Initiatives of Change - Greencoat Forums Reports

Patrick Colquhoun, Director of the British charity, Medical Support in Romania. (Photo: David Channer)

Colquhoun talked about the widespread corruption in health care across Eastern Europe and his work in Romania tackling what he terms ‘medical terrorism’. He was joined by Diana Damsa, a Romanian supporter now working for Initiatives of Change.

Spirited Colquhoun has been confronting corruption in Romania’s medical profession and working to improve standards of patient care since 1990. And he puts all his efforts down to the words of a single woman – his then 11-year-old daughter, Rhona.

After watching a programme on Romanian orphanages, Rhona turned to him said, ‘Dad, what are you going to do about it?’ Never one to turn down a challenge, Colquhoun joined forces with a friend who also wanted to help Romania and, two weeks later, the idea for ‘Medical Support in Romania’ (MSR) was born.

September 1990 marked Patrick’s first visit to Romania where, along with five others, he visited a number of hospitals, including the Salaj District Hospital in Zalau, North west Romania. Back home in Cambridge, he took the advice of medical friends and decided MSR would be ‘medically and not emotionally directed’, standing it apart from many of the child-centred NGOs operating there. Taking a single institution – the Salaj District Hospital – as its focus, MSR has worked to improve the hospital beyond all recognition.

British Ambassador Robin Barnett inauguratating the £350,000 Sterile Services project at Salaj Hospital in May 2007

Focusing on departments critical for the running of the whole hospital, the charity has invested in the laboratory, re-equipped A&E in 1996 and overhauled the hospital’s laundry system. Last year saw the completion of a new Sterile Services department at a cost of £350,000. MSR has also initiated 340 visits to Romania by 209 medical professionals to offer training and to share best practice.

But MSR isn’t only about helping one hospital. While Salaj is the focus for the charity’s physical aid, Colquhoun hopes the hospital will be a catalyst for change in a country riddled with corruption. ‘Salaj District Hospital is our partner in seeking to assist the whole of Romanian health care through piloting projects and sharing sometimes painful learning lessons,’ explained Colquhoun.

One of the biggest problems facing Romania’s health care system is the widespread practice of ‘under the table’ payments to medical staff. Low doctor wages and an entrenched culture of gift-giving are just two reasons for the substantial bribes patients feel they must pay doctors, surgeons and even nursing staff to receive treatment. Colquhoun is passionate about rooting out such corrupt practices and uses the term ‘medical terrorism’ to express the fear experienced by patients who struggle to pay. He described an attitude of ‘learned helplessness’ found in both patients and doctors when discussing corruption – a legacy of communism and obstacle in effecting social change.

With the hospital equipment brought by MSR, Colquhoun is adamant ‘Aid should be a stimulus to integrity, not an enticement to corruption’. With this principled stance he is confronting corruption wherever it is found, generating both admiration and contempt in equal measure. He shared with the forum a run-in at border control with a senior Customs official keen to help himself with medical supplies destined for the hospital as well as his stand against an incompetent doctor permitted to continue practising thanks in part to close connections with high-ranking government officials.

While the system of ‘informal payments’ is widespread in every sector of public service, Colquhoun considers it ‘most horrible in health care because it threatens and terrorises people when they are at their most vulnerable.’ To all his generalisations there were, he said, “always shining exceptions.” However, bribes are reported to be anything from €100 for a small operation to €1,000 for a Caesarean – in a country where wages average less than €300 a month. A World Bank study put the daily cost of bribes in Romanian health care at $1 million.

Colquhoun remains undeterred by the scale of the problem. His vision for turning the tide on the institutional corruption found across Eastern Europe gives Romania a starring role. MSR has just established the first wholly independent, hospital-based Patient Representative in Romania – a scheme that has proved successful in India and one that Colquhoun hopes will be replicated in Romanian hospitals nationwide.

Diana Damsa in Romanian national costume

‘Here is a country where patients are terrified that if they do not give a brown envelope to a doctor they will not be treated properly or even at all…The integrity of the profession has been destroyed.’ Yet, amidst the horror, Colquhoun sees opportunity: ‘The great thing is, everyone can have a part in reducing corruption – by not paying bribes, by not receiving them.’ Diana Damsa is one Romanian who has risen to the challenge of living without corruption. A former lawyer, she quit the profession disillusioned with the rampant corruption she had to partake in on behalf of her firm.

Of corruption in her country she said, ‘We are so used to it, it has become normal to us. But I have found saying ‘no’ in the face of bribery takes you out of that ‘learned helplessness’ Patrick talks about. I have learned to fight for my rights. I know now I have a voice and I have to make it heard.’