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Friday, November 9, 2007

Outlasting The Crisis

Working with communities to create solutions that endure
Patients and community members play an
active role in our projects.

In 1999, the armed conflict in Kosovo drove thousands into refugee camps in neighboring Albania and Macedonia. Doctors of the World-USA (DOW), already present in the region, responded to the crisis alongside numerous NGOs, providing food, shelter, and medical care to refugees. When the conflict ended, displaced Kosovars returned home, and many aid sources dried up as the world turned its attention elsewhere. But DOW remained. 
 
Armed conflicts and natural disasters inspire an outpouring of humanitarian aid and relief work – but this is not enough. Volunteer physicians save lives and monetary donations provide needed food, medicine, and shelter, but when crises end, communities may be left in the same position where they started. As Jeffrey Sachs, Director of the Earth Institute at Columbia University and Special Advisor to the United Nations Secretary-General on the Millennium Development Goals, says, “[Relief aid] is treating the emergency but not treating the underlying conditions, and that will never solve the problem.” 
 
In order for communities to take their health into their own hands, long-term development support and capacity-building efforts are needed. Governments and organizations wishing to solve global health problems must address the underlying issues that fuel inequality and create health problems. Violent conflicts and natural disasters only increase the inequitable distribution of global resources between developing and developed nations. Following the devastating tsunami in 2005, international aid poured in to provide immediate relief. But with flattened hospitals and a depleted medical corps, the health needs of the region extend far beyond the immediate needs of survivors. In Kosovo, before and after the 1999 conflict, many women had almost no access to obstetric or prenatal care – the maternal mortality rate was one of the highest in Europe. Only long-term and comprehensive development programs can wholly address pressing health needs in post-conflict areas.
 
A replicable model for women’s healthcare in Kosovo: Women’s Wellness Centers. Beginning in 2003, DOW partnered with the Kosovo Ministry of Health to establish the Women’s Wellness Center (WWC) model of comprehensive care. The few public clinics for women of reproductive age in Kosovo are inadequately equipped and dangerously disorganized; doctor-patient communication is so poor that many women are unable to follow medical advice and don’t return for follow-up care. “Women take tests at public clinics and then have to go to a private clinic for results. Sometimes women don’t even know where to go or have to go outside of Kosovo, but few can afford that,” says Sadije Llalloshi, a nurse practitioner who works at the Main Family Medicine Center (MFMC), the largest public primary care facility in Pristina, Kosovo’s capital, and the site of the newest WWC. With DOW guidance, each WWC is owned and operated by local health providers to provide a full range of services for women for years to come. 
 
The WWC model, which has been replicated at three locations throughout Kosovo, provides a single location that Kosovar women visit to receive free preventive services, obstetric care and testing, and reproductive health education. “In Kosovo in general, there is no health education,” says WWC nurse practitioner Shehrije Iberdemaj. “At the WWC, we have a big room where we give lectures and educate women about health.” The WWCs also serve as training grounds for health providers, teaching client-centered care, organizational management, and strategic planning. 
 
“The WWC is very welcoming for our women,” says Mediha Berisha, a first-time visitor to the Pristina Center. “I came because the doctor treats you well, speaks with you, and listens.” Women are grateful that there is a single resource for their health needs, and minorities are surprised to find staff that both welcome them and speak their language. Because they have nurses and doctors who are willing to listen and who communicate well, women are more likely to follow medical advice and to return for regular care. 
 
Today, all of the WWCs are owned and operated by the Kosovo Ministry of Health. After extensive training, resource development, and management guidance, DOW transferred full control of the WWCs to the Kosovar authorities, who continue to provide care for up to 30,000 women each year. Local health providers and the government are now equipped to sustain the WWC model and to further replicate it across Kosovo, benefiting thousands more women who otherwise face some of the worst health indicators in Europe.