Gentian Vyshka

The debate on culture clash necessitates a theoretical framework, and three perspectives that merit attention are homogenization, polarization, and hybridization theories. These intersecting paths lead to the hypothesis that all civilizations could assimilate into the Western model as it is currently conceived. Culture clash is approached from multiple angles due to the widely held belief that rejecting culturally novel concepts is unethical. However, imposing new rules and customs will inevitably encounter innate resistance, as evidenced by numerous examples. The exchange of behavioral models does exist, with one of globalization's main tenets being the universality of values – including the uprooting of what we refer to as primitive manners. Nevertheless, anthropology and cultural research have witnessed intergenerational and long-term survival of elements that contemporary civilization believed it had overcome or at least suppressed deep within the subconscious mind. This article will offer an essayistic approach to certain forms of culture clash.

The Yalta Conference of 1945 brought together three of the most influential leaders of the 20th century: Franklin D. Roosevelt, Joseph Stalin and Winston Churchill. Surprisingly, all three leaders would go on to suffer strokes after the conference. This manuscript examines the health status of these leaders during and after the Yalta Conference, the factors that contributed to their strokes (including the role of hypertension), and other modifiable risk factors present in each one of them, and the impact of their declining health on their countries and the world. Roosevelt's demise, prior to the conclusion of the war, triggered a leadership transition during a critical moment in history, while Churchill and Stalin's passing shaped the early Cold War era. A veil of secrecy shrouded the health conditions of these pivotal leaders. “The Big Three” made considerable efforts to hide their health conditions from both the press and the public at large.Understanding the health of political leaders is crucial as it can affect their decision-making abilities and the course of history. The fates of Roosevelt, Stalin and Churchill serve as important reminders of the potential consequences of poor health in the highest echelons of political power.

The medical profession has been surrounded from mixed feelings of admiration, mysticism, as well as of fear and refusal. Authors and enthusiastic directors have dedicated serials and movies to the physicians’ everyday work, in their ebbs and tides. Albanian cinema produced a score of titles dedicated to the medical profession, with some movies focusing on the physician as the principal role, and some others more peripherally. The physician as a movie character underwent serious changes in the way the directors and scripts defined it, and maybe even in the way the general audience perceived the same. Changes in this modeling of physician’s character were part of the maturation process of the Albanian cinematography that has otherwise been strongly politicized from scholars; this trend could as well, or mainly, be related to the intrinsic alterations of the Albanian society from the immediate post WWII, until the fall of the totalitarian regime.

In the second half of the last century, Albanian society adopted a totalitarian way of communist thinking, that could not have spared medical disciplines. Psychiatry was and probably remains a stigmatized field, whose problems almost never were discussed openly. Specialized writings on psychiatry were available and could shed light on the themes and questions of concern. A periodical journal entitled Psychoneurological Works circulated in its print edition, with its first issue of 1959, its tenth issue of 1984 till it ceased publishing some years later. The journal was a mixture of neurological and psychiatric contributions, with the latter reflecting consistent time-related shifts in thematic, terminology, and data exposure. The panegyric and enthusiastic statements served as a good disguise for the immense ailing of patients and the ethical challenges that psychiatrists were facing, while exerting their profession in the time of severe dictatorship, when the disrespect of human being reached its apogee.

Infanticide is a horrendous crime universally condemned from all ethical, juridical and moral standpoints. However, legislation on infanticide foresees mitigating circumstances for infanticidal mothers, with sentences by far disproportionate to the severity of the crime. The main justification for this abstaining from severe punishments has been the so-called post puerperal psychosis, whose diagnostic criteria and existence are still very confusing. Psychiatric experts and even jurors show excessive feelings of empathy toward defendant mothers, and fair verdicts under this setting and with this judicial tradition are questionable. Albanian courts have in some cases even denied defendant mothers the unwilling albeit necessary psychiatric treatment, thus exposing them to recidivism and to other social difficulties. Upholding the charge of infanticide in an Albanian court is hereby an impossible enterprise, with high chances for defendants to achieve acquittal on mental insanity grounds. Through describing three cases of infanticide and filicide in recent years of Albanian judicial proceedings, authors raise the concern formulated from other sources regarding the excessive empathy surrounding infanticidal mothers, a deleterious obstacle toward achieving justice.

