“Mandatory fun”

The establishment of academic child and adolescent psychiatric training in Albania is developing slowly but steadily. With funds scraped together from scarce international collaborations, limited government funding and charity, a tiny group of students make use of the basic facilities. Their working place is an oasis of silence and cleanliness in the middle of hive of activity in the maze of buildings that form the main Tirana hospital ‘Maria Teresa’.

Academic CAP training in Tirana, Albania.The psychiatric department of the Tirana university hospital started its first four-year training in child and adolescent psychiatry in 2003 – the year of the first Tirana international conference on child and adolescent psychiatry. Founding father was professor Anastas Suli from whose excellent groundwork – during the five years that followed – an extraordinary academic training programme was developed. Exchange visits with the Hacettepe University (Ankara) in 2005 gave a further push and inspiration to the Albanian School of Medicine.
The curricula of the postgraduate residency programme in child and adolescent psychiatry were developed with support, and based on standards from the European Union of Medical Specialists (UEMS) during the years 2011-2012. An international conference in Tirana on February 2012 and collaboration with professor Füsun Çuhadaroglu Çetin (Ankara), professor Myron L. Belfer (Boston) and other leading experts in child and adolescent psychiatry shaped the curricula during their five-days stay in Tirana.

Fifteen residents
In 2015 a third group began their education – the lack of funds does not allow any greater pace than that. Graduates slowly add to the number of Albanian youth psychiatrists – now counting fifteen – who are so very much needed to meet the demand.
Five residents have recently started training now, being very much aware of the privilege to become one of the first and few Albanian child and adolescent psychiatry specialists. Head of training, Dr Alikaj Valbona, underlines the high motivation of het crew: “Their awareness of the great opportunity that they are given here makes them work extremely hard. Considering the traditional medical environment they were used to, it is no surprise that they have to get used to our open and liberal way of working.” Their professor, Dr Ariel Çomo, appears to cause a culture shock to his students by giving them an overwhelming space of freedom to develop themselves. “This place has such an outstanding reputation. It was always my dream to work with children and I cannot image a better place to be educated than here under the inspiration of doctor Çomo”, says the only male student in the group. Another resident confirms: “The doctors that teach us have such an amazing good relationship with each other and they approach us with an open mind. I have to admit that we are only beginning to get used to that. But it helps us a lot and I am sure this openness is the best attitude for learning fast.”

Ariel Çomo: “These students are well connected to reality. They only have to look around them to see the problems we are dealing with. This experience tells them more than a figure. I could tell them that the average length of patient’s stay is 18.5 days and our number of beds per hundred thousand inhabitants is the lowest in the world. But what does it mean? The partisans of community mental health might say it is impossible to treat people like that. The stay is too short or too long – actually it does not mean a lot if you do not know the exact context. Our residents here are in the middle of that context. And if you ask me, these figures only show that we have an overload – the students obviously already noticed that. And it shows the necessity make a major turnover, so that finally we do not have to be leaving someone in an emergency bed because there is no other place for him to recover.”

Apart from their medical curriculum, the team of residents follow the Albanian policy of strengthening international collaboration. “The ESCAP website is an accessible platform for them to absorb new knowledge and to follow all kinds of developments in youth psychiatry and related professions. Making the connections with peers abroad would be even better, so we include different exercises in the education that will teach them how to interact. They are now preparing a small conference for example that is all centered around the exchange of knowledge and innovation in child and adolescent psychiatry.”

Only one condition
One student comments: “He leaves it completely up to us how to organize this and what it will be about – there was only one condition: to have fun is mandatory.”
Çomo: “There are many ways to inspire young people. And with their motivation it is easy to do so. But without having fun I do not have the illusion that the inspiration will last very long. I want them to be fretting on that aspect to stay creative. Fun is a good thing. If the conference includes fun, they will have thought about the social factor, the team work and the good feeling of everybody involved. It is just an angle that I like and that will make it more interesting. Imagine a career of treating children without thinking of the fun factor. That is impossible, don’t you agree?”

Tirana University has installed facilities for the knowledge input from foreign experts in a simple and practical way. The Connecticut University has donated the equipment for video conferencing and the students regularly interact with a lecturer in the USA. Çomo: “We are still experimenting with this feature, but the idea is crystal clear: part of our education comes through the internet in an interactive way, presented by excellent experts abroad. Low cost and high quality. What more do you want? The only thing that the students cannot do is shaking hands with the lecturer after the session.”
Searching for creative solutions in getting the best outcome for almost no cost seems to be an Albanian speciality. Ariel Çomo says it is in the Albanian’s genes to creatively survive. For now, Albanian child and adolescent psychiatry develops and ‘grows up’ by hard work. It does not boost for the moment. But it could well do when all the creativity and fun one day coincide with economic recovery and a bit of luck.

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Read the Ariel Çomo interview.

  • Medical education in Albania

    Abstract, published in the Croatioan Medical Journal (February 2002), of the article ‘Medical education in Albania: current situation and perspective, with reference to primary care’ by Llukan Rrumbullaku, professor of family medicine at the Faculty of Medicine of the University of Albania in Tirana.
    A radical primary health care-oriented reform of the medical services in Albania is now under way, calling for adequate revision in medical education. The reform has started in 1994. In January 1997, the Department of Family Medicine at the Faculty of Medicine, University of Tirana, was established for the development of general practice and family medicine, and with it a new era in medical education in Albania has begun. Mutual agreements for international collaborations are being realized, modern medical textbooks are being published, and the importance of continuous medical education is gaining a deserved appreciation. Here we describe medical education in Albania, including undergraduate education, vocational training, and continuing professional development. The emphasis is given on primary care, with some suggestions for concrete actions that would improve the current situation. A brief descriptive account is given of the on-going Albanian medical education reform, primarily in the field of primary health care, which assumes its most interesting global aspects and at the same time reflects the unique demands of the country.
    View the full article (open access).
    View the abstract of ‘Medical education in Albania: Challenges and opportunities’ (Medical Teacher, 2011, subscription).