Albania: Ailing Hospitals in Need of Strong Medicine

When Dhimiter Bixho, a 50-year-old Albanian, went to the doctor complaining of a stomach ache, he was surprised to learn after a brief examination that he needed an urgent operation to have his gall-bladder removed. However, he trusted the physician and didn't hesitate to pay him the 1,000 US dollar bribe required for his case to be dealt with speedily.

After spending a week in a Tirana hospital, Bixho ran into another doctor who treated him in the past and mentioned his recent operation. He was shocked to be told that his operation was unnecessary - his gall-bladder had already been removed in an earlier procedure, ten years ago.

Bixho's story caused a storm in the media, which seized upon it as yet another example of Albania's ailing public health-care system, plagued by malpractice, bribery and corruption. Over a decade after communism's collapse, the country's medical facilities are outdated and inadequate, and run by underpaid staff who accept bribes from patients and conspire with pharmacists to supplement their incomes.

A new raft of government legislation, passed in mid February, aims to tackle the problems afflicting the country's clinics and hospitals, over half of which cannot meet the needs of the population they are meant to serve, according to recent research conducted by the World Health Organisation, UNICEF, the International Migration Organisation and other world bodies.

However, analysts believe the new laws, at best, only address the symptoms of the problem - major investment and a radical overhaul are needed if the health service is to be cured of its chronic shortcomings.

Dine Abazi, head of the doctors' union, told IWPR, "The structure of Albania's health system, in which there is no reliable form of public medical insurance, has caused doctors to abuse the system and risk patients' lives in order to fill their pockets."

Following the failure of the state-run health service to act as a universal safety net, wealthy Albanians have turned to private clinics that offer preferential treatment at a high price. Meanwhile, less affluent citizens routinely ply doctors and nurses with bribes and gifts to ensure they get the attention they need at public hospitals.

Although Albanian doctors will often have gifts forced upon them by patients grateful for the care they have received, this tradition of generosity has been exploited in recent years by health workers who survive on the bribes they receive. The average monthly pay for doctors and nurses is 270 and 90 US dollars respectively.

Accounts of bribes being paid in public hospitals are widespread. For surgery, patients should be prepared to fork out between 500 and 2,000 dollars.

And it is now commonplace for Albanian doctors employed by state hospitals to moonlight in lucrative private clinics.

Many also supplement their incomes by making an underhand agreement with a particular pharmacy. By sending patients to pick up their prescriptions from certain outlets, the doctors pocket a small commission. The former, in turn, tend to charge 10 per cent more than the recommended retail price for the drug, apparently to cover the cost of the backhander.

After the 1999 war in Kosovo, Albania was flooded with pharmaceuticals originally intended for the aid effort. Officials say some 100 tons of medicine were re-packaged and resold in Albania after their expiry dates ran out.

The new laws passed in February demand the careful maintenance of each individual's health record and bring the pricing and distribution of pharmaceuticals under the control of a single, state-appointed watchdog.

The closer monitoring of personal medical records will, it is hoped, help the state better identify who should receive financial help for treatment. The restructuring of drug distribution is aimed at ending the informal agreements between doctors and pharmacists, as well as making it harder to prescribe drugs that are unnecessary, out-of-date or overpriced.

Gjergji Leka, head of the Public Health Institute, which will oversee the pricing and distribution of all medicines under the new laws, believes the lack of legal controls in the health service has caused vital funds to be drained away. He adds that the problem will remain as long as doctors find it "in their interests to prescribe countless, often expensive, medicines, even though these products may be unsuitable for the patient".

A paediatrician from Tirana, who divides her time between a public hospital and a private clinic, confirms that doctors have become adept at exploiting the system. False diagnoses are often given to patients, along with an endless list of medication, which must then be purchased from a recommended pharmacy.

However, a recent outburst by premier Fatos Nano attacking doctors "who endanger the lives of their patients" was fiercely rebutted by health workers who maintain the problem will persist as long as they are not paid sufficiently.

Meanwhile, the worst victims of Albania's health-care system continue to wind up in the hospital morgue. An investigation is underway into the death of 54-year-old Marta Ziu, whose husband alleges surgery at the local hospital in Korce killed her.

Dine Abazi, the doctors' union chief, believes "corruption is ruining the reputation of Albania's medical corps". He recently took up the case of a man who died after refusing to pay a bribe for an operation in Korce.

Briseida Mema is a freelance journalist based in Tirana.