Monday, 26 May 2014

Ambulance in the playground: Comparing two bloody children's heads across 30 years of post-socialist health care



Photo courtesy of

The child fell down smoothly. As if in slow motion I could see him leaning ahead behind one of the solid concrete benches, installed in the playground by an unknown genius of child-safety design.  Within a second just enough for me to turn my eyes from my daughter Maia’s unsuccessful attempts to hit a badminton ball with a racket I move my eyes on to him, just to see him raising up from behind the bench crying. Something dropped from his head.

“Look, he broke his head,” I muttered unbelievingly while already getting hold of the crying child. A Hungarian mummy was standing just a meter away, staring helplessly at us with her bright blue eyes. I was right, blood was leaking from under the little boy’s blond hair onto his scarf and t-shirt. That had to be stopped. “Szalfeta(napkin)?,” I turned to the young woman who kept staring at us like paralyzed. She was looking at the blood in panic, and suddenly starting speaking very fast in Hungarian, a language that I am far from understanding well. It did not seem like she understood what I asked for. “Szalfeta,” I repeated, “szalfeta”? It took her another bling to understand: “ah, igen, szalfeta,” she reached quickly into her handbag, “tesek, chak piszkos,” she said apologetically, handing me a neatly folded napkin. Never mind. I pressed the tissue onto where the blood seemed to be coming from, while the boy was screaming his lungs out. I then took his hand and said firmly “It’s OK, Lauri,” then  pressed his own hand onto the improvised bandage. “Hold it on,” I said, while leading him to sit onto the nearby wooden bench, far from the concrete ones. There I called Emese and told her that Lauri had fallen on his head and was bleeding, so she should bring his mom over to the playground and some proper bandage. And she should call an ambulance, I concluded. Emese was thrilled.

Lauri was the son of Seija, Emese’s childhood pen-friend from Finland. The two of them had arrived for a weekend visit to Budapest and were staying over with us at our flat. Lauri spoke no other language but Finnish. But he was a very bright 7-years’ old who was following promptly my instructions issued to my own kids earlier that day – to clean up their room and put their toys in order. So when time came for the usual afternoon playground time, I proposed to take him along and Sheia did not mind. Maia, also 7, was quite happy, as she seemed to be growing fond of Lauri after 2 days of suspicion. After a sudden rain shower in the afternoon the playground was almost empty, and the weather was fresh, so I initiated a badminton game with her while her brothers were digging the deepest-ever tunnel in the sand. Lauri sat down on the concrete benches watching us, then apparently decided to start jumping from one when the accident happened.

Emese and Seija arrived running within a minute or so. Lauri had stopped crying and was holding the tissue tight onto the wood. No blood seemed to be dropping from it any more. When he saw his mother he gave her a bit of crying of course, but she soon realized that the wound was very tiny. Short and strong-built with a mostly motionless face and light grey-blue eyes, which suddenly light up in a big short smile. A mother of five, she had apparently seen a lot, and was quick to tell me how Lauri had a similar accident already at the age of 1. If it were up to her she would probably not even call an ambulance, but Emese had already done so, following the advice of other Hungarian mums and dads around us. Sheia was in possession of an EU health card on her so cost should not be an issue. Some 3 – 4 minutes later a siren was heard and a Volkswagen ambulance car parked straight in front of the playground’s gate, following my intensive waving and gesticulation showing the way into the Vermezo park from the nearby Miko street.

A doctor and a nurse, both male and both in shiny red and yellow emergency suits helped each other applying some iodine substance on the wound. Supposed not to hurt at all, according to them. Then the ambulance transported Lauri, Seija and Emese to the St. Janos Hospital. An hour later they all returned, with Lauri’s wound cleaned and glued, and all in perfect mood, in spite of having queued among tens of other kids who had got hurt in the warm and inviting Budapest May Sunday afternoon. “All in all Hungary’s emergency health care showed a decent face,” Emese concluded later in the evening, after the Finnish guests and our own kids had retreated into their bedrooms.

A good face amidst extremes.

