There are scientists in Serbia whose image defies the prejudices about our country, which is unfortunately better known in the world for prisoners at the Hague Tribunal. One such scientist and leader in the area of cardiology is Dr. Miodrag Ostojić, head of the Department of Cardiology at the Institute for Cardiovascular Diseases at the Clinical Center of Serbia. He is a long-standing member of the Serbian Academy Arts and Sciences (SANU), the author of hundreds of scientific papers, and early in his career he spent a year (in 1978) specialising in Houston (Baylor College of Medicine and the Methodist Hospital) with celebrated Professor Dr. Michael DeBakey, and he later spent another year at the same hospital faculty as a visiting professor (in 1985). He has been invited to remain in the US and to take advantage of the opportunities that this wealthy country offers. Despite the favourable working conditions he enjoyed at the Texas Medical Center, he chose not to stay because he simply felt he was someone who could only thrive in this 'climate' – with fine people of pure heart. And he created a career here that shot him to the very top of international cardiology.
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The Serbian Heart Foundation – of which he is chairman of the board - was set up this year at his initiative. The Foundation aims to preserve and upgrade people's health, with special emphasis on the prevention and treatment of cardiovascular diseases, by applying modern know-how and technology. Asked why such an organization is important, Dr Ostojić explains:
- This Fund will become a member of the World Heart Federation, as nearly all countries have such national foundations. Its aim is to prevent and alleviate the epidemic of cardiovascular diseases currently raging in Serbia by taking action in several directions. One is to educate medical doctors as well as the lay population by organising symposia, lectures, TV conferences and so on…. Another goal is to collect funds so as to assist certain institutions. Having worked a long time in health services, I have come to realise that relatively inexpensive things are sometimes the most difficult to obtain. You plan for something that costs a million euros, and then you come to a situation where you have problems finding another two thousand euros. Thus, on September 26 -World Heart Day – the Fund presented three electrocardiograph devices to the Emergency Medical Center in Belgrade and one to the Cardiology Clinic at the Institute for Cardiovascular Diseases of the Clinical Centre of Serbia. These funds were collected thanks to donations from the Belgrade Land Development Agency, the Obrenovac Thermo- Electrical Power Plant, cash contributions from individuals and lecture fees earned by our experts, and given to the Fund… All these sums were paid into the Fund's account.
Until recently, there were two shifts at your Catheterization laboratories, but we understand you've introduced a third?
- We were forced to do so because there is a genuine epidemic of cardiovascular diseases in Serbia, as generations born in the 1960s are being afflicted with these diseases on a massive scale. Thus, since late October 2005, we were forced to open our catheterisation rooms around the clock. Thus far, we have dealt with some 400 cases of acute cardiac attack, encountering a death rate of two percent, which is a very significant reduction because conventional treatment results in a death rate between ten and twelve percent. To successfully treat patients who are having or have had a heart attack, catheterisation rooms are of pivotal importance to which patients are immediately taken after a chest pain arises. Emergency medical personnel establish diagnosis by way of an ECG machine, and these rooms must operate at any time of day or night, all year. The Ministry of Health of Serbia and the Health Insurance Fund have understood the proportions of this epidemic and we are now open on Saturdays, Sundays and during holidays, thereby expediting patients on waiting lists. Keeping these rooms open around the clock for acute heart attack patients is a great breakthrough for us, metaphorically speaking, something greater than the construction of the subway system in Belgrade. The Health Insurgence Fund has invested one million euros in this project for five hundred patients and here we are at the close of its first year of work. These days we are expecting to renew the project for the coming year.
An international symposium was held in Belgrade this year from which – thanks to the understanding and assistance of national television (the RTS) – 38 cardiological interventions from the Clinical Centre of Serbia catheterisation rooms were broadcast live during three days to the "M" Hotel Best Western hall where three hundred doctors participated interactively with suggestions and questions in the treatment of these 38 patients. The co-director of this symposium, along with you, was Japanese Professor Dr Shigeru Saito, a famous cardiologist and altruist. Thanks to the success of the Belgrade meeting, you have been invited to Kobe (Japan) for a similar, but larger symposium in the area of cardiac interventions. What was the topic of your lecture?
- I was invited as an international visiting lecturer, which was a great honor and responsibility, all the more so since there was a relatively small number of doctors from Europe and America that the Japanese hosts invited to this meeting as visiting lecturers. This was an invitation at a high level with business-class air tickets, accommodations at the best hotels, while we can hardly afford to pay our guests economy-class when they come here. However, it is a wonderful thing that they understand this; they understand that we are small and impoverished country. Professor Saito even paid with his own funds for his trip to Belgrade. My lecture was a very topical one and pertained to non-invasive (stress tests, stress echocardiography, Doppler echocardiography, multi-detecting computerized tomography, MRI) and invasive (coronarography, catheterisation, intravascular ultrasound, special wires that measure the flow through vessels of the heart) severity assessment of narrowed blood vessels of the heart. We have accumulated experience of our own in these areas, and are one of the centres with the most experience in so-called stress echocardiography. We conduct these tests while patients run on the treadmill, ride bicycles or are administered medication in the vein, and then we monitor the work of their heart on an ultrasound device and the ECG (electrocardiograph) and establish whether the arteries work properly. If an artery is narrowed, then a section of the heart contracts less vigorously as a pump, and we are in a position to establish that such a patient needs to undergo coronarography. As papers from our institution are cited in the best of the international books, this is the reason that I received the invitation to lecture on this topic.
