What the death of a journalist from COVID-19 says about Croatia’s health system : Peoples Dispatch

Croatian investigative journalist Vladimir Matijanić died from COVID-19 in Split on August 5. His death led to a wave of criticism against the current minister of health, Vili Beroš, and his mishandling of multiple problems that are weighing down the health system. Health services in Croatia have been weakened by years of austerity and commercialization policies, which have affected working conditions, reduced the trust of patients in the public health system, and paved the road for corruption.

Matijanić, 50, was one of the most respected investigative reporters in the country, responsible for uncloaking cases of corruption and profiteering at the highest levels. He also suffered from a number of autoimmune conditions, which necessitated regular treatment. Yet, even as his COVID-19 infection got worse, Matijanić did not rely on personal connections to speed things up –  one of the most widespread conventions for accessing timely care in Croatia today,

Ministry’s head-in-the-sand response

Matijanić suffered from interstitial lung disease and Sjorgen’s syndrome, which put him at additional risk of developing a severe form of Covid-19. But following advice of his local immunologist, he was not vaccinated against the disease. The formal inquiry after his death attempted to paint this as evidence of the journalist’s irresponsible approach to his health. They looked for additional evidence of the same in his alleged non-adherence to prescribed therapy and postponement of diagnostic procedures.

These claims were soon challenged by Andrea Topić, journalist and Matijanić’s partner, who insisted that his actions were driven primarily by health professionals’ advice. Instead, she warned, the responsibility for his death lies not with him or with the inexperienced health workers who screened him on multiple occasions between August 2 and August 5 but with a system which is unfit to meet the population’s needs, and those in charge of organizing it.

On the day of his death, Matijanić experienced bouts of coughing and extreme weakness, not being able to walk to the bathroom. In spite of that, he was not hospitalized after the first visit of the emergency team, and he died when they were called again after less than two hours. Topić recounted that during the phone calls she and Matijanić had with health institutions, their doubts were dismissed and his symptoms actively downplayed. When they did manage to secure an emergency check-up at the hospital, it was carried out, against protocol, by a resident doctor without in-person supervision from a specialist.

Attacks on health workers on social media followed soon after Matijanić’s demise. But as Topić herself pointed out on several occasions, physicians, nurses, and other health workers find themselves in a difficult position – beginning from being forced to work in understaffed facilities. Split Clinical Hospital is notorious for not being able to recruit the number of nurses they look for; and that number is still below what they actually need. Physicians, including many junior doctors, choose to emigrate over working in a health system which operates largely due to overtime work – which often goes unpaid – and comes with generous amounts of bureaucracy.

Leaking medicines policies

Contrary to the explanations which came from the Ministry of Health after Matijanić’s death, the post-mortem indicated that his condition called for hospitalization, and that his chances of survival would have improved had he been admitted. Some health professionals who looked at the reports but remained outside the official inquiry team pointed out that his condition could have benefited from the prescription of Remdesivir, used for the treatment of Covid-19 patients in hospitals, as well as Paxlovid.

Even if Matijanić had been transferred to hospital, he wouldn’t have been able to access either of the drugs. On August 5, while 605 patients in Croatia were hospitalized because of Covid-19 and 10 people died from the disease, Split Clinical Hospital was out of Remdesivir, as were other major hospital centers. Paxlovid was not available anywhere, as the ministry repeatedly postponed direct procurement and relied on the joint procurement process at the EU level. While some European countries which turned to bilateral negotiations with the drug’s producer Pfizer already have excess doses of Paxlovid, (eg. Germany), Croatia still had none at the beginning of September.

The procurement and distribution of Covid-19 drugs is not the only example where local policies linked to medicines have failed. Also in August, two oncology nurses and one physician in Rijeka Clinical Hospital faced disciplinary action as they were accused of letting cancer drugs worth hundreds of thousands of euros go to waste. The health workers stored the unused drugs – ordered for patients who died before starting their treatment, or whose course of drugs was altered in the process – in one of the rooms staff use as storage space, where they went past expiry date.

Hospital administration presented this as an exclusive fault of the health workers, but failed to mention that there was no other sanctioned course of action that they could have taken. There is currently no protocol that would allow hospitals in different parts of the country to redistribute the unused drugs for the benefit of the patients, and help to bring down the costs for drug procurement.

Problems will persist barring systemic changes

Following public uproar after Matijanić’s death, the Ministry of Health launched a formal inquiry. The results, presented at the end of August, concluded that no missteps were made by health institutions or professionals that contributed to the outcome. Instead, the minister implied that Matijanić had better access than most would have in his position, since he was at least able to reach health providers through phone.

With this, it seems the minister considers the case closed, with all involved parties, except Matijanić himself, exonerated from any responsibility. Since then, however, health workers and public health experts have warned that this is not the only case where a lack of resources and coordination resulted in death, or other serious consequences for patients.

In an interview with the weekly Novosti, Anton Glasnović, neurologist and activist of the left party Workers’ Front, pointed out that there were dozens of cases such as this every year, but they remain under the radar as the patients were not public figures. According to him, the fact that some patients are never able to access the care they need cannot be addressed in the same framework which is causing the issues. Instead, the only way to address the existing problems is going back to a concept of healthcare based on the needs of the people.

People’s Health Dispatch is a fortnightly bulletin published by the People’s Health Movement and Peoples Dispatch. For more articles and subscription to People’s Health Dispatch, click here.