Wednesday, September 26, 2007

IN DEPTH: Roma Dream of Better Health in Romania

26 09 2007 Despite rhetoric that Roma health is a priority, Romanian authorities fail to improve conditions in Bucharest’s largest Roma neighborhood.

By Marian Chiriac and Daniel Ganga in Bucharest

Almost every morning, as soon as dawn breaks, Gogu takes his cart filled with odd bits of scrap metal and slowly pulls it to a recycling center. He unloads his cart there and, in return, he gets a meagre sum of money that barely pays his meal for the day. Then he goes home.

What Gogu, also known as Ion Gogonet, does every day is not at all uncommon for many people who live in Ferentari. Located at the southern end of Bucharest, Ferentari is a large neighborhood, something in between a slum and a ghetto.

Several warehouses, a couple of dubious pubs, a few run-down stores, one little park which appears more grey than green and one soup kitchen facility away, there is Zabrautului Street.

The area is well-known for its one-room apartments in horrible five-storey buildings, with clothes hung up to dry and small windows where, every now and then, a woman’s head sticks out to shout at the kids playing with a ball below, alongside stray dogs who scour the heaps of garbage.

Here, in this ghetto-like fetid yet lively world, lives Ion Gogonet, a 50-year-old Roma man.

His one-room apartment is just 16 metres square; it includes a small kitchen and a three- square-metre bathroom. It is however connected to the electricity and running water supply systems, which, according to the dwellers, is a major improvement since not so long ago the buildings were bereft of such basic public utilities.

This is the home of Gogonet’s family: his partner, Ilie Stela, 33, and three children, two of whom already attend elementary school. Their father has to stay in a separate bed because he has had tuberculosis. He had 72 holes in his lungs and, because of his unhealthy and destitute lifestyle, he had become very ill. Yet, he refused to see a doctor, partly out of carelessness and partly out of shame and fear so that he would not to be exposed to his friends.

It was only two years ago that he was persuaded by a health care adviser to start treatment for TB. He is healthy now, even if he is still suffering from some after-effects. At least he is no longer contagious.

Gogonet is just one of the beneficiaries of a TB prevention and treatment campaign set up by several, mainly American-based, NGOs, and financed by the US Agency for International Development, USAID.

The reason for starting this campaign was that Romania has the highest incidence of tuberculosis in Europe, and the number of TB cases doubled in the 1990s. According to official statistics, in 2006, the incidence of tuberculosis across Romania was 117.8 per 100,000 inhabitants.

However, Roma communities are about ten times more affected by TB than the rest of the population, according to epidemiological data. The causes for this include limited access to public health services, very little knowledge of health issues, widespread illiteracy, living in very crowded and insalubrious places and poverty in general.

Taves Bahtalo!

The Roma greet each other every day with the words, Taves bahtalo – meaning, “Be healthy”. Good health is something every human being appreciates, regardless of their ethnic origin, especially in Romania, where the public health system is still in a poor condition.

According to a survey carried out in April by the Romanian Center for Economic Policies, CEROPE, the amount earmarked for health in Romania is a mere $470 per annum per capita, well below the world average of $650 per capita.

“Romania is in a difficult position as far as access to medical services is concerned, with an unfair regional distribution of resources, the rural areas and the poor communities living on the margins of society being the most disadvantaged”, the survey points out.

“One explanation resides in the insufficient funding of public health services, coupled with the prolonged crisis of the health insurance fund and the low level of budget spending, between 3-4% of GDP, in sharp contrast with the 8-10% in more developed EU countries.”

In this grim picture of the poverty of the national health system, the Roma stand out in a particularly noticeable way.

Officially, there are some 550,000 ethnic Roma or some 2.6 per cent of Romania’s 21 m population. But many studies and statistic say that real number of Roma people is between 1-1.5 million.

The situation in Ferentari is especially alarming. Just eight kilometres away from Bucharest’s downtown area, several thousand Roma live there in appalling conditions.

“There’s nothing we can do, my son. That’s how they’re used to livin’. The garbage truck almost never comes this way, but the thing is people ain’t no good. It’s not like when Ceausescu was alive and people were more careful ‘cause they was afraid”, says an old woman, recalling the days of the communist dictator, Nicolae Ceausescu, while selling roasted sunflower seeds.