How would you describe the standing of the medical institutions in Serbia as compared to those considered to be the best in the world when it comes to treating cardiovascular diseases?
- This is a question that patients ask me occasionally: is there a better place? I tell them that there is better, but that this does not pertain to the staff. Our staff is on par with the world's best, whether we talk about personnel with middle or advanced medical training, including cardiologists and other specialists. Nevertheless, as regards dispensable materials and instruments, we have yet to reach the best levels in Serbia. At the Clinical Centre we have equipment from 2004 and that is a relatively good thing. After two years of working day and night, a certain degree of upgrading of the system is now necessary, including both the hardware and the software, that is to effect improvement. Naturally, this equipment is not manufactured here but is delivered by large world companies such as Siemens, Philips or General Electric, so that the quality of our work depends on how well these devices are maintained, the quality of their servicing … One thing is for certain - of all the states that came into being after the break-up of the former Yugoslavia, and of all the countries of the former Eastern bloc, we are at the very top, if not the best. There are centres in the world that have somewhat better equipment than we have, giving them an edge over us, but we are at the top. Because we are very good at what we do, we are in a position to organise symposia every year in which the world's best cardiologists participate. I have already made mention of Dr Saito, and others include Antonio Colombo (Milan), Carlo di Mario (London), Junbo Ge (Shanghai), Aleksandar Doganov (Sofia), Christodoulos Stefanadis (Athens), Mathew Samuel (Chenai - India), Leo Finzi (Geneva), Kostas Totuzas (Athens), Maja Strozzi (Zagreb), Marko Noć (Ljubljana), Darko Zorman (Ljubljana). To these, of course, should be added my entire team and the most experienced cardiologists from the Dedinje hospital and the Military-Medical Academy hospital, those from Sremska Kamenica, from Niš, Kragujevac and Podgorica. Next year, we expect Franz Eberli from Zurich. The catheterisation room he heads is considered the cradle of intervention cardiology. On September 16, 1977, the first ever dilatation of a narrowed blood vessel of the heart was performed there. In addition to the above-mentioned names, S. Shandra (Hayderabad, India), T. Siminiak (Kowanówko, Poland), M. Rau (Bad Nauheim, Germany), M. Weber (Bad Nauheim, Germany), B. Petrovski (Skoplje) and perhaps some others, because we have many friends, will take part in the joint treatment of our patients at the catheterisation rooms of the Clinical Center of Serbia in Belgrade on April 11, 2007.
In passing, I would like to draw attention that it was thanks to these friends that we have retained the continuity of membership of the former Yugoslavia in the world and in European cardiology organisations since 1955, while the newly-emerging states had to apply for membership!
In recent years, has the problem of heart diseases in Serbia been given greater attention than over the past few decades?
- As regards the two new catheterization rooms at our Department that are used for examining the function of the heart and coronary arteries, the late Prime Minister Zoran Đinđić deserves credit for this. After nine years of trying to obtain these facilities from different governments, he received me, listened to what I had to say and after summing up the problem, we got these rooms. In 2004, you couldn't find better rooms for this purpose from Vienna to Athens. When I perform a coronarography, I can send an image to Houston or Milan within two minutes in order to consult with a colleague. Of course, as I've mentioned, certain upgrades of this equipment are necessary to supplement it with new, more up-to-date programs.
The Serbian government and the Health Insurance Fund have recently acknowledged the huge problem existing in this area, and they have invested no small means for both prevention and treatment. We have succeeded in entering the best medication on the so-called "positive list" so that patients can receive these medications paid for by the Fund. In this way, we are now in the position to adequately treat high blood pressure and increased levels of blood fat, as well as diabetes. Thanks to assistance received from the government, we have performed a higher number of dilatations of coronary arteries and stent placements from January 1– August 1 of this year than we did in all of 2005. It is indicative that funds are being invested and that there is great enthusiasm among cardiologists, radiologists, and other specialists, really, the entire medical staff. They are not concerned about working hours, whether it is Saturday, Sunday or a state holiday. It is no easy thing to maintain such a work programme, but I have a team that sympathizes in the misfortune that has befallen us with regard to the epidemic of cardiovascular diseases, and the team is trying to deal with it. Unfortunately, when it comes to heart disease, we are second only to Russia: out of every 100 deaths, 60 suffered from a disease of the coronary arteries or of brain arteries.
The healthy, and especially the sick, would like to hear a word of advice from a top expert in the field of cardiology.
- I appeal primarily for prevention, for healthy lifestyles. For instance, it has been established that it is more profitable to stop smoking and exercise on a regular basis than to have all those catheterisation rooms which each costs a million or a million and a half euros. In the US, they have calculated that if the number of smokers decreased by just one percent, in the course of seven years that would mean 98,000 fewer people being hospitalized, and this in turn would save the country three billion dollars. Investments in anti-smoking programmes are small compared to the returns. I think that we, too, have become aware of this in our society and that there is now a broad front for fighting for a healthy heart - from prevention to treatment.
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