Delivering babies in Sarajevo
Daniel Keith shares his experiences
During my eight week rotation in Obstetrics and Gynaecology I was given the opportunity to spend 2 weeks working anywhere in the world, to see a contrasting picture of women’s health. I chose the gynaecology department at the Sarajevo University Hospital.
Why Bosnia?
Everyone I told about my plans asked the same question. And I struggled to come up with an answer that would satisfy them. The question didn’t stop when I arrived in Bosnia. My Serbo-Croat was little better than tourist and I didn’t really know anyone in Sarajevo itself. In truth there is just something about the Balkans that keeps drawing me back. In practical terms for a short elective it seemed just right. It’s relatively cheap, nearby and easy to get to. Yet it’s culture and recent history make for a sufficiently different experience of medicine.
The City
The war ended 12 years ago, but as any visitor can confirm, the scars are still plainly obvious. In certain areas buildings lie in ruins and many are marked with bullet holes. On a stroll in the park I came across a crashed helicopter, which made for a strange sculpture when covered in snow.
Sarajevo has however landed on its feet. New skyscrapers and shopping centres have sprouted in the business district, and the historic parts of town have largely survived. The tourist industry is rejuvenating rapidly, both in the summer and for the winter skiing. The general feel is that of a typical central European city, but with a definite eastern mix. I suspect there is nowhere else in the world you can find a mosque, a synagogue, an orthodox and a catholic church facing each other.
The townsfolk are some of the friendliest and most hospitable anywhere, and as diverse as the ethnic and religious groups they fall into.
The Medicine
The buildings of the university hospital was badly bombed during the siege of the city. Most had reopened when I arrived, but the obstetrics and gynaecology building, which had been completely destroyed, was still under construction. Women’s health was therefore temporarily relocated to an old convent. The building had been a Catholic convent until the 1940s, when it was loaned by the church to the hospital. It became the department of Ophthalmology until the mid 1990s, when out of necessity ophthalmology moved out and obstetrics and gynaecology moved in.
The feeling inside was close to that of a field hospital. Many things were improvised. Almost everything was reusable. Something that surprised me, coming from a hospital where almost everything is disposable. It was like taking a step back in time. Saline was hung up in glass bottles, that were washed and refilled. Tubing was that orange rubber familiar to school chemistry labs. All instruments were washed (by medical students) and reused. School pupils on work experience were responsible for rolling cotton balls. Everything down to the doors were stamped “EU reconstruction” or “US Aid Program.” Yet in amongst this they were slowly introducing high tech instruments and diagnostic tools.
My typical day started at the general handover meeting at 9am lead by the department director Prof. Bukvic. A summary of all the patients, little of which I understood. The doctors luckily spoke English for the most part. I then attached myself to a specialist for the day and accompanied them to their clinics, rounds, operating lists and labour ward shifts. Each doctor seemed to see a couple of clinic patients, do a couple of operations and do a ward round and perhaps deliver a baby in one morning. During my stay I managed to see an impressive array of gynaecological procedures. The doctors were very keen for me to get hands on, and so I feel that I am more experienced at gynaecological examination that if I had stayed in the UK.
I spent much of my time there observing and assisting with operative and normal deliveries. Compared with my time spent on a UK labour ward, this was certainly an experience. There was yet again a sense of stepping back in time. There was no privacy. The delivery room was one cramped room with 4 beds, often with 4 women labouring at the same time. They lie with their legs open facing an observation window, where medical, midwifery and nursing students pack in to watch. Almost all normal deliveries were performed with no anaesthesia or analgesia. Episiotomies are routinely performed on all primips and roughly 80% of multips, a practice once popular in the UK. Furthering the image of old fashioned medicine the newborns are whisked away by the midwives and wrapped tightly in swaddling cloth. I was able to assist with almost every aspect of a delivery and really came away with an appreciation of how brave Bosnian women are.
Final impressions
Sarajevo may be a city under reconstruction, and medicine may still be old fashioned, but the improvisation and resourcefulness of the people has left me with a lasting sense of respect and I believe I learnt more clinical skills in those 2 weeks than the rest of the Obs and Gynae course. It has given me great food for thought to our throwaway culture and reliance on the high tech, and at the same time a look into a rapidly closing window on our own recent medical past. Given another 10 years I wouldn’t be surprised if the Sarajevo University Hospital was indistinguishable from any major European teaching hospital.
My special thanks to Prof. Faruk Havanic and the Glavni Sestre at the Klinicki Centar Universiteta u Sarajevu for a fantastic experience.
Advice to students wishing to visit the hospital - contact Prof Havanic to arrange an elective here. Get microbiology swabs taken for MRSA before departing. Bring your own theatre clogs.
Daniel J. Keith
5th Year Medical Student
Oxford University Medical School
UK
daniel.keith@medschool.ox.ac.uk