The Bulgaria 2011 Review: Health and Healthcare

Society » HEALTH | Author: Maria Guineva |January 6, 2012, Friday // 04:15
Bulgaria: The Bulgaria 2011 Review: Health and Healthcare Some 48% of all Bulgarians believe the healthcare is in a bad condition. File photo by Sofia Photo Agency

Bulgaria's 2011 health news were marked by doctors and patients disgruntled over healthcare budget cuts and poor conditions at healthcare facilities, a large-scale flu epidemic in the first months of the year, an FDM outbreak, an E Coli scare, growing cases of medical malpractice, and renewed vows of the cabinet to impose a full smoking ban.

The health care sector continues to faces huge problems - understaffing, supply shortages, braindrain, bribes to doctors and nurses to ensure better treatment, high debts and chronic lack of money.

In recession-battered Bulgaria, the government spends just 4.2% of its GDP on health. All employed and self-employed Bulgarians are obliged to make monthly health insurance contributions of 8% of their income to the Health Insurance Fund, which is the only player on the market and has been plagued by corruption and funds siphoning. Besides the health insurance contributions that the State pays for the people under its wing are meager.

People, who wish to be treated by a doctor of their choice at medical facilities, have to pay between BGN 250 and BGN 700 while to select a team they will need between BGN 350 and 950.

After years of lumbering reforms in Bulgaria's health care system, hospitals and the health insurance fund have reached the point of quickly running out of cash, dooming patients to suffering.

A number of governments have failed to implement reforms, a series of major reshuffles at the health ministry over the last few years have failed to make a difference and plug the holes in the system. As a result Europe-wide polls show that the lowest levels of satisfaction with health care are reported in Bulgaria, which even lags behind Albania and Macedonia.

When struck by a severe condition, wealthy Bulgarian regularly go abroad for treatment. The less fortunate have more sinister stories to tell.

Hospitals across the country are forced to suspend planned operations and reduced admission of emergency cases. Some even switched into a war-time regime, tapping into the reserves, meant to be used in case of natural disasters and wars.

At the same time the European Union is offering BGN 300 M in funds for equipment and repair works at hospitals, but Bulgaria fails to come up with good projects to absorb them.

Bulgarian Health System in Statistics

Mass Exodus of Bulgaria Doctors Abroad

More than 500 Bulgarian doctors left the country to go work abroad in 2010, according to the Secretary General of the Bulgarian Doctors Union, Dimitar Lenkov.

He announced the data, established by the Union on the basis of issued certificates for good medical practice, required for working abroad. Mostly anesthesiologists and surgeons left Bulgaria in 2010, followed by urologists, orthopedists, traumatologists, obstetrician-gynecologists, pediatricians, and pathoanatomy specialists.

According to Lenkov, the number of doctors who left Bulgaria in 2009 was 400, while the number in 2008 was 380. He noted that most of the doctors head to Germany, France, England, North Ireland, Denmark and Sweden.

Data from the Society of Anesthesiologists in Bulgaria showed that for several years, the number of specialists in the country dropped from 1500 to 600. The monthly salary of anesthesiologists in Bulgaria is about BGN 700-800, while in France is it about EUR 6,000.

The pathoanatomy specialists in Bulgaria are below the minimum – only 70-80 in the whole country. The lab specialists are also few - only 280. A strong drop was seen in 2010 in the number of virologists, rheumatologists, infectious diseases specialists, allergy specialists and even general practitioners, Lenkov said.

He explained that some regions of Bulgaria, mostly mountain areas that are difficult to reach, some areas in Northwestern Bulgaria and the Rhodope Mountains, lack general practitioners. The data from the Bulgarian Doctors Union showed that the number of nurses is also below the minimum. At present, they are about 30,000.

A huge number of specialists in internal diseases also left Bulgaria because the National Health Insurance Fund (HNIF) does not sign contracts with them, but rather with doctors on narrow specialties.

WHO Ranks Bulgaria 30th in Europe by Use of Alcohol

Bulgaria ranks 30th in Europe by alcohol consumption, according to a study of the World Health Organization (WHO). Estonia is first with 16 liters per person a year, followed by the Czech Republic, Ireland and France – between 14 and 15 liters.

The average consumption of alcohol in Bulgaria is 12 liters a year, according to the WHO data. 45% of Bulgarians use hard liquor, 22% drink wine and 32% - beer; about one third do not consume alcohol. Turkey is last with less than 2 liters a year, which is attributed to the Muslim religion.

The WHO study shows that alcohol consumption in Mediterranean countries, former leaders in similar rankings is down, and they have been replaced by countries such as Moldova, Estonia, the Czech Republic, and Ireland. The average consumption in Europe is 9.5 liters of alcohol a year per person 15 years of age or over.

50% of Bulgarians Believe Health Is at Risk - Poll

Lack of funding, corruption and unreasonable distribution of money in Bulgaria's health care system are the top problems in the sector, according to a 2011 poll.

The poll included Bulgarians with health insurance from the capital and the largest cities, ages 18 to 70, and was conducted by the research agency Noema on the request of "Philips."

23% of those polled believe the lack of funding is the main problem in the health care sector; 22% - corruption and unreasonable distribution of money; another 20% - incompetent and dishonest doctors.

According to 17%, poor cabinet policies are to blame and the same percentage sees as a problem the high price of health services. There were fewer respondents complaining of shortage of medications, poor facilities and equipment, and inadequate staffing.

Half of the respondents said their health is at risk. 14% of females and 18% of males worry about heart disease in the next five years; 3% of women and 0% of men worry about getting cancer. These attitudes are highly optimistic, considering data from the National Statistics Institute, NSI, showing a 51% death rate from heart disease and 28% from cancer.

20% of Bulgarians worry about losing their eyesight and 17% about motor nerve issues. Over half of Bulgarians believe the country lacks medical equipment for early diagnosing while 20% said they have no opinion; the remaining others thing the equipment is adequate.

Nearly 50% of those over the age of 56, and 20% of those between the ages of 46 and 55, have chronic diseases. The global forecast is that by 2050, 50% of the entire world population will suffer from such chronic ailments over its ageing.

Young Bulgarians Suffer from Depression, Psychosis, Alcohol Abuse

The mental health of young Bulgarians is facing increasing challenges that are staying unrecognized, according to a key Bulgarian psychiatrist. Dr. Nina Tashkova from First Sofia Hospital explains that Bulgarians aged 25-40 are facing constant strains from a deteriorating economic situation and growing social alienation, which do not fail to affect negatively their psychic lives.

According to her, the number of cases of clinical depression, panick attacks, anxiety disorders, and serious psychoses has been on the rise for the last few years and the group of people affected by these disorders is continually expanding its lower age barrier. The doctor further reports that the number of young people abusing alcohol is also rising, and with an especially strong rate among women.

Tashkova points out to what she saw as an inadequate attention given to psychiatric help in Bulgaria's healthcare and educational system. She nevertheless says that Bulgaria's youth are relatively open to talking about their mental health problems, an attitude that according to her is not always shared by their older compatriots.

Bulgaria Registers Highest Rate of Completed Suicides in Europe

Bulgaria has recorded the highest rate of completed suicides in Europe. The country has witnessed a total of 1600 suicide attempts over the past two years, half of them successful. According to psychologists, the number of youth suicide attempts is also on the rise. Another alarming fact is that the people who have attempted suicide are not being treated by psychologists.

