Area Handbook for Albania Part 8

Health and medical organizations from national to local levels were under the Ministry of Health. In the 1960s the departments of the ministry were: epidemiology, pharmaceuticals, sanitary inspectorate, medical prophylactic inst.i.tutions, personnel, administration, finance, and planning. Data for 1968 reported by the minister of health listed facilities countrywide as: 196 hospitals and other facilities with beds; 11,922 beds for medical use; 1,108 first aid stations and polyclinics; and 36 dispensaries and tuberculosis centers. The average annual increase in hospital beds from 1950 to 1968 was 323; in 1968 there was 1 bed for every 169 inhabitants.

The total number of persons employed in health and medicine increased from 9,881 in 1960 to 14,370 in 1967. The numbers of professional and semiskilled workers in 1969 were: physicians, 1,396; stomatologists (mouth specialists), 183; pharmacists, 262; medical aides, 725; dental a.s.sistants, 139; pharmacist a.s.sistants, 334; midwives, 1,091; nurses, 4,100; and laboratory technicians, 737. Dentists were not listed as a separate category. The average number of inhabitants per doctor in the districts was approximately 2,000; however, in two districts the average was over 3,000, and in one, less than 1,000. All medical personnel were in government employ, and no private medical practice existed.

The expansion of medical services after World War II was made possible to a large extent by accelerated training programs. A school for training medical a.s.sistants was begun in 1948 and, starting in the early 1950s, the Red Cross conducted courses for semiskilled medical workers.

A medical college for training professional personnel was established in 1952; in 1957 it became the Faculty of Medicine of the State University of Tirana, and the first doctors were graduated that year. During the 1950s most physicians were trained in the Soviet Union. In the late 1960s the number of persons undergoing training as midwives was increased, and the goal was to have at least one midwife in every village by June 1971.

The use of mobile medical teams and equipment played a major role in expanding and improving medical care in rural areas. Laboratory, X-ray, and other services once available only in the largest cities were established in the district and sometimes at lower levels. The regime, in its effort to build up agriculture in the mid-1960s, set as an objective the improvement of living conditions in the countryside and the elimination of the differential between city and country. Medical a.s.sistance to rural areas continued to increase in the late 1960s, but in late 1969 the minister of health stated that the differences between the center and the districts and between the cities and the villages were very p.r.o.nounced. He directed that action be taken to lessen the gap but added that differences would continue to exist.

Nutrition

Food supply--perennially a problem because of poor soil, primitive methods of cultivation, and lack of readily accessible resources--did not keep pace with population growth. For the late 1960s calorie intake per capita per day probably did not exceed 2,100 to 2,200, while the estimate for the mid-1950s was 2,200 to 2,300. The diet lacked protein and other protective elements. An estimated 80 percent or more of food intake was carbohydrates. Fruits and green vegetables were in short supply, and meats were a real scarcity. Little progress had been made in increasing livestock herds during the period of Communist rule, and credits to procure adequate supplies of protective foods from sources outside the country were not available (see ch. 8, Economic System).

The diet generally depicted scarcity and, in the mountain and rural areas, was simple and routine. Dishes, high in starch content, made from corn, wheat, rice, and potatoes were basic. Yogurt, cheese, and prepared dry beans were among the most commonly found other foods. Green vegetables and fruits appeared seasonally in limited quant.i.ties.

While some progress has been made in improving sources of drinking water, the vast majority of rural families, and some in the smaller cities, must rely on unprotected sources. Central sewage systems are found in only the largest cities.

Housing

Living quarters became increasingly overcrowded as population expanded at consistently high rates. Party First Secretary Enver Hoxha stated in December 1967 that the entire country, especially urban areas, was experiencing a housing crisis. Reports on housing construction indicated that the situation further deteriorated in the late 1960s because of the necessity to divert resources to even higher priorities, to the building of industry and procurement of food and clothing. War and natural catastrophes added to the burden. In World War II some 35,000 dwellings were destroyed. Earthquakes in November and December of 1967 demolished 3,500 homes. In April 1969, when 6,500 buildings were damaged or destroyed by earthquakes, additional thousands of homes had to be replaced or repaired.

