Tag Archives: Attila Juhász

Teaching Hungarian doctors to say hello

On June 2 several newspapers reported that a pregnant woman, after leaving the Ferenc Jahn Hospital in Budapest and while waiting for a taxi, collapsed in an epileptic seizure. The taxi driver had the good sense to hold her head to prevent her from injuring herself on the hard pavement. With the help of a passer-by he phoned the ambulance service. The dispatcher wouldn’t send an ambulance and instead suggested going to the hospital for help. But the door was locked and no amount of knocking or honking the car’s horn elicited a response. It took several more calls before the woman’s physician appeared at the door with a nurse. The taxi driver rightly pointed out that the problem is not only the state of Hungarian healthcare but also the attitude of doctors to their patients. I should add that this incident occurred at the same hospital where for several days no one noticed that there was a dead body in a restroom that served visitors to the neonatal unit.

I don’t know what our taxi driver would have thought if he had listened to a conversation between György Bolgár of Klub Rádió and a physician a day after the incident. The illustrious colleague explained to Bolgár why the hospital did what it was supposed to do. Just because the woman collapsed in front of the hospital, the institution had no obligation to accept her. He illustrated the case with the following example. Can anyone whose BMW breaks down in front of a BMW factory expect his car to be fixed right there just because the trouble occurred in front of the plant? People in a hospital have no time for such unexpected incidents. Who can go out? A doctor who is with another patient? Or a nurse who has to look after 40 patients? Yes, the taxi driver could only phone the ambulance service. Soon enough another physician, a woman this time, phoned in. She kept repeating, robot-like, that “there are rules,” and the rules say one must turn to the ambulance service in such cases. Period.

Where it all happened

And what was the reaction of the hospital administration once the story got out? The statement the hospital issued revealed that the security guard inside was fully aware of what was going on in front of the entrance. In fact, he was taking notes. “Everybody knows,” the hospital said, that between 11:00 p.m. and 4:00 a.m. the main entrance to the hospital is closed. One must use the entrance to the emergency department. As for the incident itself, “it is unfortunate that an epileptic seizure may occur at any time in the case of an epileptic patient.” The hospital administration conducted “a thorough investigation” and found that everybody followed the expected protocol. I should add that the emergency entrance is almost a whole kilometer away from where the incident occurred.

Only a few days after this incident the Állami Egészségügyi Ellátó Központ (ÁEEK), or National Healthcare Services Center, published a so-called performance evaluation, covering the 2013-2015 period. It is an extremely detailed manual of more than 1,000 pages on every possible aspect of the Hungarian healthcare system. Those who are not quite ready to wade through the incredible amount of information should at least read the summary (összefoglaló), which is depressing enough. Within the European Union, Hungary, together with countries like Bulgaria, Romania, Latvia, and Lithuania, is at the very bottom, whether as measured by mortality rate, life expectancy, or number of healthy years. There are incredible regional differences. For example, in Central Hungary, which includes Budapest, men live 6.6 years and women 8.4 years longer than their fellow citizens in Northern Hungary. The correlation between educational attainment and health is a well-known fact, which has a large literature. A man with a grade 8 education will die 12 years earlier than a man with a college degree. In the case of women, the difference is 5.6 years.

But what made the greatest impression on those who read about the study in the media was the notion of “avoidable deaths” which, according to the study, in 2014 was 26% or 32,000 deaths. Fourteen percent of these “avoidable deaths” could have been prevented by timely and appropriate care while 12% of them could have been prevented by better public health practices. Half of those who died before the age of 65 could have been saved if people were more health conscious. With these statistics Hungary ranks 26th of the 28 member states.

In addition to this massive study, Political Capital together with the Friedrich-Ebert-Stiftung organized a conference, “Can healthcare be cured?” Attila Juhász of Political Capital published a short, 30-page study with the same title which he summarized at the conference. Zsófia Kollányi, assistant professor of health policy and economy, mostly talked about Hungarians’ ever worsening health and societal conditions. She gave a few intriguing examples of the depth of the problem. For example, Swedish men live 9 years longer than Hungarian men, but the “real drama” is that if we compare college-educated Swedish and Hungarian men the difference is only five years. On the other hand, if we compare Swedish and Hungarian men with elementary educations the difference is 12 years. So, a greater emphasis on education would also most likely improve Hungary’s health statistics. However, the Orbán regime’s educational policy is moving in exactly the opposite direction.

