In Search of the Lost Pulse

Note: This is the English translation of the article originally published in issue #37 of DoR magazine. You can read the Romanian version here.

Patric Kolosvari peers at his own grimacing face among the rust stains on the mirror. He is embarrassed. There are too many eyes around him, following him from one room to the next. That’s because it’s his birthday. He is turning 11, and his mother, Ramona, is struggling to do his hair. She sticks her fingers into the boy’s brown mane and holds up a few discolored strands. She shakes a spray can and a cloud of hair spray bursts towards his head. “Sit still, won’t you!” she manages to call out as her son slips from her grip and takes refuge in the kitchen, to play Brawl Stars.

He wants to get more chests and gems to evolve one of his brawlers, Shelly. But he’d put down his phone in a blink if he were allowed to pedal on the winding, narrow streets of Turnu Roșu, his village in Sibiu county. The one thing holding him back is a recent scar across the length of his sternum. He keeps trying to hide it with a repetitive gesture. Each time someone’s eyes land on it, he pulls his T-shirt up to the base of his neck. Under the clothes, the cut continues all across his torso, stopping only where his abdomen begins.

It’s not just any scar. It betrays the precision of a scalpel and a steady hand. He got it a few weeks ago, on a surgery table at Polisano European Hospital, a private healthcare facility in Sibiu. There, a Romanian pediatric cardiovascular surgeon and his colleagues from University Hospitals Bristol come visit twice a year in an attempt to make up for Romania’s lack of qualified medical personnel. In early June, they spent five days doing pro bono surgery for ten children with congenital heart defects. The first of them was Patric.

The boy painfully picks off the scabs from the place where, not long ago, two metal claws pierced through his chest. One to the left, the other to the right. In the middle, they pried open his ribcage, revealing everything inside. A camera recorded each heartbeat and sent it to a screen suspended above an operating room anaesthetized by silence. The only noise was a constant beeping that monitored the child’s pulse: 80 beats per minute. Then 82. Until a potassium solution, dripped into the root of his aorta, relaxed the organ. And then complete silence fell.

A sickening smell of burned flesh hovered above the operating table, from the electrocautery. Thick tubes pumped liters of blood out of the child’s body and into the heart-lung machine – a giant pump which, for the duration of the surgery, took over the role of his most important organs – lungs and heart. The two surgeons, bent over his open thorax, used forceps to pull at lengths of blue thread and knot them up. Their fingers moved in tandem, though they exchanged no words. From time to time, a “suction, please” would break the silence barrier, before a suction tube snaked into the cavity below the patient’s heart. Three hours after the first cut, a hand lifted the metal claws and the wound was finally sutured, putting an end to the obstacles that hadn’t let the boy join his school’s oină team – a traditional Romanian sport, similar to baseball.

Patric spent the first ten years and eleven months of his life with a ventricular septal defect, or VSD. In other words, he was born with the second most frequent form of congenital heart disease: a small hole in the wall between the two ventricles. It did not close on its own in his first years of life, as it often happens. So he needed a patch-up. Apart from that, several fibrous obstructions developed in his right ventricle. Basically, the blood flow caused a hardening in some parts of the heart muscle, which over time formed scar tissue around its exit path. The surgery itself is nothing special, but it is one of the few of its kind that can be performed in Romania. Sometimes by teams of doctors from abroad, on mission in Sibiu and Bucharest.

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The children no one counts

Patric is one of the approximately 500 children in Romania who, each year, get corrective surgery for congenital heart defects. The number is painfully small if we consider that, over the same period, 1,200 new patients with such conditions are born. What is more, each new year inherits a deluge of untreated cases. That’s why the operating theatre sees teenagers who would have needed surgery in the first few weeks or months after birth.

The numbers are anything but encouraging, but even they are mere estimations, because Romania has no national record of patients with congenital heart defects. So doctors shoot in the dark. Some speak of 1,200 newborns with heart diseases. Others say 1,600. But we do know exactly how many die of such afflictions before their first anniversary: 156 in 2017.

