Souls Without Insurance

More than 5,000 Roma in Braila, Romania, do not have health insurance. Five thousand people who only get to see a doctor in emergency cases—often when it is too late. Five thousand people who live their lives not knowing whether they have a serious condition or if they are capable of infecting others.

Against this background, the Romanian government has further endangered the health of Roma communities. At first glance a new law seems beneficial because the government has increased state allowances for children; however, allowances are now considered income which deprives hundreds of Roma of public assistance and free health insurance. With access to medical services severely restricted, the general state of health care in Roma communities is sure to worsen.

Ignored Problems

According to official records, approximately 6,000 Roma live in Braila. In actuality, there are more than 20,000, according to the head of the County Office for the Roma Population within the Prefect’s Office. An office estimate has about 8,000 children in the Roma community, and show that only 10 percent of adults are employed, 50 percent depend exclusively on public assistance, and more than 5,500 have no income or insurance. Moreover, not only are many Roma unable to make ends meet, but even those who have a steady source of income fare worse every year, including the 400 Roma who, as of January 1, 2007, no longer benefit from public assistance. These people have been excluded from receiving the minimal guaranteed income by a law which was supposed to bring more money into the families with many children. In fact, after Romania joined the European Union the government increased by 200 lei the allowances for children up to two years of age (three in the case of disabled children).

Only the 400 families in question are considered by the government to now have a source of income, which means that they can no longer receive public assistance. And as if that were not bad enough, because these families no longer meet the minimum guaranteed income, they are no longer eligible for health insurance. From now on, these families will have to pay out of their own pockets if they have a health problem or wait until their condition worsens so that they can be hospitalized in an emergency unit—their only chance to be seen by a doctor free of charge. Waiting this long, they run the risk of transmitting their disease to other members of the family or reaching a stage where it is too late for medical intervention. In spite of their readiness to pay for their health insurance themselves, the problem is far from being solved. The Roma families must now pay for the government-supported medical insurance they received over the last five years. This adds up to approximately 15 million lei, and most families cannot afford it. “This is the perverse effect of the law. So, they are given more money for the children but the fact that the respective family will not have health insurance any more is not taken into consideration. The law must be changed,” says Sandel Grosu, a Roma leader and the head of the County Office for the Roma Population within the Prefect’s Office. He believes changing the law is the only way to solve this situation.

We asked the management of the Department for Labour, Social Solidarity and Family (DLSSF) in Braila what is going to become of these people and whether they think changing the law was for the better, but management refused to comment on the issue and only told us what the law says. “As these people no longer belong to the category of those who can benefit from the minimal guaranteed income, they no longer have medical insurance either. Given this fact, the child is insured by the law, but the parents have to pay for the insurance themselves. So they have to sign medical insurance contracts,” said Veronica Macri, executive director of DLSSF in Braila.

The lack of health insurance and of access to regular medical consultation is, in Grosu’s opinion, a bad investment, “If we do not prevent the disease, spending fewer resources, the patient will eventually get free treatment from the state. So we don’t spend on prevention but we spend more on treatment.”

There Can’t Be Programs Only for Roma

But there are also other causes for the limited access to medical services. In Braila there are 14 health and sanitary mediators: Three of them operate in the city, covering the neighborhoods Lacu-Dulce, Radu-Negru, and Km 10, and 11 operate in the county, one each in Jirlau, Visani, Galbenu, Faurei, Ulmu, Rimnicelu, and Viziru, and two in Sutesti and Movila Miresii. Apart from the mediators, whose role is to facilitate Roma’s access to medical services, the Roma also have access to a medical center in Movila Miresii, built with PHARE funds, and to another center in the city, built with their money. That about covers everything that has been made to increase Roma’s access to health services. Roma have also been included in programs which targeted people with limited means, and in national programs put together by the Ministry of Health which covers the entire population, and includes vaccination, tuberculosis, smoking, HIV/AIDS, and sexual education. The management of the Authority for Public Health in Braila explains that they cannot implement programs exclusively for Roma, because that would constitute discrimination. On the other hand, the representative for Roma in the Prefect’s Office is of the opinion that these problems cannot be solved if there aren’t programs addressed exclusively to Roma.

No Money for the Funeral

Lanurile—When we arrive the Roma community was getting ready for a funeral. A 39-year-old woman had died the day before. She had left behind a husband and three children. She had been unemployed, as is everyone in Braila, not just the Roma. Her husband was in an even worse situation. Fortunately, the children still received their allowances. Her family had no funeral aid. They all cried by the side of the dead body. The mayor of the community had given them an emergency aid of 50 lei but that did not even cover the cost of the coffin. Some of the Roma had brought a little money and food to the bereaved family, but most of them were in the same financial state. Grief and despair had seized that part of the village. I asked the mayor if he couldn’t help them in some way. The answer was quick:

Most of them are in the same situation. They only live from the minimal guaranteed income. But they don’t work all the days foreseen by the law. So I cannot pay them for what they have not done. The city hall cannot take it upon itself to bury all the dead people in the community. If I bury one, then all of them will come to me, and that is impossible. Those who do work do it here and there and everywhere and all their day’s earnings are gone by the next morning. It’s only natural that they shouldn’t have any money for the doctor. But not only the Roma have these kinds of problems. Many Romanians are in the same situation. The young people have left the village and they have found work elsewhere. So, where there’s a will, there’s a way.

