There Are Those That Leave and Then There Are Those Who Return

Letters to the Editor | Author: Yoav Chudnoff |May 6, 2015, Wednesday // 13:44
Bulgaria: There Are Those That Leave and Then There Are Those Who Return Parva Gradska Bolnitsa's building in downtown Sofia, Bulgaria. Photo by BGNES

Novinite is publishing Yoav Chudnoff's story about his visit to a hospital in downtown Sofia in April. Back then, a conversation

You can read more by - and about - Yoav Chudnoff here.

I have been told from those that are close to me that I do not know how to handle knives. A few weeks ago, the inevitable happened; I was working in back pruning roses, readying them for spring and with a swift slip of the knife, it happened! I looked down at the arm and the wound for a few milliseconds, the wound did not look superficial, it was deep, I cursed myself, went upstairs, tied a handkerchief around the wound, informed my mother-in-law that I had to attend to some urgent business without telling her what happened and walked to the neighborhood hospital (Първа многопрофилна болница or just Първа Градска Болница – Parva Gradska Bolnitsa), insurance papers in hand.

Being a long holiday weekend, the main doors were closed informing patients, or visitors, to enter from the side entrance. I walked into the dark and hospital building and was met by the guard who told me to go knock on the nurse’ station door. The door opened and was met by the nurse:

“My name is Rossi, what seems to be the problem?” asked the nurse.
“I was slicing a lamb for dinner and the knife slipped.” She looked at me a little quizzically. I realized that I should actually be a bit more serious with her considering my situation and forego the humour.
“I was pruning some rose bushes and the knife slipped.”
“I liked it when you said you were slicing the lamb, it is the Easter weekend after all.” Touch?.
“Very smart of you tying the handkerchief around the wound, let’s take a look, clean it up and I’ll see which Doctor is on duty tonight.” The nurse picked up the phone, spoke with someone and informed me to go to the third floor and wait; a doctor Zhivkov will be with you in about 10 minutes.

As I sat there waiting for the doctor to beckon me, I looked around. The waiting room was in the foyer of the floor, lights were not on, thus a bit dark. There were doors to the operating room in front of me, and, to the right, doors which led the clinic. I was thinking of calling my wife as I sat there waiting, but hesitated. She was having a girls’ night out with her friends. I really shouldn’t call her. If I call her, tell her what happened, she’ll cut her dinner short, start to worry and I’ll start feeling guilty that I spoiled her night out.

My vivid imagination starts working up different scenarios… movies… which one… what is the situation that I’m in… comedy… Laurel and Hardy… mixed up… ‘Thicker than Water’… makes sense… hospitals… blood… transfusion… mixed up transfusion… Stan Laurel becomes Oliver Hardy… Laurel (who is Hardy) tells Hardy (who is Laurel) after they had a transfusion where there blood has become so intermixed that one becomes the other: "Well, here's another nice mess you've gotten me into." Shuddering to myself as to where my mind was taking me with the scenario, I think it better to let her enjoy the girl’s night out in peace and not let her worry.

A few moments later, the door to the clinic opens and a young doctor comes out; “I'm Dr. Zhivkov, are you the one who cut himself with a knife?” “Yes””Follow me.” He takes me into one of the many rooms, he tells me to lie down on the bed. “Looks like you cut through the skin, you'll need stitches.” An assistant walks in and begins to thoroughly clean the wound and its surroundings. Once cleaned, Dr. Zhivkov begins stitching the wound. During the procedure, he begins asking me questions; “Where am I from?;” “What am I doing in Bulgaria;” “How long have you been here?” “Are you married, Do you have children?” I think that this was done to make sure that I won't pass out during the procedure. After about 20 minutes and seven stitches ready he's done. The wound smartly dressed, and instructions to come back the following day to check out the work. “Go back downstairs and complete your registration with the nurse that met with you. You'll also need to get a tetanus shot as well. She'll give it to you.”

I went back downstairs and knocked on the nurse’ door and entered.
“How many stitches did you get?”
“Not bad for slicing lamb. I will be giving you a tetanus shot as a preventive.”
“It’s always best to play safe.”
“I'm really sorry that I don't speak English very well even though that I spent a year working with an international group of military doctors and nurses in Afghanistan in 2011.”
“How did all of you communicate with each other?”“All the medical standards are the same and we are trained using the same methodology, so it wasn't a problem.”

I've heard about these teams of Bulgarian military doctors and nurses before. These highly trained groups of specialists and medical experts are sent throughout the world working under the harshest conditions and are extremely well respected by their compatriots. I never thought that I would actually meet one of them. I received the tetanus shot and completed the formalities and off I went. Strangely enough, I wasn't in pain and was in excellent spirits. I was my 'normal' self.

