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Doctors’ exodus makes Albania’s healthcare system more vulnerable

Doctors’ exodus makes Albania’s healthcare system more vulnerable

By Ervin Lisaku TIRANA, Jan. 15 – Albania has been facing an exodus of doctors in the past few years, making the country’s healthcare system, already facing one of world’s lowest number of doctors, even more vulnerable. More than 500

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Upward trend in infant mortality related to lack of equipment

Upward trend in infant mortality related to lack of equipment

In the time period between Dec. 25, 2017 until Jan. 15, 2018, eleven prematurely born babies passed away at the Obstetric-Gynecologic University Hospital ‘’Koco Gliozheni’ in Tirana. In an official response, the maternity hospital admitted that half of these losses

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Dardha village, Albania’s sole ski resort destination

Dardha village, Albania’s sole ski resort destination

TIRANA, Jan. 10 – With much of Albania covered in snow during the first days of this cold January, southeastern Albania is the sole and perfect destination that ski lovers can enjoy in the country. Despite the country’s mountainous terrain

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Women in business face hardships

Women in business face hardships

Even though women in Albania makeup half of the entire population, their path to entrepreneurship and business faces hardships. An investigative piece by Mimoza in the Voice of America Balkans inspects some of the issues businesswomen in Albania face. Women

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Inappropriate hospital waste treatment is a threat to Albania, inspectors say

Inappropriate hospital waste treatment is a threat to Albania, inspectors say

TIRANA, Dec. 20 – Treatment and disposal of hospital waste is a problem in most Albanian hospitals with dangerous medical waste often posing a threat to medical staff and patients themselves but also households and the environment in cases of

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Editorial: The last chance to depart with evil: dismantling the State Thieves Enterprise ultd.

Editorial: The last chance to depart with evil: dismantling the State Thieves Enterprise ultd.

TIRANA TIMES EDITORIAL The student protests that have been going on mainly in the capital of Tirana but also in some key university towns have provided an opportunity of reflection and reaction for a much wider issue than just education.

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Albanian-Chinese relations come with a new vitality

Albanian-Chinese relations come with a new vitality

Her Excellency Jiang Yu, the Ambassador of the People’s Republic of China to Albania is ending her mission soon, leaving behind a progressive work in our country and developing the relations between Albania and China since she took office in

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Albania:  a nation of poets

Albania: a nation of poets

At the European Capital Strasbourg, was held from Nov. 19-24 the annual World Meeting of Poetry organised by the Mots-Arts Association in collaboration with the European Council. The event held at the Municipality of the city and hosted by Strasbourg

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‘From Austria with love’’ – a postcard literature

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One of the most notable and successful activities during the Austrian cultural year in Albania, resulted to be the one of literary postcards undertitled ‘’From Austria with love.’’ This activity brought to the Albanian readers some of the most renowned

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A friend to Albania sends greetings

A friend to Albania sends greetings

A professor of German to Elmira College in New York, Carrie Hooper, sends her greetings to Albania through the Voice of America for Balkans by singing the Albanian national anthem. Hooper is a connoisseur of six foreign languages, among which

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                    [post_content] => By Ervin Lisaku

TIRANA, Jan. 15 - Albania has been facing an exodus of doctors in the past few years, making the country’s healthcare system, already facing one of world’s lowest number of doctors, even more vulnerable.

More than 500 doctors are reported to have left the country in the past few years, mainly heading for Germany, Europe’s largest economy, which has eased work procedures for medical staff coming from the Western Balkans as it tries to fill the huge gaps in its healthcare system.

The current numbers represent about a tenth of total number of doctors in Albania, but what’s worse is that an overwhelming majority of medical staff working at the country’s public and private hospitals would be willing to leave the country if they were offered an opportunity, leaving the country’s vulnerable healthcare system without key experts with decades of experience.

Many hospitals outside Tirana and healthcare facilities at remote areas in Albania already face shortage of specialty and even family doctors, leaving thousands without access to basic service and emergency health problems.

Monthly bonuses of up to €2,000 a month for working outside Tirana and in remote areas suffering shortages of specialty doctors since early 2018 have not been much appealing and facilities like the Dibra regional hospital, north of the country, continue redirecting their patients to Tirana, which becomes quite difficult in winter due to heavy snowfall that often makes helicopter transportation the sole opportunity to save lives.

Albania currently has only 1.2 doctors per thousand residents, in one of the lowest coverage rates comparable only to war-torn countries.

The Balkan country has regularly lost medical staff since the early 1990s following the country’s transition to democracy and a market economy following decades of a hardline communist regime and a planned economy.

However, the brain drain has sharply picked up in the past five years following a relaxation in procedures by Germany due to its huge needs for medical staff, mainly nurses in homes for the elderly.

“Germany has relaxed the doctor-recognition procedures. They accept them from all Balkan countries, though they first have to work in a rural area and undergo training,” says Dorina, an Albanian PhD holder in medicine as quoted at a recent brain drain study commissioned by the UNDP office in Albania.

“Almost 30 percent of students that completed studies in the same year as me have gone to Germany. Each year, around 180 doctors graduate [in Albania], and in the last 3–4 years around 30 percent have emigrated to Germany. This is, regrettably, a very high percentage, because there has been a six-year investment for these doctors,” she adds.

 

Almost everybody wants to leave

Doctors and nurses are among certain groups of mostly younger-age professionals such as engineers, IT specialists, legally leaving the country and heading mainly to Germany following a wave of ungrounded asylum-seekers of mainly non-qualified Albanians that have either voluntarily come back or been repatriated after overwhelmingly having their asylum applications turned down since 2014.

The situation is especially concerning among Albania’s poorly paid medical professionals, more than three quarters of whom say they are willing to leave the country if given the opportunity, according to a recent survey by a local Albanian NGO.

A survey with 1,000 doctors nationwide, including private hospitals, showed around a quarter of surveyed staff say they would immediately leave the country. Another 54 percent said they would consider leaving if they were given an opportunity and only 19 percent said they would continue working at home.

The situation is no better at the private sector offering better wages and working conditions where two-thirds of doctors say they would consider leaving the country, according to a study conducted in mid-2018 by Tirana-based ‘Together for Life’ association with support by Germany’s Friedrich Ebert Foundation.

The situation appears more alarming in the region of Durres, the country's second largest, and in the northern Lezha and Dibra regions where only 5 percent of surveyed doctors are willing to continue working at home.

Albania’s public healthcare system is perceived as one of the most corrupt, with bribes to doctors and nurses to get faster and more careful treatment having become quite normal practice and culture that is little denounced.

 

‘Certificates of good standing’

Some 762 doctors were issued certificates of good standing from 2013 to 2017, among whom 94 specialty doctors in documents that are issued upon doctors' request when attending post-graduate studies abroad or looking for a job outside the country, according to the Order of Albanian Physicians, the authority that issues the certificates.

However, in late 2018, a deal between the health ministry and the Order of Physicians put an end to the issue of ‘certificates of good standing’ for doctors that are already under contract in a bid to stop the brain drain from Albania's healthcare system.

The average departure of doctors from the country, including experienced ones, from 2013 to 2017 was at 190 annually, a figure considerably higher to the average 150 graduates a year produced by the University of Medicine in Tirana, the sole public higher education institution offering studies for family and specialty doctors in studies that last between six and eight years.

Bigger in numbers and with wages almost half of what doctors receive, nurses are also more willing to leave the country.

German Dekra Akademie says it has been offering free German language courses and training for hundreds of nurses in Albania during the past three years, managing to take up to 1,200 nurses to Germany where they mainly work in homes for the elderly, earning around €1,300 a month.

Around a thousand other nurses are currently receiving training throughout the country.

 

Reasons for leaving

Low job income, poor working conditions, few opportunities for career development, exposure to political pressure, verbal and even physical violence are some of the reasons that drive doctors to abandon Albania’s public sector, sometime even to work for private hospitals offering much better wages and working conditions.

Albania's Order of Physicians says frequent legal action against doctors charged with carelessness and negligence also has an impact on the decision to leave, with doctors often ending up in prison, fined or having their licence revoked.

"Some 20 doctors were sentenced to prison in 2015-16 in Albania at a time when there were only three sentenced in the US where the number of doctors is 70 times higher compared to Albania. In addition, there are many doctors facing charges and a lot of others that have been fined," Fatmir Brahimaj, the president of Albania's Order of Physicians has said.

Doctors have appealed for new provisions to divide human error from negligence in treatment, the latter punished by fines or imprisonment of up to five years for negligence in treatment.

