Christmas with the HIV children in Romania

Romania is busy preparing for entry to the EU and signs of progress are everywhere in Bucharest. But Romanian society has not yet found a zone of comfort. Social solidarity did good things but was abused by the communists. The church is a strong influence but it is battling against consumerism. Not everyone is able to put aside some of the horrors of the Ceausescu period, or even to talk freely about them.

I’m busy here in Romania but I took time off to visit a doctor I met by accident a few days ago. He’s the manager of a small hospital for infectious diseases at Singureni, just 35 kilometres south of Bucharest. It’s a big step backwards in time. There are more horses and carts than Mercedes, and the hospital’s facilities are 50 years behind those in the hospitals in Bucharest.

But it has one big advantage: you can easily find cheap space for an unprofitable activity like caring for children with HIV. Romania has relatively low rates of HIV, but the large majority (over 5000) are orphaned children, and Singureni Hospital accommodates 45 of them.

In the late 1980s, medical practice included giving children blood transfusions to improve their general health, although it has long been known that it seldom has any benefit and often has risks. This became evident when contaminated blood supplies directly transmitted HIV and re-used needles transmitted it indirectly. Some of the children were already orphans when infected, and others were abandoned after being infected.

Much has been done to improve their lives, with both local and international support. In recent years, better treatment has reduced the annual mortality rate from around 15 percent to below 3 percent, and the surviving children are healthier. For example, their rate of hospitalisation for HIV-associated complications has fallen by around 90 percent (but it is still terribly high).

The Singureni HIV children are in two groups. One group of 35 is supported by an Italian company, and I was told it was at least partly a marketing venture. I have no way of judging the motives, but the children are obviously benefiting.

The other group of 19 is in the care of the hospital manager, Dr Paul Marinescu. He took 30 children from an orphanage in another town about eight years ago, and obtained permission to redesign an old part of the hospital to be more like a family home. The differences between their environment and what I saw in orphanages seemed very large to me. None of the children were withdrawn, they treated each other with respect, and everyone was made to feel they belonged.

The hospital manager gave up a much more senior position to work in Singureni. He says they fixed up his life. All the children, now aged from 13 to 17, call him ‘father’ and treat each other like siblings.

Thirteen of the children died within two years, but since then donations of antiretroviral [1]A medication or other substance which is active against retroviruses such as HIV. drugs have prevented more deaths and greatly improved health status overall. Three of the children were in hospital when I visited. Some have other chronic illnesses and two have serious disabilities. I asked the manager how he coped with death, and how the children managed the loss of their siblings; he couldn’t answer.

I thought it was hard enough to live with just one child going through the teenage years. I find it difficult to imagine coping with 19 with all of their various challenges, as Dr Paul must do. He has many schemes but success is elusive. For example, he would like to establish a handicrafts business that could employ several of the children and give them all a refuge in hard times. Three of the children love livestock farming and have assembled a mix of ducks and hens through their own ingenuity, and Dr Paul would like to establish a smallholding as a source of income. But there is no source of capital, or of business advice. It has been hard enough to survive thus far, when there has at least been a degree of sympathy that small children can attract. The future seems more problematic.

My Romanian friends are angry that the world has largely forgotten the children, and even more angry that Romanians have done so too. But there are many other Romanians who say “We can’t do everything, there are other people in need, their parents should come forward”. In short, the arguments about the poor and the disadvantaged are much the same here as in Australia.

In all, the Singureni children seemed surprising happy and well-adjusted, and they don’t seem to complain about their lot as much as many children who live in Australia.

Don Hindle is Visiting Professor in the Medical Faculty, University of New South Wales. Donations to help the Singureni hospital are welcome – contact Dr Paul at manolesculoredana@yahoo.com [2] or Don Hindle at don.hindle@pobox.com [3].