Emergency Medicine

• Establish an Emergency Medical System training center in Tirana, in order to improve hospital-based emergency medicine and pre-hospital emergency care.
• Train a core group of Albanian trainers to conduct courses at the EMS center.
• Identify and implement techniques for triage.
• Provide Basic Cardiac Life Support training to all Albanian partners who travel to Grand Rapids.

Hospital Administration

• Introduce concepts of leadership, change management, quality assurance, continuous quality improvement, team building, effective communication, organizational behavior and structure, and planning and problem solving.
• Introduce core concepts in budgeting and allocation of resources.
• Explore possible techniques of budgeting for all department chiefs, head nurses and economists.
• Develop policies and procedures for hiring and discharging employees, using a standardized format.
• Develop job descriptions for head nurse, department chief, and various administrative positions.

Infection Control

• Provide training in infection control as part of a core curriculum for all Albanian partners training in Grand Rapids, including policies and protocols for detection, classification, reporting and prevention of nosocomial infections; basic infection control concepts and their cost implications; and techniques for the detection of different kinds of infections and incidences.
• Establish policies and programs for detection, classification, reporting and prevention of infections.

Women and Infants Health

• Decrease infant morbidity and mortality rates through improved techniques in treatment of diseases of the newborn.
• Implement, as standard practice, resuscitation of newborn in the delivery room.
• Increase knowledge and skills of both physicians and nurses in areas of newborn care.
• Teach methods for prevention and detection of asphyxia of the fetus.
• Design course in fetal monitoring and protocols.
• Increase knowledge and skills in use of ultrasound techniques, both in obstetrics and head ultrasound for newborns.
• Decrease cesarean-section rates by developing a treatment plan for high-risk pregnancies.
• Increase knowledge about induction of labor.

Nursing Practice and Education

• Foster physician-nurse teamwork.
• Establish a framework for standards of care as it relates to nursing.
• Foster the creation of an Albanian Nursing Association, and create a forum for sharing of ideas and knowledge among nurses.

Performance Improvement

• Create teams from each hospital to work on low cost, grass-roots solutions to hospital problems.
• Train hospital staff to initiate and facilitate performance improvement groups.

Library/Information Resources

• Establish in developing medical libraries at each of the three Albanian partner hospitals which meet standards set by the Bulletin of the Medical Library Association, and provide basic educational materials for the libraries.

Language Training

• Facilitate improved communications between US and Albanian partners, and improved access to international health care information, by supporting English language classes for Albanian partners.

• US and Albanian partners signed a Memorandum of Understanding on July 25 in Tirana, Albania, officially launching their partnership.

• The partnership organized a major conference on obstetrics, neonatology and obstetrical anesthesia in Tirana, December 4-6. The conference brought together over 100 physicians, midwives, and nurses from health care facilities throughout Albania. Each day of the conference focused on a perinatal issue that had been identified as problematic by the Albanian partners, including premature births, pregnancy-induced hypertension and diabetes in pregnancy. Conference participants explored various aspects of each problem, such as epidemiology, identification and treatment, the role of midwifery/nursing and neonatal care.

• In response to the medical crisis created by a car bomb explosion in Tirana in February 1996, AIHA's regional office in Zagreb, Croatia secured donations for the Trauma Hospital of over $65,000 in medical supplies from Project Hope and Project Share, both American non-profit organizations. US Secretary of Defense William Perry delivered the Project Hope boxes when he arrived in Tirana on March 31 for the South Balkan Ministerial Meeting. The US Military Liaison Team and the Albanian Ministry of Defense arranged for transportation of the boxes from the airport to Trauma Hospital.
• During an exchange visit of Albanian partners to the Bronx in June, the partnership sponsored a community health fair to reach out to the community's 150,000 Albanian-Americans. The fair was tailored to Albanian-American health needs and provided information on topics such as children's health and safety, women's health, prenatal care, and the effects of smoking and high cholesterol intake. Fifty different fliers and pamphlets were translated into Albanian and free child's thermometers and disposable diapers were available for new parents. One of the goals of this event was to show the visiting Albanian clinicians and administrators how to plan their own health fair back in Albania.
• US partners conducted a five-day Midwife Training Seminar in September for 45 midwives from the Maternity Hospital. The seminar focused on prenatal, intrapartal and postpartum care, infection control and preventative care for women.
• The Albanian and Jacobi partners organized a one-day health fair, "Family Health Day," in the center of Tirana in September. Over 200 people attended this event. The fair covered various topics including smoking, nutrition and women's health. Materials that had been translated into Albanian for the health fair held in the Bronx were used, including "Taking Your Child's Temperature," "Breastfeeding Advantages," and "Warning Signs in Pregnancy."
• In December, Butterworth Hospital of Grand Rapids, Michigan replaced Jacobi Medical Center as the US partner in the Albanian hospital partnership. Six Albanians traveled to Grand Rapids to meet their new partners and to participate in a Memorandum of Understanding signing ceremony.

