Luciana Grosu, GPJ Romania
BUCHAREST, ROMANIA – Mariuca Niculae, 75, is waiting in the hall of the Regina Maria Social Polyclinic in Bucharest, Romania’s capital. She says she is at the clinic because she suffers from “terrible heartaches.”
“It’s like a claw,” she says, describing the pain. “It never goes away.”
Niculae and another 10 patients wait to be called in for their examination by Dr. Wargha Enayati, the founder and director of the Regina Maria Foundation, the not-for-profit branch of the biggest private health network in Romania.
The foundation opened Bucharest’s first free clinic for uninsured Romanians in 2011. It aims to provide both emergency and nonemergency medical care to the socially disadvantaged people in the city who lack health insurance.
Niculae comes from a village 80 kilometers outside Bucharest with a poetic name, “Dor Marunt,” which means “Little Longing.” Before her son brought her to the clinic in Bucharest, where he lives, Niculae struggled to receive care at the hospital in the countryside.
“The hospital was one train stop far, and the doctors over there came only twice a week,” Niculae says.
Niculae has a monthly pension of around 300 lei ($90). Romanian law guarantees free health care to all retired citizens, but she says their access to the medical services they need is not always guaranteed. Therefore, Niculae says she seeks medical care not to prolong her life, but only to relieve her physical pain.
“Today, tomorrow, I’ll be dead anyway,” she says calmly.
Niculae is a widow. With tears in her eyes, she says she remembers her “old man,” her husband, who died 11 years ago. She now lives alone in the countryside. Her children live in Bucharest, but she says she doesn’t want to move in with them because she doesn’t want to burden them.
“There’s not enough room,” she says resignedly. “My son has to sleep on the floor when I came to Bucharest, and I don’t want to trouble him.”
Ill and disadvantaged, Niculae says she is well-aware of the social inequalities that exist in Romania that are reflected in the health care system.
“Nowadays, some people have and others don’t have,” she says firmly.
Led by a cardiologist who says he is committed to serving others, the capital’s first free clinic offers full medical services to uninsured Romanians. One population the clinic strives to provide care to is the city’s homeless. The clinic’s operation in the future depends on increasing funding. The national insurance fund is also in need of a larger budget because the number of people who receive care outnumber those who pay for insurance. The government plans to introduce a new co-payment system this year.
Romania offers free medical care to all citizens with identity papers who pay into the National Insurance Fund, according to the National Health Insurance House. Vulnerable citizens, such as children, students, disabled people, unemployed people and pregnant women, are exempt from paying into the fund. Emergency care is provided to everyone regardless of whether they’re insured or have identity papers.
The social polyclinic provides free medical care to around 350 uninsured patients per month regardless of whether it’s an emergency. Of these, about 50 chronically ill patients also receive free medication, new clothes, soap and other corporal hygiene products.
“Regina Maria Foundation’s beneficiaries mostly consist of uninsured people,” says Ana Smochina, a sociologist. “Romania’s total population is 21.5 millions, of which 4.1 millions are uninsured.”
The Regina Maria Social Polyclinic is considered the first project of its kind in Bucharest.
Enayati, a cardiologist, consults personally every cardiology patient that comes to the clinic and recommends the appropriate treatment and medicine for them. His patients say he treats people in a simple and kind manner, and he doesn’t stop until all his work for the day is done.
“I am trying to offer an example,” Enayati says. “People think that if you are rich, you are not supposed to do anything. But people also think that if you are poor, you can’t do anything. So this is how we end up in a world where nobody does anything.”
The polyclinic, a clinic that treats many kinds of diseases, is a rare example of cooperation between the state, civil society and private sectors. Bucharest’s municipality donated the space for the polyclinic and paid the maintenance costs. The Regina Maria Foundation brought the needed medical equipment and pays the two workers who receive salaries. The result is a modern and welcoming clinic open to all people who would otherwise be denied access to health care.
Enayati says that the highest ranking a human can have is to be in a position to be able to serve others.
“The egoistic person is nothing but an animal,” he says. “Maybe an intelligent one, but still an animal.”
Enayati says his desire to provide health care for all is inspired by the Baha’i faith, the religion he brought with him when he moved to Romania 27 years ago from Germany, where he was born into an Iranian family. Since then, he has built a successful private health business, started the Regina Maria Foundation and opened the clinic. He named them all after Queen Mary of Romania, whom he says also shared the Baha’i faith’s emphasis on serving others.
“You must serve other people, no matter who they are, because of your love for the whole humanity, not because they have the same skin color or because they live next door to you,” Enayati says.
The clinic’s staff has only two paid members: Dr. Vlad Romanescu, the clinic’s coordinator, and Victoria Banesaru, the assistant to the coordinator. All the other 16 doctors work as volunteers.
“Some of the volunteers are doctors who already work for the private paid Regina Maria clinics, but others come from afar,” Enayati says.
Enayati says no one is there for the money.
“It’s really just their desire to help others,” Enayati says.
Other organizations have also shared in this desire. The polyclinic has signed an agreement with Victor Babes Hospital, which helps it carry out more complex medical investigations involving, for example, infectious diseases, radiology, pneumology or psychiatry.
But the most common health problems patients at the clinic suffer are heart, eye, skin, dental, nutrition and mental issues, Romanescu says.
“All these are mostly poverty-related problems associated with [i]nadequate food, lack of access to water and sanitation, exposure to contagious diseases, unhealthy lifestyle and poor social relations,” he says.
