A tough nut to crack...

Healthcare. Between that and the title do I need to say more? I’ve lived in the U.S. my whole life and have participated in the healthcare system as a patient, researcher and now as a medical student, but I don’t pretend to truly understand the elaborate maze. Understanding and adapting to the system will be a lifelong challenge. With the disclaimer that I understand even less about Romanian healthcare, I would like to share what I have learned this summer. I write as someone who sees healthcare through the eyes of a U.S. healthcare participant. Bias will no doubt seep in, eyes creep me out so I couldn’t remove mine. In addition, this is by no means a comprehensive review, it’s simply a review of issues I was able to experience or discuss this summer. Conversations about the positives and negatives of various healthcare systems are important, and to me interesting, so I feel compelled to share what I’ve learned. (If you view or understand the Romanian system differently I would love your comments.) 

To start, Romania has national healthcare. From what I understand every child is covered even if they don’t have proper documentation, like birth certificates (a frequent problem with the Roma population). Employed adults are covered and have a portion of their income taken as a healthcare tax. Unemployed adults are covered by paying a tax each month and I believe if you can’t afford the tax, social services helps. So theoretically everyone in the country has access to healthcare services. In reality, bribing is a large problem, and whether it’s actually necessary or the patient just believes it’s necessary, this deters a large amount of people from accessing healthcare or waiting until they are incredibly sick to access it.   

From what I’ve heard this summer, the largest problem in Romanian healthcare currently is brain drain. Right now, there’s a hiring freeze in the public sector. The freeze is in effect for all public jobs, even jobs where there’s a deficit, like in the case of physicians. In order to hire one doctor, seven hospital workers (they could be doctors, nurses, janitors, anything really, as long as they work in the same building) must retire, quit or be fired. In addition, salaries for doctors are very low, so low many physicians have to resort to takes bribes. The entrance into the EU eliminated the need for work visas and therefore many physicians have moved to practice in other EU countries. For new doctors, the choice of specialty is very limited. Unlike the match system in the U.S., Romanian medical students’ specialty choice all comes down to one test. The score on the test places students on a ranked list. Starting from one and moving down each student selects a specialty. If all spots for the specialty that interests a student are filled before their number, they must select a different specialty. (This system makes the match look infinitely less daunting.) While talking with medical students, I learned that approximately 60% of each class leaves Romania immediately. They told me, “Romania exports Dacias (a brand of car) and doctors”. 

During my time here, I’ve gotten to experience six different hospitals/clinics. I’ve seen typical facilities as well as some of the best facilities the country has to offer. Let’s begin with what’s typical. Due to my interests I’ve spent all my time with pediatrics. Usually there are four to six children in a room and their mothers are with them. Due to building size, there are many small highly specialized hospitals in Cluj, and therefore the patients rooming together have similar illnesses. The one I visited was the recuperation hospital (orthopedics, cardiology, plastic surgery and physical therapy found on separate floors). In Targu Mures, where the facilities were much larger there was a grab bag of patients rooming together. In one room, in Targu Mures, there was a genetics trifecta of DiGeorge Syndrome, Prader-Willi Syndrome, and Cystic Fibrosis along with an accidental poisoning and a child who had been abandoned by his parents (sadly this isn’t an uncommon incident). The mothers and children seemed to be cooping well with the small space and lack of privacy, though it couldn’t be a comfortable situation. In Tagru Mures, I also visited Romania’s most specialized cardio-thorax surgery unit. This unit is set up similar to an intensive care unit at UIHC and is as well equipped. The unit has the space for ten patients and has the instruments and physicians necessary to do pediatric heart transplants. However, due to the hiring freeze and lack of public funding, currently only five patient beds are open and all pediatric heart transplants have stopped. The hospital did about eight transplants a year from 2005-2010, but for now all patients are sent to other countries. It’s really terrible to see these wonderful facilities and physicians going to waste because of governmental budget issues. The private sector in Romania is fairly small. National healthcare covers the expenses equivalent to the service in public hospitals and then the individual covers the rest. For financial reasons, most people don’t use the private sector. In addition, the public hospitals are usually better equipped for more complicated procedures and surgeries. Child birth seems to be the most frequent use of the private sector, allowing mothers to enjoy a bit more comfort and privacy.          

Finally, while in Tagru Mures last week, we had the chance to visit the medical school’s anatomy department. One of the anatomy professors showed my roommate Lindsay and me their impressive collection of formaldehyde preserved body parts. Formaldehyde preserved specimens make distinguishing nerves, arteries, and veins a breeze, but require diligence and a large amount of work to maintain. For that reason, very few were available for study in Iowa’s anatomy lab. While I was very jealous of their specimens, the professor told us he was very jealous of the number of cadavers we have access to. Currently in Romania, there are no deeded body programs (this is how Iowa obtains cadavers) and the idea of donating your body to science is not widely accepted. The professor said something along the lines of, “I don’t understand it, everyone wants their body to go in the ground”. The only bodies the medical school has access to are unclaimed bodies in state hospitals. So instead of six people to a cadaver, with two dissecting at a time like at Iowa, twenty people share a cadaver and if you aren’t naturally talented at dissecting you aren’t allowed to. The professor said he gives everyone a chance, but if someone damages too much tissue, they aren’t allowed to dissect because the class can’t afford to lose structures. Once again, this made me feel incredible thankful and indebted to my cadaver. I look forward to the memorial service for her, and my classmates’ cadavers, at the beginning of this school year.

Again this is by no means a complete assessment of Romanian healthcare. A document like that could go on for hundreds of pages. This is just what I’ve learned in my short time here. I think it’s very interesting to see a different elaborate maze of healthcare. Romania definitely has some unique challenges to work within the next few years, along with problems found in all healthcare systems that hopefully together we can all solve.