US embassy cable - 04BRATISLAVA144

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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