Whole communities in the north of Moldova live at the mercy of God. It is about thousands of people from rural areas who do not have easy access to medical services. And that’s because of the growing shortage of family doctors. Fewer and fewer graduates are willing to choose this specialization.
Adășeniul is one of the communes without a family doctor PHOTO Cosmin Zamfirache
In Romania, according to the officials from the National Health Insurance House (CNAS), another 1,500 family doctors are needed. Under these conditions, more than 190 localities do not have basic medical assistance, i.e. not even a functional family medicine office. One of the worst situations is in the northern part of Moldova, in the countryside. There are entire communes left without a family doctor, without any kind of medical assistance. They don’t even have a pharmacy. And the situation is also serious from a social point of view. The villages are aging, full of chronically ill people, with CAP pensions who cannot afford a trip to a specialist doctor in the city or to buy their medicines at full price. It is a dramatic situation and many old people actually die within days, at home. In Adășeni commune, Botoșani county, one of the poorest in Romania, the community medical assistant, until he got a personal car, walked for kilometers to get prescriptions for the elderly in the commune. Specialists from Botoșani County Insurance House, for example, say that young medical graduates don’t even want to hear about family medicine.
Over 7000 people without basic healthcare
Botoșani is one of the poorest counties in Romania. Free healthcare is actually essential for the survival of rural people. And this in the conditions where, after the exodus of young people abroad, many villages are populated, in proportion to 60%, some even 80%, with elderly people, with CAP pensions. “If they don’t get a prescription, they don’t have pills. And with a compensated prescription, I have to pay 150 lei per month. And I only receive 1500 lei pension. If there is no prescription, I pray to God and how he decides. That if they have his medicines at full price, I have nothing to eat and nothing to warm myself with“, says a woman from Avrămeni.
On top of that, in this county with many social cases, family medicine is a huge problem. In the sense that the deficit is getting bigger from one to the other. No less than 28 posts are vacant and no one is filling them. Around 20 are in rural areas. That means more than 7,000 people without a family doctor. Some do not have a family doctor or a functional dispensary within a radius of more than 20 kilometers. In communes such as Adășeni or Dimăcheni there is not even a pharmacy. And the situation tends to become desperate. More than 44% of existing family doctors are on the verge of retirement.
The people of Adășeni have no medical assistance PHOTO Cosmin Zamfirache
Obviously, no one is coming to take their place. “A crisis of family doctors has been foreshadowed for a long time. Every year the number of family doctors became smaller and smaller. In addition, it is also an aging of these family doctors. Their age being over 60 years. We have 62 family doctors out of 141, aged over 60. So 44% of family doctors under contract with CJAS are over 60 years old.”, says Alina Mustiață, director of the Botoșani County Health Insurance House. For a villager from communes like Adășeni, Manoleasa or Viișoara, a trip to a doctor means more than 60 kilometers, hours of waiting in queues and a day lost on the roads. “It’s terrible for an old man. He has to go as he can, with a bus, in the morning, or with a used car. The effort is very high for them. I go to bring them prescriptions, referrals, medicines”, says Alina Axinie, community nurse in Adășeni.
Young doctors don’t want to hear about country offices
The problem has often been raised that young doctors avoid enrolling in family medicine residency in order not to end up in rural areas. Precisely because there are no conditions for practicing the profession. In the last ten years, local authorities in many municipalities have invested money in setting up modern medical offices, equipped with everything they need. Like the one from Adășeni. Even so, no family doctor was found. Not even the complete rehabilitation of the roads in the county, nor the extra financing made through the National Insurance House. “Family medicine is not much sought after during residency. So we don’t have young people who choose this specialty. The financing is good at the moment, that is, the financing problem has been solved”says Alina Mustiață.
In Adășeni, for example, he was a family doctor many years ago, but he left for Suceava, to an emergency reception center. Villagers from the communes of Botošan, as well as specialists from CAS, are convinced that young doctors are actually fleeing rural areas. “Probably due to the fact that there are more posts in the countryside.“, adds the head of CJAS. In the villages of Botoșani there are many old people and there is not much social life. That is, there are no restaurants, places to spend your free time. Outside the taverns in the hamlets. Many communes are far from the city. “A young man came, I think he was a doctor, I don’t know. But it seemed so. He looked at the cabinet. He was with a girl from Iași in the car. It went like that a bit on the streets around here. He wrinkled his nose and left. The cabinet is equipped, but he is bored here, let the man do according to the schedule”he confesses in the local dialect. Community nurses do the hard work, a dedicated network with medical training who collect prescriptions, buy medicine, do whatever they can to keep the elderly alive.
