“The immediate crisis is, I hope, easing, although the situation remains far from stable and the future is unclear” (Redmond 1999:1652)

To witness the impact of Kosovo’s troubled history, and its accompanying effect on the changing landscape of its population, was an eye opening and insightful experience. In approaching the two-year anniversary of Kosovo’s independence, granted in February 2008, I question, through the understanding and analysis of healthcare delivery and reconstruction, how the country has healed through a process of post-conflict recovery.

Kosovo has a turbulent history, anchored in the ethnic relations between Albanian and Serb populations. The tension mounted as Slobodan Milosevic led the oppression against the Albanians, following his rise to presidency in Serbia. “Abuses of power, exploitation of ethnic enmity for political gain and unbridled nationalism have occurred in dramatic surges” in Kosovo (Shuey, 2003:300). In 1999, with a failure of Milosevic to engage in peaceful actions, NATO intervened, based on the need to protect Albanians and prevent ethnic cleansing. This lead to the United Nations Mission in Kosovo (UNMIK, under the remit of Resolution 1244) followed by the formation of the Kosovan Force (KFOR). As part of the huge international effort to assist Kosovo during this time, Professor Tony Redmond, funded by DFID (Department for International Development), took on the role of medical director at the Pristina University Hospital. He assisted in the task of rebuilding the core of the health care system and in expanding service provision in an infrastructure that had been truly devastated by the ongoing conflict (Goepp et al., 2008).

During Professor Redmond’s time at the University Hospital Pristina, in 1999, there was a great deal of change and development, with new facilities successfully implemented and the valuable reorganisation of healthcare workers realised. In a tour of the hospital it seems that since then progress has subsided. This highlighted for me the continuing difficulty of implementing a relief-to-development continuum, and the effect in failing to instigate the objective of tackling structural injustice and inequality in the immediate rebuilding of the state. Foreign donations for development have been used weakly in ways that do not aspire to assist the population as much as they do to satisfy an individual’s wish or desire to assume authority. This leads me to question the need for international input over a longer period of time in order to reach a higher-level of trust and collaboration. This may improve the impact of public service deliverance, in enabling a gliding transition from relief to development. “Dreams, statements, and printed papers are not enough for a system; well-thought actions and improvement of the situation in Kosovo are required” (Antonio Duran, adviser at the WHO Regional Office in Europe, 24th November 2008). I have realised the difficulty in attaining a united workforce, dedicated to helping those suffering in a middle resource country, where political and economic greed still run rife.

In initial meetings with representatives from all those contributing to the healthcare system, including the WHO alongside clinical, political and educational personnel, it quickly became apparent that H5N1 was causing panic. Fuelled by the fear of the sudden discovery of a potentially unmanageable pandemic within the country, there seemed to be a lack of preparation and a lack of guidance from all angles. We arrived shortly prior to a national media conference, and there had been no discussion on how the public would be addressed and how the unveiling situation would be portrayed in the media’s eye. I grasped the sense that there was unwillingness, amongst the heads of healthcare, to seek external support in dealing with the crises. This seemed evident in their lack of optimism in receiving foreign assistance, and in their scepticism towards the international community. I felt the pressure they bore in tackling the problem in isolation, was counterproductive in effectively managing the outbreak of H5NI. This is in spite of the WHO appointing a representative to reside within Pristina, to oversee healthcare troubles.

Concerned about the manner in which patients were being diagnosed and treated with H5N1, a conference call with head members of WHO staff in Geneva was arranged. Within the University Hospital Pristina, The National Institute for Public Health and the Infectious Disease Clinic are completely detached. It soon unfolded during the conference discussion that the lack of communication and cooperation between these two departments, alongside the seclusion of the WHO office in Kosovo, was culminating in a delayed and unproductive response to the H5N1 outbreak. Competing interests, between agencies, and the obstacle of failed governance, through the lack of integration and involvement of the Minister of Health in decision-making, meant that both public health and epidemiological studies were failing to be adopted as priority during the immediate outbreak of H5N1. No official data had been collected on incidence and mortality rates, there were no case notes and there was no advice circulating nationally on how to manage the spread of the disease. The isolation of contaminated patients had not been considered and the most effective use of limited resources had not been thought through. Within University Hospital Pristina, all staff members wore respirator masks. However there was no hand washing facilities or alcohol gel present. A stockpile of vaccines for H5N1 (provided by the Turkish government) is in storage in Pristina, waiting to be distributed and utilised. However both healthcare staff and the public body are refusing to consent to having vaccinations due to suspicions of contamination and distrust in politically grounded advice.

Once the complexities of a situation are realised, the need to establish more understanding through varying viewpoints and criticism is essential in order to enable more direct engagement and a greater solidarity to materialise. With all of this I feel I left Kosovo with far more questions than when I arrived, but with an enthused determination to delve deeper into issues surrounding Kosovo’s healthcare reform.

References

Goepp J. G. et al. (2008), ‘Challenges and promises for nurse education curriculum development in Kosovo: Results of an “accidental ethnography”’. Nurse Education Today, 28(4): 419-426.

Redmond A. D, (1999), ‘How do you eat an elephant?’. BMJ 319: 652.

Shuey D. A. et al. (2003), ‘Planning for health sector reform in post-conflict situations: Kosovo 1999-2000’. Health Policy, 63(3): 299-310.

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