Ferentari: Life in the Fast Lane

Ferentari is the neighborhood in Bucharest, Romania, where a majority of the Roma population lives. Poverty, lack of education, and the absence of viable projects to improve living conditions all make Ferentari a place where thousands live in unsanitary conditions, without the most basic requirements for a healthy life. The situation in Ferentari is the result of the paradoxical way in which the authorities approach the issue of Roma health. On the one hand, it is believed that suffering does not have an ethnic connection and that is why there are no special programs for the Roma. On the other hand, the authorities say that the health of the Roma population is a priority and they use every opportunity to mention efforts that have been made to facilitate Roma’s access to public health services.

There’s No Place Like Home

Almost every morning, as soon as dawn breaks, Ion Gogoneþ takes his cart filled with odd bits of scrap metal and slowly pulls it to a recycling center. He unloads his cart there and in return he receives a meager sum of money that barely pays for that day’s meal. Then he goes home.

What Gogoneþ, also known as Gogu, does every day is not at all uncommon for many people who live in Ferentari.

Located at the southern end of Bucharest, Ferentari is a large neighborhood. In fact, calling it a neighborhood is not entirely accurate; rather it is something in between a slum and a ghetto. As soon as you go past the new pastel painted apartment buildings, erected by Mayor Marian Vanghelie, you get to the real Ferentari, an area with small, rundown houses, but also with newer buildings, some with turreted roofs, clay lions guarding their entrances, or small lilac gardens. The long cobblestone streets have streams of filthy water on each side, as the sewage system does not cover the entire neighborhood. A visitor may be surprised by an unexpected sight: wooden posts topped by pigeon cages, all teeming with birds. Purple, white, or spotted, these doves look at the world below, where dressed up and perfumed women converse, and children—many of them dirty, but apparently happy—play in the dust and garbage, and pot-bellied men in worn-out clothes or, less frequently, in large-size suits, wearing wide-brimmed hats. Of course, one cannot ignore the intense smell of smoke from the barbecues or the sound of the manele (oriental Roma music), which can be heard especially on the weekends.

On the other hand, if you leave the heart of Ferentari—the area around Veseliei Street, to be more precise—you will find several warehouses, a couple of shady pubs, a few rundown stores, a little park which seems more gray than green, and one soup kitchen on Zãbrãuþului Street. The area is well-known for one-room apartments in horrible five-story buildings with clothes hung up to dry and small windows where, every now and then, a woman sticks out her head to shout at the children below playing alongside stray dogs that scour through heaps of garbage.

Here, in this lively yet ghetto-like world, lives Gogoneþ, a 50-year-old Roma man. Gogoneþ’s one room apartment is just 16 square meters; it includes a small kitchen and a bathroom of three square meters. The apartment does, however, have electricity and running water, which, according to the residents, is a major improvement as not so long ago the buildings didn’t have a supply of electricity.

This is the home of Gogoneþ’s family: his partner, Ilie Stela, 33, and three children, two of whom already attend elementary school. Next to one wall in the small apartment there is a table where the family eats and the children do their homework; on top of it there is a fish bowl with two guinea pigs. Next comes the bed in which Gogoneþ sleeps. Next to that, in another bed, Ilie and the children crowd into every night to sleep.

Gogoneþ had to stay in a separate bed because he was sick with tuberculosis (TB). He had 72 holes in his lungs and, because of his unhealthy and destitute lifestyle he fell very sick. Yet, Gogoneþ refused to see the doctor partly out of carelessness and partly out of shame and fear of being exposed to his friends.

It was only two years ago that Gogoneþ was persuaded by a health and sanitary mediator to start TB treatment. He is healthy now, even if he is still suffering from some aftereffects, but at least he is no longer contagious. “He eats a lot more now; he’s put on weight; only the asthma is still bothering him. We were very lucky with Floarea, God bless her!” Ilie says.

Everyone to the Caravan

Floarea Petre is one of the few sanitary mediators in Ferentari area. She insisted that Gogoneþ follow the TB treatment. “I finally managed to persuade him to think of himself and the children first and stop being ashamed of his disease,” Floarea says. “At first I would visit him and check if he had taken his medicine. I did that for one year. Finally he understood he had to take care of himself.”

Ion Gogoneþ is just one of the beneficiaries of a TB prevention and treatment campaign set up by the health ministry and several mainly American-based NGOs, and financed by USAID.

The campaign was started because Romania has the highest incidence of TB in Europe and the number of cases doubled during the 1990s (from 70 cases per 100,000 people to a maximum of 138 cases per 100,000 people in 2002).

