NEWS UPDATE
HEALTH AND SOCIAL WELFARE
UNMIK DPI Photo by Ky Chung
Zvecan closure ends acute lead threat
KFOR troops and UNMIK police moved into the Trepca industrial and mining complex north of Mitrovica in the early hours of 14 August, and closed down the Zvecan lead smelter, whose poisonous emissions were well over the maximum accepted limit. Pollution from the complex has affected the Mitrovica region for many years, but lead emissions rose sharply after the smelter was reactivated two months ago without using an effective filter. The plant was the main source of revenue for the region, and the takeover raised fears among the local Serb population that their livelihood was at stake. However, the Special Representative of the Secretary General (SRSG) Dr Bernard Kouchner has announced plans to make the smelter safe and put the operation back into working order. Workers at the site are receiving payment from UNMIK funds during the closure.
Mitrovica has long been considered one of the most polluted cities of Europe. In the 1980s different studies were carried out and one indicated 12 per cent of the local children given tests had blood levels which put them at risk of severe lead toxicity.
Lead is toxic for adults, but even more so for children, who can suffer from severe encephalopathy. Lead poisoning can cause anaemia by impairing the production of haemoglobin, and can seriously damage the nervous system and the kidney.
Severe lead toxicity can produce muscle weakness and pain, paresthesia and encephalopathy which may abruptly lead to seizures, coma and death.
Collection of samples, from workers and local inhabitants, is continuing.
New drug controls next month
SRSG Dr Bernard Kouchner is expected soon to sign a new regulation on the importation, manufacture, sale and distribution of pharmaceuticals. This is due to become effective on 1 September. The regulation also covers narcotic drugs and psychotropic substances.
The Kosovo Drug Regulatory Agency (KDRA) will be responsible for licensing imports of manufactured and intermediate products as well as the import of raw materials and labile blood products to be used in manufacturing pharmaceutical products. KDRA licenses will be mandatory also for the import of narcotic drugs and psychotropic substances, the manufacture of pharmaceutical products, and operation as a pharmaceutical wholesaler or retailer.
Under the regulation, drug donations will only be accepted after approval and on condition that they comply with current guidelines.
Back payments on the way
The UNMIK pay office is working hard on back payments for health sector staff, but there are still several unresolved questions and in some cases need for clarification, DHSW Officer, Dr Attila Perczel told last week’s regional health management meeting. He urged regional hospital and health house managers to make sure that payroll lists were submitted to the central authority in good time for monthly deadlines to guarantee payment of salaries.
Dr Perczel said that debate was continuing on the final workforce plan which was now about 90 per cent ready. However, some healthcare institutions still needed to clarify details.
Central procurement for dental supplies
The Department of Health and Social Welfare has distributed a list of supplies and material which can be ordered by dentistry departments in health houses. All 47 items, from amalgam to x-ray film, will be procured centrally, Dental Health Officer, Dr Blerim Kamberi, told regional managers last week. Material for dental prosthetics are excluded from the list because health houses are not equipped with suitable equipment.
Dr Kamberi has published a list of principles, based on DHSW Administrative Instruction 11/2000, setting out the procedure by which health houses will order supplies from the department according to monthly estimates of their needs. The chief dental officer said that the dental sector was due for reorganization, with care divided among seven regional dental groups. Basic oral hygiene would be among the work of primary health centres, while secondary dental care would be carried out in health houses. He noted that Pristina had special problems because facilities had been destroyed and equipment had still to be replaced.
PUBLIC HEALTH
Polio First campaign - 21 days to go
Thousands of posters are to be printed this week as part of final preparations for the "Polio First" campaign which aims to raise immunization coverage in Kosovo’s six most vulnerable municipalities.
Regional management teams in Pristina, Podujevo, Mitrovica, Shtime/Stimlje, Pec/Peja and Gjilan/Gnjilane have been meeting weekly to iron out the details of the immunization programme, which will be launched on 14 September by SRSG Dr Bernard Kouchner.
Almost 1000 healthcare workers, divided into 240 teams, will be involved in the campaign. Kosovo has not experienced an outbreak of polio for more than four years, but low coverage means that the danger of a new one is present. The situation has been complicated by the turmoil of the past years and the resulting migrations. The health promotion agenda includes radio and television coverage as well as articles in UNMIK Direct, a fortnightly supplement published in two leading newspapers, Koha Ditore and Zeri. In addition, the campaign will be boosted in the week before the launch by a powerful public address system, borrowed from KFOR and last used during the registration exercise by OSCE.
