Dr. Zbigniew Religa arrived here a year ago determined to transform this city's aging hospital into a cardiology clinic that would set a new standard for Poland's beleaguered health system.
It was not a task for a cautious man. Religa, an heart surgeon, began with three hand-picked specialists and five experienced nurses, and coaxed about $15 million in donations from factories in the surrounding Silesian industrial belt. But his clinic could not surmount the chronic troubles of all Polish hospitals: shortages of drugs, ambulances, cleaning staff and even basic sanitary equipment.
Then this month, Religa took the step he knew would get him attention: he performed two heart transplants, the first in Poland since a failed attempt in 1969. One of his two patients died. But within a week, supplies were pouring into his aging, spartan facility, and the local Communist Party secretary called to promise that cleaning personnel would be detailed from factories.
"It was one of the reasons I did the heart transplant," the 47-year-old doctor said one recent morning between bypass operations. "Now I have all the drugs I want."
"That's so typical of Poland," added a colleague, Dr. Jerzy Wolczylc. "You do something interesting and only then you get some attention."
Although he scheduled its first heart operation only three months ago, Religa's clinic now aims to outstrip the combined performance of all the other cardiology facilities in Poland. The four surgeons, working at the rate of one major operation a day, already have performed 120 open-heart operations and have a waiting list of 200.
"Our goal," he says, "is to create a cardiology clinic as good as the average facility in Western Europe."
The dizzying speed of the project's development and the stagnation in more established facilities reveal the twin poles of a hospital system that remains the most erratic in Eastern Europe. For many Poles, health care -- more than job conditions, material supplies or even housing -- is the greatest frustration of daily life and the symbol of the failures of their state-run social services.
Even Religa's record, celebrated as a triumph by the Polish media, was shaped by the troubles that pervade the hospitals: severe overcrowding, critical shortages, and lapses of sanitation and standards so low that official spokesmen have labeled them "shocking" and "nightmarish."
"The Sanitary Inspection Department has been shocked," said the official government daily Rzeczpospolita in reporting on a recent inspection of national hospitals. "They did not expect such gross negligence. Hospitals, which should set an example of cleanliness, were filthy.
Dirt and the risk of infections are only the beginning of the problems patients confront. Poland has the lowest number of hospital beds relative to its population in Eastern Europe and places are so short that noncritical patients must sometimes wait a month or more for surgery. Many of those admitted are quartered in hallways and bathrooms with regular wards already crammed to double capacity. Food has to be brought to many patients by their relatives.
Drugs are so scarce in some clinics that up to 40 percent of supplies come from donations provided by the Roman Catholic Church and foreign organizations. Staff are so poorly paid that vacancies force doctors to double as nurses while nurses clean and cook.
The result is that many Poles must pay dearly for what are nominally free services. According to doctors, former patients and reports in the official media, many underpaid doctors demand substantial bribes for even simple treatments.
For many health specialists, the culmination of such common horrors came last August with the deaths in a hospital in the town of Wloclawek of eight newborn infants improperly treated with albumin. An investigation showed that doses of the protein were administered more than 24 hours after the container of the medication was opened, even though the maximum allowed exposure time for albumin is four hours.
"This is the classic example of how bad it is," said Zofia Kuratowska, the former director of a Warsaw hospital clinic and medical counselor to the church primate's committee. "Poland is very short in albumin, it's very expensive and most of it is imported from the West. It's forbidden to use one bottle for more than one baby, or to use it after four hours. But here, they used it for many babies and for many hours . . . . Finally, something happened."
A follow-up report by activists of the opposition trade union Solidarity pointed out that two nurses were in charge of caring for 40 babies in the Wloclawek hospital.
Only four hospitals in Poland can do open-heart surgery, and cardiologists in Zabrze say Poland is 15 years behind the West in bypass operations.
Silesia, Poland's industrial heartland with a population of 6 million, had no cardiology clinic until Religa and his team arrived in Zabrze, a city that adjoins the district capital of Katowice.
Religa, who completed three separate fellowships and training courses in the United States, worked in a Warsaw hospital during the 1970s and then spent five years as a surgeon in the capital's new cardiology clinic before leaving last year in frustration. "I felt I was ready to perform a heart transplant five years ago," he said.
Looking for a place to operate independently, Religa seized on the Zabrze clinic. He was able to equip the clinic because several large factories sold 100 tons of silver reserves and donate the proceeds.
Now, Religa and the three other doctors are living in the hospital and working 85-hour weeks. "We couldn't do less," Religa said. "We have to serve 6 million people."