Taxing Albania’s Health Care System

Idriz Mulaj didn’t have much choice about where to continue his kidney dialysis treatments when the war between Yugoslavia and NATO exploded in his Kosovo homeland.

“The Serbs came into the hospital and told us to leave within five minutes or they would throw us out the windows,” the 38-year-old from the village of Klina recalls of the April day he left the dialysis clinic in Pec and began a four-day trek to the relative safety of Albania.

But once here, Mulaj and four dozen other Kosovo Albanians in need of the costly blood processing treatment discovered that Albania had been unable to care for its own citizens even before the refugees’ arrival placed new demands on Europe’s most primitive health care system.

And as they struggle to cope, many Albanian health care professionals express some resentment that the outside world sat up and took notice of the country’s plight only because the Kosovo Albanians have come here.

Tirana University Hospital has the only dialysis capability in the country: nine machines--only six of them working--and too few nurses and technicians to operate around the clock. Water and electricity are often interrupted here, even to hospitals, further hampering the clinic’s efforts to keep in service what equipment it does have.

Mulaj and other Kosovo Albanians have settled into a daily ritual of milling about in the hallway outside the dialysis clinic, hoping to wheedle staff to stay later or forgo a break to put them on one of the machines that do the blood screening work left undone by their dysfunctional kidneys.

“We came here because we thought we’d be safe. We didn’t realize we might be going to our deaths anyway,” says Adnan Goca, 30, a grocer from Pec, Kosovo’s second-largest city.

Those suffering kidney failure should have dialysis three times a week for about four or five hours per treatment, physicians familiar with the ailment says. But the average treatment routine for those in Tirana--refugees and Albanians alike--has been twice weekly for two hours per session.

Although dialysis is required by fewer than 50 of the 450,000 Kosovo Albanians who have flooded into Albania over the last 10 weeks, it is a life-or-death matter for those whose kidneys have ceased normal function.

Of an estimated 150 Albanian citizens in need of dialysis treatment, only about 30 were getting help at the university hospital before the Kosovo influx, hematologist Ahmet Durako says.

“People were coming here and dying on our doorstep because we couldn’t treat them,” Durako says of the desperate situation at the clinic before the Kosovo patients’ arrival drew international attention to their plight.

The help being promised by international relief organizations, such as Los Angeles-based International Medical Corps, is urgently needed and welcome, Durako says.

“They were doing the best they could do,” says the IMC’s Dan Spicer, a volunteer from Denver who has been working with the Office of the U.N. High Commissioner for Refugees, and other international organizations, on proposals for long-term assistance to Albania to relieve the dialysis overload.

Several projects are being weighed by the U.N. refugee agency, including upgrading the existing clinic, training and expansion of the dialysis technical staff, or construction of a free-standing dialysis clinic if the university hospital infrastructure problems prove insurmountable.

The dialysis clinic is on the third floor of a battered building in an area of the capital that suffers power outages in winter and a water shortage in summer. With tens of thousands more people now living in Tirana as refugees, the water problem is expected to be acute this season.

“Underlying all of these problems is an inherent lack of financing in the system,” says Katherine O’Hanlon, a former emergency room physician at Long Beach Memorial Hospital who has been volunteering for the IMC and other relief works the last two years. “Dialysis is very expensive, and it won’t do anyone any good if we don’t leave behind a sustainable system.”

Dialysis costs an average of $8,000 a year per patient, but money is the solution to only part of the Albanian problem.

French and Italian aid agencies rushed in with donated supplies and new dialysis machines soon after the Kosovo influx, but because they left after a month and trained too few people to operate the new equipment, the machines have malfunctioned and are no longer in use, nurse Mirela Qafa says.

The 28-year-old nurse--who is expecting a child in four months--says she works 11 hours a day, six days a week for a salary of about $50 a month. Doctors make about $70 monthly for the same working conditions.

Despite the numerous obstacles to helping Albania with the dialysis shortfall, time is of the essence, and some relief must be immediate to be effective, Spicer says. “Building a new [dialysis] center that needs a year and a half or two years to be built doesn’t work, as everyone would be dead by then,” he points out.

One foreign gesture that has helped take the pressure off the overloaded Albanian system was Austria’s decision in late May to evacuate 14 of the most urgent Kosovo cases to Vienna for treatment for as long as they are unable to return to their homeland.

For those left in Tirana, getting dialysis treatment is a daily battle, and the victors are usually those who have fallen into the more dire condition.

“You can feel yourself being slowly poisoned. You feel like you can’t breathe,” says Mulaj.

The former auto worker says he has been spending his first hours of well-being after dialysis pressing foreign embassies for inclusion on potential medical evacuation lists, but to no avail.

“This hospital is not able to take care of its own patients, never mind all of us,” he says. “If the outside world doesn’t help us or take us away, we are all going to die here.”