Cases of Elena, Mihai, their friends and physicians

Elena is aged 19. She graduated from high school in July and is thinking about completing her diploma and going to university. She always thought that she’d enjoy teaching, but now isn’t sure if the extra study is worth it. It’s expensive to live as a student and her small family can barely afford food and rent on her mother’s secretarial wage. The small remittances her father sends back from Rome are only just enough to keep everything together.

Before last week, she didn’t really see any other option, but while shopping with her best friend Nadia in Chisinau, they met a man who talked about work opportunities in Europe. He said he could introduce them to his cousin who provides Romanian documentation for Moldovans wanting to work in Italy and Germany.

Elena could imagine all the fun she and Nadia could have working as waitresses and partying in Italy.

Maybe she could even see her father again?

A few weeks later, Nadia and Elena talk about emigrating. Elena is keen, but Nadia isn’t so sure. She’s now a bit suspicious about the man they met on the street. The previous week, she had been to the Chisinau health services and had seen Dr NN. Nadia and her boyfriend Andrei had been talking about having sex and she wanted to talk to Dr NN about contraception. She was a little bit uncomfortable about going at first, but her high school had mentioned that the Chisinau health services had female doctors who enjoyed seeing young people, free of charge, and she thought she’d give it a try.

Actually, Nadia was really impressed with Dr NN. She was straightforward and didn’t make Nadia feel ashamed for thinking about having sex before marrying Andrei. They were able to talk about all sorts of

stuff – condoms, HIV and STIs, the oral contraceptive pill and abortions as a last resort. Nadia had heard most of it before, but Dr NN really seemed to care about Nadia. She was interested in what was going on in Nadia’s life and asked about her family, Andrei’s health and her plans for the future.

Nadia was surprised how quickly she opened up. She even mentioned the stress her family had been under since her father started drinking after losing his job. But when she mentioned the possibility of emigrating to Europe, Dr NN’s attitude changed immediately. She became very serious, talking about drug circles, sex trafficking and prostitution. She gave Nadia some information pamphlets and said she should be very careful about being lured into something that took her away from a promising life in the Republic of Moldova.

Nadia had never thought of her life as promising. She lived in a small village outside the capital. Her father had lost his job 10 months ago and was now drinking almost every night. He was never violent, but it still took a toll on the family. But she is about to begin her adult life. She’ll marry Andrei in September, move out of the family home and perhaps even begin a family of her own. She might even be able to go to trade school to get her diploma. Dr NN had also suggested she attend some group counselling sessions for young adults with “family problems” and she’s considering taking her up on the offer.

Nadia decides to show Elena the information Dr NN gave her about sex trafficking rings in eastern Europe.

Elena initially didn’t want to hear about it. Surely it’s only the unlucky ones who end up with their passports stolen and paying back their debt? But then a newspaper does an exposé on “Kristine”, a 21-year-old woman who left Ukraine for a marriage in the United States and found herself waiting bars in a strip club.

Elena begins to reconsider her options. Perhaps life in the Republic of Moldova isn’t so bad after all. The government has just announced it will give student scholarships to the “brightest” and “most deserving” to attend university. She could study part-time and work in the supermarket part-time for some extra cash.

Mihai is aged 16. Life has been hard for him. His mother left for France when he was five and his father lost his job four years ago. It was then things began to fall apart. He found himself hanging out with boys much older than him. Occasional absenteeism from school quickly became permanent. Within six months, his relationship with his father had disintegrated and he found himself squatting on people’s couches. Now he scrapes together a living working a few labouring jobs and occasionally begging for spare change at the train station.

One night, while Mihai is hanging out in Chisinau train station, he is approached by someone offering free health checks at the local clinic. It’s been a long time since Mihai had seen a doctor – what could they do anyway? It’s not like they could get him a job. But Mihai is somehow encouraged by the social worker and the next day decides to drop in to the clinic – no appointment necessary, or so the guy said.

Mihai is surprised when he gets to the clinic. The place is really welcoming. No one questions his dirty shirt or looks at his shoes. He is offered a warm drink while he’s waiting to see Dr DM. Mihai is surprised how friendly everyone is, including Dr DM. He doesn’t ask too many questions and gets on with the business of medicine. Of course, he asks whether Mihai smokes and uses any other drugs – but he has to, right? At first, Mihai finds himself denying using drugs, but later admits to using for two years when Dr DM takes his blood pressure and notices scars on his arm. In the end, Dr DM suggests that Mihai gets a chest x-ray and test for tuberculosis and consider an HIV test.

It’s a few weeks before Mihai goes back. He’s scared, but eventually he decides to get the tests that Dr DM recommended. It’s free and they were nice. He’s surprised about the results. The HIV test was negative, but Mihai is diagnosed with tuberculosis. Mihai always thought you only had tuberculosis if you coughed all the time.

Together, Dr DM and Mihai come up with a treatment plan that works for Mihai. He’s introduced to a community worker who will help him remain compliant with the medications and he will continue to see Dr DM for regular check-ups. Mihai feels for the first time in several years that someone is interested in his

welfare and that together, with help from Dr DM and the community workers, he may be able to improve his health and maybe even get a job.

Dr SM has a lot of work experience. She specialized in gynaecology in Romania, received additional training while there and developed many ideas about how to improve gynaecology services in the Republic of Moldova. She knew in advance that it would not be easy and that she would have to work as a volunteer, fighting against the suspicions of colleagues. It would be much easier if she left and went abroad as a lot of her colleagues had done, but she wanted to stay and make things “better”.

For five years, Dr SM has worked voluntarily trying to improve the health of adolescents and young people.

Her first step was to go to the local high schools in the hope of finding out what young people needed. She also hoped to recruit her first volunteers. She was surprised by how many people were interested. In the end, Dr SM decided to choose people who listened as well as asked a lot of questions. She trained them to be peer-educators and hoped they would be able to train their peers in good health communication skills.

The efforts of Dr SM have slowly paid off. Based on positive feedback from Moldovan youth using her service, the hospital management and donor organization decided to create a youth health centre. Ten years on, the centre is thriving. All facets of the community support the project and volunteering at the centre is now popular among young people, both as a marker of social status and as a good reference for later employment. The centre has also expanded services to other districts, facilitating a “healthy-peer” network and a disability health service, and annual meetings are held with the association of Gagauz women.

Ten years on, Dr SM is glad she chose to stay in the Republic of Moldova. Her dream has become a reality, but there are still problems. She works hard to earn enough for her and her family. Low salaries force her to work two or three jobs at a time and her working day is rarely finished before 20:00. But it has been worth all the pain. Her greatest satisfaction comes from the youth volunteers. There are those that regularly attend the centre, working hard and calling her “mother”; every day, five adolescents who would otherwise go without come to the centre in search of contraception. She knows that adolescents and young people, healthy or not, are all around us and need support and help. If they do not have enough confidence to come and address their problems with health professionals, we have to find ways to attract them.

Dr SM is not an isolated example of medical doctors in the Republic of Moldova holding two or three jobs at the same time. Almost all doctors have a permanent main state job and are allowed to have two or three other jobs, meaning they may do a few hours in a state setting then work in the other places, bringing them a total salary of 125%. Many also work in private clinics to increase their base salaries.