International Association of Physicians in AIDS Care, Journal: March 1998 - Volume 4, Number 3
Story by Ruth SoRelle; Photos by Smiley N. Pool

A version of this story was published in the Houston Chronicle.

A teenage mother cradles her three-year-old son by candlelight in the sewer below the Gara Basarab train station. The pair lives there with four other children.

The three emerged from the subway station like tiny mice, furtive and gray with fatigue and dirt. Ages 8, 10, and 11, they are members of a growing population of homeless and abandoned children who populate the city's streets and sewers.

These are among the newest of the lost children of Romania, a nation whose inner workings were long lost in the shadow of the Iron Curtain. But the pictures of their orphaned, abandoned and unwanted children made clear the horror in which the nation lived for so many years. But freedom--Western-style--was supposed to fix all that. Nine years after the Iron Curtain fell, it is clear that children still suffer as do these hungry and thirsty youngsters who may or may not give you their real names, if they know their real names. Hungrily, they chewed at the rough bread handed them by relief workers from the back of a taxi. Eagerly, they cradled steaming cups of weak tea with chapped and reddened hands. Any warmth is welcome when you are imprisoned in a cold world.

Cristian, 6, was their brother in misery, although he was temporarily ensconced in the relative comfort of the newly constructed children's AIDS pavilion at Colentina Hospital in central Bucharest. Abandoned since birth in an orphanage and considered "irrecoverable" because of AIDS, he banged his head against the sides of a crib, writhing to the strange rhythms of unheard music. With only minimal attention and love in the institution from which he came, he neither spoke nor walked nor fed himself.

Paul, 8, was put out in the yard with a rope around his neck by his father after it was learned that the boy was HIV-positive. Paul now lives in a group home run by Ann McNicholas.

If seven-year-old Ene Cristian Ionut could overcome his rage, he could tell the story about how he too became lost. Instead, he glared at the watery sun that peeked through dirty windows as he wiped his weeping, infected eyes. When he was two months old, he emerged from a hospital with AIDS acquired from a dirty needle or a questionable blood transfusion. Seven years later, he received no antiviral drugs--a resource reserved for only a few--and his 29-year-old mother, herself dying of breast cancer, sobbed in despair.

Six years ago, the world would have pointed the finger at Nicolae Ceausescu. The infamous dictator was executed in 1989 shortly after a coup toppled the Romanian government as the Iron Curtain crumpled across Eastern Europe. Ceausescu's ruinous policies placed more than 150,000 children in orphanages, desecrated a once-model medical system, and raped the national economy. Many Romanian orphans, then and now, have parents, but their parents surrendered them to state care--some because they were too poor to care for them and others because they just did not want the burden of children they were forced to birth. Today, more than 100,000 children remain institutionalized.

The nation is home to more than one-half of the children with AIDS in Europe. Most acquired the disease from infusions of infected blood or dirty needles reused in hospitals during Ceausescu's quarter-century of rule. Those inadequacies are being dealt with, but 200 children are believed to have acquired the disease in the past two years because of poor infection control in hospitals and clinics.

George, 17, is shown at an area of Bucharest's Gara de Nord railway station where a group of children are squatting. He was abandoned by his parents and put in an orphanage, but ran away because he was badly treated by the staff and other children.

Despite the Romanian government's assertion that AIDS is only a minor or nonexistent problem in the general population, infected mothers are passing HIV to their newborn children. Humanitarian workers say the government thinks the AIDS issue will be resolved when those children infected with the disease during the Ceausescu regime are dead.

Despite a worldwide effort to salvage the situation, there are few Romanian-based government and private programs directed at improving the children's plight.

Foreign programs, funded with charitable dollars and operating against incredible odds, are losing steam. But the situation still draws a trickle of foreigners trying to help. Two years ago, a delegation of eleven from Houston's Texas Medical Center went with humanitarian hopes. What they found was disturbing. And they are still wrestling with where to concentrate their efforts.

