The Rapid Assessment and Repsonse on Drug Use and Young ...



[pic]“Don’t disturb unless absolutely necessary – giving birth to Health Talks”

By Hillary Bower

Five days after I arrived in Kosovo, in 1999, the WHO administrator said to me, “You know you need to put together a Health Talks for the co-ordination meeting on Thursday.” This was less than 48 hours away and I admit I at first thought he was joking – not least because I did not know anything about anything, or so I thought. By the time I realised he wasn’t, I’d got even fewer precious hours, but after 24 hours spent in frantic talking to everyone who lingered longer than 30 seconds in the WHO office, staff or visitors, I put up the first post-it note that would go up every fortnight for seven month – “Don’t disturb unless absolutely necessary – giving birth to Health Talks…” Sure enough, after a long night’s labour, Health Talks number 10 was “delivered”.

Health Talks 10 obviously was not the first – credit for that goes firmly to Carmen Maroto and the WHO team who left and returned to Kosovo with the population – but it was a little different. In those first weeks, the most crucial information was disease surveillance data and reports from the field and Health Talks focused on reporting data from the emergency surveillance system set up by WHO and the first health NGOs. But by September 1999, with the number of health NGOs hitting over 100 and donors tripping over themselves to contribute to the reconstructing of health services, it was obvious that something that tried to track some of the political and structural developments in the health sector and reflect even a fraction of the huge number of activities going on might be useful, not only to give credit where credit was due, but to share information and help avoid duplication of effort.

Therefore, Kosovo Health Talks evolved as hundreds of patient people explained issue after issue to me, reported on meetings and contributed words, and ever-patient graphic designer Blerim Kroçi knocked the words into a more newspaper-like shape.

“But why is it only in English?” This question from Dr Xhevdet was a perfectly reasonable one that I tried not to hear for a least two weeks – not because he wasn’t right but because I was sure that the logistics of getting the now 10–12 page Health Talks out every two weeks in English, Albanian and Serbian before the “news” was old and cold – anathema to a journalist – was impossible. But with all changes proposed for the health system – the new health policy, the development of family medicine, the new pharmaceutical organization, the environmental health issues, not to mention the activities of the new UNMIK Department of Health – the bottom line was inescapable: information “dissemination” was needed whether in Pristina University Hospital or out in the ambulantas – and just in English was not enough.

Anyway, I should have had more faith. The first Albanian and Serbian issue came out just two days after the English – true testament to the overworked but dedicated translators at the WHO office. And so on Thursday mornings, with the help of drivers, doctors, receptionists, pharmacists, IT specialists, nurses, logisticians and regional public health advisors – these copies along with the English one got copied, stapled, stacked and delivered all in a pandemonic but productive rush. Mirë Faleminderit all! (Good, Thank you all!).

Now it’s the 50th issue, and many people have changed, arrived, moved on – but in health there’s always the imperative to keep up with who is doing what and why – so I guess maybe that post-it note still goes up on Natyra’s door. Here is to the next 50 issues.

(The author was the WHO Kosovo information officer from August 1999 to March 2000)

[pic] Health Action – the good health guide

By Edward Poultney

Health Action in Kosovo, and its forerunner Kosovo Health Talks, has been the barometer of WHO’s mission in Kosovo since mid-1999. In the immediate aftermath of the conflict in the summer of that year, it was a breathless product, a catch-all newsletter for the destabilized health sector and an important mouthpiece for the young Department of Health, as well as for the pack of NGOs working in the sector and for WHO’s Emergency Humanitarian Assistance Mission.

The impetus to publish came from the need to keep everyone up-to-date – as far as was possible – on the many changes taking place, on the projects and emergency programmes being run with enthusiasm, determination and dedication, but often without co-ordination.

Effectively it was the minutes of the weekly general health co-ordination meeting (GHCM), with a bit of cosmetic surgery to satisfy the reader’s eye. As the weeks went by, my predecessor, Hilary Bower, transformed the product into a professional newsletter with an eager readership. Health Talks, in English, Albanian or Serbian, was sent electronically to readers in Europe and North America. It was placed on the WHO EURO website. It set the benchmark standard for other WHO Emergency Preparedness and Response (EHA) publications in southern and central Europe. When Hilary moved on, to the WHO Headquarters in Geneva, she left behind a solid creation.

