By Osman Staff

During the year 2024, hundreds of patients were denied health treatment according to the protocol at the Oncology Hospital of the 'Mother Teresa' University Hospital Center due to the lack of radioactive substances and chemotherapy drugs.

In the last 8 months, Alma does not remember how many times she knocked on the doors of the Oncology Hospital, but the answer she received from the staff about radioactive iodine was always the same.

"No, we will get you on the phone when it comes," recalls the 50-year-old, who suffers from thyroid cancer. During the last visit in early August, her appointment lasted no more than 15 minutes, as she walked out of the ward again with her head down.

"They are killing me! They have been lying to me since January," she said, with sadness evident on her face, as she added that they told her that the iodine will arrive in September. "Is my cancer waiting for September and iodine when they bring it?" she asks.

Alma is not the only patient looking for answers. At QSUNT, another 42 thyroid cancer patients are being treated, who have not received their treatment with radioactive iodine since January.

"If the patient does not receive the dose of radioactive iodine, it is the same as if the patient does not receive chemotherapy for a cancer x in his body," said an endocrinologist, who spoke on condition of anonymity for fear of reprisals. possible from the Ministry of Health.

"The longer you delay, the more the chances of metastases increase," she added.

Radioactive iodine is not the only radioactive substance missing from the University Hospital Center. The data collected by BIRN show that there is also a shortage of 'technetium-99', which is used for scintigraphy examinations, but also in drugs used for chemotherapy such as 'gemcitabine', which has been missing since May.

In a written response, QSUNT admitted that the radioactive iodine was missing since February, while the scintigraphy was last examined eight months ago, in January 2024.

The main university hospital in the country blamed the shortage on the Vienna-based International Atomic Energy Agency (IAEA), with which the Ministry of Health has an agreement for the provision of radioactive materials, while adding that it has opened a tender for the provision of radioactive iodine.

"We have been informed by the IAEA that it can no longer make an agreement with the Albanian state, regarding the supply of QSUNT with radioactive materials," said the University Hospital Center.

"Currently patients are treated with inhibitory hormone therapy until the supply of radioactive substances, which keeps the hormonal level under control for a period of three months after the surgical intervention, a period which is carried out before being treated with radioactive iodine 131," added QSUNT.

The University Hospital told BIRN that 150 more patients who need gemcitabine are currently being treated at the Oncology Department, but even though there is a signed contract, there are currently no supplies from the importer.

In a written response, the IAEA told BIRN that it does not make the agreements or contracts public, but stressed that it is not involved in the regular supply of materials such as Iodine-131.

The last published technical agreement between Albania and the IAEA started in 2018 and ended in 2023. One of the main areas of this agreement was nuclear medicine, radiotherapy, medical imaging and food.

The private has, the public does not

Every year, about 20 cancer patients are treated at the Oncology Hospital, part of the 'Mother Teresa' University Hospital Center in Tirana. According to a performance audit undertaken by the Supreme State Control, during the years 2020-2022, 58,295 cancer patients were treated, for an annual budget ranging from 398 million to 513 million ALL, with an average annual cost per patient of 23,817 lek.

According to KLSH, over 90% of the budget of the Oncology Hospital is spent on the purchase of drugs and medical equipment. However, data collected by BIRN from interviews with patients, their families and doctors show that shortages of drugs and preparations for anti-cancer therapies are chronic in QSUNT.

"It was terrible to see my mother without medication," the son of a 65-year-old patient operated on for thyroid cancer told BIRN, who after many months of waiting, decided to transfer his mother to a private hospital, as according to what they had the doctors said, the disease could not wait any longer.

"Almost every month I asked about the radioactive iodine, but nothing," he recalls, adding that 'we were escorted home.'

Unlike the public hospital, this preparation exists at a very high cost in private. The relative said that he paid about 1200 euros for the treatment of the mother with radioactive iodine in a private hospital.

"We made the money with family members, sisters and brothers", he explained, while posing the questions: "How is it that the private sector has the opportunity and the public health does not?"

