Pumpjacks hammer in a changing world: A petro-village becomes a medical hub

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The MALP Moinesti Clinic is the only private clinic in the entire municipality and surrounding villages. (Photo: Courtesy of Dr. Mihaela Cotirlet)

Pumpjacks hammer for petroleum in Moinesti. They hammer and hammer and hammer like it’s still the 1970s, when the government-run petroleum industry kept the small municipality economically afloat. Then, Communist dictator Nicolae Ceausescu was overthrown in 1989 with a bloody revolution that ended with him and his wife getting executed on national television, on Christmas Day. 

As Romania shifted from communism to capitalism in the 90s, the petroleum industry was privatized, and life in Moinesti changed as petroleum jobs fled the community. At its worst, the municipality’s unemployment rate was more than 20%. In 1993, Romania’s unemployment rate was 8.40%.

Romania’s unemployment rate, 1991 – 2019 (Photo: Courtesy of Macrotrends.net)

At first glance, Moinesti looks unremarkable. Almost 200 miles away from Bucharest, Romania’s capital, Moinesti is surrounded by farmland and clusters of small villages. With a population of roughly 20,000, it is not uncommon to see horse-driven carts on the street. It is also located in Moldova, Romania’s poorest province and the fifth poorest region in the European Union.

Still economically recovering from the loss of petroleum industry, Moinesti is known for four things: 1) Being a “global village” destination for Habitat for Humanity, 2) having a Jewish cemetery, 3) the fact that a giant DADA mural marks the entrance to town, and 4) having surprisingly good health care.

There are two major medical facilities in Moinesti: a private clinic and a public hospital. The private clinic, MALP Moinesti, is run by Dr. Mihaela Cotirlet and provides various types of care, including family medicine, infectious diseases, rheumatology, nephrology and clinical psychology. 

The lobby of Dr. Cotirlet’s private clinic. (Photo: Courtesy of Dr. Mihaela Cotirlet)

Her husband, Adrian, runs the public Moinesti Municipal Emergency Hospital; he was voted the best healthcare and pharmacy manager in 2019 by Capital, a business and economics magazine. His hospital is working on new infrastructure projects to improve the hospital’s accessibility to neighboring counties and extend hospital spaces, bringing some jobs to Moinesti.

Good healthcare is something of an oxymoron for Romanians due to the system’s infamous corruption. After the fall of the dictatorship in 1989, the healthcare industry, much like the petroleum industry, switched from government-owned to privately owned. 

“We found ourselves in a system in which the disrespect placed its influence on the young doctors, a system that had not developed any strategy for the doctors who wanted more than the state of employment,” Cotirlet said. 

According to a study by Mihaela Cristina Dragoi, a professor at the Bucharest Academy of Economic Study, the political changes in 1989 created a partial replica of the totalitarian regime’s sanitary system: the Semashko system. Borrowed from the Soviet Union, the Semashko system’s goal was to provide free, universal healthcare through a multi-tiered system of differentiated networks of service providers.

Romanian physicians lobbied for reform, to change from the Soviet Semashko model to the German Bismark model, which provides free, universal healthcare through an insurance system jointly financed by employers and employees. According to Dragoi, reform was stunted because of Romania’s political instability. 

“Frequent changes of government and ministers, the lack of clear strategy and defined objectives to be pursued rigorously and independently of political changes slowed down the health reform process after 1990,” she wrote. 

Bribery is common in the sector, and since 2007, the EU has invested over €12 million to fight against corruption in Romania. Even though Romania provides universal healthcare, the system does not provide equal coverage; rural areas are frequently left behind.

In short, a combination of Soviet bureaucracy and crony capitalism has led to Romania’s health care sector turning a transaction of care into an economic exchange. 

Perhaps no event in recent Romanian history encapsulates the crony capitalism that has infiltrated the system as much as the 2015 Colectiv nightclub fire, which claimed the lives of 64 people. While 27 of those people died on the scene, the other 33 passed away in the hospital, some from preventable bacterial infections. Gazeta Sporturilor (“The Sports Gazette”), a daily Romanian sports newspaper, investigated, and found that government health authorities never inspected the disinfectant used by hospital staff. 