But times were changing. Kosovo was moving from “emergency” to “development”, and the needs evolved. The GHCM became monthly, some NGOs left the region, the Department (now the Ministry) of Health and Social Welfare took on its responsibilities and WHO Kosovo moved from an implementing to more of an advisory role.

Health Talks moved with the times. It changed from a fortnightly newsletter to a monthly. And, most significant of all, it changed its name to Health Action in Kosovo to align itself with the titles of other EHA publications throughout the region. But on the EHA website, Kosovo’s publication still stands out as the veteran, the pathfinder, among its new kin.

As a former long-suffering editor turned avid reader, I still look forward to each new issue. It remains an important source of information about developments in the health sector. Happy 50th edition!

(The author was the WHO Kosovo information officer from April 2000 to June 2001)

[pic] THE ONLY SOURCE OF HEALTH INFORMATION

Dr Hannu Vuori International Principal Officer at DHESP

In a recent interview, Dr Hannu Vuori said that Health Action in Kosovo was “the only source of health information from different agencies, organizations and institutions working in the health sector in Kosovo”. Articles about disease control, legislation, health education etc. are presented though “the newsletter is a bit ‘dry’. More detective stories should be included. One thing that can easily change are the titles, they should be more interesting and eye-catching.” Dr Vuori added that he himself uses Health Action as a source of information for the weekly briefings at the UN headquarters in New York.

[pic] Identify the problem

Dr Robert O’Dell and Dr Kadengjika Dabishevci ( Health Sector United States office in Pristina

Dr O’Dell thought the newsletter was informative. The statistics presented are useful for the readers but we are more interested in knowing what the issues are, why a particular issue appeared and what should we do about it. The fact that the newsletter is translated into Albanian and Serbian is very useful.” Dr Dabishevci concurred, adding that one issue for improvement is the distribution of Health Action. It needs better publicity, for example many people do not know that it can be found on WHO’s website.” Dr O’Dell also wanted also to emphasis that there is a need for more co-ordination between organizations, agencies and institutions working in the health sector in Kosovo.

[pic]More input from the regions?

Anita Kraak, Health Net International

Ms. Kraak calls Health Action a good, informative source, especially for agencies, organizations and institutions working in the regions outside of Pristina. It would be useful to have a more interactive publication, to have more space where people can react to the disputed issues. In addition, more updates of the activities of agencies or organizations working in the regions should be included, because Health Action and the general health co-ordination meeting are the only sources of information for those that are working outside of Pristina. In general, it fills an information gap and health actors should continue to contribute.”

[pic] Interesting for the newcomer

Christel Monod, CIDA Programme Officer

“Health Action is an interesting source of information for the newcomer. It provides an overview of the situation in Kosovo, including the activities of NGOs, donors, and the Ministry of Health, as well as information from the general health co-ordination meeting.

AS PER IMPROVEMENTS, THE NEWSLETTER SHOULD ALSO HAVE ARTICLES THAT RAISE QUESTIONS, AND EACH EDITION COULD HAVE A TOPIC OF THE MONTH, THE HEALTH CARE OF PRISONERS, FOR EXAMPLE.”

[pic]DELIGHTED THAT IT’S TRANSLATED INTO LOCAL LANGUAGES

JANE SCHULER-REPP AND VISARE MUJKO-NIMANI, UNFPA

MS. SCHULER-REPP IS DELIGHTED THAT THE NEWSLETTER IS TRANSLATED INTO ALBANIAN AND SERBIAN. SHE WOULD, HOWEVER, LIKE TO SEE MORE ABOUT TRAINING ( ESPECIALLY WHEN IT IS PLANNED, WHO WAS TRAINED AND HOW IT WENT. IN ADDITION, IT IS VERY USEFUL TO KNOW ABOUT SEMINARS TAKING PLACE. DR MUJKO-NIMANI ADDED THAT SHE THINKS THE ACTIVITIES OF THE LOCAL AGENCIES/ORGANIZATIONS COULD BE BETTER PROMOTED.

[pic]IMPORTANT SOURCE OF INFORMATION

DR ISTVAN ISZILARD AND ALBERT MOESLI, IOM

DR ISZILARD CALLED HEALTH ACTION AN IMPORTANT SOURCE OF INFORMATION FOR ALL INTERNATIONAL AGENCIES ACTING IN KOSOVO AND FELT THAT THE NEWSLETTER IS USUALLY INTERESTING, DEPENDING ON WHAT IS HAPPENING AT THE TIME IN THE HEALTH SECTOR.

