Development of Critical Care Medicine in Post-War Republic of Srpska - Banja Luka Region

Peđa Kovačević

doi:10.5937/scriptamed54-43703

Peđa Kovačević University Clinical Centre of the Republic of Srpska, Banja Luka, the Republic of Srpska, Bosnia and Herzegovina

DOI: https://doi.org/10.5937/scriptamed54-43703

Keywords: Critical care medicine, Low-middle-income countries, Development

Abstract

Critical care medicine as relatively young discipline, started developing in mid-1950s in response to epidemy of poliomyelitis. This branch of medicine evolved much faster in high-income countries (HIC) than in low resource settings (LRS) where the Republic of Srpska (Western Balkan) belongs. The experience of setting up a modern critical care program under the LRS constraints as a promising way forward to meet the increased demand for critical care worldwide is described. Main tool was systematic analysis of written documents related to the establishment of the first multidisciplinary MICU and its development to the present day. Successful development is contingent on formal education and continued mentorship from HIC, establishment of a multidisciplinary team, the support from local health care authorities, development of a formal subspecialty training, academic faculty development and research. Critical care medicine is a critical public health need in HIC and LRS alike.

References

1. Lassen HCA. A preliminary report on the 1952 epidemic of poliomyelitis in Copenhagen with special reference to the treatment of acute respiratory insufficiency. Lancet 1953;1:37–41.

2. Reisner-Sénélar L. The birth of intensive care medicine: Bjorn Ibsen’s records. Intensive Care Med 2011;37:1084–6.

3. Tang W, Sun S. Max Harry (Hal) Weil – a leader, mentor, friend, and wonderful colleague. Resuscitation 2011;82:1481–2.

4. Vukoja M, Riviello ED, Schultz MJ. Critical care outcomes in resource-limited settings. Curr Opin Crit Care 2018;24(5):421–7.

5. Kovacevic P, Meyer FJ, Gajic O. Successful implementation of modern critical care in the low-resources country Bosnia and Herzegovina: Single-center experience. Med Klin Intensivmed Notfmed 2022;117:269-75.

6. GDP per capita (current US$) [Internet]. World Bank national accounts data, and OECD National Accounts data files. [Cited: 1-Apr-2023] Available at: https://data.worldbank.org/indicator/NY.GDP.PCAP.CD?locations=BA.

7. Losonczy LI, Papali A, Kivlehan S, Calvello Hynes EJ, Calderon G, et al. White paper on early critical care services in low resource settings. Ann Glob Health 2021 Nov 3;87:105. doi: 10.5334/aogh.3377.

8. Thiery G, Kovacević P, Straus S, Vidovic J, Iglica A, Festic E, et al. From mechanical ventilation to intensive care medicine: a challenge for Bosnia and Herzegovina. Bosn J Basic Med Sci 2009;9(Suppl 1):69–76.

9. Rosenthal VD, Yin R, Lu Y, Rodrigues C, Myatra SN, Kharbanda M, et al. The impact of healthcare-associated infections on mortality in ICU: A prospective study in Asia, Africa, Eastern Europe, Latin America, and the Middle East. Am J Infect Control 2022 Sep 6:S0196-6553(22)00658-7. doi: 10.1016/j.ajic.2022.08.024.

10. Tokalić R, Viđak M, Kaknjo MM, Marušić A. Antifragility of healthcare systems in Croatia and Bosnia and Herzegovina: Learning from man-made and natural crises. Lancet Reg Health Eur 2021;7;9:100216. doi: 10.1016/j.lanepe.2021.100216.

11. Kovacevic P, Djajic V, Momcicevic D, Zlojutro B, Jandric M, Kovacevic T, et al. Boosting ICU capacity during the COVID-19 pandemic in the western Balkan region, the Republic of Srpska experience. J Public Health Res 2023;25;12: 22799036231151762. doi: 10.1177/22799036231151762.

12. Kovacevic P, Dragic S, Kovacevic T, Momcicevic D, Festic E, Kashyap R, et al. Impact of weekly case-based tele-education on quality of care in a limited resource medical intensive care unit. Crit Care. 2019 Jun 14;23(1):220. doi: 10.1186/s13054-019-2494-6.