• From February through October, partnership exchanges came to a halt due to political instability in Albania.
• US and Albanians partners were able to meet at AIHA's Second Annual CEE Partnership Conference held in Zagreb in May. The theme of the conference was evidence-based medicine.
• AIHA organized an eight-day Health Management Workshop in September for a group of 28 Albanian health care professionals representing both the hospital and health management education partnerships. The workshop was held in Slovenia, due to the inability of US partners to travel into Albania. The workshop was led by faculty from the Association of University Programs in Health Administration (AUPHA), with support from US partners from Butterworth Hospital and New York University. The workshop addressed issues such as management, leadership, project planning, decision-making, human resources management, and cost accounting.
• In December, two faculty from AUPHA and the Pharmacy Manager from Butterworth Hospital conducted a Health Care Financial Management workshop for 30 Albanian hospital economists and managers in Tirana.

• The initial training for a group of eight emergency medicine physicians from partner hospitals took place in January at the AIHA-supported EMS Training Center in Chisinau, Moldova. The EMS delegation's two-week training course focused on CPR, backboarding, splinting, and basic and advanced airway management.
• In May, US and Albanian partners launched in Tirana the country's first EMS training course, using training equipment provided by AIHA and a curriculum modeled on that used throughout AIHA's EMS Training Centers in the NIS.
• A second Health Management Workshop was held in June in Tirana for 21 health care managers from Albanian partner institutions. The training was led by faculty from AUPHA, with assistance from health management professionals from Butterworth Hospital and two Albanian financial experts who had previously attended AUPHA management workshops.
• Also in June, partners organized the first Albanian national nursing conference in Tirana. The 60 conference participants included head nurses from all district hospitals in Albania, faculty from the Tirana School of Nursing, and potential faculty for a future school of nursing in Shkodra. This conference presented the first opportunity for nurses from throughout Albania to meet and discuss important issues for nursing in Albania. Topics presented in the conference included a historical perspective on nursing, the professional role of the nurse, immobility, asepsis as part of infection control, non-invasive pain management, and dissemination of knowledge. Lectures, small group discussions and hands-on practice sessions were part of the conference agenda. In addition to the US presenters, Albanian nurses presented projects they had developed during training exchanges in Grand Rapids.
• From August until the spring of 1999, travel of US citizens to Albania was prohibited due to the security threats that prompted evacuation of non-emergency US personnel from Albania. In addition, it became increasingly difficult for Albanians to obtain US visas. As a result, there was limited partnership activity during this period, with exchanges only to third-country locations.
• The Albanian EMS trainers organized the third EMS training course in October, the first to be conducted on their own without US partners present. The training included CPR (cardiopulmonary resuscitation) and BLS (basic life support) instruction, airway management, patient assessment, and spinal immobilization.

• In January, the US and Albanian partners met in Chisnau, Moldova, where Albanian EMS faculty had previously trained at the AIHA-supported training center. Key Albanian officials (the Director of Hospitals for Albania's Ministry of Health, the Dean of the University of Tirana Medical School, the Director of the University Hospital, and the Chief of Cabinet from the Ministry of Health) met with their Moldovan counterparts to learn about the highly successful EMS training center in Chisnau.
• Following the trip to Moldova, the US partners traveled to the Former Yugoslav Republic of Macedonia to meet with the Albanian EMS trainers. The US partners assisted their Albanian partners in developing goals and objectives for the EMS center, and in strengthening the training curriculum through new EMS training methodologies.
• In September, US partners were able to return to Albania for the first time in over a year. They conducted a week-long seminar on performance improvement for 60 Albanian partners from the three partner hospitals. The participants represented five small working groups, each focusing on a pre-determined improvement project in their respective hospitals. The workshop facilitators encouraged brainstorming among the Albanians to identify key problems in specific areas of care, and to determine practical, low-cost solutions.