The free polyclinic has several rooms, which include various specialties, such as cardiology, ecography, dermatology and stomatology. There is also a lab and a room for psychosocial counseling. The clinic’s beneficiaries have special spaces to help them feel more at ease, including a room for mothers to change their babies’ diapers and a shower and a dressing room with free, new clothes for homeless people who want to bathe and change before their medical consultations.
Homeless people are one of the main populations that the free polyclinic aims to serve. Estimates of the number of homeless people in Bucharest range from 2,400 to 3,700, according to Maria Regina and Samusocial, an international social humanitarian emergency service.
“When [homeless] people come here, they are at first reticent,” Romanescu says. “They don’t even trust us. Life is tough for them, and they live like in a jungle.”
He says that the patients gradually regain their humanity.
“After we get to know them and they get to know us, they open up,” he says. “In the end, people are always grateful to us.”
Nicu R., 47, who declined to give his last name, is a homeless man who has been coming to the clinic for months. He says he is happy with the new dental prosthesis that the stomatology specialist at the clinic made for him recently.
“This place is great,” Nicu says. “It’s just like an expensive private clinic.”
A graduate from the Bucharest Academy of Economic Studies, Nicu is calm, polite and somewhat hesitant to talk about himself. Wearing clean clothes and reading the newspaper in the clinic’s waiting room, he doesn’t look homeless.
Gabi Prossi, a psychologist at the clinic, dismisses the stereotype that all homeless people are uneducated, violent and mentally ill.
“Actually, homeless people come from all social backgrounds, have different professions and some of [them] have even completed higher education,” Prossi says.
She says that mentally healthy homeless people may suffer even more.
“Paradoxically, lucid, mentally healthy homeless people are the ones who suffer more because they are more aware of their situation,” Prossi says.
Nicu says he first came to the clinic in 2011 when his foot froze. At the time, Nicu was sleeping outside. The doctors at the polyclinic helped his foot heal, although he still limps slightly.
Nicu has since moved to a homeless shelter in the city. He says his foot still hurts, and he can’t get a job until he fully recovers. Several employers have turned him down because of it. Without a job, he can’t afford his own living space.
“A house?” he asks. “No way. As long as I don’t work, I have no chance to rent my own place.”
The municipality of Bucharest’s branch of the National Agency for Workforce Employment sends an updated list of the available jobs monthly to display inside the clinic. Nevertheless, finding a job isn’t easy in today’s economy, not even for healthy Romanians.
“I doubt that if the press wrote about our social problems, this would change anything,” Nicu says skeptically. “There’s nothing left to change anyway.”
In addition to physical medical care, the free polyclinic also offers complete psychological counseling services to homeless patients. Its health staff comprises three psychologists and one social worker from the General Directorate of Social Assistance of Bucharest municipality.
“People who come here suffer from chronic depression, psychosis and also alcoholism,” Prossi says. “These problems are a result of their terrible life conditions.”
Because the clinic receives support from the municipality, it must also require patients to have identity papers in order to access its free medical care, unless it’s an emergency. Nearly 40 percent of homeless people lack identity papers, according to Samusocial.
“We can’t help paperless persons, unless it’s an emergency,” Romanescu says. “All medical emergencies are free at any hospital.”
Once emergency treatment is over, most homeless people return to the street, according to Samusocial.
“For the moment, we can neither hospitalize people at our clinic,” Romanescu says. “We can only offer ambulatory treatment.”
In order to sustain operations at the clinic and continue growth, Enayati says it needs more funding. The clinic currently operates on 5,000 euros ($6,500) a month.
“In the future, we would need more funding, at least 10 to 15,000 euros [$13,000 to $19,500] a month,” Enayati says.
He says that with this money, he plans to open a new gynecology room and also to buy the necessary medical equipment for the existing otolaryngology section.
“For the moment, there are no financial possibilities to open a second polyclinic,” he says, stressing that maintaining the existing project is already a challenging task.
The 14.8 million Romanians who don’t contribute to the National Insurance Health Fund – 4.1 million uninsured and 10.7 million who are exempt – put substantial pressure on the 6.1 million who do pay into the fund.
“I am a state employee, and I give a sum for the health insurance every month,” says Elena Ene, a university professor from Bucharest.
Ene says that in practice, the system doesn’t function, as those who pay are far fewer than those who don’t, and the Romanian state doesn’t help.
“Since only one-third from Romania’s population contributes to the National Insurance Fund, it is pretty obvious that there are not enough financial resources for the country’s health budget,” Smochina says.
She says that it’s also usually difficult to procure care without paying bribes.
“Actually, if I fell ill, I couldn’t afford quality medical care because of the bribe custom system in Romanian hospitals and because of the poor conditions of these places,” Ene says.
Smochina says that the Romanian state has only two possible solutions: to find supplementary money to bolster the fund or to limit the consumption of unnecessary health care.
The authorities plan to introduce a co-payment system in 2012 in order to increase the fund. Emergency services will still be available to all, but the basic medical coverage package for the insured will be reduced.
“The basic health care insurance package is too large,” Ladislau Ritli, Romania’s minister of health, said recently.
Smochina says that reducing the unnecessary use of medical services could also work. She says that media campaigns should educate citizens on when they do and don’t need to go to the hospital. She also recommends more emphasis on prevention of illnesses.
“Most people wait until their life is endangered because all medical emergency treatment is free,” she says. “But if too many people choose to go to the hospital in an emergency situation, the health services and the available funds are consumed faster.”
