Nistor worked very closely with Sina Pourtaheri, a third-year Tulane medical student who founded the program, Tulane Outreach to Romania (TOR), in 2007. A nonprofit organization designed to support medical missions for students and physicians, TOR's goal is to serve needy patients in rural Romania by providing consultations, shipping medical supplies to the area and funding education scholarships for rural Romanian students.
"The thing that made me participate was the idea of meeting new people, especially when I heard that American doctors are coming," Nistor says. "I knew I had to go there. I thought I might learn a few new things, see new patients and nevertheless, help people."
Pourtaheri's experience with other, smaller medical missions spurred his decision to found TOR. He felt that forging a collaboration between Tulane and the university in Bucharest would enable a larger mission to provide specialty services to more Romanian patients, build a relationship between the two schools and increase awareness back home of the needs of underserved patients around the world.
"Initially we didn't want to just go out there and do family medicine," he explains. "We wanted to do specialty consultations in pediatrics, cardiology and ob/gyn and then update the patients' primary care physicians. Because that's what they don't have they don't have specialty care."
The Romanian health-care system, especially in the rural villages, has many problems, Nistor says, including too few family doctors to manage large patient populations and a lack of pharmacies and small hospitals nearby.
In early April, TOR completed its first 10-day mission to Bacau, a county in northeastern Romania. The team consisted of 11 medical students, five physicians and one nurse practitioner. Each was paired with a Romanian student like Nistor to assist with translation, triaging and examinations.
The Saint Charles Borromeo Monastery in Gioseni informed local residents of the free clinics, provided lodging for the Tulanians and coordinated various clinic locations. Anticipating a high number of patients, the team split up and operated three different sites each day. Pourtaheri estimates that each site saw 100 to 140 patients per day more than 1,000 patients during the course of the mission and performed specialty services and diagnoses such as electrocardiograms, abdominal, pelvic and pregnancy ultrasounds and Pap smears.
"As an attending (physician) I would say it was very uncomplicated medicine," says mission member Dr. Hosea Doucet, a professor and director of the pediatric residency program at Tulane. "It was much less rigorous in that we weren't, like here (in the U.S.), doing registration, documentation, consents, [which] takes some of the pleasure out of medicine. There it was much more basic, much more "take care of the patient,' and that was very pleasant."
It was valuable for the Tulane students to participate in a program where the motivation was purely to do something good for others, Doucet says.
"The greatest thing I learned from the Tulane students was the way of working working long hours without thinking about relaxation," recalls Nistor. "I was also impressed by the large volume of knowledge that the American students knew."
A translator explained the doctors' diagnoses to each patient so they could return to their primary-care physicians and seek the recommended specialty care, Pourtaheri says. One patient Pourtaheri saw reported symptoms of prostatic hyperplasia, a condition that contributes to the enlargement of the prostate gland. The patient was there to request a rectal exam because his primary-care physician refused to perform the service. Previously, he had traveled to Bacau for the exam, but was sent home without results.
"This guy didn't even know what the results of the exam were," says Pourtaheri. "He didn't know if he had cancer or didn't have cancer." That was a common problem the team saw, he says: It was not only difficult to get access to specialty care, but also to follow up on it.
Another common problem was severely elevated blood pressure. Between 30 and 40 percent of patients coming through the clinics had high blood pressure rates and/or hypertensive urgency and were experiencing symptoms such as headaches and blurred vision. Patients with more severe symptoms were immediately sent to the hospital. Rates of hypertension may not be significantly higher in Romania than in the United States, Pourtaheri says, but American patients are on medication for the condition so their blood pressures appear normal.
Abnormal Pap smear results also were common, he says. Almost every vaginal exam performed during the mission revealed an abnormality associated with the growth of cervical cancer. Gynecological cancers can be very common in poor countries where preventative medical practices and early detection are rare, he explains.
The Tulane team will hold forums on international medicine in the coming year to discuss their observations working within the health system of a poor country and its approach to treating diseases.
Romania has a socialized health-care system, which means it is free to patients but very limite resoruces have to be shared among everybody, Doucet says.
It's a valuable experience for doctors in training to see how dysfunctional medical systems can be in other parts of the world, says Dr. Mark Cassidy, program director of the cardiology fellowship training program at Tulane and one of the accompanying physicians. "Even with its problems in terms of access and resources, the New Orleans system is far better than the system in Romania. There is literally nothing to offer in terms of specialty services out in the rural areas. People even if they can get into the system are forced to travel great distances to access specialty care."
Fortunately, the team was able to treat patients with less complicated problems on location because it brought a large quantity of medication and supplies from the United States, Pourtaheri says. The supplies were obtained through funding from private donors as well as a grant. TOR hopes to continue shipping medical supplies to the area through the monastery. That initiative depends in part on another project it hopes to undertake developing a Web site to inventory surplus medical supplies from a variety of warehouses stocked by donors and hospitals nationwide. The plan is to provide a catalogue system where needy clinics, including those in New Orleans, can go online to order necessary supplies.
Nistor, whose parents are both doctors in Romania, has access to education that is not typical of the rural Romanian population targeted by the mission. TOR is working to establish a scholarship fund to sponsor qualified students who don't have the resources to attend secondary school, which often is located in larger cities. The $1,100 scholarship, named in honor of former Tulane Medical School Dean Joseph Pisano, currently covers room and board, tuition and supplies for one high school student. TOR hopes to raise enough money in the future to support more Romanian students as well as providing medical supplies and supporting future missions abroad.
For more information, visit www.tulane.edu/~romania.