Doctor Mihail Okoliyski, head of the Department of Mental Health at the National Center of Public Health Protection (NCPHP), told journalists that "every day, a child in Bulgaria makes a suicide attempt." According to statistics, the youngest suicide attempt was made by an 8-year-old. Dr. Okoliyski says such acts are usually driven by family disagreements.

The experts insists on providing children with health and sex education to prepare them for potential risk situations in life.

In 2009, a total of 308 kids tried to put an end to their life, 271 of them boys. The oldest man to attempt suicide was 92 years old, the youngest one- 9 years old. A total of 2717 suicide attempts were registered in Bulgaria for the period, 673 of them ended fatally. According to Doctor Hristo Hinkov from NCPHP, Bulgaria lacks mental health prevention practices. In his words, an estimated 20% of Bulgarians have experienced some sort of psychological problem.

Bulgaria Last in EU Healthcare Public Expenses

Bulgaria is the EU country in which the least percentage of its GDP goes for healthcare – a mere 8%. Germany tops the ranking with 12%.

The Balkan country's public expenses for healthcare per capita are 5-6 times smaller than in the rest of the bloc, Dr. Stoicho Katsarov from its Center for Patients' Rights Protection informed. Meanwhile, the Bulgarian patients pay nearly 50% of the medical services upon receiving them, which is the highest percentage of all EU member states. The average for the Union is 20-25%, according to WHO data from 2009.

Over Half Million Bulgarians Deprived of Doctors Care

Over half million Bulgarians or a total of 582 809 people don't have the option of selecting a general physician in the village where they live. The data is based on an inquiry with the Health Ministry.

The most common reason is that the village is remote and/or located in a poor area. Residents of such places are forced to seek medical care in the closest town or city.

There are 424 job openings for doctors in the country, which no one wants to take. 51 are in the Kardzhali Region, the regions of Targovishte and Silistra have 27 each; Plovdiv and Varna – 26, Razgrad and Ruse – 25. There are no untaken doctor's positions in Vratsa and Gabrovo.

The State is attempting to solve the problem by offering through the National Health Insurance Fund (NZOK) additional benefits with monthly bonuses starting at BGN 150 and reaching BGN 1 200, but very few doctors, especially those with families and young children, take advantage of them.

Majority of Bulgarians Unaware of Patient Rights

The large majority of Bulgarians are unaware of their patient rights, according to a poll of the Center for Protection of Patients' Rights (CZPZ). The poll has been conducted in all 28 regional centers among 241 respondents.

The results show that 99% of the polled cannot tell the number of referrals an individual with health insurance is entitled to every year. Only 4% know what dental services paid by the National Health Insurance Fund (NZOK) they can use. 45% believe their patient rights are completely unprotected while 42% - that they are only partially protected. 94%, however, know the amount of their health insurance and co-pay fees.

15% are convinced they are entitled to free health care even if they don't have health insurance. 35%, on the other hand side, say an uninsured pregnant woman cannot receive medical help.

The most complaints received by CZPZ are against hospitals – 308. They are mainly for poor treatment of patients and low quality of medical help. There were also 182 complaints over the lack of certain medications and 52 complaints from people who have been refused medical help.

Staggering Majority of Bulgarians Avoid Fitness, Sports

Only 6% of all Bulgarians in employment age (18-65) are actively engaged in fitness and sports, according to a study of the country's Ministry of Sports and Youth. In years past, this percentage has been as high as 45%.

The study is titled "It Is Never Late for a New Beginning," and is part of the Ministry's program to spark interest in sports activity. The institution plans to provide hours for free fitness and sports at 28 facilities across the country, whose list will be published online next week.

The poll involved 802 individuals in employment age – 72% of them reported feeling tired at work; 39% work sitting at a desk, while 68% were affected by stress. They walk an average of 40-50 minutes a day or 3.7 km, but half say they spent their free time passively.

Smoking, alcohol drinking, and the use of too much salt are serious problems, the study found. 34% of the respondents were overweight; 21% - obese and 2% severely obese.

Those polled were subject to several tests, one of which was to run 50 meters – the average result was about 13 seconds, which is twice higher than what is considered normal for a healthy person. This is the second such poll of the program.

The Ministry is expected to absorb BGN 3.4 M in European funding with half of them already spent and about BGN 200 000 registered as savings. All funding is used for the information campaign and rent of the 28 facilities.

Majority of Bulgarians Favor Immediate Full Smoking Ban

A large majority of Bulgarians – 72.3% are in favor of a full smoking ban in public spaces, according to a Health Ministry poll. These respondents say the ban must be implemented immediately.

The poll has been conducted among 1 862 Bulgarians from January 24 to February 21. 22% are against a smoking ban in indoor public spaces; 2.6% support delaying the ban by one year while 3.1% want the ban to be postponed for two and more years.

Less Than 5% of Bulgarians Trust Healthcare System

As few as 4.8% of all Bulgarians trust in the country's healthcare system, with half of the nation seeking professional help only when a severe health problem is in place.

Some 48% of all Bulgarians believe the healthcare is in a bad condition, according to Prof. Lilia Dimova from the Agency for Social Analyses think-tank.

Dimova says that 20% of Bulgarians try treating themselves before seeking professional medical help. A total of 75% of Bulgaria's patients are convinced that the healthcare system in the country is not functioning properly, while 82% declare that not only reforms but very significant changes are necessary.

On the other hand side, Bulgarians e are not the sickest nation in Europe with 82% not hindered in their daily routines by severe illnesses, a percentage higher than the average for the EU (74%). Countries like Finland, Slovenia, the Netherlands, Norway, Germany and France are worse than Bulgaria in this aspect.

Even though Bulgarians generally distrust the healthcare system in the country, they also believe that Bulgaria's doctors and nurses are unrightfully underpaid, Dimova says, citing data from a survey on the relations between patients and health professionals.

Teenagers Have 11% of Abortions in Bulgaria - EU Data

A total of 10.7% of all abortions in Bulgaria are carried out by girls under the age of 20, according to a major report based on EU data.

The report, circulated in the British media, shows that nearly a quarter of all abortions in Britain are carried out on girls under the age of 20. The shocking figures, compiled by the EU, show British teenagers are far more likely than the average European youngster to have a termination, The Daily Mail notes.

The data, compiled by the REPROSTAT group, the EU's community health monitoring program, details abortion figures across the region. Most of the figures are for 2008, but the data is slightly older for several countries.

The report shows some 1.2 million terminations are carried out a year in the UK – the equivalent of the populations of member countries Malta and Cyprus combined. Breaking the figures down by age reveals that 22.1 per cent of all abortions carried out in the UK in 2008 were on girls under 20 – only in Belgium was it higher.

The abortion rate among British girls under 20 was 23.8 per 1,000. Only Estonia and Sweden had higher rates, at 24.1 and 24.4 respectively. The French figure stood at 15.6 per 1,000 girls under 20 and the German at 6.2 per 1,000.

Of the countries which allow abortion, Poland, which has extremely tight legislation on the issue, had the lowest teen rate, of less than 0.1 per 1,000.

