I've been where it's gone, so I know what I got ... An American Fulbright Lecturer in Albania, 1994-1995

Spending 10 months as a Fulbright Lecturer in Medical Sciences at the University Medical Center, University of Tirana, Albania, gave me a first-hand view of academic medicine in a country merging from more than 45 years of Communist rule that impoverished the country and isolated it from the rest of the world. Even after the fall of Communism, every aspect of medicine in Albania continues to be government controlled. Early specialization is still the rule for academic physicians. Division chiefs exert absolute authority over their domain and seldom delegate this authority. Learning and teaching resources are scant, and access to current western medical literature is extremely limited because of both poverty and priority. Despite these obstacles, the medical students and postgraduate trainees I encountered were bright and receptive, which strongly reinforces the tremendous urge to help them. Fellowships abroad, however, are limited and available only to selected junior faculty; students and clinical trainees do not qualify. If we are to help, we must take the training to them. It takes time to become an effective clinical teacher in Albania: time to understand the system; time to devise the best teaching vehicles; and time to gain the trust of the students, trainees, and faculty. Given the time, the effort can be successful. The problem is, where do we find physicians with the time and interest? Might this be a role for still-energetic retired physicians? My experience in Albania permitted me only to formulate these questions; the answers must now come from this side of the Atlantic.