• The Second Albanian Nursing Conference, sponsored by the partners in conjunction with the Albanian MOH and the Albanian Nursing Association, was held in May. This conference was a follow-up to the first nursing conference, and featured presentations from both US and Albanian nurses.
• On the partners' final exchange, in September, they conducted an evaluation of the performance improvement project, working with each of the 5 teams.

Emergency Medicine

• Albania's first EMS (Emergency Medical Service) Training Center opened in May 1998 at the University Hospital Center "Mother Teresa." The mission of the center is to improve Albania's emergency care system by enhancing medical education and practical skills of current and future health care providers. It will also eventually train first-responders in pre-hospital emergency care. The Center's training equipment was provided by AIHA and the curriculum is modeled on that used throughout AIHA's EMS Training Centers in the NIS.

  Prior to the opening, eight University medical school faculty were selected by the Minister of Health to become EMS trainers. They received two weeks of training in Moldova and then an additional two weeks of training at the Cook Institute in Grand Rapids, Michigan. As of December 2000, over two hundred students have been trained at the Center. Based on the "train-the-trainer" model, the first two classes were conducted by joint Albanian/American faculty. Since then, the Albanian trainers have taught four additional courses.

  To evaluate the success of the courses, a pre-test and post-test based on standardized clinical practices are conducted. So far the results have been positive, with the average pre-test score of 60% and the average post-test score of 95%.

Hospital Administration

• Anecdotal reports indicated that Albanian hospital institutions have experienced an improvement in communication between patients and doctors as a result of the partners' exposure to the US system of health care.
• Three hospital management workshops were conducted in conjunction with AUPHA and New York University. Each workshop had approximately twenty-eight (28) participants, for a total of seventy-six (76). A financial management workshop was conducted in Tirana, December 1997, with twenty-eight (28) participants.

Infection Control

• Thirty-six partners from the Tirana hospitals received infection control training during their exchanges to Grand Rapids.

Women and Infants Health

• Chief physicians at Tirana's Maternity Hospital reported that work done through the Bronx-Tirana partnership contributed significantly to the improvement of health outcomes at their institution. Between the years of 1994 and 1995, perinatal mortality fell from 31/100,000 deliveries to 24/100,000. Neonatal mortality dropped from 30.6 to 23.4 deaths per 100,000 deliveries. Maternal mortalities declined from 8 out of 7,200 births in 1994 to 3 out of 7,437 births in 1995.
• The Maternity Hospital also experienced a decrease in their c-section rate and an increase in the use of anesthesia in normal deliveries.
• With the support of AIHA and Albania's Health for All Foundation, a Mother and Child Health Information Center was established inside the Maternity Hospital in July 1996. The center houses a library with medical books and professional journals for physicians and nurses (largely in-kind donations from AIHA partner Jacobi Medical Center in Bronx, New York), and a computer with CD-ROM capability and Internet connection. For new parents, the center offers educational materials on topics such as breast feeding and care of the newborn. Since its inception in 1996, educational seminars for new parents, workshops and various training seminars have been held at the Center.

Nursing Practice and Education

• The partners reported an increase in collaboration between doctors and nurses, which results in improved processes and patient care. For example, nurse/doctor infection control teams have been established at the Trauma Hospital.
• An Annual Nursing Conference was established for Albanian nurses as a forum to discuss the role of the nurse, various aspects of patient care, and the formation of an Albanian Nursing Association.

Performance Improvement

• The outcomes of the five original performance improvement (PI) teams varied due to differences in topic and scope. Some notable accomplishments were patient education classes on diabetes, and a revised medical record for hospitalized patients with diabetes; the creation of a hospital-wide Infection Control Committee to monitor and enforce sanitary standards; and initiation of training courses for hospital staff on hand washing and proper waste disposal.
• The partners selected and trained Albanian PI trainers to coach new PI teams at their respective institutions. They worked on integrating the PI process throughout their institutions and sustaining the process after the partnership's end.

Libraries/Information Resources

• Health science libraries were installed at the Trauma and University Hospitals in July 1997 and additional books were sent to the Maternity Library. A US team traveled to Tirana to begin setting up a library system as well as to establish a link between the Spectrum Health library and the Tirana hospital libraries for e-mail information exchanges.

Language Training

• English language classes have been conducted to enable better communication between the US and Albanian partners as well as provide further access to international health care information for the Tirana partners. From 1996 to 1998, twenty-four hospital partners attended the English language classes in Tirana.