Health on hold: Romania's TB crisis

Romania continues to suffer Europe's worst incidence of tuberculosis - the world's biggest infectious killer disease - at 30,000 cases per year. But while the crisis is deepening, its hospitals are closing…

Three years ago, Maria led an active life, working 10-hour days in a factory in the capital, Bucharest.
But in April 2000, she suddenly developed back pains and fever. She consulted a doctor, and X-rays revealed tuberculosis.

"I was separated from my family, spent a long time in a hospital and, after some months, the disease was finally put in check," Maria said.

"When I got home, I was too weak to take care of myself, let alone go to work."

Thousands like Maria have been stricken by TB in the worst outbreak of the disease in more than 25 years, which is claiming the lives of six people a day, according to a report released by the lung disease commission of the health ministry.

But efforts to deal with the crisis are being undermined by a cash crisis in the medical sector.

The authorities there have been forced to close down more than 90 hospitals since the beginning of the year, with the loss of 12,000 beds.

Unpaid suppliers have suspended deliveries of basic medicines, syringes, and bandages to dozens of health care centres, while labs lack essential materials for medical tests.

Hospital debts have reached US$280m. Medical distributors are just over 50 per cent more. For every patient, hospitals now receive less than US$3 per day – about a third as much as they did in January 2003.

Newspapers in Bucharest have reported that doctors have resorted to raising money on the street to keep their hospitals going.

The cash crisis has meant that sufferers like Maria have more often than not to fend for themselves.

"The money my husband earned was too little to buy the pills I needed, and I had no help from the state," Maria said.

With no medication, she began to cough up blood, and when she tried to get admitted to hospital, staff there turned her away, saying there was a shortage of beds.

Eventually, a relative took pity and lent her money for some medication.

"I have paid medical insurance for 25 years," Maria said. "And now when I need treatment, I can’t get it."

The Romanian Government blames poor management in the health care sector for the massive debts.

"One reason behind the huge sums spent by hospitals is the excessive prescription of very expensive, imported medicines," said Health Minister Daniela Bartos, who has closed down "inefficient" hospitals, prompting an angry reaction from their managers.

"Health sector reforms should be made taking into account the high mortality rates in Romania and not accountants’ figures," said Sorin Oprescu, deputy chairman of the Romanian senate health commission and general manager of two hospitals in Bucharest.

The authorities cite poverty and people neglecting their health as the main causes of tuberculosis in the country, with most cases of the disease occurring in poor areas in the south-east.

The Romanian mortality rate is 25 per cent higher than the Western European average.

Romanian journalist Cornel Nistorescu believes both the government and hospitals are to blame.

"The disaster in the health care system comes from the scarce funds which are made available to it, but also from bad organisation," he said.

However, crisis or not, those with the means or connections can still secure treatment.

"Doctors ask for money, you need to bribe them to be looked after. If you don''t have the money, you may as well be left there to die," Maria said.

"If you happen to know someone in the health system, it means you have a chance from God," said Nistorescu.

Those with neither face a grim future.

"I have lost weight, I have chest pains and night sweats. I can’t go back to work," said Maria.

"All I can do now is wait for a miracle. If I spend all the money my husband earns for the pills I need, my family will die of starvation. And if I don’t take my medicine, I know I will never be cured."