Not the right place to be sick
More than three million people in Greece are uninsured. Cardiologist Giorgos Vichas opened a clinic that treats them nonetheless. A case study of genuine solidarity in the midst of the Greek humanitarian crisis..
By Elvira Krithari
Photos: A. Christofilopoulos / FOS PHOTOS
“From all the stories that come to my mind I will tell you this one because it shocked me and I want it to go down in history. To be recorded everywhere, so future generations can recall it. It is about the magnificent moment of solidarity when an old woman came to find me in my working place at the hospital, at 7.30 am when I started my shift. She didn’t have an appointment and when she entered my office she was crying. Her grandson, 30 years old, was suffering from leukemia and he had recently lost his job so he got uninsured. The medicine he had to take would last for another 5 days and he couldn’t afford to buy more. After that he had no other option. The woman gave me a pile of examinations and left telling me I am her only hope.” -Giorgos Vichas
6.3 million people in Greece are estimated to live near or under the poverty line. According to Eurostat (2013), Greece was the country with the highest risk level of income poverty in the EU28 (23.1 per cent), followed by Romania (22.4), Bulgaria (21.0), Lithuania (20.6) and Spain (20.4). Greece also tops the list when it comes to unemployment: More than one out of four people cannot take advantage of their country’s famous clichés of the sea and sun this summer due to their being jobless.
Because of the close connection between employment and health insurance in Greece, there are now more than three million citizens (data from 2013) who are denied access to the National Healthcare System. The rarity of health insurance makes it a coveted trophy rather than normality for those who unexpectedly find a job in Greece. I recall a colleague working for a Greek newspaper, who one day, after 3 months of work, eventually had the right to own a “sickness booklet” (that is, insurance). She actually celebrated it. Not without reason: From that point on she at last had the legal right to get sick.
The reduction of the health budget in Greece has exceeded 48 per cent since 2009, the year the crisis started. Every year, the budget declines by 10 per cent. This would almost certainly be unacceptable in Central European countries such as Austria, which spends more than ten per cent of its GDP on health care. While Greece faces high rates of uninsured citizens, 98% of the general Austrian population (or 99% depending on the calculation model) is insured.
Despite this, some sources report that approximately 100,000 people in Austria live without insurance: most of them immigrants. In France, of almost 65 million citizens, 200,000 live without insurance, as was stated in the parliamentary question from the Greek member of the European Parliament Kostas Chrysogonos in May 2015. At the same time, Spain finds itself with 900,000 uninsured citizens of a total population of more than 46 million people. Given that the problem also exists in other EU countries, it is difficult not to see how it has become terrifying for Greece, a country of only 11 million citizens.
The makeshift clinic that shouldn’t be necessary
In this baleful, deserted landscape of economic hardship that has deepened inequalities, solidarity is the only recourse for those who were fed up of watching Greece’s social structure collapsing beneath their very feet. Greek cardiologist Giorgos Vichas was one of them. Along with others, in December 2011 he began the operation of a makeshift clinic, reliant on volunteers and grounded in a surplus of social understanding and responsibility. It was not an individualistic act, but rather a collective effort to give people what the government had denied them and at the same time to put pressure on it to provide the services that it should. “When you know the problem exists and you do nothing to solve it, you become an accomplice in the crime”, he says. The makeshift clinic was founded under the precondition and with the hope that sooner or later it would no longer be needed.
Describing it as just a makeshift clinic is not completely accurate. This would be to exclude some of its essential characteristics: If we were to translate the term directly from the Greek, it would be called the “Metropolitan, Social Dispensary of Elliniko”, the municipality where it is located, in the south suburbs of Athens. “Metropolitan”, because it is built inside the empty area of the former Athenian airport, which the founders of the dispensary along with many locals would like to see become a metropolitan park. “Social”, because it was launched by society to serve society, without exception and without trying to become institutionalized in any form. This clinic is most definitely not an NGO. “We don’t want to be an NGO because that automatically signals the perpetuation of a problem. We want to maintain this clinic as an emergency structure that will have an expiration date,” Vichas states.