A negative perception on doctors has reduced patient confidence in the Albanian health sector, increasing pressure and insecurity among doctors, the doctors’ departure study shows.

Germany which has considerably eased procedures for medical staff from the Western Balkans is no surprise as the top destination for those wishing to work abroad with a 26 percent share.

Another 20 percent say they would prefer moving to the UK and 13 percent to Nordic countries.

Due to tight procedures for being hired in the local healthcare systems, Italy and Greece, home to around 1 million Albanian migrants, are not among the top three destinations.

Around a quarter of surveyed doctors say they constantly feel under pressure, disrespected and dissatisfied at their workplace and often face work overload.

Albania has more than 5,800 doctors, of whom more than half, some 3,347 working in the region of Tirana, home to the country's sole tertiary healthcare facility and several private hospitals.

A third to half of doctors say they are dissatisfied with the poor financing of the healthcare system, the system's weak management and bureaucracy.

Albania's healthcare system receives only around 3 percent of the GDP in government funding, some €360 million, in a budget that is insufficient for the system’s huge investment and staff needs.

Around three-quarters of doctors in the country believe they are unfairly highly criticized. Two-thirds fully or partially agreed with the statement that the "practice of not declaring their cash gifts with authorities is tough, but financially understandable."

Doctors say their wages have to increase by 30 to 100 percent in order to turn down bribes or cash gifts by patients. Current net wages that doctors receive are at around €500 a month, considerably above average wages, but almost half of what MPs, judges and prosecutors or other senior officials get.

Around half of doctors perceive their Albania future as uncertain. Women doctors are more prone to leave the country.

Doctors are also dissatisfied with the work culture in the country's healthcare facilities such as lack of respect, inefficient communication, poor team work and insufficient efforts for their professional development.

 

An inefficient system

"Albanian authorities do not assume responsibility, but simply put the people against doctors. Patients don't pay insurance, they bribe and the government accepts that doctors get bribed and not have their wages increase,” a Tirana obstetrician is quoted as saying on condition of anonymity.

“At a country where there is no rule of law, you face the population's pressure and doctors are suffering from this system. There are endless physical conflicts and doctors keep silent. In some case they receive media coverage and in other go silent. The pressure is a result of inappropriate functioning of the system," he adds.

Another doctor blames lack of transparency and ill-guided investment.

“There is lack of transparency. We really have a small budget, but even that small budget is not consulted with doctors on how it is going to be spent and there is no vision with investment and continuity with health policies," a Tirana kidney doctor is quoted as saying.

A cardiologist in Durres says departures are an issue related both to finances and dignity as the money they get is not enough to make ends meet for their households and bribes don't make them feel good.

The study suggests investment in the health infrastructure, the review of the legal framework on medical errors, more opportunities for professional and academic growth, improving the internal management at healthcare facilities, and engaging Albanian doctors working abroad more in the country's public health sector.

 

‘Quit Germany plans, earn more at home’

Prime Minster Edi Rama has downplayed exodus concerns saying the country has new doctors willing to get a job and invited doctors to work outside their residence areas to earn more through bonuses of $2,000 to $2,500, in income which he says is much better compared to Germany where most Albanian doctors and nurses are heading to.

"Everybody who contributes out of their residence areas will get paid the same as they started working in Germany. Doctors serving outside Tirana as experts will get their standard wage and a bonus of $2,000 to 2,500 a month. Taxes here are much lower than in Germany and what you have at the end of the day here is much better," Prime Minister Rama said in late December 2018, announcing the employment of 300 new specialty doctors for 2019.

Tritan Shehu, a doctor by profession who served as former health minister for the now opposition Democratic Party says “doctors find themselves out of a system that fails to guarantee them the appropriate technical and scientific level, qualifications, technology, the pharmacological ‘arsenal,’ literature, income and dignity and that the collapse that is knocking on the door requires fundamental changes in the whole system and not only facelifts.”

 

 A push for migration

Lack of proper healthcare, together with the low quality of the education system and poor income at home are the primary reason why Albanians migrate away from their native land, surveys show.

Albania has around 1.2 million migrants abroad, almost 40 percent of its 2.8 million resident population, making it one of the countries with the highest per capita migration around the world, with a series of social and economic consequences for the country’s future prospects.

Experts says Albanians are mostly leaving the country because of economic reasons, looking to escape poverty in their homes, but also to integrate into leading European economies and take advantage of better education, health and social protection infrastructure for their families.

Albania’s public health sector is perceived as one of the most corrupt and inefficient sectors, with patients often choosing to get treated at private hospitals in the country or go abroad.

Albanians are estimated to spend about €60 million annually in private hospitals and clinics whose number has significantly increased in the past decade.
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                    [post_content] => In the time period between Dec. 25, 2017 until Jan. 15, 2018, eleven prematurely born babies passed away at the Obstetric-Gynecologic University Hospital ‘’Koco Gliozheni’ in Tirana.

In an official response, the maternity hospital admitted that half of these losses could have been prevented if the hospital didn't lack the proper equipment. 

‘’More than half of the cases [of babies which passed away until the beginning of Jan.] is due to underdeveloped pregnancies, for which we don’t hold the appropriate technology to ensure survival,’’ wrote the hospital in a written answer.

The maternity hospital suffers from a noteworthy absence of incubators and most of the existing ones are dysfunctional. The remaining can handle only half of the infants requiring intensive care. This situation is ongoing for years and both the Hospital Directory and Ministry of Health and Social Protection seem to turn a blind eye to this, as multiple complaints from the doctors have been falling on deaf ears. 

‘’For at least 15 years nothing has been done in this service, only minor touch-ups. The Ministry is aware of it, and not only the ministry, but everyone, as this has been an ongoing issue for years,’’ said Edi Tushe, the Neonatology service chief at ‘’Koco Gliozheni.’’

He added that the equipment under disposition is technologically outdated, and the hospitals can get appliances only through governmental connections. 

In addition, Tushe admits this has caused staff shortage, as doctors and nurses are leaving their jobs due to unacceptable working conditions. 

‘’Koco Gliozheni’’ however, is not the only hospital in Albania which has been facing an absence in incubators, doctors and other medical equipment which are necessary for the survival of infants born with problems. 

Data gathered from Birn shows that this alarming situation is spread in the whole of Albania. 

In 2016, for the first time in two decades in Albania, a rise in infant mortality [babies under one years old] was registered

Warned deaths

Infant mortality number in Albania is the second highest for the region of Balkans, Macedonia being first on the list. According to UN Inter-agency Group for Child Mortality Estimation data, in Albania there have been 6.2 deaths in 1000 newborns for year 2017.

According to INSTAT, Albania’s State Statistics Institute, infant mortality in the country for 2016 was raised by 19 percent. 233 infants died in 2015 and 277 in 2016. For 2017, out of 30,896 registered newborn babies, only 248 passed away.  

Eleven babies who passed away at the ‘’Koco Gliozheni’’ maternity hospital in 2018 were added to these sad statistics. Doctors from this hospital, who wished to remain anonymous, said the depressing situation faced there shocked the medical staff.

Another doctor of gynecology service explained that the Neonatology service had more patients than incubators at the time. This has led medics to often create double connections between babies and medical equipment in certain situations, as the only way to survive. 

‘’I have been working in that hospital for ten years and a situation like this has never occurred, it was really absurd, even though all the children, according to what we learned, were born with issues,’’ said the doctor. ‘’Trust me, for a doctor it is heartbreaking to work in such a situation.’’

The maternity hospital ‘’Koco Gliozheni’’ has complained that it holds only six functional incubators out of 24 that it needs. However, the neonatology administration lacks other medical tools apart from incubators. Shortages are on ventilators, pulse oximeters, infusion pumps, laryngoscopes, and the list of essential devices for treating newborns with problems goes on. According to the doctors, the few functional appliances on hold are old and overused, which seriously threatens patient service.

According to Edi Tushe ‘’Koco Gliozheni’’ hospital bears about 4500 births a year on average; meanwhile, there are 700 infants on average per year that are hospitalized in need for intensive therapy and specialized care. He said that in the hospital’s conditions that can withstand only half of the cases.

Tushe also elucidates that the doctors of the neonatology service have been sending tens of letters to the hospital directory for years, which on their behalf forward those letters to the Ministry. These letters lets them know of the scandalous situation that the doctors have to work with, however the complaints have fallen on deaf ears. 

‘’The absence of equipment and tools makes the intensive and subintensive care of neonates impossible,’’ writes Tushe in a letter from Sept. 2017 directed to the Hospital Directory. 