Greece, whose abortion laws are more similar to the UK's, had the next lowest, with 2.3 terminations per 1,000 women under 20. The average rate in the EU was 14.1 per 1,000, while overall every ninth abortion in the region was carried out on a teenager. Among women over 35, though, the UK had one of the lowest rates of abortion.

In 2008, 4.3 in every 1,000 women in that age bracket had an abortion, accounting for 14 per cent of the 209,191 terminations carried out here.

This compares with Estonia, with 13.2 abortions per 1,000 women aged 35 and over, and Latvia with a figure of 12.8. Ireland and Malta were excluded from the calculations, as abortion is illegal there. There was no data for Luxembourg, Austria or Cyprus.

Health Care Legislation

Bulgarian Cabinet Caps Doctor Selection Price

At the beginning of January, the Bulgarian cabinet approved changes to the Decree of Patients' Access to Health Care.

People, who wish to be treated by a doctor of their choice at medical facilities, now have to pay between BGN 250 and BGN 700 while to select a team they need between BGN 350 and 950.

Previously, there were no clear rules and the hospitals were able to determine the amount themselves, which for certain cases has reached up to BGN 10 000, according to the Health Ministry data. The new requirements are mandatory for each hospital for patients with health insurance, whose treatment is covered by the National Health Insurance Fund (NZOK).

The choice of a doctor or a team should be made under the explicit insistence of the patient. Hospitals are asked to publish and display a list with prices for different procedures (called clinical paths in Bulgaria) and the maximum prices.

The Health Ministry is to receive the number of patients, who have decided to choose a doctor or a team every three months. The Executive Agency "Medical Audit" is in charge of monitoring and controlling the process, while violators will face legal sanctions. The amounts would be determined through a scale, depending on the price of the treatment procedure.

Bulgaria Launches Patients' Rights Council

In February, Bulgaria's Health Minister, Dr. Stefan Konstantinov, launched a Public Council on Patient's Rights. The move is based on article 86a of the Health Act in Bulgaria.

The Council's members include representatives of patients' organizations, organizations of the disabled, the Bulgarian Doctors' Union, the Bulgarian Dentists' Union, the Bulgarian Pharmaceutical Union and the Bulgarian Association of Health Care Professionals.

The Council aims at analyzing all activities related to patients' rights and proposing legislative amendments when needed. The Council will also prepare annual reports about patients' rights in Bulgaria to be submitted to the Health Minister.

Bulgaria Govt Oks Health Care Map

In February, Bulgaria's government adopted the national health care map, which has been in the pipeline since 2006, but will definitely fail to turn into the much anticipated launching pad for reforms in the sector. The document maps out 308 hospitals with more than 44 000 beds, which, quite surprisingly, means that no significant reductions in the number of hospital beds should be made.

Health Minister, Stefan Konstantinov, confirmed forecasts that in 2011 the government will steer clear of radical decisions, which might hurt its popularity prior the elections, and delay the closure or privatization of hospitals and their assets.

In 2010, hospitals across the country suspended planned operations and reduced admission of emergency cases, switched into a war-time regime and even tapped into the reserves, meant to be used in case of natural disasters.

Also in 2010, hundreds of cancer and HIV-positive patients faced a shortage of life-saving medicines because of a delay in tenders for their purchase. In 2011, the health ministry did not conduct these tenders and the payment for the expensive medicines was transferred to the health insurance fund or the hospitals.

Bulgaria to Restrict Tobacco Products Advertising

It was reported in March that advertisement of tobacco products in Bulgaria will be strongly restricted, according to the new National Program for Limiting Smoking in 2011-2015, prepared by the Health Ministry. The Program bans the production of any items such as toys or food resembling cigarettes and other tobacco products.

In 2013, there will be a ban on all forms of direct and indirect tobacco advertisement, such as displaying cigarettes and images of them in stores while the sale of tobacco products will be limited to specialized stores only. The same year, measures will be applied to restrict the showing of people smoking in Bulgarian movies, TV series and various broadcasts.

Cigarette manufacturers will be mandated to account for the exact amount of funds used for advertisement, and will not be allowed to sponsor social events. The program will also ban the use of additives aiming at improving the aroma and the taste of cigarettes.

Bulgaria's Culture Minister, Vezhdi Rashidov, however, declared he opposes the Health Ministry idea to ban smoking in Bulgarian movies. Rashidov, who is known as a heavy cigar smoker, said such interference in art is absurd and aggressive and vows the move will pass only over his "dead body." The Culture Ministry sent a statement asking to make a difference between administrative orders for smoking restrictions and art.

"Art images can contribute to the building of some beliefs, but the true, real art cannot be restricted; it is needed as freedom of expression. This is a sacred artistic right; this is the strength of art. Putting breaks on movie scenes is borderline insane," the statement noted.

The letter pointed out as example world culture masterpieces depicting people drinking absinth, smoking cigarettes, created by artists such as Picasso, Van Gogh, and Gauguin.

Cabinet Moves to Revamp Bulgaria's Notorious Emergency Medical Aid

At the beginning of May, Bulgaria's Health Ministry announced it plans to introduce standards for providing emergency medical aid, which is notorious for failing to prevent numerous deaths by being slow and inadequate.

Bulgarian Health Minister Stefan Konstantinov reported that the emergency medical teams will be required to arrive on the spot within 20 minutes after the 112 call in life-threatening cases. In non-life-threatening cases, the requirement will be 40 minutes.

The requirements are included in a National Concept for Developing Emergency Medical Aid drafted by the Health Ministry. A failure to meet the time limits will be investigated and will be pardoned only in the events of natural disasters and inclement weather.

Another major novelty in it is the inclusion of paramedics – who still technically do not exist in Bulgaria and their job is known only from American movies. They will be trained in educational institutions through 2-year courses.

The Health Ministry measures provide for a minimum monthly wages of doctors in the emergency rooms of at least BGN 720, an increase from the current minimum of BGN 630; the salary increase is supposed to help stem out the outflow of doctors from the emergency units.

A total of 6 887 medics are employed in the emergency centers around the country, while their total number is supposed to be 7 113; the remaining openings cannot be filled for lack of applicants. The average ER doctors in Bulgaria are aged between 55 and 65.

The emergency medical aid will be provided by three types of units – a doctor's unit, a paramedic unit, and a transport unit – and they will be used depending on the severity of the cases.

The emergency teams will be distributed in a new way around the country; cities of over 200 000 people will have several locations for them; temporary or permanent medical bases will be opened for faraway regions and along highways.

According to the Health Ministry, BGN 150 M are needed annually to restructure the emergency aid system, which is double the current annual budget for emergency aid. Bulgaria currently has 28 emergency medical aid centers with 198 subdivisions, which is fewer than the total number of municipalities in the country – 264.

Bulgaria's Emergency Care Centers to Be Integrated into District Hospitals

At the beginning of November, Bulgarian Prime Minister Boyko Borisov said that Emergency Care Centers must become units of district hospitals, although the step will cause 1300 people to lose their jobs. Borisov insisted that the "parasitic structures" must be eliminated because they required double the necessary administration.

Bulgaria has a total of 28 Emergency Care Centers, one in each district, with 198 branches. The units have a total headcount of 6887 at present, the job places being 7113.

