JOINT COMMITTEE ON FOREIGN AFFAIRS (Sub-Committee on Development Co-Operation) díospóireacht -
Thursday, 18 May 2006

Irish Friends of Albania: Presentation.

Chairman

As Chairman of the sub-committee, I am delighted to welcome Mr. Michael Gannon and Mr. Jack McCann from the organisation Irish Friends of Albania. The organisation aims to increase the quality of patient care in Albania through securing the services of voluntary medical personnel from Ireland and providing Albanian hospitals with vital medical equipment and medication.

Albania is one of the poorest countries in Europe and it is not an accession country for EU membership. In 2005, Development Cooperation Ireland contributed more than €400,000 to projects in Albania, including capacity building at the plastic surgery department at Mother Teresa Hospital in Tirana, and assistance for the development of an Albania credit union. We thank the Irish League of Credit Unions for its assistance in that regard.

I advise witnesses that whereas Members of the House enjoy absolute privilege with regard to utterances made in committee, witnesses do not enjoy absolute privilege. Accordingly, caution should be exercised, particularly with regard to references of a personal nature. I call on Mr. McCann to begin the presentation.

Mr. Jack McCann

I thank the Minister of State at the Department of Foreign Affairs, Deputy Conor Lenihan, for helping fund Irish Friends of Albania. I also thank DCI and the sub-committee.

Irish Friends of Albania was set up at the beginning of last year because we saw a need to go to Albania to treat both children and adults. The charity was set up as Irish Friends of Albania. The logo resembles a Claddagh ring to some extent. On the top, the helmet of Scanderbeu is depicted. Scanderbeu was one of the warlords of Albania who united many of the Balkan states. He kept out the Ottoman Turks for about 25 years. I would like to think that we are, to some extent, helping to unite part of the medical fraternity of Ireland and Albania to help the people of Albania. Scanderbeu's helmet is on top of the heart, and the logo of Albania is within the heart on the charity's logo. The Albanian logo depicts an eagle with a single body but two heads looking opposite ways. It is a depiction of a united front.

The charity began as a result of the girl pictured on the second page of the presentation. She is called Alba, who was three and half or four years old when we heard she was in a hospital in Tirana with 40% burns to her body. In the picture in the presentation, one can see bare bone on top of her head because there was no scalp remaining. That is the way she was four months after being admitted to hospital in Albania.

We took her into our hospital and we treated her over a period of three and half or four months. A second picture shows her well and back living a normal life. She has little hair and she is wearing a wig, but she is a happy child who is back enjoying herself, as children should do. We heard there were many other children there in need of similar treatment. We decided to go to Albania to see what we could do and realised it could be done. We met the only plastic surgery team in Albania. We went out with a team of 16 people — medical professionals, nurses, people to sterilise instruments and a person involved in bioengineering to ensure the equipment worked. We had a very successful trip last year when we spent almost two weeks there and dealt with 77 cases and saw 160 cases.

We went for a week this year and operated in three theatres — last year we only operated in two at a time. We brought more surgeons, anaesthetists and nurses and got through 71 cases and saw 150 cases. We achieved almost as much in one week as we did in two the previous year when we were only finding our feet and getting to know the situation and the personnel. We found that there are many more people who need treatment and we will, therefore, continue our work in Albania.

Mr. Michael Gannon

Albania is known as the poorest country in Europe, however it is actually debatable whether Albania or Moldova is the poorest. The prospects for Albania are probably better than for Moldova largely due to its location close to EU countries, beside Greece and across the water from Italy. It was the last country to emerge from communist dictatorship — in 1992, a number of years after the fall of the Berlin Wall — and has had one of the most difficult transition periods. The nation's infrastructure was almost crumbling after 50 or more years of communism. Albania cut ties with the USSR at the end of the Stalin era, created links with China in the early 1970s and subsequently cut them. In the late 1970s and early 1980s the country was at its poorest because it had no international support, an aging regime and dictator and a collapsing infrastructure. This is what Mr. McCann and his team still see on their visits.

Albania has no diplomatic relations with Serbia, however they have something in common, both countries have been left out of the next stage of plans for new EU membership. This has been a huge blow to national morale, from the man on the street to the prime minister and president. These nations cannot sympathise with one another as they share so little except the future of Kosovo. The average wage is very low — €200 per month is at the higher end of the average state wage and most of the doctors with whom the Irish doctors and nurses collaborate earn less than that. This can lead to corruption and associated problems.

