The provision of public care was one of the points of anger expressed in Greece after the train disaster of February 28. The hospital, like other public services, emerged bloodless from the austerity plans put in place after the 2010 crisis.
Giorgos Ferentinos walks through the busy corridors of the emergency room to guide us through the other wards of Evangelismós Hospital in the heart of Athens. The cardiologist is on duty, but he wants to show us what, in his eyes, characterizes the state of the Greek public hospital. Arrived at the entrance of the surgery unit, the doctor, president of the union of Evangelismós employees, announces that eight operating rooms are closed. “They are new, with new material”, he describes. Nevertheless, “they are empty due to lack of staff”. Each department suffers from the same staff shortage.
The disintegration of the care offer contributed to fueling the popular anger that erupted after the February 28 train disaster. All public services are also concerned. With the approach of the legislative elections on Sunday May 21, the situation of caregivers and their remuneration were invited in a debate between the candidates, Wednesday May 10.
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In one of the largest hospitals in the Greek capital, Giorgos Ferentinos walks through corridors with sometimes chipped walls. On the 9th floor, the doctor stops in front of the psychiatry department. Twenty patients are bedridden in the corridor. The others are gathered in a common space, without a private room, details the doctor. With the austerity measures initiated in 2010 in exchange for a rescue plan for Greece, five of the country’s nine psychiatric clinics have closed, according to the newspaper Ekathimerini*.
Two nurses for 35 beds
Overall, public health spending has fallen by 43% in nine years, according to an investigation by Amnesty International*. “Numerous acts that were not necessary have been eliminated, but at the same time essential care has been reduced”, observes Manos Matsaganis, professor of public finance at the Polytechnic University of Milan and director of an observatory at the Eliamep Foundation in Athens. “IThe health system is more supervised, which has good and bad aspects.”
The closure of certain structures has “brought patients to other hospitals, which became congested”, describes Giorgos Ferentinos, going through pathology units. In one of these wards with busy rooms, ideally two nurses would be needed for four beds. “Right now there are two nurses for 35 beds.” Greece has long suffered from an insufficient number of nurses, recalls Manos Matsaganis. The country had “too many doctors and not enough staff”, he summarizes.
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Austerity has imposed a rule as simple as it is strict: for five employees leaving the public health service or retiring, only one caregiver was recruited. “Public hospitals have not hired new doctors in recent years. The average age of doctors is rising, develops the researcher. According Ekathimerini*, between 700 and 750 doctors leave the system each year for retirement or the private sector. “Many young people go to the private sector or abroad”, continues Dimitra Stamatelou, pathology doctor at Evangelismós and member of the Greek Federation of Physicians. According to Amnesty, nearly 20,000 young doctors left Greece between 2010 and 2020.
“Think of the young doctor who does all this work [dans le public], who runs from one patient to another without rest, without having time to learn. Permanent contracts are rare.”
Dimitra Stamatelou, doctor at Evangelismós Hospitalat franceinfo
However, she feels that her service is in a “good location”because only five to six doctors are missing out of about forty positions. Other units only have half the doctors they should have, says the 30-year-old. “For the moment, I am not leaving”, she slips into a nervous laugh. But “the needs of the patients are far greater than what the public hospital can offer.”
For Manos Matsaganis, patients also arrive at the hospital for lack of other access to public offers for primary care. There are a few public health centers in more rural areas, but otherwise most doctors are private caregivers, says the researcher. And in this case, patients should generally “pay out of pocket”.
“Three to four months of waiting” for an appointment
Near Saronikos, one hour south of Athens, a single health center covers an area where 50,000 to 100,000 inhabitants live, depending on the season. So many potential patients in this less urban, more arid and mountainous area, near the west coast of Attica. “I am the only cardiologist for this region”, note in a calm voice Giorgos Vichas.
A paediatrician, seven general practitioners, a surgeon and two orthopedists work with him at the health centre. Giorgos Vichas knows precisely how many specialists are missing from his patient base: at least two cardiologists, an ophthalmologist, a gynecologist, a pulmonologist. The list goes on. The center has no ENT, no nutritionist, no psychiatrist or neurologist, lists the doctor.
Giorgos Vichas therefore decided on a D system. The doctor reserves two days a week for the emergency room. “I need this time for all the patients who cannot wait. Otherwise, it’s a three to four month wait” for a date, he warns. With this system, he says seeing about 40 more patients each week, for a total of 90. “For me, it’s fine, he breathes. It is for the patients that it is difficult.”
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That morning, in his modest office, the cardiologist checks the heart of a patient who sometimes suffers from chest pain. Pains “probably stress-related”, concludes the doctor. Giorgos Vichas wanted to see him quickly to make sure everything was fine. Without these slots, Panayotis Deliligas would have had to wait at least until the end of the month for an appointment in the public, “one more stress”. “If I had been in a hurry, I should have found the money to go private”, continues the cabinetmaker. Either 150 to 200 euros for a simple check, he estimates.
During austerity, preventable deaths
The 40-year-old is not a regular at health centers. He has been avoiding them since a family tragedy, five years earlier, in the middle of summer. “My father was due for heart surgery and we never found a surgeon. He had complications and he died.” When an ambulance arrived at home, the team did not have the necessary equipment. “He was punched in an attempt to resuscitate him.”
“My dad died because of all that crap in the audience.”
Panayotis Deliligas, a patientat franceinfo
Since the recession, twice as many Greeks say they have not received necessary care, according to a study published by Manos Matsaganis*. “Patients could not pass the examinations they needed, due to longer waiting lists”, describes the professor. Giorgos Vichas is a first-hand witness of what the crisis has done to access to care. In 2011, the cardiologist saw more and more patients losing or about to lose their jobs, and thus their health insurance. More than 2.5 million Greeks have become uninsured, according to a study* (PDF) from Panteion University. He evokes this patient suffering from pulmonary edema, “on the verge of death” but who had not consulted, for lack of insurance. “A lot of people died because they no longer had access to a cardiologist”, sighs the carer, revolted behind his calm air.
Between 2011 and 2016, Giorgos Vichas ran a social dispensary, totally free for patients without insurance. With a team of volunteer caregivers, he claims to have cared for 30,000 patients. A capital help, even if all could not be saved. A woman died of a tumor that had grown too large, another patient of cancer that had become inoperable. She was 35 years old. For the cardiologist, these deaths are “crimes”.
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Evagelia Rompapas, 85, was treated for breast cancer at the time of the crisis, but without being able to count on the public hospital. The ex-seamstress, full of energy, recounts the choice she faced: three months of waiting for exams or a mastectomy to prevent the spread of cancer. “I was ready to have the breast removed and my son said to me: ‘you are crazy'”, reports the petite pensioner. “I would rather have my chest removed than charge my children.” Finally, to ensure treatment in a private center, her son paid 2,500 euros, according to her.
In the public too, some patients discreetly pay caregivers to speed up or improve care, according to an association that collects these testimonies (in Greek) in various public services. She received 1,200 complaints related to hospitals. A reality that particularly concerns childbirth, as documented Le Monde (subscriber edition).
“Actually, you need money. It’s a big pain not to have that access in public.”
Evagelia Rompapas, a patientat franceinfo
In his apartment in a residential area of Athens, boxes of painkillers sit alongside family photos on the sideboard. Her sciatic nerve kept her up all night. Once again, Evagelia Rompapas had to consult private doctors to be treated faster. In the public, she would have waited three months for an MRI, then several weeks for an injection. Unthinkable in view of his pain. But, by choosing the private option, the retiree still does not know how much this last treatment will cost. And how will she be able to pay for it.
* These links refer to pages in English.