In Search of the Lost Pulse

In Romania, a team of foreign doctors repairs the hearts of children who fall through the cracks in the state health system.

Patric Kolosvari peers at his own grimacing face among the rust stains on the mirror. He is embarrassed. There are too many eyes around him, following him from one room to the next. That’s because it’s his birthday. He is turning 11, and his mother, Ramona, is struggling to do his hair. She sticks her fingers into the boy’s brown mane and holds up a few discolored strands. She shakes a spray can and a cloud of hair spray bursts towards his head. “Sit still, won’t you!” she manages to call out as her son slips from her grip and takes refuge in the kitchen to play “Brawl Stars.”

He wants to get more chests and gems to evolve one of his brawlers, Shelly. But he’d put down his phone in a blink if he were allowed to pedal his bike on the winding, narrow streets of Turnu Rosu, his village in Sibiu County. The one thing holding him back is a recent scar across the length of his sternum. He keeps trying to hide it with a repetitive gesture. Each time someone’s eyes land on it, he pulls his T-shirt up to the base of his neck. Under the clothes, the cut continues all across his torso, stopping only where his abdomen begins.

It’s not just any scar. It betrays the precision of a scalpel and a steady hand. He got it a few weeks ago, on a surgery table at Polisano European Hospital, a private healthcare facility in Sibiu. There, a Romanian pediatric cardiovascular surgeon and his colleagues from University Hospitals Bristol visit twice a year in an attempt to make up for Romania’s lack of qualified medical personnel. In early June 2019, they spent five days doing pro bono surgery for 10 children with congenital heart defects. The first of them was Patric.

The boy painfully picks off the scabs from the place where, not long ago, two metal claws pierced through his chest. One to the left, the other to the right. In the middle, they pried open his rib cage, revealing everything inside. A camera recorded each heartbeat and sent it to a screen suspended above an operating room anesthetized by silence. The only noise was a constant beeping that monitored the child’s pulse: 80 beats per minute. Then 82. Until a potassium solution, dripped into the root of his aorta, relaxed the organ. And then complete silence fell.

A sickening smell of burned flesh hovered above the operating table, from the electrocautery. Thick tubes pumped liters of blood out of the child’s body and into the heart-lung machine – a giant pump which, for the duration of the surgery, took over the role of his vital organs. The two surgeons, bent over his open thorax, used forceps to pull at lengths of blue thread and knot them up. Their fingers moved in tandem, though they exchanged no words. From time to time, a “suction, please” would break the silence barrier, before a suction tube snaked into the cavity below the patient’s heart. Three hours after the first cut, a hand lifted the metal claws and the wound was finally sutured, putting an end to the obstacles that kept the boy from joining his school’s oina team – a traditional Romanian sport, similar to baseball.

Patric spent the first 10 years and 11 months of his life with a ventricular septal defect, or VSD. In other words, he was born with the second most frequent form of congenital heart disease: a small hole in the wall between the two ventricles. It did not close on its own in his first years of life, as often happens. So he needed a patch-up. Apart from that, several fibrous obstructions developed in his right ventricle. Basically, the blood flow caused a hardening in some parts of the heart muscle, which over time formed scar tissue around its exit path. The surgery itself is nothing special, but it is one of the few of its kind that can be performed in Romania. Sometimes by teams of doctors from abroad, on a mission in Sibiu or Bucharest.

The Children No One Counts

Patric is one of the approximately 500 children in Romania who, each year, get corrective surgery for congenital heart defects. The number is painfully small if we consider that, over the same period, 1,200 new patients with such conditions are born. Thus, each new year inherits a deluge of untreated cases. That’s why the operating theater sees teenagers who should have had surgery in the first few weeks or months after birth.

The numbers are anything but encouraging, but even they are mere estimates, because Romania has no national record of patients with congenital heart defects. So doctors shoot in the dark. Some speak of 1,200 newborns with heart diseases. Others say 1,600. But we do know exactly how many die of such afflictions before their first birthday: 156 in 2017.