Hoxha stated in late 1969 that 185,000 flats and houses had been built since World War II. The average annual rate of construction, as indicated by incomplete reports for the 1960s, was 6,000 private dwellings and 3,000 state-owned and cooperative apartment units. Total requirements were not stated, but with annual population growth at approximately 40,000 to 50,000 persons, and considering reports relating to crowded conditions, the critical condition was unresolved. Hoxha stated in late 1967 that the housing situation had reached the point where in some instances five persons were living in one room.

Most rural houses are of one or two rooms, with a hearth, and are of simple construction. They are small and spa.r.s.ely furnished. Many are made of natural rock or stones. Urban houses and apartments are usually small and lack central heating. Kitchen and toilet facilities in apartments must be shared by three or four families.

Social Insurance

The social insurance program is administered by state organizations and covers medical care, compensation for incapacities, old-age pensions, family allowances, and rest and recreation. Social insurance was introduced in 1947. Several modifications were made later to the basic program. The law of 1953 provided a program closely resembling that of the Soviet Union, and for a number of years, following the Soviet example, trade unions administered a large number of social insurance activities. In 1965 the state a.s.sumed the administration of all phases except those for rest and recreation facilities.

The social insurance program, as provided for in the Council of Ministers decision of September 13, 1966, and effective January 1, 1967, included benefits for workers, employees, and others. Peasants in the collectives were not included in this law, but similar welfare benefits were provided from funds established by their organizations. The 1966 law continued the policy announced in 1964 that free medical care was provided to everyone. Drugs, such as penicillin and antibiotics, and vitamins prescribed during outpatient treatment had to be paid for by the user. Funds for social insurance payments came from the state budget. Contributions were paid by state inst.i.tutions and enterprises that were in the role of employers.

Workers who became incapacitated and had over ten years of work credit received payments at the rate of 85 percent of the average wage for the last month worked; persons with less than ten years' service received 70 percent, except that temporary or seasonal workers were given less. When disability resulted directly from work, pay was given at the rate of 95 percent for most trades and 100 percent for persons working in mines.

Compensation was less when incapacity resulted from an accident unrelated to work. Payments under these circ.u.mstances depended on age and years of work credit. Veterans who served in the Army of National Liberation before May 1944 and some of the Party elite were allowed an extra 10 percent when incapacitated (see ch. 2, Historical Setting).

Pregnant women were given eighty-four days' leave under normal circ.u.mstances and 95 percent of their monthly wage if they had worked over five years. They received 75 percent if they had worked less than five years. Workers could remain at home for limited periods to care for the sick and receive 60 percent of their pay. When children under seven years of age were ill, the worker was permitted up to ten days' leave during a three-month period. A subsidy, a one-time payment, of 280 leks was provided for each child. Upon the death of a family head or his spouse, 300 leks were provided for funeral expenses.

Old-age pensions were based on age and years of work. Payments were computed at the rate of 70 percent of the worker's average monthly wage.

The minimum pension was 350 leks, and the maximum was 900 leks per month; two exceptions were veterans of the Army of National Liberation who served before May 1944 and Party leaders, who were awarded an additional 10 percent. Women who reared six or more children to the age of eight were permitted to retire at age 50 when they completed fifteen years of work, instead of the usual requirement of twenty years.

Wages and Prices

The limited data available indicated that in early 1966 factory and manual workers received 400 to 800 leks in wages per month. Skilled workers were paid 400 to 1,500 leks, and senior officials received up to 1,500 leks per month. After the reduction in the size of the bureaucracy was announced in late 1966, the maximum for officials was reduced to 1,200.

Prices in leks per pound for foodstuffs in 1966 were approximately as follows: bread, 1 to 2, depending on type; flour, 2 to 2.5; sugar, 4.5; beans, 3 to 4.5; beef, 6.5; and lamb, 8.5. Prices for other commodities, in leks, were as follows: a man's suit, 400 to 1,300; a pair of men's shoes, 120 to 200; radio, 500 to 2,400; and a bicycle, 800 to 1,300.

During the late 1960s the consumer continued to feel the squeeze of the drive for greater economic self-sufficiency and the priority given to the building of means of production. Despite announcements of greater benefits to the worker, the average citizen in early 1970 continued to pay approximately 90 percent of his income for food and shelter. Basic commodities and foodstuffs were in short supply, and waiting in line at distribution points was required to obtain the most commonly used items.

