people worked for 12 hours and then gathered all to consult. What does this mean? A new mental culture. It means to be kind to each other and work as a team. Doctors should be kind to the nurses, not think they are more important than them, because without them there is nothing they can do. And most importantly – they should read continuously. So I took an English teacher and they were all taught in English, to be able to go to international congresses. Maybe they are very capable and think otherwise about what to do.
When President Parvanov opened the hospital he said that the model in which it works, should be a model for the whole of Bulgaria. I went to the hospital at 6.30 am. I left at 8 pm, and before me no one could leave. Tell me now who cares for patients better? Is that not what we want? I wanted to bring it everywhere in Bulgaria. But how?
First, build a structure, that is not subordinate to the prime minister, regardless of whether he is a criminal or not. Whether the administration is criminal, whether the Supreme Judicial Council is a criminal, or as they say in Europe, not criminal but corrupt. Though this is a crime. I’ve always fought about having a medical Chamber of independent physicians in Bulgaria. The quality of medical services in hospitals should be inspected every, to see if everything is second to none. Here’s your form!
Second, we must build a structure to continuously educate doctors and nurses. This is called “continuous medical education”. So I invited Americans who work in this way. Germans introduced this only four years ago, and we wanted to introduce continuous training for doctors and nurses 20 years ago. This obliges them to read constantly and after four years to re-certify – to understand whether they are at level, whether they attended the seminars. Not to treat them like students, but to find out whether they attended the seminars and whether they read, because there are discussed various topics. Thus, we constantly prepare doctors and encourage them to develop. Moreover, university hospitals will do research.
Third, we must build a structure that will report to the minister. The minister himself should be glad that he is being reported to, not to protect “his” people, be it in Stara Zagora or Kazanlak. These protections would disappear because they would be independent experts who will make continuous inspections. Is this not important for health? This structure would report on any errors and not allow doctors to make a profit at the expense of the patient. We can’t have a grocery store structure for interventional cardiology, and put 5 stents per patient. The heart of a 70-year-old man is destroyed without having to stop 2.5 billion times. You destroy it. Even if he was 50 years old, he would have died. The structure that controls these things must report to the judges, the judicial council.
As it says in Latin: “Salus populi suprema lex esto” ( “The health of the people must be the supreme law”). This is the most important law for doctors and nurses, and hospitals themselves. Those who want to earn money on the backs of patients, they do not care what they do, whether that patient will recover completely, or will suffer even more. I suggest a procedure to make the quality of life of the patient better.
This minister should do reform, by creating the form first. I’m sure we can implement it. Is it that hard? To do things separately, I disagree.
How do you explain that Boyko Borisov still keeps Moskov …?
Why do you always talk about names? Please say the healthcare administration.
Well, what caused the prime minister to keep the health administration as is, although the amendments to the Law on Health Insurance was declared unconstitutional, and although the idea of introducing fingerprint IDs and merging hospitals, caused a wave of discontent?
I’ve thought about this. I’m not sure what you say will have an effect. I have said it many times and there are no consequences. It’s about enlightenment. Asking about why the Prime Minister tolerates the health administration, well he tolerates the whole administration.
This great and all. but remember that during the cabinet of “Borisov 1” several health ministers were replaced. Now despite errors after errors there remains a figure – Minister Moskov. He is the face of this health administration.
That’s his job. I do not know why they tolerate him. People elected this government, right? This Prime Minister and other ministers … The question is whether you young people will gather the best experts of Bulgaria into a government. Not macho types and those who just blah blah in parliament. But to assemble a critical mass of about 30%, which can affect the other, which has the mental culture of an advanced civilization. To begin to build a real, strong civil society with a great social element so that even the poorest feel better and enjoy the life given to them by God.
In the operetta “Die Fledermaus” by Johann Strauss, it says: “Happy is he who forgets what can not be changed.” We should not act like that. True, lucky for him. Your task is to ensure that more people change their mental culture. When electing a Government we must choose people who are really interested to do more for society. Our current system can function for a certain period of time, because everyone should mind his own family, but if there is no healthy society, your family will begin to suffer also. That we must constantly criticize for errors, those who govern us, yes its true. Including in Germany and America. That is a question of an already constructed, healthy society.
Who is the most successful model for development and financing of the health sector globally? Americans, you mentioned are often criticized for not being socially oriented, many people have no access to health services.
I worked in America for two years. The German Minister of Health sent me, when I was an assistant professor in 1974 in Frankfurt to study pediatric surgery. We really achieved a lot. We introduced baby’s surgery in Germany. I returned, I introduced it in Frankfurt, then in Bulgaria. Not for nothing we were invited to Algeria, to Egypt, I even got a medal in Iran. Todor Zhivkov very much enjoyed that we were raising the image of Bulgaria. And we, the whole team, for years went for three weeks to operate in these countries, in Egypt, Algeria, Kuwait, Syria and Iran. And we operated only their children, they could not do it. So they came here to study at “St. Ekaterina.”