After Fidesz won the election in 2010, one of the first moves of the Orbán government was to abolish a recently established independent organization that dealt with patients’ complaints. I’m sure that this was at the request of the medical profession, which in those days at least was a strong supporter of Fidesz. This independent watchdog organization was not exactly the favorite of physicians. Márton Asbóth, the lawyer in charge of health issues at TASZ, told the audience that every year 3,000 people turn to the Hungarian Civil Liberties Union with their complaints. So, there would be a great need for the resurrection of such an organization.

Finally, as György Leitner of the Primus Magán Egészségügyi Szolgáltatók Egyesülete (Association of Prime Private Healthcare Providers) said, “Hungarian doctors must be taught to greet people and shake hands.” Andrea Mezei of the Emberibb Egészségügyért Közhasznú Alapítvány (Foundation for More Humane Healthcare) also complained about the attitude of Hungarian doctors toward their patients. According to her experiences, “a cashier at the checkout counter is able to greet the shoppers, but in the doctor-patient relation this is often not true.” Healthcare facilities are like “islands” out of touch with Hungarian society at large. Her foundation tries “to bring normalcy into hospitals” by organizing training for doctors and nurses. They are not welcome in every hospital, and in fact in one hospital the nurses petitioned the hospital administration to prevent them from organizing such training. Leitner, representing the private healthcare providers, seconded Mezei’s observations by saying that not only is money missing from healthcare but also the positive attitude that adds to the satisfaction of the patients.

Which takes us back to the Ferenc Jahn Hospital’s attitude toward the woman with the epileptic seizure and the doctor who compared a hospital to a BMW plant.

June 16, 2017

Russia, Hungary, and the Hungarian minority in Ukraine

A few days ago an article appeared in Foreign Affairs with the somewhat sensational title “The Hungarian Putin? Viktor Orban and the Kremlin’s Playbook,” written by Mitchell A. Orenstein, Péter Krekó, and Attila Juhász. Orenstein is a professor of political science at Northeastern University in Boston and an associate of the Davis Center for Russian and Eurasian Studies at Harvard University. Krekó and Juhász are associates of the Hungarian think tank Political Capital. The question the article poses is whether Hungary entertains any irredentist plans as far as her neighbors are concerned, similar to the way in which Russia behaved earlier in Abkhazia and now in Ukraine. After all, the Russian attacks on those territories were preceded by a grant of Russian citizenship to Ukrainians and Abkhazians. To this question the answer is negative. Viktor Orbán may sound bellicose at times, but he is interested in the Hungarians living in the neighboring countries only as a source of extra votes and perhaps a reservoir of immigrants to a country with dismal demographic figures.

The authors claim, however, that there is “a delicate balance [which] could easily topple.” What created this delicate balance? Although “Hungary’s radical right-wing, fascist, and irredentist party, Jobbik, has virtually no support among Hungarians abroad,” it is still possible that “aggressive separatist political movements, especially those with external political support, could … act as though they have a majority beyond them, as in eastern Ukraine.”  I must say that the exact meaning of this claim is unclear to me, but the authors’ argument is that the “nationalist political use of Hungarians abroad in Hungary could set the stage for such extremism and instability in neighboring countries.” In Ukraine such a danger is real “where Orban has taken advantage of political chaos to press Hungarian minority issues … in the sub-Carpathian region of western Ukraine, adjacent to Hungary.” There are far too many “ifs” here, but it is true that Orbán did announce his claim to autonomy for the Hungarian minority at the most inappropriate moment, during the first Russian attacks on eastern Ukraine.

