Romania, Bulgaria health systems are sick from underfunding, understaffing and corruption

By Alina Wolfe Murray, AP
Monday, August 23, 2010

Romania, Bulgaria have EU’s sickest health systems

BUCHAREST, Romania — No sutures and other basics; a dire shortage of staff; catastrophic hygiene; then this — a hospital blaze that killed five premature babies. Romania’s hospital system is on the ropes.

The Aug. 16 fire that broke out in an intensive care unit killing five premature babies and leaving six others in critical condition is the most compelling example of a health sector reminiscent more of a developing nation than an EU member country.

Romania’s hospitals were a nightmare under communism which ended in 1989. But more than two decades after communist rule was toppled and almost four years after it joined the EU, Romania remains one of Europe’s poorest countries — and the sorry state of its hospitals reflect that status.

In a revelation sure to add to the controversy, Bucharest Mayor Sorin Oprescu told reporters Monday that only three of Bucharest’s 21 hospitals have a fire alarm system. It was unclear whether any have sprinkler systems, but Giulesti hospital — one of the capital’s best, where the tragedy occurred — did not.

A massive shortage of medical staff, bribes to doctors and nurses to ensure better treatment, and chronic underfunding or high debts run by hospitals are everyday obstacles that patients need to negotiate. Supply shortages mean that operations sometimes do not get performed if patients do not supply their own bandages, syringes, surgical thread and antibiotics.

In recession-battered Romania, the government in 2009 spent just 3.7 percent of national GDP, or €4 billion, on health. That is less than half in percentage terms of the European Union average.

And over 90 percent of those interviewed by the Association for Implementing Democracy this year in Romania, said corruption in the health system was “a critical issue which directly impacts the patients.”

The European Commission’s annual report on Romania said last month that “two-thirds of respondents said they have offered money to medical personnel, with 81 percent saying that they believe such payments played an extremely influential role in how they were treated.”

It’s mostly a matter of money — or lack of it.

In neighboring Bulgaria, another poor EU member which spends just 4.2 percent of its GDP on health, patients also often pay for medical supplies and medicines — and preferential treatment.

“Typical forms of corruption in hospitals are bribes to secure hospital admission, purchase of medical supplies and medicines, soliciting official donations to the hospital, extra charges for treatments and operations,” says Konstantin Pashev from the Center for the Study of Democracy.

Romanian leaders regularly go abroad for treatment of serious medical conditions. The less fortunate have grim stories to tell.

“My sister had an ovarian cyst which was operated on two years ago,” says accountant Agnes Sekely, from the western Romanian city of Cluj. “She saved as much money as she could to give to the doctor (but) a month later, when she went for a checkup, the doctor said to her: ‘You owe me something.’

“My cousin … has a kidney stone and she was told that without 1,000 euros she should not bother to go to hospital for the operation.”

Standards are inconsistent. Costel Rotaru, 55, says he had to buy bandages when he was recently hospitalized with a hand infection. But Mihaela Stroe, 40, who gave birth this week in another Bucharest hospital, said that hospital provided everything.

In small towns outdated equipment is the norm, and overcrowded wards — sometimes with even two to a bed — are not unusual. Scuttling cockroaches are seen in some hospitals even in the capital and it is standard practice to pay nurses to change dirty bed linen.

Doctors and nurses in both Romania and Bulgaria are poorly paid — in Romania, a specialist at a hospital makes the equivalent of less than €1,000 ($1,300) a month. This has ensured the survival of bribes, a common practice under communism.

In contrast, medical staff in most West European countries are not even allowed to accept flowers or a box of chocolate from grateful patients.

At 73, average life expectancies in both countries are five years less than the EU norm. And things are set to get worse.

The Romanian health ministry says that 8,000 doctors have requested documents allowing them to work abroad in the last three years. This comes at a time when Vasile Astarastoae, chairman of the College of Doctors in Romania, says the country needs to double the number of its doctors to reach the EU average of physicians per patient.

Conditions are similar in Bulgaria. Stanka Markova, chairperson of Bulgaria’s nurses association, says the Balkan nation needs to double the number of nurses to reach the required doctors-nurses ratio.

She says understaffing is affecting the quality of treatment with hospitals with fewer nurses having higher mortality rates. As in Romania, medical staff are looking for jobs in Britain, Spain, and Greece, where the average salaries for nurses are five to six times higher than in Bulgaria.

Romania has 19 doctors and 42 nurses to 10,000 people, compared to a regional Balkan average of 32 doctors and 79 nurses, according to the World Health Organization.

Some of the critically injured newborns suffered burns to 80 percent of their tiny bodies and respiratory tracts and treatment was gladly shared with a medical team from Israel, headed by Dr. Josef Haik, director of the burn unit at Sheba Medical Center at Tel Hashomer.

Defying calls for his resignation in the face of public anger, Health Minister Attila Cseke called this week to be allowed to hire more staff, saying that the system needs “thousands” of professionals.

But money is a problem. Romania remains on an IMF drip as it seeks to cut down spending, reduce its budget deficit and avoid the worst case scenario of default. And there is lack of clarity about how the money available is spent.

“We must discuss about stopping wastage in the health system, a system which had in 2001 funding of 1 billion euro, and today has over 4 billion euro,” said President Traian Basescu this week.

Tragic accidents happen as well in the most prosperous EU countries. In Germany prosecutors on Monday were investigating the deaths of two infants who may have been infected by a tainted infusion at a hospital in the western city of Mainz. A third infant remained in critical condition.

But Romania’s problems appear more deeply rooted.

Investigators noted an overloading of the electrical wiring system in the intensive care unit for premature babies, which could have sparked the fire. The prosecutor’s office was investigating reports that the missing nurse was celebrating a local holiday with colleagues in another room. The door of the unit was locked and could only be opened with a card.

Surveillance video showed staff and parents trying desperately to enter the unit amid swirling smoke. Firefighters finally managed to break down the reinforced glass door.

The management of the hospital has been suspended and the health ministry has pledged to install fire detectors in hospitals.

However, for some, the measures are too little, too late.

“Incompetence, indifference and irresponsibility together equal crime,” said Sekely, the accountant. “Guilty are the doctors, the nurses, the guards, the electricians, the lack of funding, in short the whole system.

“It makes me sick.”

Associated Press writers Veselin Toshkov in Sofia, Bulgaria, Alison Mutler in Bucharest and George Jahn in Vienna contributed to this report.

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