The gross domestic product has increased rapidly in the past few years largely due to the amount of money sent home by immigrants. The GDP was €600 to €700 five or six years ago, now it is approximately €2,000. Some 20% to 25% of Albanians live outside the country's borders, most of whom are illegal, and this is what sustains the country. Greece is the nearest of these centres of Albanian population with Italy, Switzerland and Germany. Canada is responsible for the Albanian brain drain. It takes those who are most educated, most qualified, who speak foreign languages. This is unfortunate and is something we were familiar with in Ireland. However, strategically Albania is very close to Ireland and that is where there is hope.

Albania's health system is in a bad way. The country generally suffers from corruption, lack of infrastructure and a huge sense of isolation. Many of the health professionals there with whom we made contact rarely speak to similar professionals from other countries. One could count the surgeons there in particular specialties on one hand yet they may have had little or no contact with foreign professional colleagues for years or even decades. When one considers that, it is very difficult to see how progress can be made. However, progress can quickly be made once those contacts are established, and that is our aim.

Chairman

Having met the Irish Friends of Albania with Deputy Michael D. Higgins, I know you do remarkable work and I wish you well. You mention remittances from emigrants and this issue arose when some members of this committee, including myself, visited Macedonia. We went to the border with Albania and I think there are good relations between those countries. Albania would be an interesting country for our committee to visit. There is clearly a need for reform in many areas, but how would you propose dealing with crime and corruption?

Deputy M. Higgins

It is useful to hear an update on the work of Irish Friends of Albania. I suggest that this sub-committee propose to the general committee that it recommends to Irish Aid and the Department of Foreign Affairs that they treat the new application from Irish Friends of Albania with urgency and with a possible recommendation for its expansion. Mr. McCann has made it clear that far more was achieved on the group's second visit to Albania and, given the loss of population to countries where remuneration is better, it is appropriate that this scheme be expanded. This programme opens the possibility of traffic going the other way through mentoring and creating confidence that can in turn be translated back. It is good that we had this presentation which demonstrates that the programme is very competent, efficient and relatively low cost.

Yesterday we had the presentation at the statutory meeting of Vote 28, which is the general Vote of the Department of Foreign Affairs, and Vote 29, which is the Vote for Irish Aid. Under the Irish Aid heading there was support for micro projects. I suggest that be reviewed as soon as possible. This sub-committee should make a positive recommendation, particularly with a view to being able to fund the expansion suggested in the report.

Chairman

I support Deputy Higgins's proposal. As a committee, I am sure we would all wish to support it.

Deputy Mulcahy

I thank the two attendees for their presentation. It is heartening and impressive to see people taking time out of their own lives to do this vital work. We all knew that Albania and other countries were poor but it is a type of wake-up call when it is outlined before us. It is shocking that there is such poverty in a country that is only a short flight from Ireland. We tend to think that poverty exists only in Africa or Latin America but this is real poverty. People cannot get basic medical assistance on our own Continent and I have no problem saying that our first priority should be to our European colleagues. Perhaps the Minister could consider improving the figure of €400,000. I hope we can do that. The aid budget is increasing significantly and targeting this aid at the medical area would be a very good idea because that is the beach-head, so to speak, into this area.

I would like the committee to visit Albania to see if there is more Irish agencies could do there, aside from the medical area. I note some Irish agencies are assisting in building civic society but I am sure there are many more areas where we could be of help. I thank the Chairman and the two representatives for putting this issue on our agenda. Perhaps it could be put on the agenda of the Joint Committee on Foreign Affairs for a more general discussion with a view to moving on the issue.

Chairman

Will Mr. McCann deal with some of those points first and I will allow Senator Leyden and Deputy Callanan speak after that?

Mr. McCann

There are many more areas where action can be taken. We have suggested to the local university bringing over some medical students whom we could teach and helping surgeons in training in Albania who need outside liaison where they can learn and bring back new ideas to their own country. When we go there we work with them. They train and work with us. The same applies to nurses. That is what makes it good.

Any money donated goes straight into the unit. We have brought over two truckloads of equipment already and kitted out three operating theatres. They are not state-of-the-art but are very good and functional. That has made a huge difference to them because they can continue the work we started over there. They now have the instruments they did not have and could not dream of getting. They now have basic instruments such as grafting knives and electric dermatomes, which we would use regularly. They needed some of that basic equipment. The Albanians are lovely people. Some of them are well trained but they do not have the wherewithal to treat many cases. They are faced with a huge number of burns injuries, far more than would be seen in any other European country, because they cook on small stoves in a small room and, as children do, they play and knock over the boiling pot of water and suffer a very bad scald or other injury.

We were overwhelmed by the different injuries we saw, including facial and hand injuries and skin cancers that had gone untreated for many years. Everybody was affected so badly I put down on paper what it felt like seeing these people and not being in control to some extent because there were so many cases coming before one. If I may I will read what I wrote down. It is called In the Steps of Skenderbeu, the warlord who tried to unite the country. It states:

The gnarled hand stands in front of me.