Manufactured items were generally of poor quality. Automobiles were owned by the government only, and bicycles, a status symbol, were available to only a few.

CHAPTER 5

SOCIAL SYSTEM

The Communist regime was still striving in 1970 to alter the traditional tribal and semifeudal social patterns of the country and to restructure the whole system to fit Marxist-Leninist principles of a socialist society. Until after World War II the strongest loyalties of the people had been toward family and larger kin groups, which have been the most important units in Albanian society. Kin groups had been held together by strong spirit and loyalties, as well as by economic factors. The head of the family, usually the eldest male member, historically exercised patriarchal authority, with general responsibility for the welfare and safety of the members. In this patriarchal society, respect for parental authority was dominant.

Local autonomy and suspicion of central authority had for centuries been a way of life for Albanian society. This way of life persisted until the twentieth century, despite the foreign cultural and political influences to which the society was subjected during the long domination by the Ottoman Turks.

Of particular social importance during this domination was the conversion of the majority of the people to the Islamic faith. Even before this conversion, however, the people had been segmented by the schism between the Roman and Eastern Orthodox churches. The people in the north were usually Roman Catholic, and those in the south, Eastern Orthodox. Tolerance, however, has been a marked feature of the people and, accordingly, religious divisiveness has had no great effect on the tribal and semifeudal structure of the society. Indeed, the three religious faiths in the country--Muslim, Roman Catholic, and Eastern Orthodox--have represented traditional loyalties rather than living creeds for the Albanians.

Until the Communist takeover in 1944, there had been two broad social cla.s.ses in the country, an upper and a lower cla.s.s. The upper cla.s.s was composed of the landowning _beys_ (see Glossary); some _bajraktars_ (relatively well-to-do tribal chieftains); and a smaller number of rich Christian farmers, merchants, small industrialists, some intellectuals, and the higher clergy. The lower cla.s.s, amounting to about 90 percent of the population, was composed of a small group of workers, the peasant ma.s.ses, livestock breeders, and the lower clergy.

The Communist regime's political, social, and economic measures aimed at redirecting the traditional social patterns have resulted in more social transformations than at any time since the Turkish invasions in the fifteenth century. Collectivization of agriculture, industrialization and the consequent migration from rural to industrial areas, and a widespread educational system have done much to transform the tribal character of the society.

Although in 1970 the patriarchal system was still a way of life in the countryside, especially in the highlands, the authority of the master of the house had been considerably reduced. Marriage customs in particular had changed. As a result, the position of the close-knit family had been altered. Radical changes had occurred also in the life of women. Many of them have had to work outside the home to compensate for the generally low wages of their husbands. Day-care nurseries had been set up to make it easier for mothers to work and also to give the regime an early opportunity to indoctrinate the children.

Despite such transformation, however, the family was still the most significant unit in the society. The allegiance given to the family, coupled with the individualism characteristic of the people and the traditions of political autonomy in local affairs, had made it difficult for the regime to fully implement its policies for restructuring the society in general and the family in particular.

Reflecting the influence of the standard Marxist-Leninist dogma, the regime officially recognized only two cla.s.ses--one composed of workers and considered the leading cla.s.s and the other consisting of the working peasants, a third group usually being referred to as the people's intelligentsia. Actually, a distinct new upper cla.s.s, const.i.tuting less than 10 percent of the total population, emerged under Communist rule to replace the upper ruling and middle cla.s.ses that existed before the Communist takeover. This new upper cla.s.s was composed of the top ruling elite that controlled all facets of society and its supporting echelons, made up of officials of the Party and state apparatus; ma.s.s organizations; and professional and technical people, such as doctors, lawyers, engineers, and managers of state enterprises.

Members.h.i.+p in the Party or sympathy toward communism was the chain that linked this upper cla.s.s together. All its segments had benefited from the Communist system, having enjoyed considerable advantages over the rest of the population; they formed practically the only social group with a vested interest in the perpetuation of the system. The rest of the population--peasants, workers, and remnants of the upper and middle cla.s.ses--were only cogs in the Communist apparatus, all used for the purpose of implementing the Party policies for the building of a Communist society.

