By DASHNOR KALOÇI

Although it was widely promoted that; "unlike capitalist countries, in Socialist Albania the health service was free for all citizens:, throughout the entire period of the communist regime of Enver Hoxha and his successor, Ramiz Alia, it left much to be desired. Even in many aspects, such as the equipment and equipment of hospitals and other health facilities with various modern medicines and medications, it was a problem that remained unresolved until the collapse of that regime. But one of the biggest wounds of health care before the '90s, is said to have been that of the high number of deaths of children aged 0 to 1 year, or as it was otherwise known in the medical term; "infant mortality".

Among other things, this is also known from some archival documents of the Ministry of Health of that time, where its correspondence with some of the highest party and state institutions and bodies of that time is located, in which it is known that during 1971 alone, in all districts of the country, out of 72.771 births, 7027 deaths were recorded in children aged 0 to 1 year.

But what shocked Tirana and alarmed the top party and state leadership of that time was the death of 27 babies in the Tirana Maternity Hospital (today the “Nana Mbretereshë” Maternity Hospital) in just a few days at the end of September and the beginning of October 1972, which forced the relevant bodies of that time to close the Tirana Maternity Hospital altogether. But why did such a high number of deaths occur in that maternity hospital at that time and what were the reasons for the decision to close that Birthing Center? What is said in the report-information of the Minister of Health of that time, Dr. Llambi Ziçishti, sent to the highest instances of the state and what was the reaction and response of the top leadership of that time, starting from Prime Minister Mehmet Shehu, the secretary of the Central Committee of the Albanian People's Party, Hysni Kapo, the first secretary of the Tirana Party Committee and the member of the Politburo, Manush Muftiu, etc.?

The following archival documents, published for the first time, provide a detailed overview of the alarming state of infant mortality in Albania in 1971, as well as the efforts of the state apparatus to bring this tragic phenomenon under control. Through the report of the Deputy Minister of Health, Dr. Kleo Miho, as well as official reports signed by Dr. Bukurije Maçi at the Directorate of Mother and Child, the true picture of medical service in districts and villages during the communist regime is revealed.

These official documents from early 1972 reveal not only the high infant mortality rates, where respiratory diseases such as bronchopneumonia accounted for up to 60% of cases, but also the deep infrastructural backwardness in rural areas. The documents reveal the failure of the plan to build maternity homes and clinics, the lack of maternity permits and medical check-ups for children aged 0-3, as well as the scandalous food conditions in village nurseries, where even the most basic items such as wheat bread and milk were lacking. Through an administrative self-criticism, the reports also attack the bureaucracy of local health departments and the superficial or fictitious presentation of demographic data from districts. Regarding this, etc., we are familiar with the documents in question, extracted from the Central State Archive (the fund of the former Central Committee of the Albanian People's Liberation Army), which are published for the first time and with the relevant facsimiles by Memorie.al.

Continued from the previous post

REPORT – INFORMATION FROM THE MINISTER OF HEALTH, DR. LLAMBI ZIÇISHTI, REGARDING THE SERIOUS EVENT OF THE DEATH OF 27 INFANTS IN THE TIRANA MATERNITY IN OCTOBER 1972

: INFORMATION

Following our previous information on the infection circulating in the Birthing House in Tirana, the situation has developed as follows:

Since 17.X.1972, there have been no sick children from the contingent of children born in the ward isolated from contacts. This shows that the disease is under control. The number of sick children so far is 50. This also includes those who fell ill in the city, after being discharged from the hospital. All of these children have been in contact with the disease.

The disease has a severe course. As is evident from world experience, the mortality rate is over 50%. So far, 16 deaths have occurred in our maternity ward. This includes children born with very low birth weight, but who had signs of this disease. The fact that with the rigorous anti-epidemic measures, in the special ward, since 17.X.1972 there have been no sick children and taking into account the anatomopathological data, it can be concluded, but with reservations, that this is not a viral disease, which would be more serious in terms of spread. Laboratory research continues in this direction.

Regarding this disease, all maternity personnel have been placed in special conditions of sterility and prophylaxis. The team of the best pediatricians is regularly present with the children. Measures have also been taken to reduce, within the limits of possibilities, the number of women who come from outside the city and who have the opportunity to give birth in other institutions. So far, there is no reason to close the maternity hospital. The opinion of specialists is that the disease has been dominated since the first measures. The increase in the number of sick people is only due to the contingent of contacts. Control and monitoring in the city of all children discharged from the maternity hospital has also been ensured.

Every day, about 20 children are born, but so far, no cases of illness have been observed in the city among children born after October 17, 1972.

Tirana, 27.X.1972

ministry

Lamp Ziçishti

MITI BOZO'S LETTER TO HYSNI KAPON REGARDING THE SERIOUS EVENT IN THE TIRANA MATERNITY IN OCTOBER 1972

Comrade Hysni

I think that this information from the Ministry of Health should also be sent to comrade Manush, because it strikes me that there is a spirit of justification in this matter. In the maternity ward, we have a party organization that should analyze the situation more deeply.

The Bozo Myth

11. XI. 1972

LETTER WITH THE RESPONSE OF HYSNI KAPOS ON THE SERIOUS EVENT IN THE TIRANA MATERNITY WHERE 27 INFANTS DIED

Manushi is the only one who knows about the child and other services, but also the responsibility of the house staff who have not respected the rules and the required discipline. He told me that we will make these issues a problem in the Party organization.

