Between two worlds – about what I took home from Bucharest
There are places that not only change what you know, but what you feel, and Bucharest became such a place for me. I traveled there as an exchange student through the European Nursing Module with the idea that Romanian healthcare would naturally differ from Swedish healthcare, but I was in no way prepared for how deeply those weeks would affect me, not only as a future nurse but as a person in general.
Healthcare shaped by scarcity, carried by people
It was already clear during my first day at one of Bucharest’s emergency hospitals how much the environment itself shapes the work in healthcare. The corridors were worn, the equipment old and the record-keeping was largely done by hand, in folders and on notes that followed the patient through the system rather than in digital registers. Medicines were often stored openly on bedside tables instead of in locked cabinets, and even though the staff's knowledge was solid, I saw situations where the reuse of needles or the lack of protective equipment had raised serious questions in a Swedish context. It was rarely a matter of ignorance. Rather, it was an expression of completely different conditions, of an everyday life where people stubbornly and creatively make the best possible of what is actually available.
Behind the material scarcity, I still sensed an astonishing human ability to hold healthcare together despite everything. The staff improvised, collaborated closely and solved problems without complaining, and they read their patients with a sharpness that seemed to come more from experience and intuition than from technical equipment. Safety was created there not primarily through standardized routines, but through relationships, through physical presence and through a constant, lively dialogue between the people who worked side by side.
When death becomes part of everyday life
The strongest, and at the same time the most difficult, impression I carried with me from the occasions when I had to observe how death was handled in the Romanian healthcare system. In Sweden, we often surround the dying patient with silence, privacy and a conscious calm, but in Bucharest a death could occur in the middle of the morning shift, sometimes just a few meters from patients who were eating their breakfast at the same time, and the work continued without any real break or ceremony. A body could lie in the room for several hours before it was finally taken to the morgue, and what struck me most was not the callousness of the staff, but rather a form of silent resignation that grew out of a lack of time, a lack of space and a long history of prioritizing function over reflection.
The more I learned about Romanian culture, the clearer it became that the picture was more complex than that. In Romania, as in many parts of the Balkans, responsibility for the deceased often lies with the family, who bring the body home within a few hours to wash, dress and watch over it themselves before the funeral. It is a farewell that is in its own way much more intimate than the Swedish one, where the deceased is instead taken to a morgue and can lie for weeks or even months before the farewell takes place. Two completely different ways of relating to a person's last moments, one in the form of institutional order and the other of familial closeness, and neither of them alone possesses the whole truth about what dignity really means.
This also included the ethical questions that were raised around the absolute end of life. In Romanian hospitals, the law requires that full cardiopulmonary resuscitation be carried out for thirty minutes before a death can be formally confirmed, regardless of prognosis, age or diagnosis. The rule is there to protect staff from accusations of negligence, but in practice it often means that an already lifeless body is subjected to lengthy interventions that seem to serve the procedure more than the dying person. It made me think more deeply about how obedience to regulations can sometimes crowd out human judgment, and how difficult it can be to have an open conversation about palliative options within such a system when the very idea of forgoing life-sustaining measures hardly seems like a possibility.
Hierarchy, proximity and the silence that can follow from efficiency
I had expected a strictly hierarchical healthcare culture in Romania, and it was undeniably there, with doctors who were formally titled and whose decisions were rarely openly questioned. At the same time, I discovered in my daily work a teamwork that in many ways felt more equal than I had imagined, where nurses, doctors and assistant nurses talked, collaborated and solved problems together, driven more by common necessity than by formal protocols. It was as if the lack of resources paradoxically forced a form of practical equality that the flatter organization of Swedish healthcare does not always manage to achieve in practice, despite the fact that it formally strives for just this.
In Sweden, where we have access to more equipment, clearer routines and a significantly more developed digital infrastructure, I instead noticed how easily human presence can be silenced for the sake of administration. Documentation tends to replace conversation, and screens tend to replace eye contact, which certainly gives us a higher degree of security and traceability but at the same time risks making care more impersonal, even when it is provided by staff with deep empathy. In Romania, on the contrary, it was the lack of systems that forced conversation, since people simply had to talk to each other to be able to deal with the situation at all.
Integrity, community and different perceptions of dignity
One of the situations that stayed with me the most was about a woman who had one arm tied to the bed because she had repeatedly pulled out her intravenous catheter. I know too little about how a similar situation had been formally handled in Sweden to be able to make a fair comparison, but from a purely human perspective, the sight struck me, and raised a question I still carry with me, about where the line actually lies between protecting a patient and depriving her of her freedom, and whether that line even looks the same everywhere.
Another thought that grew stronger during my weeks in Bucharest was about how differently the concept of integrity can be perceived depending on the cultural background you find yourself in. In several healthcare situations, examinations were carried out openly, in shared rooms where several patients were at the same time and where screens functioned more as symbolic markers than as actual boundaries. Seen through Swedish eyes, this aroused discomfort, since we are used to associating personal integrity with privacy and solitary space.
But gradually I understood that Romanian culture values community more than solitude in a different way, and that being surrounded by others, even in illness, can be experienced as a sense of security rather than an intrusion. What from a Swedish perspective appears as a lack of integrity can instead be an expression of care in a different form in the Romanian context, an assurance that no one should have to suffer in complete isolation. This insight made me realize that dignity is not a universal and unambiguous concept, but something that is deeply shaped by the society and history of which one is a part.