According to official statistics, in 2006 the TB global incidence was 117.8 per 100,000 inhabitants, slightly lower than in 2005 (126.4 per 100,000 inhabitants). Of the 25,422 TB cases reported in 2006, only 391 were relapses and 21,031 new cases. As for the county incidence rate, Dolj, Ilfov, and Giurgiu counties were on top in 2006: 1,060 children were diagnosed with TB. The incidence for this age group has dropped from 33.4 per 100,000 people to 31.8. In 2005, the mortality rate was 8.3 per 100,000 inhabitants.

The epidemiological data before the beginning of the campaign showed that the areas most affected by TB were mixed Roma and Romanian communities living in poor conditions in Bucharest—Prelungirea Ferentari, Zãbrãuþi, Livezilor, Tunsu Petre—and Ilfov and Neamþ counties.

It should be noted that TB affects Roma communities about ten times more than the rest of the population. The causes of this disparity include limited access to public health services, very little knowledge of health issues, widespread illiteracy, living in very crowded and unhealthy places, and poverty in general.

In March 2004, Mercury Research conducted a survey in the aforesaid areas which showed that only 60 percent of Roma questioned had ever heard of TB and that only 34 percent of those who had previously heard of TB knew that it is a disease of the lungs. Half of the respondents identified TB as a communicable disease, while 43 percent were aware that TB can be cured.

In addition to such worrisome data, indicating that the Roma have very little information about health problems, only a quarter of the interviewees expressed an interest in such matters.

Even more alarming, when asked whether they would see the doctor in case they developed a cough or fever—symptoms of TB—a large number of respondents said they would not necessarily go because they could not afford to pay for the transportation and medicine.

Virtually no one knew that the treatment for this disease is free.

Based on such data, a project called “Improving the Roma’s Health in Romania” was carried out in Ferentari, between January 2004 and December 2005. For the project, 18 members of the local Roma community were trained as health and sanitary mediators whose job was to inform the population about TB.

Apart from the informational campaign, the mediators helped the doctors and the nurses by bringing a large number of people suspected of having TB, or those diagnosed with asthma or other respiratory diseases, into the medical centers.

The mediators’ mission played an equally important role in identifying and investigating persons with whom TB patients had frequent contact. More often than not, because of the social implications of the disease, many people suffering from TB would try to hide their condition from their friends and family, which made identifying those exposed to TB difficult. The mediators also succeeded in changing the perception of this disease, which people tended to consider disgraceful, and a disease which affects “only poor and miserable people.”

Floarea Petre recounts: “It took me some time before I succeeded in persuading the people in Zãbrãuþi area to enter the caravan in which they were to be examined. I did not believe that they would come in a significant number. But on that day, early in the morning, scores of women, children and men had already come out of their apartments and had lined up to be examined by the doctor.”

Many TB patients were identified in this process, including Gogoneþ. Floarea says that she alone identified five cases of tuberculosis, including a nine-year-old child. “People keep coming to see me when they have health problems, including symptoms which they believe could indicate TB. I try to calm them down and then I advise them to consult the doctor.”

Taves Bahtalo!

Taves Bahtolo literally means “be healthy, be lucky” and it is how the Roma greet one another. Naturally, good health is something every human appreciates, regardless of their ethnic origin, especially in Romania where the public health system is still in poor condition.

According to a survey carried out in April by the Romanian Center for Economic Policies (CEROPE), the amount of money earmarked for health care in Romania is a mere $470 per year per capita, clearly below the world average of $650 per capita. The survey goes on to say:

Romania is in a difficult position as far as access to medical services is concerned, with unfair distribution of resources in the territory, the rural areas and the poor communities living at the margins of society being the most disadvantaged. One explanation resides in the insufficient funding of public health services coupled with the prolonged crisis of the health insurance fund and the low level of budget spending, between 3-4 percent of GDP, in sharp contrast with the 8-10 percent in more developed EU countries.

In this grim portrait of the poverty of the national health system, the Roma are always in the foreground.

The Roma’s average life span is much smaller than that of the majority. Most frequently, death is attributed to heart conditions, cancer, various accidents, neurological conditions, brain congestion, and lung diseases. Similarly the Roma are more exposed to the risk of developing liver conditions and various transmittable diseases. Among the Roma children, the respiratory diseases have the highest incidence (14.2 percent), followed by the infectious and parasitic diseases (1.3 percent) and those associated with the nervous system (1.2 percent).

The situation in Ferentarit is quite alarming. Eight kilometers away from the capital city’s downtown area, on Tunsu Petre Street, there are several run-down five-storied apartment buildings which former President Ceausescu intended for the drivers working for the Bucharest Public Transportation Company. Now several thousand Roma live there in appalling conditions.

