Dispatch

Poland’s Shortchanged Health Care System Is Already Straining

The country’s medical infrastructure is notoriously underfunded. Doctors say it will buckle under the coronavirus.

A mural paying tribute to the sacrifice of doctors, nurses, and paramedics fighting the coronavirus pandemic is seen in Warsaw, Poland, on April 2.
A mural paying tribute to the sacrifice of doctors, nurses, and paramedics fighting the coronavirus pandemic is seen in Warsaw, Poland, on April 2. WOJTEK RADWANSKI/AFP via Getty Images
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EDITOR’S NOTE: We’re making some of our coronavirus pandemic coverage free for nonsubscribers. You can read those articles here. You can also listen to our weekly coronavirus podcast, Don’t Touch Your Face, and subscribe to our newsletters here.

WARSAW, Poland—On March 15, Dorota Gontarz, the head of a primary health care center in Krzemien Pierwszy, a village in eastern Poland, learned that a patient she had known for 18 years had died after testing positive for the coronavirus. Officially, there are more than 4,400 confirmed cases of COVID-19 in Poland and 107 related deaths, but the true number may be higher due to limited testing. Meanwhile, Gontarz and other medical workers face dramatic shortages of personal protective equipment (PPE) such as face masks and gloves, putting their lives at risk. One-sixth of Poland’s confirmed infections are among health care workers.

For those on the front lines, Polish officials’ response to the crisis does not inspire confidence. The lack of information from the government about Poland’s coronavirus epidemic and a lack of diagnostic testing make contact with patients like a “Russian roulette,” Gontarz said. As elsewhere, the supply shortages have forced many hospitals to appeal to the general public for emergency equipment. “When the epidemic began, the government should have bought up all the personal protective equipment available on the market and stored it so health centers could buy it from them, not from bloodsuckers on online auctions, as we do now,” Gontarz said.

Medical workers in Poland also point out that the health care system has long suffered from a lack of government funding, even as state investment rises in other sectors such as public media and social spending. The disparity means hospitals and clinics are underprepared for a crisis like the coronavirus pandemic.

The ruling Law and Justice (PiS) party is not likely to take such criticism well, particularly not as Poland’s presidential election campaign enters its final phase. As other countries postpone major events, the right-wing PiS is determined to go ahead with campaigning and the vote on May 10—despite strong opposition from the other parties and the public. Crises can unite citizens around their leaders, and incumbent President Andrzej Duda—the PiS candidate—could benefit from focusing on the pandemic. Some polls suggest he will win an absolute majority in the first round. But the campaign could also provoke tough questions about whether Poland was prepared for an outbreak.

[Mapping the Coronavirus Outbreak: Get daily updates on the pandemic and learn how it’s affecting countries around the world.]

On March 14, the Polish edition of Newsweek published documents from the Health Ministry that indicated in January and early February it limited its activities to monitoring the situation and exchanging information with other government agencies. Even as the virus started to spread in Europe, Poland’s chief sanitary inspector claimed on television that influenza was a bigger challenge and that the coronavirus “will not be killing” the Polish people—prompting criticism that the government ignored the problem.

Government officials insist that their response to the coronavirus did not come too late. Poland closed its borders and went into lockdown in mid-March, ahead of Germany, France, and the United Kingdom, and soon afterward introduced strict social distancing measures. “We were a step or even a few steps ahead of other countries,” said Anna Kwiecien, the deputy head of the parliament’s health committee. “One may always say something could have been done better, but I don’t know what else could have been done in this case.”

Poland has just 238 physicians per 100,000 inhabitants—the lowest ratio in the EU.

But medical workers grappling with the rising number of critically ill COVID-19 patients say Poland’s underfunded health care system, which has suffered years of government neglect, will be overwhelmed by the pandemic. Poland, the eighth-largest economy in the European Union, ranked 32nd of 35 countries in the 2018 Euro Health Consumer Index, which compares European health care systems based on accessibility and wait times, patient rights, and health outcomes. Poland also has just 238 physicians per 100,000 inhabitants—the lowest ratio in the EU.

Likewise, Polish hospitals weren’t prepared for the coronavirus. A doctor who requested anonymity told Foreign Policy that their hospital in Grudziadz, in northern Poland, was chaotically transformed into an isolation facility in March. Within a few days, doctors including psychiatrists, ophthalmologists, and ENT (ear, nose, throat) specialists were delegated to work with COVID-19 patients without any preparation. “We didn’t receive any guidelines,” the doctor said. “Most of the things we have learned from YouTube or from friends in other hospitals. Right now, it works somehow, but I’m afraid that infections among doctors will be inevitable if we’re going to work like that. And there are only few of us.”

“No one in the world was prepared for such a crisis,” they added. “But here it really looks like we are moving in total darkness, without any procedures prepared in advance.”

Amid continued economic growth and budget surpluses, PiS has recently been more generous with its public funds, overseeing an increase in public health care funding from 4.5 percent of Poland’s GDP to a planned 6 percent by 2025. But that still makes Poland one of the lowest-spending EU countries—well below the EU average of 10 percent. According to the doctor in Grudziadz, much of the increase in funding has been used to reduce many Polish hospitals’ “enormous debts.”

Critics say more money has gone to sectors that were crucial in putting the ruling party in power.

Critics say more money has instead gone to sectors that were crucial in putting PiS in power, such as increased social spending and funding for loyal media outlets. For example, almost $20 billion has been spent on the party’s flagship child subsidies program—distributed  regardless of family income—seen as playing a crucial role in its reelection last October. In February, the Polish parliament granted public media outlets—which have been transformed into hard-line propaganda mouthpieces for PiS—more than $470 million. PiS government officials now receive positive coverage for their coronavirus response, while the opposition is attacked for interfering and the EU criticized for passivity.

But many say the problems with Poland’s health care system stem less from recent spending disparities and more from systemic neglect beginning before PiS took power. Since 2014, successive administrations failed to ratify an agreement allowing Poland to take part in the European Commission’s joint purchase of PPE and other medical equipment. Poland at last joined the initiative in early March. “A pact on how to reform the system has never been worked out due to political divisions,” said Krzysztof Landa, the deputy health minister in the 2015-2017 PiS government. Each government begins its term by throwing out the ideas of its predecessors, he said.

What also doesn’t help PiS is that a large part of Poland’s medical community was already in conflict with the party. Janek Switala, a paramedic from Warsaw, said the government had repeatedly shown “embarrassing disrespect for us medics.” “Using public media, they have tried to turn the society against us,” he said. In 2017, resident doctors protested over low pay and health expenditures. Government-friendly media outlets presented photos of one doctor’s foreign medical mission as a luxurious holiday. During a parliamentary debate at the time on young doctors leaving Poland for better-paid work abroad, one PiS deputy yelled, “Let them go!”

Medical workers are increasingly afraid to speak out about the response to the coronavirus, and some who do go public are fired. Unsurprisingly, the government’s reaction to the crisis has only raised fears among medical workers that the pandemic will bring the overwhelmed health care system to the brink of collapse, as it has done in more developed systems such as in Italy and Spain.

“I am a doctor. My husband is a doctor,” said Gontarz, who works at the primary care center. “We did everything to prevent our daughter from becoming a doctor. Not in Poland.”

Dariusz Kalan is a Central Europe correspondent for international media and an analyst based in Warsaw, Poland. Twitter: @Dariusz_Kalan

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