“Above all, do no harm “is a maxim held sacred by doctors and medical students all over the world. But in Alexander Nanau’s Collective, a blistering exposé of the Romanian healthcare system, when medical treatment is hindered by corruption, negligence and incompetence, the consequences are tragic. The documentary was recently chosen as Romania’s entry for Best International Language Film for the 93rd Academy Awards.
On October 30, 2015, the band Goodbye to Gravity was celebrating the release of its new album at the Bucharest nightclub Colektiv. The underground nightclub, popular with Romanian youngsters, only had one exit, with its operating license obtained through bribes. When the pyrotechnics used for the show—deemed for outdoor, not indoor, use—ignited the acoustic foam of the nightclub ceiling, the flames spread rapidly. The fire claimed the lives of 27 people on site, and injured 180 more.
Tragically, nightclub fires occur far too frequently in many parts of the world. But what happened in the following days, gave the story a uniquely Romanian twist. As the wounded were transported to area hospitals, the country’s Health Minister promised that the burn victims would be given the highest level of care. But in the following weeks, 37 more patients died slow, agonizing deaths in the hospitals, despite repeated efforts by the relatives to have them transported out of the country for medical care.
Mass protests erupted over the bureaucratic incompetence, and led to the resignation of Romania’s prime minister, Victor Ponta. The unusually high death toll of the burn victims, spurs Gazeta Sporturilor, a sports daily, to look into the efficiency of Romanian hospitals. As its investigative team, lead by editor Cătălin Tolontan, delves into the story, two female doctors come forward and reveal a shocking fact: over half of the burn patients died from contracting severe infections from antibiotic-resistant bacteria in the hospitals. Many would have been saved if they had been transferred for treatment abroad in the first days after the blaze.
What ensues is therefore a double tragedy. Gazeta uncovers the appalling truth that the disinfectants used in Romanian hospitals are highly diluted, to the point of being no longer effective, and even the surgical sterilization tanks are rife with bacteria. Romania, in fact, has the highest ICU death rate in the European Union.
The film is wholly observational—no interviews or commentary. The result is an edge-of-your-seat thriller, reminiscent of All the President’s Men, as the journalists uncover fraud, corruption, malfeasance and inhumanity at the highest levels of the medical establishment.
On the phone from Bucharest, Nanau recalls, “It was a national tragedy, and because so many people took to the streets after the fire, protesting against the political class for being corrupt, it seemed really to be a new development in society after the revolution 30 years ago.” He explains, “I was very aware that what the authorities were doing after the fire was manipulation. I was aware that they were really incompetent and corrupt, and they acted as if they would be professional. Their message was, ‘Our healthcare system is the best and is totally prepared, and lacks nothing that the healthcare system in Germany would have,’ and it was clear to me that was a big lie.”
“The whole press just took their word for it and they just spread whatever the government would say, the message of competence,” Nanau adds. “And the only ones who really started to ask questions, and to unveil the manipulation and the incredible lies, were Cătălin and his team. And while at first I was interested in the relationship between power and citizens in a very young democracy, suddenly I realized that the best angle for that would be through the eyes of investigative journalists. The question was if Tolontan would let us follow him in his investigations.”
For a sports daily to uncover a massive healthcare scandal may sound unusual, but as Nanau elaborates, “They are really very experienced investigative journalists, but in the sports world. They wrote about sports ministers, about the big bosses of football, and the corruption with the training of players. But because it was a national tragedy, they felt the obligation to put their knowledge and their skills in the service of this new development in society.”
The unfamiliar subject of Gazeta Sporturilor’s coverage helped both the reporters and the filmmakers. “When they started to investigate the healthcare system, their asset was that nobody was taking them seriously. That's why they could get so much information. ‘Okay, sports journalists…Let them ask their stupid questions and they will go away. We will play them’.” Nanau adds, “And it was the same, I guess, with us. Nobody could imagine what someone’s doing recording all the time. What can you do with so much footage? So nobody was ever taking the documentary seriously. And that was our advantage.”
As the scandal unfolds, the story grips the nation as layers of bribery and large-scale venality are revealed. “There are other investigative platforms, but most of the readers are a very small, intellectual group of people. So the brilliant thing about this, is that Tolontan’s paper is really read daily by a very wide group of people. So his power comes from the fact that it's a sports newspaper, it has a very wide readership, much larger than [other] investigative journalists, that have a smaller, maybe more intellectual, following.”
