Healthcare Exhaustion

The nurse squeezes between boxes of humanitarian aid stacked from floor to ceiling, to call the next patient. The toddler’s mother holds her baby tight as she explains her daughter’s symptoms. After hearing the mother’s concerns the pediatrician listens to the baby’s heartbeat and looks in her ears and mouth. This is no easy feat given the toddler is kicking and flailing. The pediatrician reassures the worried mother her toddler is healthy and is only suffering from a seasonal cold. In the corner the nurse is organizing the vaccines in the refrigerator. She passes them off to the pediatrician, who prepares the syringes while she talks. It seems the toddler knows what’s coming. She is screaming and after the vaccines is even less happy. The pediatrician tells the mother to keep an eye on her daughter and if the symptoms don’t get better she should come back next week, no need to call ahead. The appointment is short, fifteen minutes at the most. In an economic crisis, efficiency is unfortunately everything.

The international humanitarian aid organization, Medicins du Monde (MDM), originally created this clinic in Perama to meet the needs of undocumented migrants. Today, the clinic serves a predominantly Greek population. With unemployment over 25%, many Greeks have been excluded from the public healthcare system. Without work they are unable to independently pay for public health insurance. As a result, it is estimated that more than 500,000 Greeks are effectively without any healthcare. Increasingly Greek and international NGO’s are filling in the gaps in public health.

Families from across Athens make the trek to the Perama clinic for its free pediatric care on Tuesdays. They patiently wait hours to see a doctor. The waiting area is a chaos of kids climbing and running, and mothers chatting squeezed two to a seat. However for many this is their only option for vaccines and basic check-ups. Without a vaccine, Greek children are prohibited from enrolling in the public school system.

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The Troika is demanding further public sector cutbacks before it releases Greece’s next tranche of rescue funds. Unfortunately healthcare has been one of the public services most affected. More than a billion dollars has already been cut. Emergency rooms are clogged with the uninsured looking for basic medicine. Hospitals are running low on basic supplies like latex gloves and band-aids. The national association of pharmacists is suing the Greek government for months of unpaid medications. Healthcare professionals have been laid off left and right, and those remaining have suffered drastic pay cuts. Many have chosen to abandon Greece to look for work abroad. The public healthcare system appears to be in a free fall.

While the Troika’s aim is supposedly austerity for long term sustainability, it appears more like a wholesale push towards privatization of the Greek economy. According to the agreement with the Troika, Greece must raise 50 billion euros through privatizations by 2022. As a result Greek healthcare is gradually starting to look more like American healthcare. Those with the resources to buy into this growing market are generally finding the services they need. However the poor and unemployed, drug addicts, and patients with diseases and syndromes requiring expensive long term treatment like cancer and HIV/AIDS, are effectively finding themselves abandoned in this transition from the public to private.

Downtown Athens is littered with men and women lost in a roller coaster of fixes and withdrawals. Austerity measures in public healthcare have been paralleled by a surge in drug use. Members of OKANA, the publicly funded national drug awareness organization, say they’ve never seen the situation this bad. Konstantina, who has worked with the organization for more than a decade, says she sees new faces among the users on the streets. There are an increasing number of middle class Greeks seeking to escape the crisis through heroin and other narcotics. Making matters worse OKANA, the only public organization with the stated mission of addressing addiction, has seen more than 40% of its annual budget cut over the last three years. This has translated into a reduction in the number of syringes OKANA has to hand out, and the number of programs it can effectively manage. Today in Greece there is an epidemic of HIV/AIDS among intravenous drug users. It is estimated transmission through needle sharing is up more than a 1000%. Konstantina openly wonders what will happen in the future when OKANA’s resources diminish further and the demand for their services continue to grow.

A cold night’s wind cuts through the winter jackets of the Praksis members on duty at the mobile HIV/AIDS test unit. Praksis, a Greek healthcare and social services NGO, has been running this mobile test unit for the last year and a half. Anyone interested in getting tested can sign up and step into the white van to get a swab of their DNA examined. In twenty minutes they get their results. The team always a doctor and psychologist, and normally two or three other healthcare professionals on call as well. Every weekend the mobile unit parks in a different place and offers the free service. The HIV/AIDS epidemic in the intravenous drug user community worries members of the Praksis team. If this epidemic spills over into the general population the consequences could set the diseases treatment back decades.

Like OKANA and MDM, Praksis offers various different services beyond the mobile HIV/AIDS testing. There is a Praksis clinic in both Thessaloniki and Athens, as well as a homeless day center, and a housing service for asylum seekers, a counseling program for ex-prisoners, and public awareness campaigns. Praksis understands public health in broad terms attempting to connect the dots between social services, education, healthcare, and direct aid. But their funding is limited and the scale of the challenges facing public health are far beyond the capacities of the organization.

