Department of Nephrology and Hypertension, University Hospital Centre Mother Theresa Tirana, Albania
Sir,
Following the very helpful report from N. Lameire [1] and the very interesting report of Macedonian nephrologists on the treatment of renal patients from Kosovo in Macedonia during the most recent crisis in the region [2], we would like to add our modest contribution to alleviate the pain of these displaced people who needed renal replacement therapy.
During the Kosovo war half a million refugees were admitted to Albania, a country with a population of 3.5 million. Among the refugees 75 patients from the chronic haemodialysis programme of Kosovo came to be treated in our dialysis centre. These figures may not seem impressive to a nephrologist from Europe or even the Balkan countries, but it was very difficult for us. To further the understanding of what it meant, we present briefly the renal replacement therapy situation and nephrology services in Albania.
The incidence of end-stage chronic renal failure in Albania has been estimated at 90110/million per year. This is approximately 400 new patients annually. The exact incidence may be higher because of screening difficulties, poor referrals, and missed diagnoses. A large number of patients do not have access to health-care centres because of an inadequate health care infrastructure.
The Albanian chronic dialysis programme began in 1985. There is only one haemodialysis centre operating in the country, which treats a total of 20 patients, for 4 h three times a week. This very limited number of patients has been determined by economic rather than medical factors. All patients receiving chronic dialysis treatment are less than 50 years old, none have any significant co-morbid illness, and hence all patients are in the low-risk group. Patients over the age of 50 years, diabetic patients and those with co-morbid disease are not accepted for dialysis; most patients with chronic renal failure are managed conservatively. New patients are admitted to the dialysis programme only if one of the established patients dies or receives a transplant. For more than a decade we have often had to simply refuse dialysis to patients. This is the desparate situation that we have been facing. As a result our immediate short-term planning has been concentrated on measures for the prevention of progression of renal failure such as adequate blood pressure control and avoidance of nephrotoxic agents.
Upon arrival of the refugees our dialysis centre tried to accomplish the impossible by treating patients day and night. We had only five machines. We decided to treat all patients, those arriving from Kosovo and the local patients, at least two times a week. It was very difficult to convince the Albanian patients and gain acceptance for dialysis two times a week. Within a short time, the number of incoming patients from Kosovo completely surpassed our capacities, of both staff and equipment, to respond to the emergency. We asked for help from almost all foreign embassies operating in Albania and from the United Nations High Commissioner for Refugees to transfer some of the patients to other European countries. The evacuation of 25 patients to Italy was coordinated by Dr Andrea Cadellano from the Italian Embassy in cooperation with the Italian Ministry of Health and Mrs. Franka Pellini, president of Asociazione dei Emodializati. Dr Florian Raunig of the Austrian Embassy coordinated the evacuation of 15 patients to Austria.
The 35 patients remaining in Albania were treated at our centre. At the same time five transplanted patients were also treated by the Department of Nephrology. Unfortunately, two of these patients had rejection despite all the medical assistance provided. Two other patients who were treated by peritoneal dialysis in Kosovo switched to haemodialysis because of peritoneal infections that developed while travelling to Albania under very difficult conditions.
In addition to the evacuation assistance provided we also had some equipment support: six new Integra machines from the International Organisation of Migration, and two Monitral and two Gambro machines as well as a number of dialysis filters with a-v lines and dialysis needles from France. The French Embassy arranged for two doctors and four nurses who came and worked with us during the crisis.
We are most grateful to all the people and organizations who supported us during such difficult days.
Unfortunately, the European Renal Disaster Task Force, which was present in Macedonia, was not present in Albania.
References