Broken Bulgaria

Sofia – Haskovo, Bulgaria: March, 2004: I had visited all of Bulgaria’s neighbors, including Romania, Turkey, Greece, old Yugoslavia, Albania, and the other sovereign states near the Black Sea, but never Bulgaria. 

Bulgaria, about the size of Tennessee, was a mountainous country of over eight million inhabitants. I had peered across the Danube River in the south of Romania over into Bulgaria in the past. That part of the world reminded me a lot of parts of Colorado. Both areas lay in about the same latitudinal position on the globe. 

Poor Bulgaria had twice fought with Germany – once in the first World War and again in World War II, so defeat had exacted a high price from the people. Then, following World War II, the communists had grabbed control of the country and it wasn’t much later that the Soviets swallowed them up. Now they were declaring independence and moving toward democracy and stability. But, the old corrupt and criminal ways of the communist philosophy and regime had made it extremely difficult to overcome poor work ethic and corruption that had continued to show itself through unemployment, inflation, and the breakdown of ethical business practices. 

In order to encourage Bulgaria, the United States had given the country more than $390 million specifically to support financial development and democratic institutions. One such grant generated from the US embassy in Sofia was a contribution to the municipality of Haskovo to enable them to renovate the most dilapidated departments of the hospital buildings. The grant was for something in excess of $300,000, earmarked specifically for the Haskovo Regional Hospital’s departments of surgery, endocrinology, and maternity. By early 2004 the renovation was completed, and while part of the facility had become better looking on the inside and outside, they were still woefully needing newer medical equipment and nearly begging for the most common medical supplies. 

A young Peace Corps volunteer from Tennessee serving her assignment in the municipality of Haskovo heard about Project C.U.R.E., logged onto our website, and fired off an application to Project C.U.R.E. on behalf of the Haskovo Regional Hospital. Her name was Laura Marzahl. 

By the first week of February, Anna Marie had reviewed all the application forms and supporting documents from Laura Marzahl in Bulgaria. In reviewing the complete list of countries waiting for us to visit and perform the needs assessment study, we both felt drawn toward Bulgaria. There were some 57 hospitals in the queue and the application from Bulgaria was at the bottom of our list since it had been received just days before. But feeling prompted to act on the Bulgarian request, I asked Anna Marie to reply as quickly as possible to the lady and see if they could move quickly enough to host us for a needs assessment study. Laura Marzahl replied with equal haste and said everything could be arranged for the visit even though it was very short notice. 

Perhaps in the 63 years that I had been alive I was beginning to learn that I could rely on the prompting of the Holy Spirit and trust the fact that God, indeed, was in control of every little detail and timing of my life. About 30 hours from the time I left Denver, I arrived in Munich. It was cold, and a mix of snow and freezing rain covered the German landscape. I could only hope that things would be a bit warmer in Bulgaria. 

Wednesday, March 24

It was late afternoon on Tuesday when my Lufthansa Airline flight landed in Sofia, Bulgaria. I was immediately met by Pavlina Passeva, director of the municipality of Haskovo, and Laura Marzahl, the Peace Corps volunteer who had become the head of the Bulgarian/American Development Committee in Haskovo. It took us about two and a half hours to drive from Sofia, the capital of Bulgaria to Haskovo, a city of about 300,000 people. “I could very well be riding through the beautiful countryside of Colorado,” I remarked to my new friends. “The snow-covered mountains, the rich, rolling farmland, the fruit orchards and rural farms … all closely resemble the state of Colorado where I live in the US.” 

Once we had arrived in Haskovo I was taken to a picturesque old hotel located adjacent to the sprawling city square. At the end of the square was situated the municipal building with the big storybook clock tower and bell tower. I had fallen in love with Haskovo within the first 15 minutes of being there. 

Thursday, March 25

They wasted no time at all in putting me to work on Thursday morning. Following a breakfast meeting I was whisked away to the large Haskovo Regional Hospital where I was not only met by all the medical personnel, but also by a bevy of television and newspaper reporters. 