Nicholas Fakiolas was the first Greek to come out in the national media as HIV positive. He says breaking the stigma around the disease has always been one of his goals. But today he is struggling to keep up his treatment. Unemployed Nicholas spends most of his free time volunteering with Zentro Zois, a local HIV/AIDS awareness NGO that operates a clinic and various education and support groups. Nicholas says the cost of his drugs has gone up dramatically in the last couple of years. So much so that he often has to decide between one drug or another or between food and his meds. On a few occasions Nicholas’s hospital has rationed out his meds pill to pill, meaning Nicholas had to make multiple trips to the clinic.

Nicholas says he finds solace in Zentro Zois and his volunteer work with them. The crisis has made him more convinced of their necessity. However he recognizes that it is impossible for organizations like Centro Zois, OKANA, Praksis, and MDM to effectively address the collapse of public healthcare. Unfortunately it seems those in public office and the Troika are convinced the pain of this collapse is necessary for an economically sustainable future. The eventual growth of a private healthcare system is apparently their definition of economic sustainability. However their conviction begs the question, will there be anyone around healthy enough to enjoy this future? And if so, how much will it cost them?

November 17th 2012. Remembering the 1973 Athens Polytechnic uprising and the subsequent massacre.

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NOVEMBER 17 2012 Athens, Greece.

39 years ago on this day the Greek Military Junta sent a tank into the Polytechnic University to quell a student uprising that had already been going on for 3 days.  After breaking down the gates of the university soldiers opened fire on those inside.  Officially the government claimed only some 40 people were killed, while more accurate estimations are closer to 150 dead.  Martial law was declared and military units patrolled Athens all night beating, torturing, and meting out summary executions.  However the students and Greek civil society would have the last laugh.  The polytechnic uprising signalled the beginning of the end of the Military Junta.  Years later an underground armed struggle group would take on the name November 17th in memory of the democracy movement’s martyrs.

This year thousands of students, and members of the general population marched from the Polytechnic University through downtown Athens, and Syntagma Square and in front of Parliament. As is the tradition the march continued on to the American Embassy, the historic destination.  The American government supported the Junta both logistically and publicly as part of it’s broader Cold War strategy.   This year the march didn’t stop at the American embassy, instead it moved on to the Israeli Embassy in a show of solidarity with the Palestinian population and as a show of protest to the recent escalation of violence in the Gaza Strip.

Portrait of a Crisis: Athens and it’s Suburbs.

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On the 17^th of June, Greeks took to the polls in a second general election in just over a month. The conservative New Democracy party beat the radical left coalition Syriza by just a few points. Across Europe and in the international markets there was quick sigh of relief. During the campaign New Democracy had vilified Syriza as being anti-European in their stance of rejecting the conditions of the EU bailout agreements. New Democracy had pledged to uphold their commitments to the Troika (the European Central Bank, the IMF, and the European Union) of continued fiscal austerity. With a New Democracy victory it was assumed the economic crisis would be brought under control and the contagion would be stopped from spreading to more European economies.

On Monday, 18^th of June, the relief was gone and the tension was back. New Democracy moved quickly to form a coalition with its old enemy PASOK, the Greek Socialists. But the political maneuvering didn’t seem to breed confidence. By the 20^th, the new Prime Minister Antonis Samaras was already pleading for leniency from the Troika, as others talked of a third bailout. According to this agreement the Greek government has to cut another 11.5bn Euros from the public sector before 2014.

Social discontent with the original bailout agreement remains widespread, and living conditions for many Greeks continue to deteriorate. In Athens the most obvious sign of this deterioration is the surge in homelessness. Its nearly impossible to walk around the capitol without seeing someone sleeping on the street. One municipal shelter in Athens estimates there has been a 25% increase in the country’s homeless population since 2009. More people are being forced from their homes every day as banks repossess their assets from home-owners unable to pay their mortgages.

Making matters worse, 36% of public health budget has already been cut with serious effects on general populations health. It is estimated HIV transmission between intravenous drug users is up 60% since 2009. The health ministry estimates suicides are already up 40% this year, and no one has a good count on the increase of people suffering from mental health problems. What is clear is people are going to the doctor less and less, and are having a harder time finding the treatment they need in the public health system. Many would argue this deterioration of public health has reached the level of an international humanitarian crisis deserving of the same international attention.

Many people I’ve talked to have said “come in September.” It is suspected that by the fall things will have once again reached a boiling point, much like what happened last fall and winter. Unfortunately I couldn’t help but be struck by a sensation of hopelessness and resignation that permeates throughout Athens and its suburbs. People have come to accept as normal the overwhelming tension in which they live. The political environment has become the most polarized its been since the country’s civil war. In parliament, Golden Dawn, an openly xenophobic fascist political party, share the podium with the Greek Communist Party and Syriza. It is hard to imagine these parties reaching a compromise on just about anything. Let alone tackling the difficult task of pulling the country out of its current predicament.

In Europe and in the government of Mr. Samaras everyone seems to be hoping for the impossible, and imagining the worst. It is time to acknowledge that the worst is already real: Greece has fallen, the contagion has already spread and the only solution are institutional reforms of both the European Union structures and its financial regulation. Greek debt must be forgiven, there must shared European financial risk. Business as usual cannot continue. Any reform short of this will only prolong the inevitable. Greece will leave the European Union and it will not be the last country to do so.