Stefan Mihailenco, from the village of Crihana Veche, in Cahul district, waited to be hospitalised for several weeks. His wife, Mrs Marioara, regularly contacted the district’s hospital in Vorniceni, yet was told there was not a bed free for her husband. On the World’s Fight Against Tuberculosis Day (March 24), Liviu Vovc, a representative of the MS, who is also responsible for TB, was invited to give an interview on Radio Moldova. “I called her directly and told her about my husband’s case. I said we were a family of three with a small child, what are they waiting for? Do they want us all to contract it?” Mrs Marioara stated. She is angry that it took several weeks for the hospital to find her husband a bed.

There are no places or the ambulance is busy

Yet the case of the Mihailenco family is not the only one in Cahul. Vasile Saparet, the head of the Phthysiatric Unit, affirmed that in the district there are 164 people with an open form of TB; only 11 of them have beds at Vorniceni’s hospital. He stated that this particular hospital is a problem: “many times when we call them we are told they have no places, but when beds are free the ambulance is busy. At present we have 20 patients with a multi-resistant form; they cure themselves at home because there are no beds at Vorniceni. Until spaces become available we give them medicine for two or three weeks and they treat themselves at home.” As they are not isolated and don’t follow a strict treatment plan, these patients threaten the health of their families and those that they come into contact with, Saparet explained.

In order so that his family did not contract the disease, Mihailenco would carry a jar with him everywhere he went to slaver in when his coughing fits became too bad. “We have a child, and also other children from our neighbours come to visit. We were afraid to also get TB, thank God he is now in hospital and receives treatment there,” his wife stated.

Veronic Timus, chief doctor of Vorniceni Hospital, stated that, at the moment, places at the hospital are not a problem, and at present in its four departments 220 patients are currently being cared for, whilst it can cater for up to 250 people. In addition to this, a further 20 beds were brought into the hospital last month when it had none free.

We paid a visit to the hospital though, and as soon as you enter an overwhelming smell of chlorine and medicine makes you want to leave. The awful stench from the toilets reaches the patients’ rooms, whilst in the doctors’ offices, the situation is far better; they are in a separate building. Yet two kilometres from the centre of the village around 250 patients from different districts are being cured of tuberculosis.

“It is enough for one patient to cough near you and you risk getting ill”

Official data shows that in the Republic of Moldova there are more than 5,000 people who suffer from tuberculosis. However, “this figure only includes people within the government’s national program of Control and Prophylaxis of Tuberculosis,” Dumitru Sain, project coordinator of the scheme said; unofficial data reveals a much higher figure of people suffering from the illness. This is due to the fact that many people who have Kock’s bacillus do not go to see their doctors. “It is enough for one person to cough near you and you risk getting ill, especially if your immune system is weak,” he adds. On our visit to the hospital we were puzzled to see TB patients walking around without face masks, and wondered how to avoid contracting the disease when Kock’s bacillus can survive in the air for two hours.

At present, people with TB are treated in five hospitals in Moldova: in Vorniceni, Balţi, Tighina and two in Chişinău. Yet along with these hospitals, three phthysiatric units, each with 30 places work in Soroca, Floreşti and Hânceşti, and according to the data offered by the Tuberculosis Prophylaxis Control National Program Monitoring Center, their total capacity is 1,090 beds.

The number of beds have been reduced together with the closing of more phthysiatric units

The authorities invoke unhygienic conditions: “would you ever stay in a hospital where rats live?” a specialist asked us. He affirmed that a hospital which treats TB patients should be isolated and have a park near it, in addition to an adequate ventilation system. Another cause of the lack of hospitals treating TB suffers was a reduced number of patients. In 1990 there were 39 cases of the disease per 100,000 people, however last year this figure increase fivefold; during this time the hospital in Cahul was closed.

Realities at the level of declarations

The deputy minister of the MS, Boris Golovin, said there is no need to reopen new hospitals in the south because “the situation of those with TB is kept under control.”