The young twisted face, motionless, stares at me.

The gaping wound cries its tears and wets me.

All this and more on my shoulders affects me.

The burns they do not stop but contract and torment.

The unclosed palate, [that is the cleft palate] wide open, defiantly gapes.

Fingers either too many, too little or just stuck together. [As one sees in syndactyly]

Walk in off the street, wait their turn in hope. [Many of them had taken a four, five or 12 hour journey just to see us]

Their faces tell it all, etched, furrowed, leathery.

Old beyond their years, shorter than yours or mine.

Only wanting what's best.

That's why they have walked for hours, travelled days, with minds focused, eaten little, smile less.

Within minutes diagnosis, treatment plan, name on list. [It is as easy as that. When they are seen it only takes a few minutes to diagnose].

Hand over heart, then thrown towards me with a smile.

I reciprocate, shake hands, then another, 160 times, each heart-shaking smile getting bigger. [You can see it in their faces. It is a dream to see].

We walked in the steps of Skenderbeu.

We stood in the shadows of those who have gone before.

We could not even speak their language yet we woke the eagles of Albania.

That is it. They are our neighbours. They live across the Continent from us. We do not speak their language but we can communicate, help and treat many people there who need treatment.

Senator Leyden

I thank the Chairman for his invitation to attend. I am aware Senator O'Rourke wished to attend also. I welcome Jack McCann and Michael Gannon and compliment them on the work they are doing. If they ever give up that work they could write poetry. I read the poem before I spoke and the line, "... we woke the eagles of Albania", is very appropriate. I am glad Mr. McCann had the opportunity of reciting it for the Official Report.

The representatives' colleague, Padraic Regan, is from Roscommon. I know Padraic and as a former chairman of the then Western Health Board, I know also of the excellent work of the two representatives in both hospitals in Galway. I am delighted they could give their time to the people of Albania and that they are targeting that country. There are many problems throughout the world but if we all do something we can help a great deal.

I was in Kenya last week for an Interparliamentary Union meeting. The Sisters of Mercy have been working in that country for the past 50 years. A colleague of the representatives, Sr. Marian Dolan, a surgeon, has been carrying out operations in the bush in Kenya. She trained the nurses to administer general anaesthetics. I compliment another colleague of the representatives, a former member of the health board, Dr. Noel Flynn, who was with them in Albania. He is an anaesthetist from Galway and was part of the team. He was an active member of the former Western Health Board when I was chairman.

I commend the work the representatives are doing and support the proposal made by Deputy Michael D. Higgins, and supported also by Deputy Mulcahy, that additional funds be made available. I realise they have an open book, so to speak, with the Minister of State, Deputy Conor Lenihan, who has been very helpful in terms of any project brought to his attention. With the €700,000 coming on line, there is a need to spend that money in a productive way.

Regarding the work the representatives have done in bringing patients to Ireland, the first patient dealt with was treated in University College Hospital, Galway. I also want to record that in 1999, I established Kosovo Refugee Aid with others. This is a registered charity, which worked with the people who were fleeing the problems in that country. Again, the hospital in Galway helped to treat free of charge patients we brought from Kosovo. Much work was done in the public service of which people are not aware.

Regarding the fundraising and so on, I am aware the organisation is well supported. It is not recognised here the number of people who are doing tremendous work around the world, whether it is the reverend sisters, priests, GOAL, Concern, Trócaire or individuals such as this group, which I never heard of until today. There are a number of others such as Kosovo Refugee Aid, which has adopted a Kosovar family in Galway whom we are trying to assist.

In view of our history, particularly the Famine in the 1840s, citizens in no other country have a deeper inbred feeling of the need to help poor countries. I commend the delegates on their work and wish them continued success. All we can do is record our support for their work and endeavour to assist them in any way we can, individually or collectively, as Members of Oireachtas or through the aid given to Albania, which is a very poor country. However, conditions are also extremely poor in Nairobi, which I visited last year, where 700,000 people live in ghettos located on 500 acres of land.

The delegates will appreciate that we are concerned about their work. I advise them to concentrate on their work in Albania and maintain a presence there because if they spread their assistance too widely, they will not achieve as much. Other organisations can concentrate on other areas of responsibility. If we all do something somewhere, we can achieve a considerable amount.

Chairman

I note another former chairman of a health board, Deputy Callanan, is present and, therefore, the former health board areas are well represented. I was also a member of a health board for a period. I call Deputy Callanan.

Deputy Callanan

I thank the Chairman for the invitation to attend. I welcome Mr. Jack McCann and Mr. Michael Gannon. I compliment them on the great work they are doing. I read about in the local newspapers but had not heard about it in as great a detail as provided today. It is great to be informed about their work.

