WORLD HEALTH ORGANIZATION
Kosovo Health Talks 33
10
20.09.2000
NEWS UPDATE
IMMUNISATION
Polio First campaign kicks off
Last minute duties kept SRSG Dr Bernard Kouchner away from Pristina's Health House No. 2 when the Polio First campaign was launched last Thursday, but his name was at the top of the vaccination team.
Dr Kouchner was represented by his adviser Dr Eric Chevallier who apologised for Dr Kouchner's absence. "He wanted to come, because he has a close interest" in the campaign, Dr Chevallier said. "I am very happy to represent him to launch Polio First in a health facility which is in closer contact with people than a hospital might be. People rely on you at local level, you are near to them and you see them throughout their lives."
Pristina's head of vaccination, Dr Nexhmedin Hoti, said that everyone hoped that as a result of the campaign "we will never again have to deal with an outbreak of polio in Kosovo." Dr Hoti said that it was important that Dr Kouchner had given his backing to the campaign, which was carried out in six municipalities with low immunisation coverage, and that was why his name was added to the vaccination team.
After administering oral doses of vaccine to two children, Dr Chevallier commented that "with immunisation teams like this the children of Kosovo will be protected from polio."
See pages 8-9 for full report and results.
HEALTH AND SOCIAL WELFARE
TB guidelines published
The Department of Health and Social Welfare has published new guidelines for the tuberculosis programme in Kosovo. The Administrative Instruction, which is now in force, confirms that Kosovo's TB programme is based on WHO's global strategy of Directly Observed Treatment Short Course (DOTS).
The programme is aimed at reducing tuberculosis morbidity and mortality rates and limiting the emergence of multi-drug resistant strains of TB.
This includes: DHSW commitment to sustained TB control activities; case detection by sputum smear microscopy among symptomatic patients self-reporting to health services; standardised treatment regimen of six to eight months for at least all confirmed sputum smear positive cases, with DOTS for at least two initial months; a regular supply of all essential anti-TB drugs; and a standardised recording and reporting system that allows assessment of treatment results for each patient and of the TB control programme overall.
The AI outlines several changes to the existing system of patient care. For example the TB hospital in Pristina will gradually be integrated into Pristina University Hospital by establishing a department of pulmonology which will be represented on the hospital board.
Similarly the TB hospital in Pejë/Pec will be integrated into the general hospital there with the establishment of a department of lung diseases. In both cases TB patients will continue to be treated in the TB hospital until the DOTS strategy is fully implemented and the number of inpatient beds needed no longer warrants a separate facility.
(See: Pharmaceuticals section)
Health programme continues
UNMIK DPI photo by Ky Chung
Health professionals on the special international team are expected today to start individual briefings of people around the Trepca lead smelter who have been tested for blood lead levels. Each person who underwent tests will be informed about the results and of any possible medical consequences.
Anyone requiring special attention will be examined by the neurologist and the other specialists, who include a WHO consultant toxicologist.
One possible consequence of the high pollution around Trepca, which was closed last month by KFOR and UNMIK, is that fruit and vegetables grown close to the source of pollution may be contaminated.
People in the immediate area should always remember to wash their hands before eating and try to keep their immediate environment dust free.
DHSW bans large institutions for children
The building or re-building of large institutions for children will not be allowed, according to DHSW regulations published last month. Administrative Instruction 23/2000 makes clear that all projects for institutionalised care for socially disadvantaged children must be approved by the department. However the Social Welfare section will be prepared to consider some types of projects to improve the quality of social services and protection of children.
These would include small residential housing projects, transit houses, half-way houses, day centres, supported housing and family centres.
The instructions on institutions was issued at the same time as AI 22/2000 on national and international adoption.
The Instruction stipulates that children born in Kosovo should primarily be adopted, or placed in families, in Kosovo. "It is appropriate to pay due regard to the child's ethnic, religious, cultural and linguistic background wherever possible," the DHSW document said. "Only if all means of placing a child in Kosovo have been exhausted will the department and respective centre for social work consider whether the child could be offered for international adoption."