Under Communist rule the stabilization of the cla.s.s differentiations had lessened social mobility both upward and downward. In 1970 it was difficult to alter one's social status except through a long process of training and education. Educational opportunities, however, had been greatly expanded, although they were still limited in the rural areas.

The best opportunities were offered to the children of the Party elite and Party faithful. But because of the great demand for qualified personnel to manage the growing socialist sectors of the economy, some children of worker and peasant backgrounds had opportunities to continue their education to the highest levels and to fully develop their abilities and capacities. The whole educational system, however, was geared to the demands of the Party, and its first objective was the inculcation of the youth with Communist ideology.

Perhaps the most radical change in the whole social system had been effected in the area of religion. By 1970 the country's three princ.i.p.al religious faiths had been eliminated as organizational bodies. All churches and mosques had been closed; the clergy was not permitted to function; and the country had been declared by the official media to be the first atheist nation in the world. Top Party and government officials admitted, however, that the closing of the houses of wors.h.i.+p and the action against the clergy had not eliminated the religious feelings and beliefs of the people.

TRADITIONAL SOCIAL PATTERNS AND VALUES

The social structure of the country was until the 1930s basically tribal in the north and semifeudal in the central and southern regions. The highlanders in the north retained intact their medieval tribal pattern of life until well into the twentieth century and were considered the last peoples in Europe to preserve tribal autonomy. In the central and southern regions, however, increasing contact with the outside world and invasions and occupations by foreign armies had reduced the tribes to tenure peasants.

Traditionally, there have been two major groupings or sub-cultures in the country: the Gegs in the north, probably numbering slightly over half the total population, and the Tosks in the south. Although the terms _Geg_ and _Tosk_ have disappeared from the vocabulary because they connote division rather than Communist unity, Tirana officials and the press have often implied in recent years that the old differences and contrasts between the two groups still existed. These differences were marked not only in the physical appearance of the people and in dialect but also in the way of life in general.

The Gegs, partly Roman Catholic but mostly Muslim, lived until after World War II in a mountain society characterized by blood feuds and fierce clan and tribal loyalties. The Tosks, on the other hand, were considered more civilized because of centuries of Greek and other foreign influences. Coming under the grip of the Muslim landed aristocracy, the Tosks lost the spirit of individuality and independence enjoyed for centuries by the Gegs, especially in the highlands.

Until the end of World War II society in the north and, to a much lesser extent, in the south was organized in terms of kins.h.i.+p and descent. The basic unit of society was the extended family, usually composed of a couple, their married sons, the wives and children of married sons, and any unmarried daughters. The extended family formed a single residential and economic ent.i.ty held together by common owners.h.i.+p of means of production and common interest in defense of the group. Such families often included scores of persons, and as late as 1944 some contained as many as sixty to seventy persons living in a cl.u.s.ter of huts surrounding the father's house.

Extended families were grouped into clans, the chiefs of which preserved, until the end of World War II, patriarchal powers over the members of the entire group. The clan chief arranged marriages, a.s.signed tasks, settled disputes, and decided what courses should be followed in such basic issues as blood feuds and politics. Descent was traced from a common ancestor through the male line, and brides were usually chosen from outside the clan. Clans in turn were grouped into tribes.

In the Tosk regions of the south the extended family was also the most important social unit, although patriarchal authority had been diluted by the feudal conditions imposed by the _beys_. The clan and tribal systems had disappeared at a much earlier period in the south and were retained into the mid-twentieth century only among the northern highlanders.

Leaders.h.i.+p of society in the lowlands was concentrated in the hands of semifeudal tribal _beys_ and _pashas_ (see Glossary). The general Tirana region, for example, was controlled by the Zogolli, Toptani, and Vrioni families, all being Muslim _pashas_ or _beys_ and all owning extensive agricultural estates. Ahmet Zogu, subsequently King Zog I, was from the Zogolli family. Originally the _pasha_ cla.s.s ranked slightly higher than that of the _bey_, but differences gradually diminished and all members were called _beys_. In the northern highlands the _bajraktars_ were the counterparts of the _beys_ and enjoyed similar hereditary rights to t.i.tles and positions.