Bulgarian Union of Physician Assistants and Feldshers

STATE AND PROBLEMS OF HOSPITAL CARE AND INTEGRATION IN THE NATIONAL HEALTH SYSTEM

HEALTHY SIMOV KARAMITEV
STATE AND PROBLEMS OF HOSPITAL CARE AND INTEGRATION IN
THE NATIONAL HEALTH SYSTEM
A B T O R E F F R A T
OF DISERTATION WORK
awarding the educational and scientific degree of Doctor,
 Modern health systems face increasingly difficult challenges, driven by the a priori humanity of medicine and limited resources. A major problem of our health care is the failure to integrate hospice care into the health system. The ambition of modern health systems to provide universal health coverage is refracted through the prism of evidence-based health needs. The principle of equal health care throughout the life cycle of human life makes hospice care an integral part of modern health policies.
   The concept of hospice originates from the Latin word hospitum, which means private boarding house. The first institutionalized hospice was opened by Cecily Saunders in 1967 in London. Sweden launched the first specialized palliative care in Europe in 1977. The rapid growth of hospice populations in developed countries gives them a decent place in health systems.
   Historically, the development of hospice care in Bulgaria has gone through two phases.  The first phase of the non-medical model is associated with the development of organized care for terminal patients from vulnerable groups of society.  In 1989, Donka Paprikova, with funds from a charity campaign, created the Mother Teresa home, where terminally ill people are cared for. In 1994, the movement was registered as the Hospice Mercy Foundation. The second phase of the integrative medical model is characterised by the fact that in 1999 hospices were already registered as medical institutions.[1] The Law on medical institutions[25] provides in general for three large groups of medical institutions, according to their medical activities in Chapter Five – ‘Other medical institutions’. It is in this so-called ‘third group’ of medical institutions that the Bulgarian legislator has included hospices, nursing homes, dispensaries, etc.[13]
   The terms ‘palliative care’ and ‘hospices care’ have been used for many years with different interpretations. In some countries they are interpreted as unambiguous, in others they are interpreted as different in terms of scope and types of activity. In Bulgaria, since the last change in the ZLZ, the "hospice/paliative" model has been adopted, positioning hospice as the main providers of palliative assistance
   In this study, we will use the term hospice/palliative as unambiguous to hospice, i.e. hospice care will be presented as hospice/palliative care.
   The long transition in our country, the economic crisis, the deinstitutionalization of social homes and the lack of structures for palliative care have caused shocks in the reforming social and health system. The access and quality of long-term care in the country has deteriorated. There was an increasing need for hospice/palliative care structures. Recognizing these trends, the reformed healthcare system envisioned a reorganization of hospitals that would include the creation of hospice services.  Hospice was expected to meet hospice/palliative care needs and reduce costly hospitalisations. Unfortunately, this idea is not realized. There was a real opportunity to provide resources and develop hospice. The operation of these hospitals without public resources makes them unprofitable.[29]
BSLAF - news

Open letter from Assoc.

OPEN LETTER

To the members of BSLAF

Prof. Penka Vracheva, PhD

 

Dear colleagues,

This open letter is addressed to all interested, analytically thinking and objective in terms of facts, events and comments members of BASF to share my decision and position on some issues.

I do it with respect to all of you!

I am officially retiring from the post of Deputy Chairman of the NSC of BSLAF.

I withdraw with dignity because I have no reason to be ashamed of my deeds.

 

Before any suspicion or speculation arises, I inform you that the decision is in the name of my family. A difficult decision for me because I have been working since 1990 on the idea of having an independent, nationally representative PSO. I have been working in a team with colleagues who are current management since 2009. The creation of the organisation for me is a cause to which I have dedicated energy, intellectual potential, image, which I have built honestly and according to the rules of time spent on my personal time, with which I have harmed my loved ones, and last but not least money spent from the family budget – I have always worked for the cause free to this day.

I will be frank in sharing that I was very hesitant about my choice - to be brief and to post my decision or to write this open letter. I chose the latter because I have to disclose some facts, leaving the conclusions to you.

I owe it to my current and former students. These young people need to know the truth, and that to stand up for it you need to be strong and willing to pay a certain price personally.

I respect the people who stand behind their words and deeds, who are responsible for them. Throughout my adult life, I have tried to be responsible, and I share Oscar Wilde's thought: ‘A person is valuable when his words coincide with his actions.’

There are no sinless people, but it is important for me that we try to be people with morals and values – to be decent people. Strive to achieve the goals, let's not forget to be correct and leave something worthwhile behind. I am not and cannot be indifferent to the attempts of some colleagues to overthrow the ‘toddler’ to whom I now liken the organisation BSLAF. My personal explanation, based on observations and not insignificant life experience, for the basis of their behavior: some are ambitious with dreams they cannot achieve, others are looking for personal dividends, others have lost positions and personal benefits they had during the time of our associate membership in BAPZG.