The problem doesn’t apply strictly to children with heart conditions. In fact, there are no records for many other diseases plaguing infants. It was only last year that an NGO managed to launch the first National Record of Cases of Cancer in Children, or RNCC. It shows how many young patients need care each year, whether we have enough specialists and beds in oncology wards, and how much money the national health insurance system should allocate for these departments. These questions are still unanswerable for those born with congenital heart defects in Romania.

Things were not much different in 2008, when Patric was born. Until then, his mother had worked as a nurse under the only pediatric cardiologist in Sibiu County, Viorela Cotarla. Ramona remembers the doctor told her to bring her son in for a checkup after the christening. As she ran the ultrasound probe over the baby’s chest, the 4.9-millimeter hole in Patric’s heart showed up from under skin and bone.

Ever since, she has lived in fear that a bad cold could worsen his condition. She spent his first seven years of life in a state of tense expectation, from one checkup to the next, hoping the doctors would find the hole had meanwhile closed. But it kept showing up on the monitor, crammed between the two ventricles. In 2015, the boy learned to read and she learned a new lesson. She understood the problem wouldn’t solve itself. So she started to look for information about surgery.

She learned that Romania only has two cardiovascular surgery centers that specialize in pediatric cases – one in Targu Mures, the other in Cluj-Napoca. Together, the two centers – which are autonomous in that they do not rely on outside medical personnel – operate on 400 to 450 children each year.

Pediatric cardiovascular surgery is also performed in Bucharest, at Grigore Alexandrescu Hospital and Marie Curie Hospital. The two have fully equipped cardiovascular surgery wards, but they don’t have doctors to hold the scalpel. That is why these hospitals have to rely on missions from abroad. Marie Curie holds monthly surgery sessions with medical teams from the San Donato Clinic in Milan. Over the last few years, the ward in Grigore Alexandrescu has received visits from American and Israeli doctors.

The problem with children suffering from congenital heart defects is not purely numerical. Some surgeries turn out to be too complex for the resources of the few state hospitals with specialized wards. In April 2019, the doctors at Marie Curie went to Milan with two babies born with a transposition of the great vessels (TGV) and tetralogy of Fallot – two of the most common heart defects. They wouldn’t have had surgery in time if they had stayed in Romania.

Many others eventually get surgery abroad, with money from donations or from the S2 Form, known by doctors and patients alike under its old name, E112. This famous document gives Romanian patients a chance at state-funded surgery in EU countries, but only if Romanian doctors declare they are unable to save them – because they lack the necessary infrastructure, the intervention is too complex for the resources of national hospitals, or because delaying action would endanger their health. In 2018, 180 children with congenital heart defects were admitted into EU hospitals thanks to the S2. The previous year, the same form allowed 177 children to get cardiovascular surgery, and the number for 2016 was 208, according to data from the national health insurer.

In search of a solution, Ramona thought she, too, could take Patric abroad. For an intervention of this kind, the Romanian state was willing to pay, on average, 20,000 euros through the S2 program. Eventually, though, the boy’s heart was repaired closer to home, at the Polisano European Hospital. Though the cost of the surgery did not exceed 4,000 euros, it was not covered by the national health insurance budget. The money came from donations to the Polisano Foundation.

Change Comes From Abroad

In the private clinic sharing a courtyard with the Sibiu County Emergency Hospital, the first heart procedures on children were performed in February 2014. Then, surgeon Serban Stoica came from Bristol to operate for free, at the invitation of a former university colleague, Victor Costache, recently appointed as head of cardiovascular surgery at Polisano European Hospital. Costache had just come back to Romania after 14 years of specialized training in France, intending to open a regional center for heart surgery. For Stoica, the center would become his first opportunity to perform surgery in his home country. During that week in early 2014, 10 tiny hearts came under his scalpel. After that, he returned each year, because he wanted to show that the lives of sick children can be saved in Romania, too. Over the past five years, he and other doctors from abroad operated on 122 children. The costs were covered by donations to the Polisano Foundation.

