Aldona's story
Almost 20 years ago, Ukrainian Aldona Redchenko was diagnosed with a thyroid tumour, which was successfully treated, but returned a few years ago. Now doctors in Latvia have prescribed her expensive drugs. Redchenko was born and raised in Latvia but married a Ukrainian and has lived in her husband's home country for 45 years. After Russia invaded Ukraine, she fled to Latvia as a refugee. The family lived in a small town in the Mykolaiv region until the outbreak of the war and for a few weeks afterward. Aldona said that the strain of the flight had also worsened her health.
"They operated on me in Kyiv and removed the lymph node, but the tests showed that there was still something left, but then I came to Latvia with the war and they found the problem in my liver. Well, then I was told that I had to be treated with very expensive pills. (...) It was a very bad situation with the stress, because we left Ukraine only after three weeks – when a rocket fell 50 meters from our house. Horrible! The windows flew out, the roof, and everything flew. Then we took our dog and one suitcase and left with my husband," said Redchenko.
Currently in Latvia, the state co-finances around €1,000 a month for her medication, but the patient has to pay around €4,000 more herself. A year-long course requires more than €48,000. Redchenko is therefore particularly grateful for the support of people on the "Ziedot.lv" charity portal, which raises funds for her medication.
"It's terrible, you know, I didn't know what to do, where to get the money, and we can't sell the house in Ukraine, now they're paying pennies with the war. We tried to sell the car, but nobody gave even 1,000 for that car. It's an old car, nobody needs it. And you don't know what to do. One has to fight. I am very grateful. I am in my eighth month of medicine, and the computer shows that the problems are getting a little smaller. The process has been slowed down by the medicine," said Redchenko.
As the healthcare system and costs in Latvia are no different for people living in other countries, they often turn to donors for health services that are not paid for by the state.
Who can receive state-funded medicine?
Rūta Dimanta, head of the charity organization "Ziedot.lv", pointed out that this year 206 Ukrainian war refugees had received help, mainly to pay for medicines and examinations, as well as to cover dental expenses. The total amount donated is around EUR 140,000.
Dimanta noted: "In the context of these Ukrainians, what we have observed is that their paid medicine has much lower prices in their home country, and for them, the shock is even greater, let's say, for all the costs that there are for dentists, for various operations and so on. They also, of course, have a lower income than the average Latvian. [..]"
Dimanta added that Ukrainians often use paid services because they do not know that the state is paying for them.
In Latvia, the basket of state-funded healthcare services is not divided by nationality. If a person is included in the statutory Register of Beneficiaries of Services (Pakalpojumu saņēmēju reģistrs), he or she is entitled to the same healthcare support as Latvian citizens, said Sandris Kundzāns, Head of the Legal Department of the National Health Service (nvd).
"Since we deal with the inclusion of these persons in this register of beneficiaries of patient services, on average there are between 10 and 15 applications a day that approach and ask to be included in the register. First of all, they are citizens of other European countries who have come here for employment. Once a person is employed here, they can therefore also ask to be included in this register and receive services.
"Of course, there are also Ukrainian civilians, other third-country nationals who have come here and have a valid visa, and this is more about employment as well, they have started to work and they can come to us and ask to be included in the register. Of course, also non-citizens and asylum seekers, those who are in temporary detention if they have entered the country illegally and are awaiting status," said Kundzāns.
Persons included in the register are entitled to receive state-funded services - outpatient care, to see a general practitioner or a specialist, to receive hospital services, and to receive reimbursable medicines.
Language barrier and other issues
Dainis Deigelis, a social mentor of the association "Gribu palīdzēt bēgļiem" (I want to help refugees), highlighted as a major problem that people from other countries who obtain refugee or alternative status in Latvia often end up in Latvia with end-stage illnesses. The situation with health services is particularly bad for refugees who tend to be undocumented for a long time.
Deigelis said: "For example, these two cases in my practice were oncology, where the person could no longer be helped, basically end-stage, already virtually incurable. This is the problem that these people have until they get into this medical system [..]. The beneficiary of subsidiary refugee status also goes through the GP system and receives a service in the same way as a resident of the Latvian State.
"The problem here is that not all GPs are able to communicate in English, especially the elderly, and not all asylum seekers are able to communicate at all in a contact language, and that is always the issue, that this is one of the biggest communication problems here."
Similarly, asylum seekers from any country have initially low-paid jobs, which also hampers timely access to a doctor or the necessary medicines. The organization "Gribu palīdzēt bēgļiem" has also collected donations to pay for medicines or services.
Gunita Berķe, the head of the oncology patient support association "Dzīvības koks", said that, for example, Ukrainians, who have the same challenges as the Latvian population with oncological diseases, tend to turn to the support association for state-funded psychosocial rehabilitation. Mentoring and other support are also provided.
"Another thing we have seen is that Ukrainians are looking for help; we have free breast prostheses and wigs available at the association. We have also offered wigs and breast prostheses and helped Ukrainian people find them, because I have to say that in Latvia these breast prostheses are state-funded once every two years, and they are not always, let's say, the best or the most suitable, and then as much as we have, we let them choose, we help them find them," said Berķe.
Berķe also pointed out that for people from other countries, language barriers and navigating the Latvian healthcare system - how medicines are allocated and how to get state-funded examinations, for which there are usually huge queues - are a particular challenge.
"And try to wait in those queues. Or at the private ones, those services are expensive comparatively. [..] And, speaking of medicines in general, I will not stop saying that we are a Member State of the European Union and we can say in words that cancer is a chronic disease, but then we also need to provide it [help]. And, unfortunately, for cancer, it is still medicines that are the key. And even if, of course, this whole strategy of early diagnosis and screening, is right, that is all very positive, but in any case, it is the tumor that will remain. In any case, we cannot always stop it, and in any case, we will need those new medicines, we will need to ensure the quality of life for the person. That is the way, I think, you cannot go to one extreme - just screening, just medication. There has to be some kind of balanced development in both directions," Berķe noted.
Public media charity marathon "High Five!" this December will call on people with acute health problems who need immediate financial help but are not covered by the state. The funds raised will be donated to "Ziedot.lv", which will help with the purchase of medicines, necessary examinations, and diagnostics, as well as other types of assistance not covered by the state.
