From the echo today

Just shows that eastern Europe have still got some way to go ? and so have we all if this still goes on ?

Someone is screaming her head off in what seems a desolate part of the yard. There is a fence surrounding some shacks and, with each step taken towards it, the shrieks get louder. Ten more steps and there’s a gate in the fence. Another ten and all hell is let loose.

There is the screaming woman – barefoot, skinny and dressed in rags. There is another woman, unable to walk, rolling around on the ground, covered in flies – hundreds of them. In her filthy hands she clutches two chunks of bread. There is a girl dipping her dry bread in the dirty puddle in front of the outside toilets. Then she eats it. No-one pays attention.

It is lunchtime in Goren Chiflik, an institution in eastern Bulgaria, housing 90 women with intellectual and mental health disabilities. It was renovated recently, but the place of horrors – the shacks for the "
most disabled"
residents – was left untouched. It is well hidden;
so well hidden, in fact, that the head of the regional directorate for social protection says she has never seen it, despite having paid numerous visits to the institution. The 30 women here are not allowed to eat with the others. Instead, they are given their food behind the fence that is usually locked, effectively turning it into a cage.

This investigation, mostly conducted undercover in institutions for adults with intellectual and mental health disabilities in Bulgaria, Romania and Serbia, uncovered evidence of human rights abuses, inhuman and degrading treatment and appalling neglect. It showed that reform in this field remains patchy and slow, and too often leaves the most vulnerable behind.

Bulgaria and Romania, both EU members since 2007, and Serbia, which seeks the same status, have a grim track record when it comes to institutional care. This investigation suggests that they are still failing to meet international standards. Inadequate policies result in underfunding and a failure to recruit qualified, motivated staff. Residents are not being treated so much as controlled. Many are gradually destroyed by constant exposure to harmful, high-dosage medication. People do not leave their beds for years. Children are being kept tied down for most of the time.
Much is at stake for these counties if they do not improve things. The European Commission has said it may suspend payments under the European Social Fund in case of serious irregularities in Bulgarian and Romanian institutions. As for Serbia, many important voices insist that the EU must demand a better human rights track record from future candidate countries. However, in practice, Brussels has been turning a blind eye to such abuses for years.


Tied up with drugs

In the institution for adults with mental illnesses in Radovets, I meet 76 unusually lethargic men. Too many hands are trembling, faces stiff and movements heavy. I am about to find out why.

Radovets is a tiny village in southeast Bulgaria and, like most institutions, it is as remote as can be. Attracting qualified personnel here is practically impossible.
Officially, I am in Radovets as a researcher for the Bulgarian Helsinki Committee, BHC, the country’s most influential human rights NGO. This was the way I chose to gather most information for this investigation, as journalists make institutions nervous.

Although almost all the residents are diagnosed with schizophrenia, Radovets does not have a full-time psychiatrist. The director of the institution, Krayo Kraev, says just one such specialist works within a radius of 50km, and he only visits once a month.

One consequence of this neglect is that all the men in Radovets are on the same therapy, haloperidol, in every medical record we see. The director confirms this. "
All residents have been prescribed haloperidol by the psychiatrist,"
he says. He sees nothing wrong with this state of affairs.

Medical experts maintain that haloperidol, an old antipsychotic drug, has extremely strong side effects, including tardive dyskinesia – involuntary movements of the face, hands and feet;
akathisia – manifested in repeated rocking movements;
lethargy and sleepiness.

The men in Radovets have taken haloperidol every day, sometimes for years. Records show that doses are high and the drug is given without consent. This means tranquil residents and untroubled staff. It also results in blurred minds and harmed bodies.

"
This is not treatment, but taking control of people,"
Krasimir Kunev, head of the BHC, says. "
I’ve never seen side effects so widespread."


During our visit, the men either sleep or sit in the yard doing nothing. Hristo is one. This 32-year-old, once an award-winning chess-player, describes his day: "
I wake up, have breakfast, take my pills, but they suck all my energy out and I fall asleep. I wake up, go to lunch, thankfully we are not given pills then, so I play some chess;
dinner comes, I take my pills, I am exhausted, I go to sleep."


As this applies for all the residents, it becomes clear why the old isolation unit – a tiny closet under the stairs – no longer has to be used. Drug-based restraint has become a substitute for physical restraint.

Challenged about the therapy, the director of Radovets says he will look into the issue.

"
In these places, it’s the staff that de facto administer medication. As the psychiatrist is not around to monitor, the staff tell him who ‘needs’ more sedation,"
Kunev says. "
The staff in these institutions are, by default, unqualified and insufficient. Thus, it’s a temptation to turn medical treatment into a method of controlling behaviour."


