Dimitar Anakiev, MD, general practitioner and global health specialist
HEALTH OF THE BULGARIAN MINORITY IN THE MUNICIPALITY OF SURDULICA, SERBIA
1. Introduction
During the Ottoman Empire (1875), the territory of today's municipality of Surdulica belonged to the Bulgarian Exarchate and was inhabited by the Bulgarian population. After the Berlin Congress (1878), it was annexed to Serbia and the population was assimilated in the following decades, but even today they do not speak proper Serbian, even though they declare themselves as Serbs. What is today called the "Bulgarian national minority" in the municipality of Surdulica are the not yet assimilated inhabitants of the Bulgarian Western Outlands , annexed to Serbia in 1920, mostly from the Trnsko region (Trnska Klisura) and then Božica and Topli Dol, a total of about 10,000 people before the war, inhabiting about 650 sq. kilometers along the Bulgarian border. These three villages with numerous hamlets and the entire territory were included after the Second World War to the Bulgarian municipality of Bosilegrad in Serbia , but in 1965, probably for the purpose of faster assimilation, they were separated and included, first to the Serbian municipality of Okruglica and then, in 1967, to the Serbian municipality of Surdulica. Thus, these members of the Bulgarian minority in Serbia became separated from the Bulgarian minority corps, becoming a double minority: both in the state of Serbia and in the municipality of Surdulica, which significantly narrowed their minority rights, for example, there is no bilingualism in this territory. Serbian is the only official language, although Bulgarian is taught in schools. The basic assimilation method of the Serbian authorities, in addition to the administrative one, was the abolition of the economic base of the population, primarily the abolition of agricultural cooperatives, which forced the population to migrate en masse to urban centers in the interior of Serbia.
2. Health care in the municipality of Surdulica
According to the 2002 census, Surdulica is a municipality with 22,190 inhabitants, of which 10,014 live in Surdulica itself, while the population growth is negative -1.19 and has a tendency to increase. Health care in the municipality of Surdulica takes place on three levels: tertiary (sanatorium with 100 +50 beds), secondary (general hospital with 174 beds) and primary (Health center with 4 clinics and 4 health stations within which the HMP service). There is no data on the existence of an institution of preventive medicine.
There are 284 patients per doctor, but more than 35% of the population of the municipality of Surdulica, according to official data, do not have any primary health care, among which is the entire population of the Bulgarian national minority.
Emergency medical care (EMC) on a rugged hilly-mountainous terrain of about 650 square km. which officially has 41 settlements (10 of which are mostly inhabited by the Bulgarian minority) and numerous hamlets (only Klisura has 21 hamlets) has one vehicle that is also used for ambulance transport to remote centers. The EMC medical team consists of two members: a doctor and a nurse, but after 8 pm, the doctor is not in the mobile team. EMC vehicle equipment is scarce: the vehicle lacks oxygen, the Life Pack exists but is either defective or staff do not know how to use it. The HMP team does not even have an ordinary oximeter, and only one bottle of infusion is available (data based on personal insight).
There is not one defibrillartor in the whole municipality.
3. An experience of EMC in the village of Strezimirovci
The village of Strezimirovci has about 200 houses, but in 1920 it was divided by the state border, so that about half remained in Bulgaria, while half with the church and cemetery were annexed to Serbia. An international border crossing was made in the center of the village. It is no coincidence that the depopulation of this Bulgarian village in the last decade, according to the official data of the Statistical Office of Serbia, was eight (8) times faster than the depopulation of the Serbian municipality of Surdulica to which the village belongs.
On May 17, 2020, around 8.30 am, I was invited to see a patient in the village of Strezimirovci. A kilometer and a half between Groznatovci and Strezimirovci, I crossed the road overgrown with thorns in 1.5 hours and came all scratched to an eighty-year-old patient in serious condition; visibly dehydrated due to enterocolitis, vital signs were weak: saturation 87, blood pressure 85 by 50, difficult to breathe, difficult to speak, febrile. We start oral rehydration as much as we can and call the EMC which took 4 hours to arrive (From Surdulica to Strezimirovci is 40 km). In those four hours of waiting, we called many doctors and the president of the municipality (also a doctor) to urge the EMC (Ambulance) to come as soon as possible. The dispatcher does not want to give the phone to the mobile team to connect with them. When the EMC team arrived, consisting of a doctor and a nurse, it turned out that they had nothing from the EMC equipment, they didn't even have an oximeter, they couldn't give oxygen. They have one bottle of infusion, which they install, but they do not have time to wait for it to expire, because they have to drive some patients to Vranje (ambulance taxi). I take off the infusion, I also collect the medical waste (needles, swabs) left on the table ... The next day they came to give the infusion again, but they took the wrong infusion with them, so they had to return...
4. The case of the village of Groznatovci:
The village of Groznatovci is located on the slopes of Mount Vrtop, where the Bulgarian statesman Simo Sokolov was born, but only the foundations of his house remain and there is no sign of him. At the last Bulgarian census, before being anexed to Serbia in 1920, the village had 65 houses with 309 inhabitants. The depopulation of the village in the last decade is 6.5 times faster than the depopulation of the Serbian municipality of Surdulica in which it is located. At the 2011 census, the village had 21 inhabitants. The only cultural facility is a school from 1910, which is neglected and prone to collapse.