The Institute of Public Health is lead agent in the Polio First campaign, backed by UNICEF, WHO and several health sector NGOs.
Restaurant closed after food poisoning
The Ferisaj/Urosevac sanitary inspector closed a local restaurant early last week after 42 people were treated for food poisoning caused by refrozen ice cream. All the patients, who suffered nausea, vomiting, fever, headache and low blood pressure, were discharged by the emergency service of Ferisaj/Urosevac health house within 12 hours and there were no fatalities.
The outbreak was investigated by a team consisting of a local clinician, epidemiologist, hygienist and local UNMIK health representative who concluded that the poisoning was caused by ice cream which had melted, been left at room temperature long enough for bacteria to grow, then refrozen and sold. The restaurant owner, who had cleaned the freezer before the inspection team arrived, said that he had suffered long power cuts in the four days preceding the outbreak.
New microbiology lab opened
DHSW co-head Dr Pleurat Sejdiu cuts the tape to open the new microbiology lab in Gjilan IPH
DHSW co-head Pleurat Sejdiu put his cutting skills into practice last Wednesday to snip the tape and open the new microbiology laboratory extension at the Gjilan/ Gnjilane IPH building.
infrastructure. IRC is the implementing partner in the scheme.
The rehabilitation of the Gjilan facilities, which cost 180,000 Euros (approximately 360,000 DEM) is part of a one million Euro ECHO programme to rehabilitate regional Institute of Public Health (IPH).
In addition to the main cost, ECHO has also paid for most of the equipment to set up the modern laboratory. The new extension will make it possible for regional epidemiologists and laboratory assistants to perform analyses locally. The laboratory is air-conditioned.
IRC used a local contractor, Mabetex, for the work at Gjilan IPH, where conditions had
deteriorated badly because of lack of maintenance over the previous 10 years.
The ECHO programme also covers rehabilitation work in the central IPH in Pristina and regional institutes in Prizren and Mitrovica.
MENTAL HEALTH
New centres identified
Progress continues on implementation of the Japanese Government-funded programme to develop community-based mental health services in Kosovo. Sites for future community mental health day centres have been identified with the help of local municipalities and UNMIK authorities in Djakovica/Gjakova, Mitrovica south and Urosevac/Ferizaj. ECHO is to support the rehabilitation, furnishing and equipping of the centre in Djakovica/Gjakova, with MDM Sweden acting as implementer. Training of staff for the new centres, by local and international experts, should be completed in time to inaugurate the new facilities in December.
WHO Kosovo’s mental health unit will be working to a tight timetable next month. During the first week, unit staff will be hosting visitors from Mental Disability Rights International and the Danish Council of Associations of Disabled People, and a conference on mental health and human rights will open in Pristina on 5 September. The conference aims are to make contact with local and international NGOs working in the sector in Kosovo, to set up a network for future actions, to nominate NGO representatives to monitor and advocate human rights for the mentally ill, and to establish guidelines and recommendations on protecting the rights of the mentally ill.
A delegation from the mental health department at WHO headquarters in Geneva is expected in Pristina later in September to discuss proposed reforms with the authorities and to collaborate with the mental health task force.
A reminder: some few copies of the second issue of Kaspar Hauser are still available from WHO main office. The Kosovo edition is published in two editions - Albanian/English and Serbian/English. Contact Liliana Urbina (lilianaurbina@netscape.net) or Aliriza Arenliu (xhizo@hotmail.com).
Institution’s problems continue
Many improvements have been made in the Institute for Mental Retardation in Shtime/Stimlje since the end of the war last year, but it is still in a very bad condition. The Norwegian Red Cross, which manages the institution has called a two-day meeting with WHO and the Department of Health and Social Welfare in Prizren on 1 and 2 September to discuss a detailed master plan for Shtime/Stimlje.
PRIMARY HEALTH
New training centres opened
The refurbished Gjilan/Gnjilane family medicine training centre, rehabilitated with funding from the Finnish Red Cross, was officially opened last Friday. Guests, including the UNMIK regional representative and local municipal officials, joined members of both the first training groups to tour the consulting rooms and clinical skills laboratory after the opening ceremony.