Every day we witness, in professional Facebook and Viber groups, endless posts with insults, accusations and attacks, calls for democracy, for order in the organization, colleagues are organized to oppose the Board of BSLAF. I am convinced that we all dream of an authoritative organization to solve our professional problems piled up with fit. Unfortunately, there is no magic wand for success, no matter how much we want it. The only formula for this is hard teamwork, unity, ethics and trust. I admit that I find it hard to believe in the benevolence of appeals. Facts are presented, documents are presented, comments are made – let each of you decide for himself what to believe. But in order to make your personal and justified choice, I will allow myself to bring to your attention substantiated facts regarding everyday ugly attacks, unfounded accusations, including threats with regard to my personality. And not because I am important in this case, but because of the activities to which I am responsible with expertise, credibility and the right to orient yourself in the situation.

About LA training:

I have devoted, together with other colleagues, a lot of energy for years to resume training and the profession. We started the L.A. programme at the Medical Faculty in Stara Zagora. To date, the feedback from employers about the staff trained in the faculty is excellent, and this can only please us - we will have worthy followers. In this sense, you assess the correctness and credibility of the accusations that I train students only in health care and by the number of classes in the discipline I serve my personal financial interests, which harms the learners in terms of medical knowledge. With such an explanation, the person fighting for democracy in BSLAF and a zealous critic of mine (I consciously do not call him a colleague) most irresponsibly determined the training of LA at the Stara Zagora Ministry of Finance for Anomaly and asked if the Ministry of Health and the Ministry of Education know about it. I would not bother to explain anything to this person, as I have not done so far, but when the claims concern the authority of the educational institution and can be grounds for hesitation among students, things should be clear and scientifically justified.

With regard to the discipline ‘General care for the sick’, let us be objective, we have all studied it and this is how it will be in the future – we know why. I explain that the minimum workload of all subjects studied in L.A. is written with a curriculum according to an ordinance. Each educational institution, as an autonomous one, has the right to set additional classes in a given discipline, which does not harm others. The argumentation of the proposal for additional hours is fine-tuned at the Faculty Council and voted on. In any specialty, including LA, training every four years is subject to accreditation, that is, an expert commission from the Ministry of Education and Science assesses the quality of training according to a number of criteria. To what extent the training of LA in Stara Zagora is an ‘anomaly’, you judge, since the grades from the last two accreditations of the specialty in the faculty are the highest of all the educational institutions in the country that train these professionals. In addition, there is no recommendation for correction in the curriculum, which is extremely rare.

According to the Ordinance on EDI (Unified State Requirements), the training in the mentioned discipline OGB, in which I lead a lecture course and exercises, must be taught by a habilitated person (docent or professor) with a basic qualification corresponding to the specialty of the students. In short, midwives are trained by an associate professor/professor with a basic qualification of midwife, nurses by nurses respectively, and LA by a habilitated person paramedic, in the future I hope by a habilitated medical assistant. The purpose of the requirement laid down in that regulation is to provide training to ensure that the specific professional model of the staff is maintained.

As a lecturer, I am also committed to training students in clinical practice - in clinics of internal medicine, surgery and pediatrics, where it is more than clear that only health care is not practiced. In attacking me, this fact is conveniently kept silent, even though a colleague of mine pointed it out in the name of truth.

(I explain that the exercises in clinical disciplines are conducted by doctors, according to the requirements).

I regard the controversy surrounding LA’s education at the Faculty of Medicine in Stara Zagora as criminal speculation, because it reflects on the dreams and hopes of medical assistants, especially students who have created their vision for their future as professionals. Let me recall how irresponsibly it was stated that training in the specialty of ‘Medical Assistant’ would be discontinued in 2027.

Given the practice of the medical activities and responsibilities delegated to us by the medical practice, all professionals are rightly excited about the direction in which we are assigned at the present time. It is incorrect to suggest that I am making efforts to ensure that our profession is in the health care sector, which clearly does not correspond to the truth. If this question were within my power and could be solved by me, then it, I assure you, would no longer exist as a problem.

And in order to get a clear idea of my statements on the matter, please read the report of the NSC, uploaded on the official website of BULAF, specifically point 5. Personally, it's my idea that we've been able to implement.

We agreed, with the Rectors Managing Body of Trakia University, the opening of two Master's programs for LA - with clinical qualification in Emergency Medicine and Primary Medical Care. To be justified in defending this idea, I worked for years, doing research to prove the need for such training. The results of the study were analysed with colleagues and published in the Journal of General Medicine, issue 5, 2024. They were also presented to the attention of colleagues attending the First National Conference of Medical Assistants in Stara Zagora.

