Author: BCI

Bulgaria lacks more than 3,000 obstetricians and neonatology and paediatrics are not attractive to young doctors

by Dr. Nikol Goranova and Dr. Dobromir Andreev

According to the National Statistical Institute (NSI), the number of people under 18 in Bulgaria as of 31 December 2021 is 1 188 803 (17.4% of the total population). Bulgaria is among the countries where the share of children at risk of poverty or social exclusion is significantly higher than the EU average.

There is no European or other developed country that does not face the challenges of an ageing population and low birth rates. According to Greek statistics, in the last year the growth rate has again been negative, with twice as many deaths as births. Hungary’s fertility rate is 1.61 births per woman in 2021, well below the government’s target of 2.1 births needed to grow the population by 2030, while Italy has recorded more than 12 deaths for every 7 births. We only mention EU countries similar in size and mentality. At the opposite pole are Denmark, Sweden and Luxembourg, where they devote the most public resources to stimulating families, as a percentage of GDP in the form of tax-free income for each child up to 18 or family benefits for education and maintenance. It makes sense that these countries would be attractive places for young families.

The budget deficit adopted yesterday is mainly made up of ‘social’ payments, but among these, direct birth promotion is negligible. In 2024, child benefit levels are expected to remain unchanged from 2023. However, the eligibility threshold for child allowances is increased to BGN 710 (income per family member) and for the first time since 2015, the allowances for children with TEC are increased, as well as the budget for social services. The one-off birth grant will increase by 50%, but it will be only BGN 375 for the first child.  There is still a shortage of places in nurseries and kindergartens and prices for clinical pathways are very low compared to the EU average. Obviously, the state remains a big debtor to Bulgarian children and families. There are no foreign investors in our sector, and national private investors have only recently appeared.

Much has been written and said about maternal and child healthcare, by almost everyone, but only this year has one newly built clinic opened its doors. That’s why patients called it “the phenomenon.” Society and the state need to support the best – those with a real contribution and result, because without increasing the birth rate the demographic crisis will engulf us!

There is now one place in Bulgaria that is developing modern paediatric care and care with leading expertise to make them fully accessible to all. Here we prove every day that high technology, hygiene and precision standards are not a luxury, but a clinical necessity and a medical value. We at ‘Mama and I’ have already explained how and why we protect and fill the vault of our national wealth and future. We are also succeeding in convincing scores of young women to have a third child after we have delivered the second. ‘Aggressively’ encouraging high fertility rates regardless of social, educational, marital, property or any other status should be national policy and a long-term strategy.

Ryan is one of those tiny and struggling children born prematurely that we call little heroes. He is the Miracle-before-Christmas for a family from a small town in Northern Bulgaria – after a two-month stay in the neonatology department of the newest maternity and children clinic in the country, Mama and I, the little one is now home with his parents.

“Ryan was born much earlier than normal. The average duration of a pregnancy is 40 gestational weeks. He came into the world at 30 gestational weeks and in an emergency, with a real life-threatening condition of the mother. At birth he weighed only 1300 g”, says Dr. Andrey Hristov, head of the neonatology at ‘Mama and I’.

“I had a problem pregnancy during which I was consulted and treated in a clinic in Sofia. After stabilizing my condition, the doctors sent me home with the agreement that if necessary I would be admitted to hospital immediately. However, complications came unexpectedly – profuse hemorrhage from an almost completely detached placenta sent me to the hospital in the peripheral city of Pleven as an emergency. My condition was dangerous both for my child’s life and for myself,” says Ryan’s mother.

“Thanks to the professional and quick actions of the colleagues from the multidisciplinary hospital, the young woman was resuscitated and immediately, without delay, was placed on the operating table for an emergency caesarean section. The result was the birth of Ryan at 30 weeks gestation,” says Dr. Hristov. The little one was immediately taken in by the on-call pediatrician, but in practice was extremely unprepared to live without anyone else’s help as a result of the premature birth. The doctors performed primary resuscitation of the newborn and created the necessary conditions for his transportation. In order to save the baby’s life, they turn to the ‘Mama and I’ teams because they know well the capabilities and achievements of the new children’s clinic, including the care of extremely immature children.

Upon receiving information about the case in the neonatology clinic of ‘Mama and I’, the doctors immediately formed a team and went to the settlement with the specialized neonatology resuscitation vehicle equipped with an intensive transport cuvee and a respirator. Within an hour and 15 minutes of the call, the resuscitation team from Pleven arrives at the scene.

“We had to immediately intubate Rayan and put him on ventilator, cannulate a vein for intravenous infusion of drugs. This happened right there on the spot, we got our intensive transport cuvee into the operating room itself to accomplish all of this activity on an emergency basis. After being transported to Pleven, Ryan was admitted to the intensive care unit of our neonatology department,” Dr. Hristov continues to tell us. The good teamwork of the doctors from both hospitals, their professionalism and the availability of modern equipment give a little hero a chance to live.

Two months of care and attention from the whole team followed. “Ryan had a very difficult time – he had to be given artificial respiration, we also injected a special substance into his lung so he could absorb oxygen, antibiotics, plasma, blood, and he underwent a number of tests. He is now in stable condition, clinically healthy and weighing 2800 g. Eventually our story has its happy ending and our child is home,” the parents excitedly shared.

