The Swiss Catholic charity Caritas has helped to transform a children's hospital in Albania into a modern medical centre.
Since 1993, Caritas has supported the hospital, originally known as the Distrofik Hospital, in the Albanian capital Tirana. It treated malnourished and handicapped children, as well as orphans and abandoned children.
Like much of the Albanian health service, it was poorly staffed and equipped, and the young patients often lay for hours unattended in their beds.
Now, in the project supported by Caritas Switzerland, Caritas Luxembourg, and the Albanian health ministry, the hospital has been transformed and is known as the "National Centre for Growth, Development and Rehabilitation".
It has become the only treatment centre in Albania for children with special needs.
Some 60 local staff, among them 12 doctors, physiotherapists and child psychologists, treat children suffering from conditions such as cerebral palsy, autism, delayed development due to malnutrition, and motor disabilities.
A new field for Albania
Treating children with such disorders is relatively new in Albania. Dr Donika Naqi, medical director of the centre, explained that there is little experience of considering the emotional and psychological well-being of the child.
"When I was training to be a doctor we learned only how to treat somatic, or physical, conditions," Naqi told swissinfo. "We would evaluate children on the basis of the health of their lungs, or their abdomens, and we never really looked at their feelings, or their brains."
As a consequence, Naqi continued, parents of children with special needs received little or no support from the Albanian health service.
"These children were neglected," Naqi explained. "Not by their families, but by society. They stayed at home and received no professional care or education."
Now though, with the support of Caritas, and Swiss medical staff who act as trainers, the hospital is successfully treating children from all over the country. The dark wards and bare walls are gone. Instead there are bright pictures, and bedrooms where mothers and children can stay together while a diagnosis and treatment are carried out.
Dr Edmond Werder, a pediatrician from St Gallen, works for Caritas as overseer of the project. He visits the hospital once every few weeks, to assess how the work is going. One thing that struck him on his very first visit was how many of the children had suffered permanent disabilities because of lack of medical care in early infancy.
"Many of these children suffered serious illnesses as small babies," Werder told swissinfo. "But the mothers didn't realise -- missed meningitis is a classic example. Now when they come to us, it is too late, they already have neurological disorders."
But it's not too late to improve the quality of life for these children. Many of them are so disabled when they arrive that they cannot walk or even sit up. Often, they benefit from the physiotherapy and the massages provided daily for small arms and legs that have stiffened from lack of use.
The hospital also offers training to the mothers, who should be able to continue some of the therapy at home. Most importantly, treatment is free, a rarity now in Albania, where visits to the doctor must be paid for in cash.
A learning curve for everyone
These forms of treatment are also fairly new for Albania, and, as Edmond Werder found out, what works in Switzerland won't necessarily work in another country.
"Of course I have had to learn that things are different here," he explained. "Traditions are different. For example, sitting on the floor is regarded as rather strange. So it took a while for us to persuade staff here to let the children sit on the floor, and move around freely. And then we had to persuade the staff to sometimes sit on the floor with the children."
Tradition is just one reason for the difference in approach. Another is the fact that Albania remained closed to the outside world for 50 years, under the often brutal regime of the Communist dictator Enver Hoxha. Verena Bruderer, a Swiss teacher of children with special needs, is now spending several weeks at the centre helping to train the staff. Bruderer believes the climate of fear during the Communist years continues to stifle initiative.
"One thing I always notice is that the staff are not creative," explained Bruderer. "They will ask me to show them a technique, and they will do it exactly like me, perfectly in fact. But they won't develop it, or take it any further."
Creating, not copying
The kindergarten at the Centre is a prime example of the imitative approach. Local children with special needs attend it on a daily basis. The curriculum is a carbon copy of the Swiss German model; children arrive and sit together with their teacher in a circle or 'Kreisli', then they have free play, followed by group activities, and a snack, before going home again.
Some of the kindergarten teachers spent time training in Switzerland, but, Donika Naqi, says she doesn't want her staff just to copy.
"We don't want to copy the Swiss and do everything they do here," she explained. "Instead we observe, and then think about which things we can implement here. After all it's our country, our life, and our society."
The National Centre is one hopeful sign in a country that has endured years of difficulty. Now, there are big plans for the future; with the support of Caritas, Naqi and her staff plan to reach and treat more children, by establishing links with hospitals in all of Albania's major towns.
And, Naqi continued, although approaches and traditions between Swiss and Albanian staff may differ, their goals are the same; "healthy children, and a healthy future generation."
by Imogen Foulkes in Tirana