When the hospital comes home. The story of Maria and a service that brings part of the treatment closer to the children with cancer.

When the hospital comes home. The story of Mara and a service that brings part of the treatment closer to children with cancer. Illness quickly changes the geography of a childhood. The child's room, kindergarten, playground, and grandparents' house—the familiar landmarks of a just-begun life—begin to share the map with wards, offices, analyses, and repeated journeys to the hospital. For children undergoing oncological treatment, some of these journeys are inevitable. Others can be avoided. And the difference can mean a few extra hours at home, saved expenses, and less fear. A blood test done at home may seem like a detail. For the child and family, however, it can mean a morning without traveling dozens of kilometers to the hospital, without waiting, and without another day spent in a place already associated with the illness. Sometimes, the journey can be taken in reverse: the medical team comes to the child, into his home world—among toys, dolls, and the mother's arms. In some mornings, Mara, the child with cancer, waits by the window. From the window of the apartment in Urziceni, the child follows the street until he recognizes the assistant's car that he loves the most, Irina. Together with his mother, Elena, they look out the window long before the time they need to arrive. When this happens, Mara begins to make hand signs to her. After a few minutes, on the other side of the door is the medical bag that she already knows very well. Somewhere in this bag are the stickers with drawings that the girl wants for herself and, if possible, for the dolls that will be "consulted" after collection. Before collection, the game begins: the assistant puts her on guard and tries to guess what she ate that day. "Soup? Juice?" The little one listens fascinated. She cries, she is afraid, but the assistant knows she won't pull her hand away. "It was so small and, yet, so brave," she tells. After collection, she receives a hug, and then Mara and the assistant continue the consultation of the dolls, sticking stickers on the other "patients" in the room. On leaving, Elena holds her in her arms and goes to the balcony for Mara to make signs for Irina until the car disappears. For Mara's family, the fact that the assistant comes home means something enormous: that day, the child does not have to spend the day on journeys and at the hospital. Before the "sticker bag" there was the hospital, the operations, and the fear. The story began when Mara was only one year and a few months old. The mother accidentally noticed a small formation in her abdomen. In the family, she would later receive a name almost childlike—"the magic" (vrăjitoarea) for something that changed their lives. The operations followed. After the first intervention, an intestinal occlusion made a second one necessary, and the child spent almost two weeks in intensive therapy. Later, recurrence came, and with it, another intervention. When the family reached the Oncology Institute of Bucharest, the little girl had gone through so many procedures that the simple appearance of a medical team in the room was enough to make her cry. The mother remembers the dreadful feeling of the first days: "I felt the drama of all the children who crossed the threshold of the ward where we were to 'fall' for an undetermined period." Only because discharge does not mean the treatment is over: the analyses, checks, and repeated procedures continue. For the first home collection, this time the assistant was the one who made the journey. In Mara's home there were no hospital corridors, wards, or waiting rooms. It was her room, her mother was beside her, and the toys were a few steps away. "The fact that she came home to collect helped us enormously," the parents tell. "With Mara in her environment, she saw in the assistant a partner, not a man who is going to 'torment' her." In the following months, the child who used to cry when seeing a medical team began to give the disinfectant spray himself, to ask what was being put into his IV, and to check with the assistants whether the device through which he received treatment was bandaged correctly. Today, Mara's mother says, when she goes for a check-up, the girl sits alone on the chair, extends her hand for collection, and just asks to be next to her. A collection done at home remains a collection. But, for such a small child, where they are when they are afraid is extremely important. For hundreds of children, the journey becomes part of the treatment. In Romania, approximately 450 children are diagnosed with cancer annually. For many, treatment extends over months or years and, between hospitalizations and chemotherapy sessions, analyses, evaluations, and monitoring are necessary. Sometimes, even a blood count can turn a morning into a trip to the hospital, to which for families living dozens of kilometers away, travel, costs, and reorganization of daily life are added. The hospital remains indispensable. But some interventions established by the attending physician—from sample collection and administering certain medications to monitoring between treatments or caring for medical devices—can be safely performed at home. The doctor decides what needs to be done in the hospital and what can be transferred home. Alina Pătrăhău, a founding member of the Give Aripi Association, remembers the question that was at the beginning of the program: "Why should the little patients come to the hospital for analyses, bandages, an injection?" Between treatments, some children were unwell, some vomited on the way. The answer was that the specialized assistants would make the journey to the child. In 2018, Give Aripi launched the mobile pediatric oncology service at home, and later developed the DARA digital platform. "After we built infrastructure in several places, we began to build care capacity at the national level. Clinical processes, instruments, and mechanisms with impact for all children with cancer in Romania. In fact, a systemic change," says Alina Pătrăhău. The child stays home. The doctor stays connected. Home care functions as an extension of the medical team beyond the ward. Behind the visit, information continues to circulate between the assistant, the family, and the doctor. "We organize the visit together with the assistants from that ward. After the patient's visit is over, the sample goes to the laboratory. The results are entered into our DARA platform, and the attending physician receives a link, visualizes it, and then sends me the medical instructions, which I communicate to the parents," explains Andreea Drăgan, the program coordinator. The service works together with the pediatric oncology teams from the Oncology Institute of Bucharest, the Emergency Clinic for Children "Marie S. Curie," and the County Emergency Clinic of Constanța and reaches families in Bucharest, Ilfov, Prahova, Dâmbovița, Ialomița, Călărași, Giurgiu, Teleorman, Constanța, and Tulcea. The services are free for the children and their families. 3,800 visits and 205,000 kilometers that children no longer have to travel Between 2020 and September 2026, according to data provided by Give Aripi, 3,800 home medical visits and over 8,000 at-home analyses were carried out. These meant approximately 205,000 kilometers of travel to the hospital that children and their parents no longer had to make and over 6,000 days of hospitalization that were no longer necessary. Give Aripi works with experts from St. Jude Children’s Research Hospital to analyze the effectiveness and cost-benefit ratio of the service. The organization's experience and the development of DARA have also contributed to the proposals formulated together with the Romanian Society of Pediatric Oncology-Hematology for the National Plan for Cancer Prevention and Control. Alina Pătrăhău condenses the bet in a question: "What if the chance of survival no longer depended on the postal code?" Who makes the journey possible in reverse Zentiva Romania is among the partners who actively support the work of the Give Aripi Association and the home pediatric oncology service. For the company, involvement in such a project extends the idea of access to health to the possibility for care to reach the patient. It is an approach that is linked to one of the principles assumed by Zentiva: health must be a right, not a privilege. "The real impact appears when a good solution can constantly reach the people who need it. Community organizations often identify concrete problems very well and build mechanisms that work. The role of the private sector can be to provide continuity and resources to grow. The Give Aripi Association captures what this can mean: sometimes, support is simply translated by the experience of an oncological child, who no longer spends hours on journeys and in hospital corridors," explains Ioana Lucescu, Communication & CSR Manager Zentiva Romania. Back to the ordinary things Today, Elena says that the family is trying to restart their lives. Mara started kindergarten, and the mother returned to work. These are ordinary things, but after months spent between operations, intensive therapy, treatments, analyses, and checks, the routine gains another weight. Mara has doctor's shoes, listens to dolls with "stickpotul," and stickers are indispensable for almost every pimple. Perhaps a child who goes through oncological treatment so early cannot keep the hospital completely out of their childhood. But when part of the care can follow them home, the hospital no longer has to occupy their entire childhood.