With 1500 medical visits each month, he and his colleagues have to struggle to procure the necessary medicine and equipment and, most importantly, the strength to be there at every turn, selflessly. The clinic relies upon the work of approximately 300 volunteers.
Medical and diagnostic equipment are donated by people from all over Greece. The clinic has its own pharmacy and its procedures are very similar to the ones of the official public healthcare structure: The doctor examines a patient and gives him a prescription card. Other volunteers take these cards and give the patients the medicine they need. Everything is free. In case there is a shortage of a certain medicine, the clinic makes a public announcement via the internet. According to Vichas, their supplies can in this way be restocked within a few hours.
In the years before the financial crisis, Greece had not solved the problem of uninsured citizens. Unemployment was between 7.8 and 10 per cent — this was close to the European average. At that time, Vichas remembers, the medical treatment of uninsured patients was not such a burning issue. It was even possible for uninsured patients to attend a private clinic, because their friends and family could afford to pay for them. Those who didn’t have that opportunity could still visit a public hospital which would cover their debt; since the number of uninsured people was not so high, hospitals could cover that from their annual budgets without problem. The legislation didn’t change after the crisis, but while the number of uninsured patients increased, the hospitals’ budgets decreased. New cuts to medical and paramedical personnel were made and public health structures were shut down while insured patients had to pay more for prescribed drugs — they currently cover 76 per cent of the price themselves.
Inequalities in access to the public healthcare system are not only due to the increasing number of uninsured patients but also to the lack of public health infrastructure. A study about the “Impact of the economic crisis on the lives of cancer patients” shows that 30 per cent of patients with cancer are facing great delays before booking an appointment with their doctors. Furthermore, 25.4 per cent find it difficult to get the products they need for their therapy. Statistics claim that these delays and insufficiencies led to the deterioration of their health or proved fatal.
Vichas: “Nothing is lost”
Efforts announced by the previous government proved ineffective. A new law in the summer of 2014 gave uninsured people who met specific requirements the opportunity to be hospitalized free of charge. A three-member committee of the hospital should pre-approve the cases that would have that right. Even today, according to Vichas’ makeshift clinic, there are few hospitals where these committees actually operate.
The current government passed a new act to deal specifically with the problem of uninsured people. According to officials in the Ministry of Health, almost everyone who is now uninsured will soon have access to the public healthcare system and have almost the same rights as those who are insured. The small print, however, leaves the issue open to new obstacles: For example, immigrants without legal documents are not included in the act, although they belong to the most vulnerable groups.
If the public healthcare system succeeds in providing access to all, the Metropolitan Social Dispensary of Elliniko will no longer be needed. Nor will the remainder of the more than 15 makeshift clinics in Athens and the numerous social health structures all over Greece. But in a place where social reforms take a long time to bear fruit, simply remaining hopeful will not make the situation any easier. While the European institutions negotiate with the Greek government on the country’s debt, the present situation for Greece remains unforgiving.
Yet, as Vichas says, “nothing is lost”. The promise of change comes from the bottom up, rather than from the top down, at least in the outcome of our introductory story of the uninsured 30-year-old leukemia patient who was running out of medicine:
“That moment, despite my anger about the unacceptable situation that people are left to die if they don’t have a job, I shared the story on my personal social media account. By the afternoon, my post had gone viral and numerous patients from all over Greece who had to take the same medicine called me or sent me messages to ask where they should send pills from their own treatment.
I recall a woman from Aidipsos who sent 15 pills. A man from Thessaloniki sent 7 pills. A woman from the island Kythira sent 20 pills. I called that woman back to prevent her from doing so, because it was very dangerous to stay without therapy for so long. She told me she was 60 years old and didn’t mind dying if this young man was going to live. By the next morning, people had gathered pills for a 3 month therapy for the 30 years old man. This was one of the most shocking examples of solidarity I encountered. This was a restoration of trust in humanity, enough for all my life.”
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