Shunning Western Europe to help the locals

Grandma Milka lives in a tiny village some 100 kilometers (60 miles) northwest of Bulgaria's capital, Sofia. She has high blood pressure, and quips that might have to do with all the soap operas she watches. Some of them are just so dramatic and emotional that they get her all worked up, she says. In truth, her blood pressure is most likely the result of not taking her medicine when she should.

"You need to take your medicine regularly," medical student Sheip Panev advises Milka. "That's really important. And remember to take it in the mornings, not late in the day." Panev, who is about to complete his medical studies, has devoted his Sunday to tending to the elderly in Milka's village. Bulgaria's northwest is one of the poorest religions in the entire European Union, and most young people have left the area. Once a month, for those who are lucky, a doctor will come and tend to the few who stayed behind. But in winter, that depends on the weather.

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Bulgarian state neglects rural population

"I always tell my daughter: By the time I've called you after something has happened to me and you have traveled here from Sofia, you might as well bury me," complains Milka. "We don't have a doctor. I have often prayed we will find a doctor who will at least come here on Mondays, Wednesday and Fridays." She says there is a midwife who lives in the village: "When I have pain in my leg, I go to her to get a shot."

Panev is sick and tired of situations like this, which is why he and other doctors from a Sofia hospital volunteer to care for the elderly in Bulgaria's poor, depopulated villages. For Panev, it's not just about gaining hands-on experience as a doctor. He complains that the Bulgarian state is not fulfilling its duty. "We need to help these people, because the state is clearly unable to do so," he says, admitting that these elderly women remind him of his own grandmother. "These people really appreciate what we do, and I am happy if I can do something good to help."

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A dearth of social services

Three years ago, Jana Rupeva of the Bulgarian nongovernmental organization Project Northwest also began assisting those who have been left behind in the country's rural villages. "Apart from caring for the elderly, we try to help teenagers with intellectual disabilities who spent all their lives in special institutions integrate into society," she says, explaining that such work includes helping them with basic things like how to get out onto street, ride trains and read the time. Critical of the fact that rural regions often lack basic social care providers, she managed to establish a workshop for individuals with intellectual disabilities through donations, but the Bulgarian state does not contribute any money. Rupeva also plans on founding an organization where these individuals prepare and deliver food to senior citizens.

"These elderly people can hardly believe someone is tending to their needs," says Rupeva, adding they are extremely thankful that, thanks to them, they can now lead a decent life despite their old age.

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Who will be left if everyone leaves?

Without volunteer medical professionals like Panev, rural Bulgaria would be lost. They can make the difference between life and death. Quite literally. "In our textbooks we are told about the crucial five to 10 minutes in which patients needs to be tended to," says Panev. In the countryside, providing that care poses a formidable challenge. "In reality, an ambulance will arrive two, three or maybe four hours later — especially in remote villages." And that means people die who in normal circumstances could be saved, says Panev. Unfortunately, there is a lack of medical personnel to remedy this problem. Most young doctors prefer moving to Western Europe than rural Bulgaria.

The freedom of movement within the EU today  means that many Bulgarian doctors, and Bulgarian workers generally, opt to seek employment abroad, which can put a strain on the country's health care system. Currently, more than 1,600 Bulgarian doctors work in Germany, for example, which is something that medical student Panev would never dream of doing. "You only live once and everyone makes their own decisions," he says, conceding that he cannot blame his colleagues for emigrating. "It is a difficult situation for young doctors in Bulgaria." But he would only ever go to Germany to specialize in a certain medical field, he says, and then return. "I feel a certain responsibly towards the people of Bulgaria, I want to treat my compatriots. That is my mission." Because, Panev asks, who will be left if everyone packs up and leaves?