Medical Shortages Cause Polish Health Care Crisis

One of Warsaw’s daily newspapers has raised $41,500 in contributions and is now campaigning for the national chain of foreign exchange stores to hold a lottery to raise more money.

The Roman Catholic Church quietly collects for its own fund. And Solidarity, the outlawed independent trade union, has discussed using the $1 million it received from the U.S. Congress for the same purpose.

The object of this concern is a serious shortage of medicine in Poland. The shortages range from antibiotics and anesthetics to more complex drugs for treatment of cardiac or cancer patients.

Indeed, the situation--crisis is the term many doctors use--extends across the full range of health care products, not just medication. Items ranging from vitamins to cotton gauze to sanitary napkins to syringes and needles are either unavailable or in a permanent state of sporadic supply.

For three days earlier this month, no drugstore in Warsaw, a city of 1.5 million, had a single tablet of ampicillin, a basic antibiotic, for sale. Experts say the situation is even worse in rural areas, which remain far down an unreliable chain of distribution.

It was “possible” or even “likely,” in the words of harassed pharmacists, that ampicillin would be in the drugstores in a few days. The problem was that it could disappear again the next week, or the week after, leaving Poland’s 35 million citizens with one more irritating, if not life-threatening, obstacle in a seemingly endless search for necessities.

Marta Brzozowska, for example, traveled 100 miles by train one week seeking a heart-ailment drug for her sister. After standing in line for 30 minutes at the largest drugstore in downtown Warsaw, she was told that the medication was unavailable “at this moment.” The unfilled doctor’s prescription clutched in her hand, she made for the bus stop, advised to check at another store halfway across town.

“I’ve been to three other towns and I can’t find it,” she said. “It used to be available, but now they say it is not. I’ve been looking for months.”

“It is a catastrophe,” said a 69-year-old man who had come away empty-handed from the same line. “A catastrophe. I am a war veteran. I have arrhythmia of the heart. I have blockage of the veins. I cannot find the medication for these problems. I go to two or three places every day. I have been looking for three months.”

The veteran said his supply of the needed medication was nearly exhausted.

“There will be one more grave,” he said, if he did not find a new supply soon. “When you ask (the druggists) for an explanation, they just say, ‘We don’t have it; we are not supplied.’ ”

Mirrors Economic Crisis

The explanation offered by Poland’s physicians and others familiar with the pharmaceutical industry is that it mirrors the country’s overall economic crisis.

Polish drug manufacturing enterprises, the doctors say, are heavily dependent on imported material--everything from chemicals to packaging. Hard currency is needed for the purchase of those products--and hard currency, of course, is in very short supply.

Also, the Polish plants that manufacture drugs are plagued by the same problems afflicting other industries here: old equipment, deteriorating physical plants, unreliable supplies of raw materials.

To the grim amusement of most doctors, whose capacity for indignation was long ago exceeded, the officials of the drug industry steadfastly deny that there is any problem from their end of the business.

Zsigmund Olinsky, director of CEFARM, the state agency that oversees the manufacture and distribution of supplies to the nation’s drugstores, says the problem is not with the supply but with the “uncontrolled” distribution of drugs. The problem is exacerbated, he said, by unrealistically low consumer prices for drugs.

Indeed, drugs are free to a large portion of the population. Olinsky said that about 35% of the nation’s drugs, both locally produced and imported, are given away free to the army, the police and the nation’s hospitals. In addition, he said, about 60% of the drugs distributed through the public pharmacies are also free--to pensioners, veterans, and those with prescriptions issued under the national health service. And finally, many government employees and their families qualify for free medication.

“The average annual increase in the price of drugs, worldwide, is 7% to 8%,” Olinsky said. “Our prices do not change.”

From his desk drawer, Olinsky withdrew a bottle of tablets, medication for ulcers.

“The price of this drug in hard currency is $56 for 100 tablets. The price for this in Poland is 1000 zlotys (about $3).”

Smuggling Suspected

Olinsky suggested that some drugs are smuggled out of the country and sold in Asia, Africa and the Middle East. But the main problem, he insisted, is “disorder” in the market. “Doctors,” he said, “prescribe medicine in an uncontrollable manner.”