Though Stoica has a terribly poor memory when it comes to past cases, he is slow to find words and swallows a lump in his throat when he remembers a 15-year-old boy with a serious heart defect – tetralogy of Fallot. Children with this condition have less oxygen in their blood and their fingers often turn blue. Corrective surgery is recommended in the first years of life. By the time he reached adolescence, one of the boy’s hands had turned into a dark blue claw. After the surgery, he called his mother, who had abandoned him in an orphanage. It was the first time he saw his fingers looking normal, and she was the only one with whom he wanted to share this emotion. The two were reunited abroad, where he works as a cook and she found a job as a cleaning lady in the same hotel. At least that was the situation the last time Stoica heard of them, because he never saw the kid again. But he came back to Sibiu each year after that.

“We have to do two things at the same time: provide food and contribute to the building of a system that would cover the needs of the hungry population,” he says, trying to get across why he keeps returning to Polisano. “But at least we have the satisfaction that we’ve tried to do what was best for everyone who came to us. You can’t wait for help [from the authorities].”

Though it started as a branch of the hospital, the only thing the foundation has in common with it now is the name and, more recently, a framework contract which gives the foundation permission to use the private hospital’s operating rooms for free during humanitarian missions, paying only for the consumables and care of the patients while they are in the ICU.

Each surgery mission is a one-week marathon during which 10 to 15 cases of congenital heart defects are treated. Two such sessions took place in January and June last year, when Stoica’s team operated on 19 children.

He works shoulder to shoulder with one of Polisano’s pediatric cardiovascular surgery experts, Anca Mandache. She was on the other side of the operating table in over half of the interventions during the June mission. But she only gets a chance to do so during the sessions financed by the Polisano Foundation: the rest of the time, there is no money to cover the costs of surgeries in Sibiu.

From Corporation to NGO

Since 2015, Costache has convinced company directors, entrepreneurs, and ordinary people to donate as much as 150,000 euros each year. That is the amount the foundation needs to hold two to three surgery sessions in Sibiu.

Fundraising is the most important part of her work, because money is crucial for this story to continue. Apart from that, she must also also handle communications, encourage parents waiting for a life-saving intervention, and motivate medical teams to come back year after year. Which is not easy, since the surgeons, anesthesiologists, nurses and IV specialists travel from abroad to do surgery for charity in Sibiu.

Catalina ended up at the foundation after a career in banking in France. She jokingly says that was another life – a corporate life. But the curtain fell on that stage of her life in 2014, when her ex-husband, Victor Costache, became head of cardiovascular surgery and together they came back to Romania. He had an ambition to start a pediatric cardiovascular surgery program in Sibiu, but was unable to get state funding to carry out surgery on children at the private clinic. That experience spurred Catalina, two years after they returned, to donate her knowledge and time to help start the Polisano Foundation. At the time, she wasn’t convinced she would stay in the organization for long. She was afraid she was signing up for a job that was a million light-years away from what she had trained for – providing financial counsel to French corporations. But, moved by the stories of the children she met, she realized life in an NGO fit her just fine.

She is seven months pregnant and juggling her pregnancy, the last details for the surgery session of June, and the final touches on her Ph.D. thesis.

It’s piling up. Still, she has to allow herself time to rest, even when her phone rings every 10 minutes. During her first pregnancy, she went into labor at eight months because she didn’t listen to the doctor’s orders and worked until the last moment. This time she can’t afford to do the same. “I mean, I have work to do,” she says.

“I’m Not a Doctor”

Two days before Patric’s surgery, Catalina visits the boy in Turnu Rosu, less than 30 kilometers from Sibiu. Even though she always takes calls from parents whose children are either scheduled for surgery or on the waiting list, she rarely gets the chance to talk to families face to face and emotionally prepare them for what lies behind the sterile doors of the operating theater. Many of them come from distant parts of Romania or even from neighboring Moldova.

