Author: Denis Tahiri
Apart from occasional surveys of medical care workers, most of whom admit planning to leave Albania, there is no official overview of the number of doctors and nurses who "took off" their white shirts and left from the country for a number of factors. However, the addition of German language courses confirms that this country continues to be the main and favorite destination of Albanian doctors.
Elson Jacaj, who heads the Albanian Nurses Association, insists that since 2015, medicine has suffered the largest exodus from nursing. “ In the last 5 years, over 8 nurses have left our country due to the demands that some European countries have had for nurses.” The causes are related not only to low salaries but also to job insecurity. “The lowest salary in the region for this profession, the lack of professional appreciation, job insecurity and the inability to find a job. From 1000 to 1200 nurses graduate from state and private universities per year, but then the capacities offered are 100 jobs per year ,” Jacaj reasons for the Albanian Center for Quality Journalism.
Why is it difficult to analyze exactly how many doctors and nurses have left Albania? The head of the Order of Doctors, Fatmir Brahimaj, explains that there is no exact number of medical staff who leave Albania, as the calculations are made based on the certificates for good professional conduct that are issued. This document is not only necessary for employment abroad, but also for various trainings and this causes a data vacuum for those who leave the system.
Matilda Gremi is a nurse who graduated in Albania and has been working in Germany for two years, at the "Universitäts Klinikum Schlesëig-Holstein" Hospital, ranked the third best hospital in Germany.
Even for Matilda, the circumstances that prompted her to pick up the suitcase are related to each other, starting from the best economic prospects, along with the opportunity to grow professionally: " The working conditions are very good and you feel safe when you work, but of course also the professional advancement, since you are given the opportunity of a specialization that is recognized in all countries of the European Union ," Matilda claims for the Albanian Center for Quality Journalism, not forgetting to add that the financial reward at the end of the month is satisfactory and allows you to live a good life.
A former official of the Ministry of Health, preferring to speak anonymously, emphasizes that it was precisely the lack of specialization for four years for resuscitators that led to the departure of the latter from Albania. " We have had more of a shortage of resuscitators. Even in municipal hospitals, we have had cases when doctors who had retired were kept on duty to fill vacancies and provide health Services. But in addition to resuscitators, in regional and municipal Services we also encountered difficulties for surgeons, pathologists and gynecologists ."
When she was convinced she had to leave, Matilda didn't know that a long process awaited her. Collecting the documents, sealing, translating and notarizing them took about two months, more time than her colleagues who applied through agencies that provide assistance Services in such cases. Matilda's first step was to acquire the language.
" The process starts with learning the language, as you need to have a B2 level. Then the interview with the hospital, who also gave me a small exam to see how proficient I was in the German language and asked me things related to medicine, when the hospital approves you, then the documents in Albania begin, while the meeting at the German embassy for medical personnel comes quickly ," says Matilda.
But none of these links have forced Matilda to go through them all one after the other, as many others have done before her, or others who are looking at pursuing nursing branches in Tirana or even in districts like a chance to be employed later outside of Albania.
But in addition to job security and professional improvement, low pay is the main reason for leaving. In a labor market like Albania, where the salary of a nurse with seniority ranges from 45 thousand to 50 thousand allek and where for doctors, the average salary is around 60 thousand allek, the countries of the European Union remain a promised land. Germany and other countries pay doctors and nurses several times higher salaries.
The influx of district nursing faculties, a way out?
According to an analysis of the Civic Center, in Albanian universities, this year alone, 2346 students were enrolled in the fields of Nursing, Midwifery, and Physiotherapy.
Migen Qiraxhi from Qendresa Cittare, says that the trend is considered to be increasing for the last 3 years.
This figure, according to the analysis of the Civic Attitude, shows the flow of requests for nurses, midwives and physiotherapists, who with the capacities offered, it is clear that a job cannot be secured.
"2346 nurses, midwives and physiotherapists cannot be accommodated in our health system or the domestic labor market, while developed European countries like Germany have been guaranteeing places for immigrants of these profiles for several years, " explains Qeraxhi.
According to Qiraxhi, " many students of these profiles have already managed to emigrate to these European countries ."
But nurses' representative Elson Jaçaj reiterates that he predicted the problems that were opening up in the Albanian healthcare system three years ago. " We have raised this as a concern, as the numerous departures from Albania, where not only young or unemployed nurses have left, but also professionals with many years of experience, are creating a gap in our healthcare system, " he says.
Despite the appeals of the nurses' association at the time, the situation continues to be worrying, as, according to Jacaj, German language courses are the most popular among them. " Despite the propaganda that is being made in the media about the opening of new hospitals, etc., it is not true, as there is a significant shortage of nurses in many hospitals and health centers. Even today, many nurses refuse to start working in Albania as most are in foreign language courses to be employed abroad, mainly in Germany, " Jacaj concludes.
