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Camelia Doru, ICAR Foundation: "Romania should encourage migration!"
Alexandra Mănăilă - Reporter
24 April 2015
Dr. Camelia Doru, an anaesthesiologist by profession, is the president of ICAR Foundation which she established more than twenty years ago to provide medical and psychological support to former political prisoners, victims of torture, inhuman and degrading treatments in the communist prisons. The foundation has subsequently widened its scope of activity, providing not only medical and psychological support but also social and legal services to vulnerable persons, Romanian or foreign citizens (asylum seekers, refugees and other migrant categories). Although the number of migrants in Romania is low now, there is a need for medical and social services, and ICAR specialists, for the time being, are those who respond to requests for medical or psychological support from this category of people. The Romanian system should be prepared in the future to receive a larger number of immigrants and to offer them medical aid and services.
Reporter (Rep.): You moved from the Intensive Care Unit (ICU) of the County Hospital in Ploieşti to the head of ICAR Foundation. Have you planned this route?
Camelia Doru (C.D.): First of all, I had never thought I would leave the ICU. I worked in parallel for a while, then I realized I was not able to cope with both challenges. Secondly, I had no idea where I could get the money from for a fully independent activity. Moreover, I would have to turn from a hospital employee into an employer with legal obligations... I obtained the first funding two years after the establishment, from the European Commission, and I started my activity in Bucharest for the former political prisoners who survived severe human rights infringements, with torture being probably the most serious of all. As I was a physician I started with medical services and in the meantime I learned from the target group what needs they had. This is the beauty of an NGO, organisational flexibility! One can adapt much more easily to the group's needs than a public institution. Thus I also created a legal department which covered legal issues and a social department, to respond to the social needs of the beneficiaries.
Rep: Which were the medical services you started with?
C.D.: I learned about the experiences in other former communist countries, where they started very suddenly and directly with mental health services and such initiatives failed because people do not traditionally go to a psychologist or psychiatrist, not even when they have acute needs; so I thought to avoid falling in the same trap and I decided to start with general medical services. We looked at the beneficiaries' somatic and psychological needs and we combined them. A lot of their complaints, of their symptoms originated in their past traumas.
Rep: How have you and how do you collaborate with physicians in your projects?
C.D.: The first physician of ICAR Foundation was me, then one of my university colleagues came, cardiologist Mircea Zodianu, who accepted to help us. He worked for us for a while, then the team enlarged. However staff recruitment was a challenge, because all the colleagues I asked at the beginning said, "Well, first you should grow a little, we'll speak later". They had no courage. For this reason I was at first secretary, nurse, medical doctor and accountant, everything. Then I was no longer able to cope with this. In time the general medicine, which became family medicine, acquired a crucial role in the medical field, and the cases which cannot be solved by the foundation's family physician are referred to specialists. In addition to the family physician we also have two psychiatrists and a balneo-physiotherapy doctor. We collaborate with an urologist, a cardiologist because these are the most demanded specialities and we tried to organize our activity the best we could. We have longer collaborations with medical doctors who have cabinets, for instance we need gynaecologists, because many of the asylum seekers, refugees are young, pregnant women. We also have children, so we also need a paediatrician and we have one. We have adapted our range of specialities to the demand. So we have both employed physicians and collaborators, to whom we refer patients and we pay for certain services. For instance if we need an orthopaedics intervention we pay for it, it is not worth while employing a doctor. However in the case of cardiology it was justified to have an employed physician - it is better than to pay for each consultation. We organized the activity in such a way so as to be economically sustainable. At a certain point we wanted to hire collaborator physicians in the reception centres for asylum seekers in the country: Rădăuţi, Şomcuta Mare, but it was complicated. We faced various reactions: "They don't speak the language, so they have to come with a translator, this means I would spend a double time for the consultation, this is not convenient for me", or another excuse, "They come with tropical diseases and I don't encounter such diseases every day, I'm not interested, I don't want to get into this". These are the issued we faced in our attempts to recruit medical collaborators. We found some, here and there. Our current beneficiaries are a few hundred former political prisoners and their families, about 150 asylum seekers and refugees. It is true that physicians need to make an additional training effort, but from our point of view - after having gone through this process - it is a huge gain, from a professional and human point of view as well. It is also a fabulous experience for physicians to get in touch with several civilisations which enter their cabinets with these patients.