Often, she only has time for basic conversations – getting documents ready, doing brief background checks. At any given time, 40 or more children with congenital heart defects are on the waiting list for surgery. It is up to the doctors to decide which cases get operated on, depending on the severity of the condition and the complexity of the intervention, because they can’t sign up for a surgery requiring special post-operative care which is unavailable in Romania. The social situation is a factor as well: The Polisano Foundation exists to help the most vulnerable children, those whose parents are completely unequipped for the tooth-and-nail fight needed to get them to a hospital abroad with an S2 form.

In the Kolosvaris’ yard, Catalina sits on an bench, pulling up her dress and resting a protective hand on her belly. She is accompanied by Doris Lupu, an old friend and journalist at Radio Vocea Evangheliei, a religious radio station in Sibiu. Catalina is aware that she only has a few weeks before the pregnancy forces her to take a longer break. In her absence, Doris will be the one to take care of communications and organizing the next surgery session.

Catalina’s first act is to look straight into the child’s eyes and tell him the words he has been waiting to hear: “We’re just telling you what will happen, Patric. I’m not a doctor. There is no doctor here.” The boy calms down immediately. When she speaks for little ears frightened by the scalpel, it is to her advantage to make it clear that she has no medical training. But she often feels like an impostor, because in the hospital corridors some nurses insist on addressing her as “Doctor.”

Now, in the dappled light filtered through the vine leaves, she borrows some of the unshakable calm of doctors under the surgical lights. She is confident as she speaks of stenosis, transposition of the great vessels, tetralogy of Fallot, or VSD. But she drops the talk about medical diagnosis to chat with Patric about the math problems in the national fourth-grade evaluation, about “Fortnite” and “Brawl Stars.” It helps that she has a son about the same age and, more than anything, that she can understand Patric’s terror at the impending heart surgery. “I don’t even want to think of what it would be like if it was my son,” Catalina says. “He gets stressed even when we need to do something basic, like taking a throat culture.”

Patric’s VSD is asymptomatic. But his heart defect must be corrected before he turns 12. Catalina explains to his mother that it is important to act before the situation worsens. She has seen with her own eyes children from disadvantaged families whose cases cardiologists kept putting off for years. Last summer, British doctors saw a 10-year-old boy with transposition of the great vessels. They couldn’t help him, because the anomaly should have been corrected in the first weeks or months of life. Now he is under medication, but even so, life expectancy for his condition doesn’t exceed 30 years.

She pauses and, for a moment, her glance rests on Patric’s eyelashes. She isn’t backed by any studies or numbers when she claims that many of those with heart conditions have long, thick lashes. It is just a connection she chooses to believe in. So she smiles each time the boy flutters them wildly.

One Good Deed Deserves Another

Catalina juggles several roles. She has to provide emotional support for parents and children, but she can’t neglect her responsibility as the foundation’s main communicator, either. And for that she needs families in extreme situations to open their doors. No matter how many numbers and documents she brings with her, it is emotion that convinces donors to support the cause of the hearts in Sibiu.

“Doris helps us with a radio promo. We get our funds from donations, after all. We need to move people emotionally, without resorting to melodrama,” she says warmly to Ramona, the mother of the boy from Turnu Rosu.

Ramona brings her lips closer to the microphone and repeats Patric’s story – this time, for Vocea Evangheliei’s listeners. The mother’s confession will reach those who keep the Polisano Foundation’s cogs turning. Some of them are religious people and have a strong sense of moral duty. Others have gone through painful trials and want to give something back. Some are Romanian doctors who have emigrated or strangers who put money in the donation boxes set up at the reception desk of the private hospital and in a pharmacy in Sibiu. “A lady from the U.S. who had a brother here wired us $ 1,000 through PayPal. I just spoke to her on the phone,” Catalina says. “More and more of them are people I haven’t met directly.”

