Helping change in Moldova’s health sector – by a SICOT Young Surgeons Committee member

  Bassel El-Osta
  SICOT Associate Member & SICOT Newsletter Editorial Board Member - London, United Kingdom

Many junior doctors around the world would probably think that only when one has the Certificate of Completion of Training can one change another person's ways of practicing medicine. A lot of junior doctors would maybe think that one should become a professor for someone to listen to them. Indeed, many young surgeons think that one has to keep quiet and listen, so their senior will teach them. But, I think there is always an exception to the norm!

I would like to share the experience that I have had in the past month in Moldova, where a fundamental health care has had a change.

Moldova is the poorest economic country in Europe and it was part of the former USSR. It is located between Ukraine and Romania and most of the population speaks three languages, namely Russian, English and Moldovian. The country is well known for its wine, however it is a totally forgotten country in Europe and the health system is an ex-traditional Soviet system.

A few years back, while I was attending the SICOT Trainees' Meeting in Moscow, I met Prof Georghi Croitor who explained about the situation in Moldova regarding trauma. Almost a year ago, I went to visit him in Chisinau, the capital of Moldova. During my visit there, I visited one of the Emergency hospitals where I met a group of brilliant trauma surgeons who work with the minimum of equipment and facilities. However, when I started to explore the trauma system in that country, I recognised that there was a huge gap in the delivery of trauma care and there was no appropriate safe method of early trauma management. The mortality rate after an RTA was quite high, there was no appropriate transfer system and, therefore, there was no appropriate receiving system.

For instance, once a trauma patient arrives at the hospital, the patient will be admitted and cared by the anaesthetist, who will then stabilise the patient and observe him/her for 24 hours and then refer to the appropriate surgical team for definitive treatment. In fact, when I was there, there was a case of a 23-year-old man who had developed compartment syndrome and was about to lose his leg because the anaesthetist did not do any primary or secondary survey.

So, it came to me that ATLS should be introduced to this country where doctors, nurses and primary care medical personnel should be trained through the ATLS system. I discussed the introduction of the ATLS with Prof Gheorgie Croitor who supported the idea and believed that together we could achieve something greater for the country. At the British Embassy in Chisinau, I met the British Ambassador and his team who have been a great help in making this possible.

As a result, we launched an application for the ATLS to be introduced in Moldova, which is required in order to have a license to start training for the ATLS system.

After a lot of communications, the letter of acceptance came through and an official visit from the European ATLS took place at the end of July 2015. An agreement has been signed with the British Ambassador and myself overlooking this ceremony.

This was an achievement for a country, where nobody believed any changes could happen. The old school professor may control everything, but yet, as a young surgeon, you can convince, you can voice your opinion, and you can make a change if you believe.

However, I do not anticipate that these changes will be a simple and straightforward process. The most important part is to believe in your idea and yourself. You need to carry the idea forward, bring a positive argument, carry it upon your shoulders and accept some defeats. You need to explain why those changes need to happen and how they will help everyone. Finally, you need to remember that you still need the support of your seniors in making it happen.

This article is a motivation letter for my fellow colleagues and young surgeons to say: “Yes, we can.”

You can see the rest of the photos via this link.