The problem doesn’t apply strictly to children with heart conditions. In fact, there are no records for many other diseases plaguing infants. It was only this year that an NGO has managed to launch the first National Record of Cases of Cancer in Children, or RNCC. It shows how many young patients need care each year, whether we have enough specialists and beds in Oncology wards, and how much money the National Health Insurance system should allocate for these departments. These questions are still unanswerable for those born with congenital heart defects in Romania.

Things were not much different in 2008, when Patric was born. Until then, his mother had worked as a nurse under the only pediatric cardiologist in Sibiu county, Viorela Cotârlă. Ramona remembers the doctor told her to bring her son in for a check-up after the christening. As she ran the ultrasound probe over the baby’s chest, the 4.9-milimeter hole in Patric’s heart showed up from under skin and bones.

Ever since, she has lived in fear that a bad cold could worsen his condition. She spent his first seven years of life in a state of tense expectation, from one check-up to the next, hoping the doctors would find the hole had meanwhile closed. But it kept showing up on the monitor, crammed between the two ventricles. In 2015, the boy learned to read and she learned a new lesson. She understood the problem wouldn’t solve itself. So she started to look for information about surgery.

She learned that Romania only has two cardiovascular surgeons specialized in pediatric cases – one in Târgu Mureș, the other in Cluj-Napoca. Together, the two centers – which are autonomous in that they do not rely on outside medical personnel – operate on 400 to 450 children each year.

Pediatric cardiovascular surgery is also performed in Bucharest, at Grigore Alexandrescu Hospital and Marie Curie Hospital. The two have fully equipped cardiovascular surgery wards, but they don’t have doctors to hold the scalpel. That is why surgeries have to rely on missions from abroad. Marie Curie holds monthly surgery sessions with medical teams from the San Donato Clinic in Milan. Over the last few years, the ward in Grigore Alexandrescu has received visits from American and Israeli doctors.

The problem with children suffering from congenital heart defects is not purely numerical. Some surgeries turn out to be too complex for the resources of the few state hospitals with specialized wards. In April, the doctors at Marie Curie went to Milan with two babies battling a transposition of the great vessels (TGV) and Fallot’s tetrad – two of the most common heart defects. They wouldn’t have gotten surgery in time if they had stayed in Romania.

Many others eventually get surgery abroad, with money from donations or from the S2 Form, known by doctors and patients alike under its old name, E112. It is the famous form which gives Romanian patients a chance at state-funded surgery in EU countries, but only if Romanian doctors declare they are unable to save them – either because they lack the necessary conditions, the intervention is too complex for the resources of national hospitals, or because delaying action would endanger their health. In 2018, 180 children with congenital heart defects were admitted into EU hospitals thanks to the S2. The previous year, the same form allowed 177 children to get cardiovascular surgery, and the number for 2016 was 208, according to data from the National Health Insurance system.

In search for a solution, Ramona thought she, too, could take Patric abroad. For an intervention of this kind, the Romanian state was willing to pay, on average, 20,000 euros through the S2 programme. Eventually, though, the boy’s heart was repaired closer to home, at the Polisano European Hospital. Though the cost of the surgery did not exceed 4,000 euro, it was not covered by the National Health Insurance budget.

The money came from donations to the Polisano Foundation.

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For Romanian children with heart conditions, the change comes from abroad

In the private clinic sharing a courtyard with the Sibiu County Emergency Hospital, the first heart procedures on children were performed in February 2014. Then, surgeon Șerban Stoica came from Bristol to operate for free, at the invitation of a former university colleague, Victor Costache, recently appointed as head of the Cardiovascular Surgery ward of Polisano European Hospital. Costache had just come back to Romania after 14 years of specialized training in France, intending to open a regional centre for heart surgery. For Stoica, the centre would become his first opportunity to perform surgery in his home country. During that week in early 2014, ten tiny hearts came under his scalpel. After that, he returned each year, because he wanted to prove that the lives of sick children can be saved in Romania, too. Here, in the past five years, he and other doctors from abroad operated on 122 children. The costs were covered by donations to the Polisano Foundation.