Just a few hours before she left for Turnu Rosu, Catalina received unexpected help from the Rotary Club. That year, the organization decided to make the Polisano Foundation the beneficiary of money earned from “renting” plastic ducks which “raced” on a stretch of the Cibin, a river that crosses Sibiu. This event raised 30,000 lei ($6,700) at the last moment to support the June session, for which the NGO’s costs will reach 55,000 euros.

Because good deeds always pay, sometimes the parents and grandparents of children who were given the chance to get a healthy heart later support surgeries. Catalina mentions “this dear old lady,” the grandmother of a little girl who was operated on recently. They had barely met, when the woman stopped her in a hospital corridor to ask how she could fill in the form to donate 2 percent of her taxes to the foundation.

When it comes from the very families whose children had surgery, support is an unexpected reward. She was amazed by the degree of involvement of a mother in Timisoara, Andreea Caradjov. In the spring of 2019, the young fashion designer became Catalina’s ally in fundraising for the June surgery mission. Back home, her two prematurely-born babies needed all her attention. Even so, she struggled to get donations, because she was outraged at the fact that the state does not cover expenses for the kind of surgery without which her son, Andrei, who had surgery in January at Polisano, would not have survived.

“Just as he was given a chance, I really, really want to give a chance to another child, through him,” Andreea says. “I believe that every person you meet in life has a purpose. Andrei’s purpose is to save other children.”

A month and a half after her son’s surgery, she was making calls to organize a charity concert at the Banat Philharmonic. She raised 3,000 euros from selling tickets and from the donation box by the entrance, and a further 1,000 euros from a second event.

Caradjov is an exception. Many of the children treated at Polisano come from disadvantaged families. Even if they wanted to help, their parents wouldn’t know how. And, since one surgery mission costs 50,000 euros on average, which covers up to 10 cases, most of the money comes from companies. It’s on them that Catalina focuses her efforts. In March 2019, she managed to secure the whole amount for one mission with a trip to Curtea de Arges. The money came from Electroarges, a producer of vacuum cleaners for the German market that also owns a majority share in the Braiconf shirt maker.

Catalina herself is amazed at how quickly things have advanced; she usually needs to apply pressure for months on end. This time, she thinks some of the help came from a promotional clip showing mothers holding their healthy children for the first time. No matter how many numbers, statistics, and reports she is armed with, emotion is the decisive factor, even when it comes to company CEOs. They are parents too.

On 10 June, she entered an operating room for the first time. Not alone; she was accompanying an employee of Romgaz, one of the largest natural gas producers in Europe. Until then she had been hesitant to provide such access to potential donors. But she believed this was a chance for Romgaz to have a face to face meeting with the team who came to operate at Polisano. It turned out to be a winning strategy, as the company decided to contribute 500,000 lei, meaning over 100,000 euros – an amount sufficient to cover the costs of the next two surgery sessions.

The Iron Man of Merghindeal

On the day of Patric’s surgery, another family is getting ready to leave for Sibiu. In Merghindeal, Sibiu county, Monica Tatu is in a flurry as she packs pajamas and a few T-shirts for her son, Daniel. In the village lost among green valleys, the only loud noise comes from the NATO firing practice in the Cincu shooting range.

The woman is slender, fragile-looking, a little stooped. Though her face betrays her age, she flits about in her two-room dugout faster than a teenager. She steps over a few pieces of cardboard and rag rugs covering the beaten earth floor. Every time it rains, the water floods her home, which is mostly built underground. Now she is looking after her five children alone. Three weeks ago, her partner left for Germany to pick asparagus.

“I’ve never eaten any,” she says. “They say it’s like the horseradish we put in winter pickles. I only heard they eat that in the city, like a side dish or something. He went to work as a picker there. He tasted some – he told me it’s kind of like leek.”

