Romania spends less on healthcare than any other country in the European Union, and because of the worst recession on record, it is planning to spend even less. This chronic underfunding and a brain-drain of medical staff could be putting patients at risk.
In a poor village in southern Romania, the Grigore family is harvesting onions. For their only son, poverty may have been a death sentence.
Constantin Grigore chokes up when he talks about his nine-year-old son. Cristian broke his arm in May and was taken to the hospital in the nearest town, Slatina.
But four days later, he was dead, apparently of a severe infection he had caught there. The picture of a little boy with big dark eyes now hangs on the outside wall of the family's ramshackle mud-brick house.
Cristian's father said the doctors simply ignored his son. The family had to buy painkillers with their own money. Then they gave the doctor US$6, all they could afford. "If I had more money he would have returned home," Mr Grigore said. "It would have saved his life."
This little boy's death shows just how sick Romania's healthcare system is. The management of the hospital and the doctors who treated Cristian Grigore were sacked.
But doctor Romeo Stanculescu, the new medical director, told me: "His phantom haunts us. I think that this child was a victim of the system. But we are the system and all our failings are reflected in such cases."
Across Romania, hospitals like this are heavily in debt. Sometimes they can only afford to pay for some of the drugs or medical supplies they need. Often they run out of the most basic things, like antibiotics or stitches.
I see a poster from the nurses' union Sanitas: "We say no to 25 percent wage cuts!" In Romania, one of the poorest countries in the EU, junior doctors earn around US$400 a month - and nurses not even that. Under the government's austerity plans, those pitiful wages are being cut by a quarter.
When I ask chief nurse Valentina Gheorghe how long this can carry on, she sounds fatalistic. "I don't know. God help us," she says.
Although she has worked at Slatina hospital for 28 years, she is planning to emigrate to somewhere like England or France. She says she needs to do it for the money. "I have two children, it's very hard," she says.
The man in charge is Attila Cseke. He gets a smaller budget than any other health minister in the EU - just 3.6% of GDP, less than half the share that Britain allocates, and a third of Germany's.
So does he agree that the system is on the verge of collapse? "I wouldn't describe it as a collapse, but instead as a very difficult moment - a crossroads in 2010," he says. "We must find the right turning that will lead us out of these problems."
The average time in office of a Romanian health minister is eight months. So how long will Mr Cseke last? The minister laughs. "This is actually my eigth month in the job," he says.
"But that's exactly one of the problems. In the last 20 years we've had 19 health ministers. Some ministers started something but had no time to see it through, and then a different minister with a different strategy would come along."
President treated abroad
In July, Attila Cseke transferred control of most hospitals over to local councils. It is a controversial move, which the minister hopes will improve management and inject more cash into hospitals like the one in Slatina. Whether he will be around to see how it works out, though, is anyone's guess.
But while Romania continues to rely on the IMF to prop up its finances, there is little the minister can do to raise wages.
Since 2007, almost 5,000 doctors - 1 in 10 - have left Romania for Western Europe, where they can earn 10 times more.
Anca Surugiu, who organises medical job fairs for a PR company called Houston, said, "We are seeing doctors and nurses aged between 23 and 63 years old. I feel sad, of course, because we're losing good people. "
Even the country's leading politicians prefer to go for medical treatment abroad. Amelia Antoniu, an operetta singer who fell into a coma and almost died after a routine operation in the capital Bucharest, is scathing when she talks about the president's operation for a slipped disc in Vienna a few years ago.
"It was like a slap on our Romanian face," she said.
And what happens here can have implications across the country's borders. Romania has the highest rate of tuberculosis infection in the European Union.
In a brand-new ward at the Institute of Lung Diseases "Marius Nasta" in Bucharest, financed by UN's Global Fund, I met Nicoleta, 28, and Amalia, 19. Pale and painfully thin, both suffer from multi-drug resistant TB, which is hard to treat and extremely expensive. Doctors call it a ticking time bomb.
Doctor Adrian Mocanu, the manager of the institute, has a serious health warning. "We can do what we can do with our specialists, but we must cooperate with all the countries in the EU," he said. Romanians now travel across the continent.
And unless they fix their health system, they may export not only medical staff, but also germs. "In the moment that Romania became a part of the EU," said Dr Mocanu, "TB is not only our problem, it is a European problem."
This edition of Crossing Continents was broadcast on BBC Radio 4 on Thursday, 12 August 2010.
- 11 August 2010