02.03.2012.
Interview with the Head of the MMA Brig Gen Marjan Novakovic
YEAR OF EQUIPPING
The Staff at the Military Medical Academy is marking the 168th anniversary of the institution on 2 March. This year can be called the year of purchasing of equipment as modern equipment will significantly boost the treatment of patients.
Brigadier General BA. Dr. Marijan Novakovic, a renowned plastic surgeon who has performed the most complicated surgeries in almost all areas of plastic, reconstructive and cosmetic surgery was appointed Chief of the Military Medical Academy one year ago. He was known as a man of continuity, a person with knowledge that will, perseverance and strong organization lead the institution forward. We talked with him before the celebration of the Day of the MMA.
• General, how would you rate the previous year? Have you seen any improvements in the work of the MMA?
I think that in this period, the MMA has made progress in treatment, and in science and in education. Specifically, the quantitative progress has been made in the number of treated and cured, but also qualitative, as new diagnostic procedures, especially in radiology, as well as in some segments of the laboratory have been introduced and implemented. There are significant changes in the therapeutic sense, since they the latest protocols in the treatment of malignant disease have also been used. The fact that our Ministry of Health certified us to become a reference Cancer Center has significantly influenced us to improve of our work. This means that we can not only diagnose malignancy but also to treat the respective cytostatic or other forms of therapy.
Opening of angio-rooom and new linear accelerator significantly reduced waiting lists for treatment of military and civilian insured and provide therapy. Furthermore, purchasing neurosurgical operating microscope enables precise execution of operations in benign and malignant processes in the brain. This will certainly improve our surgical technique and increase the rate of cured of patients.
International cooperation has also been intensified. We constantly had visits of international delegations of military and civilian medicine. This year we plan visit several military hospitals in the U.S. and prepare the ground for future military medical cooperation as part of visit plans of our Ministry of Defense.
We are about to enroll s new generation of cadets in military medicine, and recently we have another class of doctors on a voluntary military service. Another novelty is that this generation has members of the fairer sex, which is in line with UN Resolution 1325. After completing military training, the number of trained doctors with all female doctors will be significantly increased in the defense system. This will serve to make up for changing of doctors stationed in troops and will allow our colleagues to start specialization as soon as possible.
• Recently while launching a new linear accelerator, Minister of Defense said that purchasing new equipment and modernization will continue along with the modernization of military hospitals in Serbia. What else does the MMA need to buy and restore its work?
- This year, like last, we plan to acquire new ultrasounds, particularly for gynecology, where they can be used for proper diagnosis. Procuring some latest generation of devices for cardiology and nephrology is in the plan for the Centre for Solid Organ Transplantation. Purchasing these devices will significantly contribute to better diagnosis in these branches of medicine. Some parts of the plan envisions modernizing labs, by buying new lab equipment and reagent chemicals.
Our surgeons and surgery techniques are our brand and we must work to improve this segment. We expect that this acquisition will include buying new operating tables, operating lamps, as theese are obsolete as they were bought 30 years ago.
All these technological innovations will be followed by regeneration and development personnel in the country and the world centers. A female colleague, who specializes in internal part solid organ transplantation in the area of liver transplantation, will be sent to one of the largest centers in the U.S. which specializes in this pathology.
• Given the economic situation and the cuts in the military budget, is it realistic to expect those supplies?
- We try to make realistic procurement, ranging from the everyday purchases of disposable medical supplies, medicines and other things. I think that we have support, especially financial, and other users of our services. In particular, I would like to emphasize that the Republican Health Insurance Fund is complying with every aspect of our contract for the provision of civil policyholders. In addition, there are also insurance holders from Montenegro, Serbian Republic, with whom we have signed contracts, but also from other countries in the region.
• Has Wednesday - when you're on-call as an emergency room has become routine?