I wish to ask the delegates a number of questions. Is there any resentment on the part of the Albanian Government of the delegates' work? Have they received the full co-operation of the Albanian Government in respect of the great work they are doing?

Mr. McCann

We met the Albanian Minister of Health and spoke to the directors of the hospital. That was a step forward from our previous visit. We are due to meet some more government officials. It has been fruitful from that point of view.

Deputy Callanan

The idea of bringing medical students from there to this country and educating them is good. Are other specialties of Albania's health service in a poor state or is the problem only to be found in the specialty of plastic surgery?

Mr. McCann

There are problems throughout the entire health service there and the services need to be developed. Many years ago we were in the same situation here and in the past ten or 15 years we have made huge strides. The Albanians need the same level of help at this stage to bring them along and to help them in their academic work, as well as in their practical service work, until they can stand on their own feet, which, once we get the ball rolling, will be in the not too distant future.

Colleagues in the specialties of orthopaedics and general surgery also plan to go to Albania. Two orthopaedic surgeons have already travelled there and examined the situation. We are developing a plan of what work can be done from that point of view. Some colleagues in general surgery are making arrangements to travel to Albania. We have spoken to some of the other surgeons out there and they also need help from our teams.

Deputy Callanan

I wish the delegates good luck with their work.

Deputy Mulcahy

Arising from this discussion, I propose that the Chairman write to the Minister of State at the Department of Foreign Affairs, Deputy Conor Lenihan, enclosing a copy of this presentation and advising him that it is the unanimous view of members that funding for Albania should be reviewed upwards in the forthcoming budget.

Chairman

Is that agreed? Agreed. I would be delighted to do that because I am aware of the work being done by the Friends of Albania. As there are not other questions, perhaps Mr. Gannon might like to conclude.

Mr. Gannon

I sincerely thank all members for their support. I wish respond to a few of the points made.

The incidence of resentment is a real risk in projects such as this. It is a major decision for a surgeon or doctor to allow a colleague from another country to come in, examine his or her patients, make decisions and perhaps operate with him or her on those patients. We have received fabulous support from those in the Albanian health system. That was mainly due to our starting at the bottom point. We started with one child and then moved up to the top. We went over there, offered assistance to a department and it was accepted. We won the confidence and the trust of those people and together we moved up the line. That was important rather than arriving there with a budget of €10,000, or €1 million and asking how we would spend it. We approached matters from the other side and that was a successful move.

The Chairman inquired about the incidence of corruption and how it can be tackled. Unfortunately, corruption, in general and in the health system, is rampant. Our attitude or strategy has been to simply lead by example by helping people in Albania to understand from where we come, why we are doing this, to do a good day's work and to instill some pride in people working in the system there. When somebody there gets proper equipment with which he or she can work, there is immense pride. We ask for the accounts and books to be balanced at the end of the day. We ensure that everything that is given is recorded in three months' time, six months' time and so on. There is a system of control in place on the assistance that is given, but it is almost unnoticed in the sense that the positive co-operation is so strong. We hope that will continue, but we know we have to monitor the position carefully.

I was delighted with the suggestion of a member to commit, in a more co-ordinated fashion, to Albania through Irish Aid or DCI support and I was twice as delighted to hear that aid might again be committed to a particular sector such as the medical sphere. I am open to correction, but when we started this work last year — at which time I was resident in Albania, having lived there for four years — I met an EU delegation in Tirana and asked its members what the EU was doing to assist the health sector in Albania. The short answer I got was nothing. The EU is funding work on infrastructure, road construction and anti-crime, policing and other programmes. The short answer I received from a member of the delegation whom I knew well and, therefore, had no reason to doubt was that the EU did not have any health programmes in place. I was shocked to hear that.

Deputy Mulcahy

On a point of information, the EU has no competence or jurisdiction over health matters under the treaties. This might explain the position in that regard.

Mr. Gannon

I am sure there is a good explanation and the EU has wonderful projects and programmes covering other sectors in Albania. We met delegates from the WHO on numerous occasions in Tirana and are aware of various programmes of assistance in place. However, I am saying, in a blunt way, that there is a huge amount happening there. We are delighted to hear that more support may become available.

Chairman

There are no other questions or items for discussion.

We will meet delegates from the advisory board of Irish Aid, formerly Development Cooperation Ireland, in June. We do not have a date yet for that meeting. We might use the opportunity to discuss with those delegates what has been said by the representatives of Irish Friends of Albania. Some funding was given to Albania last year and we all agree that an increase in that funding should be provided. I thank our guests for attending.

The sub-committee adjourned at 12.50 p.m. sine die.