San Francisco Frontiers - In Bulgarian mountains, local doctor still on call at 90

Apostolov turned 90 in May but still scales the same hill almost every day to visit his patients at the foot of the Belasitsa mountain range, near the border with Greece and North Macedonia.

And his case is far from unusual in Bulgaria, where many general practitioners continue to work well past retirement age because there is no one to replace them, especially in rural areas.

In 2023, 54.5 percent of doctors in the EU's poorest country were 55 or older -- the highest proportion of any country in the bloc, according to Eurostat. For general practitioners like Apostolove, the average age is currently over 61.

Bulgaria also has the lowest life expectancy in the EU -- 75.8 years in 2024, compared with a bloc-wide average of 81.5 years -- and one of the highest rates of preventable mortality, according to the Organisation for Economic Cooperation and Development (OECD).

This is partly down to the shortage of doctors, leading to later diagnoses and poorer management of chronic illnesses.

Apostolov alone has more than 1,500 patients on his books, spread across several villages.

- 'I'll keep going' -

"How are you today?" he calls across a fence to two elderly women chatting in the garden of a house.

"He's even older than me, but he doesn't use a walking stick. I have two," said Milka Oumlenova, 88, after a brief consultation. "May he live a long life and keep helping us."

Doctor Apostolov's day starts around 7:00 am, when he gets into his rusty 20-year-old Peugeot to drive the roughly 16 kilometres from his home in Petrich to his office in Skrat.

Often patients are already waiting for him, seeking help with a range of issues including high blood pressure and diabetes.

"For the moment, I feel fine. The work doesn't weigh me down. I'll keep going as long as I'm doing well and the patients are satisfied," he said, sitting behind an imposing wooden desk.

Neatly dressed in a pale blue shirt and white lab coat, Apostolov opens his practice at 8:00 am.

Inside the old brick building, medicines and syringes are laid out in display cabinets dating from the middle of the last century.

At midday, he leaves the surgery to visit patients who can no longer get around themselves. And in the afternoon, he gets back in his car to tour around the neighbouring villages.

"I would gladly step aside for someone who wanted to come work here, but young doctors aren't coming," he said.

- Poor career prospects -

Apostolov began practicing in 1962 as a district doctor, before heading a hospital department in the town of Petrich and then running a cardiology practice. He was already over 60 when he settled in Skrat in 2000.

Medicine has changed profoundly during that time, he said, but "what we've learned and the experience" remain important.

According to the OECD, primary care remains underdeveloped, underfunded, and undervalued in Bulgaria, despite a relatively high overall density of physicians.

"We are the Atlas who carries everything, but this Atlas has grown old," said Gergana Nikolova, vice president of the Bulgarian National Association of General Practitioners, in reference to the hero of Greek mythology.

According to Nikolova, many young doctors are staying away from general practitioner jobs -- especially in rural areas -- due to burdensome bureaucracy, poor career prospects and low pay.

But despite the difficulties, Nikolova is proud to have "lit the spark" in several young doctors who are now training with her.

"Just like I myself trained with Doctor Apostolov more than 20 years ago," she said.

M.Hill--SFF