Surprisingly enough, she knows more about asparagus than she does about her man. He went to work abroad without a phone. And this time she doesn’t know the other workers who went with him. She’s sorry she can’t tell Daniel’s father she’s been called back to Polisano.

When he’s not away, he works as a day laborer. In Merghindeal, that pays about 30 or 40 lei a day. Sometimes, Monica works in the neighbors’ gardens to buy the boy yogurt, bananas, and his medicine and vitamin C. While she is away, she leaves her other children in the care of her daughter-in-law, who shares the same courtyard. She’s often had to leave them behind to look for a cure for her son’s heart condition.

“It hurts a lot, when you have one child that’s so sick and you have to leave the others behind. It’s not easy for me, you know.” In the handbag where she keeps her documents she has about 50 admission files, diagnosis sheets, and medical recommendations, but also a few photos of her children. Daniel looks out from one, with his big, brown eyes shaded by long lashes. In school he wanted to be the strongest, so he asked for a photo of him dressed as Iron Man.

The boy was born with aortic stenosis – a serious heart defect, generally manifested in elderly people. Basically, the opening of the aortic valve is so narrow that the heart risks bursting. His mother didn’t know he was ill until he was three and a half. He was picking apples with the neighbors when a fruit hit him on the nose. He started to bleed abundantly. “He’d just raise an arm, the way we do around here, and it would stop,” his mother says. But the hemorrhage returned in the following months. Monica had to call the ambulance four or five times a week. But the paramedics were at a loss as to what to do for him. She only got an answer when the boy was seen by the only pediatric cardiologist in Sibiu County, Viorela Cotarla, who diagnosed him with a congenital heart defect.

In the EU, Only We Need Help

Daniel underwent two minimally invasive procedures at Polisano. His mother can’t remember what year it was – perhaps 2016 and 2017. At the time, a surgeon from Sweden dilated his aortic valve opening with a catheter. But the solution turned out to be only temporary. After the second operation, the bleeding stopped, but some of the symptoms persisted. He tires easily, and the searing heat of summer turns him into a vegetable. So he hides all day long in the dugout that is his home. He has been coming back for checkups every six months.

After corrective surgery, the child patients are kept under observation by cardiologists working in state hospitals. But if it becomes obvious that the solution did not work as intended, they are sent back to Polisano. That happened to Daniel. At the beginning of the June session, Rob Martin – the cardiologist who’s been accompanying Serban Stoica each time – remembered the boy. The British doctor has been a constant presence in the program since the first mission in 2014. At the time, he was president of the British Congenital Cardiac Association. Now, five years later, he is freshly retired, so he doesn’t know whether he will come to Romania again.

“It is the only European country we go to … We can all see there is a great need here,” Martin says. He believes Romania’s only fully functional pediatric cardiovascular surgery department is the one in Targu Mures, some 100 kilometers from Sibiu. But if young patients are to get adequate treatment, the country requires four hospital units following the same model. (Apart from Targu Mures, pediatric cardiovascular surgeries have been performed at Institutul Inimii [The Heart Institute] in Cluj-Napoca. The only other institutions that host surgeries of this type – but only as a part of missions with foreign doctors – are two state hospitals in Bucharest.)

There are many specialists like Martin out there – used to charity work in countries like Syria, India, Malaysia, Peru, Kenya, Tanzania, and Palestine, they quickly understood that an EU country can have a young heart patient crisis, too. “There is a culture of aid, of transferring know-how to other centers, other countries. It is done on a fairly wide scale,” says Stoica. As for his own motivation for returning, it is simple. He wants to give something back to his country, even though it is too late for a permanent return.

At 50, he is giving serious thought to his legacy. It’s not about his panoply of surgeries or about self-confidence. Personal success means nothing if he doesn’t leave something behind in the people with whom he has operated in Romania. “The first time I came, I stayed on the left side of the operating table in 10 interventions. I didn’t operate in any of them. I wanted my colleague to learn. That is my dream,” Stoica confesses. “Now I will do the same. There is nothing I’d like more than to operate by Anca’s side.”

