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>> Românã

What if we were to return to Romania?

Serban D. Costa
Frankfurt am Main, Germany


Eversince I left Romania in 1974, there has not been a day without me thinking about going back. But if I really think about it, while there may have been some good reasons in the beginning, now it's mostly my vanity: Even though I have a good life here, a good job, good friends, and good money, I would still return to Romania. Illusion or simply a lie?

This is what Freud calls "daydreaming" (Tagträume), probably a form of self-deceit, a way to solve sub- or pre-conscious problems. I am quite sure that we, those who left Romania, have some feelings of guilt about this. Part of the guilt is intrinsic ("we abandoned our country"), part of it is fed by those who "ate soya [1]" ("you betrayed your country" because you left). When dealing with this guilt, we tell ourselves and to those who listen that we would return to Romania if… well, if everything would be the same as here [e.g., in Germany], plus jokes / rolled cabbage (sarmale) / green grass / unannounced visits, etc., that is, plus the unique and picturesque, what we call "typical Romanian".

I met some - a few - who have returned. They can be divided in two categories: Those who returned after acknowledging their inability to adapt into a foreign country, who are frustrated to the max and managed to heal that atavic, gnawing need to return. The second, smaller category, are those who returned and still stay there. If you ask them how they are doing, there's the invariable "good" reply, but they seem to almost burst into tears while they are smiling at the same time. They would have to admit they are facing enormous obstacles, the remnants of prolet-cultism, the ubiquitous corruption ("some..." would not be unbearable), the complete lack of efficiency and functionality in public institutions, the endless loss of time while trying to address even the smallest of things.

Leaving sentiments aside, what if we were to return to Romania, to work in Romania, to perform research and education in some institute, or some university?

The answer to this question has two sides. The first, the simple one, is enthusiastic - let's call it American: Let's do it, why not? Someone is inviting us (perhaps some friends who want us there and want our company), we are offered a job, we pack our stuff and - bingo! - we're home. Without a second thought, we try one thing, if it works, fine, if it does not, we leave Romania again, we go somewhere else, we wait, we come back again... in a circular motion - just like the vicious circle of returning to Romania. After all, job positions for our set of skills, for our worth (?) are everywhere.

The other side of this answer is cold-blooded - let's call it German: In order to return to Romania, we require some guarantees about our future, we need Western-type salaries, health insurance, career planning to match the set of skills, not only for us but for our spouses, who may not be of Romanian origin.

As a physician / professor in a university there are some elementary requirements in order to be productive. Academic medicine has four major fields of activity: clinic (patients), education (students and younger physicians), research (basic or clinical sciences) and administration (budgets).

The clinic is easy to address when working in a university hospital. The patient handling system is, in most cities, well defined, since those patients who require comprehensive medical procedures have no place to go but to a big-city hospital. Even if two, competitive clinics, exist, there will be plenty of patients. The health system in Romania is at an advantage here because of the co-ordination involved, which does not have negative co-notations. Thus, patients with serious needs like cancer are sent to cancer treatment centers, where receive medical attention. By contrast, patients in Germany can be treated everywhere, with variable results.

The material situation of Romanian hospitals cannot be generalized - in my opinion it is more a question of who is in charge, of his/her abilities to be a good manager and administrator, of his/her personal relationships and character. Timisoara - where I have been going to for the past twelve years - is a good example: Some hospitals meet the most stringent European criteria, while others are quite appealing.

Education is also easy to address, as it depends mostly on the interest, commitment and talent of each professor. Courses, seminars, labs - they are all in place, and the system is not that bad as it is sometimes depicted. There are some negative aspects, e.g., there is no control over the course contents and no validated evaluations by the students, and some corrupted professors are known to impose extra-academic conditions for passing the exams. How much corruption there is, no one knows - some say a lot, but I kind of doubt that.

Then there are the other two major areas of activity, research and administration - and I personally believe that here, reasonable standards are difficult to meet.