The third training centre, at the Pristina health house, was due to be opened as this edition of Health Talks is published. The furnishings, computers and main lecture facilities were provided by Operation Hope, whose medical educator, Dr Judith Csiszar, has acted as replacement training supervisor for the first two cohorts of family doctors, and takes part in the central training programmes held in Pristina on Mondays and Tuesdays. Dr Judith is a family medicine GP in Hungary.
The opening of these centres completes the first set of three. Gjakova/Djakovica, rehabilitated by Cordaid with ECHO funds, was the first to be officially inaugurated. Funds are being sought to open additional centres, with Prizren and Mitrovica among the probable candidates. Meanwhile evaluation of the orientation module for the first cohort of family doctors shows broad satisfaction with the course and training methods.
The participants appreciated the group work system and teaching methodology. Members of this first group have now completed a four-day training of trainers (TOT) course, and will be returning to the three centres again next month to start work on the second Family Doctors training module.
ENVIRONMENTAL HEALTH
Pilot healthy village gets 40 latrines
The people of Besi, the pilot project in the Healthy Village project, are beginning to see the fruits of their labours, as new latrines are topped off. It is only a month since television cameras went out to the site in Pristina region to cover the first excavations, but already some 40 toilets are ready for their first flush. Inhabitants of Besi have been following an education programme on the correct use and maintenance of the new facilities as well as wider improvements to their immediate environment.
Life should never be quite the same again for these children of Besi. The old school toilets, whose effluence seeped into the compound, have been reconstructed under the Health Village programme
Swimming pool closed at IPH request
Institute of Public Health WAT/SAN supremo Dr Selvete Krasniqi scored a notable success last week when UNMIK accepted her recommendation that Pristina’s public swimming pool should be closed for cleaning. The pool - which is more of a small artificial lake - has proved a huge success since it was opened in June, with several thousand young people crowding into the compound each day. The entrance fee is 3 DEM, so it has proved to be a nice little earner for UNMIK’s Department of Sport and Recreation, particularly during the current school holidays.
Dr Selvete’s water sampling showed that the pool contained faecal coliform germs and low chlorine, and she recommended a four-day shutdown for chlorination and cleaning. The pool has now reopened for business as usual. Dr Selvete said that "it’s important to control these things from the point of view of public health. My daughter was unhappy about this decision, but I explained it was for her own good."
CHILD HEALTH
More newborn care graduates
Healthcare workers in Gnjilane/Gjilan region received their certificates last week at the end of the latest four-day course on essential newborn care and breastfeeding. A total of 240 participants have now completed the course, which has been presented twice in each of the six health regions.
The first international course on the Integrated Management of Childhood Illnesses is currently underway in Pristina. It is based on a Kosovo-specific adaptation of the joint WHO/UNICEF IMCI programme that is now in use in more than 70 countries. Participants in the 11-day course, which covers both theory and clinical work with outpatients and inpatients, divide their days between the Pristina health house and classrooms in the paediatric department at Pristina University Hospital.
The main aims of IMCI are to reduce global mortality and morbidity associated with the major causes of disease in children and to promote healthy growth and development.
The need for better child healthcare in Kosovo is demonstrated by some of the province’s vital statistics.
The population is thought to be around two million, of which some 250,000 are under five-years-old. The number of births per year is between 35,000 and 40,000, yet there are only 125 certified paediatricians (and only 15 neonatologists). This works out at 6,500 children per paediatrician.
In September last year, the main causes of childhood illnesses recorded in Pristina University Hospital outpatients department were acute respiratory infection, sore throat, fever, anaemia, diarrhoea and otitis. All these are covered by the IMCI programme.
This is the first time that it has been applied in the Balkans region and the 20 people on this first intensive training programme represent a wide range of doctors involved in child healthcare. They include the Director of Pristina’s paediatric department, Dr Nijazi Gashi, PUH Professor of Hygiene Sabit Bajqinovci, Italian paediatrician Stefania Avanzini, WHO Regional Health Adviser Xhevdet Xhemajli, UNICEF’s Eroll Rmeshtani and Dr Sami Uka from the first cohort of the family medicine programme as well as GPs from several health regions.
