HEALTH SINCE 1945: INSTITUTIONALIZATION PERIOD, PART 2

An important factor, which determines the pace of medical science in Bulgaria from that period, is a drop out from the international isolation of the country - that, has been concomitant since the end of WW II. This is a welcome association with a number of international structures - UN, WHO, UNESCO, etc. - and, an important step forward to following the tendencies and programs of world community, as well as, the cardinal problems of men-environment-disease in the 20th century. This cooperation aside, Bulgaria continued to support intensive contacts with the countries of the CMEA /Council for Mutual Economic Assistance/. This international community of socialist countries, based on economic relations and fraternal cooperation, was created in 1949. It hosted international socialism, and, some non-aligned countries like Finland, Iraq, Mexico on the basis of relevant agreements until dissolved in year 1989 by political liquidation. Whatever the form of cooperation, the bulgarian medics participated actively in the field of health progress. For example, an extremely important project of the WHO and a group of bulgarian clinicists with leader Prof. Alexi Puchlev, was implemented on the research of Balkan Endemic Nephropathy from the early 60s.

Another important feature of medical science was the augmentation of medical cadres. It was evident that post-war Bulgaria lacks the plethora of specialists, necessary, to reform a health care system. Thus a massive trend was established towards production of medics. On 4 August 1945, with decree 180, was established second medical faculty in Plovdiv. Consecutively, medical faculties were opened in Varna /1960/, Pleven /1964/, Stara Zagora /1982/ and after the conglomeration of the National Medical Academy in 1972, filials were bridged in the towns of Tolbuchin and Pazardjik. Namely, this gave an increase of physicians, from 3 500 in year 1944 to 28 500 in year 1989. The tradition to specialization of cadres abroad continued - as, hundreds of young specialists became candidates and doctors of medicine in the frame of WHO programs and exchange fellowships with CMEA countries, viz. Soviet Union, GDR, Poland, Czechoslovakia, Hungary. However, the internal aspects of coordination were not neglected. The Bulgarian Medical Union /BMU/, which functioned short after the war, stepped place to an alternative organization - Union of Scientific Medical Associations in Bulgaria /USMAB/, based on a topic principle. Ultimately, the new organization was responsible for a network of internal relations in the forms of congresses and seminars, as well as, for providing an atmosphere of educational and ethical problem solving. This, however, not always gave a positive result - sometime, the principles of so called "democratic centralism" were broken and appeared ugly phenomenons, like, "loss of a job" or "transfer to another place" or "financial penalties", etc. Simultaneously, capitalism was presented with a monster face and the era of senators Mackarthy and Fullbright sentenced to decay. But, those were the realities of the 60s and we are not in a position to debate on the questions of Cold War, right now.

Health care from the beginning of the institutionalization period is characterized by the following features, namely:

1. increased adaptability to the new lines of social-economic progress;

2. more regulation towards the utility of resources, and, mobilization of self-control specifically in the field of prophylaxis;

3. enhanced cooperation of health care with other spheres of the social system, with, regard to complex determining of health and social problems;

4. further democratization of the health care system in accord, with, state and party directives /N.B., understand here development of relations of production, productive forces and surplus product/;

Minister of Health from that period is Dr. Kiril Ignatov /1962-1971/. Most important lines for the development of the state and the party, within frames of the Fourth and Fifth Five-Year Plans, are the decisions of the "9th Congress of BCP" /1966/ and "July Plenum of CC of BCP" /1968/. Now, while trying to be parsimonious with the interpretation of data from that period, we encountered some difficulties in the transfiguration of the material. In a future presentation we shall aim to give a fuller account of the state of health care system for the period. For the moment we have at hand some papers, presented by the Minister of Health in 1968, and, entitled "Cardinal lines of health development in the People's Republic of Bulgaria". Here are some excerpts from the concluding sections of the document:

"... In full accordance with the Thesises of the 9th Congress of the BCP, the main task of the social policy of the BCP is "to assure high vitality of the nation, to affirm a healthy way of life, to build up more favorable conditions for the multilateral manifestation of the human personality". The complex approach to health comprises the accelerated development and realization of all specific activities, that, affect the solution of the health problems.

... The Party pays a special attention to the establishment of a healthy way of living, and, the nation-wide movement for high health culture. With regard to this, additional efforts will be made for the further development of mass physical culture, sports and tourism, for increasing the sports and tourists base and its using, especially by children and youth.

... Medical science has risen to a new higher level, respectfully, of its function and importance as such on account of the higher criteria and more important role of health care. The leading force of the scientific and technical revolution in our socialist health care is the powerful scientific, educational, production and organizational-methodological potential. The coordination of the research work programs is being improved, as well as, its complex character. The information possibilities are of much better use now ... New forms of immediate transfer of the latest domestic and foreign scientific results to the consumers are organized - the health workers in the practical health network.

... In the political report of the CC of the CPSU, delivered by comrade L. Brezhnev, and in the new edition of the Program of the CPSU enormous attention was paid to the development of health care in the Soviet Union. The political report of the CC of the CPSU states, that "For both man and society there is nothing more valuable than health. The preservation and consolidation of people's health is of primary importance". The problems of health care must be considered and worked out from wide scope social positions, by involving the Councils, the Comsomol, with the public initiative and the activity of the population ... This identity in the Party's outlines for the development of our and Soviet socialist health care is determined by the decades old links and harmony between the BCP and the CPSU, between our countries and nations, between our health care systems. Our socialist health care was created and developed on the Soviet health care model, using all the time its enormous experience and achievements. That is the base on which the identical goals, means and ways of development are formed."

/to be continued/.