The film also includes families of the victims and a severely injured survivor of the fire. Gaining their participation was not easy, as the director attests. “We had to build their trust because first of all, they were assaulted by all media, so they didn't really trust the media. It was not easy to explain that we would like to follow them for a month. It was something that nobody really understood—because at that time nobody could really make a difference. What helped a lot was the fact that we hired Mihai [Grecea as a soundperson]; once he was out of coma, he joined our team. And because he a victim, because he was in the fire and barely survived it, that helped a lot to gain the trust, for them to see that we are not another outlet that needs fast footage for their evening news.”
As Gazeta Sporturilor reports on the disinfectant scandal, the story starts to take some dark, unexpected twists: the main subject of the investigations dies in suspicious circumstances, and it is revealed that some hospitals are being managed by unscrupulous mobsters with no background in medicine or finance. When asked if he was ever scared for his personal safety, the director replies, “I don't know if I was really scared. I was worried and I knew that my phone was tapped. I knew that the secret service was following me and my team. I was just really worried they might break into our studio and steal our footage. So we were very cautious, and every evening we would copy the footage onto four sources. And every evening we had people leaving the studio and going in different directions with the footage, hiding it, and then from time to time we brought it out of the country.” But he concedes, “There were so many things going on, that I did not really have the [time] to make the reflection. We went to work all the time. I was barely sleeping.”
As the scandal forces the old party stalwarts to resign, a baby-faced, mild-mannered financier, Vlad Voiculescu, is appointed as the new health minister. Nanau was granted unprecedented access to film ministry meetings. He recounts, “I called and asked for a meeting. It took about a week before he answered. I explained what I was doing, and he knew that being transparent was the only chance he’d have to show he was different. So he had the courage to let me film him.” Reflecting on it, the director asserts, “Vlad might have been appointed in order to absorb the negative energy, and nobody thought that he might become a danger. Nobody thought that he might take action, and really do something with his team.”
The young politician encounters constant bureaucratic hurdles in attempting to clean up the healthcare system. His efforts to improve the conditions in hospitals are stymied by populist media and nationalist politicians accusing him of being an outsider with foreign ties.
“Unfortunately the healthcare system in Romania is rotten to the core,” Nanau declares. “The heads of the healthcare system are also the heads of the medical universities, and that's where they start to impose their rules of corruption. People that are really dedicated cannot be fine with the fact that, starting in medical school, you learn that you have to bribe your professor in order to be assigned to a good working position in a good hospital. The exodus of doctors is very high.” He continues, “Even before [the Colektiv fire] the number of people dealing with hospital infections in Romania was very high. The journalists said there's no family in Romania that does not have at least one relative fighting infections after being in a hospital or having surgery. So the hospital infections were known by the authorities.”
Reaction to the film in its native country was noteworthy. “We had record numbers for the two weeks that we were in cinemas, then COVID hit and they had to close down,” Nanau explains. “We had 25,000 admissions, which is huge for a documentary in Romania; people aren’t used to seeing documentaries in the cinema.”
He adds, “What Collective did in Romania, it really was a turning point. After it started, the number of whistleblowers exploded. They have ten times more whistleblowers coming to them from inside different systems. So the courage of these women changed society, because they made it possible for journalists to unveil the truth. And once the veil was taken off many people said, ‘There's no way to stay, we'll leave.’ We had really the highest emigration numbers in Romania.”
Nanau acknowledges that the most difficult aspect of making the documentary, “besides the fatigue from the effort of being ready to film at any moment, was the emotional impact while working with the parents and the victims. When you shoot observationally, you really identify with these people, and you really have to be there in a certain emotional way. And trying to identify with parents who lost a child that they did not have to lose, and parents that had a solution and were obstructed by professionals, that lied to them in an organized manner. I think this is really the greatest pain I can imagine in anybody's life.”
As for the impact making the film had on him, he asserts, “I was encouraged even more in my belief that I have to take action and there are no compromises ever to be made when we face corruption. My tolerance for incompetence now is zero. Populists make all these promises, but when they come into office, the first thing they do is to destroy institutions. And the first thing they do is to replace professionals with incompetent imposters. Because an incompetent person, if assigned to a much higher position than he ever could have gotten, will serve you forever. And there is a point of no return if too many professionals are exchanged with incompetent people that serve the ones that appointed them. So my tolerance for that has to be zero.”
Collective opens in virtual cinemas on November 20 through Magnolia Pictures. Watch Q&A with Alexander Nanau via the IDA Documentary Screening Series.
Darianna Cardilli is a Los Angeles-based documentary filmmaker and editor. Her work has aired on Bravo, A&E, AMC and The History Channel. She can be reached at www.darianna.com.