All the hospital’s doctors, head nurses, and chief administrative folks had been summoned to a small, theater-type auditorium with a long speaker’s table positioned up on the stage adorned by flowers and coffee cups and water glasses. To me it had the appearance of being more of a medical convention than a needs assessment interview. 

With TV cameras running and flash attachments popping, the meeting began. The folks of Haskovo were going to make a big deal of Project C.U.R.E. being there. It took me until well after noon to walk the hospital hallways and meet the department heads and senior nurses. At the morning meeting I had given them each an assignment to be prepared to discuss with me the three things they needed most in their department. Each was eager to have me listen to their particular needs. No one had ever come to their hospital to just listen to them individually and laugh with them and be their friend. 

When finished with the main regional hospital, Dr. Yasen Yanev insisted that I go with him to a different building where the cancer center was located to also assess its needs. 

At 3 p.m. on Tuesday afternoon, there had been a meeting scheduled on the third floor of the historic municipal building. Most of the city fathers were present, as were eight medical doctors who comprised an august group known as the municipal council commission for healthcare. It had been the oversight committee for the large renovation project at the regional hospital which had been financed by the US embassy in Sofia. 

The group was primed and ready for me, But, many of the questions were completely out of my league. They were asking such questions as, “Does your being here on the heels of the US embassy financially helping us with the needed remodeling of our dilapidated facility indicate that NATO is going to choose Haskovo as a regional medical center?” Or, “How are you going to be able to help us with our disabled groups … both the old and the children?” Or, “Do you have a program to cure illicit drug addiction?” Or, “Can you help us put together a national health insurance program in Bulgaria?” Or, “Can you train us for emergency health procedures?” 

Soon I was in deep discussion explaining just how narrow and boring Project C.U.R.E.’s scope would be in Haskovo. “Our mission is to simply collect, warehouse, and distribute medical supplies and pieces of medical equipment based on imperative need around the world.” I went on, “I plan to be very narrow and very focused here in Bulgaria. I also plan to be very successful in my efforts to help meet some of the needs here if I can have your help and assistance.” 

My honest and open approach quickly won them over and they saw that I had not just come to patronize them or shove something down their throats. I had come to be of help and to be their friend and to work from a common denominator of seeking a more excellent healthcare delivery system for Bulgaria.

Before we finished they pressed me to tell them what I had seen as their major weaknesses. “You have many fine physicians and nurses in Bulgaria, but you have inherited a system from the old Soviet days that is almost impossible to render efficient. In the old days there was a strong desire to control everything and everybody and not let the left hand know what the right hand was doing. In Russia I witnessed doctors who were trained only to remove gall bladders. Indeed, they were specialized and they could remove the organ with haste, but they knew almost nothing about medicine. When there was not a gall bladder to remove they had nothing to do but go outside and smoke. Still, it was easy for the statists to control that technician.” 

I was watching the doctors’ eyes for response. “Your system here is based on separation and overt control. Today what I saw in your hospitals was to me very sad. There were six different departments within the regional hospital. No one department could communicate with another. Each specialty block had its own laboratory, each had his own x-ray or radiology department, each had its own diagnostic department, and each had its own surgical block that included at least three complete operating theaters for each of the six departments. That’s 18 complete operating theaters with only about 15% of them busy! But each specialty block has requested new anesthesia machines for each of the three theaters in each block. That’s 18 new anesthesia machines. I won’t help you with 18 anesthesia machines. Maybe three. I do not believe that your new healthcare delivery system will be able to financially sustain a fractured system. Besides, it’s not all that bad to get along with each other.” 

I could tell that I had hit a home run. They knew that the old Soviet system was not efficient. 

I summed up my medical philosophy on that point by stating, “Free medical care for all the people simply means no medical care eventually for any of the people.” 

Next Week: Beautiful Bulgaria

© Dr. James W. Jackson    

Permissions granted by Winston-Crown Publishing House