Though he has terribly poor memory when it comes to past cases, he is slow to find his words and swallows a lump in his throat when he remembers a 15-year old boy with a serious heart defect – Fallot’s tetrad. Children suffering from it get less oxygen in their blood and their fingers often turn blue. Corrective surgery is recommended in the first years of life. By the time he reached adolescence, one of the boy’s hands had turned into a dark blue claw. After the surgery, he called his mother, who had abandoned him in an orphanage. It was the first time he saw his fingers looking normal, and she was the only one with whom he wanted to share this emotion. The two were reunited abroad, where he works as a cook and she found a job as a cleaning lady in the same hotel. At least that was the situation the last time Stoica heard of them, because he never saw the kid again. But he came back to Sibiu each year after that.

“We have to do two things at the same time: provide food and contribute to the building of a system that would cover the needs for the hungry population,” – that is how the doctor explains why he keeps returning to Polisano. “But at least we have the satisfaction that we’ve tried to do what was best for everyone who came to us. You can’t wait for help [from the authorities].”

Though it started as a branch of the hospital, the only thing the foundation has in common with it now is the name and, more recently, a framework contract. The document gives the foundation permission to use the private hospital’s operating rooms for free during humanitarian missions, paying only for the consumables and care of the patients while they are in the ICU.

Each surgery mission is a one-week marathon during which 10 to 15 cases of congenital heart defects are treated. Two such sessions have taken place in 2019 so far, in January and June, and 19 children have been operated on by Stoica’s team.

He works shoulder to shoulder with one of Polisano’s pediatric cardiovascular surgery experts, Anca Mandache. She was on the right side of the operating table in over half of the interventions during the June mission. But she only gets a chance to do so during the sessions financed by the Polisano Foundation: the rest of the time, there is no money to cover the costs of surgeries in Sibiu.

The next mission was scheduled for late September, with doctors from Stuttgart. Their presence depends on Cătălina Costache, director of the Polisano Foundation.

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From corporation to NGO

Since 2015, Costache has been convincing company directors, entrepreneurs and ordinary people to donate, together, as much as 150,000 euro each year. It’s the amount she needs to hold two to three surgery sessions in Sibiu.

Fundraising is the most important part of her work, because money is crucial for this story to continue. Apart from that, she also needs to take care of the foundation’s communications, encourage the parents waiting for a life-saving intervention, and motivate medical teams to come back year after year. Which is not easy, since the surgeons, anesthesiologists, nurses and IV specialists travel from abroad to do surgery for charity in Sibiu.

Cătălina ended up at the foundation after a career in banking in France. She jokingly says that was another life – a corporate life. But the curtain fell on that stage of her life in 2014, when her ex-husband, Victor Costache, became head of the Cardiovascular Surgery ward and together they came back to Romania. He had an ambition to start a pediatric cardiovascular surgery programme in Sibiu, but did not manage to get state funding for surgery on children at the private clinic. That was why, two years after they returned, Cătălina donated her knowledge and time to help start the Polisano Foundation. At the time, she wasn’t convinced she would stay in the organization for too long. She was afraid she was signing up for a job that was a million light-years away from what she had trained for – financial counselling for French corporations. But, moved by the stories of the children she met, she realized life in an NGO fit her just fine.

As for the name of the foundation, she says that, despite being confused with the private hospital, she wouldn’t change it now. “Basically, if we changed our name, we would have to go back to square one with everything having to do with communication. I’m not ready for that. Right now, I can’t pour all my energy into that,” she confesses. She is seven-months pregnant and juggling her pregnancy, the last details for the surgery session of June, and the final touches on her Ph.D. thesis.

It’s piling up. Still, she has to allow herself time to rest, even when her phone rings every ten minutes. During her first pregnancy, she went into labor at eight months because she didn’t listen to the doctor’s orders and worked until the last moment. This time she can’t afford to do the same. “I mean, I have work to do,” she says.

