Background of Telemedicine Project
Kosova is a region formerly a part of
Yugoslavia, where ethnic strife in the
1990’s led to expulsion of the Albanian
majority from posts in universities,
including the medical school. The
Serbian minority professional staff
maintained a medical system that
provided basic emergency medical
services, where the infant mortality
rate was 51/1000, among the highest in
Europe in 1989 1 and all
advanced medical or surgical procedures
patients were sent to neighboring
countries for management of their
disease. When war erupted in the
1990’s, some 800,000 refugees fled the
region to neighboring countries with an
internal displacement of 300,000 to
700,000.2 Since the
population of the region is
approximately 2 million, effectively 75%
of the population was displaced.
When the war ended, the
situation of medical services in the
area was deplorable. The departing
Serbian medical personnel left behind
very poor, if any equipment that was
sabotaged frequently and inoperable
3. Albanian physicians had not
worked in a hospital setting in over 10
years. Young physicians received
training and education in their homes
and small clinics, and had no experience
in a hospital setting 1, 2.
On June 10, 1999, the
United Nations Security Council adopted
Resolution 1244 authorizing civilian
administration of Kosova in a
partnership called the United Nations
Interim Administration Mission in Kosova
(UNMIK) with three components under its
jurisdiction. Civil administration was
led by the UN and humanitarian efforts
were led by the
Office of the United Nations High
Commissioner for Refugees (UNHCR).
Reconstruction was the responsibility of
the European Union with institution
building by the Organization for Safety
and Cooperation in Europe. Security was
provided by NATO. Hundreds of thousands
of refugees began returning home to a
devastated country in terms of
infrastructure and services 4.
Over 350 Non-Governmental Organizations
(NGO’s) registered to assist in Kosova
and the initial assessment of the
medical situation was rather grim 3.
On June 12, 2005, Kosova celebrated six years
of peace in the Balkans but
redevelopment of the medical system
remains a work-in progress. The role of
telemedicine in Kosova seems clear as the agent and
catalyst for information, evaluation,
coordination, and collaboration. The
toll of many decades of neglect,
occupation, and war left the medical
system of Kosova in disarray but not
paralyzed. Redevelopment proceeds
around an information core with seamless
continuity among medical personnel in
the region and across the globe.
Kosova’s
Clandestine Medical System
The eruption and the
internationalization of war in Kosova
brought to light one exceptional and
unprecedented example of disrupted
medical care in this volatile region.
The government of Serbia had dismissed
the entire Albanian medical staff from
the University Clinical Center of Kosova
(UCCK), and all other regional
hospitals, and closed the only medical
school, the Medical Faculty of
University of Prishtina in Kosova a
decade before.
This situation became known to the world only
after the war ended. The new generation
of medical graduates had not seen a
patient in the clinic throughout their
entire education. Medical school classes
were being held in the basement of
Albanian homes. The old professors,
surgeons, and other doctors did not
practice advanced medicine and/or
surgery for more than a decade. This
represented an enormous problem for
redevelopment of the medical system in
Kosova. All of the sudden, the number of
priorities to be sorted out were
overwhelming and local leadership of
Kosova was faced with an enormous void
in medical expertise just as the
refugees were returning.
Anatomy of
need
There was a lack of fundamental medical
standards, policies and practice
management guidelines. The hospitals
were extremely crowded, yet
underutilized. There were no new
diagnostic or treatment modalities for
most of the diseases. There was a lack
of the most basic medical systems such
as epidemiology, preventive medicine,
specialized disease management,
emergency care and surgery. The
realization of these services, however
remain still a work–in-progress. A
large number of patients were coming
back to hospitals with advanced
diseases. Internationally contracted
physicians organized urgent services to
patients who could not be managed in the
region and were sent abroad for
treatment. A backlog of operating
procedures was created and the list of
patients awaiting operations continues
to grow.
Infectious diseases such as tuberculosis and
other medical problems are emerging.
There is a great fear that AIDS will
soon become a serious problem in Kosova,
and drug abuse is significant. Air
pollution is extremely high, and there
is a lack of public education on
health-related issues and health
hygiene. Smoking and smoking-related
diseases are very serious health care
problems in Kosova.
It is difficult to prioritize and focus human volunteering energy in such
disarray. What should be done first?
Certainly, short term volunteers
operating in a Prishtina hospital with
dozens of young surgeons looking on,
while very important, could not fulfill
the great need of the population. A
basic organization was needed and it
must be realized while full service
delivery is continuing.
Health services are the responsibility of the
UNMIK ministry of health with a shadow
authority of Kosovars that has steadily
taken even greater responsibility.
Initially, the staffing of the health
system was heavily supplemented by
international contract physicians in
anticipation that Kosovar physicians
would assume full responsibility when
training was complete. The medical
school was aided by Dartmouth University
to re-establish and implement a
curriculum. A public health
infrastructure was put in place 2
and a strategy for developing medical
leadership was formulated 1.
Emergency services for pre-hospital
through rehabilitation were assessed and
addressed 3, 4 although many
frustrations were encountered.
There was an obvious need for
electronic information and distance
learning since there was no medical
library, information system or facility
for training. The rapid training of
Kosovar physicians would not tolerate
the absence of physicians for training
because there were insufficient
personnel to cover in their absence. The
six district hospitals have over 5,000
beds among them1 with
Prishtina University Hospital as the
lead tertiary center with excess of
3,000 patients per month, requiring
about 150 emergency operations per month
3. The entire medical staff of the
hospital of UCCK is 2,179 and carries a
considerable work load.
The situation invited electronic and
telemedicine solutions with
international cooperation. The idea to
establish and implement Telemedicine in
Kosova was presented for the first time
at a G-8 Telemedicine meeting, in Berlin
May 4-5, 2000, by the author, Dr. Rifat
Latifi 5. Over the next
year the idea was pursued appropriately
to potential partners and sponsors.
The objective
was to design and implement the TCK as a
sustainable and functional portal for
information within and outside the
region with a training center for
telemedicine. The system would provide
state-of-the-art medical education,
consultation and transmission of medical
clinical data between the UCCK and the
regional hospitals in Kosova, as well as
between Kosova and the international
medical community
The Telemedicine
Association of Kosova was founded in
Prishtina, September 30, 2000. On
February 2, 2001, a Memorandum of
Understanding (MOU) for the
implementation of a TCK was signed by
all healthcare providers in Kosova. This
included the Ministry of Health, the
Telemedicine Association of Kosova, the
medical battalion of the Kosova
Protections Corps (KPC), the UCCK, The
Medical School, The Medical Association
of Kosova, and the Kosova Foundation for
Medical Development, the Department of
Surgery of the Virginia Commonwealth
University and the World Health
Organization. After extensive
preparation, a grant written by Kosova
Foundation for Medical Development and
Telemedicine Association of Kosova was
funded from the European Agency for
Reconstruction. On December 10, 2002 the
Telemedicine Center of Kosova was
inaugurated making way for the official
beginning of the first phase of
development of the TCK. This was a
historical moment for Kosova and for the
Balkan countries that received extensive
media coverage locally and abroad. Since
then, Telemedicine Project of Kosova has
been presented around the world as an
example of successful telemedicine
program in the developing countries. |
