Hundreds of families in Tepelena live with the drama of having one mentally ill person among them. Many of these families tempt to “hide” them and negate their pathology by deteriorating the health situation of the ill people, some others cannot afford to buy the medicines for their relatives and there are also some families that do not have the financial means to do the preliminary examinations that can lead them towards benefitting the KEMP (Health Commission that Defines the Ability of People for Work)
From Kristina Fidhi
“We live here in this house, 5 people, three children, my wife and I”, starts his story Kastriot Shyti, inhabitant of Krahes 2 village, about 45 years old. In fact, he is talking about a building, half collapsed with only one room. “We have been reduced to a plight of worries, of problems, unemployment, diseases. When they come, they come all of them together and become unaffordable”.
Kastriot lives in this building after getting married with Violeta. The couple normally started their life together about 20 years ago, but the collapse came after his illness due to inefficiency in his backbone. After that, there came the illness of his wife that suffers from depression and anemia. Their 11 year old daughter suffers from a meningo-encefalit caused some 4-5 years ago after passing a high temperature. The older son of the family, 16 years old is asthmatic and being in a continuous need for medical treatment, whereas the only healthy member in the Shyti family is their seven year old daughter. Out of their three children, she is the only one that attends the school.
There are some days that Kastriot stays alone in his house taking care of his children. His wife Violeta is in the Tepelena hospital since one week and her older son goes and visits her there. “I am tired”, says while trying to calm down his daughter that is passing one of her epileptic crises. “I have asked after 2007 some help from the commune. Firstly Ladi Resuli and later on Qenan Halili told me to approach the highest state institutions as the commune could not help me. After that I have gone to Tepelena. They have told me that they will do something with the economic aid, to get something to not let us without bread and water. I get 40 thousand leke, 4 thousand new Lek, I have gotten even 20 thousand lek, that’s to say 2000 lek. That was all the fund they were getting, it is not that the commune wanted to keep my money, but there were many requests and the money was not enough, and it was split in as many people as we were”, tries to explain Kastriot.
The basic economic aid is the only income for this family. The 11 year old daughter has never approached the KEMP to benefit the pension. By not getting any medical treatment, her health has never been improved. The same problems are suffering all the members of this family, they lack the financial means to go to the physician and do the necessary examinations that would make them benefit the economic aid as people with temporary or permanent disability.
“I have a son who is asthmatic with internal burning; I have cured him in a private doctor in Tirana. He has problems especially when the trees blossom and his breath is blocked, we do not have any medicine and we do not know what to do to him. The daughter has passed a temperature of 40-41 degrees and due to some reaction from the injections her body was filled with water. When this happened to her, some years ago, I was bringing her 2-3 times in a day to the hospital to get the medical treatment. I do not get anything now, no medicine as they are given with a health booklet, I am not health insured and I do buy her injections with the market price. We are now four people that get the medical treatment, only our 7 year old daughter does not need any treatment. None of us does get anything else from the state”, continues Kastriot. “The economy has its own part, when you are ill you become ignorant, no one wants you, you cannot afford the conditions. This is my economy, there is no job; if there were any job and I could get some 15
Astrit Dervishi, mayor of Krahes commune-Tepelena
thousand leke per month, I would not solve 100% my problems, but at least would not have any debt. This makes me to not move from the house. We do not have any money to go to the doctor” – says Kastriot.
The head of the Krahes commune Astrit Dervishi says that there are tens of families that suffer from extreme poverty, that feel ashamed and embarrassed for the health condition of their relatives and also lack the information on regard to the social services. “It is the physician of the commune, the person who must tell them how they can benefit the KEMP, says the mayor Dervishi. “We give to them the economic aid as being poor families but they have not brought any other document. We have a reserve fund of 3% of the budget, but we used it for the emergencies. Many houses in the commune have collapsed and slip from the rains and amortization”.
The back and forth of an ill person until he goes to the KEMP
Astrit Zeneli, a physician, being also the director of Tepelena hospital explains that for the sick people that live in the remote areas, to ensure the necessary documents to be enrolled in the KEMP, takes a long time and it is an unaffordable cost for families like that of Mr. Shyti. “I have been a member of KEMP, explains Zeneli. When someone does have a health problem as in this case, that’s to say having a sick person with neuro-psychic he has to pay a visit to the family physician; after that to the specialist of the Tepelena hospital. Here he gets the chart of the patient. With the exit card and our conclusions he has to undertake a number of examinations that cost”, – explains the physician.
Astrit Zeneli, director of Tepelena hospital
Stoli Selmani, a neuropsychiatric physician for many years in Tepelena area admits that the wife of Kastriot, Violeta has paid once a visit in the hospital and she has been diagnosed with neuroses of depression elements and anemia but she did not come again. “Without having a health booklet you cannot take any examination from the state. There are also some criteria to get the KEMP. Firstly she has to do the scanner, something that is impossible for her to do as it costs 13 thousand leke; secondly she has to come again to the neuropsychiatric physician and has to pay again. There she will undergo a psychiatric consultancy in order to evaluate her psychic situation. Everyone can undergo a depression, but not all of them can benefit from the KEMP”, explains the physician Selmani.