America learned anything from Europe, including Bulgaria. But after that they developed faster because of the so-called “liberalism.” But this is a collective liberalism. We know what problems were caused by collective fascism and communism. But liberalism should really be collective – to think liberaly, to develop everything, but at the same time to think about society. That still doesn’t exist in Germany. Do you know where it is? In the Netherlands and Denmark. These are countries where ministers go to the meeting at the ministry with bicycles, not cars. Here the MPs even have their own driver, everything is at the expense of the people.
Do you think the model of financing health care through the health fund is exhausted? We know that for a large part of the activities, the insured must pay extra.
Look, I do not know what a health fund means, but there are state insurance companies everywhere. There are also private insurance companies, if the patient wants to choose a particular clinic. But this is different. We must provide for the poorest, as it was to me at “St. Ekaterina. ” I told them: When the poorest walks in, do not ask for money. We even had three sisters dressed in the uniform of flight attendants to welcome people. Patients should see some warmth, not just constant sorrow and suffering.
How do you define management “St.. Catherine “to date? Recently it seemed that after some layers shifted, in this hospital appeared serious accusations against the doctors …
I told you it was a hospital that we have built and should be a model for all. They tell me that now it is very bad. Even the nurses have fled. With me they were stimulated and free, not suppressed. They were constantly abroad, preparing continuously. And the atmosphere was different. We are still in a phase of a civilizational process that is not enough. Ever more criminal types are coming in and they govern. Hence the trouble. But I think the young will get rid of it.
And how can we fight the corrupt practices of the “white mafia”?
As I said its not a party democracy but a mafioso democracy. And it builds a mafioso administration, which has its own small administrations. And so, a 10-percent mafioso administration is ruining people. Even the ministers in Germany say that we have no legal system … For example, the judicial system is corrupt, which means you’re not sure that what you have done will be approved or not.
What do you think of the showcase arrests in the Center “Fund for Treatment of Children”? Some speak of violations by management, others believe that the attack against Paul Alexandrov is the result of a political order.
With me, children from everywhere come to be operated on. It should be made so that the workflow is the same everywhere, so that people don’t have to send their children abroad? Back then even Turkey, Greece, Russia, Ukraine send their children here.
But some parents and doctors protect the work of the Fund during the reign of Pavel Alexandrov. There was a Consultative Council, which also followed his work. Not to mention that it is more than suspicious that the prosecutors denied their initial charges against him. So I ask you whether it is a political order.
Naturally because of this chaos, people have one desire only. To make money. We all have this aspiration, but it should be cultivated so as not to be antisocial. I think it is a lack of experience and a choice of people who are not high quality and effective.
I’m interested in why we ever created a Fund for treatment abroad. What are we in Bulgaria, idiots? No patient was sent for surgery for heart disease abroad when I came here? The same goes for children, including the most severe cases. The opposite happened, foreign countries called us to help them. This structure is redundant in Bulgaria. We must build clinics and work as we used to – to prepare their staff continuously every day, to train them and getting outside educators here if needed, so as to create everything we need here. Not to think about the easiest way, “Treat them abroad, here’s money.”
The arguments are that children are sent abroad because there is still no trained staff to carry out some of the treatments. The new management is accused of sending funds directly to Bulgarian clinics to treat children, which at this stage and with the available equipment is not possible.
It is foolish to say so without checking first. Let the court prove it, if its so. We observe a frigidity of the population – it is not fighting against injustice, as in other countries, and this is used by criminals.
The management of “Pirogov” accused of racketeering the Metropolitan Health Insurance Fund and of slashing the budget of the emergency facility. Do you believe that the advance transfer of funds to a hospital without a contract with it, is only a temporary lull and that serious tensions will arise later?
If we had the structure that we offered for the past 20 years, first, it would deal with “Pirogov” Secondly, he would check the fund, and then it would communicate to the Commission in the National Assembly so it takes a decision. We can do it. But now chaos is created and only then do we look for a point of fairness.
You have already mentioned what needs to be changed in the health management to treat the patients. But is it not more appropriate for them to get health insurance instead of paying health fund contributions?
That’s why the state seeks insurance companies – because they take money from patients. It’s a good system. But the main thing is that there should be no additional insurance. The fund should pay the etras because the hospital is making more effort and uses expensive equipment. The fund must pay, not the patient. Other countries do it this way? A book with a price list for all the procedures. The patient can always look at what this book lists and how much it is, like in Germany, for example. How hard is that?
Not to mention that phantom patients are accepted to drain the treasury …
Exactly. I told you – when the patient sees what is done and what is not, he can go to the fund and tell them, “This thing was not done. Do not pay this clinic or this hospital.” You’ll see how quickly everything will arrange by itself.