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“I’m not a doctor”

Two days before Patric’s surgery, Cătălina visits the boy in Turnu Roșu, less than 30 kilometers from Sibiu. Even though she always takes calls from parents whose children are either scheduled for surgery or on the waiting list, she rarely gets the chance to talk to families face to face and emotionally prepare them for what lies behind the sterile doors of the operating block. Many of them come from distant counties like Timiș, Iași, Botoșani, or even from the Republic of Moldova.

Often, she only has time for administrative talks – getting documents ready, doing brief social investigations. At any given time, over 40 children with congenital heart defects in need of a saving procedure are on the waiting list. It is up to the doctors to decide which cases get operated on, depending on the severity of the condition and the complexity of the intervention, because they can’t sign up for a surgery requiring a kind of post-operative treatment which is unavailable in Romania. The social situation is a factor as well: The Polisano Foundation exists to help the most vulnerable children, whose parents are completely unequipped for the tooth-and-nail fight needed to get them to a hospital abroad with an S2 Form.

In the Kolosvaris’ yard, Cătălina sits on an bench, pulling up her dress and resting a protective hand over her womb. She is accompanied by Doris Lupu, an old friend and journalist at Radio Vocea Evangheliei, a religious radio station in Sibiu. Cătălina is aware that she only has a few weeks before the pregnancy forces her to take a longer break. In her absence, Doris will be the one to take care of communication and organizing the next surgery session.

Before anything, Cătălina looks straight into the child’s eyes and tells him the words he has been waiting to hear: “We’re just telling you what will happen, Patric. I’m not a doctor. There is no doctor here.” The boy calms down immediately. When she speaks for little ears frightened by the scalpel, it is to her advantage to make it clear that she has no medical training. But she often feels like an impostor, because on the hospital corridors a few nurses insist to address her as “Doctor”.

Now, in the dappled light filtered through the vine leaves, she borrows some of the unshakeable calm of doctors under the surgical light-head. She is confident as she speaks of stenosis, transposition of the great vessels, Fallot’s tetrad or VSD. But she drops the talk about medical diagnosis to chat with Patric about the math problems in the national fourth-grade evaluation, about Fortnite and Brawl Stars. It helps that she has a son about the same age and, more than anything, that she can understand Patric’s terror at the impending heart surgery. “I don’t even want to think of what it would be like if it was my son,” Cătălina says. “He gets stressed even when we need to do something basic, like taking a throat culture.”

Patric’s VSD is asymptomatic. But his heart defect must be corrected before he turns 12. Cătălina explains to his mother that it is important to act before the situation worsens. She has seen with her own eyes children from disadvantaged families whose cases cardiologists kept putting off for years. Last summer, British doctors saw a ten-year old boy with transposition of the great vessels. They couldn’t help him, because the anomaly should have been corrected in the first weeks or months of life. Now he is under medication, but even so, life expectancy for his condition doesn’t exceed 30 years.

She pauses and, for a moment, her glance pause on Patric’s eyelashes. She isn’t backed by any studies or numbers when she claims that many of those with heart conditions have long, thick lashes. It is just a connection she chooses to believe in. So she smiles each time the boy flutters them wildly.

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When good deeds come back to you

Cătălina juggles several roles. She has to provide emotional support for parents and children, but she can’t neglect her responsibility as the foundation’s main communicator, either. And for that she needs families in extreme situations to open their doors. No matter how many numbers and documents she brings with her, it is emotion that convinces donors to support the cause of the hearts in Sibiu.

“Doris helps us with a radio promo. We get our funds from donations, after all. We need to move people emotionally, without resorting to melodrama,” she says warmly to Ramona, the mother of the boy from Turnu Roșu.

Ramona brings her lips closer to the voice recorder and repeats Patric’s story – this time, for Vocea Evangheliei’s listeners. The mother’s confession will reach those who keep the Polisano Foundation’s cogs turning. Some of them are religious people and have a strong sense of moral duty. Others have gone through painful trials and want to give something back. Some are Romanian doctors who have emigrated or strangers who put money in the donation boxes set up at the reception desk of the private hospital and in a pharmacy in Sibiu. “A lady from the US who had a brother here wired us 1,000 dollars through PayPal. I just spoke to her on the phone,” Cătălina says. “More and more of them are people I haven’t met directly.”

