Never-Ending Ordeal for Romanian Cancer Patients
"Fighting cancer is a daily battle," says Camelia Dima, whose daughter suffers from a malignant tumour. But in Romania, long waiting lists and a shortage of drugs make the fight even harder.
"Europe is characterized by worrying inequalities in cancer control and care", the European Commission recently warned.
With a 2013 budget accounting for barely 4.5 percent of gross domestic product - less than half the European Union average - Romania's health system is in a critical condition.
Thousands of doctors and nurses emigrate annually in search of better paid jobs in Western Europe, while cost-cutting measures have deprived cancer patients of access to therapies that could save their lives.
"We cannot afford to hand out caviar as long as, unfortunately, there is not enough bread to go round," deputy health minister Adrian Pana told Agence France Presse.
Since 2006, some two dozen basic, inexpensive cancer medicines have gradually disappeared from drugstores and hospitals, forcing patients to ask relatives or friends to buy them when they travel abroad.
Pana said the drugs were no longer available because producers or distributors thought it was not worth selling them as their profit margins were very low.
"The government cannot oppose their decision to give up selling a product," he stressed, blaming pharmaceutical companies for putting their "commercial interest" above everything else.
The ministry is now seeking a way to import the missing drugs directly, via a Romanian state-owned company.
In the meantime though, some patients have to pay up to $4,000 for a month's treatment, in a country where the average monthly wage is around $455.
As private health insurance is beyond the average Romanians' means and does not cover major chronic diseases including cancer, a patient's only option is often to pay for the drugs himself or to skip treatment, sometimes for several months in a row, until the public hospital doctors find a solution.
"This is a nightmare, cancer treatment should be free of charge but when they see how much they have to spend, many patients simply give up, because they don't have enough money," said Cezar Irimia, head of the cancer patients' association (FABC).
As desperate calls for help from patients and doctors has multiplied, the new center-left government in January earmarked an additional 800,000 euros to import indispensable cancer drugs.
But some think this is little more than palliative.
"It's not enough to supply hospitals with medicines for one or two months, we need a lasting solution so that patients no longer need to buy the drugs themselves," Olga Cridland, head of Pavel, a charity looking after children with cancer, told AFP.
"Cancer will not wait, patients need treatment today, not tomorrow," Irimia stressed, adding that the authorities' lack of action has killed many people who could have survived.
"Will anyone be held responsible for these deaths that could have been avoided?" he asked.
A professor at the Craiova hospital in southern Romania and head of the Romanian oncologists' society, Dr Florinel Badulescu said he felt "ashamed" he could not prevent such tragedies.
"There are people who give up, who no longer have the strength to continue the struggle," he told AFP.
Romania's cancer mortality rate is 180 cases per 100,000 inhabitants, compared to the EU average of 166.9, Eurostat figures show.
Some 2.5 million new cancer cases are recorded annually in the EU, around 70,000 of them in Romania.
Camelia Dima devotes all of her energy to saving her 22-year-old daughter. Florentina has been fighting cancer since she was 12.
After having brain surgery, she is now suffering from spinal tumours but the surgery to remove them cannot be performed in Romania, as the hospitals lack the correct equipment.
Dima dreams of taking her daughter to a hospital in Turkey but the surgery there costs some 25,000 euros, which she does not have.
"Money is a major problem. As a mother I cannot help wondering if I have done everything possible for Florentina," she said.
"A family with a child with cancer is in a tragic situation, but in Romania this is even worse, because a lot depends on their revenues," Cridland said.
"If they can afford it, they will send the child abroad for treatment, if not, they are left to their fate."
Cridland, whose son is a cancer survivor, has set up a charity to help patients and their families.
It provides free accommodation for people coming to Bucharest for treatment, counselling, classes for children who miss school while in hospital: all sorts of services the public health system neglects.
But there are things that volunteers like Cridland cannot do.
Patients who no longer respond to regular treatment need new, more efficient drugs, that have not yet been included on the reimbursed medicines list, mostly because they are too expensive.
Access to such potentially life-saving therapy is decided by a commission which analyses patients on a case by case basis.
Nearly 1,300 people are currently on the waiting list, praying to get the green light to start treatment.
Pana said his ministry faces a painful choice when it comes to deciding how to dole out its limited funds.
"To me, even one extra minute that a patient gets to live is unparalleled... but a question of ethics arises here: can the public system afford to reimburse a drug that can only prolong a patient's life by two weeks?" he said.
Pana said Romania should strive to "make more equitable a system where 80 percent of the funds earmarked for cancer treatment go to barely 10 percent of all patients".
He stressed that a growing number of people, who are still in an early stage of cancer, should have access to inexpensive, basic medicines, while the more costly therapies should only go to patients in a more serious condition.
But Irimia said: "Patients have turned into mere numbers on a list. Unfortunately in Romania the main criterion when talking about a person's life is not humanitarian but financial."