Interview with Dan Prelipcianu and Catalina Tudose

Dr. Dan Prelipcianu, professor at the Medical Faculty of Bucharest University, has been chosen as president of the Rumanian Professional Association of Psychiatrists. This year he’ll take over the presidency from Tudor Udristoiu, professor at Craiova University.

Dr. Catalina Tudose has specialized in psychiatry of the aged, and is a member of an international committee of researchers on Alzheimer. She is head of a clinic at the Obregia University Hospital in Bucharest.

Prelipcianu is also the president of ALIAT, a Non Governmental Organization (NGO) aiming to study problems of addiction. ALIAT cooperates with the Jellinek Clinic in the Netherlands. ’We shall manage to continue a Rumanian centre for the care of addicted people, while foreigners, probably Dutch, furnish the centre with trainers.’ The Jellinek Clinic has run a train-the trainers programme for Rumanians working in health care for addicted people.

Who has to decide whether this should be implemented in the curricula of medical students? Prelipcianu: ’Every university in this country has some degree of autonomy. The Minister cannot oblige them to implement a new specialization in the curriculum. To get money, you have to convince the Minister of Education that your idea is the right one. But it is difficult for the Ministry to implement strategies introduced by NGOs.’

Prelipcianu and Tudose both meet the same type of problems in continuing the work that has been started by NGOs. Most NGOs stop financing a project after two or three years, assuming that there will be Rumanian funding to continue a programme. Tudose: ’In 1999 we have had a wonderful project of community care for old people. A twinning with a British organization. But the state didn’t give any money to continue. Maybe it was too early to start home-care. People are not prepared to think in this way, generally speaking.’

How could you convince the Ministry of Health and the Ministry of Education that it is important to teach students about old age problems?

Tudose: ’Everybody knows told people have special problems, but there are no services for psychiatry for the aged. The National Health Insurance should recognize the problems and pay for treatment, that would be a big step forward.’ One legacy of communist times is the expectation that all health care should be free of charge. ’People are not prepared to cooperate. They are used to waiting for help from the state.’

Prelipcianu: ’The paternalistic ideas about the relationship between state and people are very deep-rooted.’

Tudose: ’The legislation is quite all right. In fact, the law does encourage community care, but the emotion lies elsewhere.’

How says this?? Old peoples homes built in Rumania so far are very large, based on the idea that a big institution can serve many people at once. ’The budget belongs to the local authorities, and people feel punished when they have to pay for big institutions. The solution is to build many little institutions, all over the country. Then people can think: ’This is where we can put our mother, close to our home.’

The mayor of each village can make an application to build an old peoples home. ’Every district has an institutional network for the handicapped, but many people do not know of its existence. As psychiatrists we must educate the users of health care how to use the possibilities the law gives them.’

’In the Netherlands people are used to negotiating with the authorities,’ says Prelipcianu. ’In Rumania they still have to learn. Authorities do not cooperate, you have to negotiate.’

’For the Ministry it is not easy to evaluate why valuable pilot projects in psychiatry, run by NGOs, are discontinued as soon as the foreign donor withdraws,’ says Prelipcianu.

What is causing this blockade of continuity? ’The Ministry of Health has no psychiatrist among its staff. Perhaps that is necessary, to have someone who knows the world of psychiatry.’  Tudose: ’It is good to have pilot projects initiated by NGOs. And it is not because of the law that they are not taken up, the law is quite open. In many towns people say: "We would like to do this, but we lack the experience." It is like acquiring a house without knowing how to live in it.’