Just a few hours before she left for Turnu Roșu, Cătălina received unexpected help from the Rotary Club. This year, the organisation has chosen to give the Polisano Foundation the money earned from “renting” plastic ducks which “raced” on a stretch of the Cibin, a river that crosses Sibiu. This way, 30,000 lei have come at the last moment to support the June session, for which the NGO has paid 55.000 euro.

Because good deeds always pay, sometimes the parents and grandparents of children who were given the chance to get a healthy heart later support surgeries. Cătălina mentions “this dear old lady”, the grandmother of a little girl who was operated on recently. They had barely met, when the woman stopped her on the corridor of the hospital to ask her how she could fill in the form to donate 2% of her taxes to the foundation.

When it comes from the very families whose children had surgery, support is an unexpected reward. She was amazed by the degree of involvement of a mother in Timișoara, Andreea Caradjov. In spring, the young fashion designer became Cătălina’s ally in fundraising for the surgery mission in June. Back home, her two prematurely-born babies needed all her attention. Even so, she struggled to get donations, because she was outraged at the fact that the state does not cover expenses for the kind of surgery without which her son, Andrei, who had surgery in January at Polisano, would not have survived.

“Just as he was given a chance, I really, really want to give a chance to another child, through him,” says Andreea. “I believe that every person you meet in life has a purpose. Andrei’s purpose is to save other children.”

One and a half months after her son’s surgery, she was making calls to organize a charitable concert at the Banat Philharmonic on March 20^th. She raised 3,000 euro from selling tickets and from the donation box by the entrance. Convinced she could do more, she organized a second event. In May, a beauty parlor donated all their earnings made on a Sunday. Thus she managed to raise another 1,000 euro. She had one regret: In June she couldn’t return to Sibiu to give emotional support to the mothers of children operated at Polisano.

Andreea Caradjov is an exception. Many of the children treated at Polisano come from disadvantaged families. Even if they wanted to help, their parents wouldn’t know how. And, since one surgery session costs 50,000 euros on average, which covers up to 10 cases, most of the money comes from companies. It’s on them that Cătălina focuses her efforts of direct communication. In March, she managed to secure the whole amount for one mission with a trip to Curtea de Argeș. The money came from Electroargeș, a producer of vacuum cleaners for the German market that also owns a majority share in the shirt producer Braiconf.

Cătălina herself is amazed at how quickly things have advanced; she usually needs to put pressure for months on end. This time, she thinks some of the help came from a promotional clip showing mothers holding their healthy children for the first time. No matter how many numbers, statistics and reports she is armed with, emotion is the decisive factor, even when it comes to company CEOs. They are parents too.

On June 10^th, she entered an operating room for the first time. Not alone; she was accompanying an employee of Romgaz, one of the largest natural gas producers in Europe. Until now, she has been hesitant to provide such access to potential donors. But she believed this was a chance for Romgaz to directly meet the team who came to operate at Polisano. It turned out to be a winning strategy, as the company representatives decided to contribute 500,000 lei, meaning over 100,000 euros – an amount sufficient to cover the costs of the next two surgery sessions.

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The Iron Man of Merghindeal

On the day of Patric’s surgery, another family is getting ready to leave for Sibiu. In Merghindeal, Sibiu county, Monica Tatu is in a flurry as she packs a pajama and a few T-shirts for her son, Daniel. In the village lost among green valleys, the only loud noise comes from the NATO firing practice in the Cincu shooting range.

The woman is slender, fragile-looking, a little stooped. Though her face betrays her age, she flits about in her two-room dugout faster than a teenager. She steps over a few pieces of cardboard and rag rugs covering the beaten earth floor. Every time it rains, the water floods her home, which is mostly built underground. Now she is looking after her five children alone. Three weeks ago, her partner left for Germany to pick asparagus.