It is unlikely that Hungary could convince Ukraine’s western friends to force Kiev to grant autonomy to the Hungarians of Sub-Carpathian Ukraine (Zakarpattia Oblast) who constitute 12.1% of the total population of the province. In 2001 they numbered 151,500, but since then it is possible that many of them either left for Hungary or with the help of a Hungarian passport migrated farther west. On the other hand, one occasionally hears Russian voices outlining ambitious plans for Ukraine and its minorities. For example, in March 2014 Vladimir Zhirinovsky, head of the nationalist Liberal Democratic party that backs Vladimir Putin, suggested that Poland, Hungary, and Romania might wish to take back regions which were their territories in the past. Romania might want Chrnivtsi; Hungary, the Zaparpattia region; and Poland, the Volyn, Lviv, Ternopil, Ivano-Frankivsk, and Rovensky regions. Thus Ukraine would be free of “unnecesssary tensions” and “bring prosperity and tranquility to the Ukrainian native land.”

Or, there is the Russian nationalist ideologue, Aleksandr Dugin, the promoter of a Russian-led “Eurasian Empire” that would incorporate Austria as well as Hungary, Romania, Serbia, and Slovakia. Although Dugin’s specific recommendations were first reported on a far-right Hungarian site called Alfahir.hu, the news spread rapidly beyond the borders of Hungary. Dugin is an enemy of nation states and would like to see the return of empires. “If, let’s say, Hungary, Romania, Serbia, Slovakia, or perhaps even Volhynia and Austria would unite, all Hungarians would be within one country. Everything would return to the state that existed before Trianon.” Of course, Dugin’s argument is specious. Surely, a United Europe offers exactly the same advantages to the Hungarian minorities that Dugin recommends, but without the overlordship of Putin’s Russia.

One could discount these suggestions as fantasies, but something is in the air in Russia. The country’s foreign minister considers the fate of the Hungarian minority in Ukraine to be of such importance that at the Munich Security Conference a couple of days ago he spent a considerable amount of time on the minority’s grievances.

Mind you, Sergei Lavrov’s speech was met with derision by those present. As the reporter of Bloomberg described the scene, the “crowd laughed at and booed him.” Apparently, during his 45-minute speech he “rewrote the history of the Cold War, accused the West of fomenting a coup in Ukraine, and declared himself to be a champion of the United Nations Charter.” From our point of view, the most interesting part of the speech was the time he spent on the Hungarian minority in the Zakarpattia Oblast.

I think it is worth quoting Lavrov’s answer to a question that addresses this issue:

[The Ukrainians] are probably embarrassed to say it here, but now Ukraine is undergoing mobilization, which is running into serious difficulties. Representatives of the Hungarian, Romanian minorities feel “positive” discrimination, because they are called up in much larger proportions than ethnic Ukrainians. Why not talk about it? Or that in Ukraine reside not only Ukrainians and Russians, but there are other nationalities which by fate ended up in this country and want to live in it. Why not provide them with equal rights and take into account their interests? During the elections to the Verkhovnaya Rada the Hungarian minority asked to organize constituencies in such a way that at least one ethnic Hungarian would make it to the Rada. The constituencies were “sliced” so that none of the Hungarians made it. All this suggests that there is something to discuss.

Perhaps the most “amusing” part of the paragraph Lavrov devoted to the Hungarian and Romanian minorities in Ukraine is his claim that fate was responsible for these ethnic groups’ incorporation into the Soviet Union. I remember otherwise. The Soviet government kept the old Trianon borders without any adjustments based on ethnic considerations. The ethnic map of Zakarpattia Oblast shows that such an adjustment shouldn’t have been too difficult a task.

Ethnic map of Zakarpattia Obast  / Source: http://en.wikipedia.org/wiki/Zakarpattia_Oblast

Ethnic map of Zakarpattia Obast / Source: http://en.wikipedia.org/wiki/Zakarpattia_Oblast

The small Hungarian minority is obviously being used by the Russians to further their own claims, which in turn might encourage Viktor Orbán to pursue his quest for autonomous status for the largely Hungarian-inhabited regions of the oblast. The Orbán government supports autonomy for the Szeklers of central Transylvania despite the Romanian-Hungarian basic treaty of September 1996 that set aside the issue of territorial autonomy, to which Romania strenuously objected. The treaty had to be signed because NATO and EU membership depended on it. The Ukrainian situation is different because Ukraine is not part of the EU. Whether Orbán will accept the tacit or even open assistance of Russia for the sake of the Hungarian minority in Ukraine remains to be seen. In any case, to everybody’s surprise Viktor Orbán will pay a visit to Kiev where he will meet with President Petro Poroshenko.