Chapters
Chapters

by Diana Oncioiu and Vlad Stoicescu

photographs by Zora Iuga and Silviu Panaite

No polyclinic and no health advisory center.

This is the clean result of an inventory of healthcare facilities serving Ferentari neighborhood in Bucharest. It has been like this for nearly 15 years. And as the years went by, the memory of any medical center in the area was gradually lost. It will soon be remembered only by archive documents, not by people.

There were two polyclinics in Ferentari. One of them even had the same name as the neighborhood and it was located on 73, Veseliei Street. It was disbanded in the early 1990s. Another one, Vâltoarei Polyclinic, was located on 4, Frânceşti Street and closed in 2002.

Today, the building that housed the latter is a ruin hidden from passers by a high fence adorned with barbed wire. Over the low-rise houses that border the building, one can see the first row of ghetto buildings in Aleea Livezilor.

Just a few neighbors and a medical doctor remember that there used to be a polyclinic there.

As part of the series #FerentariLux, Dela0.ro investigates the level, quality and efficiency of public services in the neighborhood. In the second episode we take a look at healthcare –the first dealt with education services, the third is dedicated to public security and order.

The remains from Dr. Tiripa’s memories

Nowadays, Marian Octavian Ţiripa does his job outside Ferentari. He has a family medicine practice in Rahova, even though many of his patients come from the area where he used to work. After the polyclinic was closed, they followed him.

On Frânceşti street, downstairs, ruins and barbed wire reign now where pediatrics used to be, while adults’ services were on the upper floor.  This is what Ţiripa remembers, adding with confidence that a lot of people used to come to the clinic. At that time, there was no such craze related to insured – uninsured patients, the doctor explains. The clinic was closed for lack of necessary funds for renovation works and security.

„Maybe they would not have closed it, had it been protected by this fence we see now,” says Marian Ţiripa ironically. His dream is to reopen the clinic, but he does not know what other doors to knock on to, since similar efforts over the past years have resulted in failure.

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Ghetto buildings can be seen over the top of low-rise houses, from the place where the old clinic used to be, on Francesti Street. The national flag watches over the dreary scenery.

Foto: Zora Iuga

Ţiripa urged his younger colleagues to open their medical offices in the district, perhaps even rent a small apartment on Aleea Livezilor. They would have patients for sure, he believes, though he is too old and sick to start all over again. Nevertheless, young doctors do not want to hear about Ferentari. They are reluctant and some even have prejudices, Ţiripa says.

I have not encountered any problems in the neighborhood. I always felt respected and appreciated,” the doctor points out. “These persons do not have a different genetic code. Poverty does not take into account ethnic criteria, you know.”

Family physicians are the only medical practitioners that work in the Ferentari area. Specifically, there are two of them. In District 5, according to the National Health Insurance Fund, there are 106 family physicians. Out of these, eight are in Ferentari, but only two medical offices are indeed located in the neighborhood – one on Lacul Bucura Street, close to the ghettos on Iacob Andrei and Aleea Livezilor; and another one on Salaj Street, close to Humuleşti Park. All the other six are located at the border between neighborhoods.

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Because of the lack of family physicians, many of the neighborhood children benefit from healthcare services only at hospitals’ emergency units.

Foto: Silviu Panaite

The medical office on Lacul Bucura Street is related to a foundation of the Baptist Church, Providenţa, which tries to provide a complete range of services in Ferentari – education, healthcare and social assistance. This explains the presence of Dr. Antoaneta Baboi’s office here. It has about 2,200 patients, reaching the threshold allowed by the Health Insurance Fund, but Baboi claims that she deals also with uninsured patients who come to her.

Home visits are provided especially for children. She has no problems going to the ghetto, because she was raised in Ferentari, she went to school here and she knows the people. Antoaneta Baboi and Marian Ţiripa are among the few physicians who go into ghettos, making home visits.

An emergency delayed until forgotten

In May 2014, School 136 from Ferentari was hosting a big event, the signing of an agreement between the Ministry of Health and the French Embassy to open a primary care medical center in the neighborhood.

An “extremely important” project for the residents in Ferentari. This is how it was described by the State Secretary Raed Arafat, who attended the festivities, explaining that the medical center would be set up with the support of the Bucharest-Ilfov Ambulance Service. No one ventured to set a certain date for its inauguration, even if the health problems identified were classified as „urgent”.

„The latest data and diagnosis regarding the district lead us to estimate that citizens in this area are coping with serious social difficulties. Disadvantaged people, often from the Roma minority (including many children, single women and persons without identity) face particular health problems because of the living conditions within an unhealthy environment and chronic diseases related to injecting drugs,” reads a press release by the Ministry of Health, from May 2014.

