Month: September 2023

Interview with Dr. Velimir Simov, leading specialist in paediatrics at the clinic for maternal and child health ‘Mama and I’

Barely 100 days after opening, ‘Mama and I’ specialists have helped hundreds of children, babies and young mothers across the country – how have you managed to fill the capacity of your newly built clinic so quickly?

The round-the-clock work of all the specialists at ‘Mama and I’ in caring for young patients and their mothers left us no time to make special analyses, but the high expertise, excellent conditions, modern equipment, the uncompromising reception of all severe cases and all patients in need, regardless of the financial, ethnic or educational indicators of the family, did not go unnoticed. Our clinical successes are already receiving recognition from Europe, and we were delighted to welcome our first triplets!

What’s next?

We discussed many different plans with the management and the main investor. For us, children’s healthcare is an absolute national priority and we have a clear vision for the future. Staff development and upskilling in a number of rare paediatric specialties is without alternative and takes precedence over further expansion of the clinic. That is why the national pride ‘Mama and I’ in Pleven is open to cooperation with all children’s wards and maternity hospitals across the country, so that together we can reduce the record infant mortality rate and confront the severe demographic crisis. As part of the high-tech ‘Heart and Brain’ hospital complex, we are very strongly supported with clinical expertise and comprehensive capacity in a number of specialties such as orthopaedics, cardiology, neurology, surgery, genetics and others.

In a number of places, paediatric and even maternity wards are facing closure or are on the brink of survival. The examples are many and, unfortunately, even in regional centres such as Vratsa, Veliko Tarnovo and Lovech – all in state hospitals.

For all the teams at ‘Mama and I’, children and mothers are patients who always come first, regardless of where they are referred from. We do not differentiate whether they are state, municipal or private health facilities. We are equally open to collaboration with university hospitals or those with first level of competence. Patients and mothers come to us from almost all over the country, including the aforementioned regional centres. We are striving to catch up with the huge national backlog in the development of child and maternal healthcare that has deepened over the past five decades. We do not have the time and energy to engage in fruitless intrigues and confrontations with self-serving objectives. Even the historical balance sheet is irrelevant – lives are being saved now, in this moment, and raising and educating a person takes a long time. Forward-thinking decisions, large and small, unite our vast collective – for the dreams and prospects of elevating our medical qualifications and, above all, for the long-term development of our country and our society.

Concentration of high expertise cannot substitute for well-organized specialties at the regional level such as pediatric medicine and maternity care, can it?

Yes, of course it is. That is why we are great supporters and support the rapid construction of the new national children’s hospital in Sofia and the specialised children’s hospitals in Burgas and Varna, which we learned about from the media. With the national leader in hospital care ‘Heart and Brain’ we have a clear common understanding and the plans for the new hospitals also include small maternity and paediatric units, which will be methodically managed and staffed by the ‘Mama and I’ Pleven clinic together with a number of luminaries from the United States and Europe. Concentration of expertise is the only successful model for development in global hospital care, which is heavily influenced by advances in high medical technology. True success at the national level comes only when this concentrated high expertise is available to the entire population, providing satisfactory (or above minimum standard) access to diagnosis and medical care in small and remote locations. So here is a private example with the clear understanding that neither the state alone nor a single entrepreneur alone can solve the health care problems of any country in the world. Since 2007, the Bulgarian Cardiac Institute, of which ‘Mama and I’ and ‘Heart and Brain’ are a part, has built and managed seven modern hospitals outside Sofia and because of their narrow specialisation, fellow cardiologists, invasive cardiologists and cardiac surgeons have reduced mortality from cardiovascular disease and specifically myocardial infarction in the face of high overall mortality nationally.

You mentioned dreams?

We share many collective and individual dreams. There is a lot of collective and individual energy behind them. I will share just one very special one: that over the next 10 years, European statistics will objectively report a drastic reduction in infant mortality and that Bulgaria will rise to at least the European average in child and maternal healthcare.

