Interview
 

Interview
Assistant professor Aleksandar Ljubić:  

PROBLEM OF FERTIL IT Y IN SERBIA  

“A decade before there were 140,000 births a year in Serbia , and nowadays there are up to 80,000 births a year. In the same period abortions decreased twice. The outstanding problem is that our women do not avoid the pregnancy. It is to reveal existence of possible genetic disorder with potential consequences”, says the deputy director of the Institute of Gynecology and Obstetrics , Belgrade .

On the way back from USA via UK he left a trail as no clinician before. Like visiting professor at the State of Indiana University, he was invited to St. Vincent Hospital for introducing his own practice and sharing the knowledge.

His visit did not remain interesting for the professional circle only. It arouse the journalists' attention and he was showered with interview requests. The theme of interest, concerning the Siamese twins, was mostly unusual and surely intriguing for the people of America .

This is a very rare diagnosis in gynecology which concerns most difficult complications in pregnancy. The incidence of this anomaly is one to 80,000 pregnancies, with 60% fatal outcome for the newborns. Three quarters of Siamese twins are unable to reach the early juvenile period.

What did a ssistant professor Aleksandar Ljubić, the deputy director of the Institute of Gynecology and Obstetrics at the Clinical Center of Serbia (well-known Delivery ward at Visegradska Street ) , say to his American colleagues?

  • A year ago we delivered four Siamese twins. It was a frightening situation that challenge many medical, psychological and ethic dilemmas. The families were very much upset by these births. Mechanisms that interfere the 12 and 13-day separation are well known. Many factors exert the influence on the separation. Therefore, the incidence of Siamese pregnancy is a bad predictor.

The people of America were concerned before while our public remained silent about these events, and more information flowed from abroad?

  • Surely! Somebody's misfortune is bad news. That is a wrong way of getting the publicity for a hospital and clinicians. I will repeat that more important is if these events gain more publicity, accomplishing the new expert contacts, continuous studying, and help from abroad.

Would you visit USA again? Were you comfortable in representing the Clinical Center of Serbia and University of Belgrade School of Medicine? 

  • Mrs. Biljana Latinović – Jekić from the Princess Katherine's Foundation, Mr. Nebojša Radamnović, PhD and me returned the visit of American colleagues. Few months ago a group of experts from USA visited our institutions and monitored the health service in Serbia . First we visited the hospitals in London . We were interested in monitoring the system of health services and establishing the long term cooperation. We are aware of our stagnation for the last 15 years. To the mutual satisfaction we had an excellent reception, and we met distinguished colleagues. They have planned to return a visit to Serbia and we plan the training visits for our students. Also we discussed joint projects with potential international financial support. These projects concerned the collateral damage of bombing, chemical pollution, nutrition etc.

Does it encompass your field of specialization?

  • Of course, we are investigating the impact of the above mentioned factors to heredity, genome, because they affect the incidence of anomaly, fertility disorders. The cooperation will involve the clinicians of different specializations and enable collaboration in the future. Clinical Center Management supports our intention for carrying out the innovative projects.

Beside the reconciliation of the opinions, did you undertake any procedures?

  • During our visit a woman from Mexico was admitted at the hospital with diagnosis of Siamese twins pregnancy. There was no practitioner experienced in conducting this type of pregnancy. The director of the Hospital Professor Alan Glichovsky was informed about our previous experience and consulted us for the suggestions concerning the particular pregnancy. This consultation gave us unexpected publicity.

What is their opinion about medical practice and research in Serbia ?

  • The colleagues from USA and UK showed respect for medical practice in Serbia , and confirmed the intention for further collaboration concerning the training courses and research work. They estimate that well educated practitioners in Serbia apply European principles of medical school and lack of modern medical technology.

We were informed about the promised donations? 