At the workshop on the topic of the Master's degree programmes, the management proposed the training to start from September 2025, but since it takes technological time to prepare a curriculum and form a teaching team of authoritative in the medical fields, we decided that it is reasonable to start the training from the next academic year. Possibilities for subsequent opening of doctoral programs were also discussed, which would provide an opportunity for LA for scientific activity and academic development.

Logically, with my resignation from the post of Deputy Chairman of the National Academy of Sciences at BSLAF, I also cease my work with regard to the Master's degree programmes. I correctly provide other experts with the opportunity to work on the topic or... possibly the opportunity to express themselves to those who proudly, ironically to me, claimed to be ‘medics, not academics’.

Dear colleagues, do you consider the ethical person who allows himself to publicly discuss my professional competencies without knowing me? In her post, she bluntly said ‘I know some things about her’.  And if you logically ask yourself why it is done, I think you can guess for yourself. The things that are supposedly ‘knowed’ are deliberately suggested by some people who, in order to achieve their personal ambitions, have an interest in compromising me. I ask myself, are they smarter or more respected with their intriguing methods?

I have correctly submitted my CV (CV) to the Board of BSLAF, which I hope will become available on the official website of the organization, so that everyone who is interested in it can get acquainted.

I am outraged by the attacks and insults directed at my current and former students, who have been described as my ‘obedients’. Ugly attacks were made against the LA student organization and its president. He's being insulted by an unfamiliar fellow doctoral student just because someone thinks that the research he's doing that's going to benefit LA has something to do with me. I, myself, have been described as a ‘communist teacher’.

I am embarrassed by this attitude of people I find it difficult to call colleagues. What example can we be for our young followers when all ethical norms and boundaries are crossed?

I have heard insults such as ‘reproaches’, ‘subjects’ and all sorts of ugly language. With regard to myself, I could responsibly state that I have never been and will never be a supporter of anyone. I took on responsibilities in the NSC team because I wanted to provide the expertise I have free of charge for the benefit of the profession and the profession. To what extent I have managed, I leave it to my colleagues with analytical thinking to make their own decision and come to the truth by comparing words and deeds, in this case I see my deeds, both in terms of my past activities and in terms of working in the team of the NSC of BSLAF.

I believe that I have nothing to be ashamed of, but I logically ask myself, and all of you, honourable Members, by these methods and repressive means, do these "fighters" "stand up for" values and "build" the democratic vision of the BLAF?

I leave the answer to this question to all of you, thoughtful and objective professionals. I am convinced that you will cope with this challenge, led by the thought that with your decision and position you become empathetic to the future and the authority of the profession. And let's not forget the two wise teachers: Life and Time...! They will prove the TRUTH to us all!

I would like to extend my heartfelt thanks to all the colleagues we have worked with over the years. I wish you health and professional success in the future! Be appreciated with dignity!

Success of the Board of BSLAF in working for the prosperity of the profession and modern professional vision of the staff with the qualification "Medical Assistant".

 

29/05/2025

 

With respect:

Prof. P. Vracheva, PhD

 

Petition

IN SUPPORT TO SUPPORT FUNDING FOR AT LEAST 100 DAYS OF PALIATIVE CARE FOR ALL 

"100 DAYS OF PALIATIVE CARE -100 DAYS OF DESTINATION"

 

Dear Ladies and Gentlemen,

We demand funding for at least 100 days of palliative care for everyone A Bulgarian citizen in need.     

To support the provision of equitable and accessible palliative care for all.

Help spread the message that palliative care should be recognised as a human right, not something that depends on geography, age, diagnosis or income.

Let’s ensure palliative care is recognised and accessible – for all!

 

Scan QR CODE AND VOTE:

qr-petitsia

27 May – World Emergency Medical Day

Dear colleagues!

Dear friends!

The Management Board of BSLAF warmly congratulates you on the occasion of May 27, the World Emergency Medical Day! Today we give deserved recognition to you, the people who stand on the front line in the most difficult and critical moments of human life. You don't just save lives, you bring hope back to where it seems lost. Your work and dedication is an expression of the highest manifestation of humanity.

Bow to your tireless work and patience, as well as to the hope you bring! We express our sincere gratitude and gratitude to your work and dedication with which you save lives every day! I wish you health, strength and satisfaction with the mission you carry with honor and dignity!

With respect and gratitude,
the Board of BSLAF

Extraordinary Congress of BULAF – 27.06.2025

On 23 May 2025, the Board of Directors of BSLAF convened an extraordinary Congress in accordance with Article 7(4)(1) of the Statutes, which will take place on 27 June 2025 in Sofia.

