The Sanitary Network close to the railway workers

Interview with Constantin Nitoiu, deputy director general of the General Department for Management, Strategy and Sanitary Network within the Transportation Ministry

Railway Journal: Why is this department needed in transportation?
Constantin Nitoiu: Within the Transportation Ministry there is the General Department for Management, Strategy and Sanitary Network (DGMSRS) which, after the ministry was reorganized by G.D. 263/1999, is a specialized body in medical and psychological assistance for personnel involved in traffic and navigation safety. The importance of this department is shown in the fact that in can, apply, within the Transportation Ministry, the sanitary reform policy. The department has the obligation to coordinate the activity of the ministry's own sanitary department, and is a network parallel to those of the Defense Ministry, Interior Ministry, SRI, SIE and the Justice Ministry. DGMSRS applies the methodology of the Health Ministry, but is subordinated to the Transportation Ministry.
R.J.: What is the connection between the hospitals, clinics and health centers of the CFR and Transportation Ministry?
C.N. Initiated 120 years ago, the Sanitary Network of the Transportation Ministry developed on the framework of old CFR regional companies, out of the need to ensure the proper health of railway personnel. In this context, numerous hospitals, clinics and health centers in railway stations were assisted by the management of each regional company. They are called railway hospitals and clinics because they were built in the patrimony of the railways. Along the years, with the reorganizations, together with the personnel with attributions in railway safety, the need was felt to control the physical and mental capacity of personnel in road, naval and air transportation, which led to the integration of DGMSRS within the ministry.
Therefore, the authority and control function of the DGMSRS has a unitary framework in the following attributions: elaboration of specific instructions, approved by minister's order, on the organization of the medical and psychological examination for traffic personnel; elaboration of criteria and methodology of granting health care stations in our network; hygiene in transport means and afferent units.
R.J.: What is the territorial organizational structure of the Transportation Ministry's Sanitary Network?
C.N.: The own Sanitary Network of the Transportation Ministry comprises 15 regional railway hospitals, 25 regional clinics (in 19 counties), 239 health centers (covering all regions), and eight Public Health Departments. The basic structure, with a juridical personality, is the regional hospital, which subordinates clinics and health centers, including dental clinics. Of the 25 clinics, 17 are located in the same building with the hospital and eight have separate buildings. Territorial clinics include territorial traffic safety commissions, and the central files. The Sanitary Network is served by around 5,800 employees, of whom more than 1,300 doctors, sanitary personnel specialized in testing the health of transportation employees. Our sanitary network also includes more than 130 psychologists that work in railway as well as auto psychological laboratories, and are in charge of issuing psychological certificates. This is how our network is different from the sanitary networks controlled by other ministries. We ensure traffic safety.
R.J.: Health care has been the subject of numerous modernization efforts lately. What can you tell us about the modernization of the Sanitary network?
C.N.: Lately, the General Health Department has involved in a lot of projects and regulations regarding all fields needed for a proper operation of the health care system. Under the direct guidance of Gheorghe Dobre, secretary general within the Transportation Ministry, and Ionel Voicu, director general at the General Juridical Department, a number of laws have been finalized that have brought about a full health care reform. Of course, the entire activity would not have been possible without the direct implication of the Transportation Ministry. Mr. Traian Basescu has supported the promotion of these laws, essential for reform.
First, I would point out the improvement in the legislative framework. I believe one of the strongest points is the adoption of Emergency Ordinance 41/1998 on the organization of health care for transportation personnel, with attributions in traffic and navigation safety, and the establishment of the Transportation Health Insurance House (CAST). The importance of the ordinance lies in the fact that is establishes a better organization of medical and psychological activity, and CAST provides the non-budget financing of our sanitary network. This led to our economic independence, and we have avoided the risk of being absorbed by the Health Ministry.
R.J.: Could you say a few works about the originality of the Transportation Health Insurance House?
C.N.: I will try to remind a few elements that make our insurance house special:
- it operates across the entire country and operates similarly to county social insurance houses;
- it directly manages the money collected;
- it approved in a representatives meeting the revenues and expenses budget, approved by the Transportation Ministry;
- it manages, as loan taker, the collected amounts;
All these elements are intended to provide a proper functionality, offering the possibility of better financing for the Transportation Ministry's own sanitary network; this is available to all personnel, especially railway employees, the most numerous group in the sector.
R.J.: To return to sanitary reform, what can you say about the activity in hospitals, clinics and health centers?
C.N.: Also part of sanitary reform is the declaration by Order 731/1999 of Traian Basescu, of seven hospitals, in Bucharest (CF 2 Bucuresti and Witting hospitals), Cluj, Constanta, Craiova, Iasi and Timisoara, as university clinical hospitals. These hospitals meet all criteria and are authorized by the Health Ministry and the Ministry of National Education. They are active in higher medical education ad in research, with students of the Medicine Institute and residents specializing in a clinical discipline, which proves once again the strength of our ministry's own sanitary network, still the largest sanitary network parallel to the Health Ministry.
Reorganization is also advanced with specialized, general and dental medical cabinets n the 25 clinics. Clinics' main activity is to test transport personnel physically and mentally. Mandatory medical tests in these territorial branches include: internal medicine, surgery, ORL, ophthalmology, and neurology-psychiatry. They issue diagnoses through para-clinical methods (medical analysis laboratories, neurology-imaging, functional samples, etc.).
In the 239 health centers equipped with general medicine and dental cabinets, traffic safety personnel is periodically tested for restlessness; the results are passed on to territorial clinics. Health centers are found in railway stations, depots, ports and airports. The activity of these units will be reorganized by order of the Transportation Minister on approval of the criteria and methodology for granting or leasing spaces and goods.
Also as part of the sanitary reform in the Transportation Ministry, there was the change by minister's order of the regulation on the organization and operation of Transportation Public Health Departments, which will provide a modern legal framework for the operation of these newly established institutions.
R.J.: Over time, you have managed to develop this sanitary network almost entirely. Now, at the end of the year, would you like to say a few works to those who save supported you?
C.N.: The DGMSRS wants to thank, through the Railway Journal, all those who have helped us in the development and strengthening of our network, especially Traian Basescu, Transportation Minister, Gheorghe Dobre, secretary general, and all general directors in railway, road, naval and air transportation.
We are a sanitary network with a well-prepared medical personnel, specialized in traffic safety. I want to assure the entire transportation personnel, especially the railway employees, who are working day and night in difficult conditions, that our network's sanitary and medical personnel will always be available for them.

Constantin Nitoiu Deputy director general at the General Department for Management, Strategy and Sanitary Network within the Transportation Ministry; primary doctor; urology surgeon; grade IV, at the CF 2 Bucuresti hospital in 1979, Ph.D. in medical science in 1982, active member of the International Urology Society since 1985. Published 69 scientific papers, of which nine abroad.

Interviewed by Oana Bran