The Bulgarian government says the remote location of so many social care homes is a key factor behind the lack of qualified staff. It says it is committed to solving this problem.

The men in Radovets are not the only ones kept restrained with high-dosage tranquillisers. It is the same in Oborishte, a care home for adults, one third of whose 98 residents have a mental illness.

A look at the medical records in Oborishte also reveals the widespread use of haloperidol. Many residents have been on 9mg per day for years. Professor Toma Tomov, a leading psychiatrist, says such strong doses should only be given for short periods and for acute conditions.

Professor Tomov asks the part-time psychiatrist at Oborishte why such high doses are routinely given to people who do not need them. "
At night, we have only one guard and one nurse and it’s scary,"
she says.

Her answer confirms that here, too, people are over-medicated with potentially harmful drugs to guarantee peace for the insufficient staff. The director of the institution, Ilcho Goranov, defends the use of the drug on the grounds that "
it is being administered by a professional"
. He has no plans to change dosages.

Those most in need get least

"
We identified what we consider to be torture – children tied down to bed;
a man who was in bed for 11 years,"
Eric Rosenthal, executive director of Mental Disability Rights International, MDRI, tells me. "
The question is whether those abuses have been brought to an end."


The answer is no.

In 2007, MDRI, which promotes human rights in this field, published a damning report on Serbia, highlighting habitual use of physical restraints and degrading treatment in Serbian care homes.

Serbia’s authorities angrily rejected the accusations and still seem in a state of complete denial. Asked to comment on the current state of its care homes, Serbia’s ministry for social affairs merely forwarded its reply to the 2007 MDRI report to me.

When I visit Kulina, an institution in southeast Serbia housing 500 adults and children with intellectual and developmental disabilities, there is some evidence of improvement. An attractive new building for "
supported living"
has been erected. There is also a new sports field and day rooms, where less disabled children can draw and play. But, as in so many of these institutions in the region, parallel universes operate in Kulina.

In the two-storey pavilion for immobile residents, there is no lift. Upstairs, I find people tightly packed in dark rooms. They are never taken out. Each room looks and feels like the next. It is dead quiet.

The "
severely disabled"
children spend their time motionless in bed – sometimes physically restrained – or tied to chairs in empty day rooms. Some rock back and forth on the floor for lack of attention. I see many such forgotten children. Bed-ridden teenagers look no older than four. Children in cribs are horribly thin, arms and legs atrophied from disuse.

In most institutions in Bulgaria, Serbia and Romania, one problem is that those who need help most get least. There is not only a lack of financial and human resources and good medical care. There is a lack of understanding. As a result, people in the gravest conditions tend to suffer most.

In all the institutions visited, reform is patchy. Most have some renovated buildings and some "
transitional facilities"
for a handful of residents. But improvement in overall standards of care, the provision of therapies apart from drugs, and programmes preparing people for a return to the world all seem a long way away.

Churug, a Serbian institution housing 206 men and women with mental illnesses, is another example of reforms that leave the most vulnerable behind. Churug contains three pavilions, of which two have been renovated. The third, housing "
severe cases"
, has not. It is an old army building with dirty, dusty, stinking rooms. The manager says the people here receive no therapy apart from drugs. Activities in the day rooms are reserved for the "
more able"
residents.

In the home for women with mental illnesses in Svilengrad, Bulgaria, it is the same story. A cosy new transitional facility coexists with a pavilion for the immobile. There, it is the stench that hits you – the sickening smell of floors and mattresses drenched with urine and faeces. Women are packed in bare rooms. One woman is quietly crying. She is lying in her own excrement.

Goren Chiflik, the Bulgarian institution introduced at the beginning of this article, offers perhaps the most shocking case of parallel universes. The small new transitional facility, the main building, an empty new pavilion and the horrifying stables, where 30 women are locked up, are all in the same yard.

Director Stanislav Enchev is not planning to move the women from the old stables to the new pavilion because he fears that "
they’ll break everything"
. He says the authorities should grant funds to build one more pavilion.

But Borislav Natov, the local mayor, says such funds will not come from the municipality. "
We have no budget to ensure normal living conditions for these people,"
he says.
Maria Chankova, head of the regional social support directorate, promises "
urgent measures"
. She has paid numerous visits to Goren Chiflik, but says she has never seen the women in the old stables.

