Serbia Trip Report
By Verica Seničić, Dr. Ivan Aksentijevich and Zoran Mladenović
From October 1st until October 8th, we traveled through Serbia and Republika Srpska. The primary objective of our trip was to identify new projects for 2018. We also wanted to investigate the current standard of care and diagnostic options for breast cancer screening and mobile mammogram, given that Serbia has the highest breast cancer mortality rate in Europe. Additionally, for the first time, we visited a few Health Centers and Hospitals in Republika Srpska (Višegrad, Gradiška, Prijedor).
Like every year, we come back from this this trip determined to do more to help people in Serbia. We are motivated by the good and honest health professionals we have encountered who still want to primarily help their patients. While the scope of our funding and faculty is sometimes limited, we are convinced that our work still has an immense impact.
Verica, Ivan and Zoran
Meetings at Institute for Oncology and Radiology, Institute for Public Health and Institute for Occupational Health in Belgrade
In Belgrade, we visited the Institute for Oncology and Radiology, which is part of the Belgrade Clinical Center. We met with Dr. Radan Džodić, Director of the Institute, and the Institute leadership. This institute is fully funded from the government budget and other European grants and there are currently several construction projects underway. These include renovations of patient rooms, and the development of a new surgical block, which will include seven linear accelerators and two gamma knives. Their only request was for help with finding observer opportunities for two or three of their radiation oncologists in training.
We visited the Institute for Public Health “Dr. Milan Jovanović Batut” where we met with Dr. Verica Jovanović, Director of the Institute. We wanted to understand some of the problems associated with poor prevention and early detection of cancer, especially breast cancer. Dr. Jovanović reviewed the situation with mobile mammography in Serbia. Apparently, there are two mobile mammography trucks covering the entire territory. According to Dr. Jovanović each truck runs on an annual operational budget of approximately $1 million. This includes repairs, salary, lodging, boarding, advertisement and outreach campaign, etc. Of the two trucks, only one is in operation, operated by the Clinical Center in Nis. Although the other truck is functional, it is not in operation because of funding and priority issues at the Institute for Occupational Health. In an effort to understand the situation better, we also met with Dr. Aleksandar Milovanović, the Institute Director there, and unfortunately realized that there is little desire or determination to change the situation. At this point, considering the cost of running the second truck, there is not much we can do.
We will continue to explore and identify other projects to promote early cancer screening and prevention in Serbia.
Visits to Lučani and Užice
During our tour of western Serbia, we visited Lučane health center and were happy to see that the EKG and autoclave, we donated last year were being put to significant use and functioning well. The hospital staff expressed that they are currently in need of a defibrillator.
In Užice we visited the hospital and met with its Board of Directors. We had a major fundraiser to collect funds for a new ultrasound system for Užice Hospital in May 2017. We confirmed that the new high-end Mindray N70 ultrasound system was delivered and operational. It is located in two rooms that were completely remodeled free of charge by Mr. Dušan Popadić, a contractor from Užice. With this ultrasound, physicians in Užice will be able to evaluate 20,000 patients every year. We also identified an additional need for a cardiac probe, special ultrasound software and a thermal printer.
Visits to Gradiška and Prijedor
We also visited hospitals in Gradiška and Prijedor in Republika Srpska. We donated 62 hospital mattresses to the OB/GYN wards of each hospital. After they requested help with the remodeling of toilets and showers for the OBGYN ward in Gradiška, Verica Seničić and Zoran Mladenović visited the hospital with the individuals from the construction company, SRMA Group. We met with the hospital director, Dr. Mirko Manojlović, and his staff. After inspection, we realized that the installation in all four levels of the vertical housing toilets and showers would need to be completely redone. We are working to understand the cost of this project; however, it will most likely exceed our funding capabilities.
The hospital in Prijedor is one of the major hospitals in Republika Srpska, together with the Clinical Center in Banjaluka and hospital in Bijeljina. We met with the director, Dr. Mirko Sovilj. The hospital was built in the 1970s, and was recently granted certification. The hospital invests a lot in the training and education of its staff; however, there were only sporadic capital investments, primarily driven by donations. The mattresses donated by SAMA are replacing mattresses that were in use since the establishment of the hospital.
Another significant stop on our trip was Kraljevo. The main hospital serves a population of about 500,000, extending over the Ras and Morava regions, and northern Kosovo. This city was also placed under considerable stress as it had to assimilate a large population of refugees from the ex-Yugoslav republics. The hospital has 560 beds and employs over 1,000 people, including about 200 doctors. It is the first hospital in Serbia that was accredited in 2007 and in 2016 it was declared the best hospital in Serbia. We toured the entire hospital and got a pretty good understanding of all their services. We encountered the following issues:
- The OBGYN ward is very busy (1,650 babies delivered in 2016) and needs renovation. Sometimes these infants need to be sent to Kragujevac or Belgrade (79 last year, fortunately only 16 this year), but they don’t have a transport incubator. SAMA will organize a project to secure a transport incubator for the Hospital in Kraljevo.
- They had a well-established screening program for colon and breast cancer. While the colon cancer screening is still working well, they have been unable to continue its breast cancer screening program because of problems with their mammogram. The cost of a new mammogram is between $175k-$200k, and it is out of our means; however, we will investigate whether we can identify a joint project with some other organizations to procure funding.
- Their oncology ward has indicated an interest in learning about and adopting aspects of the American standard of practice. As such, Dr. Aksentijevich plans to spend one week in Summer 2018 to provide voluntary medical services.