During the Kosovan war, the overwhelmingly Albanian population was subjected to several years of intimidation by the Serbian authorities. 20 per cent were diagnosed with post-traumatic stress disorder. Agron Zajmi has had his work cut out. After a spell at the University of Missouri learning about the illness, he returned home to Djakovica to set up the Child and Family Counselling Centre. Zajmi originally trained in medicine, psychiatry and neurology, and was director of the Centre of Medicine in Djakovica before the war 鈥� until he was replaced by a Serb while on holiday.
How do you know if a child has PTSD?
The main symptoms are depression, personality changes and increasing difficulty with learning. Older children often start abusing alcohol and drugs. Then there are the flashbacks, when the person has recurring memories of an event they experienced. An individual cannot suffer PTSD if they haven鈥檛 witnessed a murder or some other tragic event.
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When did you notice that a substantial number of Kosovans were suffering from it?
In the first few months after the end of the war, people were busy rebuilding their houses or looking for jobs or for missing family members. When the situation calmed down, they started to feel the changes and symptoms. After that, many looked for help, saying they were no longer the people they once were. The number of cases was still rising a year after the war ended.
Are people still coming to you today for treatment?
Yes, and it鈥檚 three years since the war, which is highly unusual. I have a lot of publicity now, which is why people find it easy to contact me. They are mostly women and children, and just a few men. Many men were killed, and the women and children witnessed the slaughter. There are 3000 missing persons in this town but the women don鈥檛 believe they鈥檝e been killed. They refuse to accept it. Of course they鈥檝e been killed, where else could they be? The women don鈥檛 want to face the truth. They are living on false hope that the men will come back home some day. I have the most problems with them. They believe that their men are being kept in some private prison in Serbia. Altogether I see about 3000 patients a year now. The phones keep ringing all the time. Patients call me at all hours.
What impact will this trauma have on Kosovan children as they become adults?
Their health will depend on their family culture 鈥� whether their parents recognise the problem and take them to a specialist. But among 16 and 17-year-olds, the number of drug addicts is rising. In Djakovica, between 20 and 30 per cent of third and fourth-formers at high school have experimented with drugs. Before the war we had only two drug addicts in the town, and they had become addicted in Switzerland. After the war, about 50,000 foreigners came to our town, and although they brought freedom, they also brought drugs and prostitution. Children suffering from PTSD may be vulnerable to drug addiction. Other types of addiction are also emerging.
If a person with PTSD doesn鈥檛 undergo treatment, which could take two to three years, they will suffer problems for life. If a child suppresses the trauma, which is often the natural thing to do if they have difficulty expressing it, they may end up with a psychologically immature personality 鈥� they may be nervous, aggressive or depressive. We are trying to set people free from their traumas, to let them express them. People who go on to develop chronic PTSD will be a problem for both their families and society.
How do you treat children with PTSD?
Apart from the most severe cases, where a child witnessed the murder or torture of their mother or father, we treated children in groups of 8 or 12 throughout the school year. Beyond doubt, an important factor in the treatment of PTSD is time. We used what we called 鈥渕ental hygiene鈥� classes. Each class begins with a breathing exercise. The children get comfortable and they and their therapist start breathing together in time. After this, they split into pairs and tell each other about traumatic situations they experienced during the war. Then one of the children from each pair retells the experiences of the other child to the therapist, and the class ends with a discussion.
Another thing they do is to have a conversation about pleasant things. The children sit with their eyes closed and the therapists lead them through so-called 鈥渟afe places鈥� in their imagination. For instance, they might imagine themselves riding on a bird across the sea to a cave where a masked ball is being held. They鈥檇 then have to choose the mask of an animal and enter the cave. In another imagination exercise, the children go into the woods. Once when we did this one of them said that the Chetniks [Serbian nationalists] were there. All Kosovans used to hide in the woods during the war.
Should all children have a 鈥渟afe place鈥�?
When I was a child, I would often visit my grandmother. She lived in a small house, and in one of the rooms she always had fruit. I would go into that room and eat fruit and stay there for hours. Nobody would find me. Every child should have a place like that. Some of the children we treated didn鈥檛 realise they already had one. We teach them that there鈥檚 always a place where they can hide. This implies hope, a perspective. Adults need one, too, not so much to hide as to have a place where they feel good.
How do you treat those children who have seen their parent murdered by the Serbs?