Borisov gave assurances to all directors of major hospitals that Emergency Care Centers had to be attached to district hospitals in an attempt to cut administrative costs and free up resources for wage hikes. He also made it clear that the restructuring would be carried out with money from the state budget and would not entail budget cuts for emergency care.

Health Minister Stefan Konstantinov echoed Borisov's opinion, adding that the state was currently making double payments to both emergency units of hospitals and to Emergency Care Centers. He said that, once the practice was eliminated, incomes of emergency care personnel would rise due to the administrative savings.

Several days earlier, the Health Ministry reported a 20% reduction in patient flow through emergency departments and an 8% decline in outpatient check-ups at these units. The reason for the downward trend is that an average 41 000 people per month prefer to visit their General Practitioners on duty.

To think that emergency care ends with ambulances is absurd, said Konstantinov. He stressed that emergency care has been debated a lot during the year and explained emergency doctors suffer from financial and organizational problems. The Health Ministry has proposed for discussion to all interested parties a package of measures to solve these problems.

Bulgaria Patients: Health Care 2012 Budget Life-Threatening

In November, patients alarmed that Bulgaria's health system will be plagued by chronic underfunding next year, putting at risk the life of all Bulgarian citizens, who need medical aid.

"Bulgaria's budget for 2012 allocates, yet again, just 4% of GDP for the health care sector, which falls a long way short of the money needed to guarantee security for the Bulgarian patients, high-quality services, prevention and access to modern treatment," according to an open letter, circulated to the media and the state institutions by "Heath Protection," a patients' organization.

It insists that the government increase up to 6% of GDP the financial resources allotted to the health care sector. Critics say Bulgaria's finance ministry belt-tightening policy has created the illusion of a healthy economy on the back of the people, who are three times poorer than the average EU citizen and are just getting poorer.

According to Health Minister, Stefan Konstantinov, budget 2012 is a "budget of the possible." He stated that he would be happier with a larger budget, but on the backdrop of the Eurozone crisis, keeping the level of 2011 funding could be seen as a small success.

Konstantinov further pointed at the "shrinking" of administration in the health care sector with cancelations of 2 000 job positions in the last two years, realized mainly through mergers of regional health inspectorates and regional health centers. The Minister vowed that hospitals' income and conditions would not go down and worsen.

Bulgarian Cabinet Vows Full Smoking Ban in Summer 2012

In December, Bulgaria's cabinet issued an official proposal to introduce a full smoking ban for closed public areas on June 1, 2012. The decision was made during the regular meeting of the Council of Ministers, which was held in the second largest city of Plovdiv. After the meeting, Prime Minister, Boyko Borisov, confirmed for the media the intentions of introducing the ban in June next year.

"This is a global trend to limit the harmful habit; the ban will be a gift to Bulgarian children since on June 1 they celebrate their day," Borisov said.

He explained the date was chosen on purpose because with the beginning of the summer owners of bars, restaurants and coffee shops will have time to adapt. The PM stressed that the cabinet had issued the proposal two years ago, but in a gesture of tolerance for these owners extended the deadline.

This is the next attempt of the government to amend the Health Care Act and ban smoking in indoor spaces. The only thing that has been achieved so far was to introduce separate smoking and non-smoking areas inside establishments. The restaurant business wants for the ban to be postponed for 2013 or 2014.

Just one day earlier, Health Minister, Stefan Konstantinov, announced the intentions of the cabinet to finally introduce the ban in next summer. Smoking will be also banned in school, kindergarten and day care yards, and in school dormitories.

Konstantinov stated that his proposal will be backed by the Council of Ministers, since the potential costs for medical treatment of smokers would otherwise greatly exceed what could be gathered by the state in terms of cigarette excise taxes.

Other amendments include a ban on the sale of energy drinks to minors. The amendments, however, are yet to be passed by the Parliament.

At the beginning of January 2011, Borisov endorsed the idea of a full smoking ban in bars and caf?s until 11:30 pm. Such a measure was to be enforced in 2010, but was postponed by the government with the argument that it might harm the country's tourism. He informed then that the option to introduce full smoking ban in establishments in Bulgaria in 2013 was on the table.

Just one day before this next change of the date, the private TV Channel bTV announced that the full smoking ban in Bulgaria has been postponed for January 1, 2014. The agreement had been reached during a meeting between the Prime Minister and representatives of hotel and restaurant owners, who are quoted saying they were deeply grateful to Borisov for the "pleasant surprise" and vowed to "be ready" by 2014.

The full smoking ban was voted by the previous Parliament and was supposed to become effective on July 1, 2010, but the new majority of the Citizens for European Development of Bulgaria (GERB) party amended the ban and adopted new rules providing for partial smoking restrictions.

The restrictions became effective in December 2010, and owners of small establishments were supposed to decide if the facility would be smoking or non-smoking while those of larger ones were mandated to have separate smoking and non-smoking spaces. Just days ago, the Health Ministry announced the full smoking ban for small establishments would be introduced in the summer.

The series of postponements are explained with allowing owners to make gradual expenses to upgrade the facilities and include ventilation equipment and non-smoking areas.

According to experts, the measure would lead to the bankruptcy of 10% of restaurants and coffee shops, to BGN 550 M less in annual turnover and would leave 15 000 employees on the streets. Losses for the State amount to BGN 94 M in unpaid Value Added Tax (VAT), BGN 11 M in unpaid corporate tax, BGN 23 M from unpaid insurance contributions for laid-off workers and BGN 8 M for unemployment compensations.

Results from the December 2010 partial ban show the turnover of facilities with separate smoking and non-smoking areas went down by 30%. Meanwhile, recent polls show that the majority of Bulgarians support the full smoking ban, despite the fact the country ranks second in the EU by smoking, after Greece.

Bulgaria Cracks Down on Poor Quality Rakia, Wine

On December 28, during its very last meeting for the year, the government decided  that Bulgarian producers and sellers of alcoholic drinks of suspicious origin will face hefty fines, bringing local laws in line with EU legislation. Fines will range from BGN 3 000 to BGN 30 000.

The executive vine and wine agency, which is part of the Agriculture Ministry, will be required to make public the names of legal alcohol producers on its website. They in turn will be obliged to describe the content of the alcoholic drinks and the technological process for its production in special logs.

The new regulations stipulate that wine should be made of grapes only and fix the minimum alcohol content – for the traditional brandy - rakia it has been set at 37,5%. The ethyl alcohol used in alcoholic drinks must be obtained solely by fermentation of agricultural products, under the new rules.

The number of methyl alcohol poisoning cases has been on the increase in Bulgaria over recent years after illegal producers started using methylated spirit, meant for spirit burners and camping stoves. Methanol, a toxic industrial alcohol, is often used to make stronger cheap, homemade brew. It can cause blindness or death. For Bulgarians drinking the locally produced alcoholic drink rakia has turned into nothing short of a cultural activity.

Other Health Stories

Bulgaria Refuses to Register Anti-Cancer Drug

At the beginning of February, the Health Ministry announced that the use of the medicine against cancer, discovered by the Bulgarian Prodan Hristov, is illegal and the Bulgarian Drug Agency will not register it as a cancer treatment drug. The reasons are the unidentified composition of the drug and Regulation (EC) No 726/2004 of the European Parliament and Council.