I find Liliana in the old stables, covered in flies. Here since 1999, she is paralysed, crouched like a grasshopper, the skin on her legs yellowish-blue. At 62, she looks malnourished, her body strikingly thin. "
Do they ever leave their beds? Do you take them outside?"
I ask. The sanitary worker gives me a sad smile: "
Usually I am alone here with 30 women. There’s no time."


Another place where care is provided for some and not others is Mocrea psychiatric hospital in western Romania. 70 out of its 160 patients are chronically ill. The institution has recently been renovated. However, about half of the patients are effectively prisoners, locked in their rooms, only allowed out under supervision for 30 minutes at lunch and 40 minutes for a walk. The resident psychiatrist explains that some "
might run away"
, and that others are "
very aggressive"
.

In another Romanian institution, Gura Vaii, there is not even consistent access to running water. The 56 patients shower once a week.

Despite numerous promises, the Romanian health ministry never answered a series of questions about the conditions in Mocrea and Gura Vaii.

At Gura Vaii, the lack of care is complete. The two day rooms are locked and unused.

"
Is anything else going on here apart from medication?"
I ask.

"
Well, the music outside,"
the manager answers, referring to the loud sound of the radio blaring in the yard. Equally shocking is the manager’s statement that most of the patients in the chronic psychiatric ward are not mentally ill but intellectually disabled, suffering from dementia or simply homeless. In the yard, they rock back and forth or stare into space. By the time I leave, even the music outside has stopped.

Getting away with murder?

"
The European Commission is fully aware of the current problems in Bulgarian and Romanian institutions,"
the European Commission said in response to my questions. "
There is always a possibility of payments being suspended under the European Social Fund in certain cases,"
it added.

Although many experts think the EU should require better track records on human rights from candidate countries, the Commission has refused to comment on this assertion.

"
Bulgaria and Romania were quite literally getting away with murder,"
Oliver Lewis, of international rights organisation Mental Disability Advocacy Center, says. "
People were, and are still, often subject to the most grotesque neglect and abuse."


Laura Parker, who worked as social policy advisor for the European Commission in Sofia before Bulgaria joined the EU, says: "
It is clear the decisions about enlarging the EU were primarily political [and] human rights are simply not an EU priority."


She and her colleagues "
tried to reflect the reality…but, by the time various European Commission officials had edited them, the final Regular Reports did not accurately represent the situation"
.

Far from the eyes of Brussels and the minds of national governments, institutions housing the most vulnerable citizens in Bulgaria, Romania and Serbia remain no better than dumping grounds for forgotten people.

The graveyard of Radovets is a metaphor for this state of neglect. For about half a century, the institution has had its own plot and dozens of former residents lie beneath this overgrown field. However, there are only a couple of tombstones. Anonymity in death is a logical end to a life spent without rights or identity.

How do these people get here?

Do their families put them in? Or who decides?

That's a very good question cumbrian buy the same could be asked about a lot of places like this in Bulgaria, good information and well done Scott

Having just returned from Bulgaria I can say that I have met both good and bad and indifferent, by the way this was not my first visit I have been visiting for 25 years and with some very long stays, so its not that I am green while I can see whats being said here I have to agree with Scott here and to say that all Bulgarians are the same or to imply that is really not in anyway near the truth? I also think that just because we can not get on with a particular group of people doesn't make them bad? you have to remember that Bulgaria is steeped in history and communism which at best we can only claim to slightly understand? the Bulgarian have a completely different way of like to us in the Uk and to most of western Europe but is doesn't make it wrong ? another example would be the Asian countries, some of them have some very harsh ways of living ? but is it wrong ? I think not.

I read this story the other day and the interesting thing is that this place, much like the orphange that was highlighted in the BBC documentary, is found in a place that no one would know about unless they happened to stumble on it while lost.

There is a darker side to Bulgaria, much like any other country, the trouble is finding the darker side and doing what one can to bring a shining light to the people found there.

I agree with you mugshot and as you say these places seem to be well hidden which begs the question why? I would say that its Bulgaria maybe hiding its dirty washing so to speak? but I do believe that with enough pressure from the right places like human rights etc then change will come but at what cost? and as is in so many cases it will be too late for some? I do hope that enough pressure can be brought about to make the difference between life and death? but its hard to say what will happen and when ?