A similar warning was also sent earlier in 2016. After the loss of the 11 newborns on Jan. 2018, the maternity hospital sent an extended rationale to the Ministry of Health about their difficult situation, and again it recieved no concrete reaction. The hospital has 20 non-functional incubators, and only six are working, while 18 to 34 babies each day need intensive therapy.

‘’During 2017 in the department of intensive care were hospitalized 957 infants, with an average stay in the incubator of two to 98 days,’’ writes ‘’Koco Gliozheni’’. 

The maternity hospital also adds that some days there eight to 19 babies born in that hospital which occupy the incubators, and six to 15 infants coming from outside Tirana. On average there are 18 occupied beds daily, and on some other days the number can go as high as 34.

In an urgent letter sent on Nov. 22, 2018 to the hospital’s director and deputy director of finance, the neonatology dept. informed again on the emergent need to replace the almost dysfunctional air and oxygen dosimeters. 

These dysfunctional dosimeters make the resuscitation of the infants in maternity rooms impossible. Alternative forms are found to attain their provisional operation, however the service writes that the Neo Puff aparatures make the resuscitation impossible, thus the hospital should make urgent interventions to replace the dysfunctional utilities.

This university hospital which deals with serious cases even from district hospitals only has one laryngoscope, an essential instrument for opening the breathing routes and aiding respiration. This hospital also lacks portable incubators for transporting graver cases to Mother Teresa Hospital. The existing ones are more than 20 years old and unsuitable. 

‘’We need equipment and medications. How could I tell to a parent that there is no oxygen mask for their child?,’’ said a nurse from ‘’Koco Gliozheni’’ hospital who wished to remain anonymous. ‘’We only have our hands, but these children won’t be saved only by our hands,’’ added the nurse. 

Regardless of the difficulties, however, the maternity hospital admits that are very rare cases when they are forced to put two infants in one incubator, as it negatively affects the health of the child. Cases in which it happens, is when the babies are born twins.

Doctors are leaving due to poor working conditions

According to Edi Tushe, this lack of working conditions is forcing doctors to quit their jobs. During 2018,  three neonatal physicians have resigned from ‘’Koco Gliozheni’’. Out of 45 nurses that the dept. needs, the staff consists of only 20 but only 17 actually work, as the rest three are on excused leaves. 

The structure should be handled by eight doctors, but Tushe said only four will be left, as another doctor is leaving soon. All the corresponding institutions are informed on the situation, but no solution has been found. 

A resigned doctor who wished to remain anonymous said that it was psychologically frustrating for her not being able to save the life of a newborn because the hospital has no equipment. 

‘’Those who are still remaining in that service are heroes, you cannot imagine how the work is done there,’’ said the doctor. 

The remaining doctors and staff seem to also be reaching an ending point. In a letter directed to director Genci Hyska on Nov. 20, they threaten a collective resigning if the situation doesn’t better, highlighting that for two years they were strained in expectation for an actual solution. They have also warned that staff shortage seriously harms the security and quality of patient service.

‘’Since we don’t have any actual solution, we are bound to inform you that this situation is no longer acceptable and tolerable- we will soon be obliged to collective resign,’’ have written the doctors and staff in the letter. 

Tushe added that it is not easy to recruit new doctors in a short period of time. He said that a neonatal doctor should be planned five years ahead, whereas here there are open calls on which no one signs up. He added that it has let the Ministry know what it should do, but he warns that the institutions plan strategies only to lock them in a drawer.

Abandonment of district maternity hospitals

According to INSTAT and the two maternity hospitals ‘’Koco Gliozheni’’ and ‘’Mbreteresha Geraldine’’ (Queen Geraldine), more than a third of the countries birth are conducted in these two hospitals. “Mbreteresha Geraldine’’ registered 3117 births for period Jan. to June 2018, with only 25 infants losing their lives out of 445 cases that need neonatal resuscitation. 

‘’Koco Gliozheni’’ reported on around 4500 births during 2017. 957 babies were hospitalized for intensive care, 630 newborns from this maternity hospital and 327 coming outside Tirana. 

‘’We would be lying if we said there are no problems, but I don’t know any doctor in neonatology who neglected their job,’’ said Gerta Hagen.

Gerta Hagen is the executive director of Hospital Foundation of Mother and Child, which has been operating on maternities ‘’Koco Gliozheni’’ and ‘’Mbreteresha Geraldine’’ since 2014, and is now cooperating with maternity hospital of Fier. Hagen said that the district hospitals are facing bigger problems than the university ones.

The Ministry of Health and Social Protection answered that the Albanian hospitals have 134 incubators. Doctors said that this is the stock number and not the number of functional equipment in hospitals. For instance, ‘’Koco Gliozheni’’ has in stock 27 incubators, from which only six are functional. 

The maternity hospital of Korca registered 988 births during 2018, out of whom 85 instants needed an incubator. The inventory of Health Ministry claims that the hospital has seven incubators, but maternity director Ardit Konomi said that they only have three incubators, and one is not working. He added that the hospital also has ten oxygen pumps and a staff shortage. They are in need of two obstetrician-gynecologists, and the service is filled by retired doctors.

For the Durres maternity hospital which bears 2500 births on average per year, the Ministry claimed that it possesses ten incubators, but director Arjan Prodani said that the hospital has six incubators, three functional and three old ones which occasionally break down. The hospital also has two ultrasounds, and needs another one, and has one monitor, even though the inventory says it possesses three. 

‘’As for the medical staff we have considerable wants, we are only three neonatal physicians while we are supposed to be six or seven. And from the remaining three, one is retired but continues to work’’ said Prodani. 

The Shkoder maternity has enough incubators to cope with the births, according to doctor Servete Stakaj, however the hospital needs oxygen and respiratory equipment. The bigger issue is the staff shortage, which aggravates the work and patient service. 

More noted absences are in district hospitals which usually send their emergencies to Tirana hospitals. Kujtim Albrahimi who is responsive to the Librazhd municipality maternity, said their hospital carries communist era incubators and two neonatal rooms with warm and cold water. Albrahimi said that requests have been made to the Ministry for another incubator corresponding to the number of births, but he also added that the Ministry perhaps doesn't have the necessary resources. 

The absence in staff and equipment in regional hospitals are bringing fatal consequences to the patients. On Dec. 7 of 2018 in Bulqize, an expectant mother lost her triplets because the hospital didn’t have a doctor and the first birthing was conducted by a nurse until a team from Tirana arrived. 

‘’They told me that she had a premature birth, but Bulqize has no gynecologist, everything here is through,’’ said father Ferit Rexhepi, still traumatized.

The couple were following the pregnancy with checkings in Tirana because the maternity hospital in Bulqize had no proper condition. On Dec. 8 of 2018 they had the following session. Rexhepi said that this situation could have been averted if doctors were available.

Hazis Jella who is director of Bulqize hospital said that the staff did all they could and that the team from Tirana arrived fast. He said that these are the capacities the hospital holds, and the saving of the babies was impossible due to their premature age. Yet, he gave no answer regarding the absence of an obstetrician-gynecologist in this hospital.

Gerta Hagen says that the handicap is on a missing referral system which would give an awareness in what diagnosis each regional hospital can treat, that on the other hand would also relieve the weight of Tirana’s hospitals. Hagen said that a protocol for case referrals is inexistent. Not all regional hospitals are specialized for everything, but according to her there should be collective specialized centers and a referral system. 

Former minister of health and gynecologist Halim Kosova said that the equipment absence is a grave issue. However, Kosova said that doctors leaving is a more serious problem. He added that a hospital which lacks doctors cannot order new equipment, and a hospital with minimal activity, equipment and staff, perhaps shouldn’t stay open. 

According to Edi Tushe, suggestions for solutions have been well received but it is the will from respective authorities to actualize these solutions which lacks. Tushe said that he was part of the ministry team working on the reproductive health strategy. This strategy was finished last year and it holds a special chapter dedicated to infant mortality.

‘’80 percent of infant mortality are neonatal, and if interventions are not made regarding this indicator, we risk to make steps backwards,’’ warned Tushe.

 

 

Courtesy of BIRN. 
                    [post_title] => Upward trend in infant mortality related to lack of equipment
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                    [post_date] => 2019-01-10 16:35:35
                    [post_date_gmt] => 2019-01-10 15:35:35
                    [post_content] => TIRANA, Jan. 10 – With much of Albania covered in snow during the first days of this cold January, southeastern Albania is the sole and perfect destination that ski lovers can enjoy in the country.

