HMD RESPONSE PROGRAMMES IN BOSNIA - HERZEGOVINA - SARAJEVO

In June 1993 HMD received an appeal for aid from the trauma and orthopaedic surgeons of the State Hospital, Sarajevo; who were in need of supplementary medical personnel. This was during a month when on one day 3,400 missiles landed in Sarajevo. Some NGO’s had been forced to leave and others were finding it difficult to recruit. Largely due to the encouragement and enthusiasm if two orthopaedic consultant surgeons – Hilali Noordeen and Chris Lavy – HMD Response was able to find and recruit medical volunteers. In co-operation with World Orthopaedic Concern (UK), to which we are grateful, HMD Response recruited and placed surgical teams for a total of 350 work days in Sarajevo over the next one year period. The teams consisted of highly qualified British, Irish and American personnel.

HMD RESPONSE'S CONTRIBUTION HAS CONSISTED OF:

1. Exchange of Technical Skills and Knowledge :
There has been an ongoing flow of improvement in medical techniques, in particular with regard to reconstructive orthopaedic surgery, between the surgeons of Sarajevo and Travnik and our visiting surgeons. This has contributed to reduced recovery time for patients thus increasing patient turnover; this is an enormous benefit to an over-stretched and under equipped medical system.

2. Provision of Equipment and Supplies :
Essential drugs and medical supplies have been delivered to hospitals and pharmacies. Specialist items needed for reconstructive surgery have been supplied, e.g. external fixtures, plates and screws for implants, drills and splits, spare parts foe equipment, antibiotics and anaesthetics, passive motion machines for rehabilitation, and several ultra sound devices.

3. Support for Development of Local Production of Orthopaedic Fixtures:
Fixater equipment for reconstructive orthopaedics is prohibitively expensive in the context of a war zone where demand may be high. HMD Response supported the local design and manufacture of orthopaedic external fixtures (patented as Sarafix). The design was conceived to meet local demands/ conditions and can be readily adapted for similar conditions elsewhere.

HMD Response is keen to support local initiatives like these and hopes to encourage local manufacture of prostheses as well as orthopaedic fixatures. The need for prostheses in Bosnia-Herzegovina is great, the number of amputees in Sarajevo alone is more than 400.

4. Provision of a Ultrasound Scanning Equipment :
A programme to detect congenital hip disorders in children was set up at the State hospital Sarajevo by John Beavis, Consultant Orthopaedic Surgeon and Senior HMD Response Medical Board Member. This programme was set up by the provision to the State Hospital of an Ultrasound Scanner. The Scanner is routinely used in detecting abnormalities in children which can subsequently be treated before the abnormalities deteriorate. The Programme is on-going and John Beavis is closely involved with training local medical personnel for the programme.

To date, this programme has been very successful and a subsequent programme has been set up in Travnik. Similar programmes are envisaged for other cities in Bosnia-Herzegovina. (In collaboration with the Linbury trust and VOCAL)

5. Rehabilitation of the Paediatric Clinic, Clinical Centre, University of Sarajevo :
In February 1996, HMD Response obtained the necessary funding to start the rehabilitation of the Paediatric Clinic. It is therefore vital in specialist treatment for children. Other than providing specialist treatment it is also a Centre for Excellence for training paediatricians and nursing staff. It serves an important health education role: it was foremost in organising and commencing preventative health measures in the area of childhood illnesses. The Centre had on its staff: eleven paediatric specialists, eight residence and four secondary doctors and general and specialised nursing staff.

Prior to the war the Paediatric Hospital was in a complex of buildings on the outer perimeter of the University Clinical Centre campus. It was part of the ongoing buildings programme which was interrupted by the start of the war. It was shelled and destroyed early in the conflict. The paediatric department was relocated to a temporary group of buildings before it was finally housed in its present site which had served as the Department of Nuclear Medicine. The original building had a capacity of 220 beds and cots, the present building has a capacity of 50 spaces. Due to the reduction in the population both in Sarajevo and the Federation and the shift in emphasis from a predominantly hospital based system to a primary care family doctor oriented system it is estimated that less that 100 spaces will serve the medium term needs. A minimum of 10 years’ useful life for this building for the paediatric department has been calculated by the Clinical Centre authorities and by the Director of the Paediatric Department and it will serve the immediate and medium term needs of the region. The Paediatric Hospital is the main referral department of the city of Sarajevo and its suburbs as well as being the tertiary referral centre for the whole of Bosnia-Herzegovina. As such it plays a vital role in the diagnosis and management of conditions such as malignancies, neurological diseases, difficult respiratory conditions and psychomotor retardation requiring specialist intervention as well as general paediatric care. In addition to this it also enjoys the reputation of being the centre of excellence for training paediatricians in organising and commencing preventative health measures in the area of childhood illnesses.

Reconstruction and re-adaptation of the unit from a Nuclear Medicine Department to a Paediatric Department commenced three months ago. This work has been divided into two phases and HMD Response, with funding from Irish Aid, is implementing the First Phase.

The First Phase includes repairs to roof, interior plaster work, painting interior and exterior woodwork, tiles and ceramic work, repair to existing woodwork, electrical repair, elevator repair and repair to the façade to insure insulation against wind and rain. The work will have two important effects:

1. It will provide essential repairs to allow children, their parents and carers decent living conditions
2. It will increase the existing bed capacity from 50 to 100.

This work, from necessity, is being done while the patients are still resident, making conditions difficult for all concerned but urgent before the onset of winter.

Further work in this phase includes repairs and safety services deemed necessary by the Clinic authorities and the Director of the Paediatric Department. These include the Director of the Paediatric Department. Included are: Fire Safety measures, repairs to remaining floors, repairs to telephone system, servicing to air conditioning, furniture and physiotherapy bath.

Phase Two will provide for essential neonatal and paediatric equipment to bring the department to a revised pre-war standard.

HMD Response has established a productive relationship with all the groups involved in the First Phase reconstruction. The Technical Sector of the Clinical Centre will supervise and provide assessments of the works to be done. Working in close collaboration with the Technical Sector will are the site supervisor and an engineer employed by HMD Response. It is expected that, as in the First Phase, local contractors and supplies will be utilised wherever possible. A local procurement agency will research the most cost effective medical equipment while collaborating with the Paediatric Department. Construction material and furnishings are available locally. Specialised medical equipment will be sought locally and in countries which supply reliable regular servicing.

The project to rehabilitate the Paediatric Clinic is being supervised by Dr. Paraic Curran (GP and Paediatrician) and Mehmed Yamakosmanovic. HMD Response has retained as consultant and technical supervisor to the proposed programme Ing Faruk Dizdarevic B.Sc, Head of the Engineering Department at the Clinical Centre. He is also the Technical Chief of the Structural Planning Committee for the country.

The First Phase reached completion on 25 July 1996. (In collaboration with Irish Aid)