He has also worked with his former colleague from university, Victor Costache, who – after specializing in adult cardiovascular surgery – says he felt it was easy to have children under his scalpel with Stoica in the room. He operated on teenagers on his own and he could do it more often. But everything grinds to a halt when money comes into the picture, since the state doesn’t cover the costs of the pediatric operations at Polisano.

Stoica cultivated this perspective on his personal legacy in Denver, Colorado, where, before deciding it was time to stop looking, he worked with a doctor he calls “one of the last gentlemen in American surgery” – David Campbell. He remembers how the surgeon took his hands and used his own fingers to take hold of the suture thread.

“I’ve never seen him actually operate. He would be with you from skin to skin [i.e. from the first cut to the last suture], but only on the left side of the table. It didn’t matter if you had done that kind of surgery before, if you had watched it or only heard about it,” Stoica says. “He was the exact opposite of the typical cardiac surgeon. He told me he had nothing left to prove. You must always compare yourself with the best. Always look up.”

He adopted not just his mentor’s outlook on life, but some of his habits, too. He used to see him walking on hospital corridors in his scrubs and Crocs. He never got to do that, but he did occasionally see patients in his Birkenstocks. He spent the first day of the surgery marathon wearing a light linen shirt. He displays no trace of the hardness you would expect in a surgeon. In between surgeries and technical conversations, he stops to listen to the disappointments of a young resident who is seriously considering leaving Romania.

He speaks with empathy, from his own experience as an emigrant. He graduated from Iasi Medical University in ’94. He left the country because he wanted to understand what quality is really about. He had that “fire in the belly,” as he likes to say of other young residents he meets during his surgery missions at Polisano. He feels that his aspirations, as well as those of others in his generation who left Romania around the same time, are best summed up by the quote: “Quality is hard to define, but easy to recognize.”

He just had to see how medicine is done in other places. And for that he needed to break away from the system. When he left, he didn’t do it out of a desire never to return. Now he is aware that there is a point of no return. He feels that he has passed it, both in his professional and private life. He was 40 when he decided to settle in Bristol, in 2009. He had worked in five countries and 15 hospitals. His children were used to moving, and he and his wife both had black belts in packing and unpacking. One summer, they moved house no less than four times. But autumn was drawing near, and he had no idea where his son would start the new school year. He stopped searching and decided to offer his family stability in the UK: “You can’t just go away and leave your parents behind. And then have children abroad and leave them behind, too. You can’t save the world if you can’t even save your own family.”

With each return to Romania, Stoica hopes he is playing a part in forming a local team. Still, he is aware that, despite his best intentions, it takes 10 years to see such a mission through. He says that developing a pediatric cardiovascular surgery department is the crown jewel of any hospital. And this needs to be understood by those who hold the purse strings, too.

“Transferring know-how is like teaching someone to fish. But in a time of famine, I can’t just come in as an expert and teach someone else to fish,” the doctor explains. “By the time I’m done transferring the know-how, they’ll starve to death.”

He finds it absurd that he has to come from a national health service abroad to do free surgeries for disadvantaged children in a private center. But, ever since 2014, he’s chosen to return to Polisano each year, because it is the only place in Romania where he found a wide-open door. Also, he wanted to contribute to what his former university colleague, Victor Costache, was trying to build there.

“I deeply admire Victor’s resilience. It’s like trying to build motorways with donations only,” Stoica says. Though he has not seen any change in the attitude of political decision-makers, he is aware that each mission changes children’s lives. Pediatric cardiovascular surgery is a field where you can’t discriminate based on the patients’ ability to pay. Because your patients are children – the most vulnerable members of society. That is why he feels frustrated at having to constantly rely on how much money Catalina can raise.