For many sick children, a single diagnosis may not be apparent or appropriate and the course is based on careful assessment of symptoms of the main illnesses, the possible causes, treatment and then counselling. The complaint might appear as a cough or acute respiratory infection but the cause or associated condition could be pneumonia or severe anaemia. Lethargy or unconsciousness could indicate septes, meningitis, severe dehydration or severe pneumonia.
The main components of IMCI are threefold: to improve the case management skills of health workers, using standard guidelines, training and follow-up and supervision; to improve the health system to deliver IMCI through drugs and organization of work and policy; and to improve family and community practices. A parallel objective is to provide comprehensive child healthcare in the most cost-effective way.
The course has had an immediate impact on the 20 participants, all of them experienced doctors. Dr Gashi, Director of the paediatric department in Pristina, said that IMCI provided a new approach to child healthcare. "We used to concentrate on the theory, but IMCI simplifies the tasks and achieves more results," he said. And what kind of an experience was it for him to return to the classroom with junior colleagues? "There is a need for perpetual learning," Dr Gashi said.
Dr Gezim Xhara, a neonatologist from Gjakova/Djakovica, agreed with this. "We have never before had material which is so well prepared," he said.
The success of the course is due to WHO Mother and Child Health Adviser Helene Lefevre-Cholay and her team of Kosovar doctors. "Normally it has taken about 18 months to adapt the IMCI course for different regions. But we have completed the work in just seven months," she said.
As good as the real thing: Dr Aurora Bakalli, of Pristina Health House, prepares treatment for a lifelike training doll held by Dr Drita Talaku, a paediatrician from PUH.
PHARMACEUTICALS
Drugs available but hospitals wait
There are now sufficient stocks of 74 essential drugs and medical supply items in Kosovo to last about six months, but they have not yet reached the hospital pharmacies. The drugs, the first to be funded under the consolidated budget, are still mainly lying in the warehouse waiting for distribution. Two more trucks are en route to Kosovo with drugs from the official hospital supplies list and are expected to arrive sometime this week. As an example of the snags in the distribution system, Prizren hospital complained last week that it had received one delivery in May but nothing since and had had to make other arrangements to meet patient needs.
Meanwhile the Saudi Joint Relief Committee (SJRC) has now reached agreement with the DHSW and WHO on a system to get drugs to hospitals. Under the accord SJRC will supply DHSW and the Kosovo Drug Regulatory Authority (KDRA) with a list of what is available, WHO will collect information from the hospitals on current stock levels and monthly requirements, and KDRA will then authorise SJRC to send the drugs out.
KFK completes plan for donors
The cooperative of state pharmacies, Korporata Farmaceutike e Kosovës (KFK), last week put the finishing touches to its strategic plan, which will be submitted to donors as part of the pharmaceutical programme.
The document will be distributed to, among others, the European Agency for Reconstruction (EAR), WHO, Pharmaciens sans Frontières (PSF) and ECHO, which are main players in the pharmaceuticals project.
Copies of the strategic plan can be obtained from the KFK main office in Pristina.
NGO ACTIVITIES
IMC’s MCH teams spread the message
International Medical Corps now has six mother and child healthcare teams working in the field in Kosovo. The teams, usually one or two doctors supported by as many nurses, are based in Pristina but provide reproductive health services at 55 ambulantas in 10 municipalities. Many of the ambulantas have been refurbished or partly rebuilt by IMC. All 12 Kosovar doctors on the teams are women.
Services provided by MCH staff include antenatal care and family planning services, ranging from counselling and provision of oral contraceptives, Depo Provera, condoms and IUDs. The teams have also started a successful tetanus immunization campaign for pregnant women, and more than 560 mothers-to-be have received tetanus shots since the programme was launched in April. Last month the number of client visits for reproductive care rose to 1,218, bringing the grand total to almost 6,000 since IMC launched a pilot programme in October last year.
The MCH programme is boosted by radio spots, broadcast four times a week which carry this message: "Do you know that a pregnant woman needs to be checked at least four times in her pregnancy? Do you know that you can prevent your unwanted pregnancy? Do you know that if you have a reproductive tract infection it can be treated? Do you know that the newborn needs to be checked after pregnancy?"
IMC Mother and Child Health officer Dr Violeta Loxha weighs in one of her patients in Lluzhane ambulanta, in Pristina region.CALL FOR INFORMATION
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