More and more families with children and expectant mothers from Northern Bulgaria, Sofia and the whole country choose ‘Mama and I’

The first (in 55 years) newly built dedicated clinic for maternal and child health ‘Mama and I’ opened its doors on 1st June this year – at full capacity. The admiration is universal, it is growing, and there is a reason why! The expertise of the doctors and highly qualified teams is at European level. The clinic is part of the high-tech hospital complex ‘Heart and Brain’ in Pleven and has the comprehensive support and advanced structure of the leading hospital in the country. ‘Mama and I’ relies on its well-developed specialist diagnostics and treatment, as well as advances in research and teaching. It maintains links with leading centres in the United States and Europe.

Invested with great love and care, the professional expertise of ASB ‘Helvetia’ in the design and construction of modern hospitals has turned ‘Mama and I’ into a palace of care for expectant mothers and their offspring. The country’s unfamiliar facilities coupled with state-of-the-art medical technology and personalized care have made the clinic a national landmark in healthcare in a very short span of time.

First successes – hundreds of children treated in just one hundred days

In a little over three months, ‘Mama and I’ has raised the level of children’s healthcare in the country, and hundreds of young patients have gained access to medical care that children receive at the best clinics in Europe and the United States. The examples are many – the specialists in the neonatology department care around the clock for the most severe cases in newborns, reaching the needy families and other paediatric clinics thanks to a specialised ambulance – a resuscitation vehicle with an intensive transport cuvee and respirator. They have the most advanced and only in the region specialized equipment for artificial pulmonary ventilation for premature and preterm newborns with critically affected respiratory and cardiovascular activity. Pediatricians from Pleven have helped children with spinal muscular atrophy (SMA) by providing all the necessary care and recently secured a vital machine for a child aged one year and eight months. Just a few days ago, a 10-year-old girl who came to ‘Mama and I’ especially from Germany was successfully operated on for a rare case of a perforated echinococcal cyst.

More and more expectant mothers from Northern Bulgaria, Sofia and all over the country are looking for and finding the best care and conditions for childbirth in Pleven, and already nearly 100 babies, including the first triplets, took their first breath in ‘Mama and I’.

With love and care for the little patients, mothers and families

Yesterday, the start of the new school year was also celebrated at ‘Mama and I’. Children and mothers of students who had to welcome the first day of school at the clinic were surprised with balloons and gifts – school supplies, presented with smiles by their doctors. “Our specialists are taking all the necessary care so that our little patients can soon get well and return to their peers at school,” said Dr. Velimir Simov, head of the pediatrics clinic. On behalf of the whole team of ‘Mama and I’ he wished the children to be healthy, curious about new knowledge, to return quickly to class and, of course, not to forget the games and great friendships.

A 10-year-old girl with a perforated echinococcal cyst has been successfully operated on in ‘Mama and I’. The child was born and raised in Germany. The family originally came from Stara Zagora and went abroad years ago. A delay in their daughter’s treatment in Germany for nearly a year and a half led the relatives to seek contact with specialists at the center of clinical excellence in Pleven. In medical practice, cases of perforated echinococcal cyst are common in adults, but in children they are extremely rare, informed Dr. Vladislav Genov, MD – head of the anesthesiology and intensive care department.

It all started with a trivial accident – the child fell while playing and then collapsed. During the first examinations after the fall, doctors found a lung cyst, which they treated for weeks.

“Tracing the chronology of this case to date, we presume it was a ruptured echinococcal cyst that had drained through the bronchi. The latter is of great importance, because otherwise the cyst would have spilled into the chest and a severe anaphylactic reaction could have ensued, with potentially fatal consequences. The drainage has practically saved the life of the child, who from the beginning was up for emergency surgery,” the specialists said.

