Medical Tests Impoverished parents can rarely afford the standard tests which are mandatory for preschool registration. Thus, many rural kindergartens allow children to enter without these tests, but this means that infections are never identified and treated, and the danger of spreading them is higher.
The TOGETHER FOR BETTER HEALTH project covers the cost of these tests in all project communities. In 2012, 127 children (15%) out of 850 children had intestinal parasites (Giardia); 72 had streptococcal infections (the real number of cases might be larger, as it is likely that not all parents collected the stool sample correctly). All infected children received treatment. While infections can reoccur due to improper living conditions, the tests allow doctors to have the families under surveillance and to notify the County Health Department about needed measures (sanitation, water testing etc.).
Medicine and Vitamins: Even when diagnosed, FCG children do not always get the prescribed medicine. For acute infections, the medicine must be purchased within 24 hours or the prescription expires – but not all villages have a pharmacy and not all children’s medicine is free. The cost of common drugs like fever medicine, painkillers, antibiotics and cough syrup are prohibitive for poor parents with many children. Poor children also become sick more often and respond less readily to treatment, due to poor nutrition.
TOGETHER FOR BETTER HEALTH helps parents buy the prescribed medicine. And over the past year 1300 children also received vitamin supplements through the project.
Immunization: The average number of children who are immunized in our communities is 70% - with a few extremely impoverished Roma settlements having rates as low as 20%. Vaccines are free but many parents do not understand their importance and fear common side-effects, hindering immunization drives. From April to June 2013, the project supported an immunization campaign in Valcele comuna, by offering parents small incentives to enable them to buy medicine for their children. This increased immunization rates with 50% over only three months.
Health and Hygiene Education:
Even when family doctors manage to go in the communities to visit children they would otherwise not see, and prescribe treatment, it is still difficult to ensure that the treatment is followed. Parents with only a primary school education typically don’t understand the consequences of untreated illnesses, and their limited access to running water and substandard housing provide a seed bed for recurrent diseases.
The TOGETHER FOR BETTER HEALTH project combines modern education practices with health and hygiene themes. During “Hopscotch Two” – a weekly two-hour activity with 2-4 year olds who are not yet enrolled in preschool, and their parents, prepared 250 children for preschool routines while educating them and their parents about basic health and hygiene issues (how to correctly blow their nose, what to do when they sneeze, washing hands etc.), and providing a healthy snack. The activity runs each year from March to June.
In addition, Health Summer Schools were held by 110 teachers in 40 communities for 1500 children age 3-14. Using a workbook designed by OvR for children and teachers, the program focused entirely on children’s healthy development. OvR provided teacher trainings and monitoring. The children received healthful snacks, and parents got to see how much the children have learned at a closing school festivity.
Access to Healthcare Services
Transportation: Many children live in villages that are kilometers away from a medical clinic, with no public transport available (none of the parents in the project have cars – only a few own a cart, a horse or a bicycle). In a neighborhood in Intorsura Buzaului, Romania’s coldest area, parents must walk with their children 5 km round trip to get to the clinic, sometimes at below -20 degrees Celsius, while the doctor only visits the community for emergencies or to see new-borns. In Ocolna, Dolj county, the children live 10 km away from the village where there is a family doctor – they hitch-hike or walk. Thus, many children are not properly treated, and few make it to specialized doctors.
The TOGETHER FOR BETTER HEALTH project provides transportation money to encourage parents to take their children to hospitals for surgeries or specialized medical checks when needed.
Involving Family Doctors: In Romania, there is a big difference between how things should work based on existing laws and regulations, and the reality in poor communities. For example, family doctors (FD) in one “comuna” (an administrative area formed of a few villages) should do medical check-ups in each village, once a week – if 50 or more people live there. However, in reality these doctors can have up to 3000 patients, so they only go to isolated villages in emergencies or to visit new-borns.
In addition, most rural FDs complain they are overworked, underpaid, and their efforts are not appreciated by poor patients who require frequent consultations and often do not follow-up with the recommended treatment.
In two project comunas (Apold and Valcele) family doctors now conduct weekly medical checks in villages where they previously did not reach..
o The City Hall provides the car and the project pays for gas for the family doctor to pay weekly visits to two isolated villages
o The doctor buys medicine from the next town for the children
o The parents receive transport money to go to specialists or hospital
o The mayor agreed to co-finance a school medical office if the Health Department approves hiring a school doctor and nurse (they will file a request)
- In Valcele (Hetea):
o The family doctor and nurse provide weekly consultations and got more children into the immunization program
o The health mediator (HM) graduated from the certified training and now as a volunteer, makes daily rounds. The City Hall got approval from the Health Department to hire the health mediator – they must start the employment procedures.
o The local NGO ProRoma and the Roma leader from the village agreed to divide the church house (the only “real” building in the village) and set up a space for consultations; the City Hall agreed to provide building materials and wood for heating.
Health Mediators Involvement
By law, City Halls can request the Health Ministry to pay for a health mediator; still 10 of the 18 FCG communities do not have one, and bureaucracy and hiring restrictions make mayors reluctant to try. On the other hand, the existing HMs have unclear roles since now they are hired by City Halls (doing more social than health work), but report to the Health Departments. Our experience clearly indicates that health mediators need more training, mentoring and oversight to become truly effective, especially in poor, isolated village with inadequate health infrastructure.
The project facilitated access for four people to the health mediators training provided by Sastipen (link to http://www.sastipen.ro ), (who passed their exams in April 2013), and supported their salary for one year. Now the City Halls must start hiring procedures, to take over this cost.
Natality rate among the poorest Romanians (mostly Roma) is three times higher than the average national rate. Despite common opinion that poor families want more babies in order to benefit from the state allowance of 45 euros per month for children up to age 2, our observations show that many women do not want more children, but either are not aware of birth control methods, or they are too expensive or difficult to obtain on a regular basis. Currently, in Romania the only free contraceptive (besides condoms which are rarely used in poor communities) is one brand of birth control pill, which does not fit for all women and is not stable (the type changes every few months according to available funds). And to obtain free birth control pills through the national program, women must take a test, which is not free.
This project covers the cost of birth control pills, if a family planning specialist has prescribed them.