MR. MOESLI STATED THAT IT IS IMPORTANT TO GIVE A GREATER VOICE TO SMALLER HEALTH ORGANIZATIONS IN THE NEWSLETTER. “THERE SHOULD ALSO BE MORE FOLLOW-UP OF THE SITUATIONS REPORTED.”

THE GENERAL IMPRESSION IS THAT HEALTH ACTION PROVIDES A GOOD REFLECTION OF THE SITUATION IN THE HEALTH SECTOR IN KOSOVO AND ABROAD. “IT IS ALSO IMPORTANT TO BE MORE ANALYTIC, BECAUSE MOST OF THE TIME THE CONTENT IS VERY POSITIVE, WHICH IN REALITY IT IS NOT ALWAYS THE CASE.”

[pic]A WELL-PREPARED NEWSLETTER

DR MATTHIAS W. REINICKE, EAR

DR REINICKE SEES HEALTH ACTION AS A WELL-PREPARED NEWSLETTER, WITH RELEVANT FACTS AND THE RIGHT FORMAT. “THE NEWSLETTER OFFERS A NICE COMPREHENSIVE OUTPUT OF THE HEALTH SECTOR OF KOSOVO. IT CONTAINS THE RIGHT AMOUNT OF GRAPHS AND PHOTOS.

[pic]TRY TO KEEP IT GOING

MR. KEVIN MCGRATH, FORMER RESIDENT CO-ORDINATOR OF UNDP

MR. MCGRATH THINKS HEALTH ACTION IS A GOOD BULLETIN, AS WHO HAS KNOWLEDGE OF HEALTH ISSUES THAT OTHERS DO NOT. “IT IS VERY IMPORTANT TO TRY TO KEEP IT GOING. IT IS ALSO IMPORTANT,” ACCORDING TO MR. MCGRATH, “TO CONTINUE INFORMING THE PUBLIC ABOUT THE SITUATION OF ISSUES SUCH AS TULARAEMIA.”

Mr. McGrath said that the covering page should have photos on it and the content needs to be directed to the concerns of the Kosovar people, for example disease control including HIV/AIDS.

Mr. McGrath added that there is a lack of coordination about what different programmes are ongoing and a lack of information sharing. “After the conflict, WHO’s role was to fill the critical gap in health sector, for example in PHC and mental health. This serious gap remains because there are no trained people to run the organizations; WHO played a critical role when they first came here trying to organize the emergency health services. Now the role of WHO changed to one of capacity building. The co-operation between WHO and UNDP is mutually rewarding. UNDP has programmes which involve municipal development and capacity building which link up with WHO.”

“THE UN SYSTEM, INCLUDING WHO, CAN PLAY A SIGNIFICANT ROLE WHEN MANY INTERNATIONAL STAFF LEAVE UNMIK. A SKELETON OF UNMIK STAFF WILL REMAIN IN KOSOVO AND IT IS NOW THE RESPONSIBILITY OF KOSOVARS TO TAKE IT OVER. IT IS ALSO VERY IMPORTANT TO HELP BRING BACK KOSOVARS FROM DIASPORA.”

[pic] IT IS IMPORTANT TO HAVE HEALTH ACTION IN KOSOVO

DR LULZIM ÇELAJ, UNICEF

DR ÇELAJ SAID THAT HEALTH ACTION IS A MUCH NEEDED NEWSLETTER. “I FOUND ALL THE NEEDED INFORMATION FROM AND ABOUT THE HEALTH SECTOR IN KOSOVO IN THE NEWSLETTER,” SAID DR ÇELAJ. “YOU CAN FIND INFORMATION NOT ONLY FROM THE MAIN ORGANIZATIONS OR AGENCIES BUT ALSO FROM SMALLER NGOS AND OTHER AGENCIES. MAYBE IT WAS NOT THE PRIMARY INTENTION OF THE NEWSLETTER TO INFORM AND CO-ORDINATE BUT CURRENTLY FILLS THIS ROLE IN THE HEALTH SECTOR. THE NEWSLETTER SHOULD BE EVEN MORE COMPREHENSIVE. IN FUTURE, IT SHOULD BE PREPARED TO PASS IT ON TO THE LOCAL HEALTH AUTHORITIES. THROUGH THE NEWSLETTER WE GATHER INFORMATION THAT WE USE AS A REFERRING DOCUMENT FOR THE PARTNERS.”