Despite the country’s mountainous terrain and plenty of opportunities to develop winter sports, Albania has only one ski resort which is located in Dardha, a tourist village in the southeast Albanian region of Korça, some 112 km off Tirana that can be reached in a two-and-a-half-hour drive.

Located in Dardha, a village with much history in Albania and whose residents were among the first Albanians to settle in the U.S. in the late 19th century, the Bigell ski resort has been operating since 2012 offering skiing and snowboarding for both amateurs and professionals in 2 km of slopes at an elevation of around 1,600 meters above the sea level.

The village is a popular destination both in summer, as an escape from the heat wave in much of Albania, but becomes almost overcrowded in winter, with visits by local and foreign tourists and travel agencies offering three-day package holidays starting at €90.

However, the underdeveloped winter sports often take Albanians to neighboring countries such as Montenegro and Macedonia with a much earlier tradition in ski resorts.

"It's Albania's sole ski resort, even though small, modest and with minimum conditions with only two cable cars which is a pity, but at least we have one, to entertain ski lovers," a tourist says.

"It's a pity that most Albanian ski lovers travel to Montenegro’s Kolasin, which is a four-hour drive from Tirana at a time when Dardha is only about two-and-a-half hours away, but we have to admit they offer better conditions," she adds.

Snow-covered landscape, warm homes under the lights of fireplaces, traditional cooking and hospitable people make Dardha an ideal getaway spot for many, travel experts say.

“Its proximity to the touristic ‘center’ of Korça makes a visit there even more worthwhile. Plus, there are plenty of skiing opportunities and other outdoor sports in this village for all the winter sport enthusiasts,” says the IntoAlbania portal.

“It’s extremely clean air revives both body and soul and, during the winter, the green forests and houses made of stone are all covered in snow, granting the place a fairy-tale appearance. This 300-year old village is a cozy place that looks and feels like home,” it adds.

Nicknamed ‘The small Paris of Albania’ and the ‘City of serenades,’ the southeastern Albania city of Korça, also features a prehistoric museum and a national education museum where the first Albanian language school opened in 1878.

Its Dardha and Voskopoja villages are also famous Lakror pies and Kernacka meatballs.

The Dajti national park, situated just 25 km east of Tirana, is another destination for central Albania residents and tourists to Tirana, to enjoy snowfall, a rare phenomenon downtown Tirana.

Located atop Mount Dajti, the Dajti national park is a magnificent and beautiful park spanning a 3,000 ha area. It boasts much lush vegetation and has groves of 200 year-old beech trees. There are significant archaeological monuments nearby, and opportunities for hiking and climbing, as well. A cable car built a decade ago transports visitors from the outskirts of Tirana to the park in just a few minutes.

Albania made it to Lonely Planet’s top 10 affordable adventure destinations for 2019 as one of Europe’s final frontiers that offers hiking amid beautiful mountain scenery, superb beaches and a unique history.

Several outdoor tour operators in the country offer hiking, rafting, biking, horse riding and birds watching adventures in the country, while cross-border tourism is gaining an upper hand with the opening of several mountain hiking trails.

The communist past is also what fascinates tourists about Albania, which was cut off from the rest of the world under a hardline Stalinist dictatorship.

The country’s tourism industry still remains heavily reliant on summer, when Adriatic and Ionian beaches are packed with tourists. Plans to switch to a year-round industry have been slowly advancing.
                    [post_title] => Dardha village, Albania’s sole ski resort destination
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                    [post_date] => 2018-12-29 15:16:13
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                    [post_content] =>  Even though women in Albania makeup half of the entire population, their path to entrepreneurship and business faces hardships. An investigative piece by Mimoza in the Voice of America Balkans inspects some of the issues businesswomen in Albania face.

Women are the half of the coin of a normal functioning of society, holding a crucial contribution in the welfare of both the economy and the social spectrum. However, in terms of establishing and carrying out private businesses they have faced various hardships towards survival and success. Only 35 percent of Albanian existing businesses as in the service, production or other sectors are owned by women.

Experts believe that women face more difficulties and discrimination than men in the business fields, even though issues faced might be the same, from corruption in customs and the tax agency, unfair competition and informality. A thrifting entrepreneurship from women positively affects the state’s economy and welfare, thus it is important to offer a kind of security. 

The Association for Entrepreneur Women have laid claims that post-90s policies and governances have undertaken limited works towards this interest group. However, since 2017 we have a state’s minister for entrepreneurial protection, who offers a few reliefs for businesswomen, considering their complaints. 

‘’After the 90s the first to overpower the great problems of poverty were women. Think of an unemployed person. Think of a person who has children to raise. And yet, women did it,’’ said Flutura Xhabija from the Professional, Business and Crafts Women Association. 

Even though we live in a patriarchal society with multiple hurdles where economical problems remain in abeyance unsolved, experts have noticed a positive trend in the progress of women owned businesses these past 28 years. 

Xhabija said that the number of female businesswomen has increased over the years. From previously 21 percent, the number has now grown into 33 percent without including the three percent of female farmers. As things are going more in balance, the crafts women are also receiving more weight. 

State economy observers claim that the investments of women is focused on the small business, or the family one. Female owned business in the country have usually started as small and medium individual businesses.

‘’A few are in judicial forms as limited liability company. These include from beauty salons, up to activities with consumer service nature, and fewer in production,’’ said Dr. Aelita Mani, director of the Business Administration Dept. at the Luarasi University. 

Out of 200 large business in Albania, only 37 are owned or led by women. Yet, the state’s minister for entrepreneurial protection is a female. The minister, Sonila Qato, seeks to help and safeguard the Albanian business.

Through various programs Qato aims to support women in Albania, also by enabling them qualifications and traineeship programs. From the two last fiscal packages approved by the parliament, one was especially for self-employment. 

However, as mentioned, women face more hardships in business success than men. Dr. Mani says that these issues come from the corruption in the customs, corruption in the tax service, and pressure. 

‘’We function in a different way and the tax agency cannot classify us. They give us solutions which hangs us around and confuse us, and then what happens is that two tax agents hide behind a tree across your store and wait until they catch you doing something wrong. If the government can’t help us, then it shouldn’t frustrate us,’’ said Manjola Lloja, director of craftsmanship store ‘’Nje mar nje mrapsh’’, with works of 250 women and girls from all over Albania.

The discrimination of businesswomen is a visible trait and it can be found in fiscal policies, quick information, and tenders for entrepreneurships. Other discriminations arise from the business model, employees, and annual profit. This discrimination also leads to less benefits, support, and more prejudice and vulnerability to blackmail. 

The minister for entrepreneurial protection Sonila Qato said that all businesswomen in Albania have an ally, since she herself is a woman. Qato said that she will try to understand their activities and offer solutions to issues with the administration. Some experts though, offer more concrete solutions as to how the government could help.

Dr. Mani said that help can come from easier fiscal policies on taxes which would incite more businesses to open, and fiscal policies to support loans or grants, even in cases where no ownership title exists. Xhabija said that the government should offer more funds and grants to women, and instead of putting percentages, to ask questions on how they make it.

Qato said that a concrete focus are women living in rural areas, first to enable them wages and secondly to give them a fair opportunity to compete for funds or state subsidies for agriculture.

Another field which remains to be notices is tourism. Women see themselves far from the resort investments, but prefer more authentic artisan works and traditional cuisine. Lloja said that there are more than enough resorts for tourism, but more should be on the little things. For instance, at the Kruja bazaar tourists can see how fezes are made. Another authentic Albanian touristic activity is offered in Shkodra in a small loom atelier, where women work the fabric by banging the batten with their feet.

The Albanian Investment Development Agency (AIDA) is one of the agencies which has financially supported hundreds of women to start their businesses. UN Women has also dedicated grants to entrepreneur women, and UNDP is focusing in women’s work qualifications. So, in a sense, progress is being done to support businesswomen, and that has left them a bit more optimistic.

‘’Hardships are forgotten when success is achieved,’’ said Xhabija optimistically.

 
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                    [post_date] => 2018-12-20 14:15:25
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                    [post_content] => TIRANA, Dec. 20 – Treatment and disposal of hospital waste is a problem in most Albanian hospitals with dangerous medical waste often posing a threat to medical staff and patients themselves but also households and the environment in cases of ending up in dumpsites or even rivers as shocking evidence has shown.

An inspection carried out by Albania’s Supreme State Audit Institution into three of the country’s regional hospitals, including the Tirana University Hospital Center, the country’s largest and sole tertiary care center, has shown that hospital waste treatment and disposal lacks both a clear legal framework and efficient treatment by both authorities and private companies contracted to handle waste through incineration.