Rep: Do immigrants have different pathologies?
C.D.: No, not at all. They don't come with tropical diseases. They come with chronic diseases just like ours, they have diabetes, cardiac diseases etc. And on top of their pathology comes the trauma pathology which impacts on the somatic level as well.
Rep: To which immigrant categories do you provide medical services?
C.D.: We have now a project financed from Norwegian funds, which allows us to provide medical aid to all migrant categories, because they have different legal statuses. We have funds for asylum seekers or refugees, for individual s with a form of protection, for third country nationals with a legal stay in Romania who come here for studies or for family reunification. We built the project in such a way so that all migrant categories are eligible for such services, including persons who have no documents. The problem is that access to this group is quite difficult, they are afraid that once they come to us they are registered and will be asked for data, but this is not our purpose.
Rep: Which are the most underprivileged among immigrants?
C.D.: From the groups we deal with, asylum seekers are the poorest, they have a small allowance and a very difficult human situation, because they are in stand-by until it is clarified whether they stay in the country or they are returned. They suffer not only materially but are also in a very poor psychical condition, because they are waiting with the sword of Damocles above their heads, they don't know whether their asylum claim is going to be accepted or not.
Rep: Coming back to medical services, how are they solved?
C.D.: Medical emergencies are generally solved in the medical system, but immigrants are humans like any other and have various chronic and acute diseases - it is this type of needs that we respond to. A lot of them need psychological support because they have already undergone a trauma, and here they are subjected to interviews which are a new trauma. Because of the suffering in their recent past they are not sufficiently coherent and in many cases they don't manage to convince the authorities that their story is real. The authorities, who are not specialised in this field, do not understand that this is actually a proof that they are honest, they don't remember certain things, they don't want to talk about others which are too personal, too painful and hence all sort of misunderstandings. This is the reason why we have psychologists in our reception centres of the Immigration Inspectorate (IGI) and we try to identify such cases, to prepare them for an interview, to explain to them their status and possibly even to accompany them at the interview. The European Directives on reception have been reviewed and emphasis is put on identifying vulnerable cases, who have some rights which have to be observed. This is a delicate work... We often meet the authorities who host us in these centres in court. For example in the first, administrative stage, some people are refused the asylum claim and they may file a recourse which is judged in court. And we issue some certificates, some kind of medical and psychological assessments we perform. The authorities say NO, he/she is not coherent, they lie, the story does not stand up, there are contradictory data. We explain that this is a certain (post-traumatic) syndrome, these are consequences of the trauma. We are not the Legal Medicine Institute which is entitled to issue such certificates in this country, however we have a much richer experience than the institute, because we have been doing this for many years. In court it is the judge who decides whether to take into account a certificate issued by us or not. We issue them upon request because it is part of the evidence to which that individual is entitled and contributes to the overall picture.
Rep: Not all hospitals in Romania are aware of immigrants' rights, hence their refusals...
C.D.: Yes, this is a problem, and state institutions should certainly get more involved, including the professional associations who should make these things known somehow. People are surprised to be refused because hospital staff knows almost nothing. It is quite difficult to collaborate with the Health Insurance House and in general with the institutions with decision making power in the Health area. Refusals are indeed quite frequent, but they become less frequent if the beneficiaries are accompanied by our people. We tried to accompany them, because they don't speak the language, they are not understood. For this reason it is better to make sure that immigrants are accompanied by someone from us when they need such services. For the time being the number of these people is low, but the system should be prepared to receive higher numbers. Then we won't be able to accompany every single beneficiary to all the hospitals where they need to go. This is a luxury, which we afford now because we have a low number of migrants! Unfortunately this is a problem which should concern the Romanian state to a much larger extent. We have a few million Romanians at the active age who work abroad and contribute to the pension and social insurance system there. Life expectancy has grown, so the pressure upon the medical service system will increase. More medical services will be needed, for a longer period of time. On the other hand natality drops. These are obvious major factors with devastating consequences 20 years from now, unless the necessary measures are taken. Romania should encourage migration, because it needs labour force. We need people to contribute to our systems, this is an issue not discussed very often. Romania is a transit country, because it does not know to be attractive and to make these people stay here. We do not have the strong, visible rejecting, xenophobic attitude as in other countries, so this could be an opportunity for us.