Artistic work during communist regime in Albania has been a strictly controlled area, due to censorship and ideological limitations. However, the creative genius of some individuals was able to transmit religious images in a disguised form, particularly when themes were permissive to ambiguous messages. Depicting child abuse was a taboo for the everyday life, but not when focusing on certain historical periods that were purposefully stigmatized from the state propaganda. Some snapshots and images from the movie ‘Red poppies on the wall’, shot in 1976, will reveal how the director and the working team operated on Christian symbols to showcase their working philosophy. Thus, sketching the abusive environment of an orphanage within the frames of a remote Roman punishment model, did nothing more, rather than confirmed the main concern that was tormenting authors while trying to delimit the events in time. The abused child is a reality beyond time, ideology and religion, and as such artworks dealing with it have their deserved professional space.

The apparatus invented by Dr. Luigj Benusi in 1943, in Tirana, was a practical application of the Kowarsky technique and Ambard laws, helping in determining blood urea levels and very important to a variety of diseases, mainly kidney disorders.The apparatus was invented and prepared from very simple laboratory materials, such as glasses, test tubes, corks and volumetric cylinders. Technologically, it was based upon the determination of blood urea through hypobromite, and, among the advantages of the apparatus of Benusi, were its extreme simplicity, the smaller amount of blood needed for producing results, as well as an easiest way to clean up and to manage the apparatus from a practical point of everyday use.

Alcohol consuming is so present in human history to the extent that it has become ‘a universal language’. Under this point of view, studying historical trends regarding alcohol consume, geographical profile of its abuse, political approaches at the level of public health in different countries and epochs, might be of interest toward understanding the actual situation. Alcohol beverages have been considered positively due to the unproven belief that they have curative and medicinal characteristics. The oldest recipe describing the way of preparing an alcoholic drink is for the beer, dating more than 3800 years before, written over a stone plaque. The entire text is a hymn for Ninkasi, the Sumerian goddess of beer. Other authors suggest that wine has been part of the menu since six millennia, with archeological uncovering of Hajji Firuz Neolithic house that yielded the six wine jars in Tepe, ancient Persia. Different options have been tested with the aim of controlling the production and trading of these beverages, with all advantages and disadvantages that these implemented options present.

Recent developments in the field of forensic medicine and the judicial practice are both factors influencing considerably toward an increasing role of toxicologists in court hearings and litigation processes. The role of forensic toxicologist has been until a few decennia before a prerogative of the medico-legal specialists, but meanwhile a subspecialty of the general toxicology seems to have been created. Vis-à-vis the increasing presence of toxicologists in penal procedures of poisoning and intoxications, Albanian courts have created their own precedents and bylaws, regulating the presence, the opinion taking, and the relative importance such an expert opinion will have on the final sentence. Due to a multiplicity of factors, legal terminology with regard to drugs of abuse needs to be revised and parallel to such a revision a better defining of the role of expert toxicologist as a collector and interpreter of the scientific proofs seems necessary. Overlapping competencies with judicial bodies and confusing legislative measures will do nothing else but complicate issues that should be and can be easily resolved, through simple and appropriate interventions at different levels.

The Divine Comedy of Dante Alighieri, and its initial part of Inferno, includes several medical terms and descriptions, whose accuracy sometimes overcomes that of a layman. The genial poet has used locutions illustrating pain and sorrow more than forty times in Inferno alone, with words like dolor, dolente and doloroso, that have caused perplexity among translators. The panoply of translations – here we are dealing only with the English versions – will prove that not only the contextual meaning but also the historical setting might create interpretative difficulties. Without obviously giving medical value for granted to all verses that include words like dolor and its derivates, however Dante’s work has been as well under the focus of medical scholars, with many publications of interest. Through comparing the original text mainly with the Oxford’s English version, we have tried to bring into the reader’s attention the painful sensations that Dante abundantly inflicted upon his characters, as an indirect way to test the poet’s perception of this strange and infernal sensation.