On the day of the European Parliament elections and 10 years after accession to the EU Hungary seems to have preserved the key features of its former socialist universal health care system, and adjusted it to capitalism where possible. The final result appears a bit clumsy and is routinely criticized as not sufficiently reformed – mostly by Hungarians and the mainstream press which reproduces stable “transition” clichés according to which whatever existed during socialism was wrong and supposed to be replaced by some ultimately better free-market alternative. But Hungary today seems like a ‘best of two worlds’ – at least in comparison to two alternative health care models that we have experienced: of Bulgaria and the UK. Although much more abundantly funded, the latter is subject to severe austerity and cost cutting pressure for decades. This results in significant deterioration of first instance patient care, which is essential for prophylactics an early diagnostics. It is simply hard to visit one’s GP or medical practice, and even harder to get any thorough tests or specialized treatment on time. Hospital care is of generally good quality, depending on the particular hospital and region, but cost cutting measures affect it as well.

Although incomparable to the UK at first glance, the story of Bulgaria’s health system over the past 25 years offers a striking example of how bad things can get when similar “market-oriented” austerity driven reforms are implemented indiscriminately without proper strategic planning and in conditions of endemic corruption , corruption and nepotism. Its starting point would be some 30 years back in time, when the country’s then socialist health care was at its best, reaching to each and every citizens through a network of ‘policlinics’ in the towns and ‘health service’ points in the villages, connected to regular hospitals in all regional and most municipal centres, and a range of academic hospitals and research or public health institutes in the capital and major cities. All these were completely owned, run and funded by the state.

Lauri’s case in Budapest of May 2014 reminded me of another quite similar one that took place back in the spring 1984, that I was the primary culprit of. Back then I successfully tore a long whole in my 11 years’ old head by sticking it with full force onto a sharp end of a telephone and phone book tablet made of cast iron. I recall well the surprise and frustration when what felt like a warm rain of blood started pouring down my face and onto the thick carpet at a friend’s sleek apartment. The friend, aged 9 and deadly scared himself, managed to supply me with a cotton handkerchief which I stuck to the pulsating wound on my head, mostly in an attempt to prevent the blood from further staining the apartment. It did not even occur to me to call an ambulance and I gave a run to the district Policlinic whose location I knew all too well from numerous visits with my parents. It took me less than 10 minutes to run there, waiting for my terrified younger brother who was trying to catch up without saying a word. 

The policlinic had a designated section for children with a separate reception, which is where I knew I had to check in first. The most impressive feature of this reception was an automated registry holding hexagonal drum, the size of a small car, which contained hundreds of health record card-books. The receptionist operated it by pressing a button to rotate it to the desired side, from where she could produce my record within seconds. Judging on my condition she then ordered me to run straight up to the third floor where there was a surgeon’s office, among all other medical specialists. Less than 15 minutes later I walked proudly out of the door, with my head stitched and bandaged abundantly, just like the heroes in the then popular TV series glorifying an alleged mass anti-capitalist partisan movement in Bulgaria during the Second World War.

Apart from separate sections for children and pre-natal and new-born care, the facility featured a fully functional chemical laboratory, X-ray cabinet, quarts radiation healing room, and even a dentists’ office, all fully available and fully free of charge. The policlinic was attached to a larger building, where Sofia’s Second City Hospital was situated. As a matter of fact, the picture of socialist-times health care was not all shiny and bright, especially in the country side. Waiting times were long and facilities appeared warn out. And  the culture of privileges that was the most disturbing characteristic of socialism translated into special treatment for different categories of people,  But equipment was functioning, supplies were sufficient, medicines were subsidized or free of charge, medical doctors and other personnel were paid as (un)decently as everyone else and received respect and gratitude.

Most of this is lost today as a result of the ill-planed and badly implemented market reforms of Bulgaria’s post-1990 health care. With a few notable exceptions, such as dentists, gynecologists or heart surgeons, medical specialists are underpaid by the state and forced into a humiliating quest of securing tips, bribes, and often using their state jobs to secure and treat patients privately. Support staff is chronically lacking in state hospitals, and so are basic supplies. Until recently patients were expected to bring sheets, cutlery, and pay in cash for the medical supplies used. A state health fund put in place with the idea to generate the revenue needed for maintain health care and subsidizing medicines has turned into a great source of disappointment. Inefficiency, abuse of funds, profiteering and outright corruption are among the accusations against the fund’s management, often heard in public and mass media. 