"Sorting, storage and treatment of hospital waste is not carried out in compliance with legal criteria and best practices," says the report analyzing the 2015-17 performance in three hospitals.

The inspection also included the Fier regional hospital, the country's second largest, and the Kukes hospital, northeast Albania, with a series of recommendations issued to authorities to improve the emergency situation.

The audit showed provisional storage of hospital waste is carried out in inappropriate facilities that could pose a threat to both medical staff and patients coming into contact with it.

"The provisional storage of hospital waste at Tirana's QSUT hospital and the Fier and Kukes regional hospitals is often handled at toilets, laundries, doctors' rooms or other inappropriate facilities where medical staff and patients could come into direct contact with it," says the Supreme State Audit.

Experts say that around a fifth of hospital waste is dangerous and other waste can become as dangerous in case of being mixed.

The audit also showed authorities at the three inspected hospitals have no information about the dangerous cytotoxic waste containing chemicals that are toxic to the cells and that the hazardous waste is not separated and packed in red plastic bags under the country's guide on the safe administration of hospital waste.

The situation with pharmaceutical waste management is no better with more than half of pharmacies in Tirana admitting to not having contracts with treatment companies over handling their expired medicines, according to a study conducted by Tirana-based Eden environmental center.

“While there is legislation in place that should ensure that Albania meets the global standard of pharmaceutical waste disposal, there is very little evidence that it is being carried out effectively," says the late 2016 report.

Back in mid-2017, a medical waste treatment company was caught on camera dumping untreated dangerous hospital waste on a river bank in the Tirana outskirts, shocking public opinion about the way a private company contracted to treat medical waste handled the process.

The publication of the scandal at an investigative TV show led to the company having its licence revoked and criminal charges being filed against a female manager for hitting a journalist confronting her about the waste being dumped into Erzen River.

Albania’s riverbeds are some of Europe’s most polluted as they are routinely used as dumping grounds, causing environmental concern among people living along the banks and the shoreline where the rivers deposit plastic waste. Waste pollution and soil erosion due to illegal cutting of trees often leads to flooding because of rivers overtopping their banks.

Waste management is one of the most pressing issues facing Albania and its emerging tourism industry, with waste often dumped in inappropriate sites and burned, triggering environmental and health concerns.

Three quarters of Albania’s municipal waste is landfilled, about 17 percent is recycled, about 2 percent is incinerated to produce electricity, and 3 percent is burned or dumped outside landfills, according to 2017 data by state statistical institute, INSTAT.

Albania has already built its first waste-to-energy plant in Elbasan, central Albania and has signed concession contracts backed by the central government to build two new such plants in Fier and Tirana, despite environmental concerns by local residents and environmentalists worried over the new plants and their incinerators increasing dangerous pollution in the country.

 
                    [post_title] => Inappropriate hospital waste treatment is a threat to Albania, inspectors say
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                    [post_date] => 2018-12-19 11:23:56
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                    [post_content] => TIRANA TIMES EDITORIAL

The student protests that have been going on mainly in the capital of Tirana but also in some key university towns have provided an opportunity of reflection and reaction for a much wider issue than just education. Not that education in itself is not big enough. It is the most important investment in a country’s future. However whether the students know it or not, and most likely they do, the protests are about much more than just university tariffs. They are about the complete failure of the education system. They are about more than that. They are a genuine reaction to the painful collapse of the governance model of these last few years.

Most of the students understand by now that solving these 8 points that they require, which would slash costs of education and increase this participation in university decision making, will make little difference in their life and in their future. This future, which so many of them are now seeking outside of the Albanian borders, is fully kidnapped by the radical degree of theft and fraud orchestrated by the ‘State thieves’ enterprise’. This is a collection of official decision makers at the highest level and a few oligarchs which are bleeding the state finances dry and engaging beyond that in dubious corruptive affairs. This is the model that leaves ordinary citizens out in the cold to fend for themselves while in the background, the propaganda machine is everyday one inch closer to making them deaf.

In the chaos if quick developments is easy to lose the full picture. Students are seeking better conditions in their dorms, lower tuition fees, professors with integrity, proper textbooks. These era all dignified requests. They should have been fulfilled a long time ago. The same is valid for many necessities that another failed system has: the healthcare sector. However things keep deteriorating because the money goes either to the PPP maestros or to the propaganda machine, which mean theft and fraud.

The most extreme example of such theft is playing out parallel to the protests. After a a series of scams, forged documents and state of the art con-schemes behind the last tenders for the construction of the Outer Ring Road of Tirana was exposed the whole thing was called off. The names behind the scheme are well known sadly to most Albanians. Ultra wealthy individuals with ties to both political sides. The responsible minister for the project shrugged. The same fake company that had gone so far as to forge documents from the United States and even form the Delaware Secretary of State showed up again in another tender, this time awarded by the Electricity Transmission company, a state owned entity. It seems that the octopus legs are innumerable.

The cases are getting more and more excessive by the day: inflated costs, shell companies, inexistent services and unnecessary financial burdens. The State Thieves Enterprise ultd. (unlimited) goes on relentless, unforgiving.

How to depart with such elemental, capillary malevolence, this wicked turning wheel? How to resist this cruel system that is being perfected everyday by the creativity and dedication and endless resources of powerful crooks? Maybe the students’ revolt is the last chance to try and take back some control, to try and instill some fear into the heart of arrogance.  This is a revolt against all political sides which more than ever resemble the bricks in the same wall: corrupted and ridiculous, fake plagiarized PhD holders waiting for their turn to steal more.

Whether this protest will turn into a political movement is difficult to say. Students are so revolted that the word ‘politics’ scares them. It shouldn’t. All efforts to escape the miserable destiny of a captured state, a captured future need to be strong, need to be political. This might be our last chance to steer the difficult transition of Albania into the right direction, our last chance to send a message to the politicians rotating for 30 years that they are the problem.  The students might be the last chance to depart with evil.
                    [post_title] => Editorial: The last chance to depart with evil: dismantling the State Thieves Enterprise ultd. 
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                    [post_date] => 2018-12-14 12:00:56
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                    [post_content] => Her Excellency Jiang Yu, the Ambassador of the People’s Republic of China to Albania is ending her mission soon, leaving behind a progressive work in our country and developing the relations between Albania and China since she took office in 2015. 

Three main points highlight the progress of the relations; first regards the political leadership which has given a positive impulse to the bilateral relations by strengthening the reciprocal political faith through various high level meetings. This has led to exchanges between the legislative institutions and political parties, which on their hand have allowed communications and learning platforms and mutual collaboration interest on the heritage of the traditional friendship shared.

The second point was that of the pragmatic collaboration. Her Excellency said that in the last three years 28 collaboration documents in 17 different fields have been signed between the two countries. The first meeting of the eco-trade Mutual Commission between the two countries has been held, which has turned to the highest platform on the communication of policies and cooperation expansion. 

In 2017 the overall direct foreign investment from China amounted to $800 million, which makes the partner country the main foreign investment source for Albania. China is still the number one trade partner to Albania, the trade volume having increased by 18 percent.

智库负责人5(ambasadore me perfaqesuesit e Think-tankeve Shqiptare)

 

Previous cooperation in the fields of energy, transport and minerals have brought more positive outcomes, and the new points of cooperation are focusing on tourism, human resources and agriculture. 

Regarding tourism, her Excellency mentioned how Albania removed the visas for Chinese citizens for the summer of 2018 and this led to an increase of incoming tourists by 64 percent.

The third point Miss Jiang Yu wanted to stress was the friendship between the two nations which lead to further, stronger cooperation between the countries. Human and cultural exchange is increasing, and an agreement for the establishment of the Chinese Cultural Center in Albania is signed to strengthen this cultural exchange among the people. The language lessons on both countries is on the rise and universities have signed agreements for student exchanges and collaboration. 

Exchanges and collaborations are increasing among local power too, with various cities and provinces having reached a sort of twining. More exchange is also on the level of think-tanks, media, radio, television and youth giving the relations a new positive shift and impact. 

This increased cooperation comes from the wide consensus of friendship through the centuries between the two nations, which is based in the deep foundations of the public volition of the two countries. Also by holding solid the overall course, the Albanian-Chinese relations are treated in the framework of the Chinese-European relations. 

This cooperation follows the general trend allowed by the 16+1 Initiative and the ‘’One  Belt, One Road’’ Initiative, and moreover it becomes concrete and deepened by the various agreements of collaboration, which seek to bring fruitful volatilities in the bilateral relations. 