“I’ve never eaten any,” she says. “They say it’s like the horseradish we put in winter pickles. I only heard they eat that in the city, like a side dish or something. He went to work as a picker there. He tasted some – he told me it’s kind of like leek.”

Surprisingly enough, she knows more about asparagus than she does about her man. He went to work abroad without a phone. And this time she doesn’t know the other workers who went with him. She’s sorry she can’t tell Daniel’s father she’s been called back to Polisano.

When he’s not away, he works as a day laborer. In Merghindeal, that pays about 30-40 lei a day. Sometimes, Monica works in the neighbors’ gardens to buy the boy yoghurt, bananas and his medicine – Tarosin and two tablets of Vitamin C a day. While she is away, she leaves her other children in the care of her daughter-in-law, who shares the same courtyard. She’s often had to leave them behind to look for a cure for her son’s heart condition.

“It hurts a lot, when you have one child that’s so sick and you have to leave the others behind. It’s not easy for me, you know.” In the handbag where she keeps her documents she has about 50 admission files, diagnosis sheets and medical recommendations, but also a few photos of her children. Daniel looks out from one, with his big, brown eyes shaded by long lashes. In school he wanted to be the strongest, so he asked to take a photo dressed as Iron Man.

The boy was born with aortic stenosis – a serious heart defect, generally manifested in elderly people. Basically, the opening of the aortic valve is so narrow that the heart risks bursting. His mother didn’t know he was ill until he was three and a half. He was picking apples with the neighbours when a fruit hit him on the nose. He started to bleed abundantly. “He’d just raise an arm, the way we do around here, and it would stop,” his mother says. But the hemorrhage returned in the following months. Monica had to call the ambulance four or five times a week. But the paramedics were at a loss as to what to do for him, too. She only got an answer when the boy was seen by the only pediatric cardiologist in Sibiu county, Viorela Cotârlă, who diagnosed him with a congenital heart defect.

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We are the only ones in the EU who need help

Daniel underwent two minimally invasive procedures at Polisano. His mother can’t remember what year it was – perhaps 2016 and 2017. At the time, a surgeon from Sweden dilated his aortic valve opening with a catheter. But the solution turned out to be only temporary. After the second operation, the bleeding stopped, but some of the symptoms persisted. He tires easily, and the searing heat of summer turns him into a vegetable. So he hides all day long in the dugout that is his home. He has been coming back for check-ups every six months.

After corrective surgery, the children’s cases are kept under observation by cardiologists working in state hospitals. But if it becomes obvious that the solution did not work as intended, they are sent back to Polisano. That happened to Daniel. At the beginning of the June session, Rob Martin – the cardiologist who’s been accompanying Șerban Stoica each time – remembered the boy. The British doctor has been a constant presence in the programme since the first mission in 2014. At the time, he was President of the British Congenital Cardiac Association. Now, five years later, he is freshly retired, so he doesn’t know whether he will come to Romania again.

“It is the only European country we go to … We can all see there is a great need here,” says Martin. He believes Romania’s only fully functional pediatric cardiovascular surgery department is the one in Târgu Mureș. But if young patients are to get adequate treatment, the country should have four hospital units following the same model. (Apart from Târgu Mureș, pediatric cardiovascular surgeries have been performed at Institutul Inimii [The Heart Institute] in Cluj-Napoca. These, however, are the only two autonomous centers. The only other places that host surgeries of this type – but only as a part of missions with foreign doctors – are two state hospitals in Bucharest.)

There are many specialists like Martin out there – used to charity work in countries like Syria, India, Malaysia, Trinidad, Peru, Kenya, Tanzania and Palestine, they quickly understood that an EU country can have a young heart patient crisis, too. “There is a culture of aid, of transferring know-how to other centres, other countries. It is done on a fairly wide scale,” says Stoica. As for his own motivation for returning, it is simple. He wants to give something back to his country, even though it is too late for a permanent return. 

