More than 300 hospitalized, 7 dead A health emergency breaks out in Albania after the epidemic was confirmed by the Pasteur Institute in Paris In this child’s eyes, our fault Doctors detect another village of sick people: Drenovica, a few kilometres from Fier. There are 33 confirmed cases here In Kuçova and Berat, the admission of new infected patients continues. Disinfection begins in the affected areas TIRANA — Cholera now has another hotspot. After the one in Kuçova, doctors have discovered one in the last two days in the village of Drenovicë, fifteen kilometres from Fier. In just a few days, 33 ill residents have been admitted to the hospital in Berat. Sixteen of the victims came from there, which suggests a serious wave of the disease. Consequently, the map of the epidemic is expanding. In the affected areas of central Albania, hospital admissions continue and the alarm has not subsided. More than 300 sick people have been treated so far and the death toll has risen. A 78-year-old man, Nikolla Aliaj, along with three other members of a family, died three weeks ago. “The child fell ill when he was suspected, but perhaps the exact time does not matter,” say relatives. The village is on alert and the authorities are trying to isolate the area. In Drenovicë, 27 infected people have been confirmed, but the death toll is also getting worse. Communication with the doctors in Berat is difficult, but the spread figures are shocking. On Tuesday morning at 11:15, experts from the World Health Organization accepted the accuracy of a diagnosis formulated at the capital’s Institute of Hygiene. The first countermeasures are being taken. It has been made known that in Kuçova, due to a shortage of beds, about sixty people were sent home by Monday. The first positive signs are also coming from Berat: on Tuesday evening, the first three sick patients were discharged from the hospital cured. ar.me. The police have surrounded Kuçova hospital, which has been isolated

CARLO BOLLINO TIRANE — The child in this photograph was brought to the hospital by a van, and that means he is getting sick. He is the last of the admitted patients reported in the Kuçova hospital, accompanied by doctors. He is at risk of being struck down by cholera and is suffering greatly. His room looked like a ward, surrounded by doctors and nurses. A tiny glimpse among the means of reflection. OMS experts are investigating, but there seems to be little doubt about the origin of the epidemic: water. It is a symbolic cry about the water supply, now transformed into a threatening machine of death. How many times have we heard and spoken about the importance of water? Albanians have now become so ... not because nature is poor in water, but because the pipelines are unable to bring it into people’s homes. And what does arrive is very polluted. We have heard, we have seen the springs from which very clean water flows, but the emergency of the taps in people’s homes has remained unresolved in many cases. For months, for years. And every time, for a moment, the problem returns as a project for Tirana, but with water it is much less stable. Yet we find some unbelievable way to block it for two days. Even sewage mixed with food, but it applies to everyone. The water emergency must be faced and it must be solved with everyone’s help. It must be encouraged because it is not right to die for a trifle.

Patients and doctors in a duel with death REPORTAGE / Through hospital wards between anxiety and hope By KOVA ARMAND MERO “The disease is accompanied by diarrhoea and vomiting. To cope with the situation, wash your hands and boil the water.” The warning is read out by a powerful loudspeaker mounted on a car that drives around the neighbourhoods of the town of Kuçova twice a day. It is an appeal from doctors and the municipality to the population of this area, over which cholera, the deadly disease, has cast its frightening roots. Anxiety and the terrible fear of infection hang over the town. The three existing polyclinics are working nonstop and are dealing with people who are reporting health concerns. Meanwhile, the hospital, built on a hill, at the highest point of Kuçova, almost at its edge, has no free beds left. “Now we are following the other admissions in turn, so we send them to Berat,” explains Xhevari Sylo, head of the doctors’ task force, set up specifically to face the situation, to Gazeta Shqiptare — “although we have evacuated all the sick from the other wards, the hospital is completely full.” After the armed guards’ checkpoint at the hospital doors, a foreign smell of choking chlorine hits you in the face at the ward entrances. At every step you find surfaces dampened from time to time with disinfectant, and the door handles are scrubbed and left wet with chlorine. The many nurses — all in uniform, their faces covered with gauze and their hands with plastic gloves — move briskly here and there carrying disinfectants from one room to another. Groups of doctors — also from Tirana — examine the patients one by one. A week has passed since the alarm first broke out. One of the 15 children affected by cholera, admitted to the hospital in Kuçova while being treated by a nurse A health team that has arrived in the capital visits the last patients in the infectious-disease ward, and some of them say they have not slept a wink In the wards, rows of IV drips providing fluids to the patients stand over each bed. Everyone lies down and only one or another, who is being followed a little more closely, dares to eat something or take anything. In the corner of one room in Kuçova hospital, a child lifts his head from under the blankets. After 6 days in a coma, a faint smile now appears on his tired, pale face. But only a few kilometres away, at Berat hospital, an elderly man has been fighting death for days. A contradictory sight that makes Kuçova a symbol of fear and cholera. Here everyone hopes that the child’s smile will bring the city back to life. sh.c.