As her Excellency leaves office, she seems positive of the future cooperation between Albania and China, as it is a mutual interests benefit for both countries that this friendship is maintained. She said that China is ready to work with Albania in establishing a new consensus, collect new stimulating energies, to strengthen the political faith and communication, to deepen and expand the pragmatic collaboration, to consolidate the friendship basis, and inspire a full potential of cooperation which would bring the Albania-China relations to higher levels. 

‘’I want to express my warmest gratitude to the media and friends from various Albanian districts for their support and help in fulfilling my duty. Wherever I am, as always, I will take care and support the course of Albania-China friendship, and give it my potential contribute,’’ concluded her Excellency, Ambassador Jiang Yu.  

4 阿中友好协会文化协会成员(ambasadore me perfaqesuesit e Shoqates se Kultures Shqiperi-Kine, dhe Shoqates se Miqesise Shqiperi-Kine

 

 

Note: The article was updated due to wrongfully assumed ''One Belt, One Road'' as ''One Generation, One Path''. Thank you Embassy of People's Republic of China for pointing out the mistake.
                    [post_title] => Albanian-Chinese relations come with a new vitality
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                    [post_date] => 2018-12-14 10:33:25
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                    [post_content] => At the European Capital Strasbourg, was held from Nov. 19-24 the annual World Meeting of Poetry organised by the Mots-Arts Association in collaboration with the European Council. The event held at the Municipality of the city and hosted by Strasbourg University professor Enrique Uribe, gathered poets, writers, scholars and researchers, professors and publishers from five continents in a conference titled ‘’Poetry, what do you have to tell us?’’.

MEP_02_Mail

The forum was organized in various panels with its speakers. Along with poets, publishers, professors, etc., were also librarians, students and pupils who wanted to discuss the period named ‘’Crisis of society, crisis of poetry’’. This comes in the face of the human apathy for safeguarding the world democracy and peace, for their cultivation and preservation through democratic institutions, and people’s unification and collaboration, by declining any sort of fatalizm, and loss of faith in the European democracy and integration.

In the concluding manifesto titled ‘’Beware Europe, Europe for Europeans,’’ it was pointed out that poets and poetry have a power to revive the faith in democratic values. The poetic passion doesn’t contain itself only in a verse, but we experience it everyday as citizens of this world, and poetry remains essentially inseparable from the notion of freedom and faith in the human society.

Among the many poets and scholars from the various participating countries, a special panel was reserved for Albania. The panel held by translator and Francophone Fotaq Andrea, who on Nov. 23 held the lecture ‘’Albanians: a poet nation’’ at Villa Schutzenberger, and then on Nov. 24 at Cinema Odysee introduced two Albanian poets, democracy martyr Havzi Nela, and Moikom Zeqo, with translated poetry specially for this event. 

In the lecture held by Andrea, he made a short introduction and recap of the Albanian poetry through centuries focused on three stages, Renaissance, post-Renaissance, and contemporary poetry, with an output to the similarities between the Albanian poetry and European one, and especially with French poetry. Andrea pointed out an instance when French writer Lamartin wrote to Arberesh writer Jeronim De Rada that ‘’poetry came from your shores, and thus shall return there.’’ 

Another instance when Albanians were held as a poet nation, was in an Italian article from 1940s which was titled ‘’Albanians, a people of poets and soldiers.’’ Later in 1989, Xavier Deniau, former secretary of state and general secretary of the Francophone parliamentary ensemble, wrote a dedicated piece for Albania, in which he pointed out that the ‘’Albanian homeland [...] is created by poets.’’ Another contribution came by Alain Bosquet and Michel Metais who introduced Ismail Kadare to the French public in 1970s and thus the Albanian poetic spirit through centuries and for that period (communist regime), leading to two translated poems of Kadare to be published in high-school book anthologies for years to come. 

A list of twelve Albanian poets were chosen for this event, with French-translated selected poetry. The poets were both classic and contemporary, such as N. Frasheri, Migjeni, Çajupi, L. Poradeci, D. Agolli, I. Kadare, F. Arapi, Xh. Spahiu, M. Ahmeti, M. Velo, P. Shllaku, D. Çomo. A special commemoration was made for democracy martyr Nela, for whom was spoken as mentioned on Nov. 24, and a poem titled ‘’When I die’’ was published online in the event’s website. 

A special notice on the first event was made to the oral poetry as an important part of the tradition preserved and conveyed through centuries, in comparison to the more savant and cultivated written poetry. A volume of the ‘’Epos of the Brave (Kreshnike)’’ was also published in French in 1968. The ‘’Epos of the Brave’’ is a cultural heritage for Albania as it holds old songs originating since 11-12th century, the songs passed orally through generations and to be sang with the traditional instrument lahuta (lute). These songs have a historical connotation which talk about the coming of the Slavs in the Albanian territories during centuries 6-8th, and Andrea drew a similarity with the French epos. 

Andrea also mentioned that an important historical attribute are the oral songs of the Albanians of Greece, Italy (Arbereshet) and of Kosovo. He said that these songs aren’t written down because during the Ottoman Empire the written local language was forbidden. However, they are precious to our history and culture as they tell of our long history and literary heritage with myths and legends preserved through centuries, which express all the suffrage endured and are an encouraging reminder to our strength. These songs are also a proof of Albania’s antiquity, being as old as our unique language.

The characteristics and stages

The first characteristic is that of patriotism. The oral poetry has accompanied the Albanian renaissance and served the shaping of the national identity which with the help of poetry brought the independence in November 1912. Analogue to that, the second characteristic of oral poetry it served was that of emancipation and bringing closer the European thought, progressing to the establishment of various poetic schools and introducing modernity. 

The fourth characteristic arising was that of the enriching of the language and literary, artistic expression. And the last but not least, was the turning of the cultivated poetry as a populist poetry, keeping alive the poetic spirit of the nation.

The first stage of the development of the Albanian poetry starts with the Albanian renaissance, star1544341016_2afisheAndreaFotaqting with poet Jeronim De Rada in 1840s until 1920s, with characterising themes of heroes and nationalistic sentiments. The second stage starts during the progressive wind in 1920-30s with the realistic and critical poetry which culminates with Migjeni. Migjeni, except being of the first modern poets of Albania, he also introduced the free verse in poetry and the poetic prose. 

The third stage lasted for about 50 years and corresponds to the closing and hermetization of our country to the communist regime. The poetry in this era was clothed by the official rules, and freedom of expression was forbidden. About 200 intellectuals were persecuted or killed for their free verses which diverged from the political requirements and propaganda. 

The fourth stage corresponds to contemporary times with modern poetry, characterized by free verse, freedom of expression, trying to reach a poetical autonomy and creative abstraction. Such poets are Kadare, F. Arapi, Agolli, Petro Marko, A. Shkreli, M. Camaj, E. Hatibi, M. Ahmeti, Ali Podrimja, Zeqo etc.. 

Andrea said that the participants showed an immense interest in his presentation. During the recital of the poem ‘’When I die’’ from Havzi Nela, some people cried. Andrea said that those tears ‘’were like roses, with a global symbolism, in the grave of Nela.’’ In that sense the people were deeply impressed by the tragedy suffered from the communist era, and how poetry kept rising afterwards and keeping the nation’s spirit alive, poetry never ceasing to inspire.
                    [post_title] => Albania:  a nation of poets
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                    [post_content] => One of the most notable and successful activities during the Austrian cultural year in Albania, resulted to be the one of literary postcards undertitled ‘’From Austria with love.’’ This activity brought to the Albanian readers some of the most renowned authors of modern and classical Austrian literature. 

At the framework of the 2018 Austrian cultural year in Albania, the Austrian Embassy in collaboration with Poeteka, ADD and Rauch opened in March the program ‘’Poetry Card- From Austria to Albania with Love.’’ The postcard format was chosen as Austria is known as a country which used postcards as a communications means among cultures quite early. This intercultural communications of image and text comprises a 115-years broad and rich tradition.

Poeteka restored this tradition before the Albanian public in a new format, dedicated to the promotion of cultures through literary texts, translation and reading of Austrian and Albanian authors. A special attribute was paid to the translators as communication bridge, as the readers were able to learn about authors’ portraits and biographies, and read their work in Albanian. 

Altogether with authors and readers an elaborative communication and exchange was achieved through the postcards. Works were brought in the original language too, for the connoisseurs of German. 

