Influenza epidemic

Concealing Death

Branka Kaljevic

SAT, 29 JAN 2000

Podgorica, 26 January, 2000 - For a whole month the authorities in charge of health have at first concealed influenza and then death. Only after in the beginning of January the virus of influenza struck down every fourth inhabitant of Serbia (almost two million people without data for Kosovo) the authorities in Serbia realised that things may be serious and proclaimed an epidemic but only in Belgrade. Quietly and without great pomp they declared to the population in an official statement that they were dealing with an epidemic of influenza, mentioning in the statement that the suddenly increased death rate of the population reached up to as much as 60 per cent.

In Belgrade cemeteries, contrary to religious customs, people were buried even on Christmas day and every morning, not just in the afternoon as customary. The cemeteries worked even in pitch darkness, and families waited for a funeral up to eight days. Mortuaries were full although there were up to seventy funerals a day.

And while alarming news with similar content were arriving from inside Serbia, from Nis, Kragujevac, Novi Sad, Uzice, Valjevo, Smederevska Palanka, persons in charge of health protection seemed to be competing in issuing statements that influenza was not the cause of death and that not a single case of death caused by flu had been reported to the Republican Bureau of Health Protection: "It is too early to make a connection between the number of funerals with the influenza epidemic and this connection could be established only after summing up of results of the epidemic in six months", declared a few days ago Dr Katarina Bukumirovic from the Republican Bureau of Health Protection.

Assurances of the similar kind continued with the explanation that influenza was a routine issue and to journalists’ questions about the number of those who died, the "expert" answer was that "it is again a normal surplus of death rate".

Of course, it is impossible to deny the death rate implied by an epidemic. But the death of more than 780 Belgraders in the first seventeen days of January, in fact in just four city municipalities, in a normal country would demand an answer to the question what is the limit of "surplus of death". There is no answer to that here. Those in charge refer to the fact that influenza is raging throughout Europe and that it is just a normal phenomenon.

Contrary to the world epidemic, the background of this one in Serbia is very complex and dangerous. There are at least three things that separate us from the rest of the world we should belong to: poverty, life under incessant stress, and the health system which are falling apart.

In Serbia for a long time already, both the people and health services are ailing. The epidemic has just warned about the fact that the system is falling apart. When influenza appeared in the beginning of December, there were no drugs in pharmacies, not even the ordinary aspirin, except on state television which regularly stated that the pharmacies were well supplied, while experts were advising the population from TV screens not to take antibiotics, and that the so-called traditional medication, such as boiled onion peels and vinegar compress, were very efficient.

It was also impossible to see a doctor. Out-patient clinics were literally besieged by patients, and the emergency service, helpless and itself decimated by the illness (in which the situation is not much better even without influenza) started giving advice over the phone instead of paying patients visits in their homes.

The effects of proclaiming the epidemic were not emptied beds in hospitals, nor pharmacies better supplied with drugs, nor warnings about the dangers of influenza. The activity of the authorities came down to the ban of visits to hospitals and prolonged school winter vacation. Minister of health Leposava Milicevic had more urgent matters to attend to. It was possible to see her only at the opening of reconstructed bridges, while her subordinates, physicians, were mostly silent. They sometimes agreed to speak about influenza, but about the death rate - not a word.

It was necessary to wait for a whole month for the routine job of isolating the virus that caused the epidemic to be completed in the prestigious, allegedly an equal to any such immunological institution in the world - Torlak. The laboratory of the Bureau for Health Protection in Novi Sad was the first to isolate the virus of A group, type "Sydney" as the cause of the epidemic. This, of course, did not make anyone feel better, especially not the ailing part of the population, because this discovery had no effect. People are still dying of consequences of influenza in their homes. More than a decade of life under stress did its bit. Serbia is a country of chronic patients. Nowadays 150 thousand people are suffering from cancer, and every year another 30 thousand fall ill of the same disease. There are more than 100 thousand registered diabetics in the Republic. There is a similar number of the depressed, patients with heart failure, ulcer and those who have relapsed into tuberculosis.

According to the last year analysis made by Belgrade out-patient clinics, a large number of citizens are passing through different depressive states: reactive depression, depressive neurosis and depressive psychosis. Majority of the patients are at the age between 45 and 54, therefore they belong to the working population and due to psychic problems are often on sick leave.

At a recent debate of the Media Centre, Belgrade physician Vuk Stambolovic warned that the population of Serbia was in a state of extreme exhaustion and that it was quite logical that the latest epidemic which in the past few years would have been of much smaller proportions became something that threatened a lot of people, became dangerous to their life and led to a large number of deaths.

When we asked a physician to say something about the evident loss of immunity of the population in Serbia she said: "There is no point in that story. It becomes pointless for a people who are hungry and living under stress, in cold apartments in the middle of an epidemic, who have no prospects for the future, whose children have fled to various countries in the world, who live in an environment where even well protected people are killed in broad daylight. There can be no talk about immunity. We are a sick people who need every sort of aid…"

The health system which is falling apart is a separate story. In hospitals except those held and assisted in medical equipment, drugs and money by the Yugoslav United Left (JUL), the party headed by the wife of president Milosevic, there is absolutely nothing. Patients must buy everything needed both for surgeries and therapy: gauze, alcohol, needles, expensive drugs such as drugs needed for chemotherapy in treatment of cancer. Of course, this principle of robbing the patients refers also to the mentioned hospitals held by JUL. This practice was introduced without any transformation of health system, special regulations and laws because of total collapse of the system of health insurance.

By decision of the state, the greatest economic systems and other favourites of the regime are exempted from paying contributions to the health insurance fund. The people who live with the average salary of 80 German marks a month avoid going to hospitals until the moment comes when they cannot do without the help of a physician. And by then it is usually too late.

Added to the general state of exhaustion, the epidemic arrived like a cherry on top. The authorities obviously were not too excited about it. They are announcing another possible wave of epidemic of influenza and still do not declare because of what the people are dying more than usual. They have more urgent matters to attend to: how to remain in power. So the situation is quite regular in Serbia: the hospitals are full, there are no drugs in pharmacies either against influenza or for chronic sicknesses, just as there was not enough vaccines against the flu last autumn. There is just an abundance of misery, death, crime and the Mafia-like showdowns.