“There’s nothing we can do, my son. That’s how they’re used to living. The garbage truck almost never comes this way, but the thing is people are no good. It’s not like when Ceausescu was alive and people were more careful because they were afraid,” an old woman selling roasted sunflower seeds angrily tells us. While she is talking about the problems of the people living in the neighborhood (“at least there are not so many junkies now; we couldn’t go out at night because we were scared of them”), she carefully sweeps the husks her own customers have discarded on the sidewalk.

One of the biggest problems in the area is that people do not have stable jobs, which prevents them from getting health insurance. It is a vicious cycle with no easy way out.

“If you have no employment record or some certificate from the employer that you are a tax payer, you can’t be registered with a family doctor’s office. This is where the problems start,” says Ioana Constantin, another sanitary mediator in Ferentari.

Young and energetic (“I’m a strong woman, but I’m also altruistic, I like to give without expecting anything in return!”), Constantin has tried everything in her power to help her neighbors. “I have contacted political parties and NGOs asking for support to find jobs for these poor creatures. That’s how we managed to get some of them hired as street sweepers for the Sector 5 Public Property Administration. We couldn’t place them in higher positions since they don’t have education.” However, many give up their menial jobs because they are not satisfied with the low salary or because they have to pay kickbacks.

Even so, Constantin is proud that thanks to her about 300 Roma (children and adults) are now registered with the family doctor’s office.

People would like to have a medical center in the area. “The nearest one is about 15 bus stops away. They are discouraged by the great distance and the transportation fares. In fact, there is one medical center which is somewhat closer, but that is a private one, so it’s expensive. Until 1993, there was a medical center in this street, but it was closed because of the conditions in the area. A police station was then opened because the local authorities thought it was much more useful,” says Constantin.

Although initially trained by Romani CRISS (Roma Center for Interventions and Social Surveys) to act as a sanitary mediator, Ioana Constantin has recently widened her scope. She now helps the Roma with their papers (“that’s the beginning, if you don’t have an ID, you can’t register with the doctor’s office”) or with their domicile (“many of them had no stable residence and thus could not get the guaranteed minimum income”).

Priority or Not?

“Sir, do you know who can send us one of them caravans like the one we had here, because there’re a lot of sick folks down here?” These are the words of an old woman from Ferentari, who sighs frequently and complains about heart pains. She came to us during our first visit for gathering information and her question is on the lips of many who live here. They ask the authorities for help and they despair about their poverty and the harsh life they are living.

Yet, the Ministry of Public Health (MSP) has no programs for the Roma communities because of the belief that disease and suffering should have nothing to do with an individual’s ethnic background.

Since 2001, the year when Romania adopted the EU normative policy that bans patients’ classification according to ethnicity, there has virtually been no official data containing an inventory of Roma health problems.

The budget money pays only the sanitary mediators’ monthly salaries. Other expenditures such as the Roma inoculation program, disease identification, and medicine supply are not included in the budget.

However, with the help of foreign funds, Roma have been the focus of reproductive health programs, which not only introduced women to contraceptive methods but also persuaded young female Roma to undergo gynecological examinations.

Simultaneously, ministry officials are currently expecting new World Bank funds to set up a network of health information and education centers. One of the objectives of this project, which is part of the Decade for Roma Inclusion, is to hire Roma to work for these centers—to be built in the middle of the communities—together with the representatives of the ministries of health, education, and labor.

Theoretically, Roma continue to be the main focus of government strategies promoting health and fighting poverty. Thus, since 2000, the staff of the minister of health has included a personal counselor for Roma problems and, a year later, the ministry of health established the Ministerial Commission for the Roma.

However, there is not much that the minister can do for the people in Ferentari. “Currently, that area is not a priority of the public health ministry. Things might change only if the Bucharest Authority for Public Health (ASPB) or some NGO identifies specific problems and comes up with a concrete plan to improve the conditions in that area. It is preferable to have a project based on a partnership between the institution and the NGO and it should rely on the active participation of the Ferentari communities,” says Dr. Hanna Dobronãuþeanu, counselor for the Roma problems within the health ministry.

Dr. Dobronãuþeanu also believes that the sanitary mediators should continue to play the major role within the Roma communities. “They are the ones who know the people’s health problems best, but their effort can become effective only under the above-mentioned circumstances.”

Certainly, in Ferentari—in the absence of substantial, long-term effort on the part of the government—only individual NGO initiatives or projects, limited in scope, will yield results.

At a first glance, it appears that Ferentari has enjoyed a lot of attention from international donors. Hundreds of thousands of Euros have been spent on all kinds of programs, from fighting TB (as discussed earlier) to sexual education (for men and women alike) to family planning and breast cancer screening. But despite all of this we are still far from yielding visible results.