Olinsky also said that “according to our expert assessments, about 35% of drugs disappear and are not used at all.”

This comes as news to most of the people who can be found standing in lines daily at the country’s pharmacies, often with desperate looks on their faces. As for physicians, the dismissive reaction of Dr. Zofia Kuratowska, a hematologist who works in Warsaw’s principal cancer hospital, is typical.

“I guess everyone has to protect his own interest,” she said, smiling thinly. “In fact, the problem is very big and growing worse from month to month. You can say, in general, that about 60% of the drugs we need are not here.

“It changes from time to time. One month you can find it, the next month you can’t.

“I’m talking about necessary drugs here, not vitamins. There are no vitamins at all in the country,” Kuratowska continued. “No, I mean antibiotics, cardiac drugs, cancer drugs, anesthesia. The problem is quite obvious. They are not manufacturing enough and they are not importing enough.”

No one has estimated the number of deaths that might have resulted from the medicine shortage, a determination that in many cases would be difficult to make. Kuratowska said drug shortages could be a contributing factor in 1% of the deaths from illness in the country but cautioned that this was only a guess.

Tragic Consequences

Clearly, though, for gravely ill patients, and their families, the unavailability of drugs can be tragic. Kuratowska recalls a period of about six months when doctors in the oncology hospital were unable to obtain a drug that has been used successfully in the treatment of ovarian cancer.

“It is not always easy to say if a drug will make the difference,” she said, “but it was a very dramatic situation, since most of these women were relatively young.”

Most hospitals, doctors say, do their best to keep supplies of drugs on hand for emergency cases. Some physicians say that if a patient is in dire need of a drug, a diligent doctor may be able to find it, although it requires telephone calls, paper work and steady harassment of officials.

Kuratowska said she has telephoned Olinsky, for example, and warned him that the death of one of her patients would “be on his head” if he did not find a needed medication. Usually, she said, the drug is found, although not always in time.

Adequate supplies of anesthetics are a continuing problem. Most anesthesiologists, like most hospitals, attempt to stash away their own supplies, but it is not easy. Often, Kuratowska said, patients for elective surgery are asked to furnish their own anesthetic.

Foreign contributions have helped, but they have not closed the gap. And with the Polish government refusing to admit the problem exists, much less find a solution, private organizations such as the Warsaw newspaper, Solidarity and the Roman Catholic Church are looking for ways to acquire and distribute the drugs.

Lay organizations operating out of Catholic churches, for example, try to distribute donated drugs to churches throughout the country, operating as a kind of unofficial drug company. These drugs are all imported, mainly from Western Europe.

One distribution point is at St. Klemensa Redemptorist, in a working-class district of Warsaw. The operation is run by a pharmacist at a state hospital who spends two evenings a week in the church basement. Five large, padlocked cabinets are filled with drugs.

“When we receive a delivery of drugs,” said the pharmacist, who asked that her name not be used, “we keep only a small part here and distribute the rest to the hospitals in the Wola area. We send some also to Radom and Kielce,” two neighboring cities.

Worsening Situation

The pharmacist, who said she has worked in Warsaw hospitals for 13 years, believes that the situation in the health care industry in Poland is steadily worsening.

“Medicine is a problem, but it is not just medicine. The shortage of surgical supplies is dramatic. Most of the time, you cannot find cotton batting. Sometimes it is not the cotton batting itself, but there are no plastic bags for packing it. Sometimes there is no plaster, sometimes no bandages. There is a big problem with intravenous solutions, especially in small quantities, for children.”

One natural result of the shortages has been the development of a black market. People seeking drugs they can find nowhere else often place classified advertisements in the Warsaw newspapers. One such advertiser last week said she was seeking a drug for her schizophrenic son. Luckily, she said later, her ad was answered by a person who sold her the drug at the market price. Many patients are not so fortunate.

Some doctors, notoriously underpaid--a doctor’s monthly salary here is usually less than a coal miner’s--have been known to sell drugs, sometimes for premium prices and sometimes even when the physicians have received the drugs as gifts or donations.

“It makes me sick to think about it,” Kuratowska said, “but given the economic situation, I know it must happen.”