"It was as though you had walked into a house where everyone was fighting," said Deanna Grimes, who came to consult about nursing education.

Mark Kline, MD, has struggled for two years to get an AIDS drug study online. It has been an uphill battle, between drug companies in the West and the bureaucracy of a health system that has too much to do and too little with which to accomplish its tasks. It looks as though he will be successful.

Mia Zamfir plays with a stray dog at the Gara de Nord. Three years before this picture was taken, she gave birth to a son who now lives at the Mother Teresa Home for Children. For the first year-and-a-half of his life, the baby lived in the station with his young mother and the other resident children. Mia, who had been on the streets for six years, was pregnant again in this picture.

There are Romanians who say, "We must change the mentality." Some soften their criticism with the words, "We are a nation in transition." They are at a loss about how to change attitudes solidified in dictatorships that lasted more than half a century.

The more cynical will say, "We are a nation in transition--but to what?"

Perhaps nothing epitomizes the future of HIV in Romania better than 19-year-old Mariana, herself an orphan who has been on the streets as a prostitute for three years. Behind the glass wall of a room at Colentina Hospital, she cradles two-month-old Ion. Mariana is skeletal, the scarf on her head covering her thinning hair. She cries bitter tears as she holds her tiny infant close. They are both ill. Ion's HIV status is still unclear. Doctors describe hers as a "social case." In other words, she caught the disease through sexual contact.

In March 1997 there were about 4109 children with AIDS in Romania. As of April 1996, about 1000 Romanian children had died.

Only education will prevent further disaster, said Maria Georgescu, MD, who heads ARAS, the local AIDS outreach organization in Bucharest. "The problem is that AIDS is not a priority," she said "The ministry (of health) says it is eradicated."

A Romanian will tell you that he or she knew nothing about the squalid, teeming orphanages of the Ceausescu regime. Conditions were hidden, said Liviu Maior, PhD, the minister of education until a recent change in government. "After 1989, what we saw was something like what the Nazis did in concentration camps."

Perhaps the public, indeed, was ignorant. But equally compelling is the defense that the populace was too afraid to complain--afraid that they would be imprisoned and their children sent to the same unsavory institutions.

Nicolae Ceausescu sought to control all aspects of the people's lives. Among his worst edicts was the requirement that women have four children--later increased to five--by age 45 before they could become eligible for birth control or abortions.

Mihai, bottom, and Marian sleep well into the morning at the Gara de Nord. Mihai, 19, is a Gypsy who has run away from home. Marian is a male prostitute. About 5000 children are believed to live on or under the streets of Bucharest, the Romanian capital.

Many women could not afford to rear the children and turned them over to state-operated orphanages. Giving up children became an accepted part of Romanian culture.

While Gypsies or Roma (as they prefer to be called) make up no more than 15 percent of the Romanian population, they account for more than 80 percent of infants in orphanages. "(Ceausescu) was consumed with the idea of creating a Ôperfect' Romanian race," said Ian Hancock, PhD, a linguistics expert at the University of Texas at Austin and a representative of the Roma before the United Nations.

The "impure" children in the orphanages were to be a "robot work force," he said. "Ceausescu was copying Hitler."

Freedom, of a sort, came to Romania six years ago, when angry citizens faced down tanks on a Bucharest street. The soldiers refused to fire their guns and joined the revolt against Ceausescu. But until late in 1996, Ion Iliescu, a dissident Communist in the Ceausescu regime, ruled the nation, presiding over its declining economy. Salaries for professionals ranged from an equivalent of $40 per month for nurses to $150 per month for senior physicians.

For four years, Iulian Mincu, MD, headed the health ministry, which operates orphanages for infants and toddlers. He was recently ousted, after elections that ejected Iliescu as well. Mincu's craggy face, distinguished by pyramids of bushy eyebrows and protuberant liquid brown eyes, showed little emotion as he was peppered with questions about the problem with healthcare and the care of children. He did not address those woes either in conversation or action.

