Doctor with an appetite to deal with malnutrition problem in Greece

Dr Michael Chourdakis has devised a programme to help Greek hospitals tackle malnutrition in patients

Though Ireland has been to hell and back in recent years, the situation in Greece is far worse.

The country is in existential crisis, a meltdown brought on by many decades of corruption, mismanagement and tax avoidance. There is real hunger in Greece, a situation inconceivable even a decade ago when the country prepared to host the 2004 Olympic Games.

As a nutritionist, Dr Michael Chourdakis is acutely aware of the problems in his country caused by the economic crash. He will speak at a conference this day week organised by the Irish Society for Clinical Nutrition and Metabolism.

Most people associate malnutrition with the developing world and particularly sub-Saharan Africa. The word has connotations of famine and distended stomachs, but it has a much broader meaning than that and denotes all kinds of poor nutrition. It also includes obesity.

Programme

Secretary general of the Hellenic Society for Clinical Nutrition and Metabolism, Dr Chourdakis devised a programme to treat malnutrition in the hospital setting, where patients can be particularly vulnerable to poor nutrition. It can prolong their stays in hospitals and many leave, after treatment, with a lower quality of life. He says many doctors and nurses are too busy treating patients to care about nutrition.

The programme aims to provide Greek caregivers such as doctors, dietitians, nurses and pharmacists with educational material in a user-friendly and cost-free way.

He persuaded politicians to incorporate changes in the Greek legislation on clinical nutrition issues to make them mandatory in every public hospital.

Has it made a difference? “It was announced on March 1st last year,” he said with a sigh, “but due to the very bad economic situation in Greece, nobody is looking at how to incorporate this legislation into everyday clinical practice. But we are very optimistic that this is going to happen. This is only the first step.”

Dr Chourdakis works in a country from which three or four doctors leave every day. Those who have remained have faced salary cuts of more than 30 per cent.

The Greek public hospital system is also in grave crisis. Hospital budgets have been slashed, fewer medications are available and basic hygiene is so bad that hospitalacquired infections are on the rise. Only the rich have guaranteed access to medicines. “You get treatment for free, but the quality of treatment is debatable,” he said.

In recent weeks the Greek government introduced a free snack for children in schools because so many pupils are going to school hungry.

“To have a change in our hospital situation, we need to have a change in our economic situation and to change that we need to change our politicians,” he said.

“I’m not very optimistic. We seem to vote for the same people who brought us here. I wish I was living in Iceland. They didn’t pay for the banks. They tried to look after their people.”

Tax evasion

Dr Chourdakis acknowledges that many Greek doctors have paid their part in bringing Greece to its knees.

In his incendiary essay in Vanity Fair, Michael Lewis pointed out that two-thirds of Greek doctors reported incomes of less than €12,000 a year. “If the law was enforced,” one tax collector told him, “every doctor in Greece would be in jail.”

Dr Chourdakis says the criticism does not extend to all Greek doctors. If doctors evade tax, they are behaving unfairly, he said, “but it is not only happening among doctors. Unfortunately, it is a state of mind in Greece. The more you steal from the tax system, the wiser you are. We don’t have strong solidarity in our educational system or in our way of life.

“One of the main problems before the crisis was that, in many hospitals in the public and private sectors, enough doctors were bribed by the patients to get them higher on the surgery list. If they used a certain product, they got a percentage of the product even if it was not the right drug for the patient,” he said.

Dr Chourdakis is not tempted to emigrate at the moment. “If we all go abroad, who’s going to stay here?”

The IrSPEN 2013 conference takes place at the Clyde Court Hotel in Dublin on March 5th and 6th. irspen.ie

The cost of malnutrition

Malnutrition among ill people is a huge cost to health services.

According to the latest figures published in the Journal of Public Health Nutrition, malnourished patients cost the State €1.4 billion a year. The cost across Europe is €170 billion.

Sick people are less likely to eat and are, therefore, more prone to infection. They are 65 per cent more likely to need a GP and their stay is an average of 30 per cent longer.

Nutritionist Niamh Rice said “significant savings” could be made if patients were screened for malnutrition upon entering hospital. She said malnutrition was something that could be dealt with easily by hospital staff.