The invisible resources
If there is one thought I wish more people would take with them from my time in Romania, it is the realization that the most important resources in healthcare basically cost nothing. To really see another person, to listen without rushing on, to touch someone with care, to call someone by name and thereby confirm that that person exists and matters, these are abilities that cannot be bought, measured or entered into a medical record system, and that is precisely why they risk being forgotten in both resource-rich Sweden and resource-poor Romania. In Swedish healthcare, they are threatened by time pressure and administrative demands, while in Romanian healthcare they sometimes appear as the only tools actually available. But in both systems, it is these invisible resources that constitute the deepest core of healthcare, and it was above all they that carried Romanian healthcare when so much else was lacking.
The silent trauma and collective memory
During my last weeks in Bucharest, I gradually stopped just observing hospitals and care routines, and instead began to listen to the voices around them, taxi drivers, guides, pharmacy staff and ordinary patients who over time shared more than I had expected. Through these conversations, I gradually understood that the way Romanian healthcare works cannot be separated from the country's history, and that the silence I encountered in the wards is in fact the same silence that permeates large parts of society in general.
Several people spoke with palpable resignation about how corruption and unequal treatment still shape everyday life, for example through the custom of bringing a small gift, sometimes just a packet of coffee, to the family doctor to ensure slightly better service. A guide I spoke to refused to participate in this herself, describing it as a remnant of a system where access to care had always been as much about relationships and unwritten rules as it was about law and competence. What struck me was not the event itself, but how naturally it was described, as if inequality had become part of the landscape rather than something to arouse anger.
Even more striking was the silence that surrounded the communist era. Since the fall of the regime in 1989, public discourse about surveillance, denunciations and fear has remained surprisingly limited, and many of those I met deliberately avoided reading the now declassified files that reveal who once denounced friends, neighbours or even family members. It is better not to know, one woman told me, and the words stayed with me long afterwards. The silence seemed to protect against the reopening of old wounds, but it also prevented any possibility of joint processing.
It was possible to sense how this unreflected past had, over time, been transformed into something physical and social rather than merely historical, a form of distrust and weariness that had been passed down between generations without ever being properly put into words. A taxi driver himself expressed it with a mixture of cynicism and sharpness, when he noted that people pretend that everything has improved now, when in reality the same people are still in control behind the scenes. In his words there was both resignation and an unbroken capacity for humor and warmth, as if the Romanian spirit had remained alive through the most difficult times.
It was in these conversations that I seriously began to understand that the emotional distance of healthcare in the face of death, which I had seen in hospitals, was perhaps not just a matter of a lack of resources, but also a reflection of a larger national habit of not dwelling on the difficult. A society that constantly turns its gaze away from its wounds carries with it a risk of never truly healing, just as a person whose unprocessed emotions can, over time, manifest themselves as illness. Romania taught me that care extends beyond the individual encounter between patient and caregiver, and that it also encompasses how an entire society relates to its own suffering, its history, and its ability, or inability, to heal together.
The escape from the country that shaped me during these weeks
The more time I spent among Romanian nurses, the stronger an uncomfortable realization emerged, namely that the warmth, competence and presence I encountered with them existed in parallel with an ongoing loss. Every year, thousands of Romanian nurses and doctors leave their home country to seek better pay, safer working conditions and professional recognition elsewhere in Europe, often in countries such as Sweden. It's called brain drain, and it's easy to treat it in passing as a statistical term, but behind the numbers hide concrete gaps in departments that are already struggling with scarce resources.
It is hard not to see yourself in that context as a guest from one of the countries that benefit from this movement. The Romanian care I admired for its intuition, its ability to improvise and its human presence is supported by people who every day choose to stay even though the alternative, traveling west, would often have meant a much simpler existence. At the same time, it is precisely this emigration that further thins the resources of a system that is already hard pressed, and thus indirectly reinforces exactly the conditions I reacted to during my observations.
Here arises an uncomfortable ethical question that I cannot avoid asking myself. When richer countries like Sweden, often with open arms, receive the skills that other countries have invested in training, who actually bears the cost of that inequality? As a visitor, it is easy to be happy about the competence and care you encounter, but more difficult to at the same time retain the idea that the same system that makes my own home country's care strong, partly rests on a resource transfer that makes other countries' care weaker. Justice in global health is therefore not only about distributing resources between countries, but also about recognizing these movements, and the human choices and sacrifices that lie behind them, as part of the same whole that I would otherwise like to celebrate for its warmth and commitment.
What remained
I didn't go to Romania to decide which country does the best care, and that question became increasingly uninteresting the further into my observations I got. What stayed with me instead was a deepened understanding that care, regardless of the system within which it is practiced, is fundamentally always about the meeting between people and the will to do good with the means that are actually available.
Sweden represents order, security and a quest for equality, but at the same time risks losing some of its warmth and spontaneity in the bureaucracy and documentation requirements that surround the profession. Romania represents closeness, intuition and a tangible resilience, but struggles with a material scarcity and with ethical dilemmas that are rarely given space to be discussed openly within the system. Each of these systems carries something that the other could learn from, and perhaps it is precisely in the meeting between them, between structure and presence, between competence and compassion, that the most sustainable form of care can finally emerge.
My weeks in Bucharest became one of the most formative parts of my education, and they form the basis of my more comprehensive reflective report Reflections on Nursing Practice and Human Values – Beyond Borders. The same questions continue into my book From system to soul, a new vision for care, where I explore in more detail the invisible space where medicine meets the human (to be published in 2027). If you want to listen to the experience, there is an episode from "En Sjuk Pod" where we talk about the exchange at the school.
What I take with me from this trip above all is the conviction that care, wherever in the world it is practiced, is ultimately about the same thing. To see the other person. To remain in the encounter. And to dare to be fully human for another person, even when the systems around are not always enough.
Anna Wretling, nursing student, Sophiahemmet University