A map tracing the movement of Condrea’s disinfectant scam entitled “The ‘Disinfectant’ Business.” Pret means price and Cipru means Cyprus. (Photo: Courtesy of the RISE Project)

The quality control came from Hexi Pharma, a pharmaceutical company who distributed antiseptics to 350 out of 367 public hospitals in Romania. Further investigation revealed that Hexi Pharma diluted the disinfectants to increase profits. In addition, hospital directors allegedly took a 30% cut on Hexi Pharma contract. According to the RISE Project, a non-profit journalism organization based in Romania, Aurelian Condrea, the owner of Hexi Pharma, would buy a liter of disinfectant from Germany for about €7.9 euros, sent to offshore mediary Condrea owned in Cyprus, and then finally sold in Romania for €75 – €100. 

Public outrage over the Hexi Pharma scandal and Colectiv nightclub fire deaths led to the resignations of multiple cabinet members, including Prime Minister Victor Ponta and Patriciu Achimas-Cadariu, the Minister of Health. Achimas-Cadariu’s replacement was Vlad Voiculescu, an economist  with no prior political experience, known for creating the Cytostatic Network, a group of volunteers who bring cancer drugs free of charge to Romania from other countries.

This is the kind of system Dr. Mihaela Cotirlet is operating in. “For some, [a doctor] is just a person. For others, it’s a white coat,” she said. “And for the system, it’s an investment.” 

Although Romania’s healthcare system struggles with corruption and inefficiencies, Cotirlet tries to operate her practice with a simple maxim: Be the change you wish to see in the world. 

One thing she is trying to change is the level of access to healthcare in rural areas, a historic problem in Romania’s universal healthcare system. Her clinic is the only clinic in the Moinesti municipality; without it, villagers from neighboring communes like Poduri and Solont would need to drive approximately 30 miles to Bacau, the county’s capital, in order to receive care. 

Although her practice is well-established, renowned in Romania and financially stable, the Moinesti native said she remembers her experience with medical school in Ceausescu’s Romania vividly. “You deliver babies, clean them in pots, and as transportation, you have to use a carriage pulled by horses,” she said. 

Romania’s healthcare system is still underfunded today. In fact, Romania spends the least of its GDP on healthcare out of all EU countries. In 2016, that meant that only 5% of the total GDP went to the public health system. According to Cotirlet, it’s this sort of environment that has made Romanian doctors tough.

2016 European Union healthcare expenditures (Photo: Courtesy of Eurostat)

“They [Romanian doctors] are used to hardship, with hospitals with no medical equipment,” she said. “For that reason, they are very good clinicians. Management counts: even with less money, people can achieve progress.”

However, until 2018, many Romanian medical practitioners weren’t paid as though they were valuable members of society. In 2015, a first-year resident physician in Romania made €260 (~$288.30) a month. Meanwhile, in the United States, the 2015 Residents Salary & Debt Report found that the average yearly salary for a first-year resident was $52,000, or roughly $4,333.33 a month. That is around 15 times more than what a first-year Romanian resident would make. 

The economics of this made living self-sufficiently as a doctor difficult, if not impossible, leading to a brain drain. From 2009 to 2015, half of Romania’s doctors left the country, leaving almost one-third of hospital positions vacant. Despite Romania being a leading EU state in medical school graduates, the Ministry of Health estimates that one in four Romanians have insufficient access to essential healthcare, which makes practices like Dr. Mihaela Cotirlet’s all the more necessary.

Sometimes, it can feel like there is no incentive for people to stay. That goes beyond just doctors. According to the Carnegie Council for Ethics in International Affairs, conservative estimates put one in five working-age Romanians living abroad. Romania has the second-fastest growing diaspora, only after Syria. 

But Dr. Alexandra Scovronschi, also a Moinesti native, decided to move back home after completing dentistry school not only to start a family with her husband, a surgeon at a public hospital, but to start her own private dental practice. 

According to residents of Moinesti, Scovronschi’s dental practice is one of the first in Moinesti that has been accessible to locals. Because Moinesti was a small town where Scovronschi grew up, some parts of starting a business were simpler because she knew the people and the people knew her. It made it easier for her to build a client base. 

An aerial view of apartment blocks in Moinesti, Romania. (Photo: Courtesy of Daniel Anturaju via Flickr)

Scovronschi remembers the pumpjacks digging for petroleum as that segment in Moinesti’s economy began faltering. It was the same year she had a health scare and underwent surgery at the public hospital in Moinesti, which has received national prestige for its hygienic conditions.

Scovronschi said she knew she wanted to be a doctor since she was a little girl, but didn’t realize how badly she wanted it until she decided to go to college for economics instead of pursuing medicine. 