According to the regulation, all innovative and highly technological medicines for cancer treatment should be assessed by the European Medicines Agency. Their permission for use is issued by the European Commission.

The Bulgarian Drug Agency also warned it will perform checks to establish whether the medicine "Antimalignacyt" is illegally distributed in the country. If it is found, the agency will impose fines of up to BGN 50,000 and will suspend its distribution.

In the summer of 2010, Hristov, who currently lives in Vienna, said he stopped the production of the medicine because he was waiting for its registration. He said, however, that he was ready to resume its production if Bulgaria agrees to register it.

Bulgaria's PM Boyko Borisov has stated he could not lobby for the registration. In his words, Hristov has to convince the country's health authorities in its effect. Hristov submitted a registration request for his anti-cancer medicine "Antimalignacyt" about 20 years ago. He was planning to start a production and open hospitals in Bulgaria.

BGN 50 M for Bulgarian Patients Spent on Salaries 2006-2009

In March, a check by the Bulgarian National Audit Office revealed that nearly BGN 50 M, provided for expensive and life-saving medicines for treatment of cancer and other serious diseases, have not reached the patients, but were used for other purposes. The check for the period 2006-2009 included 22 hospitals. The total number of patients treated in this period was 478 518, with the biggest number being in 2007, while the smallest – in 2006.

The Director of the Bulgarian National Audit Office, Valeri Dimitrov, announced that the BGN 50 M have been used for paying salaries, compensations and renovations, even though there has been a systematic shortage of life-saving medicines throughout these four years.

He added that there have been many cases of delayed or temporarily suspended life-supporting or life-saving treatment of patients in this period. According to the National Audit Office, a change in the mechanism for prescribing and supply of these medicines is required.

The audit office has given 12 recommendations to Health Minister Stefan Konstantinov for improving of the ministry's work, including update of internal rules, regulation of the terms for including patients in treatment when there is a waiting list, and making these regulations valid for all hospitals.

In 2005, the National Audit Office recommended the creation of such an information system provide control and transparency of the Ministry's activities. According to the actual contract for its creation, signed in 2008, the information system had to be ready in 100 days. However, Bulgaria does not have the system yet, although BGN 2.146 M have been paid in advance for its creation.

Radiation Fears Spike Sales of Drug against Thyroid Cancer in Bulgaria

In mid-March, as Japan races to avoid a nuclear disaster in the aftermath of a devastating earthquake – the worse in the country's history, some Bulgarians scrambled to obtain potassium iodide, a drug that can protect people from radiation-induced thyroid cancer.

Health officials warned that the consumption of potassium iodide tablets without a doctor's prescription can be dangerous, especially for the little children, the elderly people and the people with thyroid gland problems. Potassium iodide, also known by the chemical symbol KI, is used to saturate the thyroid gland with iodine so that radioactive iodine inhaled or ingested will not be retained by the gland.

For Bulgarians trying to buy the pills, experts said there is no need for them — and certainly no reason to use them now — because Bulgarians are not being exposed to dangerous levels of radiation from the Japanese plants, nor are they likely to be. They stressed that talk that Bulgaria may be affected by radiation waves following the explosions at the Japanese quake-stricken Fukushima Daiichi nuclear plant was just absurd. Bulgaria's Health Minister also tried to assuage fears of radiation winds reaching the country after Japan nuclear plant blasts, which has spiked demand for the drug potassium iodide.

Unique Stem Cell Transplantation Carried Out in Bulgaria

In March, the first transplantation of stem cells from a non-family member donor in Bulgaria was carried out at the National Specialized Hospital for Active Treatment of Hematological Diseases in Sofia.

The stem cells arrived from Frankfurt at the Sofia International Airport and were taken to the hospital by the director, Georgi Mihaylov. They were used for the life-saving transplantation of a 28-year-old woman with acute leukemia. According to experts, the recovery period from such transplantation is long.

Nearly 30 Bulgarian patients are waiting for transplantations. For some of them, donors have already been found from Germany, Israel, Cyprus and Italy. Stem cells are used for transplantation in different diseases – lymphoma, leukemia, bone marrow aplasia, thalassemia, congenital immunodeficiency, some metabolic defects.

At the beginning of March, Bulgaria's Health Minister Stefan Konstantinov announced that the Transplantations Fund will be closed and its functions will be taken over by other units in the healthcare.

The decision was made after patient organizations warned that the Director of the Fund, Sofia Mutafchiyska, was forcing patients waiting for transplantations abroad to transfer their individual accounts to the fund as a condition to be included in it. At the same time, it was revealed that the fund had not absorbed the BGN 5 M from last year's budget and the money was returned.

Bulgaria Urges Blood Donations amid Acute Shortage

In 2011, for the ninth successive year Bulgarians were invited to donate blood as part of the national spring campaign, initiated by the country's Red Cross. Bulgaria is showing no sign of being able to cope with the acute shortage of blood as people are becoming more and more reluctant to join donation campaigns, a check showed.

The major part of Bulgarians who undergo planned operations ask their relatives to donate the needed blood, falling an easy prey to the black market dealers.

Lingering around the National Transfusion Centre, a group of a dozen gypsies may look like any other Roma men who roam along the suburban streets of the capital, but their real purpose is trading blood for money. The Roma charge from BGN 300 to BGN 600 for the priceless document that proves one of them has donated at least 450 ml of blood.

The black market for blood has recently seen some upgrade with the dealers starting to do business online, which only cemented their status as a staple, though stark, example of health care reminiscent more of a third world country than an EU member state.

It is only after the start of the transition period that Bulgarian hospitals became chronically short of blood for transfusion. Under the communist regime hospitals disposed of sufficient amounts of blood reserves as blood donation campaigns were mandatory.

The number of blood donors shrank dramatically since the fall of Communism, leaving patients with yet another psychological obstacle to overcome beside the disease itself and the hospitals' insufficient capacity.

Bulgaria's Ministry of Health says it is recording an ever-declining trend of the number of the voluntary blood donors. Data shows that Bulgaria lags far behind international standards for blood donation - 21 donors per 1 000 people against the required 60 donors per 1,000 people.

Poor economic conditions and low living standards top the list of reasons, together with the fact that blood donation costs time, some pain, and occasionally unpleasant consequences.

Bulgarian Pharmacists Launch National Protests

In May, Bulgarian pharmacists launched gradual protests across the country over the Bill for Medical Products, passed by the cabinet on April 20. The pharmaceutical workers were also outraged about the lack of transparency in the management of the national medication policy.

The decision to protest was made at the emergency meeting of the Managing Council of the Bulgarian Pharmacists Union (BFS) at the end of April. Pharmacies across the country closed for up to two hours at the time, while regional branches of BFS are deciding which pharmacies will close when in order to not violate patients' rights.

BFS insisted that amendments in the law must be passed only after being discussed with them and are firmly against the one providing people without pharmaceutical degrees can work in pharmacies. The Union also opposes the elimination of the Supreme Pharmaceutical Council from the issuing of permits for medication retail.

Bulgarian Team Performs Breakthrough Bloodless Urology Surgery

In October, a team of Bulgarian physicians conducted for the first time in the country two successful urological surgeries with the use of the robot da Vinci.

