DAFOs in Albania

When most of us hear of Albania, we think of a mysterious, closed country. While Albania has been storm-tossed by communism and international political domination, Dale Scalise-Smith, PT, a professor and chair of Utica College’s Physical Therapy Department, sees something else: a bursting need for pediatric physical therapy.

Two colleagues of hers, Tom Crist and John Johnson, had long been interested in Albania. The country, of archeological significance, has been heavily populated since prehistoric times: Albania was part of the ancient Greek, Roman and Ottoman empires. As a link (and thus a major shipping route) from the land-locked countries of Europe to the Adriatic and Ionian Seas, it experienced considerable violence and competition for control. So there’s lots to study for a forensic anthropologist. (Forensic anthropology is the study of human remains in order to determine identities and how people lived and died.)

Albania became free of communist rule in 1992: as a sovereign nation, it is relatively young. It is also the poorest of the European countries. Through her colleagues, Dale made contact with the embassy and arranged a trip. When she requested some donated DAFOs in May to take along, we sent several boxes out of our “donation” stock. They included DAFOs: 2, 3, 3.5, and 4; JumpStarts of all sizes and styles; and a box containing several pairs of children’s shoes.

The first time Dale and her colleagues went to Albania, she saw 57 patients. The second time, just this year, they saw 200 people in 16 days, 70 of them in a three-day clinic. She saw the more involved patients more than once. Some partner clinicians relieved them at the end of those two weeks and stayed to work another 10 days. The therapy unit traveled to Korce, Sarande, Tirana and Gjirokaster, making their way to the Greek border.

Most of these patients were children. To communicate with patients and their parents, Dale worked through a translator the entire time. She recalls patient assessments and solutions, as well as parent education sessions where she demonstrated exercises the patients could do at home.

One case had her baffled right from the initial assessment, though. She could not figure out what was wrong with one child; the cause of atypical gait, knees bowed out, was a mystery. Fortunately, she had an archeology student assisting her that day. “Rickets,” he said. Dale had a hard time believing that; she hadn’t heard of a case of rickets (bone fragility due to calcium and vitamin D deficiency) in a long time. But the archeo student recognized the skeletal stance from his experiences studying old and ancient human bones. The leg bones are prone to fracture and bow out at the knees. Another feature of rickets is “double malleoli”—deposits form a lump just above the actual medial malleoli.

When she gave people the equipment, they shed tears of gratitude, Dale says. That’s one of the reasons she plans to go back in 2009. The other is that she wants to do some teaching. Albanian physical therapists are paraprofessionals, not licensed professionals as in other countries. There is a big need for more depth in the course of study—in fact, the school they go to offers one degree for both PT and speech pathology. Dale’s in conversation with the Albanian government to institute a professional physical therapy education program to the country that is consistent with the European physiotherapy model.

She plans to provide clinical services as well. If you have anything you can donate to Dale (see below), please send it along to her. And thanks for looking outward.
—Susan Witter

How You Can Help
The patients in Albania need lots of things besides braces. If you have any serviceable pediatric walkers, shoes, socks, sturdy strollers, crutches or canes, please send them directly to Dale:

Dale Scalise-Smith, PT, PhD
Professor and Chair
Department of Physical Therapy
Utica College
1600 Burrstone Road
Utica, NY 13502

Gjirokaster, an ancient city in the south of Albania with traces of human habitation dating back to the 1st century B.C. Dale gets a sense of this baby’s mobility challenges. An Albanian child with a rare case of rickets. Dale with some of her helpers and Joanna from Albania.