Spitali Rajonal, Shkoder

Summer 2013: Extern at General Hospital in Shkodra, Albania 

 Having worked and volunteered in both hospitals and clinics in America I wanted to experience first hand the quality of health care that is provided in other parts of the world, as well. In the summer of 2013, while visiting my country, I spent time in the regional Hospital of Shkoder, one of major cities in Albania. I shadowed physicians and other medical staff in several wards and I saw how care was provided. My grandfather, Pandi Todhe, and father, Teodor Todhe, had both worked in this hospital as Doctors in the Pediatrics wing. It felt surreal walking through those very same hallways, seeing their names written on the walls in their honor, and interacting with the staff in the similar manner that they had once years ago. 

woman holds her newborn

Quality is typically assessed through the interaction between individual doctors and patients. However, emerging evidence shows that the average quality of care given by groups of doctors and other providers is an important determinant of overall community health status. For example, in a cross-sectional analysis in the former Yugoslav Republic of Macedonia, researchers found not only that patients' heath status was significantly higher in areas where quality was higher but also that the overall self-reported health status of those members of the general population who had not recently received care was higher (Peabody, Tozija, and others 2004).


According to WHO, the leading cause of disability, disease, and death in developing countries stem from the environment. The health hazards in the environment include poor water quality, lack of sanitation, vector borne diseases, and toxic substances in the communities, work place, or even in their homes. (A)

My experience  at Spitali Rajonal in Shkodra was intense. The hospital had very limited resources and lacked the technology that American hospitals have to make the diagnosis or provide treatments. And yet, the doctors were very committed to their patients. 

Moments after woman has just given  birth

 

 

This hospital, like many throughout Europe, do not have the capacity to treat an acute heart attack or an ischemic stroke conditions like most American hospitals do. Likewise, all regional hospitals lack entirely the capacity to treat cancer patients because of lack of chemo drugs or radiotherapy. Screening programs to detect serious illnesses at an early stage were nonexistent.

The most impressive fact was that patients there seemed subdued to the lack of opportunities to treat their conditions. At that point it became clear to me that the medical profession has many facets. Besides treating diseases and restoring the health of sick and injured patients, physicians have a duty to work hard to preserve the health of patients, and protect their health potential by preventing diseases and injuries not only in one by one basis but the entire populations.

Man from car accident getting an x-ray

I found myself shadowing doctors in the pediatrics wing of the hospital, the OBGYN department, the Emergency Department, and the imaging department of the hospital. I observed how medical care was provided to injured patients such as in a car accident, a woman who just given birth with a cesarean, and a patient in the ER who needed an x-ray of his chest.

Older woman has open wound

 

 The radiologist informed me of several challenges that the doctors and the staff face every day. The one that really struck a nerve was that because of the poverty of the country, people break into the hospital during the night and steal equipment such as x-ray machines, screening devices, tools, and even medications. Many times the doctors or staff themselves have to buy the missing items that were stolen in order to continue with their work. 

Not even the pediatrics wing where new born babies can be found are off limits as people steal blankets among other items. However, none of these instances can compare to the power outage (lasting roughly 6 hours a day) that the hospital's patients, doctors, and staff have to endure in the harsh winters.  

Woman gets x-ray in radiology room

 Many people avoid going to the hospital unless it is life or death because of the infamous conditions that the hospitals have.  Sadly, when an individual is diagnosed with a form of terminal illness such as a form of cancer, many come to terms and try to find peace that their life will be over soon.

The question everyone wants the answer to is: How do we improve the Quality of Care in Developing Countries?

The Institute of Medicine defines quality as "the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge" (Institute of Medicine 2001, 244)(B)There is however, a large variation in the quality of care in developing countries in which the dependent factor is the amount of resources available.

These variations result from gaps in knowledge, inappropriate applications of available technology (Murray and Frenk 2000), or the inability of organizations to change (Berwick 1989).
 Local health care systems may have failed to align practitioner incentives and objectives, to measure clinical practice, or to link quality improvement to better health outcomes. (B)


Sustained investments in healthcare delivery are KEY to ending extreme poverty. Institute of Medicine's (2001) landmark report, Crossing the Quality Chasm, illustrates the process in which we can impliment changes to improve care. This process has 6 goals: (1) patient safety, (2) effectiveness, (3) patient centeredness, (4)timeliness, (5) efficiency, and (6) equity (see box 70.1). (B) 

 

The world bank has stated that Albania has the most unequal health system in Europe and Asia. Albanian citizens must pay for healthcare out of their pockets. In private hospitals, citizens who pay hospital contributions are not compensated and have to pay full price for surgeries. Although Albanians can go to state hospitals, the care and outcome of treatments are not as satisfactory.

The World Bank has stated that Albanians spend 750 million euros a year for treatment.  Albanians have to pay for 60% of any treatment while 40% is paid by the state. This makes it extremely difficult for low income paid citizens to benefit from health care. 

The World Bank has issued a report and in the chapter on Albania, it states that this country has one of the most unequal health systems in Europe and Asia.
The report states that this inequality is a result of the fact that Albanian citizens must pay for most of the health care from their pockets.
- See more at: http://www.balkaneu.com/world-bank-albania-unequal-health-system-europe-asia/#sthash.58x9dCZp.dpuf

The World Bank has issued a report and in the chapter on Albania, it states that this country has one of the most unequal health systems in Europe and Asia. - See more at: http://www.balkaneu.com/world-bank-albania-unequal-health-system-europe-asia/#sthash.58x9dCZp.dpuf

The World Bank has issued a report and in the chapter on Albania, it states that this country has one of the most unequal health systems in Europe and Asia.
The report states that this inequality is a result of the fact that Albanian citizens must pay for most of the health care from their pockets.
- See more at: http://www.balkaneu.com/world-bank-albania-unequal-health-system-europe-asia/#sthash.58x9dCZp.dpuf

It is easy to take for granted the resources and conditions that we have available here in the United States. Experiencing and observing hands on health care/ treatment/ diagnosis/ in its purest form with just the doctor, patient, and a stethoscope taught me things that can not be taught within a classroom but one has to experience for themselves. 

A typical room for patients awaiting their doctor in Albania, Shkorda

There is still hope for Albania as the country is slowly developing as it plays catch up with the rest of the world. The many years of darkness under the Iron Curtain and Communist Rule has prevented its people from having any contact with the ever evolving outside world which is one of the biggest reasons as to why it has such a oblique health care. 

 

 (A)http://www.who.int/heli/risks/ehindevcoun/en/
 (B)http://www.ncbi.nlm.nih.gov/books/NBK11790/