The Minister of Health, Alexandru Rafila, stated that there would be a need for a number of school medicine doctors nine times greater than the existing one. This, so that each school unit has medical staff.
The school doctor, almost non-existent in the countryside. Source: archive
However, the minister believes that a realistic objective would be, rather, the existence of a medical assistant in each educational unit.
Alexandru Rafila, about the lack of school doctors: “Let’s be realistic!”
“Here we have to be realistic, because we have heard all kinds of proposals, to have a doctor in every school. It’s a very good idea, but we need to know how many doctors there are in Romania and how many should be in schools. There should be 7,000-8,000 doctors in schools, there are about 900 doctors in school medicine at the moment”, Alexandru Rafila also said. The minister believes that, rather, one medical assistant can be provided for each teaching unit. “We must, however, be able to offer school medicine services either through integrated community centers or through collaboration with family doctors and, last but not least, through collaboration with the Order of Medical Assistants. A medical assistant in every school – this goal can be achieved”the minister emphasizes.
The lack of school doctors in Romanian educational institutions, especially in rural areas, has become a normality for years and years. No one is surprised anymore when they hear that in schools where hundreds of children study there is no doctor, nurse, dentist or school counselor. As for the psychologist, what else can we talk about? It is an unfamiliar term for the vast majority of us. But, paradoxically, there are extremely many schools that, although they have never had a children’s doctor, instead have ultra-equipped offices. We encounter such a situation at General School No. 1 in Ciolpani. Mariana Banu, the director of the school, stated for “Adevărul” that, when she needs it, she collaborates with the local family doctors. “Our luck is that there is a doctor’s office in the immediate vicinity of the school. And when we need it we ask for help there. We call the family doctors to the school when, for example, we have cases of parasite infestation, when there are situations of children with lice or we are dealing with other incidents. For example, a child injured in sports class. Because anything can happen, we take all the precautions,” explained the director.
The paradox in the system: we have medical offices, but we don’t have doctors
The family doctors from Ciolpani, two in number, come to the school whenever needed by rotation. “She and the nurses also do volunteer work. Because we do not have a contract concluded with them”, says Mariana Banu. She believes that the presence of a school doctor, especially in large educational institutions, should be mandatory: “We need them like air. We, for example, have four kindergartens, a primary school and a general school. There are a lot of children. I should at least have a school doctor working part-time and a full-time assistant.” I am not saying that while the students would need to be monitored, their parents would need counseling. Most bring their sick children to school, the little ones cough, their noses run… and we are still surprised that flu epidemics or childhood diseases appear. Parents need health education, and this can be done in school by school doctors“.
At the school in Ciolpani, the issue of bringing in a doctor was never raised, instead the town hall allocated money for the establishment of an office equipped with everything necessary. “They made a construction and were obliged to provide the material base. And the material base is equipped. Then, I requested the mayor’s office to hire someone, and the mayor’s office, in turn, requested this from the Directorate of Public Health. And we got stuck, we didn’t get any response”says director Mariana Banu.
Family doctors volunteer in schools
I also analyzed the problem from the point of view of the family doctor from the village, obliged by his job to volunteer in schools. Dr. Mihai Mara, who opened his practice in the town of Ceanu Mare, in Cluj, told us that there are four schools in the commune, but none of them has a school doctor: “They don’t have a school doctor, they don’t have a nurse, they don’t have anything. They don’t even have a dentist, let alone a psychologist or counselor.”
Until the pandemic, the doctor took care of both the patients who came to the office and the students: “For many years we went like this, more out of inertia. That if everyone went, let me go too. And I filled myself with papers, papers and reports. Then he came COVIDand the legislation prohibited the access of foreigners to the school, who were not directly related to the school. And then I stopped too. And after that, I didn’t go anymore. I don’t have any collaboration, work, volunteer, etc. contract with the school. I told them that if there is a problem, the parents should come to the office with the child. And if a serious incident happens at school, then they must call the Ambulance”.
Dr. Mihai Mara believes that being a doctor in the village is, for most, not attractive at all. “You are far from the city, from family, from friends – if you choose to live there. If not, you have to commute”, ehe asked. But, beyond the refusal of doctors to practice in village schools, we encounter another phenomenon: there are not enough medical personnel to fill the possible vacancies. “In Romania there are very few family doctors, in rural areas people have to walk 5, 10 kilometers to the nearest office. Under these conditions, where to get school doctors? Because most of them also come from family doctors”, says the doctor.
The solution, in the hands of local authorities
The solution lies in the hands of local authorities, who should find qualified staff, request a budget, offer doctors an attractive salary and good working conditions. “Parents should also put more pressure on the authorities. That there is, after all, a discrimination: schools in the capital and those in big cities have more doctors than those in the countryside”, considers Mihai Mara. He also explained to us what the duties of a school doctor are: “He has much simplified responsibilities compared to a family doctor. Basically, you get rid of everything it means bureaucracy, being just an employee, you work with children, you get involved in all kinds of prevention, education, awareness projects. A school doctor, however, also triages the students, the balance exam, measurements, prevention, completes the medical records, consults the children. It’s beautiful”, Dr. Mara also said.
