Our work Albania Background We are working with Ryder Albania in Albania. Ryder Albania started work in Tirana in 1993. It was established with support from the Sue Ryder Charity in the UK and still maintains close links with that organisation. Initially Ryder Albania provided free home care services to terminally ill cancer patients and to the elderly suffering from chronic illness in the capital city. Then in 1996 it extended its services and opened a home care service in Durres, the second largest city in Albania. Today, Ryder Albania’s multidisciplinary teams offer home care services in both cities. For a while the organisation rented space and was able to provide in-patient services. Sadly, lack of funds during the recession meant that this service had to come to an end. The Team The organisation started with two doctors and a nurse in Tirana. It now has two multidisciplinary teams – one in each location. The team in Tirana has three doctors, four nurses and a social worker and the team in Durres has two doctors, three nurses and a social worker. There is also an administrative support team in place. Services The teams provide free medical care, psychological counselling and assistance with social service issues to patients and their families. Impact The Tirana team cares for approximately fifty patients and the Durres team looks after forty patients. In the period November 1993 to June 2018 Ryder Albania has cared for around 8,400 patients (4,400 in Tirana and 4,000 in Durres). It has supported approximately 25,200 close family members. Training and Lobbying The team in Albania understands the importance of training medical staff and provides training on a national basis. To date, more than 1,200 doctors, nurses and social workers from different parts of the country have been trained by Ryder Albania. In addition, the hospice established the Albanian Palliative Care Association which is an umbrella association for palliative care providers in the country. As a pioneer of hospice services within Albania, Ryder Albania has taken on a lobbying role to improve the quality of services for patients with terminal illness. This has led to a national strategy on palliative care and the introduction of professional standards in delivering hospice services. Challenges Challenges the teams face include:- Working in such a poor country. 32.8% of the population lives under the poverty threshold ($5 a day) according to World Bank Statistics The public health system is struggling to come up with a solution to the country’s needs Corruption in the country is commonplace Opioid availability – only 75% of the WHO recommended drugs can be prescribed in Albania Opioids are only available to oncology patients No paediatric opioids are available – medical professionals are faced with reducing adult doses A general fear of using opioids within the country Almost no funding for palliative care from the state health care system – the only contribution is the reimbursement of the cost for some drugs A reluctance to tell patients their true diagnosis Palliative care within the country As of 2017 there were 12 providers offering palliative care in Albania. Geographically, coverage is about one third of the country and in terms of actual access this is less than 6%. State In 2001 a state palliative care service, the Oncology Home Service, was established and provides home care services to cancer patients who are referred from the National Oncology Centre in Tirana. For many years this was the only state provision. As of 2015 there are palliative care units in eight regional hospitals. These units are based on a model developed by Ryder Albania in Durres. There is no specific provision for paediatric palliative care in the country although the National Oncology Centre provides some in-patient palliative care advice. Palliative care is recognised as a basic human right and the legislative framework is in place but lack of finance means that implementation of policy is challenging. NGOs In addition to Ryder Albania there are two other main NGO providers. The organisations work together and are members of the National Association for Palliative Care which campaigns for the development of palliative care in the country. Viewpoint of Alex Padureanu, Executive Director of Hospices of Hope “I have visited the Ryder Albania hospices and spent a great deal of time with the teams and I am hugely impressed with the organisation and its staff. They care deeply about their patients and approach hospice care in an extremely professional manner. I was really pleased to have the opportunity to join Dr. Ali and Dr. Fabian visiting patients in their homes and was so impressed with the level of professionalism that I witnessed. It is very frustrating that such a great team does not have the resources to allow all its members to shine. Everyone I spoke to told me how difficult it is to deliver good palliative care when 99.9% of the families will not pass on the real diagnosis to the patient. Educating the population is an absolute must. But all the Albanian families that I visited seemed to be very close and willing to do everything they could to look after their loved ones Dr. Fabian explained that not all types of necessary opioids are available, making it difficult to control pain. Paediatric opioids are not available so physical adjustments of the dosages are necessary, something unacceptable in the EU. He also told me how difficult it was to manage the need when primary care is so under resourced. A single GP may have more than 4,000 patients spread around a wide, rural area. I was particularly touched by one of the patients I met. She kept saying “thank you for seeing me, thank you so much for caring”. I believe that our partnership with Ryder Albania will make a huge difference. Initially we will be providing advice on issues such as fundraising to the teams. But we would like to follow the model we have now introduced in Moldova and establish a national network of hospice services in the country. Plans are still at a very early stage, but I am very confident we can work with the Ryder Albania to achieve this goal and improve the situation for terminally ill patients in Albania.” Medical Supplies We have started sending donated medical supplies to Albania. The first shipment arrived in September 2018. The future We are assessing the possibility of creating a national network of hospice care in Albania. This is similar to the model we have adopted in Moldova and a summary is in this video.