The surgery was done at the University Hospital in the northern city of Pleven, which has the equipment. The President of the Medical University in Pleven, Prof. Grigor Gorchev, said this was a breakthrough in Bulgaria's medical science to be included in medical books in a few years. The team performed the surgeries on two men, 59 and 60, suffering from prostate cancer. The Bulgarian doctors were led by Prof. Ottavio de Cobelli, from the European Oncology Institute in Milan.

One of the doctors further explained that in such bloodless interventions the recovery is quick, without cuts and trauma. Currently, the Bulgarian State is financing only gynecological surgeries with the robot, but the hospital is applying with the cabinet to have funding for urological ones as well. Gorchev says there are plans to purchase a second robot in the next 1 to 2 years.

Bulgarian Women Advised to Check Risky Breast Implants

At the very end of the year, Bulgarian doctors asked 3,000 women who received faulty silicone breast implants supplied by Poly Implant Prostheses (PIP) to undergo regular checks or have them removed.

Dimitar Evstatiev, national plastic surgery consultant said in an interview that about 3,000 pairs of potentially defective breast implants produced by French company Poly Implant Prothese (PIP) have been imported in Bulgaria.

The Bulgarian expert said the French company Poly Implant Prostheses (PIP) is the only one to blame since after initially meeting the requirements, it started using silicone in them was not meant for medical use. As a result the PIP implants had a higher rate of rupture than other implants and may cause breast cancer. According to unofficial data, tens of thousands of women in some 65 countries across the world, mainly in Western Europe and Latin America, may have been affected by the hazardous product.

The French Health Ministry recommended that women with breast implants reported to contain substandard silicone should get them removed. The UK government ruled out routine removal, saying there was "no evidence" of a safety concern.

Medical Malpractice

Bulgarian Surgeons Operate Toddler's Wrong Arm

At the end of January, doctors from the emergency "Pirogov" hospital in the Bulgarian capital Sofia did surgery on a toddler's healthy arm.

The child – a girl, 1 year and 10 months of age, was scheduled to have part of the bone in her right arm removed. The surgeons' team, however, operated her left arm. According to the "Pirogov" press center, the reason was a technical mistake made at the time the toddler was admitted at the hospital.

The receiving physician and the assistant surgeon were sanctioned by a "dismissal warning," while the head surgeon was threatened with dismissal, despite the fact she immediately realized the mistake and closed the surgical opening. The mistake will not leave the child's left arm damaged. The case was investigated by a special commission, which issued the proposal for the penalties against the three doctors.

Bulgarian Toddler Dies Waiting on Ambulance

In February, a 2-year old girl passed away at the 7th hospital in the Bulgarian capital Sofia while waiting on an ambulance. Anastasiya has been brought to the hospital by her parent for an exam. The girl died inside the doctor's office. The initial diagnosis is acute respiratory insufficiency. The parents are blaming Emergency Services for delaying by half hour the ambulance the doctor requested.

The Head of the Emergency Services, Dr. Georgi Gelev, denies there has been a delay. The call about a dying child has been placed on the emergency 112 hotline at 4:35 pm; the ambulance left at 4:37 pm and arrived at the hospital at 4:42 pm only to find out the toddler had already passed away, Gelev insists. A second call for another ambulance has been placed through a stationary phone at the hospital, but this ambulance has been cancelled at the 2nd minute.

Bulgarian Doctor Fired for Confusing Stroke with Flu

In March, a Bulgarian doctor from the Sofia emergency room was fired one day after he confused symptoms of stroke and flu. The Head of the Emergency Care Unit at the Bulgarian Health Ministry, Dr. Georgi Gelev, has conducted a probe in the case, after being alarmed by Darik radio. Dr. Georgi Hadzhinedelchev was terminated on the grounds of being reckless when fulfilling his duties.

Krasimir Petrov, 50, called his girlfriend telling her he did not feel well. The woman called an ambulance and left work to go to the emergency room. Hadzhinedelchev diagnosed Petrov with flu and recommended he sees his personal physician.

The patient's condition, however, continued to deteriorate and three-hours later, the girlfriend called another ambulance. The second doctor diagnosed Petrov as having suffered a stroke.

Bulgarian Patients' Rights NGO Outraged by Doctor's Blunder

In July, the Bulgarian National Patients' Rights Organization demanded termination of the right to practice medicine of a doctor from the Black Sea city of Varna over an irreversible mistake.

Milko Mihalev, 42, from the town of Provadiya, near Varna has lost his right hand after a procedure prescribed by a cardiologist. The nightmare began on July 7 when the man went to his family physician with acute chest pains. The doctor issued a referral for a cardiologist.

The latter conducted a cardiograph and sent the patient to a private clinic in Varna where he underwent a procedure and his right hand was bandaged. Mihalev insists no one warned him of possible complications.

Very soon after the bandaging, the man felt severe pain and his hand and arm went numb. The family called an ambulance and say that the medics, who came, never checked the arm. Two days later Mihalev was referred to the Saint Anna hospital in Varna where, in the course of 5 days, doctors made 4 unsuccessful attempts to save his arm. The fifth had been done in the "Tokuda" hospital in the capital Sofia, where the arm was finally amputated. Mihalev, a father of 2, had been employed as a driver and can no longer practice his profession.

The National Patients' Rights Organization demanded an investigation in the case from the Executive Agency Medical Audit, the Bulgarian Cardiologists Union and the Health Ministry and asked the Bulgarian Doctors Union to terminate the medical practice rights of the cardiologist.

The investigation in the case executed by the Executive Agency Medical Audit concluded that there were serious violations in the doctor's treatment. In a press release, the Bulgarian Health Ministry informed financial sanctions were pending after the completion of the probe.

Preliminary results showed that a full medical history of the patient has not been taken prior the treatment; the doctor did not take into account other ailments, and did not order all needed medical tests.

3 Women Die in Sofia Maternity Wards

On November 29, a woman died during the delivery of her baby in a Sofia maternity ward, becoming the third such case in less than three months.

The tragic incident occurred at the 1st Sofia Maternity Ward "St Sofia." The baby was reported as doing well. According to unofficial information, the cause of death was pulmonary embolism. Doctors have recommended a cesarean. This was a second child for Daniela Dimitrova, 31.

Relatives of the woman say there were no problems during the pregnancy and she went to the hospital in good health. They also inform that doctors even refused to tell them the name of their colleague, who did the delivery. The husband threatened to sue the maternity ward. The Sofia City Hall probed the incident since this is a municipal hospital.

The Head of "St. Sofia," Dr. Elian Rachev had been unavailable for comments – first he did not answer his cell phone and later turned it off. The Head of the maternity ward has also declined comments over pending results from the official probe, which at the end exonerated the doctors.

The string of tragic deaths began on September 12 when college student Deyana, 19, was admitted at the "Sheinovo" maternity ward. She died after fighting for her life for 42 days. She was released from the hospital without a diagnosis and all necessary tests. The probe showed the cause of death was sepsis, due to inadequate doctor's care. Deyna had been transferred back and forth to four different hospitals, two of which were fined.

Another mother, Nadezhda Uzunova, 35, died at "Sheinovo" in November, after coming to the hospital several times and being sent back because the doctor on duty kept telling her she did not "yet have the required signs for being ready to give birth." Nadezhda passed away just minutes after being admitted in the hospital, while the baby was placed on a respirator, but also died the next day.