At 50, he is giving serious thought to his legacy. It’s not about his panoply of surgeries or about self-confidence. Personal success means nothing if he doesn’t leave something behind in the people with whom he has operated in Romania. “The first time I came, I stayed on the left side of the operating table in ten interventions. I didn’t operate in any of them. I wanted my colleague to learn. That is my dream,” Stoica confesses. “Now I will do the same. There is nothing I’d like more than to operate by Anca’s side.”

He has also worked with his former colleague from university, Victor Costache, who – after specializing in adult cardiovascular surgery – says he felt it was easy to have children under his scalpel with Stoica in front of him. He operated on teenagers on his own and he could do it more often. But everything grinds to a halt when money comes into the picture, since the state doesn’t cover the costs of the pediatric operations at Polisano.

Stoica has cultivated this perspective on his personal legacy in Denver, Colorado, where, before deciding it was time to stop looking, he worked with a doctor he calls “one of the last gentlemen in American surgery” – David Campbell. He remembers how the surgeon took his hands and used his own fingers to take hold of the suture thread.

“I’ve never seen him actually operate. He would be with you from skin to skin [i.e. from the first cut to the last suture], but only on the left side of the table. It didn’t matter if you had done that kind of surgery before, if you had watched it or only heard about it,” Stoica says. “He was the exact opposite of the typical cardiac surgeon. He told me he had nothing left to prove. You must always compare yourself with the best. Always look up.”

He adopted not just his mentor’s outlook on life, but some of his habits, too. He used to see him walking on hospital corridors in his scrubs and Crocs. He never got to do that, but he did occasionally see patients in his Birkenstocks. He spent the first day of the surgery marathon wearing a light linen shirt. He displays no trace of the hardness you would expect in a surgeon. In between surgeries and technical conversations, he stops to listen to the disappointments of a young resident who is seriously considering leaving Romania.

He speaks with empathy, from his own experience as an emigrant. He graduated from Iași Medical University in ’94. He left the country because he wanted to understand what quality is really about. He had that “fire in the belly”, as he likes to say of other young residents he meets during his surgery missions at Polisano. He feels that his aspirations, as well as those of others in his generation who left Romania around the same time, are best summed up by the quote: “Quality is hard to define, but easy to recognize”.

He just had to see how medicine is done in other places. And for that he needed to break away from the system. When he left, he didn’t do it out of a desire to never return. Now he is aware that there is a point of no return. He feels that he has passed it, both in his professional and private life. He was 40 when he decided to settle in Bristol, in 2009. He had worked in five countries and 15 hospitals. His children were somewhat moveable, and he and his wife both had a black belt in packing and unpacking. One summer, they moved house no less than four times. But autumn was drawing near, and he had no idea where his son would start the new school year. He stopped searching and decided to offer his family stability in the UK: “You can’t just go away and leave your parents behind. And then have children abroad and leave them behind, too. You can’t save the world if you can’t even save your own family.”

With each return to Romania, Stoica hopes he is playing a part in forming a local team. Still, he is aware that, despite his best intentions, it takes 10 years to see such a mission through. He says that developing a pediatric cardiovascular surgery department is the crown jewel of any hospital. And this needs to be understood by those who hold the purse strings, too. “Transferring know-how is like teaching someone to fish. But in a time of famine, I can’t just come in as an expert and teach someone else to fish,” the doctor explains. “By the time I’m done transferring the know-how, they’ll starve to death.”

He finds it absurd that he has to come from a national health service abroad to do free surgeries for disadvantaged children in a private center. But, ever since 2014, he keeps choosing to return to Polisano each year, because it is the only place in Romania where he found a wide open door. Also, he wanted to contribute to what his former university colleague, Victor Costache, was trying to build there.

“I deeply admire Victor’s resilience. It’s like trying to build motorways with donations only,” Stoica says. Though he has not seen any change in the attitude of political decision-makers, he is aware that each mission changes children’s lives. Pediatric cardiovascular surgery is a segment where you can’t discriminate based on the patients’ ability to pay. Because your patients are children – the most vulnerable members of society. That is why he feels frustrated at having to constantly rely on how much money Cătălina can raise.

