Monday, April 9, 2012

Battling a culture of medical graft

In Romania, bribes are required for care. One doctor flies patients elsewhere for surgery.

By Alison Mutler And Vadim Ghirda

Associated PressBUCHAREST, Romania - Dr. Catalin Cirstoveanu runs a cardio unit with state-of-the-art equipment at a Bucharest children's hospital. But not a single child has been treated in the year-and-a-half since it opened.

The reason? Medical staff he needs to bring in to run the machinery would have expected bribes.

So Cirstoveanu launched a crusade to save babies who come to him for care: He flies them to Western Europe on budget flights so they can be treated by doctors who don't demand kickbacks.

That's what Cirstoveanu did last month for 13-day-old Catalin, who needed heart surgery. Cirstoveanu packed a small bag, slipped emergency breathing equipment into the baby carrier, and caught a cheap flight to Italy, where doctors were waiting to perform the surgery.

The operation was successful. Two days later, though, a 3-week-old baby whom Cirstoveanu whisked away to the same clinic in northwestern Italy, with tubes piercing her tiny frame, died before she could have lymph gland surgery.

"I was very worried it wouldn't work," said Cirstoveanu. "But in Romania, she would have died anyway."

Cirstoveanu is fighting an exhausting, largely solitary battle against a culture of corruption that's so embedded in Romania that surgeons demand bribes to save infants' lives and that patients must slip cash to a nurse to get their sheets changed.

It's one of the reasons why the country's infant mortality rate is more than double the European Union average, with one in 100 children not reaching their first birthday.

"To be honest, it's so deeply rooted into our system that it's really difficult to eliminate," Health Minister Ladislau Ritli said in an interview.

Officially, the new cardio unit that Cirstoveanu runs at the Marie Curie children's hospital isn't functioning because jobs have not been filled. The real reason appears to be that Cirstoveanu banned staff from taking bribes. That means high-tech machinery is idle because qualified experts do not apply for jobs.

The zero-tolerance policy on corruption makes for a grueling work schedule for Cirstoveanu, who must shuttle babies abroad for surgery and take care of them on the flight. During the two-hour flight with the girl who died, Cirstoveanu fixed tubes, sedated her and hand-pumped oxygen to keep her alive.

Patients in Romania routinely discuss the "stock market" rate for bribes. Surgeons can get hundreds of dollars and upward for an operation, while anesthetists get roughly a third of that, depending on what a patient can afford. Nurses get a few dollars from patients each time they administer medications or put in drips.

While the Romanian state appears unwilling to do anything, it often foots the bill.

At the Marie Curie unit, Catalin's operation would have cost $2,700 to $4,000 without bribes. Romanian state health insurance is paying 10 times that for his operation in Italy, a small fortune in a country where the average monthly salary is about $500 after tax.

Many disillusioned doctors have abandoned the country, which spends just 4 percent of its gross domestic product on health care, about half the percentage of GDP Western European countries spend.

Last year, 2,800 Romanian doctors - discouraged by the antiquated and corrupt health system and low wages - left to work in Western Europe, according to the Romanian College of Doctors.

Bribes across Romania accounted for $1 million a day in 2005, according to a World Bank report; more recent estimates are not available.

The tragic plight of Romanian children is nothing new.

In an effort to boost Romania's then-population of 23 million, Communist dictator Nicolae Ceausescu banned birth control and abortion. Thousands of infants were left in orphanages in harrowing conditions broadcast around the world after his execution in 1989.

Nearly a quarter-century later, the country's shortcomings are again on display. Yet remarkable things are happening at the Marie Curie hospital. Anca Mandache, a pediatric heart surgeon, left her career in France to offer her services to the Marie Curie hospital, making one tenth what she would have earned in France. Others also are expressing an interest in working at the clinic.

Cirstoveanu says he feels "ashamed" that he has to go to the lengths he does to save children, but talks with pride in seeing the joy of parents whose babies survive.

They are in awe of his dedication.

"Cirstoveanu is more than a hero - he is a god for us and the children," said Gheorghe Meliusoiu, 28, Catalin's woodcutter father. "If there were more like him, many lives would be saved."

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