OSI's Roma Health and Health Media projects collaborated with the Center for Independent Journalism, based in Bucharest, Romania, to support journalists investigating access to health care for Roma. The articles, including the following, bring to light the need to improve the quality of health care for Roma and explore the systems that create unequal access. Below is an English translation; the original article in Romanian is available on the Center for Independent Journalism website.

Timboiesti is a commune in Romania with 4,550 inhabitants, 60 percent of whom are of Roma origin. In the summer, only women, children, and the elderly are at home. Because many Roma have ceased receiving public assistance, those who are able-bodied leave home to work on farms, while the most determined find work harvesting fruit in Greece. Mayor Maricel Alexandrescu says Roma migration has allowed the commune to get rid of its social problems; though he notes that this is not entirely true as, “the elderly, the sick, the children, and the scoundrels have stayed home.”

As the provisions of Law 416/2001, governing the guaranteed minimum income necessary to receive public assistance, have become more restrictive, hundreds of people have been excluded from the health insurance system. They learn to live with their suffering unless, like Ileana Banu, a woman of 58, they make compromises. She married a retired man so that she could use his medical insurance when she needed to undergo kidney surgery. In order to facilitate the impoverished people’s access to medical services, local authorities demand that the National Health Insurance Fund exempt low-income people from an obligation to pay their contribution retroactively.

Children Raising Children

In Timboiesti’s Roma community, real-life and hardship start early. Six and seven-year-old girls take care of their younger siblings leaving the girls very little time for school. At the age of 13 or 14, some girls already have their own children and most have done more than their fair share of rocking and washing babies. Gabriela and Neculai Gilca have 12 children who take care of themselves. While the parents harvest cherries, it is up to the middle sisters—the older ones are already married and settled down—to take care of the younger children. Ana, a six-year-old girl, is rocking three-month-old Estera on her knee, chasing the flies away while Lidia, a fifth grader, is cooking for her siblings. On the next lane, passing by the modest residence of Gheorghe Calin and Verginia Marin, we are greeted by seven children. The crumbling clay hut is home to nine. There is no toilet in the backyard.

“When I saw you at the gate, I got scared and I wanted to hide under the bed. I thought you were coming to give me a shot,” Viorica, a 10-year-old girl and the most talkative of her siblings, candidly told us. The girl complains that while her parents were away working in the fields an equally impoverished neighbor broke into their hut and stole a pot of beans and 50 lei. Three of the sisters go to school, but they admit they are not good students. “We can hardly spell, cause Miss ain’t teaching us, but other kids who are better students,” Viorica, the children’s spokesperson, told us.

Mayor Alexandrescu, who listens to the conversation, admits that ethnic discrimination is still an issue, but he believes the responsibility to fix this problem lies with poorly trained teachers, many of whom were former drivers or accountants. “Well, if they are called names at school and they get bullied all the time, how can they learn anything? The child can’t see the school environment as a second family. I have always criticized [the teachers] for what they are doing and that meant quarreling with my wife, who used to be a teacher,” the mayor explains.

Cardiac Lane

There is hardly a home without a sick individual in the hamlet of Ruget. Most don’t have medical insurance so when they get sick they prefer to stay at home and live with their condition. Or they get out of the house and complain to each other. “I can’t breathe in this heat and I feel butterflies in my chest,” a father says of his symptoms. That’s a sign of heart disease, the mayor thinks. He has accompanied us throughout our journey inside the Roma community and informed us that the area is known as “cardiac lane” because people borrow pills for cardiac problems from one another.

Maria Arfir, 43, has been living with a heart condition for four years and says, “I have a prescription since last winter, but I never bought the drugs; I couldn’t afford it. I said, ‘Forget myself; I’ll buy medicine for my children.’ Besides, the prescription is valid only 30 days and now I have to make another trip to the doctor’s office.” She had to borrow a pill from her neighbor Ion Sava, 71. The man worked for years in a state farm and says he is, “sick in the heart, lungs, stomach, and kidneys.” Sympathetic neighbors say, “[Sava] drank water from the pond and made clay bricks under the scorching sun when he was working at the state farm, that’s why he’s sick.” Ioana Sava, 38, is also sick. She shows us a bundle of prescriptions she couldn’t fill. “I have no insurance and I stay home and I lie in bed all day long. If you have no certificate that you’re on welfare, they make you pay for the drugs. What if I ain’t got the money? Honestly, today I didn’t have two lei to buy me the cheapest medicine,” the woman says.

