Warden Training

So, I am traveling on a bus back to Korca, winding over the mountain road between Tirana and Elbasan, pitching side to side as we pass dump trucks, and motorcycles, hay carts, old ladies walking their cows, herds of sheep and goats and even a couple of Germans on a bicycle tour. Clarinet music is playing to a syncopated Balkan beat over the bus speakers. I am gazing out the window at the deep valley far below the cliff edge of the pavement which has a 104 degree haze lying over it. The little boy in front of me pukes his breakfast over his mother. She puts her head down, as does the old lady in her traditional black dress and white scarf across the aisle. When the young girl who is sitting on her mother’s lap in the seat next to me starts to look a bit green, I pull a plastic bag from my pocket and hand it to her mother. She accepts this gratefully and passes it to her daughter. The bus conductor (most every bus in Albania has a conductor to take fares and help with baggage) opens a roof vent which helps a lot. What strikes me then, is that none of this seems particularly remarkable to me. I am suddenly made aware of how much I have accepted as normal things that would have amazed in their strangeness a few months ago. Humans, even old ones, adapt quickly. I go back to looking out the window, dozing off occasionally on the long trip.

I was in Tirana again for two days of Warden Training. I am a warden for the Korca region. This involves responsibility for safety and security and an intermediate role in the Emergency Action Plan for Peace Corps Albania. This is not a abstract exercise. The Peace Corps had to evacuate from Albania in 1997 during civil unrest that followed the collapse of Ponzi schemes that evaporated most of the assets people had from distributions following the collapse of communism a few years earlier. There were riots, fires, shootings, road closures, etc. (I wonder how Americans would have reacted had the malfeasance of Madoff and Stanford had as broad an effect on our economy). Eight of our current volunteers were evacuated from Georgia after the Russians invaded last year. They could hear artillery from where they were staying. If you are evacuated from an assignment before completing enough of your term of service, you are offered placement in another country, based on their need and ability to absorb additional volunteers. A few went directly from Georgia to Albania and began service following abbreviated pre service training in Albanian language and culture. Three in my group went home for awhile before returning this year to start again. Albania is also an active earthquake area and, during a drought a couple of years ago, large forest fires raged nearby in Greece.

I am supposed to keep track of the 8 volunteers in my region and be ready to assemble them and keep them at my apartment for awhile, and evacuate them safely through Tirana, if communication is maintained and that this advised or, on my own initiative, to either Macedonia or Greece, if communication is lost, the situation meets established criteria and I decide it is a good idea. At training we reviewed policy and procedures and did some exercises with various scenarios. I am glad there are only 8 volunteers in my region and I would guess that some would proceed on their own across the border, since Pogradec, where there is one volunteer, is only a few miles from Macedonia and Bilisht, where there are two, is walking distance to Greece. Other regions have a lot more volunteers and, if the one airport or ports were closed, might have a long and difficult trek to the border.

The election in June was very close. It took weeks to get the result. The current, right of center government had to make a deal with a leftist splinter group to continue in power. The left of center opposition has not been happy with this, but it seems the election was generally fair and the results have been accepted. International monitors were positive in their assessment. All this seems hopeful to me. It is hard for me to imagine bands of heavily armed factions fighting it out in the streets of Korca, burning public buildings, blocking roads, and pulling people from their cars, as happened in 1997. Perhaps the worst consequence of that was the large migration of educated professionals from Albania as engineers, doctors, nurses, and teachers left en masse; a severe setback for a poor country trying to emerge from more than a generation of communist dictatorship.

A few of the people at the NGO’s where I do some of my work were here through that period. They acknowledged being uncertain and scared at times, but say they kept their heads down and got through it. Korcans I have talked to about it say they stayed inside and away from windows, lay on the floor if they heard gunfire and had problems keeping kids occupied when schools were closed for months and they couldn’t play outside. Food and other supplies were difficult at times, but friends and family helped each other. That was a time when steel doors and bars on windows were put on apartments and concrete block walls with steel gates were built around homes. Some people are able to adapt to a lot more than wild bus rides.

Ekskursion

Once a month, Dr. Isufi organizes an outing for his patients. He hires a larger furgon to take them and a few family members to some scenic place near Korca. He invited me along on a recent trip to a lakeside park.

A basic, 15 passenger furgon (deluxe models have additional features like shocks or brakes) was filled with 24 people. In typical Albanian fashion, the aisle was filled with plastic stools for extra passengers. Since I was an honored guest, I got a plastic chair in the front of the aisle. The bus was a bit hard to start, so the driver had to work on it and get some water for the radiator. Eventually we were on our way heading northwest from town.