The village has four neighborhoods: Selo, Rashini, Vukovi and Rovinari. The villagers are supplied with water from six sources, all catchments are private, without hygienic supervision. One of the catchments is located in the village itself (Rašini neighborhood), so during heavy rains the water becomes muddy and the users then use the water they get in the cans from the neighbors. The largest source of water, on the Vrtop mountain, which belongs tо Groznatovci cadastral, the municipality sold to a tycoon from the neighboring (Serbian) region for a water factory. The same fate befell a source from the Bulgarian village of Topli Dol...
There is no asphalt road to the village and no communal service comes, a phenomenon typical for the whole area of Trnska klisura, waste is thrown into the valleys of rivers and bays, there is no central sewerage, but field toilets or septic tanks are used.
Electricity was brought to the village in 1966, today the main line is three-phase, but all connections are single-phase. Electricity often goes out in bad weather. The village has two cemeteries, one common with the neighboring village of Drainci (mahala Vukovi) and all cemeteries are in three parts: Turkish, from the time of the Ottomans, Bulgarian and Roma. Turkish graves are associated with the excavation of iron ore from surface mines dating back to Roman times (Andaci), while the Roma were temporarily settled in the Rovinari neighborhood and performed blacksmithing.
The administrative village of Groznatovci belongs to the "Klisura area" (Trnska klisura) and is part of the local community Drainci-Groznatovci-Strezimirovci. The president of the local community, in several terms, is local Bulgarian, from the village of Strezimirovci, currently a member of the ruling Socialist Party of Serbia in Surdulica, formerly a member of the also ruling Radical Party. In the village of Drainci, there is an informal taxi service that takes villagers to Surdulica and back 2-3 times a week for a small fee (When has enough passengers).
I settled in the village of Groznatovci at the end of 2019 and for the next 14 months I performed voluntarily and without compensation - according to the principles of humanitarian medicine - medical consultations and examinations for the villagers of all three villages of this local community and several times I went to the village of Kostroševci.on the way to the monastery of Palja, which is the main cultural landmark of the Klisura region.
In all three villages of the local community Drainci-Groznatovci-Strezimirovci, according to my free estimate, about fifty men, women and children live. They own 3 cows and one calf (all in the village of Drainci), about 20-30 sheep (Drainci and Strezimirovci) and currently, in February, one pig (Groznatovci). There are two shops that also serve as cafes, but only one of them, in Strezimirovci, works every day and offers a wide range of groceries.
In 14 months, in all three villages, I performed 193 medical consultations, of which 168 in the village of Groznatovci, 11 in the village of Drainci and 10 in the village of Strezimirovci (and an additional 4 in Kostroševci). This disproportion is the result of my location: in Groznatovci, most patients are within half a kilometer of the doctor, and most only fifty or 100 meters, while patients from Drainci and Strezimirovci are on average 2-3 kilometers away, which corresponds to the standard of humanitarian medicine. every 1.5 km distance the visit to the doctor decreases by 50%. In most patients, I performed consultations 2-3 times, in one case 9 times, and in one case I performed 44 medical consultations and examinations for members of one of the rare large families.
The following data refer only to Groznatovci, and are representative for the entire local community Drainci-Groznatovci-Strezimirovci, and probably for the entire Klisura area.
5. Health condition of people in Groznatovci:
During 2020, in Groznatovci, I performed medical consultations with 13 patients aged 90 to 36: including 5 women and 8 men. Of these, 6 are pensioners (3 women), 6 unemployed persons (2 women) and 1 employed person (migrant worker). Pensions are in most cases 150-100 EUR (in June 2020 the average pension in Serbia was 237 EUR), 5 of the unemployed do not receive social assistance, which is 68 EUR. They make a living from temporary jobs, most are semi-skilled or unskilled workers, the unemployed without social assistance do not have social insurance, the purchase of medicines is a problem and those with social assistance the state subsidizes (approximately 2/3 of the price) one box of medicine per month. Getting medicine is a problem.
The ratio of acute to chronic diseases is 13.7% to 86.3%. (table).
Among acute diseases, the highest number of respiratory infections is 43.3%, skin infections 43.3%, gastroenteritis 8.6% and injuries 4.3%.
Chronic diseases predominate: cardiovascular diseases (hypertension, arrhythmias, ischemic heart disease) 46.5%, lung diseases (COPD, asthma) 15.38%, NVD 15.38%, diabetes 7.7%, renal insufficiency 7.7%.
In the village of Klisura, approximately 8 km from Groznatovci, there was a well-equipped clinic that was recently closed and turned into a health station with the optional presence of a doctor for several hours once a week.
6.Health behavior of people of Groznatovci:
Alcohol is widely consumed, which is partly a consequence of culture and partly the result of a hopeless social position. Alcohol abuse has a wide range: chronic alcoholics make up 23.07%, subchronic 23.07%, occasional but frequent use of alcohol by 15.38% and an equal percentage of 15.38% of those who stopped getting drunk, while abstainers make up 23.1%.
The use of tobacco is equally widespread: 61.8% are smokers, 15.38% have stopped smoking and 22.82% are non-smokers.
Alcohol and tobacco abuse have a large share in mortality.
Excessive use of salt is common in the diet, and purchased food is increasingly replacing domestic products.
7. Mortality
During 2020, 10 people died in all three villages (one from Groznatovci): 3 as a direct or indirect consequence of alcoholism, 2 due to cancer, one from a stroke, one due to disruption of the abdominal aorta, one pneumonia.
8. Fertility
Zero
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