Unlike in many other Western countries, a career in medicine did not equate to wealth. During her summer holidays from business school, Scovronschi said she worked at a small tile business in Southern California where she made around $1,600 a month – more than five times what she would have made as a first-year medical school resident. 

In 2018, the government raised the base gross salaries for public health employees by more than double in order to stem the hemorrhage of medical professionals. First-year residents will now earn €715 ($792.85) a month. Whether this succeeds in stopping the brain drain is yet to be seen. This move is also intended to help stop the common practice of bribing medical professionals for better care. 

“Receiving flowers, boxes of chocolate, and coffee is not bribing. It’s a form of showing respect and appreciation after the work with the patient,” Cotirlet said. “This is rooted in customs, but what is condemnable are the ones who ‘ask something’ because now the salaries are sufficient.”

Many of the municipality’s Gen Z population decided to pursue medicine in college. Raluca is a Moinesti native who is on her first of six years of medical school at the Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, generally abbreviated as UMF Cluj. She has requested that her surname be withheld. 

According to Raluca, out of the 30 students she graduated high school with, 15 wanted to go to medical school. Eight got into a medical college in Romania, four reapplied and got in the following year, and five decide to change their path. 

Cluj, the fourth most populous city in Romania, can sometimes feel like a whole world away from Moinesti. “In Moinesti, it’s impossible to go outside and not bump into someone you know. In Cluj, you can walk for three hours and not find someone you know,” she said. “I don’t plan on going back to Moinesti.”

Although she was born around the time the petrol industry left Romania, she said she remembers the pumpjacks hammering for oil even though all the jobs left the community, sending them into a downhill economic spiral. “Bad men got rich backs on the backs of the people,” she said. 

Petroleum pumpjacks in Romania. (Photo: Courtesy of Desteptarea)

Growing up in a Romania defined by corruption and scandal can make it hard to not become at least a little cynical, especially for an aspiring doctor. 

“At a certain moment, you need to have hope. And then you meet people who have no hope for the future, and that affects you,” she said. Becoming a doctor is a life-long ambition, and she said that she can’t picture herself being happy doing anything else, but to find happiness in her career, she might have to leave her country. 

“It’s easier to leave than to stay and fight. So many people want to leave. So many people in my year want to leave,” she said. 

According to her, this leaves Romania’s medical system in a tenuous state – without capital and with young people leaving, there are few people bringing in new ideas. “At the same time, there is nothing to offer them,” she said. “Either way, the school makes money.” 

This system made her want to leave Romania for a long time. “Now, I don’t. The salaries are rising. And I still have five years to decide.” 

Raluca said that although the system creates good doctors, it’s deeply flawed. For her, two of the largest problems are the underfunding and bribery. Growing up, she said there was pressure to bring mita, or bribes. “It’s ugly. I hope my generation stops accepting money,” she said. What makes mita particularly heinous to her now is that with the salary increases, it is unnecessary. 

“I just want to live in a state where there is no political turmoil,” she said. 

As a new generation is left to find hope and battling a fight or flight instinct, the pumpjacks of Moinesti still hammer.

SOURCES

The Coffee Cup Crisis: Starbucks Needs a Greener Solution

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People get used to grabbing a cup of Starbucks coffee before starting their day. But, would you mind spending more on your single-use coffee cup? Apparently, no one would do that. While since 2020, customers will be charged an extra 25 cents if you drink in a disposable cup at any shop in Berkeley, California. It sounds like a great way to cut down on disposable coffee cups, but for chains like Starbucks, which goes through about 6 billion cups a year, this represents no less than an existential dilemma, and Starbucks needs a greener solution to handle its cup problem.

Litter Reduction Ordinance, the policy passed by Berkeley’s City Council in January 2019, is designed to reduce single-use food ware from entering the landfills and 25 cents paper cup fee is part of it. By far, it is the first and the hardest line drawn to-date against single-use cup waste by any U.S. municipality. Although it is not the first worldwide policy to combat the use of disposable coffee cups, its emergence marks that the nation started to say ‘no’ to those environmentally-friendly single-use paper cups.

“Most people don’t know this, but Starbucks paper cups are not recyclable in most cities across the U.S. because the cups are lined with plastic. In today’s world, a paper cup is no longer just a paper cup. It’s plastic pollution,” said Ross Hammond, the former U.S. Campaigns Director for Stand.earth.