After a short ride we pulled into a private park with grass among large trees by a lake with swans and ducks. There were rowboats for hire, but these were being used by wedding parties for photographs of brides and grooms rowing on the lake and feeding the swans (we are in the thick of Albanian wedding season. I will write more on this later as I am attending a wedding back in Thane at the end of the month). Our group sat on blankets and laid out a typical feast of roast chicken, pilaf, cheese, bread, fruits and vegetables, sausage, beer and raki. Being the guest, everyone made an effort to feed me. Luckily, Dr. Isufi invited me to go walking while I was still able to stand.

We walked to a nearby village where a friend and former patient of Dr. Isufi runs a small coffee bar. Dr. Isufi pulled his hat low over his face and had me walk up to the elderly man, who was sitting on a chair in front of the small, empty store, and ask for directions. He then pulled up his hat and surprised his friend, who was obviously delighted at both the visit and the prank. They shared a beer and I sampled some water from a local spring, and his son and grandson came from the house behind the shop to join us.

We took a short cut through fields back to the park and the patient group. Most of them were still eating, although some were walking along the lake and waving at and well wishing the wedding groups in the boats. After a few hours, we loaded up and headed back to Korca. Each person paid about $2 for the trip.

Dr. Isufi spent 5 years after medical school working as an emergency doctor at a small city near the lake. After communism fell, he returned to his home town of Korca to work as a sports medicine doctor for the local soccer team. After a couple of years, the owner of the team wanted to charge Dr. Isufi to continue the relationship, so Dr. Isufi built a small gym and clinic in front of his parents home, where he also lives with his wife and children, and continues to run his rehabilitation and sports medicine practice. According to a friend of mine, it is the only one of its kind in Albania. He has been here for more than 20 years and is largely self-taught in his specialty.

The clinic is pretty different from anything I have ever encountered in the US. Patients seem to come in without appointments, often walking in on another patient undergoing evaluation or treatment to ask their own question. I have not seen any record keeping or consent forms, although the doctor does make a ledger entry if there is any payment, although this seems infrequent and is rarely more than a few dollars. His diagnoses and treatments seem pretty reasonable for the most part. Most of the patients seem to being doing well, although many have been coming to the gym for years.

Dr. Isufi does not have a car and gets around town on his bicycle or on foot. His parent’s home is near the center of town, so he does not really need a car. He even is able to make house calls on patients who cannot get to the clinic. In typical Albanian fashion, these involve sitting and drinking coffee (or sometimes raki) with the patient and family and chatting about everyone’s family including the doctor’s and mine. Eventually the discussion gets to the patient and their problems.

On the weekend Dr. Isufi likes to work on a ski area of which he is a part owner. It is in the mountains nearby. It is not Sun Valley. It is not Soldier Mountain (a small Idaho ski area owned by Bruce Willis). It is much more like a small ski hill that was set up by a group of Boy Scouts as an eagle project in Cambridge, Idaho, using a washing machine motor to operate a rope tow. Dr. Isufi would like to have a disabled ski program there someday.

One of the other owners owns a bakery in Korca has a van. One Sunday four of us piled into it with bags of cement, shovels and picks, and three steel posts scrounged from somewhere. I was among the youngest of the group and the oldest, who they call “The Commissar” (which he was during communism, but now it is just a nickname), is 78. Two years ago they built a day lodge and that day we dug a trench along the hillside on the northeast corner of the building and built a stone foundation for a kitchen extension. The steel posts were put on concrete footings and set vertical with a level. There were no plans, and, as far as I could tell, none were used for the day lodge either. We worked hard all day long, but did take about an hour for a typical Albanian lunch, complete with the feed the visitor event. I had bought a loaf of corn bread and some fresh vegetables from a small store before we set out, but the others shared homemade sausage, cheese, sardines, beer, bread, and summer apples. They told stories and jokes over lunch. Dr. Isufi speaks a bit of English and tried to translate some of it for my benefit. After a short rest, we were back at work. I was pretty beat at the end of the day. On the way back we stopped to admire a used snow grooming machine they had acquired from Italy that was stored with friends in a village and a building that was being built by some friends at another village along the way.

Dr. Isufi’s wife would like to move to America. He could probably make orders of magnitude more money working as a family doctor in some rural area of the US where most of the doctors appear to be foreign medical graduates. They could have their own house and cars and a second home at a ski area. Dr. Isufi would be a lot better than most of these doctors I have met, but his heart would not be in it. I think he would find American medicine a high pressure, money machine with little time to talk with patients and their families. He would find it strange that there are insurance companies and lawyers that can dictate how long and in what manner he can treat his patients without seeing them or even talking with them or him.

There are lots of problems with medical care in Albania. It is very centralized in Tirana and a patient with any degree of complexity to a problem usually must make the long and difficult trip. Many Albanians do not trust their doctors, who may have bribed their way into medical school or a hospital or clinic position. Complicated, modern equipment, given by a foreign donor, may not be adequately maintained or used appropriately. Many health professionals have emigrated, as Dr. Isufi’s wife urges. In spite of everything, medicine is often provided by doctors to patients humanely and effectively. The same, I think, is true for America.