  • The adjacent hospital in Indianapolis had between three and five years old available medical equipment. Since they acquired new equipment the old was replaced and preserved. During our visit supported by the Foundation we got a proposal for donation of this equipment which will be delivered to Serbia in the spring. In the meantime professor Golberg, the former president of the World Association for Endosonography, came from Philadelphia and offered us a donation of 20 ultrasound machines with only prerequisite that we take the transportation on ourselves. HRH Crown Princess Katherine by herself managed to organize a financial donation for people of Serbia . The communication within the scientific circles is established on personal enthusiasm. There will be mutual visits with exchanging the experience and knowledge in an effort to consolidate our reputation in medicine.

Did the Institute of gynecology and obstetrics get any other support?

  • We achieved more. With a help of the people and the state of Japan we got a donation of medical equipment for the operating room, delivery ward and neonatal care unit. With a support of HRH Crown Princess Katherine we reconstructed a new operating theatre for Caesarian sections and intensive care unit. In the future the pregnant women and patients with malignancies will be treated in separate units. I am proud to inform you that this project was carried out by the national construction companies with the aim to support the children care. The slogan of this charity action was « Future of Serbia – mothers and children ».

In our poor economic situation every donation for the Institute is valuable?

  • More than one hundred of 700 employed at the Institute of gynecology and obstetrics are physicians. The Institute was founded 80 years ago. Reviewing the past we are satisfied with continual development of the Institute and achieved demands of modern medicine by the means of the active personnel training and adequate education, and preserved ethic attitude of medical treatment. Despite the poor economic situation in a daily practice we favor the empathy and emotional attitude for our patients. Regardless of the maximal efforts in some cases we are facing the failure of medical treatment. We are less powerful than nature and God, and bitterly we regret every loss. The work is our main strength for carrying out the mission. Sometimes a bad outcome results from our actions with a public discontent. Fifty percent out of 20,000 medical workers in Serbia are physicians. Daily situation is that the question - how are you - is followed by statement “I'm in pain”. I am surrounded with people that permanently help the others. The society shares a partial responsibility for public health service. We act considering the social and economic conditions. I try to raise self-confidence due to permanent improvement in conducting the new therapeutic methods and permanent medical care for our patients.

You have mentioned before the problem of fertility in Serbia . Would you discuss the facts?

  • Serbia is facing the problem of an old nation with decreasing fertility, birth rate and abortion rate. A decade ago in Serbia there were 140,000 births a year, and nowadays there are up to 80,000 births a year. The outstanding problem is that our women do not avoid pregnancy but are facing the problem of conception. Rate of premature deliveries and spontaneous miscarriages has increased. Academy of Science in Serbia is currently conducting a prospective study concerning the objective parameters of reproduction in the last decade the results of which will be presented at the International Conference in June 2004. That is a predictable burning problem. The problem of conception has an equal impact to both of potential parents. It is to reveal the existence of possible genetic disorder with potential consequences to fertility. First we have to investigate the impact of external factors, and afterwards to reveal the conclusions.

The fertilization in vitro brings the solution for many marriages. Are you practicing this method?

  • Fertilization in vitro became a routine medical treatment for exceeding the problem of sterility. The Institute of gynecology and obstetrics in Belgrade is the only public hospital practicing all methods of this complex and expensive treatment. The costs of procedure are not covered by health insurance and patients do the payment alone. Total or partial coverage of the cost would make this procedure more accessible for parents in need. The financial monitoring enables the estimating of reliability and quality of this method. Our results have satisfied the European criteria for health services.

The pregnancy conceived in vitro fertilization requests specific caution. High incidence of multiple pregnancy, specific prenatal care and continuous invasive tests are typical for this procedure. For spontaneously conceived pregnancy the incidence of twins is 1.2%, and in vitro fertilization has a rate of 23% for twins and 2-3% for triplets. Multiple gravidity is under specific risk of increased possibility of abortions and premature delivery (delivery of twins is commonly expected in 31st to 32nd pregnancy week).

Current available medical treatments of fertility disorders and gravidity complications have a positive impact to parental and reproduction care in Serbia .

Ognjen Janevski