An unhealthy and unclear mixture between state support and regulation and expected profit-making hampers the work of hospitals and makes the plight of ordinary patients a living health, in which they receive unreliable and bad quality service, but are constantly required to pay for privately, often under the counter. Emergency health care is unpredictable, with stories of human lives being lost due to late arrival of ambulances of shortage of available hospital beds competing in the news pages with never-ending tensions of emergency surgeons and other specialists, whose payment levels are inadequate for the levels of stress and responsibility endured Subsidized medicines are limited in number and inadequately chosen, shortages of vital medicaments such as insulin are frequent, and a monopoly-driven and over profiteering pharmaceutical industry makes quality health care practically unaffordable for the majority of the population.

In contrast to all this, Hungary seems to have found the middle way, but maintaining an acceptable standards of universally accessible health care, maintaining old formats like district child, natal and prenatal care centers, combined with a relatively better established and competitive market of private health care options. A centralized computerized register of all patients makes access to state-funded health care and subsidized medicines quite straightforward, and emergency aid arrives on time, as in Lauri’s blood and tears playground incident.

Wednesday, 22 January 2014

I like you more, dear, but my time belongs to another

This is probably the closest briefing of my response to the founder of one of the many social networking services that I am registered with by have no time to use. In a personal message today Malte Zeeck asked for my honest feedback on the reasons for my "absence" from InterNations.org.

In a smart marketing move, Zeeck listed how he and his team has tried to make InterNations more attractive and useful to its expatriate members around the world: expanded reach in 190 different nations in more than 300 Local Communities; thousands joining InterNations' private community week-by-week; interesting, high caliber people; top-quality information; and lively forum discussions. And he did not miss to remind me the one thing that I truly like most about InterNations: its offline side. "Our Ambassadors regularly organize offline events in many cities around the world as our members love to meet face-to-face and get to know each other better at InterNations get-togethers, first-class parties, wine tastings, lectures, etc..," Zeeck wrote. Now, how cool does that sound, and how much sweeter a concept than Mark Zuckerberg's cyber-world dreams?

Yes, I like it more. And yet, indeed, I do not use it at all. Meaning: not a single status update for years, no reply to numerous inquiries by interestingly sounding/ looking men/women, not a single visit to face-to-face InterNations get-togethers. Nothing. All of a sudden Zeeck's question intrigued me more than the usual marketing inquiry. Why, indeed, did I not use the network, whose concept and ideas in principle suit me better?
 
There was a short answer: Facebook. But I gave Zeeck a longer one, in which I self-analysed my own e-networking behaviour. Here it is, for the sake of science, business and curiosity:

Thanks for inquiring and sorry about not being able to use a social networking service that appears superior in concept and approach to 'mass consumption' services as Facebook and Twitter. In fact I truly appreciate your effort to step up offline communication with the ambassadors and so on - it is much more human and natural this way. Well done!

Yet, I am not using it actively indeed. And the reason is that I have no time and capacity left for it. I deal with social and political campaigning, journalism, expert contributions and media research on both national and international level and this leaves me with just enough time to spend with my kids and family. Frankly, I have practically turned Facebook into my primary environment for both personal and professional communication. Mind you, I am no big fan of Facebook, ideologically and conceptually. But with over 1500 real contacts there, Skype and good old email, I am fully equipped with information channels. No, I am grossly overloaded! I do not use TV and radio for years now - it all comes via Facebook.

Information overload and time pressure prevents me from using all other social networks where I have profiles, apart from LinkedIn.  What might help your analysis perhaps: even without doing anything, I appear active on two of them: Twitter and Google+, both of which parasitise my hyperactivity in Facebook. Twitter has some level of integration with Facebook, so my status updates appear as twits as well; and Google+ almost automatically republishes my posts in Blogger.