[pic] A GOOD SOURCE FOR DATA FROM THE HEALTH SECTOR

DR XHEVAT JAKUPI, HIV/AIDS OFFICER DHESP/WHO

“CURRENTLY, HEALTH ACTION IN KOSOVO IS THE ONLY SOURCE OF INFORMATION WHERE YOU CAN FIND DATA AND UPDATES FROM THE HEALTH SECTOR, BUT IT HAS TO INCREASE ITS NETWORK AND PROVIDE INFORMATION FROM DIFFERENT AREAS OF HEALTH. ONE IDEA IS TO HAVE SPECIAL SECTIONS FOR PRIMARY, SECONDARY AND TERTIARY CARE, FOR PUBLIC HEALTH, DISTRICT HEALTH IN KOSOVO ETC. IT IS ALSO IMPORTANT TO HAVE RELEVANT INFORMATION FROM THE WHO OFFICES IN COPENHAGEN AND GENEVA.”

“THE DATA THAT I FIND IN THE NEWSLETTER ASSISTS ME AS A HEALTH PROFESSIONAL. I AM VERY INTERESTED IN KNOWING WHAT IS HAPPENING IN DIFFERENT HEALTH AREAS IN KOSOVO. MY ATTENTION IS FOCUSED ON HIV/AIDS AND I OFTEN FOUND INFORMATION ABOUT WHAT THE OTHER ORGANIZATIONS ARE DOING IN THIS AREA.”

DR JAKUPI CAPITALISED ON THE INTERVIEW TO POINT OUT THAT THE NUMBER OF HIV CASES IN KOSOVO DOUBLED IN 2001, AS COMPARED TO 2000. HE WOULD LIKE TO REPORT MORE REGULARLY IN HEALTH ACTION IN ORDER TO GET LOCAL AND INTERNATIONAL ORGANIZATIONS/AGENCIES TO COLLABORATE ON HIV/AIDS PREVENTION ACTIVITIES IN KOSOVO.

[pic] TULARAEMIA ( BACK AGAIN…

THE FIRST CASES OF TULARAEMIA IN KOSOVO APPEARED IN NOVEMBER 2001, AND INCIDENCE CONTINUED INTO JANUARY 2002. AS OF 30 JANUARY 2002, THERE WERE 570 SUSPECTED CASES. LABORATORY ANALYSIS CONFIRMED 150 CASES. THE EPIDEMIOLOGICAL CURVE INDICATES THAT THE HIGHEST NUMBER OF CASES WAS IN JANUARY 2002 AND PROBABLY REPRESENTS THE PEAK OF THE OUTBREAK. MOST OF THE PATIENTS LIVE IN VILLAGES AND ARE BETWEEN 15 AND 55 YEARS OLD.

TULARAEMIA IS A BACTERIAL INFECTION THAT IS TRANSFERRED FROM AN ANIMAL TO A HUMAN. INFECTION CAN OCCUR THROUGH TICKS, WATER CONTAMINATED BY RATS, UNDER-COOKED MEAT FROM AN INFECTED ANIMAL AND THROUGH SOIL THAT IS CONTAMINATED. SYMPTOMS INCLUDE A HIGH FEVER, GENERALISED ACHING AND SWOLLEN GLANDS, WHICH CAN LAST OVER A PERIOD OF A FEW WEEKS. NORMALLY, IT IS NOT POSSIBLE TO CATCH THE DISEASE FROM OTHER HUMANS.  BOTH SEXES ARE AFFECTED, WITH MALES HAVING A SLIGHTLY HIGHER RATE.

THERE ARE AROUND 22 EPIDEMIC LOCATIONS IN KOSOVO, BUT PRISTINA, LIPJAN/LIPLJANE AND OBILIQ/OBILIć ARE THE MOST AFFECTED. THERE HAVE BEEN NO DEATHS FROM THE CURRENT OUTBREAK OF TULARAEMIA IN KOSOVO TO DATE.

