By DASHNOR KALOÇI
Part Three
Memorie.al / Even though it was widely propagandized that “unlike capitalist countries, in Socialist Albania the health service was free for all citizens,” throughout the entire period of the communist regime of Enver Hoxha and his successor, Ramiz Alia, it left much to be desired. Indeed, in many aspects, such as the apparatus and equipment of hospitals and other health facilities with various contemporary medicines and medicaments, it was a problem that remained unresolved until the collapse of that regime. But one of the greatest wounds of the healthcare of the pre-1990s, it is said, was that of the high number of deaths of children aged 0 to 1 year, or as it was otherwise known in medical terminology; “infant mortality.”
Among other things, this is also made known by some archival documents of the Ministry of Health of that time, where its correspondence with some of the highest party and state institutions and organs of that time is found, in which it is made known that only during the year 1971, in all the districts of the country, out of 72,771 births, 7,027 deaths were recorded in children aged 0 to 1 year.
But what shocked Tirana and alarmed the high party and state leadership of that time was the death of 27 infants in the Tirana Maternity Hospital (today the “Nana Mbretëreshë” Maternity Hospital) during only a few days at the end of September and the beginning of October 1972, which forced the relevant organs of that time to completely close the Tirana Maternity Hospital. But why did such a high number of deaths occur in that maternity hospital at that time and what were the reasons that the decision was made to close that Birth House? What is said in the report-informations of the Minister of Health of that time, Dr. Llambi Ziçishti, sent to the highest instances of the state, and what was the reaction and response of the high leadership of that time, starting from Prime Minister Mehmet Shehu, the secretary of the Central Committee of the PLA, Hysni Kapo, the first secretary of the Party Committee of Tirana and member of the Political Bureau, Manush Myftiu, etc.?
The following archival documents, published for the first time, bring a detailed overview of the alarming state of infant mortality in Albania in 1971, as well as the efforts of the state apparatus to bring under control this tragic phenomenon. Through the report of the Deputy Minister of Health, Dr. Kleo Miho, as well as official reports signed by Dr. Bukurije Maçi at the Directorate of Mother and Child, the true picture of the medical service in the districts and villages during the communist regime is revealed.
These official documents of the beginning of 1972 bring to light not only the high figures of infant mortality, where respiratory tract diseases such as bronchopneumonia accounted for up to 60% of cases, but also the deep infrastructural backwardness in rural areas. The documents reveal the failure of the plan for the construction of birth houses and consultories, the lack of maternity leaves and medical check-ups for children 0-3 years old, as well as the scandalous conditions of food in village kindergartens, where even the most basic items such as wheat bread and milk were missing. Through an administrative self-criticism, the reports also strike at the bureaucracy of local health sections and the superficial or fictitious-form reflection of demographic data from the districts. Regarding this etc., the documents in question make themselves known to us, extracted from the Central State Archive (fund of the former Central Committee of the PLA), which are published for the first time and with the relevant facsimiles by Memorie.al
Continues from the previous issue
LETTER OF PRIME MINISTER MEHMET SHEHU, ON THE GRAVE EVENT OF THE DEATH OF 27 INFANTS IN THE TIRANA MATERNITY HOSPITAL IN OCTOBER 1972 AND MEASURES AGAINST THE PERSONNEL
To the Maternity Hospital and the Ministry
I am not a doctor. But logic tells me that the source is the personnel itself that serves in the maternity hospital (doctors, nurses, attendants), and the conditions of filth there. That is, there is a lack of HYGIENE DISCIPLINE there. From whom do the doctors demand hygienic discipline, when they themselves violate it, without the feeling to the proper degree of responsibility, and of respect for human life?
Not only should the maternity hospital be closed and transferred, but this personnel, abusively all of them, must pass “through the eye of a needle,” on the part of the control to find the bacterium and to be disinfected, since as you yourselves say, “even after the temporary closure of the Obstetrics Corps, the return to this ward creates a guarantee, only in case the hygienic rules of asepsis are applied meticulously.” Then, you be the first to apply these rules! Act according to the principle: “do as I do,” and not according to the principle: “do as I say, but do not do as I do”!
