In Kosovo, a post-war country facing widespread poverty and a population reeling from 10 years of oppression, Minister of Health Ferid Agani has been at the forefront of instituting mental health reform. Agani spoke to Dartmouth undergraduates and graduate students about the circumstances of the Kosovar people, his efforts to create a mental health care system and the obstacles he has faced in a Monday afternoon lecture in the Haldeman Center.
Agani, a neuropsychologist, explained the extreme mental health problems facing the Kosovar people after a decade of ethnic cleansing and noted that 62 percent of the population has been close to death at least once, 49 percent has been tortured or abused, 4 percent has been sexually assaulted and 26 percent has witnessed the murder of a family member. In addition, over half of the population is living in poverty, earning less than $2 per day.
After the war, Agani used his clinical medical background to enter the Kosovar political sphere, becoming an official in the Ministry of Health, he said.
"I was always motivated to work for the benefit of citizens," Agani said. "I have never stopped working with patients, even now as a minister. Once a week or twice a week, I go into work four, five hours with patients. This is keeping me alive. Otherwise I would be exhausted."
The country lacked a mental health care system prior to its independence and had only one psychiatrist per 110,000 inhabitants, Agani said. There were few social workers and only one child psychiatrist in a country in which over 50 percent of the population was under 16, making for very poor institutional resources for mentally ill people, Agani said.
"Everywhere we needed to change something to respond to very high mental needs," he said.
In 2001, Agani and the rest of the Kosovo Health Ministry instituted reforms that centered on a community-based, family-centered integrative model of medical and psychosocial services a "culturally sensitive" model that the World Health Organization had suggested.
"The Kosovar population has very strong family structure that takes care of ill members of family and the mentally ill," Agani said. "That is something that is not changing despite severe cultural transition, despite a very strong tendency toward nuclear family organization as part of the process of modernization. Evidence-based practice showed family-based is always more productive."
Along with this family-centered model came completely new health infrastructure, including nine regional mental health centers, eight "integration homes," medical health centers for children and drug addicts and expanded human resources, including 58 new psychiatrists.
"It is very difficult to change attitudes and to establish teamwork, and we're still continuing to have problems, but we are working in that direction," Agani said.
Agani and representatives in the Health Ministry have faced obstacles such as families in severe economic conditions and a lack of financing and institutional resources, praising the connection between Kosovo and the Geisel School of Medicine. Recounting an anecdote of a mentally ill mother previously housed in an asylum, Agani said she was transferred into an integration home in the process of reform and was reunited with her two grown children after many years.
"The patients are much more satisfied with the level of care," Agani said.
Audience member Kaila Pedersen '14 traveled to Kosovo last summer and spoke with health officials in the capital city of Pristina about the challenges of rebuilding health infrastructure after the war.
"One thing I found interesting was the family-centered and community-based approaches because I know even in the U.S. there is definitely a stigma associated with seeking out mental health," Pedersen said. "I think that is just as prevalent, if not more so, in Kosovo."
Patrick Saylor '16 said he attended the lecture as part of a larger effort to take advantage of important speakers visiting the College.
"I think what was really interesting was how the population demographics of Kosovo are such a factor in its process of going through reform," Saylor said. "I'm also curious how that's going to change in the future as that generation becomes older."
Agani's lecture was sponsored by the Office of the Provost and the dean of the Geisel School.
