Comment by Emilia Milcheva:
While politicians argue about how much exactly the hospital will cost for the “future of Bulgaria”, a scandal with accusations of abuse of a woman in labor has blown up the present. The two cases are running in parallel and do not intersect, as usually happens with political populism and real life.
How much the National Children's Hospital - construction and equipment - will cost has yet to be decided, because there is no approved financial model, and the first sod is scheduled for next year. But the answer to the question of whether Dr. Irena Shikova from the largest obstetrics and gynecology clinic in the country, “Maichin Dom”, showed aggression towards a woman in labor cannot be overturned.
Personal history or abuse (of power)
The hospital where Dr. Shikova works conducted an internal investigation into the accusations of aggression made by Antonia Andonova, and found no evidence of harsh treatment. The woman spoke in a post on social networks about slapping, screaming and insults during the birth of her son Philip. Much of the alleged things are not true, said “Maichin Dom”, where the Executive Agency “Medical Supervision” - the body that monitors the quality of health services - also came to inspect.
2 years ago “Medical Supervision” inspected the hospital again, three times. “Capital” revealed that the reports had been changed, and the chief inspector, Dr. Vasko Katsarov, had been fired. The reason for the inspections was a protest and a dismissal. Part of the “Mother's Home” team rebelled against the way salaries were distributed in the hospital, whose director, Prof. Ivan Kostov, signed for 60,000 leva per month. The doctors also protested because of the dismissal of the temporary head of anesthesiology and intensive care, Dr. Elena Georgieva. But the then Minister of Health, Hinko Hinkov, chose not to remove Prof. Kostov, as other ministers before him had done.
Institutions protect themselves
The culture of institutional self-defense is a practice in Bulgaria and one of the reasons why citizens' trust in the systems is eroding due to a refusal to take responsibility. The Ministry of Interior (self-)checks itself and does not find cases of police violence and corruption. The prosecutor's office even rewards prosecutors whose names were heard in the "Eight Dwarfs" affair with promotions. Hospitals check cases in which women in labor, babies and other patients die - and do not find medical errors.
Is this case a personal story or a model of abuse of power and profession, ask the organizers of the petition demanding that Dr. Shikova be stripped of her right to practice obstetrics and gynecology due to accusations of slapping and insulting the woman in labor, Antonia Andonova. The petition signatures are already approaching 5,000, and tomorrow (July 15) a protest will be organized in front of the “Mother's Home”, and social networks are abuzz with memories of women who have also experienced aggression from Dr. Shikova. A petition and demonstration in support of the doctor herself were organized by her grateful patients.
Politicians do not interfere
Bulgarian politicians follow the tactic of non-interference in healthcare - they only approve the pouring of a certain amount of money, that is, they set the amount in the “ATM”. Every year, the parliament votes on the same allocation of the NHIF budget, which is 9.7 billion for 2025 - over two-thirds for hospitals and medicines. MPs do not dare to propose a change that would significantly increase the money for prevention and outpatient care.
No government has found a sustainable solution to the crisis with nurses, nor with the pay and decent treatment of medical specialists, who are protesting because of miserable salaries and inhuman workload. Politicians do not propose new better standards, including in AG practice, and changes in medical practices to increase control over dentists and anesthesiologists. No one raises these topics, despite the case of the death of a 6-year-old child placed under general anesthesia for dental treatment. Proposals for video surveillance have stalled (just like those for the mandatory wearing of body cameras by police officers, b.a.).
It is more convenient for politicians to focus on “visible results” - hospital renovations, new equipment, ambulances, medical helicopters, and “Bulgarian Christmas”, instead of working on systemic measures such as prevention and e-health. Inaction does not prevent them from hurling mutual accusations of guilt and from time to time laying some gift on the altar of populism - of course, with taxpayers' money, but also to their detriment. Although the problem of antimicrobial resistance and antibiotic abuse in Bulgaria was included in a report by the European Commission and the National Agency for National Health Insurance (DANS), since July the NHIF has already paid in full for one antibiotic in two concentrations for home treatment of children up to 7 years old with the active ingredient azithromycin. But not fever-reducing drugs, cough syrups, nose drops.
And again about the children's hospital
When the leader of “We continue the change” (PP) Assen Vassilev dropped a “bomb” that the National Children's Hospital would cost 1 billion leva, the Public Council and the cabinet explained that this was an expert assessment prepared during the government of Nikolay Denkov. “The budget of 400 million euros (382 million euros excluding VAT) that is being discussed was calculated by international consultants based on preliminary data on capacity, equipment and construction parameters, compared with average European prices. In this sense, it is indicative and does not take into account important local features - for example, that some clinics will be partially equipped when they move.
The values of 4,000 euros/sq. m. (in the center of Sofia, real estate transactions exceeded these prices, b.a.) are valid for the most high-tech parts of the hospital - such as surgical rooms, intensive care units and neonatology, and correspond to real costs for the construction of new children's hospitals in the EU”, says the Public Council in its position.
The total area of the project is 90,000 sq. m - 440 beds, 26 wards, over 38 diagnostic rooms, 18 operating rooms. But in a country where there are not enough at least 512 pediatricians - the number of workers is about 950, (and there are regions without general practitioners), the real problem of the children's hospital has been named long ago - staffing. It is no wonder that one day Dr. Shikova will work at the National Children's Hospital, after the investigation so far has exonerated her.
Independent control?
And one of the biggest problems of healthcare in Bulgaria is that it does not actually have independent external control, especially in cases of violence against patients, unethical behavior or questionable therapies. It is time to think about a health ombudsman, because patients are locked in a circle of impunity.