Nina Petrova is a 58-year-old nurse working in the ICU in a public hospital in Blagoevgrad, a town in Southwestern Bulgaria. Nina’s monthly salary for her 10-hour shifts is 700 BGN or about 350 € – barely above the minimum wage in the country. Often, Nina alone needs to take care of more than 30 patients at a time as there is not enough staff in her care unit. She is in direct contact with coronavirus patients, and yet she is given only one mask and one pair of gloves per shift and no other protective gear. She has wanted to get tested for COVID-19, but since she was not showing any symptoms, she could not be tested for free, and the only option was to pay 130 BGN (65 €) to a private laboratory to get results.
Nina is not a real person, but the working conditions described here are the lived reality of the majority of nurses currently employed in Bulgaria. Low salaries, lack of basic equipment, insufficient staff – the situation is not new for the healthcare sector in the country. Unsurprisingly, women are hit much harder by this, as close to 80% of the workers in the healthcare and social work sector in Bulgaria are women In the last three decades, the number of nurses in Bulgaria has shrunk in half, with many leaving the country in search of better paid opportunities in Western Europe and North America.
The ongoing coronavirus crisis has only exacerbated the already tragic conditions in Bulgarian hospitals and visibilized further the results of 20 years of liberalization experiments in the sector. Ever since the reforms of 1998, Bulgarian hospitals have been operating as self-sustained commercial units competing for public resources. The financial model in the country’s healthcare sector boils down to one simple rule: the more patients and interventions a hospital covers or undertakes, the more funding it gets from the Public Health Insurance Fund; if a hospital cannot “attract” enough patients and generates debts, it is shut down. Needless to say, this model hits hospitals in smaller towns and cities the hardest, as there are not enough patients. To make things worse, private hospitals are also allowed to obtain public funding for certain interventions, meaning that they, too, compete with the already financially drained public ones.
Nurses in Bulgaria have recognised these tendencies and are now actively fighting for better working conditions, decent salaries and reforms in the healthcare system to change the status of hospitals as commercial entities. Over the last year numerous protests and demonstrations of nurses took place all over the country: they camped in front of public institutions, and protesters went as far as to occupy spaces in the Bulgarian Health Ministry and lately even the Parliament. Their demands have not yet been sufficiently met by the government, while public officials and media outlets linked to the ruling coalition have openly discredited the nurses and their struggles. As a result, in the onset of the coronavirus outbreak medical staff in many hospitals across the country moved the struggle to a new level by collectively resigning, as they rightfully feared that their care units were too poorly prepared to face a pandemic of this magnitude.
While the government did take some steps to provide protective measures for medical staff after the initial wave of resignations, most of these efforts were limited to the three main hospitals in the capital, Sofia, that are receiving patients with COVID-19. The majority of the hospitals in the country remain widely unprepared to protect their staff against the virus. At the same time, criminal investigations for spreading fake news were opened against medical staff who dared to speak about the lack of protective measures in their care units. Instead of raising wages for all, the government promised a one-time bonus of 1000 BGN (500€) to a tiny minority of 1,700 medical staff for their work on the “frontline” of the pandemic. On top of this, as planned operations have been canceled or postponed, many hospitals have witnessed a drastic decrease in the number of patients and interventions performed. As explained earlier, fewer patients and fewer interventions mean less funding for the given medical entity. Ironically, in a situation of unprecedented public health crisis, hospitals might be forced to close due to “unbalanced budgeting”.
More than 20 years of neoliberal efforts in the healthcare sector have brought us to a point where even the everyday “normality” in the hospitals before the COVID-19 outbreak felt like a crisis – both for the patients and for the workers. All over the world, states are forced to admit that having healthcare systems based on the principle of competition and profit maximization is a guarantee for a disastrous outcome. In a patriarchal capitalist world, it is not a coincidence that precisely the care work sectors are heavily underfinanced, neglected and feminized. Over and over again, women are expected to take care of the reproduction of society’s livelihood and receive (close to) nothing for their hard labor. Only if we understand the connection between patriarchy and capitalism especially in the sectors that heavily depend on care work will we be able to hit the heart of the problem: If we want to (re)build a public healthcare system based on solidarity and care, we need to start by understanding and questioning the economic conditions behind the current system, and the working conditions of the people there.
Kalina Drenska is a feminist activist in the Bulgarian socialist feminist collective Levfem and a member of the member of the editorial collective of the Bulgarian magazine for critical and political analyses dVERSIA. She has a master’s degree in media and political communication.