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Friday, 09 December 2005 |
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by Siobhan O'Donnell
Introduction Kosovo is a province within Montenegro and Serbia. It has a population of 1.9 million (2002 estimate) of which one quarter live in its capital, Prishtina. The majority of the people living in the region are Albanian, while Serbs (and other ethnic groups) make up the remainder. Kosovo has endured centuries of conflict between these two ethnic groups. While the province enjoyed a relatively high degree of autonomy in former Yugoslavia this came to an abrupt end in 1989, when the Serbian leader, Milosevic, brought it under the direct control of the Serbian capital, Belgrade. The ethnic Albanians strongly opposed this and as a result, the friction between the Albanians and Serbs intensified forcing hundreds of thousands of Albanians from their homes. As the war between the two ethnic groups raged on, the international community grew very concerned about the human costs and the risk of the conflict spreading to other neighbouring regions. As a result, an agreement was signed in 1999 to end the fighting, which enabled the Albanian refugees to return to Kosovo in order to re-establish their lives. Since 1999, Kosovo has been under interim UN administration and in 2001 it successfully held its first democratic election. Subsequently, the international community has participated in the restructuring of this province however, reconciliation between the ethnic Albanians and Serbs, as well as Kosovo’s future, remains uncertain. Population Health Kosovo was always the poorest province of the former Yugoslavia, however the economy was particularly damaged at the end of the conflict in 1999 by poor economic policies, a lack of external trade and financial investment. Since the province has received support from the international community there has been some reduction in poverty, however, over one third of the population still lives below the national poverty line. This is in part attributed to the weak governance, the lack of an integrated social statistics system required for planning, poor education and high levels of unemployment. Furthermore, evidence suggests that Kosovo’s health indicators are among the poorest in South East Europe.
Health Care System The health care system of Kosovo suffers from years of neglect, poor policy, weak management, a lack of maintenance of the physical facilities and equipment as well as staff/professional development. These chronic issues were only exacerbated by the conflict in the late 1990s, which resulted in major damage to health infrastructure. Disability and Rehabilitation Before the conflict, persons with disabilities were perceived as unproductive members of society, a financial burden to their family and were typically isolated. Health professionals did not have the knowledge base, skills or resources to provide the rehabilitation services required to help these individuals become productive members of their communities.
Kosovo has only a few existing institutions that offer rehabilitation services. In total, there are four community hospitals and a few private clinics. Furthermore, the services offered are extremely limited in scope and disabled individuals often have difficulty accessing them due to isolation, lack of funds and/or transportation. Physiatrists and physiotherapists typically provide rehabilitation services. The majority of therapists obtained a four-year secondary level of education in physiotherapy upon completing elementary school. In addition, there was a small group of physiotherapists, approximately 20, who completed a two-year post-secondary education in physiotherapy outside of the province. Physiotherapists in Kosovo were required to work under the direction of physicians (typically physiatrists) and they had very limited professional autonomy.
Personal Experience
I traveled to Kosovo for 2 weeks in October 2003 with the International Centre for the Advancement of Community Based Rehabilitation (ICACBR). Established at Queen’s University in 1991, ICACBR is one of six Centers of Excellence funded by the Canadian International Development Agency. Through community based rehabilitation services, education of rehabilitation personnel and policy development, ICACBR’s aim is to maximize community participation and citizenship of persons with disabilities and minimize the inappropriate use of resources.
I learned of ICACBR’s efforts in Kosovo, specifically the development of a 3-year Bachelor’s degree program in physical therapy at the University of Prishtina, through colleagues of mine at the University of Toronto that were intimately involved. ICACBR collaborated with the University of Prishtina, Handicap International and other international and local institutions to strengthen the rehabilitation system in Kosovo by investing in the education of future therapists at the university level. For this purpose, Canadian clinical educators were hired to design specific physiotherapy related courses, develop learning resources and teach physiotherapy students within the three-year program. Translators were hired locally to assist with the translation of the materials prepared as well as teaching.
My role in the project
I was a clinical educator on the project, which involved developing and teaching a course entitled Advanced Orthopaedics to final year physical therapy students at the University of Prishtina. My primary responsibilities included the development of a manual and presentation material; classroom and clinical teaching in addition to, the development of the course examinations (written and practical).
A typical day
A typical day involved lectures in the morning to learn/review theory and a lab in the afternoon to practice clinical skills. In addition, I organized a couple of structured clinical sessions at the hospital in order provide the students with an opportunity to assess a patient with a specific orthopaedic condition.
Successes
Some of my personal successes included:
- The development of teaching and learning resources including teachers notes, course notes, overheads and handouts in orthopaedics which were translated and left behind as a future resource.
- Knowing that I assisted in educating the first generation of physiotherapists at the University level.
Challenges Some of the challenges I faced included:
- Learning how to teach effectively through a translator
- Frequent power outages while preparing lessons plans for the next day!
- Coming to the realization that what I thought were the student’s learning needs was not necessary in keeping with their actual needs and having to adjust lesson plans accordingly.
- Empowering students to commit to ongoing learning and to challenge the current method of practice knowing that they have limited resources and a lack of skilled mentors locally.
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Last Updated ( Friday, 09 December 2005 )
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