The endocrinologist of the Oncology Hospital who spoke to BIRN emphasized that radioactive iodine is a very important therapy for thyroid cancer patients. Like chemotherapy, radioactive iodine, if not given according to protocol, causes disease progression.

"We, the white shirts, try and pray that when this diagnosis comes out there is no residual tissue in the thyroid, because in these cases the follow-up part is easier," said the doctor with 10 years of experience in Oncology.

"In those cases where there is residual tissue... since they are not done at QSUNT as an analysis, we approach as an alternative that the examinations and treatments are performed privately," she said, while adding, "we have no other way."

Like radioactive iodine, the lack of technetium-99 has become a concern for the doctors of the radiology department at QSUNT, making it impossible for them to do the scintigraphy examination.

"In our service, no type of examination related to scintigraphy is performed," said a radiologist who chose to remain anonymous. "The technetium material has diagnostic value when used to do thyroid scintigraphy, so it serves to diagnose hyperthyroidism, cold nodule or warm nodule," he explained.

The radiologist, who has been in this service for several years, says that he feels very bad in this situation, since "the role of the doctor is to help the patient to solve the problem and ensure victory, which is ultimately the patient's life." ".

"In these cases, I feel like a man who doesn't have the tools at hand to fight an equal war," he added.

QSUNT said through an official response that from January to May, there are 554 patients who have not been examined according to the protocol requested by doctors, including bone, thyroid and renal diseases.

'They are killing my mother'

It is not only radioactive elements that have been missing since January at QSUNT. The Oncology Hospital has also turned into a nightmare for patients suffering from cancerous diseases, due to the constant lack of chemotherapy drugs.

This drama of theirs is shown through the testimonies of patients who are currently suffering from cancer.

During this year, at different periods of time, BIRN has learned that four important medications in the fight against cancer have been missing - gembcitabine, irinotecan, erlotinib, paxlitacel, which are provided only by the Ministry of Health, as they are hospital medications and cannot be available in pharmacies.

The lack of these drugs has brought negative consequences to the health of patients and has alarmed their families.

Hawaja, 65 years old, has been diagnosed with breast cancer and is being treated at the Oncology Hospital. In the month of May, they informed him that the medication for chemotherapy "gemcitabine" is missing and that the therapy should be stopped and it was resumed in the month of August.

"They are killing my mother," said the son, while adding that he felt "devastated."

The 40-year-old man recalled that the mother's tests before the lack of gemcitabine were fine and without problems, but with the lack of this drug, the mother had metastases.

"The cancer in my mother's body spread," he said, as he bowed his head and wept. "My mother raised me with a lot of hardships and today I can't provide her with the medicine to fight cancer," he added through tears.

The 40-year-old confessed that he tried to smuggle the medicine, but he could not find it in the pharmacy.

"I was ready to sell anything, but I couldn't find it," he said, adding that the lack of this drug constituted a crime.

"SPAKU should investigate properly and you will see how they kill people by not providing them with the necessary medicines," he said, while emphasizing that no one is responsible for the advancement of his mother's illness.

An oncologist, who has been working in this service for years, told BIRN on the condition of anonymity that the situation was serious as many cancer patients were left without treatment.

"In pancreatic cancer, bladder cancer, lung cancer, and breast cancer, gemcitabine is used as a first-line treatment," she explained.

"So, if a patient is diagnosed with these diseases and you don't have this medicine, you have denied the patient treatment from the beginning," added the doctor.

The oncologist explained that there is no substitute for this drug and therefore patients cannot take any other drug if it is in short supply.

"As a result of the lack of gemcitabine, we have had patients who have deteriorated or metastasized," she said.

The fact that gemcitabine does not have another substitute medicine is also accepted by QSUNT, in the official response. But according to the University Hospital, "the patients were not left without treatment, as other treatment schemes were used according to the case, based on the medical protocols and the relevant staff".

Hava's son, who said that he could not speak by name because he was afraid that the Hospital would take revenge by denying chemotherapy to his mother, said that he would not wish the encounter as a patient at QSUNT even on his enemy.

"This is to burn the soul forever," he emphasized. "To watch your man die because there is no medicine." /Reporter.al/