“What is also important to us is the quality of life the child will have after discharge. I am happy that the screening tests performed on Ryan showed that he has no eye involvement, we discharge him without any signs of respiratory failure and without the need for additional breathing support at home,” says Dr. Andrey Hristov. He concludes, “Ryan’s story is a story of goodness that brings hope and needs to be told. Because children are our most precious!”

The executive director of the Bulgarian Cardiac Institute is a guest on an episode of the Bulgarian National Radio’s podcast “In the center of the system” regarding cholesterol. 50 percent of people aged 50 have atherosclerosis in the vessels.

This is the medical facility in Burgas, which for me is not only a hospital, but a place where there is humanity and humanity, for them there are no Saturdays and Sundays, says Mina Dzhuglarska

Burgas resident Mina Dzhuglarska arrived with a broken leg and crutches to the editorial office of Flagman.bg to thank the people who saved her family. We know Mina Dzhuglarska well through her dedicated work in support of children with special needs in Burgas Municipality.

“My husband, who is a father, a grandfather and a pillar for our family, is with us for Christmas because he has you” – today her gratitude is for the director Dr. Lidiya Stefanova and the whole family of the Heart and Brain Hospital, and her emotional story is too personal, it does not need editing and introduction, so we provide it to you:

“It all started on October 22, Sunday, my husband Vasil Dzhuglarsky was hunting. As he was leaving, he felt bad, called me on the phone and said, “I feel bad, I have pain in my chest and I can’t breathe.” It was more than clear to me that things were very serious, but I tried my best to take the tension and pain away from him. With our combined efforts, he made it to Heart and Brain Hospital. This is the medical facility in Burgas, which for me is not only a hospital, but a place where there is humanity and humanity. Led by the director Dr. Lidiya Stefanova, there are no weekends for them. October 22 was a Sunday, but immediately the team gathered in an emergency because of my husband. My husband was found to have a very serious aortic problem, which I cannot say in medical terms, lest it sound silly. Basil’s life was in their hands and everything was happening in such a short time. Terror flooded all of us, his loved ones. Separately, I had a broken leg for two days, lying motionless at home with a cast, splint and two crutches.

For what was happening, I thought, evil never comes alone. Immediately, the team admitted him, they kept him alive and began a week of physical and mental preparation of his condition so that the surgery could take place, in which innovative methods and techniques were applied, with the insertion of an endoprosthesis and other necessary things, which every day and every hour there was a specialist to explain to us in a human way.

On the day of the surgery, Assoc. Prof. Vladimir Kornovski, the cardiac surgeon, who is world class in his professionalism, together with his team did a 12-hour surgery in which other unexpected problems happened, which were managed and everything ended in the best way. Despite the 12-hour surgery and that we loved ones stood and waited for the outcome, there was no one to explain to us why the surgeries were so long, what was happening, the time it took. The team that performed the surgery took care afterwards as well. Every day they explained to us what was next. For the blood donors, for example, they said we could take the notes later – it took 6 once and then 8 more. We were constantly reassured, met with such humanity and helpfulness that there was no way I could not come and tell them in person in the run up to the Christmas holidays. The good example must be told, we cannot just berate the health system. The good example is there, the doctors are fighting for us, for our loved ones and for our lives. Besides the teams who knew their job perfectly, they were ready for a surprise, the most human thing is that they explained. Assoc. Prof. Kornovski patiently answered all my layman questions after those 12 hours.

In the process of my husband’s recovery, I also met with the director, Dr. Lydia Stefanova, I wanted to tell her that this is a very modern hospital, there is even a psychologist there. And orderlies, nurses, technical secretaries – all in the right place at the right time. She was saying, “the patient has a right, he comes first, this is more than normal what we have done, madam.” With a smile she found a way to explain to me that this was Heart and Brain and so it would be.

Many thanks to everyone who helped him be home, recovering. I can see the joy of the medical teams too when we go for check-ups. They welcome him and are happy for him. The survival rate in such a life-saving operation, despite the good technique and training of the medical staff, is very small in terms of success rate. My husband was given a second chance, for him to be alive and among us, his family.

Now we will all be reunited on Christmas Eve. Every year there was someone and something to be thankful for. This year we will thank the entire Heart and Brain Hospital family. You are a heart that works with a brain. I hope that you will become a brand, as Dr. Stefanova dreams, and that you will truly be the pride not only in Burgas, Bulgaria, but also abroad.”

by Dr. Nicole Goranova and Dr. Dobromir Andreev

The old wisdom “health is great wealth” is always relevant. Today, the population is ageing and life expectancy is increasing, but even at a very old age, health is everyone’s wealth.

Insurance and reinsurance companies, insurance schemes, bankers and investment bankers – all of whom evaluate thousands of classes of risks – have for decades included the health status of the population, employees, entrepreneurs and even political leaders in their wealth assessment matrices, analyses and projections. However, we empirically know something more important and more valuable – the essential component of wealth, prosperity, happiness and longevity is our healthy children! We in the ‘phenomenon’ ‘Mama and I’ are developing the existential core in the vault of our national wealth and our future.

The full article is available here in Bulgarian.