The disease of the Romanian health care system

Photo: Rarpet (CC) commons.wikimedia.org

Popescu’s cousin, Catalin, lived in Râmnicu Vâlcea, a small town 180 kilometres northwest of Bucharest. On that day, Catalin and his fiancée had just moved into a new flat. “He was very excited about the new life he had ahead of him,” Popescu says. The night in which he and his mother ended up in the hospital, Catalin had woken up in the middle of the night. He felt ill and was not able to move his right arm and leg. His fiancée took him to the local hospital in Râmnicu Vâlcea.

“When they arrived, no one took them seriously,” Popescu says. “They said: ‘fill in these papers and wait.’ My cousin started to feel worse and worse.” As he and his fiancée waited for a doctor to come, Catalin could no longer feel anything on the right side of his body.

Communist creation

His mother learnt what happened and rushed to the hospital. The neurologist told her that her son had a brain haemorrhage and that they should go to the hospital in Bucharest. Catalin’s mother suggested doing a CT scan in Râmnicu Vâlcea to get the process started, but the doctor informed her that the CT-scan machine was out of order.

It was not just bad luck that the scan machine did not work, according to Bogdan Tănase, a surgeon and president of the Alliance of Physicians of Romania – an NGO with the purpose of modernising Romania’s healthcare system. “Our hospitals and medical equipment are obsolete,” he says. “Many hospitals were built after the 1977 earthquake and don’t meet today’s standards. The hospital where I work was built in 1990. It is almost thirty years old and that is considered a ‘young’ hospital.”

Tănase is one of Romania’s few doctors not afraid to shed light on the country’s healthcare problems. He calls Romania’s healthcare system a “communist creation”, that is essentially the same as it was before the 1989 revolution, ending 42 years of communist rule in Romania. “The mentality of the people is the same. People talk about reforms, but nobody actually does anything.”

Because of the broken CT-machine in Râmnicu Vâlcea, an ambulance took Catalin, his fiancée and mother to Bucharest. They only made it a third of the way. In transit, Catalin started shaking and trembling. The ambulance was forced to stop at the hospital in Pitești, a city between Râmnicu Vâlcea and the capital. “They did a CT-scan of Catalin’s head and found that the amount of blood in his brain was massive,” Popescu says. Despite the discovery, the hospital sent them all home with an explanation that the hospital has no space or the medical staff to accommodate Catalin. Catalin’s mother was furious. “You can’t send my son with a brain injury home,” she said. “He might die tomorrow.” The doctor made some calls to hospitals in Bucharest, but they all said they cannot accommodate Catalin because their emergency rooms were full. “You’re not doing anything, but I am taking my child and going to Bucharest, either way,” the mother said in reaction.

Brain drain

The doctors in Pitești’s hospital said it was impossible because the emergency ambulance was not prepared and there was no available medical staff. They told Catalin’s mother to call the hospital back in Râmnicu Vâlcea to send another ambulance, with a doctor.

“It took an hour and a half for the ambulance to arrive, valuable time that was lost when my cousin was in really, really bad shape,” Popescu says. In a country that lost half of its doctors between 2009 and 2015, it is not surprising there were no doctors available. Freedom of movement and residence is one of the pillars of the European Union, but when it comes to providing healthcare to the people of the EU’s poorest nations, that is a problem too.

Romania is one of the EU’s youngest members, and since its joining in 2007 the number of doctors that have left the country has skyrocketed. At the end of last year, about 15,700 doctors worked abroad, according to a survey conducted by the Romanian Association for Health Promotion. They make up over 20 per cent of all Romanian doctors and are lured in by what their own country lacks: a functional healthcare system with modern hospitals and equipment where doctors receive good salaries. France, Germany and Britain are among the most popular destinations.

It is a big problem, according to Tănase, the surgeon. Though he understands why young doctors leave: “The salaries are low, while the expenses of healthcare professionals are high; access to information, private courses, specialisations, it all costs money.”

The doctors that do not leave prefer to work in urban areas, Tănase says. “They want to work in big cities like Bucharest, Cluj-Napoca, or Iași because the healthcare system is better there. Say you work in Buzău, 90 kilometres from Bucharest, there are times when you might not have an anaesthetist available. A surgeon cannot operate without an anaesthetist.” It has led to a shortage of doctors in rural areas, where about one in four of the population lacks sufficient access to essential healthcare, according to data from the European Commission. These problems are compounded by the low quality of health education, according to Tănase. “Doctors are taught very theoretically, but not practically. After they graduate they do not really know how to do the things they learnt from the textbooks.” The fact that doctors leave does not have to be a bad thing, he adds. “The doctors that go to other countries learn. Maybe they will come back and change something here.”

