For the past three years, every 21 days, Brunilda Alimerkaj packs a bag and leaves her home in the southern Albanian oil town of Ballsh on a 1,200-kilometre trip to the cobblestone streets of Bergamo in the north of Italy.
There, in a hospital on the outskirts of the city, she is hooked up to an intravenous drip and receives a dose of a drug called Trastuzumab, her last hope in a 12-year battle with breast cancer.
It is a journey that has driven Alimerkaj, a 42-year-old council worker and divorced mother of two, deep into debt.
But, she believes, it is the only reason she is still alive.
Trastuzumab, commonly known by the brand name Herceptin, is on the World Health Organisation’s list of essential medicines for a healthcare system. But, in Albania, it is frequently in short supply.
The incidence of breast cancer in Albania is rising, yet Albanian women like Alimerkaj face a fight to get the treatment they need, their chances of survival hurt by late diagnosis, drug shortages, and the lack of a national register of cancer patients vital to a health system’s budget and procurement plans.
It is a state of affairs that is costing lives and driving those who can afford it, and frequently those who cannot, to seek expensive treatment abroad.
“I can say this with certainty – if I had been treated in Albanian hospitals I would not be alive today,” Alimerkaj told BIRN in Tirana. “It’s not the fault of the doctors but of our healthcare system, which guarantees nothing for patients.”
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A type of targeted cancer drug called a monoclonal antibody, Herceptin, works by attaching itself to a protein found in large amounts in some breast cancers and stopping the cancer cells from growing and dividing.
The fact it was in short supply in Albania was not widely known until January, when Valbona Reci took the microphone at a Town Hall meeting with the country’s prime minister, Edi Rama, in the northern town of Rreshen.
A local high school teacher, Reci told Rama she had breast cancer and had been prescribed 18 doses of Herceptin, one every 21 days. But of the first eight, she had been given only three.
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