From the Balkans to Boston

 

 

At Children's Hospital in Boston, Abazi (right) tests a new technique to check the function of a shunt in a patient with hydrocephalus.

Gani Abazi is standing in front of Children’s Hospital in Boston when his pager goes off. He’s been developing a test for people with hydrocephalus, a dangerous buildup of cerebrospinal fluid on the brain. A patient is waiting.

Abazi’s journey from a poor village in the former Yugoslav province of Kosovo to one of the most prestigious centers of medicine and learning in the United States might seem unlikely. But nothing he achieves surprises those who know him well. “Gani has more persistence than most people,” says Frank Rowbotham, who has been Abazi’s Rotarian host counselor for the past two years. “He knows what he wants.”

Abazi, 28, is the first Ambassadorial Scholar from Kosovo – a Balkan republic that in February, after decades of conflict, declared its independence from Serbia. While earning his master’s degree at the Harvard School of Public Health in 2006-07, Abazi received a rare second Ambassadorial Scholarship, which is helping to fund a two-year research fellowship in neurosurgery at Children’s Hospital. Through it all, he has remained focused on his goal: to return to Kosovo and modernize its outdated postcommunist health care system, which lacks both the doctors and the equipment to handle specialized care.

Obstacles range from lack of funds to corruption to institutional inertia, but Abazi has no doubt he will succeed. “I’ve seen war,” he says. “I’m not afraid of anything.”

Kosovo’s citizens – the majority of whom are ethnic Albanians – are the poorest in Europe. Abazi grew up on a small farm with six brothers and a sister. “We didn’t have a social welfare service,” he says. “We had to take care of ourselves.”

Serbian dictator Slobodan Milosevic came to power when Abazi was in fifth grade, instituting a repressive regime in Kosovo that abrogated the rights of Albanians to education and employment. During the 1990s, as Yugoslavia was falling apart, Kosovo had no official Albanian-language secondary schools or universities. Albanians who wanted to study in their native language (instead of Serbian) turned to an underground system.

Throughout high school and his first year of university, Abazi attended classes in a three-story house in the city of Peja. His teachers often worked without pay, and students had to be careful about carrying books with them. “If you were caught by the police,” he recalls, “they would beat you and confiscate the books.”

The tensions between Serbs and Albanians erupted into war in March 1999, during Abazi’s first year of university. After his village was bombed, Abazi, working as a paramedic, helped carry the wounded as the ethnic Albanian population fled through the mountains of Montenegro and into northern Albania. “We carried stretchers by hand,” he recalls. “Six people per stretcher, 100 kilometers through the mountains, in the snow.”

The war, he believes, made him stronger. “I saw many people dying,” he says. “I feel it made me much more persistent in what I want to achieve but also more compassionate. And I feel it has made me a better doctor.”

During the war, hospitals in Kosovo were burned and looted. In 2002, the United Nations Development Programme found that the equipment that remained in municipal clinics was 20 to 30 years old and that physicians numbered 78 per 10,000 inhabitants, compared with 300 or more in most other European countries. Even before the conflict, the health care system in Kosovo had been one of the least developed on the continent.

As a medical student in Prishtina, Abazi observed the problems directly. “The most heartbreaking thing was when patients had cancer or needed surgery that couldn’t be done in Kosovo,” he recalls. “All of these patients, they either have to go abroad, or they die.”

Abazi is critical of international experts who say Kosovo should concentrate on basic medical care and leave specialization to more developed countries.

“I feel for the neurosurgery patients who don’t have treatment in Kosovo,” he says. “People who have done cost analysis say we can’t afford to treat them, we cannot afford to invest in building resources and training people. I feel they are wrong. Once you invest some money in training experts as well as in improving the infrastructure of the hospital, you are able to save the lives of thousands a year and provide sustainability of service for many generations to come.”

Determined to do his part to improve the situation, he applied for an Ambassadorial Scholarship. Not long after, his own family found itself at the mercy of Kosovo’s stunted health care system.

In 2007, after graduating from the Harvard School of Public Health, Abazi returned for what he hoped would be a relaxing summer at home before going back to Boston for his research fellowship. Instead, he found his father ill. Local doctors were unable to identify the problem. Increasingly worried, Abazi decided that finding treatment abroad was the only option.

Abazi took his father to Düsseldorf, Germany, where he had done a neurosurgery internship in 2006, and where his brother Nazmi was living. They arrived at the hospital to find Nazmi had been admitted with massive brain injuries after being hit by a car; he was being treated by the same neurosurgeons under whom Abazi had studied. Nazmi Abazi is now out of the hospital but continues to undergo treatment.

Diagnosed with lung cancer, their father – a nonsmoker – died two weeks after coming to Germany.

“My dad didn’t live long enough to see the results of my work,” Abazi says. But he tries to live by a request his father made when he started medical school: “Please do only good deeds so I can continue to be proud of you.”

Partly on Abazi’s recommendation, two doctors, one from Kosovo and the other from neighboring Macedonia, began their studies as Ambassadorial Scholars this semester. He envisions these doctors forming a core of specialists who will train more doctors in the region, until patients no longer need to leave home for treatment.

“It’s much cheaper than sending patients abroad,” he says. “And then you’re also postponing developing a system of care at home. Kosovo one day will need its own specialized services, the sooner the better.”

Rotary is a key part of Abazi’s dream. When he applied for a scholarship, he says, “I wanted to get a degree in a more advanced educational system, be exposed to different cultures, and get the technical expertise that I need so I can perform better as a doctor.” But he understands that as an Ambassadorial Scholar, much is expected of him in return. “I have a responsibility to contribute something that will make a difference in people’s lives,” he says. “Rotary has really helped me a lot. I don’t know how to thank Rotary enough.”

Klaus Hachfeld, the governor of District 7910 (Massachusetts), who counts Abazi among his close friends, believes the scholar has taken to heart the way Rotary can improve people’s lives. “In true Rotary form, the man has made friends everywhere,” Hachfeld says. “You ask him to do something, and he does it.”

When he was preparing for his medical school entrance exams, Abazi never doubted himself. “I didn’t prepare a plan B because I didn’t believe in a plan B. I said, I’m going to get into this school no matter what.”

His advisers say he’ll need that confidence as he works toward his goals, the next of which is to get accepted into a neurosurgery training program, an extremely competitive process. “Gani’s got a long road ahead of him if he wants to open up people’s brains,” Rowbotham says.

Henry Schmidek, Abazi’s mentor and a retired professor of neurosurgery at Harvard Medical School, believes Abazi will be the minister of health, if not the president, of Kosovo someday. But to help lead his country’s medical establishment, Abazi will need all the training – medical, organizational, and leadership – that he can pack into his time here, notes Joseph Madsen, the neurosurgeon who is Abazi’s adviser at Children’s.

“My major hope is that all these things together will produce the person who can do the job he’s signed up for, 5 or 10 years from now,” Madsen says. “He thinks about how to make Kosovo a better place every day.”