The first postcard to be introduced was that of a document from 1944, which celebrates the collaboration between the two countries. Among other interesting pieces were stamp portraits of authors, but especially an early 1944 publication of Rainer Maria Rilke in Albanian, translated by writer Arshi Pipa and published from ‘’Fryma’’ (Breath) literary magazine. The postcard was symbolically inaugurated on March 21, the World Poetry Day.

Besides those were also other publications such as poetry dedicated to Albania by albanologue Franc Nopsca. 

Nopsca was born at an aristocratic Austro-Hungarian family and is regarded as the one of the founders of paleobiology and Albanian studies, as well as completing the first geological map of Northern Albania. 

He studied at the Vienna university for fossilized bones and acquired a PhD in geology. He moved to the mountainous areas of Albania as having an interest in Albanian nationhood, and soon became associated with the Albanian resistance groups against the Ottomans and even smuggled weapons. After the Ottoman Empire left the Balkans, the countries separated and suffered internal conflicts, for which Albanian arose to its independence. Nopsca happen to be in the middle of it, and during the first world war he served as a spy for Austro-Hungary and at an international conference for the clarification on the status of Albania, he was a contender of the throne.

He published more than fifty scientific researches about Albania, covering linguistics, history, folklore, ethnology, the kanun (Albanian customary law), etc.. A number of his unpublished works, texts and drawings were acquired by scholar and nationalist Mid’hat Frasheri, but after Frasheri left in exile, the full Nopsca library were confiscated by the communist regime and now lays at the National Library. 

Other portraits of the postcards are those of Joseph Roth and Nopsca with Albanian traditional costumes. The literary postcards collection consists of ten authors which is precious for both cultures, unites literature, journalism, travel diaries, short prose, translator and graphic artists, the biggest part of whom have visited Albania through the literary residency program ‘’POETEKA-Tirana in Between.’’

‘’I recall my childhood and I notice how my curiosity for the foreign was awakened and how my path from north Austria to Albania was sketched. A sunny May day in the 70s I was on a cruise between Patra and Brintisi, in the naval strait between Corfu and Butrint, when I saw Albania for the first time. The shore left me an enchanting impression. Then the country for us was unobtainable, but I knew that I would later tread in that place,’’ wrote in his specially written essay artist Christian Thanhauser.

Other authors have also grasped the attention of Albanian public during this cultural exchange year between Albania and Austria. One of them is Austrian nobelist Elfriede Jelinek, whose short creative story was published in a postcard on April 23, the World Book Day. The collection was then complemented with a postcard of Austrian journalist Joseph Roth, known for his texts dedicated to Albania of the both world war periods, and who appears dressed in traditional Albanian costumes. Then, the collection was forwarded by writer and translator Ilir Ferra, born in Albania but who has established his career in Vienna and writes in German. 

Other writer and poets published as part of the project were renowned poet Georg Trakl, children’s writer Christine Nostlinger, author Andrea Grill and contemporary writers like Erwin Einzinger. 

The project ‘’From Austria with love’’ became attractive to the reader who bought the postcards from libraries, but the this activity was also extended as souvenir gifting in the art of writing. The initiative encouraged both the recognition of Austrian writer in Albania, but also the recognition of Albanian writer working in Austria, who write both in Albanian and German. 

Moreover the program ‘’From Austria to Albania with Love’’ made known the work of Albanian writers and translators who brought to the Albanian public the aforementioned Austrian writers, such as Arshi Pipa, Lindita Arapi, Admira Poci, Oriona Kraja Zylja, Majlinda Cullhaj, Lindita Komani. The successful projects of the Austrian Embassy and Poeteka will be celebrated on Dec. 14 near the youth center ‘’Arka’’ in Shkodra.
                    [post_title] => ‘From Austria with love’’ - a postcard literature 
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                    [post_content] => A professor of German to Elmira College in New York, Carrie Hooper, sends her greetings to Albania through the Voice of America for Balkans by singing the Albanian national anthem. Hooper is a connoisseur of six foreign languages, among which Albanian. And the entire interview is also conducted in Albanian. 

She came in touch with Albanian language after an Albanian student signed into her Italian class. She ordered a Braille book to learn the language with the help of her student. She later on transcribed an Albanian-English dictionary into Braille for easier learning, then moved on to audio cassettes with Albanian folk tales. Afterwards Hooper took two Albanian courses at the Arizona State University, started reading articles in Albanian from her Braille computer, has a friend Tim Hendel, who records Albanian radio programs for her, and also practices her speech by talking to Albanian people on the phone.

Hooper came in touch with the Albanian community through Father Arthur Liolin, Chancellor of the Boston-based Albanian archdiocese. Hooper also sings, as she studied for music, and can also play the traditional Albanian instrument cifteli, gifted to her by Gjergj Dedvukaj, director of the ‘’Bashkimi Kombetar’’ (National Unity) Ensemble, a Cultural Arts Association, to which she is also a member. 

Hooper also has written and published a poetry book in the Albanian language, called ‘’Paintings in words.’’ The book has been promoted in New York by the Society of Albanian-American Writers, and has been published in Kosovo under the care of writer Adnan Ahmeti. 

‘’O language of Albania, the music of your words fills my spirit with joy! Your expressive words fill my heart with joy! When I hear your words, my whole being is filled with joy! Through you I have come to know a strong, brave, and courageous people, who have survived the oppression of foreign rulers and an evil dictatorship. Resound, O beloved language, no matter where your people live! May you live forever, O beautiful Albanian language!’’ has written Hooper in an article about Illyria, an Albanian-American newspaper based in New York.

Her learning of Albanian and five other foreign languages, as well as being able to teach is an inspiring story as Hooper was prematurely born by two and half months. She was held in an incubator for two months, but was left blind after she received a higher dosage of oxygen. She also teaches musical lessons and plays the piano. She expresses gratitude and a sense of luck that her district in Elmira had funds to make her schooling easier and everyone was rather helpful in her further successes. 

Hooper admires Albania and its people. She admires the love the Albanian nation feels for its country regardless of all what it has gone through, and it is precisely this sort of strength to survive for the betterment of the country that impresses her. 

‘’I am impressed by the fact that such a small country has such a long tradition, and has survived many horrible moments, experiences, has survived communist dictatorship; has always survived,’’ said Hooper. 

But adding more to it, she is impressed by the Albanian hospitality and generosity. She takes for example her experiences with the Albanian-American community at the USA. She said that whenever she has visited Albanian communions, she would always feel their love. 

‘’It is very important that for emigrating Albanians to preserve their language, teach your children your language, because without a language you don’t have an identity and without identity you don’t have a nation,’’ said Hooper in expressing a simple message to all Albanians living in immigration.

Hooper has participated in countless events organized by the community of the Albanians at the USA, in which she has hosted the events, or spoken to them in the Albanian language. She has sang and composed songs in Albanian, and has held speeches at various schools about learning the language. She has conducted interviews, and has also held presentations about Albania at the college where she teaches.
                    [post_title] => A friend to Albania sends greetings
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            [post_content] => By Ervin Lisaku

TIRANA, Jan. 15 - Albania has been facing an exodus of doctors in the past few years, making the country’s healthcare system, already facing one of world’s lowest number of doctors, even more vulnerable.

More than 500 doctors are reported to have left the country in the past few years, mainly heading for Germany, Europe’s largest economy, which has eased work procedures for medical staff coming from the Western Balkans as it tries to fill the huge gaps in its healthcare system.

The current numbers represent about a tenth of total number of doctors in Albania, but what’s worse is that an overwhelming majority of medical staff working at the country’s public and private hospitals would be willing to leave the country if they were offered an opportunity, leaving the country’s vulnerable healthcare system without key experts with decades of experience.

Many hospitals outside Tirana and healthcare facilities at remote areas in Albania already face shortage of specialty and even family doctors, leaving thousands without access to basic service and emergency health problems.

Monthly bonuses of up to €2,000 a month for working outside Tirana and in remote areas suffering shortages of specialty doctors since early 2018 have not been much appealing and facilities like the Dibra regional hospital, north of the country, continue redirecting their patients to Tirana, which becomes quite difficult in winter due to heavy snowfall that often makes helicopter transportation the sole opportunity to save lives.

Albania currently has only 1.2 doctors per thousand residents, in one of the lowest coverage rates comparable only to war-torn countries.

The Balkan country has regularly lost medical staff since the early 1990s following the country’s transition to democracy and a market economy following decades of a hardline communist regime and a planned economy.

However, the brain drain has sharply picked up in the past five years following a relaxation in procedures by Germany due to its huge needs for medical staff, mainly nurses in homes for the elderly.

