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Over the last 14 years, 160 British health professionals have made 267 visits to Romania under the auspices of Medical Support in Romania, a charity which provides equipment and training. Bemused by this, a young Romanian asked me why such numbers want to go to Romania, when young Romanians in their droves want to leave.

Endemic corruption is one factor behind the exodus; whilst the warmth, generosity and hospitality of the Romanian people lie behind the enjoyment of those who go there. The Romanian people do not deserve the endemic corruption which is so catastrophic for their country.

The giving of under-the-table bribes to doctors—and in some cases other hospital staff—is common to virtually all former Soviet bloc lands. ‘The practice of “informal payments” to doctors for faster and better care equals 5 to 30 per cent of all health care spending in most countries in the region,’ stated an article in the McKinsey Quarterly 2003 Special Edition, Global Directions.

WIDESPREAD CORRUPTION
A 621-page report by the Open Society Institute in 2002 stated that Romania’s health service was ‘ranked as the most corrupt institution according to citizens’ actual experience’. It placed healthcare at the top of ‘loci of corruption’ in Poland, said medical corruption was ‘widespread’ in Hungary, and found that almost half Bulgaria’s population ‘believe most or all doctors are corrupt’, with ‘doctors ranked only lower than customs officers as the public officials exerting the strongest pressure to obtain bribes’.

Such euphemisms as ‘presents’, ‘brown envelopes’, ‘collateral things’, even ‘bribes’ do not describe the reality. This system of bribes is best described as medical terrorism. Bribes are what doctors receive. Terror is what the population experiences.

In 1998 a woman told me, ‘The anaesthetist said that unless I gave him enough money before the operation, he would not wake me up afterwards.’ In 2002, the same anaesthetist told another patient, ‘I would rather let you die than give you an anaesthetic, if you do not give me enough money.’ ‘My mother paid the bribe, because she was terrified not to,’ a young woman said of her uncle’s emergency admission to hospital.

EMERGENCY ADMISSION
People believe that if they do not pay the bribe, then they, or their children, may not be treated properly or even looked at. It is mass terror, in an area of maximum human vulnerability.

Corruption also extends to major medical equipment contracts. No wonder the Romanian health system is virtually bankrupt, with many hospitals unable to buy even basic items.

In 1999 a World Bank loan funded the installation of X-ray units in 28 TB departments in Romania. When British Xray specialists tested this equipment in one hospital, they found that it gave 16 times the standard dose of radiation and did not comply with EU standards. Cheaper, better units were available in 1999. One of those on the committee who chose the model was closely linked with the firm that imported them.

In October 2000, a $21 million contract was agreed for sterilization equipment for 60 Romanian hospitals. The next Minister of Health unsuccessfully tried to stop it. One item of equipment was described by a British sterilization expert as a ‘potential bomb if badly maintained’. Maintenance in Romania tends to be crisis-related rather than preventative.

These examples happen to be drawn from Romania. But similar scandals take place to varying degrees throughout the former communist world.

The origins of medical terrorism are simple; the outcomes foul. A senior Hungarian civil servant told me that the early Stalinist leadership of these countries needed doctors, but wanted to pay them the same as road sweepers. Whole populations were encouraged to pay bribes. This gave the Party the added advantage of being able to exert political pressure on doctors, who were breaking the law by taking bribes.

With the fall of communism, rising pay and many doctors in lucrative private practices, many hoped that these underthe- table payments would die away. But the problem has got worse, with surgeons able to take £1,000 a week.

This criminality is slowly destroying the whole medical profession. Too often medical decisions are not medically driven. A Romanian doctor said: ‘Forget the Hippocratic oath, it is meaningless in Romania today.’ He wants to leave and practise outside the country.

A few doctors actively refuse bribes. Quite a number will not demand them. But because of the behaviour of the worst doctors, patients tend to assume that all doctors expect bribes. This damages the medical profession’s integrity and credibility.

PROMISING EXAMPLE
If the medical profession chose to put patients first, and to renounce bribery, a moral revolution would occur. Honest doctors would be catalysts for ending the endemic corruption in other spheres which is so catastrophic for these countries.

In one Romanian hospital, in Zalau, three families of patients, who did not give bribes, instead gave sponsorship to the new Paediatric Surgical Ward—a promising example, with the current under-funding of Romanian hospitals.

Tackling medical terrorism could be the strategic lever for shifting corruption in the former communist world—and I believe that Romania could lead the way.

Patrick Colquhoun is Director of the British charity, Medical Support in Romania.