Background: The Albanian medical system and Albanian health legislation have adopted a paternalistic position with regard to individual decision making. This reflects the practices of a not-so-remote past when state-run facilities and a totalitarian philosophy of medical care were politically imposed. Because of this history, advance directives concerning treatment refusal and do-not-resuscitate decisions are still extremely uncommon in Albania. Medical teams cannot abstain from intervening even when the patient explicitly and repeatedly solicits therapeutic abstinence. The Albanian law on health care has no provisions regarding limits or withdrawal of treatment. This restricts the individual's healthcare choices.DiscussionThe question of 'medically futile' interventions and pointless life-prolonging treatment has been discussed by several authors. Dutch physicians call such interventions 'medisch zinloos' (senseless), and the Netherlands, as one of the first states to legislate on end-of-life situations, actually regulates such issues through appropriate laws. In contrast, leaving an 'advance directive' is not a viable option for Albanian ailing individuals of advanced age. Verbal requests are provided during periods of mental competence, but unfortunately such instructions are rarely taken seriously, and none of them has ever been upheld in a legal or other official forum.SummaryEnd-of-life decisions, treatment refusal and do-not-resuscitate policies are hazardous options in Albania, from the legal point of view. Complying with them involves significant risk on the part of the physician. Culturally, the application of such instructions is influenced from a mixture of religious beliefs, death coping-behaviors and an immense confusion concerning the role of proxies as decision-makers. Nevertheless, Albanian tradition is familiar with the notion of 'amanet', a sort of living will that mainly deals the property and inheritance issues. Such living wills, verbally transmitted, may in certain cases include advance directives regarding end-of-life decisions of the patient including refusal or termination of futile medical treatments. Since these living wills are never formally and legally validated, their application is impossible and treatment refusal remains still non practicable. Tricks to avoid institutional treatment under desperate conditions are used, aiming to provide legal coverage for medical teams and relatives that in extreme situations comply with the advice of withholding senseless treatment

Near-death experiences have been described with a variety of forms and narratives. Different medical conditions leading to loss of consciousness or causing a restriction in the perceptive field have been related with the appearance of near-death experiences. A few literary narratives of these experiences are available, with fictional characters exposed to helplessness and despair during the impending death. A situation of near-death experience is described in the last part of the seventh chapter of an Albanian novel „The castle‟ of Ismail Kadare. The last two pages of this chapter describe the confusion following the crash of a tunnel dug deep underground from Turkish soldiers, which aimed to reach inside a besieged castle. Darkness-related hallucinations and restriction of cognitive field due to environmental factors will be responsible of the aftermath following the deliberate crash of the tunnel, caused from the castle inhabitants, after fierce fighting during the siege. A fictional description of these experiences and of the psychological and physical agony will complete the rest. Near-death moments and respective descriptions have been an important field of medicine, humanities and forensic sciences. Only some writers have hazarded into describing such personal experiences of despair and helplessness during the agony and impending death.

Euthanasia is not legal in Albania, yet there is strong evidence that euthanising a terminally ill patient is not an unknown concept for the Albanians. The first mentioned case of euthanasia is found in 7th century AD mythology and during the communist regime (1944–1989), allegations of euthanising political prisoners and possible rivals in the struggle for power have widely been formulated. There is a trend among relatives and laymen taking care of terminally ill patients to apply tranquilisers in an abusive dosage, or even against medical advice, aiming at sedating the ailing patient. These actions, the refusal to keep on consistently applying life prolonging treatment, and other data, suggest that covert euthanasia is a practice and legal interventions are needed towards formalising it. This might well improve end-of-life care standards, since the inadequacy of structures, such as hospices and residential asylums, is becoming a major drawback in the struggle for dignity and accessible socio-medical help for third age persons and terminal patients