Cruel Cough Adds to Misery of Refugees

KUKES, Albania — They call it the Kukes cough.

Feverish infants wrapped in dirty blankets who are hauled by refugee mothers to the medical tents have it. So do many of the elderly women sleeping three or four to a bed in the overrun emergency ward of Kukes Regional Hospital.

The deep, chest-heaving hack can be heard all through the night in the muddy, garbage-strewn encampments in northern Albania that are home to tens of thousands of Kosovo refugees, most of whom were not so long ago underfed and exhausted.

“My baby’s whole body shakes when she coughs,” said Sehane Bytyci, a 25-year-old refugee from the Kosovo town of Suva Reka who was coughing, Kukes-style, along with her little girl, Hyrije.

Doctors attending to the massive refugee population here focused at first on serious war wounds--extracting bullets and shrapnel, reconfiguring faces struck with rifle butts, treating severe burns and cuts.

“Head wounds, body wounds, wounds on the extremities--I’ve handled all of them,” said Ylber Vata, head of surgery at Kukes’ 250-bed hospital. The facility treated as many patients in April--more than 17,000, according to hospital records--as it typically does in a year.

But as the flow of refugees has slowed, medical personnel have turned their attention from life-threatening trauma to the respiratory and gastrointestinal ailments that are turning the unsanitary, open-air campgrounds into massive sick bays.

Camp doctors are not yet sounding alarms. But with more refugees expected from Kosovo and with Kukes’ vast camps already crowded, health workers are far from ready to declare the public health situation under control.

“You can never feel comfortable,” said Bertrand Bainvel, who is overseeing the medical response here for UNICEF. “We have to always prepare for the worst.”

In the camps, flu-like symptoms are spreading swiftly, fueled by chilly temperatures, strong rainstorms, poor hygiene and weakened immune systems.

The most distinctive sounds in Kukes these days are the roar of helicopters delivering relief supplies, the boom of the occasional Serbian artillery shell fired into the surrounding Albanian hills, and the ugly, unsettling heave of the Kukes cough.

“Everybody who comes in here is coughing,” said Naser Ejupi, a doctor from Kosovo province who attends to patients at one camp. “People have not been washing well or eating well. They’ve been exhausted and they’re getting sick.”

Ironically, field doctors say, the cold and wet conditions that are causing the flu to flourish are keeping other worrisome ailments under control. Bacterial infections, which can be spread by flies and thrive in warm weather, have so far been held in check.

A handful of bloody diarrhea cases have been reported among refugees, which doctors call a disconcerting sign that life-sapping dysentery might be on the rise. Also worrisome have been a few reported cases of measles.

To keep sickness from spreading, relief workers have been improving water systems and stressing proper hygiene. Garbage crews have been clearing the camps of dirty diapers, moldy food and other trash, as well as installing latrines to replace the open fields that had been used as bathrooms.

Albania’s health situation was grim--lagging well behind the rest of Europe--even before the wave of refugees began more than a month ago. A polio epidemic caused 16 deaths in 1996. Cholera hit Albania hard in 1994, killing 25.

“The quality of health services is largely inadequate,” a UNICEF study issued last year said of the country’s health status. “As far as service quality is concerned, the poor and the non-poor population are treated equally bad.”

Evidence of inadequate conditions is visible at the hospital, a decaying facility that is short of everything from drugs to patient gowns. Awful smells permeate the hallways, and patients sometimes must sleep with one or more strangers in the same bed.

Dr. Bajram Cena, the hospital director, acknowledged that his poorly equipped facility has been overwhelmed. Needed most, Cena said, are more medicine and medical equipment, and at least six more ambulances to transport patients in serious condition to the Albanian capital, Tirana. Greece’s recent donation of an ambulance doubled the hospital’s operating fleet.

The facility also lacks clothing for the many new arrivals, Cena said, an important factor because most refugees are arriving in grubby clothing that was not changed during their treks.

Despite the deficiencies, relief workers from the L.A.-based International Medical Corps--which recently donated 50 hospital beds and a stockpile of drugs to the facility--say the hospital has the basics to do the job.

“This is not perfect, but it’s up to snuff compared to other hospitals I’ve seen in the world,” said Dr. Lawrence Stock, an emergency room physician at Antelope Valley Hospital in Lancaster, who has traveled in China and Bosnia-Herzegovina. “It’s a decent physical structure. It’s reasonably clean and it has heat.”

To buttress Kukes’ facilities, relief organizations have set up medical tents inside the refugee camps, many staffed by physicians who are refugees from Kosovo.

A special immunization campaign has begun to protect children from measles and polio--diseases that if left unchecked could spread quickly.

And as a first response to newly arrived refugees, the Italian Red Cross has set up a makeshift hospital near the border with Kosovo, a province of the Yugoslav republic of Serbia, complete with an operating room and nursery.

Most of the doctors’ attention these days is directed at conditions exacerbated, but not directly caused, by Yugoslav aggression--from asthma and heart disease to diabetes, gallstones and cancer.

Take Mustaf Pnishi, flat on his back in the hospital, who suffered a burst appendix during his four-day walk from southern Kosovo.

Or Fatmira Baftjari, who gave birth prematurely soon after arriving here.

“Walking for a long period of time, not eating enough food and suffering so much stress--those are some of the factors leading to all these premature births,” said Dr. Safet Elizi, head of Kukes’ maternity clinic, where births--and complications--have skyrocketed over the last month.

Still, Elizi is heartened by what the births represent--a new generation of Kosovars who may grow up in a far more peaceful place.