- We admit civilian health insurance holders on other days, but that day we are on duty for the whole of Serbia, and all acute illnesses and injuries is upon the MMA to deal with. Our teams are well coordinated and that the days they perform examinations, treatments and operate a large number of people. Of course we cooperate with other clinical centers and medical institutions in Serbia. We strive to always meet the needs of patients and provide treatment for our more serious cases of injury and illness, with prior notification and consultation with their treating physicians. Now only do we help the Orthopedic Clinic, which is under renovation, and provide care for some emergencies that this clinic should admit.
• Late last year, you announced that the MMA will hire 171 new medical workers – of all profiles: doctors, nurses and technicians. When do you expect staffing to refresh?
- Now we have a little more empty space for a generational change, retirement and other factors. That issue settled plan - holding competitions for specialists and for senior and middle medical technicians. So we can physically enhanced to provide better service to our policyholders. As we and institutions dealing with education, the clinics where they are needed we will receive the young doctor, who will end up in our specialization. Those who specialized in show quality and commitment and successfully pass the final exam, will allow to remain in permanent employment.
We are soon going to announce vacancies for specialists, residents and medical technicians. The goal is avoid the generation gap between highly skilled colleagues, professors, assistant professors, specialists and young people. We need continuity in education so that young fellow colleagues have the time to work with their older colleagues, after specialization, to gain additional knowledge and experience, which, of course, they will implement the treatment as if they worked in the department for treatment.
• The School of Medicine, University of Defence MMA this year will enroll the fourth generation of cadets at the Military Medicine study. What are the experiences?
- Experiences are very good. Not ply the professors from the MMA, but also from other faculties, who give lectures say so. They are enthusiastic about the activity and motivation of our students, which in the end, is proven by their grades because the average GPA of cadets is B. No wonder when they were submitted to rigorous testing and selection before enrolling the school of medicine. In addition to undergoing medical examination and tests of knowledge - universal for all medical schools – they underwent psychological testing. Experienced clinical psychologists checked future candidates, based on the new program and specific tests that are done in our ministry, to prove not only if they are in the clinical sense capable of performing military service, but may indicate the development of their profession.
Rigorous selection contributes to a having a small class of students and enables good mentoring. We had as many as ten applicants for one spot. This selection has given excellent results in these three generations of cadets we have had so far.
• There is a continuation of exchange of expertise on national and international level that continues. Last year you hosted numerous professional and scientific meetings, workshops, and guest lectures at the Academy of eminent figures from the medicine. Which part would you highlight?
- There was practically no branch of medicine that did not organize a scientific meeting of the MMA, whether as a regular expert meetings of some associations - pediatricians, gynecologists, surgeons of any branch, internists, psychiatrists, transfusion ... Almost every week there was a meeting. We had an outstanding guest from India, who held an honorary lecture in the field of solid organ transplantation. His findings have significantly influenced our thinking about the work in the field of solid organ transplantation, which now deals with transplantation of kidneys and liver, and is also planning the development of transplantation of other organs.
In addition, in collaboration with colleagues from abroad - Germany, Spain, the United States - and the Serbian Medical Association, a Symposium in Reconstructive Surgery was also held. Present colleagues rated this as one of the best meetings that deals with reconstructive surgery.
We are happy to receive domestic and foreign colleagues who want to participate in our professional meetings, this being a good chance that our doctors learn something new.
We started to organize meetings in continuing education when the colleagues from the Medical Chamber, the Serbian Medical Association and other organizers offer this. Furthermore in order to get a proper license and certain points as a medical institution, we are obliged to organize meetings of doctors and medical staff. The last meeting was organized by the Serbian Medical Chamber dealing with maltreatment and misdiagnosis. Lectures resulted in a conclusion that we need to improve communication. This is something I insist on, when it comes to communication between doctors and nurses, because I have the impression that such communication is lacking.
• Another novelty of the a three-year program training15 Algerian military doctors at the Academy. Do you expect that foreign doctors will come to you in futuire as well?