Tuesday, 21 January 2014

The Lost Island: Seeking to Dispose of Recycling House Waste in Buda

Google street view: the lost recycling waste 'island' on  Miko u. January 2012
Some time before New Year the recyclable waste collection 'island' near our house in Budapest suddenly disappeared. Just before your imagination gets wild, an 'island' is the bureaucrats' slang for a bunch of containers of various colours where residents are supposed to drop their previously selected recyclable garbage. Something we had been doing systematically since we moved into the neighbourhood, and had sort of got accustomed to. And now, bang, it was gone. Vanished. Missing from its steady place on the corner of the Vermezo Park, in the Miko u. - Krisztina Korut intersection. From one week to the other, it simply wasn't there, and I felt stupid with, two bags full of plastic, glass, cans and paper, on my way to the train station, and without any place to leave them. Others before me, who had apparently been in the same ridiculous situation, had simply dropped their selected waste on the sidewalk, right in the place where the containers had been for years, forming an unaesthetic pile. What does one do? Well, I walked a few steps to the nearest public dustbin, and hanged the bags on it - someone should inevitably collect them, sooner or later.

I remembered writing my first message to the First District Council, enquiring about the location of this 'island' back in 2007, just after we had moved in our flat. They wrote me back  then, kindly and in English. So I tried the same, using the contact form of Budapest's Municipality:

Üzenet: Dear Budapest Municipality,
As a house-owner and resident of District I, on Attila ut 75, I noticed that the local separate waste collection 'island' on  Miko utca disappeared some 2 months ago. Where are we supposed to dispose of separated recyclable waste, which is piling up? My contact phone is <...>.
Promisingly, a confirmation arrived back almost immediately, informing me in English that my message had been registered and assigned a number. So all I needed to do was wait. It was December 20, 2013. Soon after we left Budapest for a lengthy Christmas and New Year trip. But I remembered about the lost 'island' on the first day after we returned home - I simply had no idea where to dispose of the selected recycling garbage. Trying to keep it at home sounded infeasible. So with no hesitation I dropped it in the general waste collection bins at the entrance of our house. Other neighbours seemed to have done the same and in the following days the bins suddenly started filling up much quicker than before.

On January 17 the expected reply arrived into my email box - in good English, signed by Domokosné dr. Burza Eszter, Head of Public Utilities and Environment unit at the Department for City Management in Budapest. Impressed, I read:

To inform you the waste collection island was pulled down by the Local Municipality of the 1st district’s request. In the 1st district you can be found other waste collection island places, which will be operate until September 2014, when the house hold collection of the separate waste (paper, metal and plastic) will be start in your local area.

1The list provided the following locations, quote to quote:
  •  Kosciuszkó Tádé utca, next to CBA department store; 
  • \between Krisztina krt. - Attila út; Lánchíd utca parking place - Öntőház utca;   
  • Sánc utca - Mihály utca; and  
  • Somlói út 51. supporting wall before.
Here is what I wrote back:

Thank you for your kind reply. I studied the offered alternative recyclable waste collection 'islands' and realised that the nearest location is about 15 minutes of walking distance (one way) from Attila ut 75, and even further away from nearby areas of the Buda Castle District. This is inadequate for the purpose of daily recyclable waste disposal, which amounts to about half of the overall amount of waste generated for a family of two parents and 3 children  in pre-school and early school age - such as ours. As a result we have been forced to interrupt a well established practise of selective waste collection, and began unfortunately disposing all of our waste in the general community waste collection bins of our house.

Other families in the neighbourhood appear to be in a similar situation, as disposing of recyclable waste in this neighbourhood has become intangible since the sudden removal of the Miko u. 'island.' This led to: obvious doubling of the amounts of garbage disposed daily; overfilling of the green collection vessels in the house; subsequent spillage of odour and waste that create unhygienic living environment; and epidemiological risks. A similar situation can be observed in neighbouring houses. No information or instruction of any kind has been provided to the affected households, which undermines people's confidence in Municipal services in principle.

I would therefore kindly request your action for:
- coordinating with the municipal service providers the urgent restoring of recycling  waste collection possibility for the Attila ut/Miko ut neighbourhood and the adjoining parts of the Buda Castle District; and
- promptly communicating with the affected community, instructing it how to best maintain recycling collection habits and dispose of the selectively collected waste.

This time I Cc-ed the exchange to the Waste Management Working Group (HuMuSz) - a renown NGO in Hungary, requesting their assistance. I also offered my help as an environmental communications expert to the municipality's team. This story is to be continued, I suppose.