“Everything remains at the level of declarations, even if the problem is known, nothing is done for it. Money is needed, and as we don’t have it, we can’t move further,” Vasile Saparet, the head of the Phthysiatric Medical Unit from Cahul stated. At the same time, several doctors who we spoke to confirmed to us there were more patients with an open form of TB, i.e. contagious ones, than with the closed form, even if they couldn’t offer us a precise figure.

Both at the MS and at hospitals we asked about patients who had to wait weeks to be seen, yet were told that such cases did not exist. Aliona Serbulenco, the chief of the Department of Public Medical Services had not even heard of Stefan Mihailenco’s case, and a reaction only appeared when we told them how he was hospitalised in Vorniceni. Other sources from the MS state that this case is unique. We weren’t able to obtain data regarding the number of patients and places per district very easily, even if the employees of the Tuberculosis and Prophylaxis Monitoring Center asserted that they had nothing to hide and that they cooperate with the press, they failed to give us the information we required. Moreover, the vice director of the centre, Nicolae Nalivaico, asked us why we needed these statistics and refused to give us them.

A nurse from the Phthysiatric Institute, Chiril Draganiuc, told us that sometimes there are more patients than beds, and in such incidents “they send them home till they find a free place.” However, Liuba Nepoliuc, the chief of the Phthysiatric Unit from the same institution considers that it is not the lack of beds in the the hospital which is a problem, it is the patients who stay longer than is necessary.

“Formerly there were such cases when there were not enough places in hospitals, but now this is not a problem. Even if there are no place here, patients go to Vorniceni or to another hospital, but patients from the hospital go home and new places regularly appear.” However, the same nurse told us patients don’t want to go to Vorniceni because the conditions are worse and in that hospital there is not even clean water or toilets.

Nepoliuc said these patients have many problems and it’s not a secret that most of them have a disadvantaged social situation, needing decent living conditions. Many of them have a job, that is why they need to go home to work their land and feed their family.

All roads lead to the government

The problem of tuberculosis is not just Moldova’s problem, but it is also the whole world’s problem. That is why it is the responsibility of our state when its citizens get TB, Sain stated, the coordinator of the Tuberculosis Prophylaxis Control program. Meanwhile, its budget only covers treatment for a small number of people who have contracted a resistant form of the disease (MDR). Yet even this is insufficient, and in 2007, of the 1,500 who had MDR; the MS covered the expenses for only 50 people. Victor Burinschi, the Coordinator of the Moldova Global Fund, said that “it’s too small a sum of money, but this happens because the MS supports the hospitals with salaries and pays their bills.”

For a six-month treatment of a patient, 67,000 lei is spent by the MS, the remainder of the expenditures are covered by the Global Fund. Last year they and the Green Light Committee spends almost $3,000 on just one person with TB.

Even if the representatives of the Global Fund assert there were no violations recorded during the launch of the project which fights tuberculosis, they prefer to offer medicines and equipment to hospitals rather than money. Sain affirmed that “if the Global Fund donated money, it wouldn’t be spent on patients’ treatment.”

More patients, less money

How is the state going to solve the problem of tuberculosis? One thing is certain, besides the decrease in the number of places available in hospitals, the cost of the social package offered to patients who cure themselves at home will also be reduced. Since the beginning of 2008 patients will be offered an allowance to buy food of just 200 lei per month, compared to the previous amount of 320 that was previously given to them. “The number of patients has increased,” Svetlana Plamadeala, a representative of the Carlux Association asserts. These social packages are offered to encourage patients to continue the ambulatory treatment. If patients do not go to the doctor, then they can’t receive the ticket which allows them to claim free packs with health care and hygiene products in. However, the MS affirmed that TB can be cured, and its specialists guarantee that by 2015 4,850 who have the disease will be cured. What is this source of information from? It is unknown, yet Global Fund intends to reduce its donations, because “step-by-step the responsibility for the state should grow, thus, one day, Global Fund will leave Moldova,” Burinschi confirmed.

Diana Lungu and Veronica Russu

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