Today I’m venturing into the world of healthcare, specifically hygiene or rather the lack of it in some Hungarian hospitals. A discussion of the high rate of infections contracted in hospitals began when the movement “1001 physicians without gratuity” called attention to the problem. According to the statement of these doctors, the problem has been known for years. But not only is nothing being done to try to eradicate the problem, the number of reported cases has also been kept secret. The doctors complained about the quality of the sterilization machines, a lack of diapers, not enough disinfectant, etc. The group demanded the release of data about the number of cases of hospital infections and the death rate from such infections. That was at the end of February. Since then a fair number of articles have appeared on the subject that further highlighted the terrible conditions that exist in Hungarian hospitals.
Nothing, however, elicited a greater outcry than a news story published a couple of days ago by Index, which claimed that the department of dermatology, venereal diseases, and skin-related cancers at the hospital of the Budapest Medical School ran out of “rubber gloves” and therefore the unprotected staff must use “nylon gloves,” which are not as effective. The “rubber gloves” must be saved for operations.
Well, this is where my definitional problems began. I have heard of “rubber gloves” (gumikesztyű), the kind we use when washing dishes, but I had never heard of “nylon gloves” being used in hospitals. I suspect that Index’s reporting was not precise. The gloves we see in doctors’ offices and hospitals are “nitrile non-sterile single use” gloves. I assume that this is what Index called “nylon gloves.” These same gloves also come in a sterile form, which is more expensive, but the non-sterile gloves (which retail for $7.99/100) “pose no higher risk of infection for non-surgical procedures when compared to sterile gloves.” In fact, I read that even doctors and nurses dealing with HIV patients are well protected wearing these gloves.
Latex gloves used to be common in operating rooms because they fit more snugly (though they also puncture more easily). But a fair number of people are allergic to them, so many hospitals have opted for alternatives, admittedly more expensive.
If we’re dealing here with the distinction between latex and nitrile gloves, the hospital’s director was correct in explaining to the journalist that these two kinds of gloves have nothing to do with one another. That is, a shortage of one wouldn’t affect the other. No operation had to be postponed because of a possible shortage of nitrile gloves in the wards. However, the likelihood that the department did run out of ordinary nitrile gloves is very high. Tímea Szabó (PM member of parliament), who is currently working in a hospital as a volunteer to experience first hand conditions in Hungarian hospitals, has been reporting shortages of all sorts of the most basic necessities.
Quite apart from this particular case, the fact is that hygiene doesn’t seem to be a high priority in Hungarian hospitals. One reason is the shortage of money, which unfortunately cannot be eliminated by “loving care” as Zoltán Balog, the minister of charge of healthcare, suggested. And because of this shortage hospitals try to save on items they consider non-essential. Here is one example of what is considered to be a “luxury” in Hungarian hospitals. The World Health Organization suggests the use of at least 20 liters of hand sanitizer for every 1,000 patient days. In Hungary hospitals use only 6 liters. They try to save money on disinfectant as well. Moreover, according to one man who worked as a sterilization machine operator, hospitals often sterilize equipment that should be discarded after each use. According to the whistleblower who no longer works in a hospital, he was instructed to resterilize equipment used in laparoscopic surgery as many as fifteen or twenty times. The interesting thing is that it is more expensive to resterilize equipment than to purchase new equipment. In fact, it can be twice as expensive. But since sterilization is done “in house,” the management can put in a request for new equipment but use the money for something else. As he said, “the money simply disappears.”
Meanwhile, the Állami Népegészségügyi és Tisztiorvosi Szolgálat (National Public Health and Medical Officer Service / ÁNTSZ) steadfastly refuses to release details about hospital infections and the resultant number of deaths even as it claims that its reporting is among the most comprehensive in the European Union. The website of the Országos Epidemiológiai Központ (National Epidemiological Center / OEK) does provide countrywide numbers, broken down by year, although its website is so user unfriendly that I didn’t even try to find them. It seems that Társaság a Szabadságjogokért (TASZ), the Hungarian equivalent of the American Civil Liberties Union, did look at their data but found them totally useless. What the doctors demanded and TASZ now demands as well is not aggregated numbers but a breakdown by individual hospitals. ÁNTSZ refuses to release this information. As one of the department heads of ÁNTSZ explained, if they published the data they would create panic. People would avoid hospitals where the number of infections and the resultant death rate is high and would go to hospitals where the danger of infection is low. But this could have grave consequences. Some patients might end up in hospitals that are not equipped to handle their problems. TASZ is not satisfied with this answer, and the organization will sue ÁNTSZ for the data. TASZ usually wins its cases against government authorities.
The stories of infections and death continue to multiply in the Hungarian media. A few days ago Index reported another serious infection, this time in a hospital in Pécs. The infection, called “methicillion-resistant Staphycoccus aureus” (MRSA), is caused by a type of staph bacteria that has become resistant to many of the antibiotics commonly used to treat staph infections. This sounds bad enough in English, but I’ll bet that Hungarians were petrified to read that “meat-eating bacteria are at work in a Pécs hospital.”
Infections picked up in hospitals are a problem worldwide, but according to some Hungarian doctors who came forth lately, the Hungarian situation is worse than that in most developed countries. One doctor I heard being interviewed claimed that the number of deaths as a result of these infections is twice as high in Hungary as in the U.K. According to one of the sources I consulted, the disparity is even worse. The British figure is 6.4% per 100,000 while in Hungary it is 14.7%.
It is ironic that in the country of Ignác Semmelweis, the pioneer of antiseptic procedures, hospitals are not using enough disinfectant, doctors and nurses don’t wash their hands often enough, toilets don’t function, and hygiene is altogether neglected. Devotion and hard work on the part of the staff is simply not enough, although admittedly it would start to address the problem. How often members of the staff wash their hands is not a question of money.
Hungarian healthcare needs more funding and an entirely different attitude on the part of hospital managers and staff. One of the early tasks of the post-Orbán administration should be to break the stranglehold on Hungarian healthcare by hospital administrators, trade union leaders, the Hungarian Medical Association, and those doctors in high position who are the beneficiaries of this corrupt system. Otherwise healthcare in Hungary will never improve.