As Hammond said, the majority of customers reasonably think that Starbucks single-use paper cups are environmentally friendly and can be completely recycled. Starbucks, the most successful worldwide coffee chain, operates over 28,000 stores across the globe. People assume these cups with the green mermaid logo will get recycled and turned into new products after throwing them in the recycle bin. However, Starbucks disposable cups cannot actually be 100 percent recycled.

Why single-use cups are hard to recycle

While drinking a Grande size cup of Americano in the morning, look out for the statement at the bottom that reads “This cup is made with 10 percent post-customer recycled fiber. Do not microwave.” The main reason why Starbucks does not recommend the cups be put in the microwave is because each one is lined with a thin layer of 100 percent oil-based polyethylene plastic, a waterproof material to hold liquids safely.

According to research from Creative Mechanisms, a Pennsylvania-based engineering company that specializes in plastics, polyethylene is an incredibly useful commodity plastic. Because of the diversity of polyethylene variants, it is incorporated into a wide range of applications. It is always being used to make containers, plastic bags and wraps.

Although the polyethylene could be recycled the same way as paper, the current technology is not widespread across the country. This is what makes the polyethylene such a large pollution problem. According to the data from Stand.earth, a non-profit environmental organization also located in Seattle along with Starbucks, is one of the organizations and activists that is pushing Starbucks to pay more attention to environmental issues, only 18 of the largest 100 U.S. cities provide residential pick-up of paper cups for recycling. Most recycled paper mills are not able to separate the polyethylene from the paper cups due to the lack of the recycling capacity of polyethylene.

Credit to Jiajun Chen

Other research from the Carton Council shows that only three paper recycling mills in the U.S. can process plastic-coated paper. These mills make up less than 1percent of the over 450 pulp and paper mills in the U.S.

In the end, most cups end up in a landfill.

In addition to the landfill, those paper cups and other kinds of trash such as paper box, are wrapped and exported to China. Jim Ace, the senior campaigner for Stand.earth, explained that compared with landfills, China could process much of the waste and turned it into new products, and the price of shipping commodities to China is very cheap. China was the biggest garbage-importing country across the world, disposing of over half the world’s garbage in the past two decades. However, this changed after the Chinese government announced a ban on imported trash at the end of 2017.

Ace also pointed out that, as the fastest-growing market for Starbucks, China doesn’t want to receive more trash from North America. He says this is because China already has to dispose of large amounts of garbage from their local market. China’s restrictions on the import of waste will indirectly lead Starbucks and other companies to increase trash in landfills across the U.S.

‘To be charged rather than get discounts’

Besides the policy introduced by Berkeley, the current incentive plan in the U.S. launched by Starbucks allows customers to receive 10 cent discounts if they enjoy Starbucks drinks using their mugs or cups, but only 1.4 percent of Starbucks’ beverages were sold in reusable cups as of spring 2017. However, Todd Paglia, the executive director of Stand.earth, thinks that this is not enough of a discount to encourage customers to bring their own cups when they normally pay $4 or $5 to purchase a cup of coffee. He also suggested the discount should be increased at least 50 cents or even $1 per cup.

Ace held similar perspectives to Paglia’s. He thinks changing the current incentive plan from a positive to a negative thing would have more of an impact on customers’ behavior. “If people want to use single-use paper cups, they have to be charged rather than get discounts when they bring their own cups,” Ace said.

The government plays a crucial role in reducing the use of disposable coffee cups. As an iconic brand, Starbucks does not want to revise their current market plan due to the fierce market competition and customer loyalty. However, Ace says that the government can push companies to change through establishing policies or drafting documents.

“They’re smart. They know that. If they don’t take action, it actually is worse for them,” Ace said. “I understand why they do it, but I think the example of the UK shows us that, as soon as either a city or a state government starts to take action on it, the private sector gets very active, very quickly. It’s an interesting dynamic.”

In July 2018, all Starbucks stores in the U.K. were required to add 5 pence, about 25 cents, to each single-use cup due to the introduction of ‘Latte Levy’ by the U.K. Parliament. This was to encourage people to reduce using disposable cups and cut down the enormous quantity of paper cups that could not be entirely recycled in the U.K. According to a report from the U.K. Parliament, more than 2.5 billion disposable coffee cups are used in the U.K. each year, but only less than 1 in 400 cups (0.25%) is properly recycled. Thanks to the rapid growth of coffee shops in the U.K. over the past 20 years, disposable coffee cups consumption will approximately reach 3.75 billion per year by 2025 without any regulation.