It is very difficult. For example, there was a girl named Genta who saw her father murdered and stopped talking because of the trauma. I was working with Genta and her mother but I didn鈥檛 have any success for a few months. The girl did start to talk about the horrors of war, she told how the Serbs took her uncle, but she never mentioned her father. Yet she wrote poems about him. I didn鈥檛 know whether or not I should confront her with the problem. I was thinking, if I confront her I will touch a wound and I will be unable to stop the bleeding. Eventually I did get her to address the issue, with another doctor. She cried and cried. Today she is a good skier, and her mother and uncle go everywhere with her.
Do people in Kosovo still hate the Serbs for what they did?
Hatred of Serbs is very strong. Years will have to pass before that hatred is alleviated, maybe decades. It will never be forgotten. When I was growing up, my father used to discourage me from making friends with Serbs. I didn鈥檛 doubt his experience, but I also told him that times had changed. Of course, it turned out he was right. Now the tragedy is bigger. It鈥檚 very difficult to talk about this in a time when people still don鈥檛 know where their husbands and brothers are.
Is there a shortage of psychiatrists in Kosovo?
There are definitely too few. A psychiatrist is needed for every 10,000 to 15,000 citizens. But today in Kosovo there are significantly fewer 鈥� about 50 for a population of 2 million. Kosovo needs about 200 psychiatrists.
Do you see your role as crucial?
As a doctor, my role is very important. Many educated people are leaving Kosovo due to low salaries, so my presence in the town or society means a lot. If I left, many others would do the same. My colleagues are very surprised that I haven鈥檛 moved to the larger city of Pristina. Life there is better. But I鈥檝e decided to stay where my grandfather and great-grandfather lived, and I believe I have everything I need.
During the war, the Serbs targeted and killed prominent residents of Djakovica, such as lawyers, doctors and political activists. How did you survive?
For the first 10 days I stayed at home. We built an exit so we could flee when the police came. On the 11th day I decided to go to Albania with my family. We left with my brother鈥檚 family, in two cars, and we joined a large group of fugitives from Pec. I was wearing a disguise all the way. It took us three days and nights to cover 50 kilometres. For the next three months, we were refugees.
Where did you end up?
I worked in a refugee camp in Tirana with more than 3000 Kosovan refugees. When I walked through the camp among the refugees鈥� tents, some of my former patients recognised me. They started crying and kissing me. When the foreign non-governmental organisations in the camp noticed how warmly I was welcomed, I was appointed to lead a team of 20 doctors at the Human Rights Centre in Tirana, financed by the Netherlands. We performed up to 150 medical examinations a day. People were traumatised and needed help.
When did you decide to go back to Djakovica?
When I heard of the peace agreement signed by Yugoslav President Slobodan Milosevic in 1999, agreeing to the pull-out of Serbian troops, I immediately returned home, and so did 90 per cent of Kosovans. I went home alone at first to tidy the house, because Russian officers from KFOR [the international peacekeeping force for Kosovo] had lived in it. Everything had been stolen. Then I went to the hospital and found some colleagues who had survived the war holed up there. With help from the Dutch, we replaced all the broken windows and obtained anaesthetics for the doctors to use. On the same day, I started work at the department of psychiatry. I knew my work would be connected to PTSD and I was aware there was a lot to be done. I was significantly influenced by the American doctors in Kosovo, because they were working exclusively with children suffering from this condition. I was certain I had to dedicate my time particularly to children, especially considering the birth rate in Kosovo, which is among the highest in Europe. The children witnessed numerous tragedies of war.
When did you grow fond of psychology and psychiatry?
I knew I wanted to be that kind of doctor by the fourth or fifth grade of elementary school. My grandfather and great-grandfather had been psychiatrists of sorts. Or it might be more accurate to say they were quacks. They could treat with their hands and communicate with God. My grandfather was especially famous for curing a boy who didn鈥檛 want to eat or speak. He advised his parents not to force the child to eat during the day, but to leave some food for him at night. After a couple of days the boy started to eat at night. He is now 70 years old. Even today we have quacks and fortune-tellers who have more work than I do. People believe in them because medical science is so underdeveloped here.
What do you think the future holds for Kosovans?
I鈥檓 an optimist, because I connect success with the development of the rights and education of women, and Albanian women have made considerable progress over the past 10 years. Our whole society is advancing as a result, because the women are the ones who bring up the children. We need to dedicate more time to children and adolescents, to prevent them from stepping into the wicked life of the Western world, and to allow them the possibility to choose a better path.