Experience du CHU de Sarajevo
Updated on 08/09/2011 by Dr Guillaume ThieryDevelopment of Intensive Care Medicine Bosnia and Herzegovina
Two university hospitals, namely the Clinical Centre University of Sarajevo and the Clinical Centre Banja Luka, have set up medical ICUs in 2009, thanks’ to the help of French intensivists.
Among country of the former Yugoslavia, Bosnia and Herzegovina most suffered from the wars which devastated the Yugoslavia in the 90’s. During this period, the medical system was mainly turned toward war injuries. After the war, the country and its medical system had to be rebuilt, but this took time. As a result, Bosnia and Herzegovina did not benefit from the major advances in intensive care medicine that occurred over the last 20 years could hardly.
When the war ended, a French network, the “Association Médecine France Bosnie-Herzégovine” got involved in this process of reconstruction of the medical system, by helping Bosnian doctors to implement modern European standards in medicine. As part of this cooperation, a French intensivist, Dr Guillaume Thiéry, from St Louis Hospital in Paris, went to Bosnia and Herzegovina in 2008 to live there in order to set up two medical ICUs, and to implement training programme of intensive care medicine. He is today the medical director of the Medical ICU in the Clinical Centre University of Sarajevo, the main hospital in the country.
A medical ICU in the Clinical Centre University of Sarajevo
This 2000-beds tertiary hospital is the referent hospital for more almost 1 million people. So far, there was a 12-bed surgical ICU, a 6-bed neurosurgical ICU and a 6-bed cardiosurgial ICU. The lack of unit to care for non surgical critically ill patients was obvious. In July 2009 a 6-bed ICU was created. Except its medical director the Dr Thiéry, the whole medical and nursing staff came from other departments of the Clinical Centre. Part of the medical equipment was given by some French hospitals, and part of it was provided by the Clinical Centre. After a few months, the ICU has shown its ability to care for critically ill patients using modern standards of care with reasonable costs compatible with local resources.
Creating a new ICU in such a hospital was both exciting and challenging, in an environment not used to this approach of intensive care medicine, and with a staff that was not trained in intensive care. The key point was, and will remain the education. Although the team had to face many difficulties, the obvious benefit for patients has always kept enthusiasm and willing to improve. When the H1N1 pandemics hit Bosnia and Herzegovina, the need for a medical ICU became clear, and the interest started to grow in the medical community. The next step, maybe the most important in order to ensure the sustainability of these units, will be the implementation of a specific training programme. The model of multidisciplinary supra-specialization based on the European model has been proposed and should be implemented soon.
Other intensivists in the US, some of them coming from ex-Yugoslavia, and in France joined the project. A network has then grown aiming to give Bosnia and Herzegovina a high level of intensive care medicine.
It is likely that many countries are in a similar situation regarding intensive care medicine. We believe that this model of development used in Bosnia and Herzegovina, namely the combination of the implementation of ICUs and the introduction of a supra-specialization training programme can be put into practice to many of these countries. The scientific societies of western countries could play a major role in such projects.