The trial worked. Six weeks after the ‘Latte Levy’ was introduced, the use of reusable cups in 35 selected Starbucks shops across parts of central and west London increased by about 150 percent, according to a preliminary assessment by Starbucks. Although the proportion of customers bringing in their own mugs was still modest – only 5.9 percent compared to 2.2 percent, the ‘Latte Levy’ was still seen as a long-term and effective way to control the use of disposable coffee cups in the U.K, according to a report by Independent.

“We are encouraged by the initial results of our trial that show that by charging 5p and increasing communication on this issue, we can help to reduce paper cup use,” said Jason Dunlop, the chief operating officer of Starbucks in the U.K.

In response to growing environmental problems, other European countries followed Britain’s lead in reducing the use of disposable coffee cups. Up to 200 million disposable coffee cups are thrown away every year in Ireland, according to MyWaste, an Irish government-funded organization. In November 2019, Ireland imposed ‘Latte Levy’ to cut down on single-use coffee cups. Customers would pay an additional 10 pence to the price of a takeaway coffee cup.

Besides, Germany introduced the ‘FreiburgCup’ scheme in 2016. The project aims to encourage people to use recycled cups in coffee shops. It is very simple for customers to participate. Customers only need to pay a deposit of one euro when ordering coffee to use the reusable coffee cups. After drinking the coffee, they can return the cups to any coffee stores and get the deposit back. For the convenience of the customers, around 60-70% of local coffee shops participated in the project in Germany.

South Korea, another leading country in coffee consumption, announced a campaign to curb the use of single-use at coffee shops in August 2018. Shop owners could be fined up to 2 million won ($1,780) if they are found to offer disposable cups to consumers frequently. In order to promote the implementation of the campaign, the government also provided financial support for recycling firms by 1.7 billion won ($1.5 million).

The cup of the future

Caption: Starbucks is experimenting with coffee cups in an attempt to reduce slowly decomposing waste. (Credit to Daniel Acker of Bloomberg)

Starbucks is taking action in the face of growing policy opposition.

In March 2018, Starbucks announced its new environmental plan regarding disposable paper cups. To create an innovative sustainable cup in the future, Starbucks and McDonalds pledged a fund of $10 million for the Closed Loop Partners, an investment platform that funds sustainable consumer goods, recycling and the development of the circular economy. As an essential part of investments, the NextGen Cup Challenge, an innovation challenge to redesign the fiber to-go cup, was created by the Closed Loop Partners.

The NextGen Cup Challenge attracted 480 entries, ranging from amateurs to industrial design firms. All 12 of the winning entries at the first stage came up with greener alternatives to the plastic lining, such as water-based coatings. Up to six of 12 winners will enter a business accelerator, where their innovations could be tested whether they can scale or not.

Caption: winning works of NextGen Cup Challenge. (Credit to NextGen)

“The level of interest we saw in the Challenge demonstrates a real appetite for long-lasting, sustainable packaging solutions,” said Kate Daly, Executive Director of the Center for the Circular Economy at Closed Loop Partners. “This level of industry collaboration in support of the NextGen Cup Challenge is really exciting, and we look forward to building on this momentum to encourage more innovative solutions. Fully recoverable fiber to-go cups are just the beginning.”

However, Starbucks was forced to make a promise to the public to quell the anger of people in 2008 that their paper cups would be 100 percent recyclable by 2015. Starbucks also promised that they would establish an incentive plan, which would encourage approximately one-quarter of their customers to bring their own coffee cups to the store. To achieve this goal for the environment, Starbucks also had a partnership with the Massachusetts Institute of Technology, aimed to develop new disposable paper cups.

But Starbucks failed to fulfill their commitments, saying that they were unable to find an available plan to execute after attempting for two years. Therefore, the company adjusted its promise for the number of customers they hoped would bring their own cups to the store from 25 percent to 5 percent.

Although Starbucks had failed to follow its commitments before, Paglia maintained a relatively optimistic attitude to this new environmental plan in response to the public pressure.

“There are more and more big Industry players working together to solve this problem, so I think that looks pretty promising,” Paglia said. “I would say that none of this would be happening if the public and if Stand.earth didn’t pressure Starbucks to live up to its original promise. I think that they are now going to do that.”