PREVENTIVE AND CONTROL MEASURES INCLUDE LEAFLETS BEING DISTRIBUTED IN MOST MUNICIPALITIES; INFORMATION PROVIDED TO TV STATIONS, RADIO STATIONS AND NEWSPAPERS ABOUT THE DISEASE, MEASURES TO AVOID IT ETC. ANY WATER SHOULD BE BOILED IF USED FOR PERSONAL CONSUMPTION OR FOOD PREPARATION. ANY FOOD SHOULD BE PROTECTED FROM ANIMALS AND COOKED THOROUGHLY. DEAD ANIMALS SHOULD NOT BE HANDLED. IPH TEAMS ARE EXTERMINATING RATS AT AFFECTED HOUSEHOLDS AND SURROUNDINGS. IPH TEAMS TOGETHER WITH MUNICIPAL SANITARY INSPECTORS ARE ALSO VISITING RESTAURANTS, BAKERIES AND OTHER FOOD-RELATED AREAS TO PERFORM DERATISATION AND DISINFECT WELLS AND OTHER SOURCES OF DRINKING WATER. THERE IS NO SHORTAGE OF CHLORINE.

OVERALL, THERE IS NO SIGNIFICANT SHORTAGE OF ANTIBIOTICS, ESPECIALLY AT REGIONAL HOSPITALS AND THE UNIVERSITY HOSPITAL IN PRISTINA, BUT THERE ARE SOME REPORTS IN THE FIELD THAT IN SOME REMOTE AREAS PATIENTS HAVE TO BUY DRUGS IN PRIVATE PHARMACIES. THERE IS NO VACCINE TO PREVENT TULARAEMIA.

[pic] ELIMINATING MEASLES

The HEALTH21 Regional Strategy for Europe was endorsed by all Member States at the 48th meeting of the WHO Regional Committee in 1998. Target 7 specifies the elimination of measles and the goal is for all countries to achieve and maintain the interruption of indigenous transmission of measles by the year 2007. At present, according to WHO, measles represents one half of the 1.7 million annual deaths due to childhood vaccine-preventable diseases globally (see the WHO Weekly Epidemiological Report for details: : 15 February 2002, Vol. 77, 7 (pp 49-56)).

Not a single case of measles was reported in Kosovo during the last one and a half years. However, 18 cases have been reported since December 2001. The Institute of Public Health (IPH) in Kosovo is now working on the Measles Elimination Programme and taking into consideration reported cases, they have adopted four main strategies to be urgently implemented:

1. To strengthen surveillance and to provide laboratory confirmation of the cases;

2. To conduct door-to-door measles vaccination in the areas of the reported cases;

3. To conduct a catch-up campaign in the spring of this year, as part of the Measles Elimination Programme of Kosovo; and

4. To strengthen routine immunisation through public awareness campaigns.

IPH has established and conducting the measles specific surveillance and case investigation procedures in line with WHO guidelines. IPH is planning to target children between 12 months and 14 years of age for the catch-up campaign. They are also planning to give the OPV vaccine to the same target group and vitamin A to children under five during the campaign.

This month we will be focusing on the activities of DanChurchAid (DCA). In Kosovo DCA has concentrated on mine clearance and mine awareness.

ON THE FIRST DAY OF THE NEW YEAR, KOSOVO MADE HEADLINES IN DENMARK. ON THE FRONT PAGE, A LEADING DANISH PAPER PRESENTED THE SUCCESS STORY OF REMOVING MINES IN KOSOVO ( HIGHLIGHTING THE LEADING ROLE OF THE DANISH NGO DANCHURCHAID (DCA). SINCE 1999, DCA HAS REMOVED ONE-THIRD OF ALL MINES IN KOSOVO. CHRISTIAN BALSLEV-OLESEN, THE FORMER GENERAL SECRETARY OF THE ORGANIZATION, STATED THAT "KOSOVO IS A FANTASTIC SUCCESS STORY. IT IS THE FIRST TIME THAT A FORMER WAR ZONE HAS BEEN SO QUICKLY CLEARED OF MINES." THE DANISH ORGANIZATION HAS ALSO TRAINED SOME 200 LOCAL INDIVIDUALS IN MINE REMOVAL. IN ADDITION TO THIS DANGEROUS WORK, THEY HAVE BEEN PROVIDED COURSES IN ENGLISH AND BOOKKEEPING.

In spite of the success, nine local mine removers have had accidents, which has several times resulted in the loss of a leg. Nevertheless, DCA will continue to work with mine removal in other parts of the world, and possibly: nearby the Albanian side of the border to Kosovo.