- Military Academy has always been known for educating not only our young doctors. We had a postgraduate type specialization, master's, doctoral, and now the basic study of medicine, which are also foreigners. My impression, and to see the basis of numerous bilateral meetings with other delegations, each of which tends to visit the MMA and meet with the basic elements of work that is increasingly concerned that, in addition to its enrollment of students in basic studies, we wanted to send doctors of specialization.
I expect them to be even more. This is the first tour of Algeria. Colleagues from Angola also showed interest in this type of training. When we recently had with them in high ministerial visit in their main military hospital, we met a solid fellow who speak Serbian, since they had spent 30-35 years in our country on specialized studies in anesthesia, radiology, internal medicine. Very nice, we were received in his country, still preserved in Serbian.
• You had numerous visits of a number of foreign delegations, and some, like German delegation, wanted to see the Institute for Medical Research from the vivarium of MMA and of test animals on the Torlak farm. What will be happen to these institutions, as without them we cannot imagine any research?
- Not only German colleagues, but others, especially those engaged in basic studies, are satisfied when they see that how we perform experimental surgery on animals. Vivarium is an old story, because it has been since the establishing of the MMA. It enables allows these experimental surgeries to be performed and contributed to the establishment of new methods of surgery, but we must rationalize. It will continue to exist, but we will determine the new guidelines - which part of medicine it can be used for and which segments of medicine have no need for it. This does not concern the vivarium alone, but the farm of test animals as well. Unfortunately, when your priorities are treatment and education, scientific research is always neglected for financial reasons. Farm animals will return with Torlak, partly from urban areas, mostly have to relocate.
We think that this year the capacity of the Institute for Medical Research to direct the development of IVF medicine - artificial insemination. We have all the facilities and apparatus, and personnel - molecular biologists, gynecologists, pathophysiology, which will deal with this segment of science. You know that the military unit now has more women, so we have to develop that part and gynecology.
• Improvement and development of the MMA remains imperative of the time, but this is a huge responsibility and obligation. Do you now encounter fewer obstacles along the way?
- Generally, there are no obstacles, as everyone is willing to cooperate. This also goes for ministry of defense and the Ministry of Health, National Health Insurance Fund, and all other funds from neighboring countries. I think that in some areas of work there should be fewer administrative procedures which tend to slow the whole process of treatment. In all other segments – when it comes to contacts with colleagues from other clinical centers, doctors, deans of medical schools, and public relations – we have encountered no problems, all to the contrary. MMA is not stagnating, on the contrary - I think it goes further.
FIGURES
MMA as a hospital treated 11 309 22 369 military and civilian insurance holders last year alone. A total of 27 739 operations performed, day 10.5. The Emergency Room examined a total of 48 739 - 17 852 30 887 military and civilian insurance holders. On Wednesdays when MMA Emergency Room is on call, a total of 20 461 patients were admitted (426 per day) and while 2372 people - 2503 military insured persons (398) and 17 958 civilian (1974) klept for further observation and treatment.
The National Poison Control Center examined 3986 patients. The Center for transplantation of solid organs transplanted kidney is 21, out of nine cadaveric (compared to a total of eight cadaveric kidneys in the period since 2005. Until 2010.), Five liver transplants. When it comes to the outpatient treatment than medical center, in the cabinets of 277 740 people were examined, and diagnostic exams was 46 953.
RESULTS
During the last year were put into operation a linear accelerator - to implement 3D confrontal seterostatic and radiotherapy for cancer patients (investment of 260 billion RSD.), hyperbaric chambers - the capacity of 8 plus 2 seats (an investment worth 70 billion RSD.), Angioroom implementation of cardiovascular interventional procedures in patients with acute coronary insufficiency (investment of 60 billion RSD.) and computer network connections in 1200, for implementation and commissioning of health care information systems.
MMA School of Medicine within the Defence University, which this year is enrolling fourth generation of cadets at the Military Medicine study, initiated the program for the training of 15 Algerian officers in various aspects of specialization of the MMA established a center for solid organ transplantation, a Military Medicine review received his first impact factor.
