Lukas Radbruch, Chair of Palliative Medicine, University of Bonn, Germany, and Fellow of the International Associate Faculty of the Institute of Palliative Medicine, San Diego Hospice, and Ali Xhixha, Medical Team Leader, Sue Ryder Albania, Tirana, Albania
As I step off the airplane, I am shocked: I left rainy and cold Germany in the morning, and here in Tirana it is 39°C, and it feels even hotter under the burning sun. I am visiting Ali Xhixha, the leading physician of the palliative care team of Sue Ryder Albania in Tirana. Ali and I have been teamed up in the Leadership Development Initiative (LDI) led by Frank Ferris and Shannon Moore in San Diego, and a field visit is part of the programme.
So here I am. Ali and I are driving through downtown Tirana, a city with nearly a million inhabitants (with 2.8 million in the whole of Albania), a mixture of modern shopping streets and small ‘garage shops’ (shops that have opened up in the backs of garages), and even people selling stuff from cardboard boxes on the sidewalks, but all of it vibrant and alive. The infrastructure is bad, even addresses are difficult, and so Ali, Lili (the nurse) and I are standing at the corner of the street, waiting for the daughter of the patient to come and guide us to the flat.
We visit the new patient, who had surgery for his retroperitoneal cancer only two weeks ago, having had six kg of tumour mass removed. He is 67-years old, but had been working as an engineer and in his second job as a radio announcer until he fell ill, and now he is suffering from weakness and tiredness. The family does not want us to tell him anything about diagnosis or prognosis. We visit Ismael, head of a large family, who has been suffering from lung cancer for more than two years now. His wife cared for him until she too died from cancer, and now his daughters take good care of him. He is weak too, but he insists on showing us out at the end of the visit, as traditional Albanian hospitality demands. We meet Violeta, who has cancer of the colon and is worried about the fever she developed yesterday. She tells us about the dream she had yesterday, where four men were in her flat. And now she counts our heads (three men) and laughingly tells us that here there is only one man missing. Ali adjusts the medications for symptom control, the team talks to the patients and caregivers; they explain, they listen and more than once they laugh with them.
I am really impressed. The Sue Ryder Albania palliative care team does such great work. They have to patch the deficits in a lacking healthcare system, with meagre resources and few staff members. For all patients the caregivers insisted that no information about diagnosis or prognosis should be disclosed, and this does not make it any easier to provide adequate care for the patients. And I admire them even more because the team manages to do all this work in these temperatures. This must truly be the hottest place in palliative care!