Recommendation report medical/technical charity aid Moldova
General
Wednesday afternoon, May 5 2005, the volunteers of the Urgenta crew arrived in Moldova. We were welcomed by Prof. Victor Vovc who provided us with his assistant Dennis to accompany us on our tour through the Moldovian hospitals. The rest of the afternoon was dominated by a first briefing by Dr. Victor Savin, director of Healthcare Chisinau.
The University Hospital exists of a group of hospitals, located throughout the city of Chisinau. It offers all medical specialties. There are mainly two kinds of hospitals in Chisinau: local and government hospitals. We focused on the local hospitals. These hospitals are closely related to the Medical School of Chisinau. The total number of hospitals in Moldova is approx. 100.
From all over the country, the more severe cases are brought to a hospital in Chisinau. Depending on the type of injury or disease, the patient is admitted to the hospital with the suitable specialty.
The average length of patient admission has been brought back from 21 to 8 days due to a change of regulations. Formerly, the patient was only discharged after he/she was declared healthy. Nowadays, Dr. Savin has introduced the policy to let patients heal at home as soon as possible, under supervision of the family doctor. The average family doctor's practice exists of about 1,500 patients. This system was implemented fairly recent.
There are 18 local hospitals, 5 Outpatient Clinics and a Stomatology, Psychiatry and Dermatology Hospital in the city of Chisinau. In total, the local hospitals account for 2,960 beds. The government hospitals offer 7,900 beds and are larger in comparison to the local hospitals. Additionally, there is a railway, a military and a trade union hospital. The whole city of Chisinau accounts for 13,260 beds. Fourteen local hospitals reside in the rural areas of the Chisinau region. Moldova has 4 million inhabitants.
The medical system is still organized according to Russian standards. It's a fairly traditionally structure which still has to be changed to modern (western) standards. In 1989, a beginning was made with the introduction of a health insurance system for all inhabitants of Moldova. This system is not comparable to western medical insurance schemes. The biggest problem, according to Dr. Savin, is the current status of the system. It's in a rather basal state, to say the least. Most basic examinations are covered but further tests and examinations, if required, are generally paid by the patient.
Read an extensive report on this subject by the Worldbank and the Moldovan Government (pdf).
The standard of medical technology in the hospitals is at a very moderate level. Buildings are 40 up to 50 years old and in a poor state. They were built in a time of technical developments but they suffer from a total lack of maintenance. Due to this lack of maintenance, there are a lot of non-functional installations. The same applies to the present medical equipment, which hardly ever works. The equipment is of Russian origin and completely out of date. Dr. Savin thinks all equipment is in such a state that a new start is necessary. This new start is only possible through initiatives and investments from other countries or institutes.
Recently, the World Bank has been investing, but only in Pediatrics technology.
Dr. Savin proposed to visit four cooperating hospitals during our stay: the Children's Hospital I and II, the St. Michael Hospital and the Trinity Hospital (Sfanta Treime). The Urgenta Hospital, which is expected to become a government hospital, will not be visited due to the relative good state and high medical standards.
The St. Michael Hospital consists of two buildings, which were built 15 years ago. The founder of this hospital used his influence in the Moldovian government to make these buildings as modern as possible. In the current state, these buildings are functionally the best of all four hospitals, according to Dr. Savin.
The Trinity Hospital is a 30-year-old university hospital, which suffers from a severe lack of maintenance. So far, an amount of 150,000 euros has been invested but a total investment of approx. 1 million euros is needed to get this building in basic order again.
The organization of a hospital stands or falls with, what we call, the triangle: Doctor, Care and Technique. Dr. Savin states the technical side of the hospitals has been neglected for many years now. There is little or no technical education and the current technicians are not well trained. He acknowledges this must improve dramatically to obtain a good balanced triangle.
The majority of patients in Moldova can be categorized in:
- cardiology patients, approx. 50%
- oncology patients, 20%
- traumatology and toxicology patients, 17%
- gastro-enterology patients, 4%
- patients with pulmonary diseases (astma etc.)
Ten years ago, the construction of a new orthopedic center started but has been cancelled due to a shortage of money.