RAA 1A personal note by Cristina Enache,
Advocacy Officer, the Romanian Angel Appeal Foundation

Over 300 municipalities, one fifth of Romania

In October 2015, the Romanian Angel Appeal Foundation started one of its longest lasting advocacy activities from the past years: local meetings with municipalities all over Romania.

The objective: to persuade them to acknowledge their responsibility and take more effective action in providing support services for the people affected by Tuberculosis living in their communities. We learned from the beginning that we needed to add a second objective: to increase the information and awareness level of people working in both local authorities and local and central public institutions.

In one and a half year, we organized over 30 meetings, in 7 counties and in Bucharest, and we passed our message on to over 300 local authorities. In geographical terms, our community advocacy covered a fifth of Romania.

“Tuberculosis is a long forgotten tale”

First surprise (that wasn’t exactly a surprise): but for local doctors, nurses and community health workers, very few people understand the real public health threat that is Tuberculosis. The decision makers at community level don’t have the basic knowledge about the disease or even know it still exists. Most of them remember Tuberculosis as a disease from the ’60s when they had to boil the milk and patients were usually treated in sanatoriums with a combination of drugs and non-pharmaceutical “water, sun, and food”. Those who know that Tuberculosis still exists widely regard it as a disease of the marginal: very poor people, alcoholics, people who very rarely come in contact with local decision makers, education services or even with health care providers.

Second surprise (endemic and somewhat expected): the local authorities are very little interested in community health. Rural and small urban communities lack medium and long term social and health strategies and even in large cities it’s difficult to find a coherent, sustainable, long term strategy based on a proper needs assessment.

Third surprise (truly disappointing): some TB doctors and most of the family doctors are not happy with treating TB patients in ambulatory. They strongly believe that the patient should be hospitalized until cured and that the community is not ready to accept and support TB patients. Things like family, job, school, social group, personal comfort that shape one’s existence lose significance. Treatment and hospitalization are seen as compulsory and low treatment adherence is linked more to the patient’s ill will than to the lack of ambulatory support services.

“The patient is the disease”RAA

For most of the local decision makers, the TB patient is only one thing: a patient. Community integrated support is still a new and blurry concept. Many of the decision makers don’t see how or why they should get involved since there is at least one family doctor in the community who is the sole responsible with providing health care services. Stereotyping and generalization don’t help either: the TB patients are mostly “poor, uneducated, alcoholics, uncooperative”. This view does not come from real life experiences but rather from what the decision makers imagine a TB patient is.

The patient is the disease therefore any other needs it might have are not relevant until it is cured.

Continue reading…

Further reading: English language summary of TB Medicine Crisis in Romania published by the Romanian Health Observatory and STOP TB Partnership Romania.


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