EH 3_2015

EUROPEAN HOSPITAL Vol 24 Issue 3/15 4 NEWS & MANAGEMENT Country profile: Fighting infectious diseases Chinese products gain quality and soph Romania: Land of hope Shanghai hosts th world’s largest me Interview: Daniela Zimmermann. Report: Brenda Marsh Although Romania joined the EU in 2007, only recently has its macroeco- nomic increases influenced a rise in a middle class and dented the coun- try’s widespread poverty. However, development is still hampered by corruption and red tape in its com- mercial world. Through the post-communist years and EU involvement, various IMF, EU and other financial agreements have been made to encourage structural reform and strengthen the financial sector’s stability. In 2013 Romania’s economic growth rose due to strong industrial exports and an excellent agricultural harvest, and the country’s current account deficit was substantially reduced. At the end of 2014, the economy showed a 2.8% growth – lower than the 3.5% posted in 2013. Industry output came top in revenues with exports (70% to the EU) still behind economic growth. In that year the Romanian government had met its annual target for the budget deficit, the external deficit remained low, and inflation was lowest since 1989. Thus, in 2014, there was a gradual loosening of the monetary policy – but reports indicate that progress on structural reforms has been uneven and the economy is still vulnerable to adverse external events. Internally, its tax evasion, weak domestic demand, ageing population and insufficient healthcare represent top liabilities. Acknowledging her considerable skills in public and global health issues, clinical research, medical edu- cation, programme evaluation, inter- national health policy, the epidemi- ology of infections and emerging and re-emerging infectious diseases, Daniela Zimmermann of European Hospital asked Monica Deac MD PhD for a brief overview of Romania’s healthcare delivery. A little background With medical studies at Cluj University in Romania behind her, Deac worked as a general practition- er from 1979-1982, and took on the role of epidemiology and infectious diseases resident for the Medicine and Pharmacy department at the uni- versity in 1983. ‘I began my research activity in the Cluj Hygiene Institute and even today I work in this branch as a first degree researcher,’ Deac explained, adding that she became an infectious diseases specialist in 1987 and gained her doctorate in 1995. In 1996 the expert gained the title First Degree Scientist and Researcher and, a year later, produced her first book. In all, Deac has notched up more than 20 years as a teacher and over 32 years at the university. Qualifying in laboratory medi- cine in 2004, she became involved in several infectious diseases pro- jects, including nosocomial, strep- tococcal, staphylococcal infec- tions and others related to chil- dren and adults, as well as urinary tract infection (UTI) in the elderly. Now a senior epidemiologist and associate university professor in the Biology Faculty (epidemiol- ogy, hygiene, medi- cal education, microbiol- ogy) at Cluj Babes Bolyai University, Deac says: ‘I’m coordinating some infectious disease prevention from Transylvania/Romania, while work- ing in the Public Heath Centre in Cluj, and also doing morbidity and mortality studies for them.’ Leading causes of death ‘As everywhere else, cardio-vascular diseases are in first place for us. In recent years even the incidence of cancers is higher than 10 years ago. Concerning infectious diseases, the situation is also growing, but in normal limits and winter, especially for respiratory viruses, we have less reported influenza cases. ‘CC (cervical cancer) continues to be at a high level in females before 50 years of age. In the rest, all dis- eases in Europe are also present in Romania. Maybe in seasonal limits (summer time) a morbidity concern- ing diarrhoea in all ages in the popu- lation, caused by lower rural hygiene conditions, is remarkable.’ She has worked on a study of diar- rhoea in the population and, relating to this, it is noted that only around 28% of the rural population is con- nected to a proper central water supply. Most families use private or public wells, with little or no pol- lution control – and seven million people use pit latrines. Information regarding the quality of drinking water in Romania’s rural areas is unavailable to the popula- tion. Often, they are also unaware of the interconnections between the quality of water, sanitation, hygiene, fertilis- ing of the soil and general health. The coun- try has until 2018 to implement EU regulations within the EU Water Framework Directive.) Disease notifications ‘There are less internal data to com- pare with other countries,’ Deac points out. ‘Romania transmits all ill- ness data to the WHO. In some stud- ies about antibiotics use in Europe, Romania’s practices are increasingly included. The country is monitoring some diseases and especially look- ing for infectious diseases caused by someone arriving from abroad, for example importing malaria, etc. Our data are sent to CDC/WHO, which makes the general statistic data for several illnesses. Government prevention measures ‘There are immunisation programmes for several infectious diseases (dates for age grouped children) up to the CDC and OMS demands, education carried out by several medical clini- cians, in the clinic or by the family doctor in the practice and, of course, by doctors from Public Health insti- tution branches.’ EU healthcare support ‘Up to now there hasn’t been much European Union healthcare support. More is obtained from ideas than from direct financial help.’ Medics’ migrations ‘This is a difficult situation because we continue to lose more and more doctors and have received some from Moldova and India. Two thousand five hundred Romanian doctors have left already – in the last two to three years. The cause is the bad salary we continue to have in our country.’ Romania provides 1.9 physicians per 1,000 people and has 6.6 hos- pital beds for the same number. Life expectancy is 71 years for males and 78 for females. The probability of not reaching age 60 is 21.6%. However, life for Romanians is slowly improving and a change in the public’s satisfaction with it should show signs of improvement in the future – if the world and its economies can remain stable. With native language Romanian, and fluent German and Hungarian, plus English and French, the internationally recognised epidemiology and hygiene expert Dr Monica Deac is active in many international disease-related societies. Report: Nat Whitney This spring, the China Medical Equipment Fair (CMEF), which out- grew available space in Shenzhen, was held at Shanghai’s newly built, massive, National Convention and Exhibitions Centre, with Reed- Sinopharm premiering a combined CMEF, PharmChina and API (pharma ingredients) event. The organisation was touting that this is now the larg- est healthcare show in the world – evidenced outside, inside and all around the Shanghai exhibition area. While there were some pre- and post-show transportation challenges, with the venue only beginning expan- sion to accommodate such large crowds, those who persevered were rewarded with a unique experience in seeing the world’s premier medi- cal products displayed in one loca- tion in the second largest and fastest growing medical products market in the world. Providing almost 300,000 sq.m. of exhibition space for 6,500 exhibitors, the first of the 210,000 visitors stood shoulder to shoulder as the opening bell sounded. What they found were several new twists to the 2015 exhibition: more concentration on education and 107 separate pro- fessional conferences held during the four-day show. Exhibit space in the international hall increased by 50% compared to the previous event held in Shenzhen. Several country pavilions and the IVD pavilion grew, and first time pavil- ions came from India, Netherlands as well as Germany’s Schleswig- Holstein. The French Pavilion hosted a group of 16 French companies, 50% of them first timers at the event. Progress made in quality and sophis- tication of the latest Chinese medi- cal products was demonstrable and UK will cFollowing up on European Hospital’s page one report (Issue 2: Cut prescriptions… Choose treatments wisely!) Mark Nicholls reports that the United Kingdom has also launched the campaign to help. TheAcademyof Medical Royal Colleges (AMRC), which represents all medical royal colleges in the UK, has unveiled the USA-inspired ‘Choosing Wisely’ programme in partnership with spe- cialty organisations in an attempt to reduce harm caused by using too much medicine or interventions that have no benefit to patients. The AMRC states that unneces- sary care occurs when people are diagnosed and treated for conditions that will never cause them harm. There is also growing evidence that many people are over-diagnosed and over-treated for a wide range of con- ditions, such as prostate and thyroid cancers, asthma, and chronic kidney disease. As a first step, organisations partici- pating in the initiative are being asked to identify five tests or procedures commonly used in their field, whose necessity should be questioned and whose risks and benefits should be discussed with patients before using them. These might include tablets for mild depression, too many rou- tine and unnecessary blood tests or medicines for mildly raised blood pressure. Results from the systematic review will be assessed, analysed and com-

EH 3_2015

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