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From the October 2001 issue of World Press Review

Corruption and Albania's Hospitals

You’ve Got to Pay to Pee

Olsi Kolami, Shekulli (centrist), Tirana, Albania, July 1, 2001

“It is not enough that we are sick,” a patient from the district of Librazhd says. “The cleaning staff is making life even more difficult for us.” He counts his coins while a cleaner waits for him to hand them over. Says another patient, “I have a kidney infection, and I have to use the bathroom several times a day. I have to pay 200 lek [US$1.34] each time I go in.”

The phenomenon: Bathrooms in public hospitals have suddenly become private property. Usually the cleaning staff manages the restrooms. They say they do not get paid enough, so they follow people down the hall to collect what they think is owed them.

Their daily bread: Individuals have claimed public restrooms as their private property. They say that their children would starve if not for this business. “I have been working here for the past three years. Two of my sons do the cleaning, while my wife and I collect the money,” says an owner of a public restroom in the capital. Most restrooms charge between 200 and 300 lek [$1.34-$2] per use, and if you need toilet paper, you will have to pay an additional 100 lek [67 cents].

Corruption of the white coats: There is a lot of talk about dishonest doctors. In fact, this is how most doctors are perceived by the public. Doctors, however, think differently: “We do not accept bribes; we accept only gifts. Why is there so much talk about a mere 2,000 lek [$13.46] that patients give to doctors when they pay as much for a good lunch? We should not forget that doctors are duty-bound to save lives, not to rob people,” says Dr. Ahmet Duraku of Hospital No. 1. Were it not for these gifts, he says, Albanian hospitals would be staffed only by cleaning people, so meager are the salaries of doctors.

The cause: A pediatrician recounts: “True, we do accept small amounts of money, but they are barely enough for coffee. It is not right to criticize doctors for this. What we accept is minimal compared to what we give.” Dr. Duraku continues: “Our salaries are very low. We cannot make ends meet with 12,000 lek [$80.80] a month. We spend more than half that amount on utilities and plain bread.”

A demand: With time, what doctors call a gift or a tip becomes a demand. Patients tell stories of doctors asking them for a precise amount of cash. The patients may not be able to afford it, but they do not hesitate to pay. “He asked me for 8,000 lek [$53.87] before going into surgery. And I gave it to him because I did not want to die on the operating table,” says Islam S. from the district of Peshkopi. Nurses and anesthesiologists charge their own fees, establishing a whole hierarchy of fees. “I thought I was done,” the same patient continues. “But I noticed that they were delaying the anesthesia. One of the nurses told me to give 2,000 lek to the anesthesiologist if I did not want to wait forever. So it was only after I paid the 2,000 lek and another 1,000 to the nurse that surgery began.”

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