MENTAL HEALTH
Strategic plan to be presented
The momentum to reform mental health policy and practice in Kosovo is being maintained, with three important meetings scheduled before the end of this week.
On Friday morning the mental health task force is due to meet the Department of Health and Social Welfare to iron out the remaining wrinkles in the fourth draft of the strategic plan on mental health. Dr Benedetto Saraceno, director the mental health and substance dependence department at WHO headquarters in Geneva, and Dr Shekar Saxena, co-ordinator of health determinants and populations at WHO HQ, will attend the meeting.
That afternoon there will be a meeting with representatives of collaborating centres in Birmingham (UK), Asturias (Spain) and Trieste (Italy). It is hoped that this will lead to the twinning of these centres with mental health units in Gjakovë/Djakovica, Ferizaj/Urosevac and Mitrovica.
The visitors, local professionals on the mental health task force and UNMIK representatives will be following up action to implement the WHO mental health support project, which is funded by the Japanese government.
The centres in Birmingham, Asturias and Trieste are expected to provide expertise in the future by sending experts to Kosovo to train local mental health professionals and primary health care staff and by inviting Kosovar professionals for training in the collaborating centres
The aim is to achieve sustainability and continuity through these exchanges.
The strategic plan will be presented to a conference next Saturday at the grand Hotel. The subject of the conference is "Community Mental Health: introduction to a change."
The mental health task force was set up last November by the neuro-psychiatric branch of the Medical Association of Kosovo and the Mental Health Unit of the WHO humanitarian office in Kosovo.
For further information, contact Dr Liliana Urbina by email: , or Aliriza Arenliu through email:
GENERAL HEALTH MEETING
Polio, MH and municipalities on agenda
The next General Health Co-ordination meeting will be held at the medical faculty in Pristina at 11.0 am next Wednesday, 27 September. The meeting is now held monthly.
Dr Matthias Reinicke, WHO's IPH co-ordinator, will present the results of the first round of the Polio First campaign (see the Focus section in this edition). Other speakers will be Bengt Stahlhandske, deputy co-head of DHSW, on the implications of the devolution of healthcare to the municipalities, and Dr Liliana Urbina, on the strategic mental health plan.
Any NGO interested in making a presentation at future meetings should contact Natyra Bajrami at WHO main office.
PRIMARY HEALTH
Family teams process gets underway
The WHO primary care group is now working to establish diagnostic equipment needs for family health centres. This work will include identifying simple diagnostics, x-ray and biochemical needs.
Donors are being sought to cover the cost of equipment for the family centres.
As family medicine training prepares to enter its fourth month, primary health co-ordinator Sue Woodward has begun talks with potential donors on the funding of primary family nurse training within the context of the family teams of the future. Last weekend the Helsinki Group organised a workshop to discuss this and hear views on the subject from the DHSW, the Department of Education and others (see: Nursing section).
Bedtime radio phone-in for health
Staff from WHO, the European Agency for Reconstruction and ECHO took part in a marathon late night health issues phone-in on Pristina's Radio 21 earlier this month. The health panel consisted of WHO's Sue Woodward and Genc Bucinca (regional family medicine team manager for Pristina), the Agency's task manager for health Dr Rob Stevens, and ECHO's Health Advisor Dr Skender Kutllovci from ECHO.
The live show began at 10.30 at night and lasted for two and a half hours. Despite the late scheduling the panel received many calls.
The second edition of Kosovo Family Doctor is now available. Copies can be obtained from WHO office in Pristina, or by request from Edward Poultney through
MOTHER AND CHILD HEALTH
Reproductive health trainers sought
At the end of next month the family doctors training programme will have completed the module on mother and child health and then be ready to move on to the reproductive health module. GPs on the course will be taken through the different components of reproductive health: safe motherhood, family planning, sexual and domestic violence, control of reproductive tract infections (including STDs/HIV) and adolescent reproductive health needs.