“The programs carried out so far should be only the preface to a large, coherent campaign designed to address the complex health problems of the Roma population in Ferentari. Of course they have been very useful, but they have not always been focused on the most stringent needs. Besides, the real causes are poverty, unemployment, or lack of education,” according to Alina Constantinescu, who worked in Ferentari as a social worker for the American organization Doctors of the World. “Furthermore,” she warns, “as Romania has become an EU member state, the U.S. and other western countries have ceased to finance projects in this country for Romania is now deemed capable of solving its problems alone. Well, I kind of doubt that.”

Planning Is What We Do Best!

The health ministry’s strategy is focused exclusively on supporting the sanitary mediators. The decision was based on the idea that now the most important thing is to change the Roma’s mentality.

Thus, the 500 sanitary mediators who are now working throughout the country are on a mission to facilitate communication between Roma and the doctors, but also act as living models within the Roma communities.

The mediators—who are all women—must enter the people’s homes, find out their problems, and try to find solutions to them. In fact, not only do they take care of health related problems, but they also help Roma get their ID cards or birth certificates and report social problems to the authorities.

Even if, with the help of sanitary mediators, significant steps have been taken, the problems are far from being resolved. First, the mediators are employed only for a limited period of time, usually one year, and then their labor contracts are extended for another year, which makes their job less secure. Then their salary—paid by the Authority for Public Health—is far from motivating, as it amounts to just 400 lei a month, sometimes less.

More often than not, the mediators are asked to perform services they cannot provide. Communication with the doctors has not always been easy. During the interviews, none of the mediators admitted that she had problems communicating with the doctors; however, all of them said they had heard of cases in which the medical personnel went as far as refusing to work with the mediators whose role they said they did not understand.

“At first the doctors did not understand the role of the sanitary mediator. Some believed she was a sort of Roma healer who was supposed to relieve them of the burden to look after their Roma patients,” says Daniel Rãdulescu, the health project coordinator of the Roma Center for Interventions and Social Surveys–Romani CRISS.

In this respect, Rãdulescu mentions the case of a doctor who, when confronted with a sick female patient of Roma origin, told her she was no longer his business and sent her to see the mediator. “Go to your Gypsy lady,” he said. “You have your own doctor now.”

Even if, in the meantime, mediator-doctor relations have improved, those directly involved in the field of Roma health care say there are still many unsolved problems. One example is related to Roma’s access to public health services, which, according to the health ministry officials, has improved. The Romani CRISS representative thinks differently. “I believe that even if there are more people registered with the doctor’s office now, this does not mean that they have equal access to the services provided by that doctor,” Rãdulescu explains. “Very often, Roma people inform Romani CRISS that some doctors display racist attitudes. Such allegations are very difficult to prove. People hesitate to file complaints of this sort and, on the other hand, the doctor has many ways to cover his or her racism with a shade of professionalism.”

Even State Secretary Ervin-Zoltan Szekely, who is in charge of the relationship between the health ministry and Parliament, confirmed the existence of such cases:

We have recently received a notification from the National Council for Combating Discrimination (CNCD) about a Roma woman who had filed a complaint for not having received adequate medical assistance which resulted in serious problems when she gave birth to her child. We reported the case to the Control Department of the Ministry of Public Health, which, together with the local Authority for Public Health, assessed the situation and imposed sanctions on that doctor not because of having committed an act of discrimination, but because he had failed to provide proper medical assistance. So he was not sanctioned for discrimination because that is difficult to prove.

Romani CRISS also monitors instances of segregation in hospitals—which is illegal in Romania—but admits that such cases are equally difficult to prove. With respect to this topic, the health ministry representative neither confirmed nor denied this possibility. He labeled such practices as “criminal.” Szekely added that the ministry could monitor and check the activity of medical personnel with respect to ethnic segregation. “To be perfectly honest, so far we have carried out control mainly in financial matters. This is where our investigation teams have uncovered the biggest problems. Discrimination and segregation have not been our priority so far. However, we are planning to include these phenomena in the scope of our investigation work,” Szekely stated.

We asked some people from Ferentari comment on this topic, but we only received reluctant confirmations under the condition of anonymity or refusals to discuss the topic.

Resistance to change among Rome people is less frequently used as an argument when personal health is at stake. According to people familiar with the Roma communities, many Roma prefer to expect help, having become accustomed to the many NGOs that give them free food or clothes, which causes them to make less effort to secure their own rights.

The solution in this case is, according to Daniel Rãdulescu, to join hands and approach all the causes of poverty and lack of education. “We may try in vain to improve access to health services or to prevent the spread of diseases if people have no ID papers or reliable sources of income that could allow them to enjoy healthy food and better living conditions,” Mr. Rãdulescu thinks.

He also knows from experience, however, that some Roma “should realize that they can, for example, get free treatment in certain cases. On the contrary, many still prefer not to get treatment when they should, and thus procrastinate until they are forced to resort to the emergency services.”