About two weeks ago Hungarians were stunned to learn that a dead body had been found in a restroom in the Ferenc Jahn Dél-pesti Hospital, a restroom that served visitors to the neonatal unit. Even more shockingly, the woman had died approximately five days earlier. That could mean only one thing. No one had tried to clean that facility for at least five days. Admittedly, it was locked from the inside. But still. For five days? The deceased, it was reported, had been homeless.
Hundreds of questions were addressed to the director of the hospital, who refused to say anything. Reporters couldn’t even find out how often public lavatories in the hospital are cleaned. Eventually a former president of the association of hospital directors informed them that there are no common rules or even guidelines for cleaning hospital facilities. It is up to each hospital to determine how much cleaning and sanitizing must be done to satisfy basic hygienic levels. I find this surprising in a country where there are rules for everything, usually imposed from above.
Vasárnapi Hírlap talked to a representative from an unnamed hospital where patient bathrooms are cleaned twice a day and restrooms used by the public even more often. I would be curious to know whether this was a state hospital or one of the few private ones. At any event, as a result of this shocking case, the public learned that hospitals hire outside firms to clean their premises. Since these companies serve several hospitals, it can apparently easily happen that members of the cleaning staff are not even familiar with the layout of the hospital in which they are working on any given day. Currently an “internal investigation” is being conducted, which normally means that no one will be held responsible.
In cases like this the government papers are silent. Magyar Idők and Magyar Hírlap simply reported the news and added that an immediate internal investigation will be undertaken. A week went by without another word on the subject. But then on December 3 Zoltán Ónodi-Szűcs, the latest undersecretary responsible for healthcare, gave an interview to Olga Kálmán of ATV in which he announced that what happened in the hospital had nothing to do with healthcare. “It is essentially a problem of homelessness.” Suddenly, Magyar Idők got the signal they were waiting for: a directive on how to handle this “unfortunate” affair. Without such a cue, these servile papers are at a loss.
Those who know Hungarian should take the time to watch this disgraceful interview in which the undersecretary’s callousness and lack of concern for his fellow human beings are on display. To his mind, the hospital is in no way responsible because, after all, the door was locked and the cleaning is done by an outside firm. There is nothing wrong with hygiene in general because “there are few countries in Europe where the danger of infection is as low as in Hungary.” As for ambulances not arriving on time for seriously sick people, he offered the following answer: “the ambulances are on time unless more calls arrive than there are available vehicles.” What a brilliant mind. As for the statistical proof of Hungary’s excellent record, it doesn’t exist because Hungarian authorities refuse to reveal the figures.
The beleaguered Ferenc Jahn Dél-pesti Hospital was in the news again today. A couple of days ago the Department of Ophthalmology had to be closed temporarily because the whole floor was infested with bed bugs, but as the hospital assured the public, “the patients were moved from the department which was completely disinfected. The fumigation didn’t interfere with the care of the patients, who are safe.”
And now let’s move on to another piece of news that appeared in Magyar Nemzet, whose staff is doing a great job of annoying the government by finding negative stories. Their latest is a thorough article about the causes of the high mortality rate of cancer patients in Hungary. First, let me quote from a Eurostat study on cancer statistics in the European Union.
Among the EU Member States, the highest standardized death rates for cancer were recorded in Hungary and Croatia, both with rates over 330 per 100,000 inhabitants in 2012…. For men, the highest standardized death rates for cancer were reported for Hungary, Croatia, Slovakia, the Baltic Member States, Slovenia and Poland, all with rates over 400 per 100,000 inhabitants. For women, the highest standardized death rates for cancer were recorded for Denmark and Hungary, both with rates just over 270 per 100,000 inhabitants.
Of course, there are several reasons for these bad statistics. One is Hungarians’ reluctance to have regular checkups, which may be caused in part by the inordinately long wait time (hours) to see the doctor even if the person has an appointment. Second, a person whose GP suspects cancer has to wait months for an examination by a specialist. All the while the tumor continues to grow. Third, and this is what the article is talking about, in Hungary 56% of financial resources allocated for cancer patients is spent on chemotherapy and only 31% on surgical procedures and 13% on radiation. Yet early surgical intervention combined with radiation is the most effective way of treating cancer patients. Chemotherapy as a stand-alone therapy is most often used to prolong lives for a few months in advanced stages of the disease.
Magyar Nemzet’s article is based on a study by The Lancet Oncology, using admittedly old data (from 2009). It shows what percentage of money allocated for cancer treatment goes to surgery, to chemotherapy, and to radiation. In percentage terms, Hungary allocates less than half of what Germany does to surgery and more than three times as much to chemotherapy. For breast cancer patients only 14% of the money goes for surgical intervention and 79% for chemotherapy. For prostate cancer 5% goes to surgery, 92% to chemotherapy. In Germany the percentage of funds allocated to surgery for breast cancer is 53%, for prostate cancer 46%.
So, if, the article’s conclusions are correct and if Hungarian medicine hasn’t dramatically changed its treatment protocols (which apparently it hasn’t), the country’s bad statistics could be greatly improved by introducing a different allocation system. But that’s not enough. One also needs knowledgeable and caring doctors. It was again Magyar Nemzet that published a story addressing this issue a few days ago. A woman was worried about a lump in her breast, and her gynecologist sent her to a surgeon. The surgeon was either ignorant or negligent. He announced that there was nothing wrong, just a scratch which he disinfected. Then he tossed her a piece of paper that said “kontroll p. e.” P. e. apparently means “in case of complaint (panasz esetén).” The complaints came, and eventually the patient ended up at another specialist who eventually operated on her, but it was too late. By then the cancer had spread. She sued the doctor who let her go without explaining the next step to be taken. After four years of fighting the case in court, the Kúria just awarded her 5 million forints in compensation. Unfortunately, a few months ago she died.
For a doctor to merely give his patient a piece of paper is, of course, not good medicine. But patients also have to change their attitudes toward their own care. Hungarians are not accustomed to asking questions and demanding answers from their physicians. And, I suspect, there are not enough “Google doctors” in Hungary. That is, not enough Hungarians do their homework before going to the doctor. Not enough know what kinds of treatment are most effective and have the guts to argue their case.