Health Minister, Stefan Konstantinov, stated that the hospital was to be blamed for the tragic double death. The Executive Director of Sheinovo, Dr. Ivan Kostov, resigned in the aftermath. Three probes – from the Medical Audit, the Regional Health Inspectorate, and the Prosecutor's office, which are taking place in the maternity ward over the tragic incident were launched.


Foot-and Mouth Decease

On January 5, the first in the past 12 years case of foot-and-mouth disease (FMD) occurred in Bulgaria. A wild boar with FMD was killed in the region of the southeastern Bulgarian city of Burgas. A 10 km security zone was established and all vehicles passing through the region were disinfected. All living animal trade in the Burgas region has been stopped. The European Commission was informed about the accident.

FMD is a sometimes fatal viral disease of cloven-hoofed animals, including domestic animals such as cattle, water buffalo, sheep, goats and pigs. Humans are very rarely affected.

FMD is highly contagious and, while it is not so dangerous for humans, a possible outbreak may cause severe economic damage in case there is a ban on the export of animal products, according the Bulgarian Agriculture Minister Miroslav Naydenov. At the time, several centers of infection had already been registered in Turkey.

At the end of August, Bulgaria's government announced it will start building its border fence with Turkey no earlier than the beginning of 2012. It had initially intended to have the fence built by October 2011.

A total of 21 companies are competing in a public procurement for designing the fence. The facility's construction will be financed by the Bulgarian State budget and is expected to cost approximately BGN 7 M.

The decision for the fence's construction came after a number of villages in the remote Strandzha region in south-east Bulgaria bordering on Turkey experienced severe outbreaks of FMD, leading to the destruction of hundreds of heads of livestock. In January-February and then again since mid-March, Bulgaria was struggling to contain the spread of FMD.

Officials said they believed the disease was spread from flares in Turkey by wild animals roaming the Strandzha Mountain forests.

In the Cold War period the Bulgarian-Turkish border was a border between the Soviet-dominated Warsaw Pact and NATO, and as such was one of the most-heavily fortified borders in Europe. Since the early 1990s, Bulgaria has torn down its border fortifications and has ever dismissed its Third Army, which was deployed in the area.

Bulgaria's intention to build a new fence on its Turkish border came as Greece also announced plans for similar measure but designed to tackle the influx of illegal immigrants from the Middle East via Turkey.

Meanwhile, Turkish regions along the Bulgarian border began taking measures to prevent the spread of food-and-mouth disease from Bulgaria even though the Bulgarian authorities claimed the infection came from Turkey.

The Turkish authorities suspended all movement or evacuation of animals in the region of Kirklareli, known in Bulgaria as Lozengrad. The measure will be in place until May 9, 2021. What is more, the authorities in European Turkey started immunization of local domestic animals against FMD. According to EU sources, the European Commission has provided Turkey with 850 000 immunization doses even though the Turkish state has not provided official information.

Bulgaria's fight against the spread of foot-and-mouth disease (FMD) along its southeast border reached ridiculous dimensions after a statement snipers will shoot down infected cows caused a scandal.

Bulgaria's Defense Minister Anyu Angelov denied any kind of involvement of the military in the hunting down of FMD-infected cows in the regions bordering Turkey. It was reported in April that farmers in southeast Bulgaria will be receive compensations totaling BGN 2.4 M (EUR 1.2 M) for their livestock destroyed in order to contain the spread of FMD.

The compensations are a part of the overall measures of the Bulgarian government to counter the new FMD outbreak. They are being provided to three groups of farmers – those who have their livestock destroyed; those who will be prohibited from moving or selling their animals within a 10-km zone, and those who are not allowed to trade in milk or meat.

While the estimates show that the compensations for the slaughtered livestock will be about BGN 2.4 M, the overall compensations for farmers in the southeast Burgas District will amount to BGN 6-10 M, or up to EUR 5 M.

131 Bulgarians Died during Flu Epidemics

In March, data from the public health body RIOKOZ showed that total of 131 people have died from flu during the two epidemics in Bulgaria in the period December 2010 – March 2011.

According to Angel Galabov, head of the Institute of Microbiology at the Bulgarian Academy of Sciences (BAN), a total of 27 608 Bulgarians have been hospitalized during the four months of the flu epidemics. He explained that the most common complications of flu are bronchitis, laryngitis, otitis media, sinusitis, and cute respiratory failure, and the most affected age group is people between 46 and 64 years.

Of the deceased, 45 people were between 46 and 64 years old, 42 people were above 65, 19 people were between 30 and 45, seven – between 15 and 29. Five of them were children between 5 and 14 years, while 13 were the children below 4 years. Such data mean that the flu remains a serious, according to Galabov.

He noted that Bulgaria was well equipped with anti-flu patent medicines and that the serious illnesses were caused by seasonal flu.

E Coli Panic Spreads, Bulgaria Escapes the Worst

At the end of May, lab tests of a variety of imported produce proved negative for Enterohemorrhagic Escherichia coli (EHEC), the Bulgarian Food Safety Agency reported. The tests included iceberg lettuce, peaches, oranges, spices, tomatoes, and cherry tomatoes from Spain, iceberg lettuce from the Netherlands and peppers from Greece.

The tests have been done as a prevention measure after the EU system for alarm of dangerous food products sent a warning that organic cucumbers originating from Spain and imported to Germany were believed to be infected with a special strain of Enterohemorrhagic Escherichia coli (EHEC) which causes the hemolytic uraemic syndrome, associated with hemolytic anemia and might cause acute renal failure and death.

The Food Safety Agency further informed there has not been any import of cucumbers in Bulgaria in the last month and the batches of organic cucumbers from the two provinces of Spain, Alneria and Malaga, which have been identified as one of the sources for the outbreak, never reached Bulgaria's market.

Bulgaria's Food Safety Authority further stressed they were in the process of contacting all retailers, suppliers and caterers in relation to an outbreak of E Coli in Germany to ensure there is no contaminated product here. The probe covered all fresh vegetables, imported from European Union countries.

The recommended precautions include washing produce carefully before consumption, along with thorough washing of dishes and frequent washing of hands.

In June, the European Commission lifted its warning over the Spanish cucumbers, saying tests "did not confirm the presence of the specific serotype (O104), deemed responsible for the outbreak affecting humans" – a move welcomed by Spain, which threatened to file a suit on behalf of its farmers against German authorities who had alleged a link between Spanish vegetables and the deadly strain of bacteria.

EC noted establishing the source of the infection was a priority with John Dalli, Commissioner on Health and Consumer Policy, saying this would be the only way to undertake the needed measures.

Days after EC lifted the ban, the EU's Reference Laboratory for E. coli in Rome announced that scientific analysis and lab tests have failed to show that contaminated vegetables are behind Europe's deadly E. coli outbreak.

"Alarmism over the consumption of vegetables is not justified ... since laboratory analyses do not support the hypothesis that contaminated vegetables were the source of the infection. It would be sufficient to follow basic kitchen hygiene to avoid infection, such as washing your hands after handling food and ensuring knives are clean," the laboratory, part of Italy's Higher Institute for Health (ISS), said in a statement.

