Harvard Public Health Review
Spring 2005





Letters from Albania

HSPH alum Harriet Epstein, MPH'81, set out to build a systme of foster homes and services for Albanian families and children housed in state-run institutions. In her second installment of letters, Epstein shares her triumphs and take-home lessons.

Editor's note: For letters published in the Fall 2004 Review, please click here.


June 6, 2004

Dear Friends and Family,
It has been a month of many "best things." Our sweet Suela* (twelve months old) went home to her new parents: Her mother is a chemistry teacher and her father is a lawyer. On the day they came for her, they brought a beautiful new blue dress with hand-crocheted edging and a matching blue ribbon for her head. Her father called to say we had given them a gift of "gold." It seems Suela loves to hear the birds sing, so these new parents went through the process of getting her a passport so they could vacation in Macedonia, where there are many birds. So much for all the talk that Albanians won’t adopt children who aren’t their own "blood."

A second "best thing": Lolita Hoxha, Alketa Kolprecaj, the acting director of the Home, and I have been moving about the country like a horde of invaders looking for a permanent home for our three disabled children. In the meantime, we arranged for them to go a few days a week to a development center for children with disabilities. Mehmet, who is nine and has Down’s syndrome, just started to walk last September. Our new nurse noticed that he and another child start to cry whenever Mehmet leaves. We are delighted to realize Mehmet now has a "best buddy." Yesterday, we arrived at the Home as the bus was leaving, and there was Mehmet waving at us through the window. Lolita and I looked at each other in total wonder. We hadn’t known he knew how to wave "bye, bye."

The most important "best thing" this month is that our friend Margaret Brown, a British advisor to the Albanian Minister of Labour and Social Affairs, persuaded the Ministry to include a stipend for Albanian foster carers in their budget through 2007. Using our data--which includes Lolita’s first-hand experience itemizing the cost of raising her own child in Albania, government stipends allotted to disabled individuals, financial figures we developed during our first family re-integrations at the Home, and information we acquired about children placed in privately run institutions--Margaret proposed an allowance of 6,000 leke (about $60) per month.

Hooray! This is a DOABLE amount that will make foster care possible in Albania, and it means we can start setting up a system. There is still a long way to go, but knowing there is an economically reasonable allowance (which will be adjusted for inflation) makes the job possible.

Otherwise, life is busy! I went to Montenegro last weekend to revisit the magnificent medieval town of Kotor. I also discovered the town of Budva, which was restored to "movie lot wonderful" condition after the 1979 earthquake and is now a popular tourist destination. It has been a cool and rainy spring, so we missed the usual crowds.

July 5th

Dear Family and Friends,
Another one of our babes is off tomorrow. This tiny little preemie has entranced two lovely parents from Saranda, who have redecorated and repainted their house to welcome her. Lolita was there today, and she was so excited to participate. Adoption is a special birth of a family--somehow even more wonderful than when a child is born. It is truly joyous.

More good news: the law firm working on our government contract agreed to do some pro bono work and help with the development of a child protection system and proper child guardianship law. I actually danced around the office with joy. If a real child protection unit gets off the ground, then it will actually be possible to set up a system that has real teeth and responsibility.

At this point we have 26 children at the befotrof (orphanage). We are hoping for at least three family re-integrations and several more adoptions. All of our accomplishments show how important it is to set up services in communities. Albanian families and communities are, as Lolita says, "lovely." Even she has been surprised at the reception our children have had.


July 31st

Dear Family and Friends,
It’s been nearly a year since I began this adventure. Eighteen of the 43 children who were in the Home when I arrived have been placed either in adoptive families or with their families of origin. Even "stuck cases" are now with families! Of the children who remain, 11 are in the pipeline to be placed by October.

Whether I have accomplished any of my larger goals remains to be seen. I have been increasingly concerned about such issues as corruption and accountability, and if and when the legislation to develop foster care will happen. However, I do know there are now some people in Albania who understand that it’s possible to get children home if the proper supports are in place, that children can be moved through the system at a faster rate, and that there are alternatives to institutional care.

I also know that Alketa has developed the loveliest child advocacy skills. Her inherent warmth and tenderness, her integrity, and her willingness to learn and explore have been a delight to watch. And Lolita has become a strong and thoughtful voice for Albanian children. I have seen this young woman learn so much, use her voice, and grow. She told me that, following a meeting last week, she asked her team, "What did you learn today?" It is a question I have used throughout my career, and one I would always pose at the end of a day when we were visiting other programs. Both Alketa and Janet Smith, a volunteer social worker from England, burst into laughter. How nice to be copied like that!

The end of this project is coming, and I am starting to think about my next job. What and where it will be, I don’t know. By late summer I will have done the piece that I do best.


September 15th

Dear Family and Friends,
I am back home in Massachusetts! I don’t remember the air ever smelling so sweet. Nothing beats New England in the fall.

My last month in Albania was amazing. I spent the time doing an assessment for Christian Children’s Fund, an international children’s services agency with an office in Tirana, the capital city. I also went to Kukes and Tropoja in the northeast to see what services are available for vulnerable children and families in these isolated and very poor areas.

What I saw made the World Bank’s Poverty Assessment palpable and real. The loss of development was summed up by one woman who told me: "Even my mother had a high school education. My children will be lucky to get through elementary school." The government has pulled out resources, and there is little left. Many people have fled, and those who are left are without work, schools, or proper medical care.

Next, I’m off to Mozambique with a team from Abt Associates evaluating a landmine survivors program funded by the Centers for Disease Control and Prevention. Looking ahead, who knows? I’ll be looking for the right match.

Love, Harriet

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