Romanian doctors tempted abroad by a better life
"There are several reasons one might stay in Romania," says medical student Andreea Rosca sweetly, over a ginger beer in a Bucharest bar. "You love your country, you have family, friends. Maybe you dream about changing the system. I personally do not believe it will happen."
In the past seven years, 10,000 doctors and nurses have left Romania, according to estimates from a doctors' organisation.
Most of those who leave are young, at the start of their careers. They cannot live on the 250 euros (£205; $340) monthly starting salary, they say, and unlike older doctors are insufficiently experienced to set up a private practice, parallel to their work in state hospitals.
A specialist can earn 1,200 euros a month from the state, and at least double that in private practice.
So Andreea, 27, plans to pack her bags as soon as she graduates from the Medical University in Bucharest this summer, and to try her luck finding a medical career in France or Switzerland.
"I do not feel the moral obligation to stay here, considering that nobody is doing anything for us to stay and to have a decent life."
More than half her class plan to leave Romania, she says: for Germany, the Nordic countries, France or the UK.
"Thirty per cent of the Romanian population does not pay health insurance, because they are too poor," explains Dr Cristian Posea, medical director of the Cantacuzeno hospital in Bucharest.
"Yet they are still entitled to state medical care."
He is proud of the equipment at his hospital, and of the rearguard action he and others fight to persuade doctors and nurses to stay.
"The maintenance of the equipment is problematic though," he admits.
In the intensive therapy ward for premature births, I count five babies in incubators in the care of a single nurse.
In hospitals in western Europe, the ratio is closer to one nurse for two babies, Dr Marian Martin explains. For the healthy babies, there is just one nurse for 14 babies.
"It is difficult, but this is the situation."
At 37, with a family of her own, she still lives with her parents.
In a waiting room in another building, pregnant women sit quietly watching the door. Inside, Dr Ilonka Gussi rests on a bed, a little weary. A specialist in difficult pregnancies, she has worked 80 hours in the past week, half in this hospital, half in her private practice.
"Many hospitals only provide accommodation and staff, while patients are expected to arrive with their own medication. The hospital is just an intermediary," she says.
She feels the main problem is more about bad management than lack of resources. Hospital chiefs are often appointed in Romania on the grounds of political loyalty, she says, rather than professional ability.
In a cafe down the road from the hospital, Costin Minoiu opens his laptop to show me the latest job offers from abroad, mediated by his organisation Careers in White.
There are jobs for nurses in Britain for £12-14 an hour, for doctors in Ireland for 50,000 euros a year, and one for a specialist in Denmark for an annual salary of 83,000 euros - numbers which would make any Romanian doctor's eyes water. I ask why anyone stays.
"Some people don't want to relocate their family; some are just in love with eastern Europe and want to stay and make a difference here - there are a lot of doctors like that."
He has no qualms about helping medical staff leave Romania.
"In an ideal world, they would work abroad a few years, gain useful experience, then come back. But it doesn't often happen like that."
On a Saturday morning in the mainly Hungarian-speaking town of Sfantu Gheorghe in central Romania, hospital manager Robert Nagy takes me to the casualty ward.
He checks the figures: 3,300 people came to casualty in the first 40 days of the year, he says.
The hospital serves the whole of Covasna county. Dr Alexandru Mundru says he stays simply because he likes his job: "I used to work in the insurance system - but I missed the daily practice of being a doctor."
This morning he's the only doctor on duty, serving two waiting rooms full of patients. The shortage of doctors is particularly acute in three fields: casualty, anaesthetics, and surgery.
In intensive care on the third floor, the sound of elderly people groaning into oxygen masks punctuates my conversation with Dr Emese Jakab.
"Most of the young doctors would like to stay, but they have no choice but to leave, mostly for Germany," she says.
An important part of Robert Nagy's job is to tour the country, trying to recruit medical staff before they either leave or are snapped up by other hospitals. To help him, the town council offers free accommodation for 5 years for doctors who move to the town.
"But the biggest problem is still to come," he says. "Replacing the doctors who retire."