Romania’s healthcare system is drenched with diseases. The combination of poverty, corruption and the remnants of communism, exacerbated by the mass amount of doctors moving abroad after the country joined the EU, has led to a system that has left patients in a dire position. The cure may lay in the new generation of doctors.
It is the end of October, when Roxana Popescu receives an alarming call. “It was 4 in the morning”, she remembers. “My aunt was on the other end of the line and told me that she was in the University Hospital in Bucharest with my 26-year-old cousin Catalin. He was in a coma.”
Before her aunt and cousin end up in the capital city’s hospital a long story precedes. A story that in many ways shows what is happening in the country’s healthcare system. Roxana Popescu’s cousin lived in Râmnicu Vâlcea, a small town 180 kilometers northwest from Bucharest. “He just moved to a new flat with his fiancee. He was so excited about their new life.”
That night in October Catalin wakes up in the middle of the night, feeling ill and not able to move his right arm and leg. “His fiancee took him to the hospital in Râmnicu Vâlcea. When they arrived, no one was taking them seriously. They said: ‘fill in these papers and then you have to wait.’ My cousin started to feel worse and worse and couldn’t feel the right side of his body anymore.”
At that time his mother finds out what happened and hurries to the hospital. She speaks to the doctor in charge of the emergencies. “The neurologist told my aunt that my cousin had a blood injury in his brain. ‘Go to the hospital in Bucharest, because our CT-scan is not working’, the doctor said.”
A CT-scan machine that is out of order exposes one of the problems in the Romanian healthcare system. “Our hospitals and medical equipment are obsolete”, Bogdan Tănase, surgeon and president of the Alliance of Physicians Romania said. He is one of the few doctors in the country that is not afraid to speak up. “Many hospitals were built after the earthquake in 1977 and don’t meet the standards of nowadays. The rooms can be as small as four square meters.”
Because of the broken CT, the doctor in Râmnicu Vâlcea makes some calls to hospitals in Bucharest. But they all say they can’t receive Catalin because of full emergency rooms. “The doctor knew something was wrong with my cousin and told one of the hospitals he will come either way”, Roxana Popescu said. An ambulance takes Catalin and his mother to Bucharest.
They only make it a third of the way. “In transit Catalin started to shake and tremble. They called a hospital in Pitești, a city between Râmnicu Vâlcea and Bucharest. In that hospital they made a CT-scan of his head and found out the amount of blood in his brain was massive.” Despite the discovery, the hospital sends Catalin and his mother away with the explanation that there is no space. “My aunt said: ‘You’re not doing anything, but I will take my child to Bucharest. Either way.’”
The people in the hospital tell them they can’t go to Bucharest, because the emergency ambulance is not well-prepared. “They told my aunt to call the hospital in Râmnicu Vâlcea to send over an ambulance with a doctor. That took an hour and a half, another hour and a half of valuable time that got lost when my cousin was in a really bad condition.”
Missing ambulances and the lack of doctors: another problem in Romanian health care. “There are statistics that over 10,000 Romanian doctors work outside Romania’s borders”, surgeon Bogdan Tănase said. “Doctors move because of the small salaries, the working condition and the corruption.”
On the highway towards Bucharest, Catalin falls into a coma. When they finally arrive at the hospital in the capital, the emergency doctor starts yelling at them. Roxana Popescu: “The doctor said: ‘This is not possible, you told me he would be conscious. I can’t do anything now, he is in a coma and we don’t have space. Go to another hospital.”
But Catalin’s mother knows there is no time to waste anymore. “She fought for over an hour with the doctor, in front of the emergency center, with my cousin in a coma.” Catalin’s mother is desperate and calls the doctor from the ambulance. He gave her a number from someone in charge of the hospital. After some calls and another thirty minutes of waiting, there finally is a spot for Catalin.
The system to blame
“My cousin lost almost nine hours in this situation, when he was bleeding like hell. He was conscious when he went to the hospital in Râmnicu Vâlcea and he ends up in a coma in Bucharest. I can’t blame the people who are working, I blame the system.”
What follows are two heavy months, in which Catalin sometimes shows 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 can survive in this system, with a lot of corruption and bacteria.”
“There is small and big corruption”, surgeon Bogdan Tănase explained. “Small corruption in terms of bribing doctors.” It is common practice in Romania to bring an envelope with money if you visit a hospital. Websites discuss what costs you can expect. On totuldespremame.ro, meaning ‘everything about mothers’, it can be read that prices in Bucharest for a natural birth vary between 88 and 176 euro. A cesarean section will cost approximately between 176 and 330 euro. These are unofficial payments to doctors, on top of the taxes Romanians pay. A lot of money for a country where the average monthly salary is around 730 euro, according to the Romanian national institute for statistics. If patients don’t bring bribe money, they are forced to wait longer and experience healthcare of an even lower quality than otherwise.
Bacteria in hospitals are another problem. It became painfully clear after the 2015 Colectiv nightclub fire, where 64 young people were killed. The vast majority died in hospitals. Eugen Iancu lost his 22-year-old son Alex to the fire. “He died three weeks after the incident”, he said. Eugen Iancu shows an enormous stack of paperwork. “This is his file. He had five infections that he caught inside the hospital.”
Catalin was lucky enough not to be infected by bacteria, but the nine hours he lost on his way to Bucharest eventually took their toll. “After two months of fighting for his life, my cousin died on the third of January, a day before his birthday”, Roxana Popescu said. The next day Catalin’s Facebook page fills up with birthday wishes, but Catalin couldn’t look at them anymore. “It is awful. He was ready for his new life, with his fiancee in their new apartment, but never got the chance to live it.”
At the end of the story, Roxana 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 ends up dead at 26, maybe because of a stupid thing that could have been avoided. I am getting mad again, but it is too late for my cousin. Maybe not for others, but nothing can be done anymore for Catalin.”
Hope for a cure
Bogdan Tănase has hope that the healthcare system will be cured eventually. “It is in the nature of things to change for the good.” The fact that 10.000 doctors are working outside Romania’s borders, could contribute to this change, the doctor argues.
“The quality of heath education in Romania is low. The doctors are taught very theoretically, but not practically. When they are finished, they don’t really know how to do the things they learned from the books. If these young doctors go to other countries, they learn. Maybe they will come back and change something.”
But not only the doctors that move away and gain experience abroad can make a change. Andreea Berariu, a 26-year-old paediatrician resident from Bucharest, is convinced that the new generation of doctors have a different mindset than the older ones. “They want to do things right”, she said. “Some of them start to speak their minds, saying that things are not okay. They have unlimited access to online research and understand the international climate.”
Yes, young doctors do get frustrated, Andreea Berariu admits. “They want to do what is right, but they don’t have enough experience or the right equipment. But at least their mindset is different. They don’t take bribes and only want what is best for the patient.”