Children Parenting Children

Only 20 percent of Roma in the county have access to sexual education. I spoke with a young woman of 16 from the community of Unirea. She already has a one-year-old child. I asked her whether anyone has ever come to their village to explain to them what contraceptives are, how they are used, or to give them at least some basic notions of sexual health. She felt embarrassed and looked over her shoulder to the elderly woman who was with her and who remained a few steps behind. The young girl pulled us aside and told us that no one from the Authority of Public Health has ever visited or educated Roma. “No one has come here to talk to us about this. I know a few Romanian girls in the village who take (oral contraceptives). But it’s a shame for us. How could I do this? I am a married woman, I have a child. How could I take them? Only certain girls take them,” she answered smiling embarrassed. I asked her whether she really wanted to have many children. She said looking at the woman behind her, “To tell you the truth I don’t really want another baby just yet. But my mother and my mother-in-law tell me that it’s the proper thing to do. I, for one, have had enough of this one, too. It never stops crying. I know that only certain girls take those... contraceptives. That’s what we have been taught ever since we were little girls. But I’d take them, too, when no one sees me.” The young woman would have talked to us some more, but the old woman called her and she ran back to her. The old woman pointed at us and asked her something, but the girl denied and shook her head. They went away. On the way, the young woman clung to the branches of a wax cherry tree and quickly picked some wax cherries. Still only a child...

Roma Need a Tenth-Grade Education to Work as Dustmen

We need clever projects dedicated to Roma, not just ones that are meant to get some funds, or to check off another activity on the to-do list. This is also the case of the career fair entitled Job Market for the Roma Ethnics, organized by the County Agencies for Employment. For instance, last year in Braila, 11 employers participated, with an offer of 154 jobs. The offer was rather good but the action was a total failure. Only 58 Roma participated, of which 23 were employed as unskilled construction and textile workers, street sweepers, plasterers, decorators, and assemblers for textile manufacturing. And when we find out why less than half the Roma who participated did not get a job, things become complicated. Grosu had this to say:

The offers are not tailored either to their training or to their needs. It’s no use listing engineer jobs on the job market for the Roma. They lack the education. It was just for the show. And this is another vicious circle. It’s no use giving one a job if they haven’t a place to stay or the required training to do it. To say nothing of the fact that in order to become a street sweeper, the graduation of 10 grades is required. Why is that? One possible explanation is that due to the extensive choice available, the employer has set very high standards. There could also be a certain amount of discrimination to it.

The Sanitary Authorities Deny Discrimination

Even if he agrees that the health issue of the Roma community is a serious one, Lucica Scutaru, the director of the Authority for Public Health in Braila, says that the problem is not the result of discrimination. Instead he attributes this problem to the Roma’s lack of interest in their own problems and in finding ways to solve them. According to the director everyone else cares about the Roma’s problems, but not they:

People have to understand that the Roma population has never been discriminated against. During Ceausescu’s regime, a pediatrician made sure to go the Roma children first when he made his home visits. So did I. They were simply irritated by my visits because they did not trust I did a proper job. We often feared they would die. There was positive action then, too. We would try to reach them, but they were not at home. At the time of the demographic policy, the doctor had to give and sign declarations on the basis of which he was penalized if anything happened to the child whose mother did not take care of it, or did not give it the medicines in the prescription. So, from the point of view of their health, the Roma population has never been discriminated against. Oh, then they were insolent and had an offensive behavior, that’s why the doctors and the rest of the population, for that matter, rejected them. But that’s another issue. That was because of the way they conducted themselves and to which the rest of the people reacted accordingly. And now they say they have problems and that no doctor sees them... But the doctor will not see any Romanians who do not have health insurance, nor Hungarians or anybody else in the whole world, not only in Romania. People have to have medical insurance.

Yet, There Is Hope

We met a 14-year-old girl in a village, who really wanted to become a sanitary mediator. Her mother wanted her to go to the Sanitary high school in the city and then return to the village:

I have a clever daughter. I know I cannot keep her at home. I see very well how things are going nowadays. Maybe with the help of the teachers from the school in our village she will go to the Sanitary high school. Then she can come back as a sanitary mediator. I know that she can become a sanitary mediator anyway, but I’ve always thought that the Sanitary high school is the cleanest place for a girl to learn. It’s the best for her. It’s my dream. I only hope I will not need her so much for the field work this year, because she must study for the graduation exam.

I also asked the girl what she wanted. “I want to work here as a sanitary mediator. Mr. Grosu from the Prefect’s office told me about that. I thought I could do that, too, especially since we don’t have one in our village. I only hope to pass the graduation exam.”