Every October, when the Nobel Prize in medicine is announced, the world's eyes turn toward Sweden's medical system and respect it as a voice of authority.
But every day, Swedes' eyes turn toward their medical system with dismay.The system, once admired for providing top-quality care at almost no cost to patients, has deteriorated under budget cutbacks.
The decline is chronicled almost daily in the Swedish press, including these reports within the past 10 days:
- Legionnaire's disease breaks out at a top hospital in Uppsala, killing two patients and causing hospital officials to ban showers in three buildings. An outdated plumbing system is seen as a principal contributor to the problem.
- A 57-year-old woman began bleeding profusely around a tube accidentally left in her neck after previous treatment. The ambulance driver alerted the nearest hospital, but when they arrived, the emergency room said it could not take her and sent her to another hospital. By the time she got there, the woman had bled to death.
- A survey of Stockholm-area hospitals shows the waiting list for operations for uterine prolapse - a painful and often embarrassing condition - is up to a year long. "These are patients who are suffering," says Anders Olund, a doctor at the hospital with the shortest waiting time - 10 weeks.
All this is especially frustrating for Swedes, whose renowned Karolinksa Institute gains international fame for awarding the Nobel Prize in medicine. This year's prize will be announced Monday.
About 80 percent of the cost of running Sweden's hospitals comes from public coffers - funding that was slashed as the country tries to shake off the huge debt it incurred running its extensive cradle-to-grave social welfare system.
The government now says the economy is recovering, but its 1998 budget proposal calls for cutting medical expenditures about $100 million from what was spent two years ago.
According to the Organization for Economic Cooperation and Development, Sweden and Ireland are the only Western European countries whose spending on health has declined in terms of gross national product in the past decade - Sweden's from 9 percent to about 7 percent. The United States, by comparison, spends about 14 percent of its GNP on health care.
The news is not all bad. This week, a hospital performed a dramatic heart transplant on a 5-month-old baby.
In addition to awarding the Nobel Prize, the Karolinska Institute also has done pioneering work in treating severe spinal injuries.
But Karolinska's prestige makes the medical system's problems all the more painful for its doctors, such as Bertil Hamberger, who stepped down last year as chief of the surgery clinic for the institute's hospital.
Because the name is so admired, "when I resigned, my colleagues (in the United States) called and said `What is happening there?' " he said in a recent interview.
What had happened was that budget cuts had strapped the hospital to the point where patients often were bedded down in corridors.
"Certain days and nights, you wondered whether it was a war hospital," the surgeon said.
The pressure on the wards was so bad that patients sometimes had to lie around all day when they should have been moving, or were sent home days or weeks before they should have been, Hamberger added.
That kind of treatment killed her boyfriend, Kirsi Kandelberg believes. After an arterial operation on 56-year-old Eero Jukarinen, infection set in. But he was sent home just three days after the operation at Ostersund Hospital, and over the course of the next year, the infection spread, he had to have both legs amputated and died slowly and painfully.