[quote="
krypton"
]Having just returned from Bulgaria I can say that I have met both good and bad and indifferent, by the way this was not my first visit I have been visiting for 25 years and with some very long stays, so its not that I am green while I can see whats being said here I have to agree with Scott here and to say that all Bulgarians are the same or to imply that is really not in anyway near the truth? I also think that just because we can not get on with a particular group of people doesn't make them bad? you have to remember that Bulgaria is steeped in history and communism which at best we can only claim to slightly understand? the Bulgarian have a completely different way of like to us in the Uk and to most of western Europe but is doesn't make it wrong ? another example would be the Asian countries, some of them have some very harsh ways of living ? but is it wrong ? I think not.



Hi Tony I don't now why you have edited my post since there was nothing in it that was derogatory in any way and I am told that posts that have a problem should go to the bin ? or is this forum making up the rules to suit as they go ? I joined this forum because I believed that this is a place where we can all have our say both positive and negative although I didn't say anything negative in my post so why was it edited? I have no problems with anything I said in that post and it was wrong of you to edit it, I have no intentions of contacting you to ask why either, and whats more it won't push me away as it has Scott who has now left because you did the same to his post which to be honest he only had a few lines and in no way did he say anything wrong, the trouble here is when some people say some things they think it aimed at them ? if well I wasn't talking about anyone in particular I was generalising and if you took it personally which I think you must have then maybe you should think about your position on here, sorry if you don't like this but I didn't like you editing my post either for no reason?

Hi George I'm not totally sure what is going on here because I am guilty of not reading all of this post therefore it would be difficult for me to make a comment now, all I can say its lets move on and get back to where we were and accept that we can all make mistakes even me and I am in no way suggesting that either you or Tony were wrong as I was not able to see your post, we are all adults on here so lets act like it and start to consider the more important issues of this topic


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Hi Ashley thanks for your comments and yes you are right we should get back on topic [You must be registered and logged in to see this image.] and I hold my for Tony so lets move on now

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I think the that there are a lot of places like this around the world and indeed we had the same in the uk many years ago but I believe that by education we can change all this for the better I don't blame anyone for this because blame is not going to solve the problems but with the EU involvement and the rest of the world I do believe that given time it will happen but it will be too late for some

I have read the letters Bulgaria is a hopeless country the Bulgarians do not want change they are so used to being told what to do by the communist I have come to the conclusion they cant think for themselves to me Bulgaria is a nothing place it might be steeped in history before we moved here we read every book on Bulgaria it did not give us the true picture we have a nice house just wish it was anywhere but here I feel so sorry for all those poor soles in the mental institutions maybe if it is being kept in the public eye something may get done but I wonder how long that will take things in Bulgaria seem to take so long to do if ever I hope to be able to move one day but will have to wait for the right time junenan

Hi Juenan sorry to hear of you experience of Bulgaria I guess you could be right about books not giving the true picture? but there are so many people in Bulgaria from all over the world who have found happiness so maybe you have just been unlucky? I have found from my experience its best not to listen to REA's or read to many books or use the forums that have loads of Adds on them, as in my opinion you may get a one sided view? I do believe that forums like this that doesn't promote any REA's or carry any adds other than the member adds is the place to get a true picture from those who have already made the move and in some cases made the wrong choice, but overall most seem to have made the right choice so you will get an honest view here about different parts of Bulgaria, obviously there will be places to avoid just as there is anywhere including the Uk I wish you all the best and hope things can work out for you.

The report is indeed giving the other side of Bulgaria. However, many countries outside the 'sophisticated' West could probably give equally disturbing reports. It is because so many Brits have chosen to live here that these reports are so distressing for them. There is much more to understand about the new country of choice than just what the weather, neighbours, infrastructure, building etc etc is like. I have just started to read a new book titled 'The Reunification of Europe'. It is a hard read and I am only really interested in Bulgaria. I was surprised to read that there is something politically called 'the third way' and as far as I can understand (not being very intellectual) is that many Bulgarians cling to a policy of 'Bulgaria for the Bulgarians' and the manifesto is very similar to Communism and run by ex-Communists. It sounds very much like our BNP in Britain. This could be one reason for Bulgaria resisting every attempt to accept EU rulings. This report of mental institutions is very disturbing but should not really interfere with Brits coming here to live. I understand people saying that little things can make a difference but I really think that trying to interfere will only bring unhappiness with a new life in this country. If you find this hard to live with then its not for you. Its good to read about the downsides though because it could make the final decision about your move.

I think what you have said oldun is very true and if we can all look at Bulgaria in a different way and perhaps a more positive way then we would see things differently however when I say positive I also mean with our eye open! as St Frances of Assisi said "
God help me to accept people as they are and not how I would like them to be"
and its true and its something we should all keep in mind all of the time and if we find that life in any given place is not for us then we move elsewhere and find that little dream

sarah