[Transitions editor’s note: Victor Costache served as Romania’s health minister from November last year until late March, when he resigned amid mounting concern over the government’s handling of the coronavirus pandemic. In April, he left Polisano European Hospital for a position at a private hospital in Brasov.]

The donations are just a bandage for a wound that will keep bleeding. Stoica is aware of it, Catalina knows this too. What they need is sustainability. For Polisano, that means training local medical teams, as well as having the hospital included in the National Cardiovascular Disease Program. That would mean a fixed number of interventions each year would be paid for from the state budget. The national program also covers the costs of supplies needed in pediatric heart surgery – the most expensive component of the operations at Polisano. If they received funding from the state, the private hospital could fix the hearts of 50 children each year, Stoica believes.

Merciful Hearts

The Polisano European Hospital’s board of directors has been trying to join the National Cardiovascular Disease Program for six years. Between 2013 and 2019, Costache – the hospital’s medical director and head of cardiovascular surgery – sent 20 or so memos on the subject to the Health Ministry, the national health insurer, and the county health insurance office.

“We believe that including our clinic […] will help relieve the waiting lists for the other four centers […] in the country, reduce the enormous expense borne by the Romanian state for transferring children with congenital heart defects abroad for treatment, and bring down the percentage of avoidable deaths that is unacceptable for our country,” Costache wrote in a memo sent to the national health insurance office in early 2018. In the same document, the doctor requested a yearly budget of 100,000 euros for 60 heart operations on children in Sibiu.

No answer was forthcoming. That is because one of the issues in the Romanian health system is that no one replies to memos, even if you are a part of a specialized commission put together by the Health Ministry, Costache says. The paper’s neutral language hides the doctor’s accumulated frustration with the bureaucratic roadblocks preventing him from repairing more hearts at Polisano. (The national health insurance office informed me that they did send a reply last year; the institution explained that it only provides funds to hospitals which meet all the criteria in the evaluation forms, provided they fit into the budget allocated for the National Cardiovascular Disease Program, which was not the case for Polisano.)

“There is a limited number of children we can operate on, because we do surgery out of people’s mercy,” Costache says. “We’ve found no understanding from decision-makers in the health system. We lack cardiovascular disease centers, we lack specialists, and yet we trample the few initiatives we have for this.” Costache makes no effort to hide his vehemence. He admits that he finds it increasingly hard to stomach the “administrative shortcomings” which financially limit the number of pediatric surgeries. The hospital’s team is ready to intervene for standard congenital heart defect cases, but the surgeries are prevented by lack of money.

Epilogue

In Turnu Rosu, thick smoke blankets the Kolosvaris’ courtyard. They’re grilling fatback for Patric’s birthday. The trotting of the horses on the street outside is drowned out by a hit by Romanian teen band 5GANG. The children gather around the boy and sing “Happy Birthday to You.” Ramona scoops up a dollop of whipped cream and puts it right on Patric’s nose. It is his first anniversary with a healthy heart beating in his chest. Though still waiting for the end of the six weeks of physical recovery, he knows that, come autumn, no one will tell him “careful, don’t tire yourself” when he hits the oina ball and sends it flying over the school’s roof.

The Iron Man of Merghindeal has also returned home to his village in central Romania. He stayed in the hospital for three weeks after being operated on by Stoica in Bristol. Beside a healthy heart, he brought home a mental picture of the Atlantic. And his mother collected presentation flyers for the British hospital, to show the family back home how well the English treated Daniel.

A few days before the start of her maternity leave, Catalina is drinking frappé at a cafe in Sibiu’s Small Square. She is trying to contact all the foundation’s board members, because she can’t leave before passing the baton to Doris. To her, the 122 children operated over the last five years are living proof of what a team of doctors can do in alliance with civil society. She works until the last moment, because she knows that, by the end of the year, 10 to 15 new faces will join them. One corner of the cafe hosts a different exhibition each week. This time, the wall to Catalina’s left is covered in a dozen paintings of hearts.