The healthcare situation on the islands of Kefalonia and Ithaca is extremely critical, with severe staff shortages, overwhelming pressure on existing doctors, and increased needs due to tourism. Upgrading healthcare infrastructure and creating incentives to attract and retain doctors is imperative.
Meanwhile, the issue of understaffing is chronic and visible in most hospital facilities in the country, especially in island regions where the workload is disproportionate in the summer compared to winter. The Ministry of Health recently attempted, unsuccessfully, to cover the gaps with temporary solutions and requisitions, facing opposition from the medical community.
Specifically, the medical community reacted strongly to government efforts to cover staffing shortages with temporary solutions and requisitions, warning that if the provision for the requisition of private doctors in the National Health System (ESY) is activated, there will be serious upheavals. Efforts to cover emergency shifts with the transfer of doctors within the ESY and private doctors on contract also face opposition from hospital and private doctors. The Panhellenic Medical Association (PIS) described the regulation as shameful, supported by the Union of Doctors of EOPYY, the Association of Pathologists, and the Hellenic Cardiology Society.
General Hospital of Argostoli
Ioannis Fisfis, urologist and president of the Medical Association of Kefalonia and Ithaca, describes the difficulties faced by medical staff at the General Hospital of Kefalonia. "There is a problem in the pathology clinic as there has been only one permanent pathologist for years and another colleague who comes seconded from the old IKA," he notes.
Understaffing is the main issue, especially during the summer months when the pressure increases due to tourism. "Until recently, we tried to second rural doctors to hospitals to cover the gaps," adds Mr. Fisfis, emphasizing the need for permanent solutions.
The housing problem is highlighted again as one of the main reasons why doctors do not come to the islands. "Although the state has classified the hospitals of Kefalonia as remote to make them more attractive, the provisions have not been implemented. Incentives are needed. Without them, doctors will not come," Mr. Fisfis points out.
Incentives for Remote − Island Areas Remote Clinic (Article 43 - Law 4368/2016)
- Paragraph 4 of Article 22 of Law 4208/2013 (A' 252) is amended as follows: "For occupying a position in the ESY medical branch or hiring in the PEDY, the service of the rural service doctor (obligated and on tenure) in island areas and remote or problematic areas, according to the existing provisions, as well as in designated remote Regional Clinics, is recognized and calculated at five times compared to the service of other doctors. For specialized doctors on tenure, the service in the above areas is calculated at seven times." This provision has been in effect since 18.11.2013, the date of publication of Law 4208/2013 (A' 252) for doctors who graduated from this date onwards and for doctors who graduated before this date it has been in effect since the publication of this law.
- In paragraph 2 of decision A2d/GP oik. 137/31.12.2014 of the Minister (B' 27/2015), a clause is added after the second clause as follows: "To obtain the specialty title of Pathology and Surgery, it is allowed to submit two (2) applications, one in hospitals of partial and one in full training, only in the case of applying for partial training in hospitals of island, remote, or problematic areas, with the obligation of the trainee to remain in this hospital for the entire duration of their contract. If they resign and leave the said hospital before the end of their contract, their application for the full training hospital is deleted. With a decision of the Minister of Health, the above partial training hospitals of island, remote, or problematic areas are determined."
- In paragraph 2 of Article 28 of Law 4025/2011 (A' 228), a clause is added as follows: "The service time of ESY specialized doctors spent in PEDY - Health Center or in PEDY Regional Clinic or in PEDY Multivalent Regional Clinic, or in PEDY Special Regional Clinic in island, remote, and problematic areas, as defined in PD 131/1987 (A' 73) and in related ministerial decisions, for tenure rural service, is counted as service time for their scientific advancement."
- Paragraph 5 of Article 28 of Law 2646/1998 (A' 236) is amended as follows:
- "With a decision of the Minister of Health, the PEDY - Regional Clinics, PEDY - Multivalent Regional Clinics, PEDY - Special Regional Clinics, and PEDY - Health Centers can be designated or de-designated as Regional Clinics and Health Centers of remote and problematic areas, and financial and other incentives can be provided to rural service doctors appointed to them."
- The second sentence of the second paragraph of case (c) of paragraph 2 of Article 21 of Law 3580/2007 (A' 134), as in effect, is replaced as follows: "The local authorities and their public entities can provide the auxiliary doctor and the rural service doctor of their area, for the entire duration of their contract or tenure, with free meals, suitable accommodation, or financial allowances to cover these needs."
Health Center of Sami
Stratos Sifnakis, general doctor and scientific head of the Health Center of Sami, describes the exhausting reality he faces daily. "There are three of us: myself, Mr. Moschopoulos, and Ms. Flamianou, pediatrician. Mr. Moschopoulos and I cover the Health Center of Sami, with Mr. Moschopoulos doing his 12 shifts a month and me the remaining 18 to 19," he explains. The overall lack of doctors on the island has led Mr. Sifnakis to perform up to 25 shifts a month, allowing Mr. Moschopoulos to assist the General Hospital of Kefalonia with six shifts due to its severe shortages, as Mr. Sifnakis tells thekefalonianglobe.com.