The conclusion: „There seems to be a rise of pathologies identified, such as HIV, hepatitis, tuberculosis and other respiratory diseases. All of them are symptoms that should be adreesed urgently, today.” For such a diagnosis, the minister asked, at the time, for a study by Medecins du Monde, paid by the French Embassy.

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Even when facing emergencies of all kinds, many of the Ferentari ghettos inhabitants are accustomed to waiting.

Foto: Zora Iuga

Two and a half years later, the medical emergency remained recorded on paper, and the plans announced by the Health authorities got lost somewhere in the twilight zone of the ministry. A winter passed and then a spring, and  then another summer, and in Ferentari the health problems are as serious as they used to be, the medical needs are even higher, while there is  no sign of any primary care medical center.

Dela0.ro contacted by phone the Minister of Health in 2014, Nicolae Banicioiu, who signed the agreement on behalf of the Romanian state. He answered with an annoyed tone: „Do not ask me about it, as I’m no longer the minister! We went through stages, you know that there are agreements to be signed, there have been some missions, but I do not know what happened. I know that things were pretty advanced, but I cannot tell you exactly the stage

Since signing the agreement with the French Embassy, Bănicioiu remained Minister of Health for another year and a half, until the series of events that followed the Collective club tragedy.

If the minister who signed the agreement does not know much, maybe a technocrat such as Secretary of State Raed Arafat is more familiar with the situation. The assumption would prove erroneous. Contacted by phone, Arafat said he did not have much time to talk, after learning what it was about. Our questions were sent to him twice, via text message. We did not receive any answer.

By the time this article was published, neither the French Embassy, nor the Ministry of Health answered to formal requests sent by Dela0.ro to clarify the situation of the promised support center for Ferentari.

The Embassy request was submitted 21 days ago and it is still being processed, according to Gabriela Dita, responsible for media relations. As well, a similar request is being processed by the Ministry; in this case, 11 days after we sent our request, they said it would take other 19 days to answer.

We required a monosyllabic answer:  is the Ministry still involved in the project? On a social network, where a Dela0.ro reporter made public his frustration with respect to the institutional refusal to clarify things, the current Minister of Health, Vlad Voiculescu, indicated that he will try to answer quickly to the request. In a subsequent telephone conversation, Voiculescu admitted that it was the first time he heard about such a project.

Formally, however, an answer did not arrive from the ministry.

A mediator instead of a system

Ioana Constantin lives in Ferentari, on Aleea Livezilor, in a social housing unit overlooking the heart of the ghetto. 13 years ago she was working at the cigarette factory, then she became a salesperson and afterwards a maid. Since 2002, Ioana Constantin is a healthcare mediator.

For people in the neighborhood, she has long been „the girl that helps.” No one knew then very well the specific work of a mediator. Ioana checked who had a family physician and who did not, whether they suffered from any chronic disease or if people had identity documents. Until 2010, there were three mediators in Ferentari. After 2010, when salaries were reduced and costs were massively cut off in the health sector, the only one left was Ioana Constantin.

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38 , Livezilor Street. The place where Ioana Constantin leaves every morning when she goes to solve part of the neighborhood’s healthcare problems.

Foto: Silviu Panaite

Initially, healthcare mediators were subordinated to the Ministry of Health. After decentralization in 2009, they became subordinated to local authorities, even if their activity is still financed by the ministry.

Ferentari problems have been about the same since 2002 – there is an ongoing struggle of 15 years for taking over and managing medical cases where documents are missing or people are uninsured. It is a vicious circle that can only be broken by coordinating several central and local authorities – without school education or documents it is impossible to get a job with a labor contract, without a contract you do not have insurance and without insurance you can benefit from healthcare services only in emergency situations.

In 2015, according to the Bucharest Ambulance Report, District 5 was the first in terms of number of requests for an ambulance correlated to total population.

Healthcare policy in Romania, based on subsidizing services, is only theoretically aimed at protecting vulnerable categories, because, in fact, the practical effects are contrary. Health services are under-utilized by the poor and the benefits of subsidizing favor mostly the wealthy. This is shown by a study carried out by the World Bank in 2011 – and the conclusion is endorsed by the Ministry of Health in the National Strategy for 2014-2020.

In Romania, three out of four poor patients pay out for medical care from their own pockets, while nearly two-thirds of these patients pay in full all medication, out of their pocket.

From the onset, the mediator Ioana Constantin explained to Ferentari people that children are entitled to medical assistance even if their parents do not have labor contracts. Today, she targets the pregnant women in the neighborhood and tells them they are entitled to healthcare during pregnancy even if they are not insured. She does it because there were cases when doctors asked money from pregnant women.

An uninsured person who wants to be in the system even without having a steady job has to pay an initial amount of 483 lei, then 69 lei each month. That’s because, by law, upon becoming insured, any person should pay not only the monthly contribution, but also an amount covering six months preceding his/her entry into the system.