Rep: Do you have translators able to clearly describe a medical condition of an immigrant and to be understood by Romanian doctors?
C.D.: Many dialects are spoken, for this reason it is very difficult to have trained translators. We also work with cultural mediators who come from communities and who understood what to do. The translator is the interface between the physician and the patient. If they interfere, adding their own input instead of simply translating, as it often happens, we don't get the results envisaged. This is a very big issues, because translators are difficult to find and they usually don't stay here, they are educated people and go to Western Europe. This is a continuous challenge we face. On the other hand it would be much more difficult if people would go directly to the public system, without the medical doctors being warned first.
Rep: In addition to medical services immigrants also need medicine, which sometimes they can't afford. How can you help them?
C.D.: With the Norwegian project we managed to budget expenses for medicines, analyses, treatments. We have an amount for investigations which we split over the project months and we allocate it to the number of individuals. Now we have a campaign of laboratory analyses which we perform in the centre. It covers all usual analyses in the basic package, and in the near future I wish we could also perform a TBC (tuberculosis) screening.
Rep: How do immigrants see Romanian doctors?
C.D.: A medical doctor is a medical doctor anywhere. You go to a physician hoping they will help you, regardless of whether you are in Afghanistan or Romania. Someone has a problem they want to solve and they know what they expect from the physician. When you have a stomach ulcer you no longer care whether the physician in front of you is a woman, has no veil or is a man. We tried to see whether there are such issues, generally not, except for some specialities: gynaecology and urology. People come to the doctor simply because they need medical services. Our dream is to be a centre from where to disseminate the knowledge we acquired over time and to contribute to health policies which should also include this category with special needs. I wish ICAR became a reference centre and a services centre for migrants in Romania.
Reporter (Rep.): You moved from the Intensive Care Unit (ICU) of the County Hospital in Ploieşti to the head of ICAR Foundation. Have you planned this route?
Camelia Doru (C.D.): First of all, I had never thought I would leave the ICU. I worked in parallel for a while, then I realized I was not able to cope with both challenges. Secondly, I had no idea where I could get the money from for a fully independent activity. Moreover, I would have to turn from a hospital employee into an employer with legal obligations... I obtained the first funding two years after the establishment, from the European Commission, and I started my activity in Bucharest for the former political prisoners who survived severe human rights infringements, with torture being probably the most serious of all. As I was a physician I started with medical services and in the meantime I learned from the target group what needs they had. This is the beauty of an NGO, organisational flexibility! One can adapt much more easily to the group's needs than a public institution. Thus I also created a legal department which covered legal issues and a social department, to respond to the social needs of the beneficiaries.
Rep: Which were the medical services you started with?
C.D.: I learned about the experiences in other former communist countries, where they started very suddenly and directly with mental health services and such initiatives failed because people do not traditionally go to a psychologist or psychiatrist, not even when they have acute needs; so I thought to avoid falling in the same trap and I decided to start with general medical services. We looked at the beneficiaries' somatic and psychological needs and we combined them. A lot of their complaints, of their symptoms originated in their past traumas.
Rep: How have you and how do you collaborate with physicians in your projects?