The presence of mines and UXO created, in Kosovo, an environment of fear, causing economic and social dislocation and paralysis. In a post-conflict environment where people have returned to find homes, factories and commercial centres destroyed; where agricultural machinery, draught animals and possessions have been looted or damaged; to high unemployment and a massive dependency on outside assistance, mines represent one problem among many. However, the clearance of mines/UXO (and the reduction of psychological fear of their presence) was a vital and non-negotiable precursor to economic and social recovery in Kosovo. This work needs to be understood as returning the rural areas to a neutral, non-threatening state (status quo ante bellum) and does not, in itself, cause economic recovery, but greatly facilitates it. In December 2001 virtually all international mine action NGOs left Kosovo with the UN declaring that the mines problem is contained and there is minimal danger to social and economic activities.

While the amount of actual area cleared in minefield clearance tasks by DCA is not large, the areas they have opened are impressive in size and value. Adapting to the defined nature of minefields (known threat) in Kosovo, DCA developed a threat removal approach, which accounts for the smaller quantities of land cleared in contrast to the high number of mines located and destroyed.

DCA is a Danish agency and a member of the ACT (Action for Churches Together) network. The intervention examined was part of the UN-co-ordinated mine action response involving various independent commercial and NGO humanitarian mine action agencies in Kosovo. It was DCA’s first direct implementation of a mine action programme.

Mine action in Kosovo began in mid-1999. Only two and a half years later, by the end of December 2001, international agencies, including DCA, and UN-MACC (Mine Action Co-ordination Centre) curtailed operations. By December 2001 the population was considered to be facing only minimal threat, no worse than other European states that continue to deal with residual risk from the presence of mines and UXO from WWII. The identified minefields had been cleared, all affected communities had received mine awareness education and the number of monthly casualties from mines or UXO had fallen to between only 1 or 2 people out of a population of over 2 million. In the last decade of humanitarian mine action intervention the successful experience of Kosovo is exceptional and its context very particular.

[pic] The 40th Medical Battalion of Kosovo Protection Corpse (KPC).

BY DR SHAIP MUJA

THE 40TH MEDICAL BATTALION OF KPC WAS ESTABLISHED AFTER THE TRANSFORMATION OF THE KLA INTO THE KOSOVO PROTECTION CORPSE (KPC). THE PURPOSE WAS THE CREATION OF A STRATEGY FOR HEALTH INSURANCE WITHIN KPC, AS WELL AS FOR THE EMERGENCY SITUATIONS, TOGETHER WITH OTHER CIVIL STRUCTURES OF KOSOVO, INCLUDING HOSPITALS, HEALTH HOUSES AND PRIMARY, SECONDARY AND TERTIARY STRUCTURES. IMMEDIATELY AFTER THE WAR, WE HAD NO PREMISES AND WE STILL DO NOT HAVE ALL THE NECESSARY EQUIPMENT. WE HAVE SEVEN AMBULANCES IN SIX AREAS AND ONE FOR THE KOSOVO GUARD IN PRISTINA. WE HAVE A WAREHOUSE FOR EQUIPMENT AND MEDICATIONS, BUT ONLY FOR KPC NEEDS.

ONE OF OUR MAJOR TASKS IS THE SURVEILLANCE OF THE EPIDEMIOLOGICAL SITUATION IN KOSOVO. DURING THE TULARAEMIA OUTBREAK IN 2000, TOGETHER WITH WHO, THE DEPARTMENT OF CIVIL PROTECTION AND IPH, WE CREATED A HEALTH INSURANCE STRATEGY. WE ALSO ASSISTED IN THE TRAINING OF SANITARY INSPECTORS FOR FOOD CONTROL; WE HAVE EXPERTS FOR DDD (DISINFECTIONS, DERACINATION AND DESINSECTION) WORKING IN PUBLIC INSTITUTIONS AND PRIMARY SCHOOLS.

IN ADDITION, WITH REGARD TO DEPLETED URANIUM, WE HAVE SENT URINE SAMPLES OF PATIENTS AND CHILDREN TO THE HIGH INSTITUTE IN MUNICH, GERMANY, WHERE IT WAS FOUND THAT THE RESULTS WERE NEGATIVE. WE HAVE A TEAM OF SPECIALISTS FOR PTDS. OUR STAFF CONSISTS OF 4 DOCTORS AND 10 NURSES.

