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A Case of Obesity

Dr Blaga struggles to take good care of her 400 patients under four

by Iana Bejaniyska , UNICEF Consultant


Dr Blaga is an experienced family doctor. She has 2000 patients on her list. She has not been affected by the salary cuts that numbed all public sector employees last year, including hospital doctors and nurses. She is well established in the system unlike younger colleagues who feel there are little or no prospects for them in Romania and are fleeing to greener pastures in Western Europe. She has a good income but she is running out of energy and time.
 

‘When I retire in ten years time, there won’t be enough qualified medical staff in our country to fill the vacancies. The health care system will collapse.’


Among the austerity cuts is the subsidy of early medical care for mothers and infants. Until last year family doctors received a good remuneration for every home visit to a newborn. Now they can only claim 7 RON ($2.40) per consultation. Many of Blaga’s colleagues are giving up the visits. A crucial stage of child development and health education is being abandoned to chance. Out of the goodness of her own heart, Blaga continues to make home visits, having taken on the workload of less charitable colleagues. She is really squeezed but she believes that her advice to mothers is vital in ensuring that infants have a balanced diet and the right kind of care. It is her own brand of preventive medicine which will see children grow to become healthy adults.

This young mother would have been lost without the doctor’s home visits

‘The Romanian people are ignorant when it comes to healthy living. Traditional values have been lost. A mother whose child has a bit of fever now rushes to her family doctor. This would never have happened in the days of our grandmothers. We need health centres like in Norway and Finland which deal exclusively with prevention. Psychologist, nutritionists and paediatricians have to be in place with the requisite time and resources to guide people and, especially, parents.’


This is a utopian vision of the future. The reality on the ground is that although, in theory, every Romanian child has free access to health care, the services and medication that are still available for free after the latest cuts are minimal. If a child has the flu, the only treatment available for free is Nurofen for Children. As a consequence pharmacies are permanently out of stock. The next best treatment costs 12.30 RON ($4.30) and is beyond the means of families on low income. To get round this, they take their children to emergency. This puts a huge pressure on hospitals but secures a peace of mind for the parents.


Another austerity measure was to cap the monthly expenditure of family doctors. If, depending on the case load, a doctor has used up their allocation for the month before the month runs out, they need to charge patients who come to them thereafter. Social justice aside, a likely spin-off of this will be even more pressure on emergency services as patients from poorer backgrounds desperately seek to receive free care and medication.


Furthermore, the drop in income and price inflation have forced many families to buy cheap but filling food. Children end up consuming inordinate amounts of bread and milk without the necessary intake of proteins, vitamins and minerals which a balanced diet would provide. Allergies, anemia, digestion problems and obesity among children are rising steeply.


‘I wouldn’t like to think that Romania is as poor as some African countries,’ says Dr Blaga. ‘Our children aren’t starving but the financial crisis has resulted in unhealthy lifestyles. Our problems aren’t measured by the ribs you can count on a child but by the number of obese children in our schools.’

 

 
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