REFORMING HEALTH CARE IN ROMANIA

The San Francisco International Program [SFIP] promotes world- wide educational and cultural training for professionals through an exchange system. Each participant stays with a host family and works closely with a mentor in his or her field. The program is an affiliate of The Council of International Programs, a private, non- profit organization which operates successfully in countries throughout the world. As a participant in SFIP, Dr Viorica Petrescu of Romania is studying the delivery of prenatal health services in the United States. She has been training at Marin Maternity Services, San Rafael, California, a state sponsored program for low or no income families. Nearly 70 per cent of the clients are Central American refugees, many of whom are illiterate.

Dr Petrescu, 38, is an epidemiologist at the Institute of Public Health and Medical Research in Cluj, Romania. She teaches public health to the medical students there. Dr Petrescu received her Master of Public Health degree in Israel at the Browns School of Public Health and Community Medicine, Hebrew University, Hadassah, in Jerusalem. Dr Petrescu is dedicated to reforming the health system in Romania. Jan Spence interviewed her for Share International.

Share International: What are the most urgent needs for health care reform in Romania?

Dr Petrescu: We have a lack of drugs -- for instance, penicillin and other antibiotics. Drugs are expensive, when they are available, especially imported drugs from the Western countries. There is a lack of supplies like disposable syringes and needles. Even our disinfectants, like chlorine, are of such low quality that they are practically inactive.

Our medical equipment is very old. Even our new equipment is outdated. I would like to have the most advanced medical, technical and laboratory equipment. We also need computers.

Romania is facing economic difficulties. The inflation rate is extremely high. Unemployment is high and increasing. There is no organized system to address unemployment. All these factors have an impact on the daily lives of the patients, especially the elderly and persons with low income.

SI: It seems that Romania has been somewhat isolated.

VP: Yes. Before 1989 it was the policy of the dictatorial regime. The idea was to prove to the world that we were as gifted and capable as other nations, and could be independent of them. But we ignored our mistakes. Lies and distortions were published, including false health reports. We were also not permitted to leave the country, or to meet with people of the Western world.

SI: I read in your papers about infectious diseases. The AIDS age- group percentages are shocking. Can you explain?

VP: In 1990, our AIDS statistics became known. We had 2,703 cases in the country; 90 per cent belonged to the age group 0-4 years, and 25 per cent of these to age group 0-1 year. A big majority of the children were in orphanages. They were abandoned children and in fragile health. Some were premature.

One way to invigorate them was with blood transfusions. They were given blood to improve their condition. At that time, we didn't have the equipment to test the blood. The kids got AIDS because the blood was infected.

SI: Were disposable needles used?

VP: No. The needles had to be sterilized. They could be used again, but had to go through the sterilization process. Of course, this wasn't possible. Our dictators didn't want to talk about this issue. AIDS was regarded as a disease associated with the capitalist world. This is how they justified the issue. Romania had 75 per cent of the pediatric AIDS cases in all of Europe. When the statistics came out, many countries gave us donations of equipment to test blood for HIV -- as well as contraceptives, drugs, hospital supplies, and some disposable syringes. Holland and Germany helped the most. Now each blood bank in Romania can screen the blood, as you do in the US and everywhere in the world. We learned a lesson.

SI: The orphanages in Romania have received some media attention. Tell us about the orphanages.

VP: They are the consequences of the law implemented by the dictators. When I say dictators, I refer to Ceausescu* and his wife. She was very involved in everything. Sometimes she advised him and he would follow her advice. They implemented the law on abortions, that abortions were not allowed. At the same time, there was no comprehensive program for family planning. There were no birth control methods. Obstetricians who performed abortions were put in jail for several years. Maternal mortality was the highest in Europe, due mainly to illegal and self-induced abortions.

SI: When people had children that they couldn't afford, they took them to the orphanages? And the orphanages didn't have the facilities to give them the proper care.

VP: Yes. Actually the orphanages were in the same condition as the less privileged hospitals and clinics. There was no heat. Electricity was often interrupted. The quality of food was bad, and there were shortages. Some of the children were from gypsy families. Some of them were from disrupted families, where the father was in jail or the mother was addicted to alcohol. Some of the children were handicapped.

They were very, very disadvantaged children. They were abandoned. They were undesired by the mother who already had three or four children.

SI: How has this condition changed now that abortions are legal?

VP: The population dramatically decreased after 1989. We have a non- government organization that deals only with the subject of contraceptives and sexual education. But birth control devices are still very expensive.

SI: The no-abortion law was for what purpose?

VP: To populate the nation. To have young people, to make the nation strong and great. A big population does not make a strong country. But the dictators were primitive and uneducated. At the same time, Elena Ceausescu was pretending to work at the National Chemistry Institute. She was also a member of the Academy of Sciences and President of the National Health Council.

SI: She wanted to appear brilliant.

VP: Yes. But she was completely ignorant. We found out later that a scientist was writing her works for her. At the same time, she was very dictatorial. You could be persecuted if you spoke out against either of them.

SI: Life expectancy in Romania is the lowest in Europe, 66 years for men, 72 years for women.

VP: We didn't have a comprehensive health promotion program, promoting a healthy life style -- no smoking or alcohol, less stress, proper nutrition. People are not trained to watch their level of cholesterol. Also, the effects of pollution --I think America is 30 years ahead in this regard. Mrs Ceausescu had another stupid idea, to build huge industrial plants without thinking about nature, the forests, the valley.

Our technology in the factories is out-dated, too, and polluting. Cigarette smoking is popular. American tobacco companies are very aggressive. They even post large signs on the traffic lights. My father is a doctor, and founded the Anti-Smoking League in 1991, but it's difficult to compete with rich American corporations.

SI: You are training in a very wealthy county, Marin County, and there is poverty there too. Have you witnessed these extremes?

VP: I saw many large and elegant homes. Then I made home visits with the public health nurse to the canal community in San Rafael where a lot of the clients from the clinic live. I was surprised to see the over-crowded housing. Several women, each with several children, live in a two or three room flat.

When they all gather in the evening, assuming they have husbands, there could be 15 to 18 people in a small flat. I saw poverty in these living conditions.

SI: What is the most memorable experience you have had here in the US?

VP: It is a wonderful experience to see different races and nationalities come together and get along. It is a lesson to be learned by Europe, especially today in the Balkans area, where there are ethnic tensions and conflicts. Nationalism is on the increase. It is a nice cultural experience to see a compatible society, as you have here.

SI: What have you gained from this experience? What will you take back to Romania with you?

VP: Professionally, I've learned how to organize a comprehensive mother-and-child health service, to serve medically and psychologically -- to integrate the services of health education and health promotion. We need a curriculum in medical and nursing schools with more emphasis on the importance of preventive medicine and promoting health. Health promotive and disease preventive medicine must be a first priority national health policy in Romania, while decentralizing the health system.

*President of Romania for more than 20 years. He and his wife Elena were executed on Christmas Day in 1989.

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