KPC HAS DONATED FIVE HAEMODIALYSIS MACHINES TO HOSPITALS AND TWO INCUBATORS TO THE NEONATOLOGY UNIT IN THE PRISTINA HOSPITAL. WE ASSISTED THE CROATIAN MINORITY IN THE VILLAGE LETNICË, MUNICIPALITY OF VITI/VITINA, WITH SECONDARY SERVICES ON THE REQUEST OF THE MUNICIPALITY OF GJILAN/GNJILANE; WE ALSO ASSISTED IN THE VACCINATION OF CHILDREN IN THE REGION OF SHALA (MITROVICA); WITH PHC SERVICES WE ASSISTED IN THE NERODIME AREA. WE ARE ALSO ASSISTING KPC MEMBERS IN THEIR PURSUIT OF GRADUATE STUDIES. KPC HAS ALSO INITIATED THE CO-ORDINATION OF TELEMEDICINE IN KOSOVO.

FOR EMERGENCIES, PARAMEDICAL PERSONNEL AND DOCTORS ARE TRAINED IN HOW TO MANAGE EMERGENCY SITUATIONS: FIRST AID, TRIAGES, EVACUATION ETC. WE HAVE INTERNAL TRAININGS WITH KFOR AND IOM. THE AIM IS TO ORGANIZE THE OPERATIONAL STANDARD PLANS AND TO CREATE CONTINGENTS OF OPERATIONAL PLANS. DAILY RESPONSIBILITIES OF THE 40TH MEDICAL BATTALION OF KPC ARE TO ASSIST THE WAR INVALIDS; ASSIST THE MEMBERS OF KPC, AND MEDICAL EVACUATION ABROAD, TO TURKEY, ALBANIA, ITALY, GERMANY AND AUSTRIA. TO DATE, 500 PEOPLE HAVE BENEFITED FROM THIS PROJECT. THE PRIORITIES ARE CHILDREN AND INDIVIDUALS WITH CARDIOVASCULAR DISEASES, WITH HAEMOLYTIC DISEASES, PROSTHESIS AND ONCOLOGICAL DISEASES. DURING THIS YEAR, WE ARE EXPECTING TO CARRY OUT 200 MEDICAL EVACUATIONS.

[pic] FINNISH NURSING PROJECT SUPPORTED TRAINING OF FAMILY NURSES

The project Finnish Support to the Development of Nursing in Kosovo supports nursing in primary health care (PHC) in three sectors:

1. training of family nurse trainers;

2. upgrading training of PHC nurses; and

3. improving the status of nursing in Kosovo.

The project is financed by the Ministry for Foreign Affairs of Finland and UNMIK, and it aims at improving the skills, knowledge and status of nurses in Kosovo. During the three years of the project, some 850 nurses working in health houses and ambulantas in Kosovo will be trained, with a total contribution from Finland of three million German marks.

A six-month-long training of trainers (ToT) course for 44 family nurse trainers started in January 2001. During the ToT modules, the trainers completed 960 hours of training, of which 576 hours were theoretical and 384 practical. Compiled test results and assessments show improvement in the trainers’ skills, knowledge and attitudes. By the end of 2001, 37 nurse trainers were engaged in full-time upgrading training.

As for the upgrading component, more than 800 PHC nurses will be trained during four rounds of 18-week upgrading courses. During the upgrading course, the trainees complete 800 hours of training, of which 480 hours are theoretical and 320 hours practical. The first upgrading round started in August 2001. In December 2001 diplomas were issued by the project and by the Department of Health, Environment and Spatial Planning (DHESP) to 155 K-Albanians for their completion of the first upgrading round training, whereas 16 K-Serb nurses received their diplomas in January 2002. There were no dropouts from the first upgrading course.

The second round of training is scheduled to take place between 6/2(14/6/2002. The number of participants is anticipated to be 216, or 24 per learning centre. The third round will take place in August(December 2002, and the last and fourth round of upgrading is scheduled for January(May 2003.

The aim of the ToT and the upgrading training is to provide nurses working in PHC with the knowledge, skills and attitudes necessary to provide quality care in co-operation with other professionals in PHC. The participants of the ToT course have also acquired basic teaching skills. The training closely follows the content of the training programme for doctors in family medicine, in order to create true family medicine teams. Relevant health education material developed and tested by other agencies has been used.