Let this case serve you for a general shake-up, not only in the maternity sector, but also in all other sectors, of healthcare and everywhere, in the city and in the village. And keep the responsibility on yourselves, and not throw it on the mothers, claiming that they are the carriers of the microbe! How do you know? Where did you get this theory from?! As if you have hygiene cards for all the mothers who enter the birth houses! If you had control, you would have discovered the source in time. Therefore keep all the responsibility on yourselves.
Note. In the new temporary birth center, no one from today’s personnel of nurses should serve, until their hygienic side is ensured and there are no bacteria, return to the maternity hospital only when you are sure that everything is in order.
October 1972 Mehmet Shehu
REPORT-INFORMATION OF THE MINISTER OF HEALTH, DR. LLAMBI ZIÇISHTI, RELATED TO THE GRAVE EVENT OF THE DEATH OF 27 INFANTS IN THE TIRANA MATERNITY HOSPITAL IN OCTOBER 1972
I N F O R M A T I O N
Following our previous reports on the situation in the Birth House in Tirana, we inform you of the following: The sick children are in the process of recovery and from the contacts no suspicious case has been signaled.
Since November 3, 1972, there are no new cases either in the maternity hospital or in the city. The children have been born so far in the Birth House of the Combine.
Currently the situation is such that with that capacity and with the conditions that that House has, this practice should not continue further. The personnel serving there have been brought from other districts. It is foreseen that on November 15, 1972, the Birth House in Tirana will be reopened. For its reopening and functioning, a series of measures have been taken in order to avoid to the maximum in the future the spread of any such infection. These structural measures the maternity hospital has not had in the past.
A special ward for newborns was created. In this ward there will be 6 separate rooms to avoid the gathering of children, and a larger hall divided into four parts, where the system of boxes or semi-boxes will be placed to prevent the transmission of infections.
The isolation ward was created in the form of two separate boxes to place the sick children. In case of need, it is foreseen that another ward will be added adjoining the first and in communication with it.
The installation of oxygenation was decided everywhere, so that the need for movements of the children is not felt.
The material that will be used for the children will be sterilized in an autoclave. The equipment has been given and the centralized sterilization system has been created.
The linen used by the doctors, the gowns and aprons will be autoclaved every day. To separate these, measures have been taken for the creation of a special wardrobe separate from that of gynecology and that of the aborted.
Continuous sterilization of all environments, equipment, furniture, etc. has been done.
All employees have undergone bacteriological examination. The suspicious ones will not be accepted for service.
Measures have been taken for the sterilization and preservation of the cleanliness of hands before every contact and manipulation with the children.
To put these measures into effect, the material base has been increased, both in linen, furniture, apparatus, etc.
The special service of the sanitary inspectorate has been established.
With these measures certainly, infections will be avoided. Continuous work will be done for the education of people. The fact that only one violation caused on October 30, 1972, the appearance of some new cases, as has been said in the first report, makes you certain that the strengthening of hygienic discipline is the main factor and here we must all insist.
We worked on the remarks of Comrade Prime Minister and again before the activity resumes in the obstetrics corps we will provoke another meeting to insist even more on the measures that have been taken and on the responsibilities that emerge for us.
These days we will gather the obstetric doctors from the districts and directors of institutions to familiarize them with this issue and to determine the measures that should be taken for each institution. Such a thing we have also done with the heads of Health in Korçë.
Tirana, November 15, 1972
M I N I S T E R
Llambi Ziçishti
REPORT-INFORMATION OF THE DEPUTY MINISTER OF HEALTH DR. KLEO MIHO, SENT TO THE EXECUTIVE COMMITTEE OF TIRANA, ON THE GRAVE SITUATION OF INFANT DEATHS IN OCTOBER 1972
PEOPLE’S REPUBLIC OF ALBANIA Secret
MINISTRY OF HEALTH Tirana, December 4, 1972
Directorate of Mother and Child
No. 54/177 Prot.
Subject: Information on infant mortality for the month of October 1972.
TO THE EXECUTIVE COMMITTEE OF THE P. C. OF THE DISTRICT
(Health Section)
In the analysis of infant mortality for the 6 and 9 months of 1972 that we have sent you, we have drawn attention to the increase of this mortality in the third quarter.