C.D.: The first physician of ICAR Foundation was me, then one of my university colleagues came, cardiologist Mircea Zodianu, who accepted to help us. He worked for us for a while, then the team enlarged. However staff recruitment was a challenge, because all the colleagues I asked at the beginning said, "Well, first you should grow a little, we'll speak later". They had no courage. For this reason I was at first secretary, nurse, medical doctor and accountant, everything. Then I was no longer able to cope with this. In time the general medicine, which became family medicine, acquired a crucial role in the medical field, and the cases which cannot be solved by the foundation's family physician are referred to specialists. In addition to the family physician we also have two psychiatrists and a balneo-physiotherapy doctor. We collaborate with an urologist, a cardiologist because these are the most demanded specialities and we tried to organize our activity the best we could. We have longer collaborations with medical doctors who have cabinets, for instance we need gynaecologists, because many of the asylum seekers, refugees are young, pregnant women. We also have children, so we also need a paediatrician and we have one. We have adapted our range of specialities to the demand. So we have both employed physicians and collaborators, to whom we refer patients and we pay for certain services. For instance if we need an orthopaedics intervention we pay for it, it is not worth while employing a doctor. However in the case of cardiology it was justified to have an employed physician - it is better than to pay for each consultation. We organized the activity in such a way so as to be economically sustainable. At a certain point we wanted to hire collaborator physicians in the reception centres for asylum seekers in the country: Rădăuţi, Şomcuta Mare, but it was complicated. We faced various reactions: "They don't speak the language, so they have to come with a translator, this means I would spend a double time for the consultation, this is not convenient for me", or another excuse, "They come with tropical diseases and I don't encounter such diseases every day, I'm not interested, I don't want to get into this". These are the issued we faced in our attempts to recruit medical collaborators. We found some, here and there. Our current beneficiaries are a few hundred former political prisoners and their families, about 150 asylum seekers and refugees. It is true that physicians need to make an additional training effort, but from our point of view - after having gone through this process - it is a huge gain, from a professional and human point of view as well. It is also a fabulous experience for physicians to get in touch with several civilisations which enter their cabinets with these patients.
Rep: Do immigrants have different pathologies?
C.D.: No, not at all. They don't come with tropical diseases. They come with chronic diseases just like ours, they have diabetes, cardiac diseases etc. And on top of their pathology comes the trauma pathology which impacts on the somatic level as well.
Rep: To which immigrant categories do you provide medical services?
C.D.: We have now a project financed from Norwegian funds, which allows us to provide medical aid to all migrant categories, because they have different legal statuses. We have funds for asylum seekers or refugees, for individual s with a form of protection, for third country nationals with a legal stay in Romania who come here for studies or for family reunification. We built the project in such a way so that all migrant categories are eligible for such services, including persons who have no documents. The problem is that access to this group is quite difficult, they are afraid that once they come to us they are registered and will be asked for data, but this is not our purpose.
Rep: Which are the most underprivileged among immigrants?
C.D.: From the groups we deal with, asylum seekers are the poorest, they have a small allowance and a very difficult human situation, because they are in stand-by until it is clarified whether they stay in the country or they are returned. They suffer not only materially but are also in a very poor psychical condition, because they are waiting with the sword of Damocles above their heads, they don't know whether their asylum claim is going to be accepted or not.
Rep: Coming back to medical services, how are they solved?
