The Path to Recovery
Understanding The Fight Against Childhood Pneumonia in Rural Romania
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CORBASCA, Romania - A typical spring day in a village echo with the laughter of children playing in gardens and the chatter of neighbors crossing paths on dusty streets. But for five-year-old Antonia, these scenes remain often distant when she needs to stay indoors to protect her health. A severe case of pneumonia in her early years left her vulnerable to complications, and even a simple cold means she must stay home, needing to take extra care.
In their modest house, decorated with love and care, in the commune of Corbasca in Bacău county, Romania, Antonia’s grandmother, Maria, pours all her love into caring for the girl on her own. “Antonia is my heart/life. She is an energetic child, and she loves playing outside and, most of all, going to daycare. She asks me every day: ‘Granny, can I go tomorrow?’,” Maria says, lovingly describing her granddaughter. In rural communities like Corbasca, where many vulnerable families live, the path to health and well-being is often fraught with obstacles. For families like Antonia’s, even preventable conditions like respiratory diseases can become challenging, and many Romanian children pay a heavy price for poverty, low access to health services, education, or social support.
Antonia, five years old, sits on her bike in the dusty yard of her home in Scărișoara village, Corbasca Commune, Bacău County, Romania (Febryary 28th, 2024).
Maria fights back tears as she tells the story of almost losing her granddaughter to pneumonia at a very early age: “Her mother had just separated from her father, and Antonia had been in the hospital for pneumonia. After being discharged, she was supposed to continue the treatment at home, but they could not afford it. The girl ran a high fever and started seizing. That’s when I thought we’d lost her. She was not even three years old. Since then, I’ve always taken extra care of her, so that it never gets to that again”.
Antonia, five years old, and her grandmother, Maria, pose inside their home in Scărișoara village, Corbasca Commune, Bacău County, Romania (February 28th 2024). Maria is Antonia’s only caregiver, and she must pay particular attention to any signs of respiratory illness, ever since the girl had a severe case of pneumonia which left her vulnerable to complications.
Zooming out to the international context, the battle against pneumonia in children under five has made significant advances, but despite strides in reducing child mortality rates worldwide, vulnerable communities continue to be affected. Children face a disproportionate burden of preventable deaths, their lives cut short by diseases that thrive in conditions of displacement, poverty, and neglect. Within this global landscape, Romania stands out as a sobering statistic: it leads the world in mortality caused by pneumonia in children under five years old (2021). This startling data casts a harsh light on the challenges faced by vulnerable communities across the country.
At the heart of the matter stands a combination of medical vulnerabilities, aggravated by socioeconomic disparities, gaps in health education and even cultural norms.
“At a national level, the number two cause of death for children under five years old are respiratory conditions. This high mortality rate is also followed closely by the World Health Organization, and it is an indicator of the low level of parental education in Romania,” explains Dr. Cecilia Lucaci, who leads the Department of Health Promotion and Evaluation at the Bacău County Public Health Department.
Dr. Ovidiu Emilian Bibire, a dedicated family physician who has served the commune of Corbasca for close to 24 years, offers valuable insight into the complexities of combating pneumonia in young children. “There are multiple causes that factor into the high mortality rate from preventable respiratory diseases, especially in rural Romania. As we know, there is a high number of teenage mothers, who might not be prepared for the challenges of raising a child. Moreover, mortality rates are also fueled by poor social and economic conditions and cultural norms that prevent vaccination and addressing medical conditions in a timely manner. The medical system in Romania also contributes to these delays. If I refer someone for specialized testing in an acute phase of a disease, scheduling delays may even lead to the condition becoming chronic,” Dr. Bibire explains.
Education and prevention would, therefore, be the most potent weapons in the fight against pneumonia and the high child mortality rate it drives. Empowering mothers to recognize early signs of respiratory distress in their children, health and sanitary education, combined with vaccination, are the clear ways forward in solving this grave issue. Yet, vaccination hesitancy is strong, as Dr. Lucaci reveals. “Around 50 per cent of parents of children reaching immunization age are refusing vaccination in Bacău county. This is extremely worrisome, and in my opinion constitutes one of the main causes driving child mortality rates so high,” she explains.
Lăcrămioara, a community nurse, measures the pulse and oxygen saturation of five-year-old Antonia, during a home visit in the commune of Corbasca, Bacău County, Romania, February 28th, 2024. Antonia has a history of pneumonia complications and must receive careful health screenings in order to stay healthy.
Against this backdrop of intersecting challenges, however, in Corbasca, local health professionals work tirelessly to bring better access to services for vulnerable families. Working alongside Dr. Bibire is Lăcrămioara Vrânceanu, a community nurse whose dedication to fieldwork and the families she serves has made an exceptional difference for the community. “I conduct home visits to families in the villages, I identify vulnerable cases, I refer them to the doctor, and I counsel mothers and families on health matters such as the importance of hygiene, breastfeeding, nutrition and vaccination.”
Lăcrămioara’s mission in Corbasca started in 2016, when UNICEF led an ample project to identify vulnerabilities and support the definition of a Minimum Package of Services (MPS) which served as a blueprint for much-needed policy action. This concept includes the delivery of basic, integrated services in health, education, and social/child protection at local level, with a focus on the most vulnerable children. In the county of Bacău, this programme was followed by the piloting of five Integrated Community Centers (ICCs), through UNICEF’s flagship initiative Romania for Every Child, launched in 2021 . This project developed together with local and county authorities and professionals brought together at local level, specialized services free of charge, such as health, education, and social care, under the same roof in the heart of vulnerable communities.
Over 7,220 children and parents/caregivers have so far accessed the services provided by the integrated community centers (social, medical, educational services, specialized psychological services, physical therapy, speech therapy, etc.), over 1,000 adults participating in parenting education sessions.
Antonia, five years old, plays with a toy in bed in her house in Corbasca Commune, Bacău County, Romania, February 28th, 2024. The girl had a serious case of pneumonia when she was under three years old, and now has a predisposition to complications, which is why she must take extra care during recovery from even a simple cold.
The impact of UNICEF’s work, however, matters most beyond the field of national policy. As Lăcrămioara visits Antonia and her grandmother for a medical check-up, she offers kindness, advice, and information on the next vaccines, and brings them the peace of mind and optimism that only constant support can provide. Inspired by her, Antonia even dreams of becoming a medical professional herself: “When I grow up, I will be a doctor, so I can take care of all adults and children”.