Wednesday, 16 October 2013

The Power of a Price Tag


Two bulbs, one price.
It all started because of the rain this morning . Emese complained that it is too dark in the dining room where she usually works from home – and no surprise so, with  only one out of three bulbs in the large Tiffany-styled lamp above the table actually working.  So there I was, on an urgent errand to bring home light bulbs from the corner CBA. Trivial as it sounds, I found there two types of plain light bulbs – a fancier Eco “Save 30%” one, and a more generic looking bulb. Shame on my green consciousness, I immediately reached for the later, expecting it to be cheaper. These simple bulbs do not seem to last long anyway, so it makes little sense opting for a fancy one is all that I can say in my defence. But to my astonishment both bulbs appeared to cost the same: a discouragingly expensive 629 HUF, that is slightly over EUR 2.

This made me take a closer look. The first bulb is packed and labelled as Emos Classic Eco Halogen and is produced in the Czech Republic. The second one has generic packaging with no brand name, no energy saving label, and no 'Eco' sign and is marked as produced in Hungary.  All other functionality parameters of both products are exactly the same. Both items are sold for the same price - although positioned in separate shelves, with different price tag codes, but one and the same product name:  'Emos Eco', and an identical end price of 629 HUF.

A nearby shop attendant assured me that what I see  is not what I see, and that in spite of all visible differences, both products are Eco Emos Hallogen,  as indicated on the shop's price tag. With Emese desperate for light, I bought both of them and made sure to carefully collect the payment receipt where the products clearly appear under the same name. First thing I did at home was to take a photo of all this mystery. Second, I wrote to Emos.eu whose contact pages are impressively accurate, with the names and emails of responsible officials. Presenting myself as a free-lanced journalist and blogger covering consumer and environmental advocacy issues  for a number of websites and mainstream media in Hungary, Bulgaria and other EU countries, I described the issue and inquired photo attached:

  • could Emos confirm that the two products are indeed the same, in spite of the different information on the package;
  • if so, please explain briefly the discrepancies in labelling; or
  •  if not so, please explain the possible reasons for such misleading product placement and the actual origin and price for the second product?
 
The reply arrived almost instantly – and this is where I really start liking Emos. Mr. Gergely Gurály, Managing Director of EMOS HU Kft, in charge of business activities with CBA, called this a “strange case” and confirmed right away that the second product is not one of Emos’. He kindly promised to inquire with the shop owner. Helpfully, he also passed on a comment by Emos’ Country manager for Slovenia and Hungary Mr Michal Novotný: “on the other side we see that they sell other bulbs than ours” – the other side standing for the Czech headquarters, apparently.  Some fifteen minutes later Mr Gurály reported that the store’s owner was first of all “very sorry for this inconvenient situation,” and will be checking what could have happened, because “it is very strange for him as well, as they are using BARCODE readers, and these are different products with different EAN.” EAN is the long barcode number on every product, I learned.
 
Instead of just leaving it there, to what may easily turn out to  be a sheer price tagging mistake in the shop, I dug out the box of the the second bulb from the paper-recycling bin (yes, the lamps were already shining above happy Emese’s laptop) and gave it a more thorough examination. This is when  I noticed the tiny print on one of the parts that could only be seen after a consumer already opened the box. It reads: GE Hungary Kft, and a street address. Bingo! Equally well hidden on the other cover of the box I spot a tiny index: 13188445 SBOX 42W HALO A/CL/E27 240V BX 1/10 GR. Each of these letter and number combinations supposedly says something about this product.  Yet I could not find it in GE’s online product catalogue. To be sure no stone was left unturned, I submitted an inquiry through GE Hungary’s web contact form  with one simple question: how much does this bulb normally cost? For if it is in fact cheaper than the other, then the wrong price tag in the shop works in fact against GE’s generic looking product – everyone would prefer a more superior looking Emos bulb for the same price I suppose.  

