Coordination by Angelos Skordas
Edited by Panagiotis Sotiris
They travel for a simple examination and when there is no return ship they spend the night at the doctor’s office. They move to neighboring cities with a hospital or even to Athens during the last months of pregnancy. In extraordinary cases, they are forced to give birth even in Health Centers with the exclusive assistance of a midwife, while there is always the need for an emergency transfer to a large urban center.
Pregnancy for women in critical and inaccessible areas turns into a challenge – one of the many that those who stubbornly insist on setting up their lives in the Greek periphery have to face. Risks, anxiety and exorbitant costs accompany pregnancy in mountainous areas and especially on small islands, such as those of the Cyclades.
No secure infrastructure
“A pregnant woman in the Small Cyclades has to go back and forth to Naxos for her regular monitoring” says in “Vima” n Panagiota Voulgaris, president of the Cyclades Medical Association. As he explains, infrastructure that can support a safe birth exists only in Syros, Naxos and Santorini. “We would be pleased if almost all births on these big islands were catered for. But in practice this does not happen due to a lack of staff.”
“On the islands and in other regional hospitals there are too many problems” confirms the president of POEDIN Michalis Giannakos. According to him, there are dozens of places on the map without coverage of a pediatrician or other necessary specialties. “If a hospital does not have an anesthesiologist, as in Kythira, surgery cannot be performed. How will they manage a complication?’
The transfer process
So in many cases the transfer is the only safe solution. However, as described by Alexandros Zampraspresident of the Medical Association of Lesbos, it is not a simple process: “There is no fixed mode of transport. In other words, know that you will pick up the phone, you will explain the incident you have and at a specified time a specific vehicle will come to transport the patient to a specific structure.” Rather, the process is complex and almost always uncertain. “I have to look for an on-call clinic in Athens, find which doctor is on call, call him on his phone, ask him if he accepts the incident. If he gives me a positive answer, I should take the ER and explain to them that I spoke with such and such a doctor and he accepts the incident. And finally, let the EKAV answer me about the means they will send and when they expect it to arrive.”
Inequality in health services
A look at the geographical distribution of gynecologists-obstetricians in the Greek territory is revealing of the inequality in the provision of critical health services between the center and the region. According to ELSTAT, in Greece in 2022 there were 3,090 obstetrician-gynecologists, of which 1,429, i.e. 46.2%, were in Attica. On the contrary, in 11 mainland and island prefectures their number was in single digits.
Gynecologists per inhabitant
“Border areas are suffering” says in “Vima” o Loukas Klentzerispresident of the Association of Obstetricians and Gynecologists of Greece and doctor of the University of Sheffield. “Unfortunately, we have a very uneven representation of gynecologists per 10,000 inhabitants” he admits. As he emphasizes, in some areas this ratio climbs to 20, while in others it drops to zero. “The entire North Aegean does not have the gynecologists Vasilissis Sofias and Soutsou have” he says characteristically.
Insufficient care in Aegean – mountainous areas
“Geography makes it difficult for Greece: North and South Aegean have problems, as do the mountainous areas” continues Loukas Klentzeris. “In the region, and especially on the islands, the infrastructure for the care of pregnant women is lacking. On the contrary, in urban centers it is extremely sufficient.” Therefore, high-risk pregnancies from one point onwards should be transferred to Athens or at least to the regional university hospitals.
Incentives for doctors
For the president of the Association of Obstetricians and Gynecologists of Greece, it is imperative to give incentives to doctors, not only financial but also of a research nature, in order to practice the profession in remote areas. Michalis Giannakos also emphasizes the importance of providing incentives. “Otherwise why would the gynecologist or nurse go to an island?” he wonders. “The first gets 1,850 euros and the second 800. To live you need much more” he emphasizes, underlining that in these specialties there is a wave of resignations but also a lack of interest in the new announcements.
The cost is prohibitive for pregnant women in the Region
“The local administration must be pressured to provide accommodation for the doctors” completes on the part of the Panagiota Voulgaris. “Furthermore, local communities benefit significantly and directly from the presence of health workers”. Regarding pregnancy on the small islands of the Cyclades, the president of the local Medical Association emphasizes that insecurity and high costs – at least five times higher than in urban centers – are among the reasons why births are decreasing. “Usually pregnant women rent a house for two to three months. They are forced to move because the pregnancy is unpredictable. This means financial bleeding for the family.” explains and concludes: “Of course, if someone has the financial comfort, she can spend the entire pregnancy in Athens. However, for the average citizen, the cost is prohibitive.”
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