C.D.: Medical emergencies are generally solved in the medical system, but immigrants are humans like any other and have various chronic and acute diseases - it is this type of needs that we respond to. A lot of them need psychological support because they have already undergone a trauma, and here they are subjected to interviews which are a new trauma. Because of the suffering in their recent past they are not sufficiently coherent and in many cases they don't manage to convince the authorities that their story is real. The authorities, who are not specialised in this field, do not understand that this is actually a proof that they are honest, they don't remember certain things, they don't want to talk about others which are too personal, too painful and hence all sort of misunderstandings. This is the reason why we have psychologists in our reception centres of the Immigration Inspectorate (IGI) and we try to identify such cases, to prepare them for an interview, to explain to them their status and possibly even to accompany them at the interview. The European Directives on reception have been reviewed and emphasis is put on identifying vulnerable cases, who have some rights which have to be observed. This is a delicate work... We often meet the authorities who host us in these centres in court. For example in the first, administrative stage, some people are refused the asylum claim and they may file a recourse which is judged in court. And we issue some certificates, some kind of medical and psychological assessments we perform. The authorities say NO, he/she is not coherent, they lie, the story does not stand up, there are contradictory data. We explain that this is a certain (post-traumatic) syndrome, these are consequences of the trauma. We are not the Legal Medicine Institute which is entitled to issue such certificates in this country, however we have a much richer experience than the institute, because we have been doing this for many years. In court it is the judge who decides whether to take into account a certificate issued by us or not. We issue them upon request because it is part of the evidence to which that individual is entitled and contributes to the overall picture.
Rep: Not all hospitals in Romania are aware of immigrants' rights, hence their refusals...
C.D.: Yes, this is a problem, and state institutions should certainly get more involved, including the professional associations who should make these things known somehow. People are surprised to be refused because hospital staff knows almost nothing. It is quite difficult to collaborate with the Health Insurance House and in general with the institutions with decision making power in the Health area. Refusals are indeed quite frequent, but they become less frequent if the beneficiaries are accompanied by our people. We tried to accompany them, because they don't speak the language, they are not understood. For this reason it is better to make sure that immigrants are accompanied by someone from us when they need such services. For the time being the number of these people is low, but the system should be prepared to receive higher numbers. Then we won't be able to accompany every single beneficiary to all the hospitals where they need to go. This is a luxury, which we afford now because we have a low number of migrants! Unfortunately this is a problem which should concern the Romanian state to a much larger extent. We have a few million Romanians at the active age who work abroad and contribute to the pension and social insurance system there. Life expectancy has grown, so the pressure upon the medical service system will increase. More medical services will be needed, for a longer period of time. On the other hand natality drops. These are obvious major factors with devastating consequences 20 years from now, unless the necessary measures are taken. Romania should encourage migration, because it needs labour force. We need people to contribute to our systems, this is an issue not discussed very often. Romania is a transit country, because it does not know to be attractive and to make these people stay here. We do not have the strong, visible rejecting, xenophobic attitude as in other countries, so this could be an opportunity for us.
Rep: Do you have translators able to clearly describe a medical condition of an immigrant and to be understood by Romanian doctors?
C.D.: Many dialects are spoken, for this reason it is very difficult to have trained translators. We also work with cultural mediators who come from communities and who understood what to do. The translator is the interface between the physician and the patient. If they interfere, adding their own input instead of simply translating, as it often happens, we don't get the results envisaged. This is a very big issues, because translators are difficult to find and they usually don't stay here, they are educated people and go to Western Europe. This is a continuous challenge we face. On the other hand it would be much more difficult if people would go directly to the public system, without the medical doctors being warned first.
Rep: In addition to medical services immigrants also need medicine, which sometimes they can't afford. How can you help them?
C.D.: With the Norwegian project we managed to budget expenses for medicines, analyses, treatments. We have an amount for investigations which we split over the project months and we allocate it to the number of individuals. Now we have a campaign of laboratory analyses which we perform in the centre. It covers all usual analyses in the basic package, and in the near future I wish we could also perform a TBC (tuberculosis) screening.
Rep: How do immigrants see Romanian doctors?
C.D.: A medical doctor is a medical doctor anywhere. You go to a physician hoping they will help you, regardless of whether you are in Afghanistan or Romania. Someone has a problem they want to solve and they know what they expect from the physician. When you have a stomach ulcer you no longer care whether the physician in front of you is a woman, has no veil or is a man. We tried to see whether there are such issues, generally not, except for some specialities: gynaecology and urology. People come to the doctor simply because they need medical services. Our dream is to be a centre from where to disseminate the knowledge we acquired over time and to contribute to health policies which should also include this category with special needs. I wish ICAR became a reference centre and a services centre for migrants in Romania.
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