Elena is a nurse in the public hospital in Kozloduy, a small town in northwest Bulgaria, the poorest region in the EU. Her working day sometimes lasts up to ten hours. She works alone with up to thirty patients per shift, as there are not enough nurses in the hospital. At fifty-four, Elena is considered a young nurse — her colleagues at the hospital are over sixty; some are even over seventy. Her monthly salary is €375, which is slightly above the national minimum wage, set at around €325 for 2021. Her salary is barely enough to live on, as Elena has to support her own household as well as the family of her daughter, who recently became a mother. To make ends meet, Elena took up a second job as a nurse in a private practice. Because of the financial difficulties and the enormous workload, she is considering immigrating to Germany and looking for a job as a care worker there.

“Elena” is a pseudonym. But the situation I’ve described represents the everyday reality for most nurses in Bulgaria, after twenty years of neoliberal experiments in the health sector, which have hit women particularly hard. As in many other care professions, about 80 percent of health care workers in Bulgaria are women. Miserable wages and poor working conditions are the reason why many of them — especially the younger ones — leave Bulgaria to find better jobs in countries like Germany, the UK, Greece, Spain, and Italy.

By 2018, Bulgarian hospitals were facing a loss of almost thirty thousand medical nurses, while the average age of those working in the country’s health care sector is now fifty-eight. Since there are no official guidelines specifying how many patients can be cared for by one nurse, it is often the case that a single nurse has to look after twenty, thirty, or even forty patients per shift. Simply put, health care in Bulgaria rests largely on the shoulders of overworked women who are nearing or even past retirement age.