AMBASSADOR URGES HEALTH MINISTER TO IMPROVE

UNCLAS BRATISLAVA 000144

SIPDIS


SENSITIVE

E.O. 12958: N/A
TAGS: PGOV PREL PHUM SMIG EIND ETRD LO
SUBJECT: AMBASSADOR URGES HEALTH MINISTER TO IMPROVE
STERILIZATION REGULATIONS


Sensitive but Unclassified - protect accordingly.


1. (SBU) Summary. On January 29, Ambassador Weiser met with
Health Minister Zajac to discuss the new draft regulation on
sterilization and overarching reforms in health care,
particularly pertaining to the Roma minority. The Ambassador
pressed Zajac to incorporate recommendations from
international and domestic specialists into the
sterilization law. The Health Ministry had been in the
center of controversy after the January 2003 publication of
"Body and Soul," a report that alleged over one hundred Roma
women were victims of coerced sterilizations. Zajac said the
GOS had done its best to investigate allegations of coerced
sterilization, find violations, and seek solutions.
Discussions also included health care programs for returned
victims of trafficking and the donation of medical supplies
that had been arranged by the Ambassador. End Summary.

New Sterilization Regulations: Concrete Suggestions
-------------- --------------


2. (SBU) On January 29, Ambassador Weiser met Health
Minister Zajac to discuss newly proposed regulations
governing sterilization. The Health Ministry had been in the
center of controversy after the January 2003 publication of
"Body and Soul," a report that alleged over one hundred Roma
women were victims of coerced sterilizations. The Ambassador
noted the ensuing investigation had revealed problems in the
health care system that could be resolved to the benefit of
everyone. Minister Zajac admitted mistakes had been made in
minority policy. He said the GOS had done its best to
investigate the allegations, find violations, and seek
solutions. With regard to recent health reform and legal
proposals, the ambassador expressed appreciation for GOS
attention to international concerns.


3. (SBU) The Ambassador urged Zajac to include
recommendations from numerous human rights and medical
specialists in the new regulations on sterilization. (The
Ambassador in a letter also encouraged Justice Minister
Lipsic, as Chairman of the Legislative Council, to support
the suggestions.) Specifically, the Ambassador asked that
the new regulations:

-- Incorporate a clear definition of "informed consent." The
absence of such a definition may result in the continuation
of the very practices which have recently come under
criticism.
-- Institute a mandatory waiting period between the time
the patient gives consent and the surgical procedure. This
would allow a more cautious approach to sterilization,
especially after repeat caesarians and for minors.
-- Eliminate the list of medical indicators for
sterilization. There is no internationally accepted norm,
and such lists do not clearly define the procedure as
elective.
-- Elimination of sterilization committees. The committees
are obstacles to better communication between practitioners
and patients about reproductive health and do not ensure
quality service to the patients.


4. (SBU) Zajac stated that these concerns would be addressed
in the next ethics committee meeting, with due consideration
given to the comments submitted by the Ambassador.

Aftermath of the MOH Investigation
--------------


5. (SBU) According to Zajac, the MOH investigation found
violations of the previous sterilization regulation that
affected two minors. The Ministry was not able to find fault
with hospitals or doctors, but admitted that laws in this
area were ill-defined. He added that investigators lacked
data on ethnicity. However, Health Ministry specialists
believe that more non-Romany women underwent sterilizations
than Roma. Zajac added the ministry had already responded to
nearly 400 out of 1000 letters from concerned individuals
and organizations about the allegations of coerced
sterilizations and the subsequent investigation. He
indicated that they intended to respond to all of them. He
also said that specialists from the ministry participated in
discussions with the Government Office for Human Rights and
attended several conferences on the topic.


6. (SBU) Zajac noted Roma settlements have severe health
concerns and reform is just beginning down a long road.
Significant structural changes were needed to improve
preventive health care and educational opportunities for
marginalized groups. Specifically, he wants to encourage the
insurance industry to support preventive health care and
pressure practitioners to protect patients' rights. He
discussed current proposals for Roma health projects, which


included two mobile emergency units and a possible
specialized office for minority affairs. He promised that
his ministry will continue to confront problems instead of
avoiding them as in the past.

Health Care Reform and American Assistance
--------------


7. (U) Zajac gave the Ambassador a brief explanation of the
health care reform package, loosely modeled on Oregon health
care, and stated he intended to move these reforms through
quickly while political will exists. The Ambassador
suggested the Minister and his staff might visit the U.S. to
discuss minority outreach programs and indigent care with
American counterparts and to strengthen relationships
between American and Slovak hospitals. Zajac stated this was
a high priority. The Ambassador mentioned that he had
arranged with the University of Michigan hospitals for the
shipment of two pallets of medical supplies to the
children's hospital in Kosice. Two American corporations,
U.S. Steel and Plastipak, were paying the cost of shipping.
Zajac indicated his appreciation for the donations.

Trafficking in Persons
--------------


8. (U) The Ambassador urged the minister to develop
assistance programs for victims of trafficking. He stated
that while numbers of returned victims are not high compared
to other countries in the region, the treatment of
transmittable or life threatening diseases and psychological
counseling should be provided for returning victims. He
added that victim protection and prosecution of traffickers
are not the only aspects to battle this global problem, and
Slovakia could serve as a future model for other nations in
providing medical treatment and health counseling. Zajac
responded that this was an area that they were already
examining and that he would look at ways to establish a
program to meet the health needs of trafficking victims.

Policy on Pharmaceuticals
--------------


9. (U) Minister Zajac also mentioned concerns from the
pharmaceutical industry about Slovakia's recently adopted
policy on medicines. He stated that while multi-national
companies are concerned about limited access to non-
generics, the ministry is battling serious corruption
problems and the high cost of drugs. The Ambassador replied
he believed there were some misconceptions and suggested
Zajac meet with the companies for further discussion. Zajac
said he planned to address drug companies at an American
Chamber of Commerce event in the near future, which the
Ambassador could attend.

WEISER


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