Starting time for registration of delegates - 9.30 a.m. The Congress will be opened by the Chairman of the Board of BULAF at 10.30 a.m.

The Congress will be held under the following DAY ORDER:

1. Examination and adoption of the financial statement for 2024 of the Bulgarian Association of Bulgarian Associations in Bulgaria (BSLAF) and approval
and adoption of an updated draft budget for 2025.
2. Consideration, discussion and vote on the proposed changes by
Ministry of Health in the Code of Professional Ethics of BSLAF.
3. Examination and vote on resignations of members of central bodies
of the BSLAF.
4. Consideration of proposals and nominations for regular and reserve members of the
central authorities of the UASF. Election of regular and reserve members of the central
bodies of BSLAF.

Important: Due to the large number of events organized in the city.
Sofia in the period of holding the Congress, the Board of BSLAF decided to
provided additional time for the organisation of a hall by the Secretary-General, such as
commissioned, additionally and not later than 15 days before the date of holding
Congress to notify you in writing of the exact location and address of the meeting.
Information on the venue of the Congress will also be published on
the official website of BSLAF.

With respect,
Alexander Alexandrov,
Chairman of the Board of BSLAF

Happy May 24th!  

 

Happy May 24th, folks!

Let us keep and build the belief that knowledge and spirituality are the spark for the progress of humanity! Because only with knowledge can we build our better future!

Happy holiday to our fellow university professors who have dedicated their way not only to the protection of human health, but also to building the spiritual health of our future colleagues - the students!

Happy Holiday!

 

With respect,

the Board of BSLAF

General Assembly of RC Sofia – 07.06.2025

Dear colleagues,

The Board of Sofia City convenes a General Assembly for its regular members, which will be held
07.06.2025 /Saturday/ at 11.00 on Tsar Boris III Blvd., N136A, after registration
Attendance, with the following agenda:

1. Report on the work done so far, acquaintance with the main documents of the
The Regional College of Sofia City.
2. Election of delegates to vote at the General Assembly.
3. Adoption of the Statute of the Regional College, adoption of the Rules of Procedure of the
the bodies of the Regional College.
4. Dismissal of the Chairperson of the Ethics Committee and election of a new one.
5. Financial Report of Sofia City so far.
6. Others.
The meeting will be held on a delegate basis - one representative of three members.
I ask for your activity and commitment.
Membership cards will also be distributed.

With respect:
Desislava Tsenova
Chairman of RC - Sofia city.

General Assembly RK Blagoevgrad – 30.05.2025

To all regular members of RC Blagoevgrad

The Board of Directors of RC Blagoevgrad convenes a general meeting on 30.05.2025. (Friday) at 11:00 in Blagoevgrad, 2 Bratya Miladinova Str. (RHI building).

The meeting will be held on the following agenda:

Report of the Management Board for 2024 and the first quarter of 2025
2. Others.

With respect:
Krasimir Tanchev
President of RC Blagoevgrad

Meeting of the Board of Directors of BULAF - 23.05.2025

TO MEMBERS
OF THE GOVERNING COUNCIL OF THE BULGARIAN UNION OF MEDICAL ASSISTANTS AND FELDCHERS

Concerning: Meeting of the Management Board

Dear Colleagues,

I am convening a meeting of the Board of Directors of BSLAF, which will be held on
address: Sofia, 136A Tsar Boris III Blvd. at 11:00 on 23 May 2025, at
the following agenda:

1. Adoption of the 2024 Financial Statement and examination and adoption of an updated
draft budget 2025
2. Adoption of Internal Rules, Policy and Rules for the Site and the Appendices to
them in compliance with Regulation (EU) 2016/679 and the Personal Data Protection Act
data.
3. Consideration of proposed changes by the Ministry of Health
in the Code of Professional Ethics of BLAF.
4. Convening of the first for 2025 Extraordinary Congress of UASF and designation
of the agenda, date and place of its holding.
5. It's all sorts of things.

With respect,
Alexander Alexandrov,
Chairman of the Board of BSLAF

General Assembly of RC Smolyan – 12.06.2025

Dear colleagues,

The Management Board of RC BSLAF, Smolyan, at its meeting of 12 May 2025, decided:

On the basis of Article 24(2) of the Statutes of the Bulgarian Medical Association, a General Meeting of the Regional College of Smolyan was convened on Thursday 12 June 2025 at 14:00 in Smolyan, Bulgaria Blvd. 24, floor 1, office 108, at the premises of the former Dental Clinic, with the following agenda:

1. Report of the Board and Committees for the year 2024 and first quarter of 2025
2. Other

12.05.2025
gr. Smolyan
President of the RC of BLAF – Smolyan
/M.F. Emilia Ayanska/