It smelled like antiseptic and dust. The entire building seemed to be covered in, if nothing else, the memory of grime. The walls were a bland, tan color and the floor was lined with once-white tiles. People stood outside the Gynecological Department building at the University Clinic of Kosovo, sitting in the tree-shaded grass or on the steps of the building mingling with each other.
The overall layout in the building is disorganized and confusing to navigate. The hallways are not well-lit during the day, which doesn’t help. It is hard to believe that nearly half the babies in Kosovo are born here. But it is impressive that so many infants are safely guided into the world in a building that can’t even afford to have the “Gynecology Center” sign on the front replaced with letters that aren’t cracked and missing. It is more impressive, however, that they are being born safely at all.
The babies in this hospital owe their lives to the doctors and midwives on staff. The doctors and midwives owe some of their success to Action for Mothers and Children, a non-governmental organization that has worked since 2007 to improve maternal and perinatal health care for the country.
“We want to make sure we raise the voices of mothers and children when it comes to health care improvement”, said Mrika Aliu, executive director for AMC. “I see Action as being a source of information to provide technical support to public institutions to make sure they are doing the right things for mothers and children.”
Immediately after the war, Kosovo had the highest perinatal infant and maternal mortality rate in Europe. The University hospital staff did the best they could to deliver babies safely during the war. One reporter described a grim scene here, writing of mothers collecting their dead infants from cardboard boxes in the basement mortuary. At least that is no longer the reality for the mothers who come here, even if the building has many shortcomings.
In 2000, the rate of perinatal mortality was 29.1 percent, according to a report published in 2014 by the Ministry of Health. Perinatal refers to the death of a fetus during pregnancy, birth, or within the first week of life. It includes those babies that are stillborn and die in the womb before they are born.
The main causes for the deaths were the rate of babies being born prematurely, due to stress and malnutrition of the mothers, and the lack of basic medical care equipment and medications such as steroids and ventilators to help babies with underdeveloped lungs breathe until their lungs fully develop. The other main causes were infection, asphyxia, and congenital anomalies.
By 2014, the mortality rate had declined to 11.99 percent for the whole country. That was a 17 percent decrease in infant or fetal deaths from the year 2000. Of the 27,013 babies born in 2014, only 361 newborn deaths were reported. Doctors delivered 10,291 babies at University Clinic that year.
The current mortality rate is 22.3 percent at this facility in Prishtina. This is higher than the rates for other hospitals and clinics in Kosovo because doctors at University Clinic reportedly handle more difficult cases and take care of more patients. Congenital anomalies are still a leading cause of infant mortality, but doctors are working to identify and treat those issues early to safely treat mothers and babies.
Action for Mothers and Children has been working to help with those issues, mostly through educating the mothers and their doctors, as well as supplying doctors across the country with much needed medications. AMC is currently invested in organizing four main projects as a part of a 3-year plan to decrease child mortality and improve women’s health care: supplying medical equipment, women’s resource centers, cervical cancer screenings, and a neonatal transportation project that will pilot in January 2017.
They supply the medication Surfactant that helps develop lungs in premature babies, allowing them to breathe. It is not readily available to regional hospitals. This month, they have piloted a program in Prishtina that provides free cervical cancer screenings to women in the hospital. The neonatal transportation program will allow them to safely transport prematurely born infants in regional hospitals to Prishtina where they can receive more experienced care. But the program that is quite literally a part of the hospital now is the women’s resource center. It has been set up in the Gynecology Department’s building to teach expecting mothers about everything from diet management to breastfeeding.
“It is not our goal to just set up the center where women can just come, but also how can we make this center be an integrative service for health care institutions,” said Aliu.
The woman’s resource center in the hospital is a recent addition, and has helped 179 women so far this year. The center is strangely out of place in the hospital: at the end of one of the long, dark hallways, through glass double doors that are usually locked by the staff. The center itself is a bright, newly dried white. Inside there is a tree painted on the wall opposite open windows. There are a few brightly colored chairs set up in a circle around the room and swatches of purple, green, red, and yellow carpet squares on the floor.
During classes, the women sit with the head nurse, Sadije Pnenigi, who runs the classes. She begins each class by updating the patient’s charts: keeping track of how far along they are, how much weight each woman has gained, and whether they are in any pain. She goes around the circle and asks if they have named their unborn children. If yes, she writes the names down on Post-it notes pink if the child is a girl and blue if it is a boy, and sticks the post it notes on their swollen bellies. If no, she writes a “?” on their post-it note instead.
The classes are mostly driven by questions from the women who attend. It is an open dialogue. Sometimes other women will chime in to help answer the question and the midwife explains the answers. Pnenigi demonstrates techniques to help relieve their discomfort, having a couple women softly bounce on a medicine ball and massaging their backs. She shows them videos of stretches to do and how to breastfeed. They all leave at the end of the hour-long class and shake Pnenigi’s hand, thanking her.
This resource center is a good step in the right direction. However, the staff at the hospital agree that more needs to be done to help develop the women’s health care system.
“It is not enough just to teach people,” said Dr. Syhdea Latifi-Hoxha, a gynecologist and professor who has worked in the field for 35 years. “It isn’t a problem for us to host lectures and to teach people. The big problem is implementation. It is excellent to write. We have protocols written, but implementation is another thing. Implementation of the protocols is a big problem.”
Some of the doctors say that being understaffed is a major hindrance to their ability to give women the best treatment they can.
“What I consider as a doctor as unacceptable is working 24 hours a day without having a break,” said Dr. Vlora Ibishi, a gynecologist who works in the hospital. “Maybe we want to help, but we cannot.”
While the women’s health care system has made large strides, most people agree that more needs to be done.
“We know what is needed. But we haven’t developed the perinatal care system well enough,” said Dr. Syhdea. “Together with my team, we are working not just to help women personally, but to create a system that can function well. But up to now, it is not functioning well.
(Caroline Ford is a reporting intern at KosovaLive this summer in collaboration with Miami University in the United States.)