Meanwhile, Dr. Claudia Stein, a German trained public health physician and epidemiologist with the World Health Organization (WHO), Head of the Department of Food Safety, Zoonoses and Foodborne Diseases (FOS) pointed out the efforts to establish the source of the contamination could take days and months, adding the outcome might be failure to find the source, as it often occurs.

The Beijing Genome Institute, which tested samples from Germany, announced the strain is new, very toxic, and had been the result of the mutation and combination of the very aggressive O104 strain, found in South Korea, and the 55989 strain from Central Africa.

Bulgaria will declare losses of EUR 10 M from unsold cucumbers due to the E.coli outbreak, Minister Miroslav Naydenov announced in Luxemburg at the emergency talks among EU Agriculture ministers.

One of the key topics on the agenda of the forum revolved around options for reimbursing vegetable producers in the EU for the inaccurate warnings that the outbreak might be linked to Spanish organic cucumbers. The news about the deadly bacteria caused consumption of cucumbers to plummet.

Bulgarian cucumber producers suffered a loss of BGN 1 M per day since the onset of the cucumber crisis, which translates into a loss of BGN 7 M per week. Spain, on the other hand, claimed that local farmers had clocked up losses of EUR 200 M per week.

The estimations about losses in Bulgaria come from the Bulgarian Greenhouse Association and match the data supplied to the Agriculture Ministry.

EC said it will ask EU countries to grant EUR 150 M in aid to European vegetable producers hit by the cucumber scare. EU Commissioner Dacian Colos urged German health authorities to find the source of the deadly bacteria as soon as possible, insisting on prompt and clear results about the contamination in order to restore consumer confidence.

The e.coli outbreak set the latest reported death toll at 47, according to global news agencies. Only one of the fatalities has been reported outside Germany – in Sweden. According to the World Health Organization (WHO), a total of 3800 people in 16 countries have contracted the infection, 860 of them being in critical condition. In Bulgaria fears were sparked by the suspicious death of a 66 year-old man in the southeastern Bulgarian town of Haskovo, but tests proved the deadly E. Coli bacteria was not the cause.

The man was suffering from another, less dangerous strain of the E. Coli bacteria, officials from the Bulgarian Health Ministry revealed. He was treated for diarrhea but passed away as a result of a heart attack.

No cases of the life-threatening E. Coli infections were registered in Bulgaria. The source of the outbreak remained a mystery for a long time, but the latest belief is that it was caused by vegetable sprouts grown on an organic farm in Germany.

Bulgarian Govt Assuages Fears about Contaminated Cantaloupes

In September, Agriculture Minister Miroslav Naydenov confirmed that no cantaloupes imported from the US were sold on the Bulgarian market, adding that if there were imports of that type of fruit, they arrived from neighboring countries.

He went on to say that Bulgaria firmly supported the newly passed EU rules forcing all producers to mark the fat, sugar and salt contents on prepackaged food from 2014. Under the rules approved by EU ministers, packaging will also have to show the amount of calories and the carbohydrate content, and all fresh meats will have to be labeled with their country of origin.

The listeriosis scare broke out after 16 deaths and 75 illnesses were linked to an outbreak from contaminated fruit in the US state of Colorado, as reported by international news agencies. The source of the outbreak was traced to cantaloupes grown at Jensen Farms in Granada, Colorado.

US health authorities warned the number of incidents was likely to grow, since symptoms can take four weeks or more to appear. Listeria monocytogenes bacteria cause a disease called listeriosis. The bacteria are commonly found in the soil, where they eat dead plant matter.

Blood infection with listeria is extremely serious. The bacteria can enter the brain and nervous system, causing disability or death. Listeria can also infect a developing fetus, causing miscarriage, stillbirth, premature delivery, or death of the newborn.

Bulgaria in International Health News

Bulgarian Authorities: Radioactive Mushrooms Isolated, Not Chernobyl-Related

In June, the Bulgarian Food Safety Agency reassured that the shipment of Bulgarian mushrooms destroyed in the UK due to excessive radioactivity is an isolated case that has nothing to do with the aftermath of the Chernobyl disaster.

The announcement came after the Daily Mail reported that UK border authorities had discovered and destroyed a ton of dried Bulgarian wild mushrooms that exhibited levels of radiation from cesium 137 10 times higher than the allowed norm. The Daily Mail further quoted UK agencies linking the radiation nature of the shipment with the aftermath of the Chernobyl NPP disaster back in 1986.

"The mushrooms in question have been harvested in an area in the Rhodope Mountains nearby the site of shut-down uranium mines. Thus the radiation found in them is not caused by Chernobyl," said Bulgarian Food Safety Agency Director Yordan Voynov.

Voynov clarified that the shipment amounted to 600 kg, rather than a ton. It has been shipped first to the Netherlands and then on to the UK. The mushrooms are from the Hydnum repandum species, known as Wood hedgehog or Hedgehog mushroom. The Food Safety Agency Director assured that this was an isolated case and no radioactive mushrooms are sold on the Bulgarian market.

60s Bulgarian Antismoking Pill to Make Medical Breakthrough

It was reported in September that a pill, which was developed in Bulgaria during the time of the Communist regime, can make medical breakthrough by helping millions of smokers to give up the habit safely and cheaply. The pill has been sold in Bulgaria as Tabex since 1964, and has the chance of becoming a hit on the developing countries markets because it is made from a widely-available, plant-based ingredient.

Attention focused on Tabex with the publication of the first large-scale, modern study of the pill's effect in the New England Journal of Medicine. The study has been conducted in Poland by University College London. It shows the effect of the Bulgarian pill is comparable with the way more expensive Chantix of Pfizer and Zyban of GlaxoSmithKline.

The experiment involved giving Cytisene, the main ingredient of Tabex, to 740 volunteers, who smoke over 10 cigarettes a day in the course of 25 days – they were instructed to take 6 pills daily in the first three days, and then begin reducing the number of cigarettes they smoke with fully stopping smoking after the fifth day, and continue taking the pill for another three weeks.

8.4% smoked less than 5 cigarettes a day in the first 12 months after stopping taking the pill, compared to 2.4% in the control group. 13.2% have been able to completely give up the harmful habit, compared to 7.3% in the control group.

The study further shows Tabex is the most effective if taken for more than four weeks, while his rare side effects included upset stomach, nausea, and dry mouth.

Monthly expenses for the use of Tabex are estimated at USD 6 to 15, compared to USD 100 for other brand-name products, which can make the Bulgarian pill extremely competitive on markets in poorer countries, but it is unclear if it will ever reach those in the US, Western Europe and Japan, where there is no license for its sales. Tabex is a product of the Bulgarian Sopharma company and it is offered in Central and Eastern Europe.

Bulgaria Can Boost Its Medical Tourism - Study

Bulgaria is among the countries that can provide low-cost medical services and health professionals with considerable experience, which can turn it into an attractive tourist destination, a new study has shown. Countries such as Poland and Bulgaria will experience a rush of Britons seeking cheap medical treatment abroad, an Economist Intelligence Unit report predicts, according to The Independent.

As cost pressures in the healthcare systems of rich countries rises, developing countries have the chance to develop a medical tourism industry to boost revenues and develop healthcare expertise.Figures suggest more than 50,000 people in the UK a year go abroad for treatment and the report said outbound medical travel from the UK had been growing far faster than inbound over the past decade.

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