System to blame

That possible change is too late for Catalin. On the highway heading towards Bucharest, he fell into a coma. When they finally arrived at the hospital, the emergency room doctor became angry and started yelling. “He said: ‘This is not possible, you told me he would be conscious. I cannot do anything now, he is in a coma, and we don’t have the space. Go to another hospital,’” Popescu recalls.

Catalin’s mother knew there was no more time to waste. “She fought for over an hour with the doctor, in front of the emergency centre, with my cousin in a coma,” Popescu says. Catalin’s mother is desperate and calls the doctor from the ambulance, who gives her the number of the person in charge of the hospital. After some calls and another 30 minutes of waiting, there is finally a spot for Catalin. The time it took between arriving at the local hospital in Râmnicu Vâlcea and getting a spot at the ER in Bucharest was nine hours. “My cousin lost nine hours when he was bleeding like hell,” Popescu says, clearly agitated. “He was conscious when he went to the hospital in Râmnicu Vâlcea but ended up in a coma in Bucharest.” She takes a breath. “I can’t blame the people who are working in healthcare; I blame the system.”

What followed were two distressing months, in which Catalin sometimes showed small signs of improvement. “After three days he woke up from his coma for the first time. It was a surprise for everyone because the doctors said his chances would be around one per cent. The doctors called it a miracle. For us, it was not a miracle. It is a miracle if he would survive the system, with all its corruption.”

It is common practice in Romania to bring an envelope with money if you visit a hospital. Websites discuss what costs can be expected. For example, totuldespremame.ro (“everything about mothers”) state that prices for a natural birth vary between 88 and 176 euros in Bucharest. A caesarean section will approximately cost 176 to 330 euros. These are the unofficial payments, on top of the taxes Romanian citizens pay for the national health system. This is a lot of money for residents of a country with an average net monthly salary of 580 euros, according to the country’s national institute of statistics. If patients do not bring bribe money, they are forced to wait longer and receive an even lower quality of healthcare.

Surgeon Tănase labels this kind of corruption “small and basic” and says it stems from the communist era. “The salaries of doctors, prosecutors and teachers were very small. Communist leaders knew that salaries would be complemented with the bribes people would bring, so there was no need to give medical staff a higher salary. This practice was perpetuated by every government that led Romania after the fall of communism.”

It does not stop with the envelopes for doctors, nurses and other healthcare professionals. There is corruption on a higher level too, which manifests itself in shady acquisitions and fraud. An infamous case came to light after the 2015 Colectiv nightclub fire in Bucharest, where 64 young people were killed. The vast majority died in hospitals. Eugen Iancu lost his 22-year-old son, Alex, in the fire. “He died three weeks after the incident,” he says. Iancu shows an enormous stack of paperwork. “This is his file. He had five infections that he caught inside the hospital.”

After the scandal, journalists with the sports newspaper Gazeta Sporturilor started looking into hospital supplies. They discovered that the disinfectant supplied by the company Hexi Pharma had been diluted. In some cases, the substance contained only ten per cent of the concentration the label said. The reporters revealed that hospital directors received a 30 per cent cut of the contract with Hexi Pharma – which explained how the small company could win so many large public contracts.

Catalin was lucky enough not to be infected at the hospital, but the nine hours he lost on his way to the hospital eventually took its toll. “After two months of fighting for his life, my cousin eventually died, a day before his 27th birthday,” Popescu says. The next day Catalin’s Facebook page was filled with birthday wishes he would never see. “It is awful. He was ready for his new life, with his fiancée in their new apartment, but never got the chance to live it.”

After telling Catalin’s story, Popescu’s emotions visibly rise: “My aunt experienced nine hours, nine desperate hours, where she had to fight like a lion to get a place in the emergency room for her son. The poor guy ended up dead at 26 because of a stupid thing that could have been avoided. It is too late for my cousin. Nothing can be done for him anymore, but maybe something can be done for others.”

Hope for a cure

Andreea Berariu, a paediatrician resident from Bucharest, is convinced that the new generation of doctors could contribute to the much-needed change. “Young doctors have a different mind-set,” she says. “They want to do things right.” During her residency programme, Berariu was offered envelopes with money several times. “I refuse to take it.”

Young doctors have unlimited access to online research and understand the international climate, Berariu says. “Some of them start to speak their minds and say that things are not okay.” They do get frustrated, Berariu continues. “They want to do the right thing, but they don’t have enough experience or the right equipment. At least their mentality is different. They don’t take bribes and only want what is best for the patient.”

Tănase also hopes that the healthcare system will be cured eventually. He says the poor quality of Romania’s healthcare derives from the underlying politics. “We have had 27 ministers of health in the 28 years since the end of communism. One year is not enough to change anything, even if you want to.”

“I have hope things will change. It is the nature of all things to change for the good,” Tănase adds. But in the meantime, patients continue to pay the price.

Fieke Snijder is a Dutch journalist specialising in international politics, particularly in Eastern Europe.

Health care, hospital system, Romania