Before GE could have responded, a third message arrived from Mr Gurály, conveying the owners’ explanation that the matter was of an administrative failure in the shop’s IT system, whereby the staff attached the EAN of the Hungarian (GE product) article to the EMOS article product card as a secondary EAN.  The shop owner reportedly asked for my apology, and is willing to pay me back the price difference – which is fair enough. So apparently my original suspicion that a cheaper product is tagged with a misleadingly high price was confirmed. I would suggest that CBA could also instruct their staff how to handle customers’ inquiries more carefully, but this might be too much to wish for I suppose. So this is where this story ends, pointing at how easy it is for a retailer to shift the marketing of a product one way or another – and suggesting an interesting line for further inquiry into the impenetrable secrets of marketing and retail. For now that  think about it, this is not the first time that I come across products tagged for retail under different names.

Thursday, 19 September 2013

Basescu's Green Failure



Anti-green talk is becoming a common act of despair for a certain quality of East-European leaders who have long lost the battle for decency in politics. By piling up false and ungrounded accusations against the Green movement, [Romania’s] President Basescu is in fact publicly resigning from his duty of serving the public’s interest. Just alike a myriad of post-socialist politicians of the past two decades, he is openly betraying people’s dreams for democracy, good governance, local entrepreneurship, health and clean nature. Instead, they have been turning Romania and other countries of Central Easy Europe into dirty lawless extraction fields for the profits of multinational corporations and local oligarchs, mostly controlled by the criminal structures around the former regimes’ secret services like Securitate. It is their shady deals, non-transparent business practices, and dirty technologies exploiting the pristine natural resources of Romania and the rest of  the region, that Basescu is trying to back, not the interests and prosperity of his fellow citizens.  In vain! For Romanians, just like all European citizens today, have the right to protect their natural environments, and the power to stand up for it against their untrustworthy political representatives, and move on without them in a green, sustainable and equitable Europe.

Earlier this week Romania's President Basescu made the following statement, translated by Bucharest-based of environmental journalist  Raul Cazan:

  "You know, this is, if you wish - I do not want to offend anyone - a sort of delayed environmentalist reaction. Environmentalists were extremely vocal, in the ‘70s and ‘80s in Europe. They have lost the battle against the need for development, be it in Italy, France or Germany. Therefore they are not very strong today, because they are not very credible. We can not remain as in the eighteenth century, we can not preserve everything, because development obliges us to find solutions that will allow us, on one hand, to go forward, and on the other hand, to affect the environment as little as possible with this advancement of ours. I would say, for example, what would Italy have done if environmentalists had been successful, because the whole country of Italy is a protected monument, right? They would not have built any highway. What would have France done with its nuclear power plants? It has 80% of the energy generated by nuclear power plants. The ecologist idea is overdue and I do not exclude the possibility that environmentalists that failed in the rest of Europe to find Romania as an area in which to practise what they could not achieve in their countries. So I think things are extremely complicated, in the way we approach them now."

Basescu's comments were made after over 10 days of environmental protests on the streets of Bucharest. The rallies, reportedly of unprecedented scale, are against the government’s controversial decision to greenlight the construction of an opencast gold mine near the Transylvanian town of Rosia Montana.  Over 8,000  marched across the capital on Sunday, carrying signs reading “I love nature, not cyanide” and “Corruption equals cyanide.” According to police, 6,000 demonstrators also rallied in the major Transylvanian city of Cluj and 900 people gathered in Brasov, RT.com reported.The controversial project of Canada's Gabriel Resources Ltd intends to extract over 300 tons of yellow metal and 1,500 tons of silver from the gold mine that has been known since Roman times. According to the campaigners, the quarries would destroy four mountain peaks and three villages out of 16 in the local municipality, and will involve the use of around 12,000 tons of toxic cyanide per year.

These events are in striking similarity to what is happening in neighbouring Bulgaria. Environmental protests against a controversial amendments to the Forestry Act lead to mass scale protests in June 2012, which then escalated by the year's end, causing the resignation of the centre-right government of Boyko Borissov in the spring of 2013 and preliminary elections. After taking a narrow win in them, a new government was formed, backed by the Bulgarian Socialist Party, the Muslim-minority based Movements of Rights and Freedoms, and nationalist-populist fraction Ataka - just to  be confronted in turn by ever larger protests, as soon as it appeared to serve a shady industrial and media mogul's interest. Disillusionment from traditional political parties whose leaderships act in favour of industrial and economic interests and ignore the public ones, is common for the region of Central and Eastern Europe.