The costs of departures and the deterrent policy that does not exist
Every citizen of every country is considered an asset to the economy of his country. The work arm, and even more so when it comes to specialized work, is something that many countries invest not only a lot of money to specialize, but also a lot of time. Specializations in medicine and training in its specific branches are one of the most difficult and delicate professions to train, because they have to do with the health of citizens throughout their professional life.
" Every nation ensures its continuity through the cycle of generations, a society for a young person from 0 to 22 years old, constantly invests energy, finance, healthcare and education, while this young person is expected to return the investment to society by contributing to its economy and general standards. Unfortunately, in this case it seems that we are investing to lose both financially and professionally ," says Qiraxhi.
The head of the Albanian Nurses Association also shares the same opinion regarding the costs of leaving nurses. “ For the state, it is an irreparable, uncompensable cost, since we prepare and invest for others to get ready, ” insists Jacaj, adding that “ recently, many lecturers have become part of several companies recruiting nursing students for hospitals or clinics abroad .”
But even though the departures of these specialized medical workers are present, there is no measure to prevent the phenomenon caused, primarily for economic reasons.
Districts, where the lack of doctors has brought consequences
In the villages of Mujalli, Daullas and Greçalli in Fier, the basic health service doctor serves in the health center only one day a week. As a part-time doctor, he has to provide service to nearly 3 residents of these villages who are actually not covered by health care.
From the residents of the area we talked to, we also learned the reason why they only have medical service one day a week.
" We had doctors, we had a female doctor but she retired, then a young girl came but she stayed for two months and left for Germany. Now we have about a year with the doctor who comes once a week, usually on Wednesdays because he is also a doctor at the Farm. As for the nurse we have, she is here from the village ," says one of the residents of the village of Greçalli.
Also, another resident says that this situation has been going on for almost a year, where even though they have raised it as a problem, there has been no reaction from the state authorities.
" We have nurses, but no doctors . It's like if we have a health problem, we have to wait for the doctor to come and get a referral and then go to the hospital ," explains another resident.
We also tried to meet the head of the village, who refused to talk about this issue and in response only told us that a request has been made for this issue, and that he hopes to get a solution soon.
Not only nurses…
In addition to nurses and other medical professionals, of course doctors are no exception to this trend. From the official data released by the Federal Chamber of Doctors in Germany for 2018, Albania ranked second in the Balkans for the number of doctors who have emigrated and are currently wearing the white shirt in German healthcare. All this led to the creation of gaps in many regional hospitals and a shortage of doctors in some areas. According to these data on the flight of doctors from the Balkans, Serbia leads the way, losing 1128 doctors who fled to Germany. Then the trend is followed in second place by Albania with 630 doctors for whom the Ministry of Health does not provide any official map of which hospitals are left without doctors. While Bosnia and Herzegovina is in third place with 533 doctors who left, North Macedonia with 470 doctors, Kosovo with 292 doctors and finally our neighbor, Montenegro with 40 doctors who left.
While there is a vacuum of information from the Ministry of Health, the Germans detail where the Albanian doctors are currently employed, 556 of whom are employed immediately in hospitals, 14 doctors are engaged in ambulatory service and 31 in other Services. For many of them, the first step on the way to leaving was getting a professional certificate that guarantees good behavior. But can it be said that all those who applied for a certificate at the Order of Doctors, have in mind exactly the opening of the door to ran away from Albanian medicine? During the last three years, the Order of Doctors in Albania has issued 403 professional certificates of good conduct, of which 73 were requested by doctors only during the period January-September 2020. In fact, the professional certificate of good conduct is a document necessary in cases of employment or treatment abroad.
According to a 2018 study by the organization "Together for Life" , broken down by gender, it results that 25% of male doctors and 27% of female doctors are ready to leave immediately, while 49% of men and 57% of women would leave if given the opportunity.
"If we look at the workplace, it turns out that of the surveyed doctors who work in health centers, 16% would leave immediately, 63% would leave if they were given the opportunity and 21% say they would not leave Albania. Among physicians working in specialty health centers, 35% would leave immediately, 50% would leave if given the opportunity, and 15% would not. Among doctors working in municipal hospitals, only 6% would leave immediately, 60% would leave if given the chance, and 34% do not want to leave. Among the doctors working in regional hospitals, 21% would leave immediately, 55% would leave if given the opportunity and 25% do not want to leave," says the study of "Together for Life", which adds that the situation is different for doctors who work in university hospitals, where 54% of them are ready to leave Albania immediately, 35% would leave if given the opportunity and 12% do not want to leave.
According to this study, what stood out was that of the doctors who have scientific degrees (Dr., PhD), 32% of them said that they would leave immediately, 51% if they were given the opportunity and 17% would not. they left.
"Of the specialist doctors, it turns out that 21% of them would leave Albania immediately, 51% would leave if they were given the opportunity, while 28% do not want to leave. Among general practitioners, 32% express the desire to leave Albania immediately, 57% say they would leave if they were given the opportunity and only 11% say they do not want to leave," the study states, adding that it is noted that general practitioners and those with scientific degrees have a greater tendency to leave.
