In Transylvania, in the city of Targu Mures, Northern Romania, is the headquarters of the country’s emergency rescue service SMURD.
It was founded just after the Romanian revolution in 1990 by Raed Arafat, a young intensive care doctor who was shocked by the high mortality rates in the country’s emergency wards.
After leaving the Middle East as a teenager, he studied medicine in Romania. He is now a household name and one of the country’s most popular figures.
Arafat says, however, that much more needs to be done to reform the healthcare service: “We need more funding. We need to work a lot on the development of human resources and on mechanisms to keep human resources here in Romania. The third issue is the infrastructure: Our hospitals are very old. We need to modernise them to make them more efficient.”
Thousands of well-trained medics have already emigrated westwards to countries like Germany and France where they can earn much more money, and this haemorrhaging of much needed personnel causes real problems especially in rural areas. Today, Romania is short of an estimated 40,000 doctors. The country spends just four percent of its GDP on healthcare, half of the European average.
Raed Arafat explained: “We are suffering from the fact that we are not giving hospitals enough money. A lot of time we are paying less then the real costs for them, and this is what is happening and this is what is causing many times the arrears to appear.”
We met Alexandra Dragusin and her daughter Ariana in Bucharest. Alexandra told us of her horrific experience in a public children’s hospital. Ariana caught a virus and needed to be hospitalised. Her mother stayed with her overnight and says she was forced to sleep on the cold floor, without a bed or mattress.
There have been many reports that Romania’s health-care system suffers from widespread corruption, and Alexandra confirmed this: “The nurses didn’t care about anything, only about the money. If you wanted to change the sheets of the baby’s bed you had to pay. Otherwise they wouldn’t give you any attention. So for everything that I had to ask from a nurse I had to pay, to put something in her pocket.”
Alexandra says that by chance she noticed that her daughter had been given the wrong medication, but that wasn’t the worst of it. The virus made little Ariana vomit for many days meaning she was highly malnourished and needed to be put on a drip.
“The nurse came to put in the drip,” said Alexandra. “She had no experience and I realised that she had no experience, because her hand was shaking. I was very, very nervous because the drip she wanted to put into my daughter’s arm was broken. It was broken and I said: ‘I can not believe that you want to put a broken drip into this child hand. That is not possible!’”
Just a few hours later Alexandra discovered that a large part of the tube going into her daughter’s arm had filled with air. She took the tube out herself, saving Ariana’s life in the nick of time. The young girl made a full recovery, but after seeing this with her own eyes her mother spoke out. She says urgent changes are needed to stop something like this from happening to someone else in the future.
She is far from alone in her criticisms. Even the International Monetary Fund has tried to put pressure on Romania to reform its healthcare system. Cristian Romulus Parvulescu, Dean at the National School of Political Studies and Public Administration (SNSPA) said the system is fundamentally flawed: “It’s impossible to fund the healthcare system in its current form. It’s a system which doesn’t work, which doesn’t ensure equal treatment for all Romanians, and is very expensive.”
As well as being a Deputy Minister for Health in the capital, Dr. Arafat makes the long journey to the city of Targu Mures to work during the weekends with SMURD. After spending some time with the Paris Fire Brigade, Arafat decided to implement a French-style system in Romania.
He has worked hard to turn things around, after seeing how bad they were two decades ago. “We could see as students that patients were coming in dead or were coming very late to the hospital and they were not helped and were coming in with complications because of lack of proper emergency care until they arrived,” he said.”
Arafat told also euronews of a recent political row in January. As a guest on a live TV show he criticised plans to open the emergency services to the free market, meaning that private firms could compete with SMURD.
The president of Romania called in to the programme while it was still on air calling Arafat an “enemy of health reform” and as a result Arafat resigned. Hours later thousands of Romanians spontaneously took to the streets in his defence.
Arafat defended his stance: “Once you start to allow commercial competition, you will start diminishing the public system and the integrated emergency system which will become dangerously affected. Because then those who are the components of the system will start fighting against each other to take the market of each other.”
Years ago the emergency services were all divided. But now Raed Arafat has brought them together under a single emergency number, ending confusion and speeding up response times.
He proudly showed off the Targu Mures call centre: “Here, we brought everyone together. Here you can see that you have all the components; the police, the gendarmerie, the medical service, operators for the 112 emergency number, the fire service etc. And that means that we can manage the resources much better and we can manage the information we get much better, especially in the case of mass casualty incidents. So it’s better efficiency and also a better cost efficiency.”
Political instability has worsened the problem. Romania has had 22 health ministers in the last 21 years. That has made a coherent health policy impossible.
Arafat showed us how the Targu Mures emergency unit has been upgraded, as an example of how he hopes all the hospitals might one day look: “What we did here needs to be done in this hospital on most of its floors, in most of the other hospitals. This is why we are asking for structural funds. To have clear funds for the infrastructure and repairing the infrastructure of the health care system in Romania.”
The biggest problems are in rural areas, where there is a lack of personnel and reaction times are slow. Just a few weeks ago a SMURD branch was set up in the village of Raciu at the request of its Mayor Joan Vasu. He was able to get EU funding for water and electricity, but for the emergency services he had to turn to Arafat.
The mayor told euronews about the difficulty of setting this up: “The problem was the lack of money, because one single village alone cannot finance everything. So we had to convince six other mayors from villages around to join in a collective ‘rural cooperative society’. It took 10 years to reach an agreement, but we got there, and now we have emergency services.”
On its first day a farmer was seriously injured by a horse. SMURD dispatched a helicopter and saved his life. This year, 20 more rural SMURD branches will be set up.
In Raciu we also met a goat farmer called Istvan who was a huge fan of Arafat, and has had his own experience of the men in red: “When my boy was badly hurt by a wooden pole in the stomach the SMURD ambulance came and took us to Targu Mures and in no time he was right as rain.”
As the men in red were flying out on another emergency to save the life of a baby with a heart condition, Raed Arafat was hoping for success in his battle to cure what he sees as Romania’s critically ill healthcare system.