Zoran Kostovski, the Australian Honorary Consul in Skopje, is a man with incredible personal energy and vibrant enthusiasm. He is also connected at every level of government thanks to the success of his private company, Motiva, which he started after reading Body Language by Australian author Allan Pease. The objective of Motiva is to provide its clients with training in superior communication techniques – particularly of the non-verbal variety – and it is through his delivery of these workshops to politicians that Zoran has not only befriended Nikola Gruevski, Macedonia’s current prime minister but, to my great fortune, the current health minister, Dr Bujar Osmani.
When I first shared a bottle of Macedonian wine with Zoran he revealed there were only ever ten or fifteen Australians with no family connection to Macedonia visiting the country at any one time and that despite this minuscule number, they managed to keep him busy round the clock. This may have sounded like a complaint had Zoran not reassured me that he thoroughly enjoyed the entertainment his position afforded him. There was a poet who fell off his chair and fractured his hip. ‘Dangerous work, poetry,’ he said. Not long after, he was called to the police station for a female with schizophrenia found wandering the streets of Skopje in a state of undress. She had run out of medication while on holiday. Then there was the man who got so depressed after arriving in the drab city he promptly threw himself out of the second-storey window of his hotel. As anyone in ambulance work knows, the second storey is a half-arsed attempt at suicide. Once, I tell Zoran, I went to a man threatening to jump off the first level of a high-rise parking station. Ridiculous. Most interesting of all, says Zoran, was the man from Melbourne who arrived in Skopje at the time of the Victorian bushfires wearing little more than shorts and a T-shirt, carrying a handful of possessions in a small plastic bag. Apparently he wanted to get as far away from the fire as he could.
My request to meet the health minister, in order to acquire permission to join ambulance crews in Skopje, was a comparatively easy one, Zoran assures me. ‘And he’s an outstanding guy, in the toughest job, trying to do his best to bring reform.’
Indeed, on the day I’m meant to meet Dr Osmani, the front page of every newspaper shows hospital doctors walking off the job in protest at their low wages. In Macedonia, public hospital doctors earn little more than 400 euros a month, while nurses get 350 euros. Because the average rent is around 150 euros and electricity in the winter another 100 euros on top of that, most in the medical profession cannot even afford to visit a restaurant or have a drink in a bar. The wages are so low that over time it has become common practice to ask patients for money. Jumping the queue for surgery is achieved with cash alone and those without it may wait for a decade. The poor have enough trouble getting a prescription.
There is probably never a good time for an Australian paramedic to take tea with the health minister of a country burdened by such challenges. Nevertheless, I was invited to do so by Zoran and we sat in the very pleasant company of a softly spoken Osmani as he elaborated on his work.
Most significantly, his effort to stop kickbacks in the form of over-supplied medical materials to hospitals has put many of his public hospital doctors offside. At a Holiday Inn conference in 2008, Zoran introduced Dr Osmani to a patient classification software developed by Australia that keeps track of hospital resources and is known as the Australian Refined Diagnosis Related Groups (AR-DRG) system. Many countries suffering the effects of health service corruption have installed this program with enormous success, including Saudi Arabia, Greece and Romania. On behalf of the prime minister, Zoran negotiated the purchase of the AR-DRG software by Macedonia for a very modest price. Two years later it is ‘still in the process’ of being installed. Across Macedonia, hospital heads have made every effort to block its introduction, revealing just how many people are dependent on medical supplies kickbacks to supplement their incomes. As effective as the AR-DRG system may be, it does not address this root cause of corruption.
As for my placement on ambulances of Skopje, Dr Osmani has no objection and simply warns me not to injure myself. He is unconcerned I might pen something critical about the Macedonian health system. ‘It wouldn’t be news,’ he says. ‘Everyone knows the country is poor. Why should we pretend it to be otherwise?’
At a roadside kiosk Dr Aquarius buys us bottles of Pimp Juice, a local soft drink we sip through straws on the way to the next job. Earlier in the week I saw a billboard for the beverage depicting a smiling gangster with gold teeth. This is what many of the young men look like in Shutka, the capital of gypsies, and I wonder if it’s bottled there.
For my benefit Sammy takes the ambulance past the house of Esma Redzepova, known globally as the Gypsy Queen, a singer whose remarkable voice carries the collective emotions of the Roma, and whose music I have followed for some time. In opposition to those who react angrily to being labelled a gypsy, Redzepova encourages the Roma to be proud of the term and has always used the earnings from her record sales to distribute free medicine to the poor.
A little further on, near Topaana, one of the earliest gypsy maalos, stands the ominous new American embassy. Rumour has it this is not just any embassy. The complex is so vast one would need an hour to walk around it. Much to the dismay of Topaana gypsies it has also taken up every inch of what was once the beloved city park they used for weddings and picnics, forcing them onto a small, cramped traffic island in the embassy’s shadow.
Just off the Krimska Road, a family of rotund Macedonians has had a fierce argument during which the father has shattered a framed photograph of his wife and stormed from the house leaving her and his three adult children in a state of hysteria. The two daughters, both in their mid-thirties, are howling uncontrollably on the lounge while a younger man, probably in his late twenties, kneels at his mother’s feet sobbing. One would think the woman’s husband had passed away, but he has only gone to the pub. Were it not for the fact we attend jobs like this every day in Skopje I would not be so cynical. Nor would I be wondering why so many simple disagreements in this country result in group hyperventilation or all-out brawls.
Dr Aquarius tries to calm the lady, gives it about a minute or so, looks at her watch, then twitches an over-plucked eyebrow at nurse Spazovska and rolls up the sleeves of her lab coat. Spazovska knows the drill and opens a black briefcase she has taken into the house. In it are rows of glittering glass ampoules tinkling like little wind chimes whenever she handles them. It’s pretty much all the nurses ever carry, the drugs – the first line of emergency care in Macedonia. The only other items apart from medications are cotton balls for swabbing, needles and saline, and a bunch of thin candles to light for the dead. With nimble fingers Spazovska removes an ampoule of Valium 10 milligrams, snaps its neck, draws it up and hands it to Dr Aquarius.
Seconds after stabbing it in, without further ado, we are out the door.
Valium, valium, valium. Half the briefcase is full of the stuff. At a guess there’d be at least twenty ampoules in there and even that is not enough some nights. Morphine supplies may be out of stock, while some doctors buy aspirin for heart patients with their own money. But the Valium never dries up. This surprises me as the drug is dispensed like candy. So popular is Valium in this city that it is common for ambulance crews to administer ‘one for the patient and one for the relative’. Balkan funerals are the worst. At these there can be fifty, even a hundred, distressed mourners demanding a shot.
Our next job – or ‘invitation’ as the medics endearingly call them – is to a woman with high blood pressure and a headache. Again, along with a prescription for Monopril and a beta-blocker comes intramuscular Valium.
‘We take the Pimp Juice, they take the Valium,’ laughs Dr Aquarius afterwards. ‘That is how the world goes round!’
An hour later everyone is thrilled to have discovered an apartment block with an elevator, none happier than our smoking asthmatic nurse. On the top floor a man has been vomiting for a week. Exciting stuff, I think to myself.
The apartment is painted a deep red and decorated with