There are even worse problems in the household of Constantin Bran and his wife Aurica. The man was recently injured by a wagon in the woods and he had to stay eight months in the hospital. Although he is still visibly suffering, Bran says he cannot go back to the hospital because he is not insured. He also complains that his wife is, “sick in the head and in the belly” and that she suffers from epilepsy.

Counterfeit Certificates

This is the picture of life in a village where, of the more than 300 families that received welfare and were covered by health insurance, only 36 have remained. Mayor Alexandrescu, a veterinarian by profession, admits it is now easier to treat an animal than it is to treat a human being despite the fact, according to Deputy Mayor Daniela Mihalcea, that the local officials sometimes, “make decisions with their hearts.” Mayor Alexandrescu says:

The modification of Law 416 on the guaranteed minimum income has left us with no alternative but to reject their desperate requests for those certificates which would enable them to have access to public health care. Let the welfare be no more than 5 lei, but at least give the people medical insurance. The central government has to think about the poor as well. How can these unfortunate fellows pay retroactively for their insurance? We are talking about 1,500 lei which they should pay in a lump sum.

Some time ago, mayoral officials issued a fake certificate for a young Roma who wanted to undergo an abortion, but the girl was exposed as uninsured at the hospital. The officials swore they would never make such mistakes again. Yet, every week, sick people come to the mayor’s office to complain that they have no access to the doctors in Focsani. “I have over 30 million lei to collect from them. One hundred today, two hundred tomorrow, the debt has increased. I gave them money at least to cover their bus fare,” the mayor of Timboiesti told us.

Doctors Work Hard

Dr. Viorica Cristescu and Dr. Liviu Grigore Cristescu have a combined number of 3,490 patients on their lists, some of them from the neighboring commune of Slobozia Bradului. Dr. Viorica Cristescu is in her office with several patients while her husband is making house calls trying to persuade the mothers to have their children inoculated against rubeola. The doctors have a difficult time because of the bureaucracy involved in filing their reports to the County Health Insurance Fund, and also because they have only one nurse, who serves the whole. Everyone knows that the doctors have so much work to do that there is little time for prevention and health education.

“There used to be eight nurses working for the doctor’s office, every one of them qualified in one field or another: pediatrics, gynecology, personal hygiene . . . Now Mrs. Mariana Irimia, our nurse, has to do everything, just like us. As a doctor, however, you need to study continuously, to keep up to date with the latest treatment methods and new medicines, to attend to the patients, not to do paperwork,” says Dr. Viorica Cristescu.

Roma often suffer from the most difficult problems. There are multiple cases of chronic diseases in their communities, tuberculosis outbreaks, epilepsy that runs in the family, and a family with five children all of whom suffer from muscular dystrophy, a genetic disorder. “Over the years, we have noticed that the Roma get sick more frequently and we dedicate most of our time to them,” said the doctors. The doctors said that there has been some progress with family planning, and Roma women have stared using contraceptive methods if they know they can’t afford to have more children. “We also have very young female patients who get married. Because they are beautiful, their parents usually withdraw them from school for fear they might be kidnapped or raped. They come to the medical unit accompanied by their mothers and mothers-in-law,” the doctor tells us.

The doctors are also very familiar with the problems of the uninsured. “Well, in the end we examine them, what else can we do? We send them to the specialist if necessary,” Dr. Viorica Cristescu says. She adds that a more serious problem is that the uninsured have no access to free or partially covered medication. The doctor says she found it easy to establish strong connections with the local Roma community as she is a native of Timboiesti. She also has Roma patients from Slobozia Bradului, where there is only one doctor, with an equally complex set of problems. If she were to start all over again, she would not work here, “These are hard times, but we have to live with it. If I were young again I wouldn’t do the same thing I’m doing now. For the time being, I think it is very hard to persuade a young doctor to come here and work in such a community.”

Finding Work in Crete

Timboiesti is also home to several Roma who are able to provide for their families. Not in Romania, but in Greece, where they spend three months every year picking olives, figs, and oranges. When we visited Timboiesti, Vasilica, 38, and Ion Nicutu, 39, were building a top story to their old house. They found the secret of their prosperity on the island of Crete, where they worked for several years. “We have returned to make this community beautiful” the man said jokingly, while showing us the improvements he has made. “We used to have no job and no land, so we went abroad to earn some money to raise our children,” his wife added. People like the Nicutus show us how mentalities have started to change in Timboiesti. In Crete "they learned what it means to be respected for who you are and what you do,” Mayor Alexandrescu commented.