One of the biggest problems in the area is that people do not have stable jobs, which prevents them from getting health insurance.

“If you have no employment record or some certificate from your employer that you are a taxpayer, you can’t be registered with a family doctor’s practice. This is where the problems start”, says Ioana Constantin, a health adviser in Ferentari.

People would like to have a medical centre in the area. “The nearest one is about 15 bus stops away. They are discouraged by the great distance and the bus fares. In fact, there is one medical centre which is somewhat closer, but that is a private one, so it’s expensive”, Ioana added.

Priority or not?

Yet, the Ministry of Public Health, MSP has no programmes for the Roma communities. That is because of the idea that disease and suffering should have nothing to do with an individual’s ethnic background.

Since 2001, the year when Romania adopted the EU regulations that ban patients’ classification according to ethnicity, there has virtually been no official data containing an inventory of the Roma’s health problems.

Surprisingly enough, officials often say that Roma are the main target group of the government strategies to promote health and fight poverty. However, there is not much that the health minister can do for the people in Ferentari.

“Currently, that area is not a priority of the MSP. Things might change only if the Bucharest Authority for Public Health, ASPB or some NGO identifies specific problems and comes up with a concrete plan to improve the conditions in that area”, says dr. Hanna Dobronauteanu, former counsellor for Roma issues within the Public Health Ministry.

For now, in Ferentari – in the absence of a substantial, long-term effort on the part of the government – only individual NGO initiatives or projects appear to be yielding results, but these are limited in scope.

Hundreds of thousands of euros have been spent on all kinds of programmes, including fighting TB, providing sex education and family planning, breast cancer screening and other schemes. But all that is, as yet, producing few visible results.

“The programmes carried out so far should be only the preface to a large, coherent campaign designed to address the complex health problems of the Roma population in Ferentari”, says Alina Constantinescu, a social worker for the American organization, Doctors of the World.

“Of course they have been very useful, but they have not always been focused on the most stringent needs.

"Besides, the real causes are poverty, unemployment or lack of education”, Constantinescu says and warns: “Furthermore, as Romania has become an EU member state, the US and other western countries have stopped funding many projects in this country for Romania is now deemed capable of solving its problems alone. Well, I kind of doubt that.”

Planning is what we do best!

When targeting Roma issue, the health ministry supports only the health advisers, who are members of the local community, trained to facilitate communication between people and their doctors. Thus, the 500 health advisers now working throughout Romania – who are all women – must enter people’s homes, find out their problems and try to put in place solutions to them.

In fact, what they do is not only to take care of health-related problems, but also to help the Roma get their ID cards or birth certificates or to report their social problems to the authorities.

Even if, with the assistance of health advisers, significant steps have been taken, the problems are far from being solved. First, they are employed only for a limited period of time, usually one year, and then their fixed-term labour contracts are extended for another year, which makes their jobs insecure.

Then their salary – paid by the Authority for Public Health – is far from motivating, as it amounts to the equivalent of just €125 a month at the most.

Furthermore, there are problems related to the Roma’s access to public health services. While health ministry officials say it has improved, local NGOs are of a different opinion.

Daniel Radulescu, the health project coordinator of the Roma organization Romani Criss, says: “Even if there are more people registered with the doctor’s office now, this does not mean that they have equal access to the services provided by that doctor. Very often, Roma people inform us that some doctors display racist attitudes”.

Even the State Secretary at Health Ministry, Ervin Zoltan Szekely, confirms the existence of such cases. “We have recently been informed about a Roma lady who had filed a complaint for not having received adequate medical assistance which resulted in serious problems when she gave birth to her child. The officials assessed the situation and imposed disciplinary sanctions on that doctor not for having committed an act of discrimination, but because he had failed to provide proper medical assistance. So he was not sanctioned for discrimination because that is difficult to prove.”

Romani Criss also monitors instances of segregation in hospitals - which is illegal in Romania – but admits that such cases are equally difficult to prove. “Discrimination and segregation have not been our priority so far. However, we are planning to include these phenomena in the scope of our investigation work”, Szekely says.

Many Roma hope such promises may mark a shift in official attitudes to improving health care provisions for them.

Marian Chiriac is BIRN Romania country director and Daniel Ganga is a freelance journalist of Roma origin. Balkan Insight is BIRN`s online publication.

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