The ToT course and the upgrading courses are taking place centrally in Pristina or regionally in the health houses of Pristina, Gjakovë/jakovica, Gjilan/Gnjilane, Lipjan/ Lipljan, Mitrovica, Pejë/Peć, Prizren, and Ferizaj/Uroševac, where the family medicine training for PHC doctors is also conducted. Upgrading training in Serbian was conducted in Preocë/Preoce during the first round of training, which produced 16 graduates on 11/1/2002. The second round of training in Serbian will be carried out in two places and a learning site in the Gjilan/Gnjilane municipality.

In November 2001 a mid-term review was conducted about the project, and the feedback from the mid-term review as well as feedback from the project partners contributed to the monitoring and planning of the project.

As part of its aim to increase the status of nursing, the project was also involved in other support to nursing, e.g. facilitating nursing co-ordination meetings, preparing minutes of the meetings, outlining draft job descriptions and presenting them to the nursing unit for further processing, participating in the drafting of a nursing strategy for Kosovo, and participating in the preparations for the establishment of the nursing college.

For further information, please contact the project co-ordinator, Martina Jägerhorn, [martina_jagerhorn@],Tel.: +358-40-7450 971, or the project manager, Fekrije Hasani, [fekrijehasani@] Tel.: 044-177 684, or contact our office in the DHESP, Government building/room N302,

Tel.: 038-504 604 4769.

-----------------------

EPIDEMIOLOGICAL UPDATE

NEWSLETTER ON EMERGENCY PREPARDENESS AND RESPONSE, january 2002

( in Kosovo

Health Action

HEALTH AGENCIES IN ACTION

Health Action in Kosovo (formerly Kosovo Health Talks) is a newsletter of the Emergency Preparedness and Response programme at the World Health Organization Regional Office for Europe. The information is compiled by the WHO Office in Pristina based on health information from health agencies, organizations and other sources.

All rights are reserved by the organization. The document may, however, be freely reviewed abstracted, reproduced or translated in part or whole, but not for sale or for use in conjunction with commercial purposes. This newsletter is not an official WHO publication. The views expressed in it do not necessary represent stated policy of WHO.

Correspondence should be addressed to:

Health Action in Kosovo [who_kosovo@]

Tel.: (+381) 38 549 216/218

Attn: Natyra S. Bajrami

Chief Editor: Dr Giuseppe Annunziata [gia@who.dk]

Editorial team: Jeffrey V. Lazarus [jla@who.dk], Natyra S. Bajrami [natyrabajrami@] and Sue Woodward [who@]

For more information about WHO emergency preparedness and response programmes,please contact:

Dr. Jan Theunissen [jth@who.dk]

Dr. Edouard Kossenko [kossenkoe@who.ch]

The newsletters of the Emergency Preparedness and Response (EHA) programme can be found at (then click on “emergency preparedness and response programme”.

• Health Action in Albania

• Health Action in the Federal Republic of Yugoslavia

• Health Action in Kosovo

• Health Action in the North Caucasus

• Health Action in Tajikistan

• Health Action in the former Yugoslav Republic of Macedonia

Health Action Takes Centre Stage

In this edition you will hear from friends old and new. It seems that Kosovo Health Talks and now Health Action in Kosovo has been a good companion to the growth and development of interventions in the health sector of Kosovo. Many of the issues we have reported on have always been on the agenda, but have for many reasons been thrown into sharp relief, not only by the Kosovo political agenda but also by what has been termed the crisis in health within the sphere of health care, which has had a profound effect on the management, delivery and status of services. These interventions derived their raison d’ être from the recognition that the promotion and maintenance of the public’s health depended upon the possession of certain basic social resources of income, accommodation, food, transport, work, protected environments, supportive public services, education and health promotion, comprehensive basic health services and equal opportunity. This backdrop provided the stage for Health Talks to examine and inform on a range of issues and programmed projects over the years.

The selection of the topics chosen are influenced by local community needs and the main health actors, who have taken a broad perspective on the compatibility, utilisation and mobilisation of their resources to achieve the greatest impact on these basic social resource needs among the entire community. In producing this 50th edition I should like to place on record our sincere thanks to all the contributors and the editorial expertise over the past three years.

Sue Woodward, WHO Head of Office in Kosovo

Case definition: Tularaemia

“Each person with shivers, a high temperature that lasts 2–3 weeks, headache, weakness, muscle and joint pain, swallowing problems, enlarged cervical lymph nodes on one or both sides, with or without caseation and suppuration, in Kosovo, has to be suspected of having tularaemia”.

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[pic] Dr Shaip Muja, 40th Medical Battalion of KPC

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