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 Dr Cirstoveanu has launched a lonely 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 he did last week for 13-day-old Catalin, who needed heart surgery. Dr 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 three-week-old baby that Dr Cirstoveanu whisked away to the same clinic in Italy – with tubes piercing her tiny frame – died before she was able to have lymph gland surgery. "I was very worried it wouldn't work," he said. "But in Romania, she would have died anyway."
The soft-spoken doctor is fighting an exhausting and largely solitary battle against a culture of corruption that is so embedded in Romania that surgeons demand bribes to save infants' lives, and it's even necessary to slip cash to a nurse to get your 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," the health minister Ladislau Ritli said.
Patients in Romania – a member of the European Union – routinely discuss the "stock market" rate for bribes. Surgeons can get hundreds of euros and upward for an operation, while anaesthetists get roughly a third of that, depending upon what a patient can afford. Nurses receive a few euros from patients each time they administer medications or put in drips. Getting a certificate stamped to have an operation abroad can easily cost hundreds, if not thousands of euros if you ask the wrong doctor. While the Romanian state appears unwilling to do anything, it often ends up footing the bill.
At Dr Cirstoveanu's unit in the Marie Curie hospital, Catalin's operation would have cost €2,000-€3,000 (£1,666-£2,500) 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 €350 after tax.
Bribes across Romania accounted for some €750,000 a day in 2005, according to a World Bank report; more recent estimates are not available. The culture of bribes – or "informal payments" as they are commonly known – is tacitly accepted. But anger is rising. One of Marie Curie's donors, Procter & Gamble, has gone back to the hospital and the health ministry several times to ask questions about when the unit will start functioning.
The tragic plight of Romanian children is nothing new. In a misguided effort to boost Romania's then population of 23 million, the dictator Nicolae Ceausescu banned birth control and abortion, which led to thousands of infants being left in orphanages in harrowing conditions, subsequently broadcast around the world after his execution in 1989.
Nearly a quarter of a century later, the country's shortcomings are again being seen through the gaze of children and powerless parents trapped in a web of corruption. For those whose children die shortly after birth, grief is magnified when they do not receive a birth certificate or even see their babies alive. Angela Vasile, whose baby daughter Cristina lived only one day, saw her infant just once after she died, lying on a metal table. Ms Vasile was then put in a ward of nursing mothers, adding to her anguish.
Bianca Brad, a Romanian actress and singer, spoke out publicly about the pain of losing her baby at birth, calling the situation "criminal". She founded the Emma Association to help grieving parents, offering support for those who do not receive psychological counselling and remain locked in years of grief.
Officially, the new cardio unit that Dr Cirstoveanu runs isn't functioning because jobs have not been filled. The real reason appears to be that Dr Cirstoveanu has banned staff from taking bribes. That means that hi-tech machinery lies idle because qualified experts do not bother to apply for jobs, as they know they cannot supplement their incomes with bribes.
The zero-tolerance policy to corruption makes for a gruelling work schedule for Dr Cirstoveanu, who needs to shuttle babies abroad for surgery, and take care of them on the flight. During the two-hour flight with the girl who died, Dr Cirstoveanu fixed tubes, sedated her and hand-pumped oxygen to keep her alive. In the less than 24 hours he had in Bucharest between returning from Catalin's trip and departing with the little girl, he squeezed in a shift in his own clinic.
Many disillusioned doctors have abandoned the country, which spends only 4 per cent of its gross domestic product in healthcare – about half the percentage of GDP spent by Western European countries. Last year, some 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.
"Ideally, we would have decent salaries and nobody would be tempted to accept informal payments," said Mr Ritli. "And the population would be educated so people would believe that this is not the only way to get proper healthcare."
Yet remarkable things are happening at the Marie Curie Hospital. Dr Cirstoveanu is overseeing the survival of Andrei, an eight-month-old Roma baby born to underage parents. His intestines are almost non-existent. The tiny infant, who weighs about 2kg, with limbs that look like gnarled twigs, was given only days to live. His bright eyes, alert gaze and lively personality have endeared him to all staff who comfort him in their arms as much as they can outside of his incubator.
Andrei could get life-saving surgery in the United States – but a fee of hundreds of thousands of dollars is proving prohibitive. Nurses are so fond of the bright boy that they are playing the state lottery in an attempt to raise funds for his surgery.
Even in this grim setting, there are signs that doctors are mobilising in an effort to make things better. Anca Mandache, a child heart surgeon, left her career in France to offer her services to the Marie Curie hospital, accepting a tenth of her previous salary. Others also are expressing an interest in working at the clinic.
Dr Cirstoveanu, who also flies sick babies to Germany and Austria, says he feels ashamed that he has to go to the lengths he does to save children, but talks with pride of the moment he sees the joy of relieved parents whose babies survive.
They are in awe of his dedication. "Dr Cirstoveanu is more than a hero – he is a god for us and the children," said Gheorghe Meliusoiu, Catalin's 28-year-old woodcutter father. "If there were more like him, many lives would be saved."
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