Romanian Health Care System Is Sick

ODOBESTI, Romania -- The stench of urine hangs in parts of the hospital in Odobesti, a hill town known for producing some of Romania’s most fragrant wines.

Patients bring their own food, soap and toilet paper. Sheets on iron cots are soiled and torn. Worse, medicines, syringes and bandages are scarce.

“The last few months have been the hardest of my career,” said Dr. Ilie Manole, deputy director of Odobesti Municipal Hospital and a physician for 27 years.

“We are between a hammer and an anvil,” he said. “We want to treat the patients, but we have to rely on their good will to buy medicine.”

Manole said the hospital, which serves this community of 10,000 people in the foothills of the Carpathian Mountains, has performed only emergency surgery in recent months.

It points up the neglect that has plunged health care into crisis throughout this formerly communist country.

In May, four hospital chiefs in the northeastern city of Iasi announced that they could no longer keep their Hippocratic oaths to help patients because of a chronic shortage of drugs.

Parents of children with AIDS are suing the government insurance agency because Iasi’s pharmacies stopped supplying the free medicines to which all children under age 18 are entitled.

Suppliers have halted deliveries to hospitals in recent months because of unpaid bills; many pharmacies no longer honor prescriptions for drugs covered under the cash-strapped national insurance plan.

The crisis prompted the government to promise an extra $265 million to pay hospitals’ debts. But basics such as anesthetics, bandages and syringes are still hard to come by.

There have been reports that some patients have died -- al though not in Odobesti -- because of the shortages, but there are no reliable estimates of such deaths.

President Ion Iliescu has been holding crisis meetings with government ministers. Former Health Minister Daniela Bartos, who was blamed for failing to resolve the crisis, lost her job in a government reshuffle last month.

“The health system is sick,” said the new minister, Mircea Beuran, a surgeon and close advisor to Iliescu. Dealing with the crisis, he conceded, “will be one of the most difficult operations I’ve ever performed.”

In Bucharest, the capital, district mayors said they would inject $11 million to improve medical facilities in the gritty city of 2.3 million.

Although the national health insurance board technically shows a yearly surplus of $458 million, it has not been allowed to spend all its funds by the government, which is trying to keep the budget deficit low to meet International Monetary Fund requirements for loans.

According to the World Health Organization, Romania spends only $190 per capita on health care, just a fourth of what is spent in neighboring Hungary, another former communist country.

Most Romanians say the state health system has declined steeply since communism ended, and few people can afford the private clinics that have opened.

Under dictator Nicolae Ceausescu, who was executed on Dec. 25, 1989, medical checkups were free and hospitals had basic medicines. But they didn’t have the latest technology, and people had to bribe doctors and nurses to get care.

Today’s problems are evident on the grounds of Odobesti’s hospital, not far from the lush vines that produce the famous sweet “Yellow of Odobesti” wines that Ceausescu adored.

Fir trees planted to shade the shabby vanilla-colored hospital buildings are brown from neglect.

Stray dogs limp on furless legs raw from scabies. The Romanian flag fluttering outside is faded and fraying.

“It is catastrophic,” Georgeta Nedelcu, a nurse at the 90-bed hospital, said of the shortages inside. “It is not enough to be kind; you need materials too.”

In the pediatric ward, where musty air mixes with the scent of urine, a 3-year-old girl with bronchitis wheezed as she slept, tended by her 12-year-old sister.

Nearby, Monica Chiriac, 18, nursed her 1-year-old son, who she said has “hepatitis and all kinds of other things.”

Lunch was pasta soup served from an iron bucket and boiled rice with wisps of carrot, parsley sprigs and chunks of bread.

Electricity is expensive, so the lights go out at 9 p.m. There is hot water for only a few hours each day.

In winter, patients bring wood to fuel the hospital’s ceramic stoves.

Anica Bivolaru, a patient who is suffering from hepatitis, said she had been in and out of hospitals since 1973 and had never seen conditions so grim.

She said her husband is in debt after borrowing hundreds of dollars to pay for medicines that the couple can’t afford on his monthly pension of $36.

“It’s never been this bad,” she said.