The month of October of the current year is much higher (9.5%) than the previous months as well as from October of last year. Especially worrying is the increase of infant mortality in the districts of Berat, Fier, Korçë, Lushnjë, Sarandë, Skrapar and Tiranë, which continuously stay below the average of the Republic, while for the month of October of this year they are much above the average of the Republic and above their usual level. But also the other districts, with the exception of Gjirokastër, Përmet, Kolonjë, Tepelenë, Vlorë and Lezhë, have a very high infant mortality for the month of October.
During the months June-July-August and until the middle of September, in most districts the Viral epidemic of the ‘ECHO’ group passed, from which many children of small ages and those under one year were affected. In Tirana during the month of October there was a nosocomial infection in the neonate ward of the Birth House which caused quite a few deaths. Likewise a bacterial infection appeared in the city of Burrel and in some surrounding villages in the first days of October, from which several children under one year of age found death.
Besides these we do not know and have no other signals that explain the rise of infant mortality in the month of October. Some districts try to justify this increase with the premature atmospheric changes (the premature cold), from which many diseases of the respiratory apparatus in children were caused.
We think that this is not the main reason, since and near these districts with high infant mortality, there are districts that had the same atmospheric conditions and have low infant mortality for the last 2-3 months such as: Gramsh, Mirditë, Kolonjë, Tepelenë, Vlorë, etc.
Nevertheless, according to the partial data that we have for these last months, it results for us that there are quite a few negative factors that influence the health and life of children:
1 – In some districts there have been many premature births from which a large part of the children have died.
2 – There have been many accidental deaths (asphyxia, etc.)
3 – There are numerous deaths within the first 24 hours of admission to institutions.
4 – There are still many deaths of children without being visited and without receiving any medical help, as well as births without medical assistance.
We mentioned some worrying factors which with greater work can be reduced to a minimum in a very short time. Therefore for all these I request:
a)- The organs and health workers, at the center and at the base, to follow and study continuously the causes of premature births, to focus attention on the implementation of the law on the rights of the pregnant woman, to cooperate more with the organs of power, the mass organizations especially of women, and to seek their help to not allow eventual violations.
b)- For the reduction to a minimum of accidental deaths in infants of breastfeeding age, the health workers must do greater work with parents in the direction of good upbringing and care for children, and in some case the medico-legal autopsy should also be requested.
c)- For the numerous deaths within the first 24 hours of admission, besides the convincing work with parents for the timely and regular treatment of children, their timely admission to hospitals, it is necessary that on the part of the directorates of health institutions (hospitals and birth houses) and the section, the means and measures needed for emergency and reanimation in these institutions be reviewed.
d)- With the completion of all the villages of the Republic with midwives in this month, it is necessary that births with full medical assistance be done close to or one hundred percent. At the same time, regular follow-up at home or consultory of children should be done, especially in the first months of life. For this, the midwives must be checked and helped in their work more by the section and the people’s councils of the villages, as well as by the mass organizations.
e)- Deaths without medical help should greatly concern all the organs and health workers. The health sections, the doctors of the zonal hospitals and those of the health centers must do the maximum so that these cases are reduced as much as possible, and now the possibilities and medical forces are greater for such a purpose.
For the increase of infant mortality in the last months and especially in October, the Ministry of Health draws the attention of the sections and all health workers, who must mobilize more in this direction, strengthen and not weaken the organizational measures from any decrease of infant mortality.
The health sections should urgently study and draw conclusions for the increase of infant mortality in the month of October, exchange experience with neighboring districts and those with low mortality, and take all necessary measures for the influenza epidemic ‘A-2’ that is spreading, so that it does not damage and cause numerous deaths in children.
I request once again that the material sent earlier on the 6 and 9 month mortality be worked on with all the demography commissions and pediatric and obstetric doctors. Likewise the material that we are sending you should be worked on immediately in these commissions, with the directors of the institutions, the Presidency of the Executive Committee as well as the Party Committee should be informed and for the difficulties that you will have, seek the help of these organs./ Memorie.al
Continues in the next issue