People working illegally cannot afford to do this, explains Ioana. When they are sick, they resort to self-medication, thinking that they can use the same medicine as their neighbor, for instance. And they also take antibiotics when the pain is unbearable, from pharmacies that give medicines without prescription.

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Ioana Constantin (left), showing a Dela0.ro reporter some of the dreadful things she encounters on the field.

Foto: Vlad Stoicescu

Ioana Constantin insists that there is an urgent need for a socio-medical community center in  Ferentari. Otherwise it is impossible to really help the people in the ghettos, where you see outbreaks of infection. Such a center would provid them basic services such as measuring blood sugar, blood pressure, and even include a gynecological practice, a dentist and a dermatology practice as well.

Children in the ghettos are full of sores, Ioana warns.

A chaos adorned with principles

About 30% of the district population lives in ghetto areas. Out of these, approximately 80% are uninsured. They are the beneficiaries targeted by some programmes developed by NGOs.

The major problem with these non-systemic interventions is that they function for a short period, and the change they produce is barely noticed. There are just two NGOs that have been steadily working in Ferentari over the last five or ten-years – Carusel and the Policy Center for Roma and Minorities.

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In some places in the neighborhood, syringes of drug addicts mingle with trash.

The first NGO is dedicated to improving the situation of drug addicts. The second focuses especially on education, housing and access to utilities. There is simply too much to do and not enough resources to treat with priority such a specialized need as healthcare is. Ultimately, the Romanian state should deal with this.

Among the main values underpinning the Ministry of Health vision for the National Strategy 2014-2020, fairness is understood as expanding access to basic health services for the vulnerable and disadvantaged people.

As part of the Implementation Report of the National Strategy for 2015, within the evaluation indicators targeting vulnerable groups, mention is made that the ministry, in collaboration with the Ministry of Development and Ministry of Labour, has carried out the mapping of health network and community assistance needs, identifying vulnerable rural areas. But there is nothing there about urban ghettos, a reality that has become more obvious in Romania over the last decade.

However, during 2012-2014 an atlas of marginalized urban areas was drafted with funding from the World Bank, as part of a Regio project –  under the Ministry of Development. Health Ministry officials were not involved, but the atlas contains an index of human capital development – evaluated in light of health services they receive.

Ferentari is not mentioned even once in the 300 pages of the atlas, but the project provides a mapping of disadvantaged areas found in District 5. Almost all the marks shown on the map are in Ferentari.

There is no significant difference with respect to indicators such as housing and labor market, as compared with other areas of Bucharest. If we take a look at the chapter that includes healthcare services, District 5 – where Ferentari is located – is up to five times worse than other districts and almost three times worse than the city average.

We stick with this word: fairness.

Epilogue in a tiny studio on Livezilor Street

In 2009, Ferentari received support from Sastipen, an NGO specialized in public health policies. They set up a medical center near the park on Aleea Livezilor.  The center worked with Ioana Constantin and  Dr. Ţiripa for nearly two years.

Patients came from all categories, from children and the elderly to drug addicts and people practicing prostitution. In 2011, the center was taken over by the Carusel NGO, which focused its activity specifically on drug addiction.

There have been some health programmes here and there, remembers Ioana Constantin. For instance, a programme that taught about 400 men about sexually transmitted diseases. The classes were held in Ioana’s a tiny studio on Aleea Livezilor, because the foundation had not found another place.

Throughout classes, the participants would ask Ioana to get out of the house because they were ashamed. Finally, they asked her to organize similar meetings with women. The mediator urged them to go home and explain to women what they have learned. „If we say such things, they will think we were with other women and that’s why we want to use a condom now„, they replied to Ioana.

In theory, a health mediator is a person who ensures a good communication between the community and health professionals. He/she ensures that children should be enrolled at a family physician, informs medical institutions in the event of an epidemic and gives people advice on personal hygiene, family planning, healthy diets for children, making sure that the little ones are taken to the clinic for vaccination.

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When people are left with no hope, salvation often comes in the shape of an icon. They are always present in many houses from Ferentari.

Foto: Zora Iuga

In 2008, there were 688 health mediators in Romania. In 2012, three years after decentralization, 422 were left. In 2013, there were just 200. As their number decreased,  the quality of their service was affected, as well. Upon decentralization, authorities established who pays their salary and who is their employer, without dealing with the assessment, monitoring and training of mediators.

The health mediator remained in a gray area, despite the existence of a job description.

The same area is being haunted by the would-be strategies of the Romanian Health authorities, and no one can be held accountable for these failures. Meanwhile, a neighborhood on the outskirts of Bucharest, where there has been no institutional healthcare unit in 15 years, has become a huge outdoor insulator.

In this insulator people live and die on their own.

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