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He added that the equipment under disposition is technologically outdated, and the hospitals can get appliances only through governmental connections.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