Moldova: Follow-up to MDA30741.E and MDA30742.E of 17 December 1998 on the availability and quality of medical services, particularly for women, and the treatment by the authorities of the members of women's organizations, and women activists who are not members of women's organizations, who advocate for women's rights (January 1998 - December 1998)

In a 31 December 1998 letter sent to the Research Directorate, the administrator, who is also a registered nurse, of the Minneapolis-Moldova Partnership in Minneapolis states the following:

While I don't espouse to be an expert on medical care in Moldova, I have visited there a number of times over the past five years in conjunction with our partnership there [for information on the Minneapolis-Moldova Partnership, please consult MDA30741.E of 17 December 1998]. The source of my answers is from direct personal observation (in Chisinau, Moldova, the capital city) and from discussion with Moldovan women.

I have been aware of discrimination in care more to persons without connections (to wealth or high ranking officials) than in regards to whether they are women or men. In other words, it doesn't matter if you are a man or a woman seeking medical care, the ability to pay bribes dictates more what level of attention you will receive. It seems to me, problems in health care affect both genders equally. However, I need to qualify that I have only observed care in the metropolitan area and cannot speak to differences that may occur in the rural areas. I suspect that isolated cases of gender discrimination indeed do exist. In general, I would say that the level of health care available to women in Moldova with specific medical concerns (reproductive health, breast cancer, etc.) is no where near the world standard for adequate care. I have been involved in a women's health project in Moldova for the past three years and have found that routine tests (pap smears, mammography, breast exams) are not performed in Moldova. Slowly the concepts of preventive care are being introduced, but so far, it is limited and reaches a limited population. Most equipment is outdated or not functioning, personnel to run equipment are not always adequately trained and accurate, timely diagnosis is inconstant.

In regards to your question 3a, instances of mistreatment in hospitals is common to all people (unless again, you are someone with power, money or prestige). This is a cultural phenomenon that has existed for many years. If people complain, they may or may not incur ridicule or humiliation, but generally, nothing will be done to remedy their complaints.

Generally speaking, there have been some improvements in the care of women in the 1990's. The partnership we are involved in with the Ministry of Health in Moldova has opened a basic Women's Wellness Center in Chisinau, Moldova based on the premise of education and prevention. It has basic lab equipment but no ultrasound, sophisticated lab equipment, mammography or x-ray capabilities. It performs education classes for women of all ages and performs routine prenatal as well as women exams, STD testing and hemoglobin testing. There are a couple of "private" clinics that have some sort of outside funding to get established, however, one must have the ability to pay to attend these clinics. Again, I remind you, this is in the city, and I do not know if this exists in rural areas.

Nothing is easy for women of Moldova in my estimation. They have a high inflation rate, commodities are scarce, conveniences we have to help with meals, child care, etc. are almost non-existent and they are mostly required to be at home with children no matter what their profession before the birth of a child. Extended families often assist with child care but if this is not possible, the woman must take the child with her to a doctor's appointment. Openness and awareness about health issues is only beginning to exist and with only 3% of their already meagre GNP devoted to health care, health care worker salaries are low, equipment and treatment protocols are not current, medications while more available in the city are difficult to obtain. Most clinics do not make appointments so women can only show up and sit for hours, sometimes in unheated and unlit corridors waiting to be seen. Because there is little health education, most problems are at a critical point before even being seen, limiting treatment options to the most drastic.

I have worked as the administrator of the Minneapolis-Moldova Partnership since early 1994. While I have not polled all those in our institution that have been involved with the work in Moldova, I think most would agree with everything stated in this letter. So generally speaking, this information provided here represents my viewpoint, however, all involved from HCMC [Hennepin County Medical Center] would find no point of argument.   

In a 6 January 1999 letter sent to the Research Directorate, the liaison officer of the World Health Organization (WHO) Liaison Office in Chisinau states:

Due to insufficiency of relevant official data from both national sources in Moldova and WHO on the subject (gender inequities in medical services), the following present my personal viewpoints.

The current condition of health/medical services in the Republic of Moldova is continuously deteriorating and affects both genders rather equally.

At large, women have universal access to available gender-specific services (family planning, female cancers, childbirth and prenatal care); however because of shortage of some medicines and supplies and high cost of the others, some of these services (e.g. prenatal genetic screening, ultrasound and other investigations, etc.), are hardly affordable to certain population groups.

3a-c) Being a medical doctor and keeping close contacts with health care institutions in the country, I can say that the cases of mistreatment in hospitals (e.g. inadequate emergency care, demands for bribes, etc.) take place nowadays and probably increasing since 1990-1991. However, there have been few if at all communications about them made public (e.g. by health authorities, in press or by non-governmental organizations dealing with gender issues). Again, they concern both genders more or less equally.

4. The quality of health care in Moldova deteriorated in Moldova since the early 1990s, e.g. that for women, as consequence of profound and continuing economic crisis.

This Response was prepared after researching publicly accessible information currently available to the Research Directorate within time constraints. This Response is not, and does not purport to be, conclusive as to the merit of any particular claim to refugee status or asylum.

References

Minneapolos-Moldova Partnership, Minneapolis. 31 December 1999. Letter sent to the Reaearch Directorate by the Administrator.

World Health Oranization (WHO) Liaison Office in the Republic of Moldova, Chisinau. 6 January 1999. Letter sent to the Research Directorate by the liaison officer.