The module will be addressed not only from the clinical perspective but also from within the social, economic and cultural contexts. This is in keeping with the reproductive health plan action as declared by the International Conference on Population and Development held in Cairo in 1994.
WHO intends to recruit more trainers to help in conducting the programme. For more information, please contact Dr Emmanuel Owoso, reproductive health adviser, WHO Pristina. Tel. 549.216/8, e-mail
(See p7 for Kosovo natality statistics)
PHARMACEUTICALS
Urgent TB drug procurement sought
The Department of Health and Social Welfare is to take on responsibility for the procurement of TB drugs, which are part of the essential drugs list for hospitals. The DHSW Drug Procurement Office has agreed that TB drugs will be included in the tender to be called next month, but the delivery delay following tender is likely to be about five months. Doctors of the World currently holds stocks for about five months, which means there is likely to be a shortage.
ECHO has been asked to fund an urgent procurement to cover the probable gap before the DHSW order is met. There are almost 1,200 patients on the TB register. Drugs are distributed through Doctors of the World centres based in Pristina, Prizren, Gjakovë/Djakovica, Pejë/Pec, Gnjilane/Gjilan, Mitrovica and Ferizaj/Urosevac.
Report on TB drug distribution
(These opinions are based on the recent situation on the field with regard to TB drug treatment rather than on the Tuberculosis Action Plan Kosovo 2000).
Between 22 June and 6 July WHO pharmaceuticals assistant Dardane Arifaj visited several municipalities to investigate the availability of TB drugs and check that they were being provided free of charge. Dardane writes:
Generally the situation was unsatisfactory and in many places patients were asked to pay for approved drugs, both in private and state pharmacies.
Although the recommended drugs were on the shelves in all 20 sample pharmacies visited, patients were expected to pay in each case. The average price per unit is listed below:
Drug / strength / Unit price (DM)Isoniazide / 50mg / 0.03
Ethambutol / 400mg / 0.16
Rifampicin / 300mg / 0.21
Pyrazinamide / 500mg / 0.26
Streptomycin / 1g vial / 1.0
In rare cases patients are buying these drugs, usually at least one or two of those listed and very rarely all four drugs for the first two months of the treatment course. Comment: usually these are patients who refused to be hospitalised, and the doctor prescribed all four drugs. In one municipality where TB drugs are not available, the pulmonologist is prescribing treatment and the patient has to find the drugs. This raises questions about whether the patient is buying all drugs needed for treatment, and even returning to see the doctor again.
Occasionally patients walk out of pharmacies empty handed after discovering that they have to pay. Comment: when patients discontinue the course of drugs, for whatever reason, they are likely to become resistant. The question here is: is anyone following up on those patients?
Clearly not all patients know how to obtain free TB treatment.
Some health facilities were using old health cards and have a clear picture of how and when each patient has been treated. But other health facilities lack records and do not have a complete picture of patient history.
NURSING
LEMON project still growing
The Learning Materials On Nursing (LEMON) project is continuing to develop in Kosovo. So far 58 nurses (including instructors) and midwives from different parts of Kosovo have attended one of the three workshops held since February.
NORWAC (the Norwegian Aid Committee) provides main funding for the project, while the UK's Department for International Development (DFID) provided funds for the first workshop and for translation of the LEMON package.
The LEMON Project, which is now in use in a dozen countries, makes much needed learning materials available to nurses and midwives in their own languages in the countries of eastern Europe and the newly-independent states of the former Soviet Union. Workshops are used to inform them about the project, to help them to use interactive materials and to help them pass on their knowledge to colleagues. The latest workshop took place this month.
The Kosovo LEMON Group, whose members were initially elected by the 25 participants of the first workshop, contribute to and co-ordinate the work of the project.
The group has shown great commitment to involving their colleagues in learning through the project. Members of the group report that there is enthusiasm to learn, that the learning activities are raising nurses' awareness and motivation, and that this has influenced some nurses' behaviour, leading to favourable comments from doctors. Members of the group said they "now see wider knowledge and we see what we can do ourselves, independently."