I got home, called out to my mother-in-law to let her know that I returned. I walked into the living room, where she was watching the news on television. “Sorry, it took a little longer that I thought. I had to go to the hospital and get stitches.” “Yoav, seriously that's not funny even for you.” “No, really, I cut myself in the garden and had to get stitches.” “Maria called earlier and I told her you went out drinking with some friends.” “I told you that I had something urgent to tend to.” She finally realised that I was indeed quite serious. “Did you call Maria?” “I thought it best to let her enjoy the girl's night out, it really wasn't a matter of life or death, I'll let her know when she comes home.” Many hours later, Maria returned home and I told her of my exploits that evening. “Sounds like you had a more exciting time than me.” she quips. Well, my Laurel and Hardy scenario didn't play out. “I think you'll need to stay away from knives for a while.” AGREED!

The following day, I was off to the hospital and my meeting with Dr. Zhivkov in order to check up on the injury and the stitching. I walk up to the third floor, rang the bell next to the clinic's door; the door buzzes open; I enter; Dr. Zhivkov sees me and tells me to wait in the foyer. After a few minutes, I enter and he takes me into the examination room. He goes over his handiwork. All is good. Dr. Zhivkov is a young person no more than 30 years old. We start talking. Over the several decades that I have been coming to Bulgaria, I have had the ‘unfortunate’ privilege of visiting emergency rooms on two occasions. Each time, being amazed at the work performed. I have also read about the emigration of Bulgarian doctors and nurses to Germany and other European countries, yet here is a young doctor treating me. Is it that the media pulling the wool over my head concerning the reality, or is it true.

So I asked.

He said that his group is a relatively young one, the oldest being 50. One of the members of the group will be leaving Bulgaria in order to work in the ‘West.’ He was in Belgium for 6 months on specialization (Laparoscopic surgery), but returned to Bulgaria as he believes that he can do more here in Bulgaria having a bit more freedom. He isn’t in it for the money, rather wants to help. His technique when it comes to talking with his patients also differs. The system, rather doctors, have considered themselves to be above all, patronizing and maybe a bit cold. They treat each patient formally, without speaking with them or understanding them. He believes that by conversing with patient during treatment, he can learn more about the patient. “For example,” Zhivkov points out, “when I was treating you, I was asking you many questions, both personal and general. It is a way to begin a relationship, putting you at ease which in turn helps me with my work. When a patient feels comfortable with the doctor, the patient, will, on most occasions, speak with me about his or hers’ overall condition; ask me questions about different procedures. The end result is that the patient becomes more informed and a part of their own treatment.”

“I saw a job advertisement from a German hospital in one of the Bulgarian newspapers many months ago. Isn’t this a way for German hospitals to ‘steal’ Bulgarian specialists? Last year, I met a young biologist when I was doing some volunteer work in Turkey who mentioned that even though that he has a needed specialization in Germany, he cannot find work, yet there always seems to be an opening for specialists from what he called ‘the cheaper countries.’ These countries would be Poland, Bulgaria, and Romania for example. No offence to these countries, he told me, but it is a way for these institutions to save money, by offering a lower wage to non-Germans coming to work there but high enough to lure specialists from their home countries in search of ‘better pay?’ A German doctor would earn maybe EUR 7000 to EUR 9000 a month, whilst the doctors from the cheaper countries would earn maybe EUR 4000 to EUR 5000 a month. What these doctors may not realize is that with this pay, after taxes and other expenses are taken out, there isn’t that much money left over to live on. They are left with the title ‘I work in Germany.’”

“I don’t think that the Germans would ever admit that they are doing this. They would not say that there is a shortage of ‘home-grown’ specialists or that they are finding other ways of cutting costs.”

“Where I work, for example, where 70% are Bulgarian and 30% are expat are employed. My expat colleagues, who hail from throughout Europe, the Caribbean and Central America, find that even though the pay here in Bulgaria may be 4 to 5 times lower than their home country, they feel more comfortable working here for the lower pay. They say it is more than enough to live on. They also tell me that their standard of living here is more relaxed… not as stressful as in their home country. How do you keep up with the latest laparoscopic surgical techniques?”

“I attended several conferences in the United Kingdom which provided me with many new techniques. In Scotland, there is an advanced hospital utilizing the latest techniques: The Cuschieri Skills Centre in Dundee. I understand English, but English with a Scottish accent took getting used to. There, I saw and worked on the advances. Understandably, we may not have all these advances here, but I am able to use the techniques that I learned and adapt to the conditions I work under.”

“Did the hospital pay for these courses and seminars?”

Dr. Zhivkov laughed: “It comes out of my pocket.”

A few personal notes here: my expat colleagues are college educated and find that they face the same employment problems that their Bulgarian counterparts have when looking for long term work irrespective of the country they live in. Comparisons can easily be made between countries, no matter the country.

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Tags: Zhivkov, doctor, Afghanistan, Germany, hospital

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