There is little doubt that the hospital was damaged when the Serbs departed, but this was but a last parting shot at an institution that had been run down for years and particularly since 1990. It was about then that Milosovic redeployed Serb staff from Belgrade to replace local ethnic Albanian staff and the slide to the present situation really began.
I was here myself in 1992. All the senior staff whom I met were Serbs and unhappy at their forced exile from Belgrade. They told me that the Albanians had walked out and set up their own parallel medical school. Those Albanian professors are now back, and while some jumped before they were pushed, and others left in protest at the failure of the Serbs to recognise the Albanian language, they certainly describe a grave injustice.
When NATO arrived many Serbs left, but not all, and the hospital still had many Serb staff—particularly doctors. The mass return of Albanian staff to the hospital led to a very unstable situation, culminating in the wounding of Serb staff and the disappearance of the previous (Serb) occupant of the office where I now work. It was the intervention of the British army that ultimately sounded the call to order. However, the exodus has continued, with only a handful of Serb patients remaining and the last two Serb doctors leaving last week.
The hospital I first saw had dogs running wild, eating the waste, clinical and domestic, which was strewn around the hospital. The mortuary was littered with rotting corpses and the kitchens were filthy and unstocked. The drains were overflowing and discovered to have been blocked with the stock of the hospital pharmacy. The dogs have now been removed and the British army has cleaned the stinking mortuary and buried the dead. The World Food Programme feeds the sick; Pharmaciens Sans Frontières runs the pharmacy, and Oxfam has cleared the drains and will improve the supply of clean water. There are many non-government organisations from around the world working in the hospital, and together we are helping the local doctors and nurses to provide care to the people of Pristina.
There is around me, at least in the hospital, a palpable air of optimism
I am here as part of an advisory team, funded by the Department for International Development. An international and therefore neutral medical director was thought the best option by all sides and my appointment has been greeted by cooperation and support. This now predominantly Albanian institution is staffed largely by doctors who have not practised in the hospital for nearly 10 years or trained in the parallel Albanian medical school. Lessons were taken in private houses and exposure to inpatient hospital experience gained by pretending to be hospital visitors and stealing on to the wards to take histories. The effort required to complete this training was considerable, but the doctors are well aware of their lack of hands-on clinical experience. We have to identify training needs urgently while supporting clinicians in their daily activities.
External advisers in all the major specialties have begun arriving to work alongside local doctors. An NHS management team has already visited and partnership with the NHS is being developed. A management board has been established and decisions about the future role and direction of the hospital are beginning to be addressed. The semi-autonomous clinic system prevalent throughout hospitals in the former Yugoslavia is about to yield a little to the development of a central admissions and emergency centre. This British funded programme will supply a single point of entry to the hospital and a focus for the development of clinical training.
The future will not be easy. The only Serb members of the hospital management board were the last two Serbs to leave, and any prospect of reconciliation between the two communities still looks very far away. Yet in spite of, but perhaps because of, the suffering that has brought us to this position, there is around me, at least in the hospital, a palpable air of optimism. The staff remains unpaid but patients get treated and the hospital looks cleaner every day. The army is still present but in much smaller numbers. A man with severe complications from a gunshot wound had surgery by a local doctor operating with colleagues from Britain and the Lebanon, with anaesthesia and intensive care provided by an Albanian with two French colleagues. The type of operation he required was agreed between all after his details, including digital clinical photographs, were emailed to a surgeon in Salford.
The immediate crisis is, I hope, easing, although the situation remains far from stable and the future is still unclear. The mortuary fills up but now gets emptied, and the fridge is still working. There is still rubbish around the hospital but not as it was before. The trickle of Serb patients has never actually stopped and I meet regularly with Serb doctors outside the hospital. They remain fearful, but I'm told that one will rejoin the hospital board next week.
So how do you eat an elephant? One bite at a time.
Figure.
NIKOLAS GIAKOUMIDIS/AP PHOTO
The immediate crisis at Pristina hospital is easing