THREE people held down the screaming four-year-old boy while a doctor took a bone marrow sample. Another person held his mother at the door as she screamed hysterically.
In a Dublin hospital the boy would have had a general anaesthetic for the procedure.
In the Albanian capital Tirana the anaesthetic is non-existent.
James Dillon, chairman of the Irish charity Health Action Overseas, watched this procedure 10 days ago during a week-long visit to Tirana's devastated hospitals.
He returned home haunted by one question: how could this be happening in a city less than two hours journey by plane from London?
The diplomats' wives who might have organised the fund-raising lunches for emergency and routine medical supplies have left the city. The aid agencies pulled out before the elections and the children of Tirana's hospitals only have the hospital staff to care for them with little or no medical supplies.
Disposable gloves and needles are washed and reused in the main hospital, although there is no running water.
Women who give birth in Tirana's maternity hospital usually leave hours after the baby is born to avoid picking up secondary infections. Doctors stitch Caesarean sections with ordinary thread.
"There is a genuine attempt to do whatever can be done for these children. The staff in the hospital are really begging for help and making a genuine effort to make do with what they have.
Mr Dillon was talking to a doctor when a woman dressed in black came up to the doctor and shook his hand. She thanked him for everything he had done for her nine-year-old son, who had died.
"The doctor said that in any other country in the world this child would still be alive. But there were no medical supplies to intervene and in the later stages of his illness there weren't even any pain killers."
Another doctor told him of a colleague's efforts to save a man in Vlore, a town where some of the most vicious confrontations have taken place. The doctor worked on the man for 2 1/2 hours removing two bullets. Then gunmen burst into the room and shot his patient dead on the operating table.
"The collapse of the economy means that no matter who's in control there is no money for hospitals. Then you have the fact that so many civilians are armed. Even the Coca-Cola factory is surrounded by armed civilians. And every night after curfew there is gunfire."
Mr Dillon says his hardest moment when he picked up a baby girl in the children's hospital. She was one of about 15 babies in the room, all there because they were abandoned at birth.
"I asked, naively, what was her name and the nurses said she didn't have one. Then they said you give her a name but I felt it was too much responsibility for me. I already felt a bond with that unit that I couldn't break."
He has heard of women being raped by the gangs that roam the towns and villages outside the capital, and is not sure if this accounts for the high number of abandoned babies.
He filmed the children on their stained sheets in iron cots in the hospital. One badly dehydrated baby girl was bundled in what looked like a grubby sweatshirt and a folded pair of jeans was her pillow.
An eight-week-old boy with meningitis was hooked up to a makeshift drip and swaddled in a blanket. "He's losing weight quite quickly and the doctors were very pessimistic that the child would live." A four-year-old girl with huge brown eyes seemed to smile uncertainly at the camera.
"That child has a form of cancer. There is no chemotherapy available and no pain killers. She will certainly die over the next few weeks."
Health Action Overseas is one of the few agencies to have an active project in Tirana. Janet Colgan, a former Women's Aid worker, runs a helpline for women who have been raped or abused. Mr Dillon hopes to channel aid to hospitals through this women's project.
Next month the organisation plans to send three 40ft containers of aid - blankets, sheets and medical supplies - to Tirana. "We requested, and I think we've received, assurances from the Italian forces to get, the convoy through to Tirana.
Mr Dillon believes that Pounds 120,000 in provisions would solve the immediate hospital crisis. "It seems totally illogical to me that a country just across the water from Italy and up from Greece should be neglected by the European community.
"Sometimes in the hospitals parents who had stayed day and night with their children would just look at me. They looked as if to say 'please help my child.'
"It only took me 1 1/2 hours to fly there from London. Surely somebody can help them."
Health Action Overseas will hold a fundraising concert at Necarne Castle, Irvinestown, Co Fermanagh, over the August Bank Holiday weekend.
The line-up includes Van Morrison, Mary Black, Kieran Goss, Shane McGowan and Mick Flavin. Tickets are available on 0801 232 233322 in Northern Ireland (also operates as a donation line) and 01-4569569.