“I am in this field and I have also worked in the KEMP. There are mentally-ill people, psychic-ill people and there are people with neurology with damages. The first contact is the physician of the village who must orient these sick people and their relatives where to go. All the areas have physicians, but in order to go to them you must be health insured to get the recommendation and go to the specialist. If the patient is not health insured, the road is not opened to him. Under such conditions, the patient chooses to come directly to the physician” continues Mrs. Selmani. “He has to pay the bill of 1500 leke to the receptionist to do the basic examinations, but he cannot do further examinations such as the scanning of the head, as there is needed the health booklet.
Referring to the case of Shyti family, the physician Selmani says that: “this family has a daughter with disabilities but they have not brought her here as they lack the financial means. It’s enough for them to get a recommendation from the family doctor and to bring her here to pay a visit and I will bring her to the psychiatric hospital for children in Tirana. There she has to pass an intelligence test for children. Based on the percentage of loss of the mental ability there is fulfilled the patient’s file and is also compiled the recommendation for her treatment with the economic aid. But the family has to afford all these expenses with their incomes, and that is it which has hindered them to treat their daughter and make her benefit from the support given to these people”, – explains the physician.
The specialists of the State Social Service(SHSSH) tell about hundreds of “hidden” cases of patients that cannot cover the preliminary
Dhimitër Mjedi, Head of SHSSH-Gjirokastra
expenses for examination. “It is the negligence of the patients that most of them have not benefited from this fund, but we understand that they do not have the possibility to come and be present even for a visit. The commune has its own responsibilities on that. There are cases that such families can benefit from the special funds of the commune. The physician of the commune had to make present the case of the family you are referring to long ago”, – says Dhimiter Mejdi, head of the State Social Service.
Safet K. inhabitant of Tepelena, has arrived in the southern part during the communist time to work as a miner in Memaliaj; he says that he has three mentally –ill children. They, according to him are treated with the economic aid, but it is not enough even for the bread. “What can I buy their medicine with? What can the medicine do to them now? We are to be disappeared without a trace.”- says desperately the father of the three grown-up children.
The economic aid and the need for medical treatment of the neuropsychiatric –ill people
According to the specialists, minimally, a neuropsychiatric-ill person needs to have continuous examinations, in spite of the preliminary ones, such as the intelligence tests, EZHE, encephalography and a scanner of the head. “None of my patients that are getting the economic aid is able to buy the contemporary medicines”, says the physician Stoli Selmani. “The medicines that feed the brain such as neuromidina that does the regeneration of the brain’s cells or the neutropia that helps on the blood circulation are rather impossible to be purchased by them”.
The physician, Stoli Selmani
Referring to the health conditions of her patients, who in the recent years their number has been increased, “we can tell that in most of the cases there is an installed pathology that brings non-returnable defects to the patients, nevertheless they are in need of the continuous medical treatment as they may start the epileptic shock or psychotic turbulences of character that have to be kept under continuous control, but this is something that the family members do not want to understand. Only 20% of the money they get from the economic aid may be used for the medicine. We are often confronted with psychotic turbulences. The patients perform uncontrolled actions; they become aggressive towards the others and to themselves. During the puberty period the hormones affect the body and make them very energetic. But their family members come to us with the empty booklets, without any medicine subscribed there under the psychosis that what the medicine can do to the sick people if they take it. Unfortunately, they belong to the very poor families, – concludes the argument Selmani.
For many years, the specialists have proposed the setting up of a special commission to study the new cases that surprisingly enough have increased a lot. “We do not know the reasons why such irregularities have happened in some years”, explains Selmani for example why do there prevail the cases of autism and psychic illness in the people born in ’97-2001, 2007-2011? Based on my experience the cases are higher in the children born in 2007. What is that: a vaccine of measles, German measles, is it inherited or is it anything else? There are different diagnosis that are concentrated even geographically in some of the areas and not in others. There are families that have three or four members suffering from schizophrenia in Krahes, Memaliaj and in many other areas” says Stoli Selmani
In the whole Tepelena district around 750 people are receiving the economic aid due to a physical or mental disability, out of whom 35% are with neuropsychiatric pathology. Among the later there are disabled people that need to get three kinds of medicine, especially those that are treated with antiepileptic medicines. Only one of such preparation costs about 9000 leke, whereas the monthly pension for such a patient reaches to 9500 leke.
Tepelena is an area highly affected by the mental diseases which originate from the economic problems, family crises and other unstudied reasons. For many years, the whole region is known for the high number of the attempted suicides, but the areas of Krahes – Kalivac can be defined as typical areas for the great number of suicides. During the last two months, two young people from Krahes suicide in the arch of few weeks.
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