By administration, I mean running a section or a clinic. Even today, top-down management means total dependence toward the "center", the "top", thus even those in a decision-making position are paralyzed when it comes to important resolutions. The "center" is Bucharest, while "the top" means the government and employees in the capital. Investments are not quite what they should be, several years behind, and steering them is impossible, unless you've got connections. I often hear that "there is no legal framework", as if laws are randomly generated and not issued by elected politicians - who in fact should listen to their constituency (ergo, to physicians).

If you want to put together a team - the sine qua non for a functional clinic, in particular for research - you need to pass some exams. This can only be achieved in a central location, in Bucharest. In fact, you are "chosen", you do not choose. The argument here is that, should there be free choice, those who can "pay", who have "connections", would be selected. This is already happening, so what gives? If the criteria used to evaluate clinics were to be objective, then no head of clinic could afford to hire only "connected" people, because the clinic would fall apart. Thus, what is really needed is an objective and periodic evaluation process, applied to all the clinics in Romania. To stay in the human resources sector, it is nearly impossible to fire someone - be that nurse or physician, regardless of the reasons. And if, as it happens, that person "is well connected to someone from the [traffic] police", you do not even consider termination, you keep that person beyond the age of retirement.

To perform research in an academic environment, you first need what's described as the "culture of research", the appropriate state of mind, as an inherent attribute. This state of mind pertains to education, and education falls today in the hands of teachers without proper research background or training. The enthusiasm of any youth for research - an extra-curricular activity in Romania, with all its sleepless nights and its weekends lost in the lab - is ultimately related to the power of example. How many university professors spend their leisure time in front of a computer, at the library or in the lab, engaged in research? Even though there may be an additional salary incentive for doing research, this is a rather negligible sum, so there's really no material gain.

Besides the urge to discover, health care research depends significantly on the working conditions, and more so on the perspectives offered to someone who has good results. In medicine, one has the possibility to work with databanks, with statistics derived from long-term patient observations for quality control. This should be, in itself, the very starting point of medical research, one that does not cost much - what you need is commitment, tenacity, perseverance and honesty. You also need a computer, a phone, and time.

Clinical trials can be sponsored by the health-care oriented private sector. Sponsorship means providing the medication, the infrastructure and personnel. As far as I know, there is no nurse or physician conducting only clinical trials, being paid for by a company. One could begin by joining international trials, e.g., those based on the GCP (good clinical practice) system - in order to learn from the experience of large and established groups. These groups have an active interest in allowing other countries to join, but an important requirement is the existence of adequate infrastructure (study center, study nurses, warranted patient follow-up), and the existence of GCP-compatible personnel. In this regard, there may be two or three university centers that are noteworthy.

This would be the beginning. The next step would be the collaboration with people in the lab, thus implementing what is described as 'translational research', i.e., transferring lab-derived results and technologies to the clinic. This is a rather expensive process, since it implies solid experience in molecular and cellular biology, in cytogenetics, etc., doubled by proficient labware, reagents, antibodies, etc. There are currently many Romanians, scattered around the globe, who worked in good research groups and have the know-how. But material aspects back in Romania are far from inviting, let alone the proper infrastructure and utilities that would be mandatory in order for them to continue their work. Perhaps one ought to consider enabling some research groups to relocate to Romania, while being funded by external grants.

The dilemma is quite simple: There are no adequate conditions, but if we continue to wait for someone else to do something, we might wait a lifetime. It is up to us, those who believe in research, both expatriates and from Romania, those who are motivated by the urge to discover and to overcome adversities, to drive this change. Our only option, in principle, is to never give up - it sounds so easy, but in fact it is extremely hard, because we have to persevere and be patient in the same time.

My personal conclusion? I would rather quote the great German poet, Wolf Biermann, exiled by the former East German government, who upon attending a concert in West Germany once said:

"Ich möchte am liebsten weg sein, und bin am liebsten hier" (I would love to be somewhere else and I love to be here).



1. In the post-1989 Romania, the expression "you did not eat soy-salami" became a leading criterion to ignore Romanians who did not live in Romania in the 80's - when shops sold mostly soy-salami, as opposed to meat-based products. (translator's note)

Ad Astra • Volume 2, Issue 1, 2003 • Viewpoint
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