The donations are just a bandage for a wound that will keep bleeding. Stoica is aware of it, Cătălina knows this too. What they need is sustainability. To Polisano, that means training local medical teams, as well as having the hospital included in the National Cardiovascular Disease Programme. That would mean a fixed number of interventions each year would be paid for from the state budget. The National Programme also covers the costs of supplies needed in pediatric heart surgery – the most expensive component of the operations at Polisano. Stoica believes that, if they received funding from the state, the private hospital could fix the hearts of 50 children each year.

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New hearts out of people’s mercy

The Polisano European Hospital’s board of directors has been trying to join the National Programme for six years. Between 2013 and 2019, Costache – the hospital’s medical director and head of the Cardiovascular Surgery ward – has sent around 20 memos on the subject to the Ministry of Health, the National Health Insurance system and the County Health Insurance office.

“We believe that including our clinic (…) will help relieve the waiting lists for the other four centers (…) in the country, reduce the enormous expense borne by the Romanian state for transferring children with congenital heart defects abroad for treatment, and bring down the percentage of avoidable deaths that is unacceptable for our country,” Costache wrote in a memo sent to the National Health Insurance office in early 2018. In the same document, the doctor requested a yearly budget of 100.000 euro for 60 heart operations on children in Sibiu.

No answer was forthcoming. That is because one of the issues in the Romanian health system is that no one replies to memos, even if you are a part of a specialized commission put together by the Ministry of Health, Costache says. The paper’s neutral language hides the doctor’s accumulated frustration with the bureaucratic roadblocks preventing him from repairing more hearts at Polisano. (The National Health Insurance office, however, informed me that they did send a reply last year; the institution explained that it only provides funds to hospitals meeting all the criteria in the evaluation forms, as long as they fit into the budget allocated for the National Programme, which was not the case for Polisano.)

“There is a limited number of children we can operate on, because we do surgery out of people’s mercy,” Costache says. “We’ve found no understanding from decision-makers in the health system. We lack centers for cardiovascular diseases, we lack specialists, and yet we trample the few initiatives we have in this sense.” Costache makes no effort to hide his vehemence. He admits that he finds it increasingly hard to stomach the “administrative shortcomings” which financially limit the number of pediatric surgeries. The hospital’s team is ready to intervene for standard congenital heart defect cases, but the surgeries are prevented by lack of money.

Epilogue

In Turnu Roșu, thick smoke blankets the courtyard of the Kolosvaris. They’re grilling fatback for Patric’s birthday. The trotting of the horses on the street outside is drowned out by a hit of Romanian teen band 5GANG. The children gather around the boy and sing Happy Birthday to You. Ramona scoops up a dollop of whipped cream and puts it right on Patric’s nose. It is his first anniversary with a healthy heart beating in his chest. Though still waiting for the end of the six weeks of physical recovery, he knows that, come autumn, no one will tell him “careful, don’t tire yourself” when he hits the oină ball and sends it flying over the school’s roof.

The Iron Man in Merghindeal has also returned home to his village in central Romania. He stayed in the hospital for three weeks after being operated on by Stoica in Bristol. Beside a healthy heart, he brought home a mental picture of the Atlantic. And his mother collected presentation flyers for the British hospital, to show the family back home how well the English treated Daniel.

A few days before the start of her maternity leave, Cătălina is drinking frappé at a café in Sibiu’s Small Square. She is trying to contact all the foundation’s board members, because she can’t leave before passing the baton to Doris. To her, the 122 children operated over the last five years are living proof of what a team of doctors can do in alliance with the civil society. She works until the last moment, because she knows that, by the end of the year, ten to fifteen new faces will join them. One corner of the café hosts a different exhibition each week. This time, the wall to Cătălina’s left is covered in a dozen heart paintings.

This piece was researched thanks to financing from the Journalism about Solutions Programme, supported by UniCredit Bank and Lidl Romania and organized by DoR and Ashoka Romania.