After the problem was diagnosed, a difficult period began for the family in Germany – going to doctors, tests, procedures and consultations. Doctors there try to treat the child without applying radical action. No one explains to the parents why their child cannot be operated on. At the same time, the girl is forced to learn to live with the consequences that accompany her health problem – maintaining a fever, general malaise, lack of a normal active lifestyle for a child of that age. She is often absent from school. All these circumstances, as well as the fact that some time ago the father underwent successful surgery with the breast surgeon Prof. Evelyn Obretenov, made the parents seek contact again with the teams of ‘Mama and I’ and ‘Heart and Brain’.

Upon admission of the child to the modern hospital in Pleven, full examinations and a categorical decision for emergency surgery by a multidisciplinary team of specialists followed. The doctors performed a so-called pyramidectomy – the part of the lung that was covered by the cyst was removed. The specialists are adamant that if the operation had been carried out immediately, when the problem was diagnosed, it would have been possible to remove only the cyst without the subsequent removal of the affected part of the lung.

The little patient is feeling well and is now back with her family in Germany.

“For us, the patient always comes first” – with this understanding in the heart and soul, and in deed, the Bulgarian Cardiology Institute (BCI) established the first specialized cardiology hospital in 2007 in Pleven. To date, it has seen hundreds of thousands of satisfied patients and saved tens of thousands of lives in life-threatening cardiovascular diseases and events, mainly myocardial infarction.

What is the top priority of government health policy in Bulgaria?

There is no single political or legal definition. It undoubtedly includes the provision of accessible and quality medical care, treatment and health services for the entire population of the country. In the leading modern ‘Heart and Brain’ hospitals and the brilliant newly built ‘Mom and Me’ clinic, patients young and old from all over the country and from all countries in the Balkans, from absolutely all age groups, from absolutely all ethnicities, including people from Africa and Asia, are treated. “We have never ‘selected’ patients to be hospitalized, neither by ability to pay, nor by any other criterion, such as financial or educational background, ethnicity, origin, etc., but only by medical indicators and indications, and we practice evidence-based medicine” – firmly states Prof. Dr. Iana Simova, Executive Director of BCI.

Private hospitals do not receive government subsidies and capital injections

So how do they manage so that they are not, as the minister puts it, “ticking bombs”, but rather should be and are like “ticking clocks”? False accusations of patient selection or of not accepting the most serious cases collapsed quickly this year when the NHF announced that 24% of major cardiac surgery (in 100% acute life-threatening conditions) in 2022 was carried out in ‘Heart and Brain’, and with a record low in-hospital mortality rate for the whole of Europe. Over 60% of all cardiac surgery interventions and invasive cardiac procedures are performed in private hospitals with – by common admission – very good clinical outcomes. Serious private hospitals have opened their own pathology departments, laboratories and other units with low or no profitability.

Emergency care is state-run by law and physically located more often in government hospitals

This continued monopoly, for which there is no clinical pathway and is fully funded by the state budget, distorts the picture of private hospitals’ contribution, creates conditions for the feudal influence of individual state directors and, worst of all, suppresses patient choice. One glaring example of feudalisation in Pleven: the state emergency is located in the state hospital building. The director of the state hospital has banned and, after a series of scandals with the changed director of the emergency, has managed to restrict the referral (sending) of emergency patients to private hospitals in the city and especially to Heart and Brain. Although there is full preparedness and excellent facilities for providing state-of-the-art emergency care, a number of patients are forcibly taken to their non-preferred government hospital – against their will and the will of their relatives. Rough administration of the process violates the patient’s right to choice and lowers the quality of hospital healthcare in the country, which certainly remains a top government priority. And the public function that a doctor performs – whether his employer is public, municipal or private – is the same. For example, whenever a Bulgarian court has appointed a doctor as an expert from a private hospital in a court case, he has always responded and given his objective professional expertise.

The Minister has repeatedly reaffirmed his correct understanding that it is only through the joint and coordinated efforts of private and public hospitals, including mergers, privatisation or other organisational forms of cooperation, and only through competition on quality, that we can raise national healthcare to a European level.