Here are all the ministry’s measures TIRANA — “General quarantine will not be applied in the country. The guidelines of the World Health Organization do not provide for the establishment of a sanitary cordon in such cases. However, we are in constant contact with the WHO and will wait for further instructions from it.” Minister of Health Maksim Cikuli made this statement to Gazeta Shqiptare, thus dispelling a doubt many people had. “We have taken other organizational, health and propaganda measures that will improve the situation,” Cikuli later added. The Ministry of Health itself, already on alert from the outset of the first alarming analyses carried out by Albanian doctors, has drawn up strategies to fight the disease. The main objective is the elimination of the disease from the infected hotspot and the prevention of its further spread. Groups of doctors are providing the necessary assistance to local health authorities to face the emergency situation. A permanent communication chain is already operating between Kuçova and Tirana. The ministry has sent equipment and specialist doctors who carry out tests on site. Mass disinfection of rural homes in the infected area and of individual wells suspected as sources of infection has begun. In the area’s water-supply systems and wherever technically possible, the amount of chlorine has been increased, a key immediate measure. In towns and villages, a feverish prevention campaign has begun to inform the local population of the measures it must follow to protect itself from cholera. “50,000 leaflets with advice for the population will be distributed,” said Minister Cikuli. The nursery and kindergarten in Kuçova have been temporarily closed pending an improvement in the situation. Fortunately, there is no sign of the infection from the country’s other areas. The ministry has taken steps to increase controls in other cities as well. Meanwhile, classes in schools throughout Albania will not begin on Friday or Monday. This was officially announced yesterday by the Ministry of Education: “For one day.” This is a sign that the structures of the new Albanian state, 1994-95, which is facing many difficulties, considers the situation quite serious. Minister of Health, Maksim Cikuli

URA VAJGURORE — A truly absurd and equally shocking scene in Ura Vajgurore. While in the whole municipality, because of the epidemic — or the real danger — the supply of drinking water has been blocked (a limited amount by tanker trucks), water for cooking continues to appear somewhere from the water pipeline in the neighbourhood. It supplies the city’s residents. Just a few metres from there, where a man comes from when he goes to Ura Vajgurore, he knelt down to fill bottles with contaminated water. The display of irresponsibility shown in this case has an even more tragic side: the epidemiologist had advised them. In the photo, residents fill water from tanker trucks in the village, for the city’s public supply.

The start of lessons is postponed TIRANA — School will not start today. This news was announced by the spokesperson of the Ministry of Education: “For one day.” Not in the normal course of the new school year 1994-95 structure, which is faced with full weeks of lessons, the school for the 8-year and secondary system opens at the beginning of the week, and on 19/09/1994. Schools for the start of lessons in a few days' delay were ordered by the health authorities after receiving the news that cholera had struck Kuçova. a.(e)

LATE AUGUST 1994 — In the village of Lapardha, a few kilometres from Berat, three people from the Xha family die mysteriously. Symptoms: diarrhoea and vomiting. Only after three weeks is it discovered that they are the first victims of the terrible disease. 3 SEPTEMBER 1994 — Several people are admitted to Kuçova hospital. Symptoms: diarrhoea and vomiting. 4 SEPTEMBER 1994 — A 39-year-old pilot, Y. Bullari, and S. Parangoni, 25, from Ura Vajgurore die within a short time. Meanwhile the number of hospital admissions increases to 30 cases. 10 SEPTEMBER 1994 — The first suspicions about the disease that has struck Kuçova emerge from the Albanian laboratory: the appearance of cholera. 11 SEPTEMBER 1994 — The number of affected people reaches over 130. At 23:00, Avllan Piro, 47, dies in Kuçova hospital, unable to be saved medically. 12 SEPTEMBER 1994 — French specialists from the World Health Organization arrive in Tirana at midday. Samples are sent to Paris to confirm the results of the Albanian analyses. In the evening, another victim in Kuçova hospital: Nikolla Aliaj, 78. 13 SEPTEMBER 1994 — Around 11:15, the replies from the Pasteur Institute in Paris arrive: the spreading epidemic is cholera. The number of affected people reaches over 300 cases. Among them, about 35 are children. The flow of sick people to the hospital doors continues.

The Directorate of Health Education advises the population: — All kinds of food must be boiled. Boiling kills the cholera microbe. — Hands must be washed thoroughly before preparing and serving food. — All dishes and other utensils used for cooking and food must be washed well with water and soap. — Fruit should be eaten only after being washed. — Drinking water, and if it is not clean it must be boiled in any case. Water is also one of the disease’s protective means; where possible, chlorine should be added. This substance is also deadly to the cholera virus. — Sea and lake water must not be used for washing and must not be consumed within 24 hours. Do not throw waste or any kind of dirt into them. — Hands should now be washed with soap and rubbed vigorously from time to time; soap is the best protective means. The disease is transmitted through faeces. These are the source of the microbe and sick people, but even carriers of cholera are also dangerous; a very fast route of infection. — Cholera is a curable disease, but only in hospital. Do not panic. At the first signs — diarrhoea and vomiting — go to a doctor immediately. While you are waiting for the medical examination and this should be as brief as possible — you should drink as many fluids with a little salt as possible.