Medical Care in Romania..

Angy, Florinel and Paula at the Sunshine School

Alex 'vacuuming' during his PT session

While I have been working on many different projects during my two-plus weeks here in Romania, not a day has gone by that I haven't worked with Sunshine School and Darius House PTs, Paula and Angy.  Nor has a day gone by that I haven't been asked to give advice to an RCE employee or family member..aches and pains, circulatory issues, tennis (or ping pong actually) elbow, pounding headaches, you name it.  So all my years spent as a PT and working in a hospital have been invaluable.

Alex getting a little help from his friends

You have to know, however, that they come to me not because I know everything, because I clearly don't. They come because I'm accessible, they know me, and they don't have to slip me a bribe in order to receive some sort of advice. Even though Romania has socialized medicine, there are many obstacles that make good care often inaccessible to the average Romanian.
And even in a socialized medicine system, patients have to buy and get their medicines from a pharmacy even when they are IN the hospital. They also have to provide their own bed sheets and blankets. If a family member wants to stay at the hospital to help care for a family member, the hospital charges them a daily fee.  The hospital needs the help because of staffing issues, the families want to help, but often can't afford to pay the fee. 

Ad for a PT clinic in a small village

Another interesting point is that people are often admitted to hospitals just for diagnostic work-ups that in the US could be done as an outpatient. The reason for this is that if they are admitted to the hospital, all the testing is free. If they get the tests done as an outpatient, they have to pay a lot of money for them. But by far the biggest obstacle for all in seeking medical care is the bribery system that is in place. In order to be attended to and get decent care, patients and/or their families often have to give money to nurses, physicians and many other caregivers. There are exceptions as there are medical personnel, who, because of moral or religious convictions, refuse to take bribes, however these people seem few and far between. Because of the need for extra cash when seeking medical care, people often put off going to the doctor/hospital until they are very ill. 

Toni

Adequate equipment/technology is also a problem. It isn't uncommon to have to wait for a very long time to have an elective surgery done, due to faulty or broken equipment. This just happened to a friend the other day who needs arthroscopic surgery on her knee-- something that is done very commonly in the US. The "machine" needed to do the surgery was broken and now the procedure has been delayed for more than a month.

Stephanie with both legs casted

The doctor-patient relationship is very different in Romania as well.  Physicians generally don't  dispense a lot of information and unless patients/families push them to answer their questions. It is typical to be left without the critical information needed preceding or following a procedure. An example is little Stephanie who is just over 2 years old. She has spina bifida and was admitted to the hospital for surgery on her hips and ankles. After the surgery both legs were put in a cast that she had to stay in for 2 months. Her mom told me she wasn't prepared for that and no one ever told her it would be that long. You can imagine what the past 2 months have been like! The cast comes off next week.. I will go see her after that.

I spent some time with Stephanie's mom yesterday encouraging her to ask specific questions regarding Stephanie's follow-up care after the casts come off... any restrictions to her movement or are there specific ways to handle her, when can therapy begin, etc.   One thing I DO like about the Romanian system is that patients have easy access to their medical records and films. I've looked at a bunch of x-rays (head, knee, pelvis) and medical records over the past couple of weeks in people's homes. It's unusual for the patient NOT to have them. Having access to x-rays and records makes it easier for me to understand what is going on.  I have even been able to do a little bit of teaching on reading radiographs so people at least know what they are looking at.

using BOTH hands!

Toni kissing a 'baby' in a magazine

As far as physical therapy in Romania goes, it is known by many names:  physiotherapy, kinetotherapy, medical gymnastics, etc.  Massage is very prevalent and widely taught as the solution to many problems. Vojta therapy is also common in the treatment of children.  Vojta was started by a Czech MD named Vaclav Vojta in the 1950s and was used primarily for kids with a diagnosis of cerebral palsy. Physical therapy programs are typically 2 years long and most students go on to get a  master's degree which teaches them to evaluate and assess patients in greater depth. Over the past 11 years I have tried to impart some of what I learned in the US on those here in Romania. It's a process that will continue on...

A couple updates..

The goat purchase will be made next week! Ovi has a man searching in a nearby village for a goat that I can try milking (yikes!) before we take it over to the poor family that is expecting it.

Toni and her Mom and Dad

Happy at her LAST P.T. session!

I saw little Toni for the last time this morning.  We had a great session together with both her Mom and Dad. We talked about how much progress she's made over the past 2 weeks. She can now kneel, lift her arms up into the air while she's kneeling, she can pull herself up to stand, maintain standing, she can even take some steps. Her weaker left hand has come a long way in a short time: she can now use it to manipulate objects of all sizes, eat, clap and even blow kisses!  Her mom is especially pleased with her progress as she has taken Toni to many specialists and clinicians with few acceptable results. As our session ended, she grabbed me and squeezed me tight as she cried and told me in Romanian.."I will never forget you"... this is one of the reasons I come here. Your life can be used to touch others' in ways unimaginable...RCE's call is to 'make mercy happen' and I see that here every single day..

Romanian words of the day:

Yes= da
No= nu (new)
Thank you= multumesc (mool-to-mesc)
You're welcome= cu placere (coo pla-chair-e)