"There is great physical and psychological exhaustion," Mr. Sifnakis adds, stressing the need for an additional permanent doctor and a nurse at the center. He regularly communicates with the 6th Health Region and its director, Mr. Giannis Karvelis, who responds positively. However, he reiterates the urgent need for a permanent doctor at the Health Center of Sami as the shifts are challenging to cover, and the lack of a medical laboratory technician has halted laboratory services for two years.
Regarding this issue, Mr. Sifnakis mentions his efforts to facilitate the situation for his fellow citizens. "Since I took over as the scientific head of the Health Center of Sami in September, to serve the local residents, I arranged a collaboration with the Kefalonia Hospital laboratory. Specifically, every Friday from 08:00 to 09:30 in the morning, we conduct blood draws at the Health Center of Sami, and we transport the biological material with our vehicles to the General Hospital of Kefalonia to ensure basic service for the people," he explains.
Focusing on the needs of the Health Center of Sami, he emphasized, "At this moment, I need a specialist or general doctor-pathologist, at least one more nurse, and a medical laboratory technician." He also highlights the need for an administrative staff member and a maintenance worker, as the lack of staff has forced doctors to undertake technical tasks.
Answering why he thinks doctors do not come, Mr. Sifnakis explains that incentives are needed. He mentions that rural doctors in Sami call him saying they struggle to find housing on the island. Despite the challenges, he emphasizes that thanks to the dedication of doctors and nursing staff, the residents are currently well served at the Health Center of Sami, but "we cannot pull one doctor here one day and there the next, something must be done."
Health Center of Ithaca
The situation is no better at the Health Center of Ithaca, as described by the director, Vina Georgana. "We have many problems with doctors. There is only one pathologist, one pediatrician, and a contracted cardiologist. Currently, all the rural doctors have left," she notes.
The situation is so difficult that they rely on help from the military and temporary doctors from other areas: "The military helps us. They sent us an airman who does many shifts, but it cannot continue. And from Pyrgos, a doctor came for a month."
Moreover, the placement of a conscript doctor at the Health Center of Ithaca is provided for by a joint decision of the Deputy Minister of National Defense Yiannis Kefalogiannis and the head of the general health services of the Ministry of Health. Ms. Georgana emphasizes the importance of this decision, stressing the urgency of its implementation.
Despite the support from the mayor and his assistance in communication with the Ministry of Health, the procedures are slow, and the shortage of staff is intense, especially during the tourist season. "We have a shortage of doctors, and due to tourism, the population has already tripled, and we have an issue," Ms. Georgana mentions.
She stresses the need for hires, requesting at least two more permanent general doctors and a pediatrician to stay longer on Ithaca. "We are well-equipped, we need hands to operate the machines," she adds, underscoring the need for human resources.
Contract Signing for the Renovation of Argostoli Hospital
Optimistic steps are being taken towards the modernization and renovation of hospital facilities on the two islands. Specifically, a few months ago, a contract was signed for the upgrade, renovation, reconfiguration, and modernization of the General Hospital of Kefalonia, with a budget of €8,000,000. The funding comes from the National Recovery and Resilience Plan "Greece 2.0," with the support of the European Union.
The renovation includes replacing all sanitary ware, new tile investments, new flooring, new internal and external frames, installation of new suspended ceilings, painting of all internal and external surfaces, air conditioning installation, and all necessary electromechanical works extending to all patient wards, corridors, sanitary areas, and auxiliary spaces.
The reconfiguration will take place in the artificial kidney unit and its extension, the creation of an MRI unit in an existing space, the conversion of two or one of the two first wards (building A) into inpatient wards in the surgical clinic, and the renovation of the maternity clinic with a total area of 440 square meters. Additionally, there will be a complete renovation of 45 toilets, the pathology, surgery, and pediatric clinics, outpatient clinics, and the physiotherapy unit.
Furthermore, the work includes the application of thermal insulation to the shell of the central building of the hospital and the laboratory wing. These works are expected to significantly improve conditions for patients and hospital staff, offering better quality healthcare.
Renovation of the Health Centers of Sami & Ithaca
As part of a major program worth €700 million, exclusively funded by the Recovery Fund, the renovation, upgrade, and improvement of 168 Health Centers out of 312 in the country will be financed. Among these Health Centers are the Sami and Ithaca Health Centers, for which a total funding of €3 million is planned, with €1.5 million allocated to each.
The funding will be used for various interventions, such as:
- Internal arrangements of the Health Centers
- Restoration of damages
- Installation of equipment to facilitate people with disabilities
- Thermal insulation works
- Electromechanical interventions
These improvements will contribute to upgrading the infrastructure and providing better healthcare services to the residents of these areas.
Necessity for Substantial Intervention
As evident from the doctors' statements in this report, the state must take immediate action for the substantial enhancement of healthcare in Kefalonia and Ithaca. It needs to offer meaningful incentives to attract and retain doctors on the islands, strengthening the infrastructure and ensuring adequate staffing of health units. The residents and visitors of Kefalonia and Ithaca deserve high-quality healthcare, and the state must ensure that their healthcare needs are met in the best possible way. Finally, the state must act effectively to prevent the worsening of the crisis and ensure healthcare that meets the needs of the time and society.
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