The almost universal opinion was that Mincu was the problem--not the solution. Many people said that at one time he was a personal physician to Ceausescu and had a hand in the disastrous health and nutrition policies that led to the infection of so many children with HIV.

Cristian Tudora Dorina and her son, Ene Cristian Ionut, were living examples of those policies. Seven years ago, when Ene was only two months old, he developed pneumonia and was hospitalized. He stayed for three months and emerged with AIDS. Two years ago, his mother developed breast cancer.

"No one will help us in our village, and all of our relatives have deserted us because of AIDS," she said through an interpreter. "We are treated like animals. There is no compassion."

Mariana, 19, an orphan who worked as a prostitute for three years, is HIV-positive; she contracted the virus through heterosexual sex. She cradles her infant son in the AIDS pavilion at Colentina Hospital in Bucharest. When this photograph was taken, the infant's serrostatus was uncertain.

Sharon Cermak, a Boston College occupational therapist who visited Romanian orphanages in varying parts of the country in 1991 and again in the summer of 1996, said things are better and worse. The orphans are not priorities, she said. There are not enough caregivers to provide the stimulation the children need--and those who are available often do not recognize the need for such special treatment, she said. And some are so poor that they resent the attention given the orphans. Why should they work so hard to care for their own children and see these infants given everything? Cermak said.

Beth Crawbuck, a board member of the Children of the World aid group, spent a month touring Romanian ophanages. "Many of these facilities have been painted and cleaned up, and the children have changed," she said recently. "They have gotten older, and the cold has set into their expressions. These are children who are destined to a life of no love, no expression, no nurturing, and no hope. The entire experience of the world for many of these children is seen from their beds."

It was the children's obvious need for love that drew the strong heart of Ann McNicholas to Bucharest in the first place. She had just returned to Britain for rest and recuperation after feeding the hungry children of Ethiopia six years ago when she saw the first videos of Romanian orphans.

Within a few weeks, she was in Bucharest to evaluate the situation. Six years later, she was still there.

Her temper is as peppery as her hair. She will let nothing--not etiquette, manners or government bureaucracy--stand in the way of getting what her children need. But when a child like little Anca or Peanut, both living in the foster homes she has established, grabs her hand or begs for a whooshing spin through the air, her face softens. Over and over again, she responds to their demands. It is her aim to rescue such children from the bleak existences of orphanages and hospitals.

Alexandru Serbanescu, MD, director of the hospital where the AIDS pavilion is located, estimates the life span of a child with AIDS at about seven years. "When they come to us, they cannot speak, they cannot walk, they cannot dress themselves. They must live ninety years in seven. They need food. They need love," he said.

A Romanian child closes the windows of a care facility at Burile-Mare. The farm was established by two groups to house previously institutionalized children.

In the orphanages, said McNicholas, there is no bonding, no contact, no holding. Babies are swaddled and bottles propped in their mouths. "It is easy to put a child in an institution," she said. "It is hard to get them out."

McNicholas's support comes from the United Kingdom, but she knows it will dwindle without some kind of Romanian match. It is a fear that Marolen Mullinax, a Texan who runs a home for children with HIV, shares. Mullinax's work is in Constanta, a port city on the Black Sea where the rates of Romanian childhood AIDS are among the highest.

The Constanta hospital system provided the building that was remodeled into five small apartments designed to accommodate a "mother" and no more than six children. Meals are prepared in a central kitchen. The facility includes a Montessori kindergarten and a chapel. They started with American caregivers, but now Romanian women have taken their places. The progress of the children is phenomenal, said Mullinax, the project director.

"This is a model that just provides children with a stable home and mothers," she said. Those who came unable to walk, talk or feed themselves made good progress in a loving environment.

"This would be applicable to each of the 104,000 institutionalized children in Romania," Mullinax said. "To hell with cleaning up the institutions. Children don't belong in institutions."

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