“Germany has relaxed the doctor-recognition procedures. They accept them from all Balkan countries, though they first have to work in a rural area and undergo training,” says Dorina, an Albanian PhD holder in medicine as quoted at a recent brain drain study commissioned by the UNDP office in Albania.

“Almost 30 percent of students that completed studies in the same year as me have gone to Germany. Each year, around 180 doctors graduate [in Albania], and in the last 3–4 years around 30 percent have emigrated to Germany. This is, regrettably, a very high percentage, because there has been a six-year investment for these doctors,” she adds.

 

Almost everybody wants to leave

Doctors and nurses are among certain groups of mostly younger-age professionals such as engineers, IT specialists, legally leaving the country and heading mainly to Germany following a wave of ungrounded asylum-seekers of mainly non-qualified Albanians that have either voluntarily come back or been repatriated after overwhelmingly having their asylum applications turned down since 2014.

The situation is especially concerning among Albania’s poorly paid medical professionals, more than three quarters of whom say they are willing to leave the country if given the opportunity, according to a recent survey by a local Albanian NGO.

A survey with 1,000 doctors nationwide, including private hospitals, showed around a quarter of surveyed staff say they would immediately leave the country. Another 54 percent said they would consider leaving if they were given an opportunity and only 19 percent said they would continue working at home.

The situation is no better at the private sector offering better wages and working conditions where two-thirds of doctors say they would consider leaving the country, according to a study conducted in mid-2018 by Tirana-based ‘Together for Life’ association with support by Germany’s Friedrich Ebert Foundation.

The situation appears more alarming in the region of Durres, the country's second largest, and in the northern Lezha and Dibra regions where only 5 percent of surveyed doctors are willing to continue working at home.

Albania’s public healthcare system is perceived as one of the most corrupt, with bribes to doctors and nurses to get faster and more careful treatment having become quite normal practice and culture that is little denounced.

 

‘Certificates of good standing’

Some 762 doctors were issued certificates of good standing from 2013 to 2017, among whom 94 specialty doctors in documents that are issued upon doctors' request when attending post-graduate studies abroad or looking for a job outside the country, according to the Order of Albanian Physicians, the authority that issues the certificates.

However, in late 2018, a deal between the health ministry and the Order of Physicians put an end to the issue of ‘certificates of good standing’ for doctors that are already under contract in a bid to stop the brain drain from Albania's healthcare system.

The average departure of doctors from the country, including experienced ones, from 2013 to 2017 was at 190 annually, a figure considerably higher to the average 150 graduates a year produced by the University of Medicine in Tirana, the sole public higher education institution offering studies for family and specialty doctors in studies that last between six and eight years.

Bigger in numbers and with wages almost half of what doctors receive, nurses are also more willing to leave the country.

German Dekra Akademie says it has been offering free German language courses and training for hundreds of nurses in Albania during the past three years, managing to take up to 1,200 nurses to Germany where they mainly work in homes for the elderly, earning around €1,300 a month.

Around a thousand other nurses are currently receiving training throughout the country.

 

Reasons for leaving

Low job income, poor working conditions, few opportunities for career development, exposure to political pressure, verbal and even physical violence are some of the reasons that drive doctors to abandon Albania’s public sector, sometime even to work for private hospitals offering much better wages and working conditions.

Albania's Order of Physicians says frequent legal action against doctors charged with carelessness and negligence also has an impact on the decision to leave, with doctors often ending up in prison, fined or having their licence revoked.

"Some 20 doctors were sentenced to prison in 2015-16 in Albania at a time when there were only three sentenced in the US where the number of doctors is 70 times higher compared to Albania. In addition, there are many doctors facing charges and a lot of others that have been fined," Fatmir Brahimaj, the president of Albania's Order of Physicians has said.

Doctors have appealed for new provisions to divide human error from negligence in treatment, the latter punished by fines or imprisonment of up to five years for negligence in treatment.

A negative perception on doctors has reduced patient confidence in the Albanian health sector, increasing pressure and insecurity among doctors, the doctors’ departure study shows.

Germany which has considerably eased procedures for medical staff from the Western Balkans is no surprise as the top destination for those wishing to work abroad with a 26 percent share.

Another 20 percent say they would prefer moving to the UK and 13 percent to Nordic countries.

Due to tight procedures for being hired in the local healthcare systems, Italy and Greece, home to around 1 million Albanian migrants, are not among the top three destinations.

Around a quarter of surveyed doctors say they constantly feel under pressure, disrespected and dissatisfied at their workplace and often face work overload.

Albania has more than 5,800 doctors, of whom more than half, some 3,347 working in the region of Tirana, home to the country's sole tertiary healthcare facility and several private hospitals.

A third to half of doctors say they are dissatisfied with the poor financing of the healthcare system, the system's weak management and bureaucracy.

Albania's healthcare system receives only around 3 percent of the GDP in government funding, some €360 million, in a budget that is insufficient for the system’s huge investment and staff needs.

Around three-quarters of doctors in the country believe they are unfairly highly criticized. Two-thirds fully or partially agreed with the statement that the "practice of not declaring their cash gifts with authorities is tough, but financially understandable."

Doctors say their wages have to increase by 30 to 100 percent in order to turn down bribes or cash gifts by patients. Current net wages that doctors receive are at around €500 a month, considerably above average wages, but almost half of what MPs, judges and prosecutors or other senior officials get.

Around half of doctors perceive their Albania future as uncertain. Women doctors are more prone to leave the country.

Doctors are also dissatisfied with the work culture in the country's healthcare facilities such as lack of respect, inefficient communication, poor team work and insufficient efforts for their professional development.

 

An inefficient system

"Albanian authorities do not assume responsibility, but simply put the people against doctors. Patients don't pay insurance, they bribe and the government accepts that doctors get bribed and not have their wages increase,” a Tirana obstetrician is quoted as saying on condition of anonymity.

“At a country where there is no rule of law, you face the population's pressure and doctors are suffering from this system. There are endless physical conflicts and doctors keep silent. In some case they receive media coverage and in other go silent. The pressure is a result of inappropriate functioning of the system," he adds.

Another doctor blames lack of transparency and ill-guided investment.

“There is lack of transparency. We really have a small budget, but even that small budget is not consulted with doctors on how it is going to be spent and there is no vision with investment and continuity with health policies," a Tirana kidney doctor is quoted as saying.

A cardiologist in Durres says departures are an issue related both to finances and dignity as the money they get is not enough to make ends meet for their households and bribes don't make them feel good.

The study suggests investment in the health infrastructure, the review of the legal framework on medical errors, more opportunities for professional and academic growth, improving the internal management at healthcare facilities, and engaging Albanian doctors working abroad more in the country's public health sector.

 

‘Quit Germany plans, earn more at home’

Prime Minster Edi Rama has downplayed exodus concerns saying the country has new doctors willing to get a job and invited doctors to work outside their residence areas to earn more through bonuses of $2,000 to $2,500, in income which he says is much better compared to Germany where most Albanian doctors and nurses are heading to.

"Everybody who contributes out of their residence areas will get paid the same as they started working in Germany. Doctors serving outside Tirana as experts will get their standard wage and a bonus of $2,000 to 2,500 a month. Taxes here are much lower than in Germany and what you have at the end of the day here is much better," Prime Minister Rama said in late December 2018, announcing the employment of 300 new specialty doctors for 2019.

Tritan Shehu, a doctor by profession who served as former health minister for the now opposition Democratic Party says “doctors find themselves out of a system that fails to guarantee them the appropriate technical and scientific level, qualifications, technology, the pharmacological ‘arsenal,’ literature, income and dignity and that the collapse that is knocking on the door requires fundamental changes in the whole system and not only facelifts.”

 

 A push for migration

Lack of proper healthcare, together with the low quality of the education system and poor income at home are the primary reason why Albanians migrate away from their native land, surveys show.

Albania has around 1.2 million migrants abroad, almost 40 percent of its 2.8 million resident population, making it one of the countries with the highest per capita migration around the world, with a series of social and economic consequences for the country’s future prospects.

Experts says Albanians are mostly leaving the country because of economic reasons, looking to escape poverty in their homes, but also to integrate into leading European economies and take advantage of better education, health and social protection infrastructure for their families.

Albania’s public health sector is perceived as one of the most corrupt and inefficient sectors, with patients often choosing to get treated at private hospitals in the country or go abroad.

Albanians are estimated to spend about €60 million annually in private hospitals and clinics whose number has significantly increased in the past decade.
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