Interview: Velina Markovska
Intern Reporter: Gabriela Koleva
Business Card: Assoc. Prof. Dr. Emil Kovachev was born in 1975 in Varna. He graduated from MU-Varna in 1998, and in 2003 he acquired the specialty of Obstetrics and Gynecology and began working as an attending physician in SHOGAT "Prof. Dr. D. Stamatov" - Varna. He has specialised at Barzilay University Hospital, Ashkelon, Israel, in the field of Assisted Reproductive Technology and Gynecological Endoscopy. Chairperson of the Bulgarian Association of Infertility and Reproductive Health, member of the Bulgarian Society of Obstetrics and Gynecology, the European Association of Reproductive Health. Assoc. Prof. Dr. Kovachev is the head of the Department of Obstetrics and Gynecology at MU-Varna, and he has been the Executive Director of SHOGAT "Prof. Dr. D. Stamatov" - Varna since February 2016.
Assoc. Prof. Kovachev, we are on the eve of 21st January – the Maternity Care Day. How and why did you choose this profession of gynecologist-obstetrician, and when did you understand that this was your calling - helping in delivering new life?
The profession of gynecologist-obstetrician is one of the noblest, or perhaps even the noblest one, because the gift of a new life is an incredible mystery. I owe my inclination to this profession to my family. I am a third generation gynecologist - my grandfather and my mother practised this profession. Since I was a child I have empathized with the problems of Obstetrics and Gynecology, and perhaps this is one of the reasons prompting me to choose this specialty.
You have been practising the profession of gynecologist-obstetrician for 16 years. What is your greatest achievement during this period?
There are scores of achievements. That is why it is difficult to choose the greatest among them. I have assisted at the birth of hundreds of babies, I have helped many infertile patients, and I take pride in it. As a specialist I feel happy when one assisted reproduction is successful with subsequent successful pregnancy and childbirth. Besides the satisfaction we- specialists get, this is a joyful moment for the couple as well. However, not everything in Obstetrics and Gynecology is full of pleasant moments. Of course, there are unpleasant ones too. These are the unsuccessful reproductions, the typical diseases and complications in Gynecology. There are emergencies that require quick and adequate surgery. One of my greatest achievements over the past year has been the increase of the share of endoscopic operations at the Gynecological Hospital. In the general public, they are known as bloodless operations, referring to laparoscopic and hysteroscopy operations. Our desire is a greater share of the gynecological operations to be performed through this modern method rather than the conventional open surgery.
You have mentioned the reproductive problems among couples. Is their number increasing or decreasing?
Unfortunately, their number is increasing. In comparison to prior large studies from 1980-82, the rate of infertility in Bulgaria was 7.5%, while in 2005, when the next survey was conducted, the percentage of couples with fertility disorders had increased to 11-14%. Globally, this rate varies within 10-11%. In modern genesis, the percentage distribution of infertility is 50% male and 50% female factor. In general, the number of couples with fertility problems is increasing, which is due to several reasons. On the one hand, sexually transmissible diseases occur more frequently, and many of them damage the reproductive function of the woman and more rarely of the man. On the other hand, more frequently the first pregnancy is planned after the age of 35. Modern urbanization is yet another reason for reproductive problems - the lifestyle, striving for realization in society. All this leads to increased infertility and incidence of some common gynecological complications and accompanying medical disorders.
You are the head of the Department of Obstetrics and Gynecology at MU-Varna. Are your present students interested in specialising in Obstetrics and Gynecology, and how do you motivate them?
This specialty has always been up-to-date and interesting for medical students. It combines two specialties in itself: Obstetrics and Gynecology. In general, in the past and now, the desire of students to this profession is incessant. A few months ago two new graduate students, who are among the top medical students of class 2016, launched their specialisation at the Gynecological Hospital. Our hospital is the second largest Gynecological Hospital in Bulgaria after the Gynecological Hospital at University Hospital - Sofia, and we have the opportunity to offer the graduates all the prerequisites for their successful realization, as the greater part of the Department of Obstetrics and Gynecology at MU-Varna is located at our hospital. I wish to thank the management of Medical University - Varna and the Rector Prof. Dr. Krasimir Ivanov for their efforts and support for the improvement of the material and technical base and the creation of two ultra-modern training facilities that will improve the education of students.
Is there any great interest in the specialty and profession of midwife?
The interest in this profession is great as well, but unfortunately, after graduation, many of them emigrate. This fact is really alarming, and I think it is high time the government took appropriate measures to reduce the number of emigrants midwives. One of the main factors for this is the low remuneration. This is unpleasant, given the fact that medical universities in Bulgaria invest a lot of money in their education, and after that they do not practise in our country, and in fact we suffer from deficiency of personnel, which in fact we have trained in our country.
Assoc. Prof. Kovachev, you've participated in over 20 OG national and international congresses, and you have more than 90 scientific publications in the field of Obstetrics and Gynecology. How does this contribute to your work as a lecturer?
Participation at scientific congresses and publications contribute to the development of every doctor and lecturer. Being in touch with the innovations in scientific information, and getting acquainted with the specific problems in a particular specialty has always been an important factor in the development of medical science. All of us, at the Department, participate at foreign and Bulgarian congresses, where we present our innovations and laparoscopic operations. Obstetrics and Gynecology is a specialty that consists of a lot of practical work, but there should always be a balance between the new scientific knowledge and the practical skills.
How do you assess the level of Obstetrics and Gynecology in Bulgaria in terms of innovation in comparison with best practices globally?
In Bulgaria Obstetrics and Gynecology have good traditions coming from the past. The level of Obstetrics and Gynecology and in particular reproductive medicine are in no way inferior to leading European and world countries. Moreover, some centers for assisted reproduction in a Bulgaria have a higher percentage of clinical pregnancy in comparison to middle European percentage. In Bulgaria the specialists have the opportunity to perform all methods of assisted reproduction and to use high-tech equipment for laparoscopic surgery.
What is the trend in birth rates – is the number of newborns in Bulgaria increasing or decreasing?
At SHOGAT "Prof. Dr. D. Stamatov" – Varna, we had 2268 childbirths during the past 2016. Their number was 2258 for 2015. So we finished 2016 with 10 childbirths more. Unfortunately, for Bulgaria, the birth rate is falling – there are nearly 4 000 births less than the last year, which is an alarming fact for our nation. The new 2017 began well, but it is too early to make any predictions about what we can expect.
What would you like to wish your colleagues?
I'd like to congratulate all my colleagues - gynecologists-obstetricians and midwives on our professional holiday. I wish them plenty of professional success – may we have more deliveries of safe and sound babies in 2017, and personally I wish them good health. Besides us - gynecologists-obstetricians and midwives, all kindergarten teachers and nurse-maids, who help in raising our children, have their professional holiday on that day as well. Happy holidays to them too!