Enter Capo

13.11.72

REPORT – INFORMATION FROM THE MINISTER OF HEALTH, DR. LLAMBI ZIÇISHTI, ON THE SERIOUS INCIDENT IN THE TIRANA MATERNITY AND MEASURES TAKEN TO STABILIZE THE SITUATION

: INFORMATION

ON THE SPREAD OF AN INFECTION IN THE NEONATOID WARD IN THE TIRANA MATERNITY HOSPITAL

As reported in previous information, starting from 3.X.1972, in the neonatal ward of the Tirana Maternity Hospital, a rapid spread of a severe infection was noted, which was manifested by a sudden deterioration of the general condition, with a rise in temperature, a decrease in weight and gastro-intestinal disorders. From the above date until 6. XI. 1972, out of 411 newborns, this infection affected 67 of them and caused 27 deaths (= 40%).

The number of sick people includes 17 children who showed signs of the disease after leaving the maternity hospital. Of these, 4 died in the Children's Clinical Hospital. The Ministry of Health was notified of the situation on 9.X.1972 and immediately a large commission with various specialists was convened, who on this occasion proposed a series of measures to make it possible to stop the spread of the infection.

These measures had a general hygienic, prophylactic and organizational character and were accompanied by anatomo-pathological research and extensive microbiological analyses. These examinations pointed out on 16.XI.1972, the presence of the microbe 'Coli pathogen O111' in sick children, in some baby food containers and in some maternity rooms. It is assumed that the primary source of the microbe is a healthy and temporary carrier (perhaps a mother).

The discovery of the causative microbe made it possible to implement a series of more concrete and specific measures, since the routes by which the infection spreads in newborn children are well known. Infections caused by pathogenic coli are known and described in all countries and from time to time this microbe takes on highly aggressive characteristics towards newborns and young children. These aggressive characteristics become pronounced in institutions with a concentration of children as a result of the multiplication and rapid transmission of the microbe from one child to another, causing a high mortality rate reaching around 50%.

The main measures that were implemented at this time consisted of repeated disinfection of floors, beds, premises, hands and in the replacement and multiplication of many equipment in order to eliminate the possibility of transmission and spread of the microbe. Other important measures consisted of the creation of special and isolated premises for sick children for whom a more complete and intensive treatment was implemented, assisted by pediatricians from the children's hospital and by specialist doctors who carefully and regularly followed all the work processes in the maternity home.

Children who had been in contact with the sick were kept isolated in separate wards. New, uninfected wards were created for the remaining newborns. Separate personnel were assigned to each ward, creating the possibility of avoiding the spread of infection by the personnel themselves.

A great deal of work was done with the doctors of the maternity hospital by the friends of the commission regarding the fundamental problems of maintaining and protecting the newborn child, on its proper nutrition, on appropriate medication, etc.

The measures taken made it possible to achieve a significant change in the situation and microbiological research resulted in very limited or completely negative results. This change was noted

also from the fact that from 17.X.1972 to 30.X.1972 there was no sick child among those born during this period and were kept separate from sick children or from contacts. These children were also followed up at home after leaving the maternity ward and continue to be healthy.

At this time, extensive work was done to fully utilize the capacity of the Yzberishi (Combinat) maternity hospital as well as those in the villages and to limit unnecessary arrivals from other districts.

The children discharged from the Tirana Maternity Hospital were followed with great care by the staff of the children's clinics and by the doctors and staff of the polyclinics, with whom explanatory work was also carried out. The measures and the situation created over the last two weeks allowed us to believe that the situation could be completely under control, provided that the rules were maintained by the staff themselves, who are the main factor in the direct and indirect spread of the infection.

The closure of the obstetrics department of the Maternity Hospital was not considered necessary during the first phase of the epidemic, because there was no precise data on the causative microbe and on the mode of spread of the infection. At this stage, it was thought, among other things, that it could be a viral, airborne infection that is not related to environmental conditions. After the determination of the microbe and the measures taken, the closure of the obstetrics department was not considered necessary due to the fact that the situation was kept under control and no new cases appeared for a period of two weeks.

During this phase, repeated examinations indicated that the situation had also been contained from a microbiological point of view. The possibility of the spread of infection, as far as the cleanliness and sterility of the personnel were concerned, could have been the same in the premises where the obstetrics sector could eventually pass. But despite the organized controls, two serious violations of epidemiological rules by the personnel were observed, which allowed four new cases of the disease to appear on 30.X.1972, followed by six more cases by 3. XI. 1972.

Once again it was proven that the infection could only spread through known epidemiological routes. Since 3.XI.1972 there has been no new case. On 5.XI.1972 a wide consultation was held, following which it was decided to immediately close the obstetric sector of the Tirana Birthing House and to use the maternity capacity of the Combine with expansion.

Such a measure appeared possible at a time when the number of children in the maternity ward had dropped to 18 and came into effect on 7.XI.1972 at 6 o'clock, with personnel from other maternity hospitals. Over a period of several days, the Tirana Maternity Hospital will be disinfected once again, but as was pointed out in the consultation, even after the temporary closure of the obstetric corps, the return to this ward creates guarantees only if the rules of hygiene and asepsis are strictly implemented.

Therefore, it is necessary to conduct educational work with the personnel and to complete a series of structural measures to prevent or easily cope with possible intra-hospital infections. From this situation, conclusions will be drawn both for the maternity hospital itself and for other curative institutions. Of the sick children, all are currently improving. The development of the situation is being systematically monitored by the specially created headquarters. / Memorie.al