Personal Narrative of Prof. Reuben Eldar, Laureate of Croatian National Decoration for Humanitarian Work

Cover Page > Croat Med J. 2006;47:801-4 Personal Narrative of Prof. Reuben Eldar, Laureate of Croatian National Decoration for Humanitarian Work I would like to use this opportunity to express tia, mainly in the areas of rehabilitation medicine my gratitude to His Excellency, President of the and quality of care. Republic of Croatia, Mr. Stipe Mesić, for award- The specialty of Physical and Rehabilitation ing me the Katarina Zrinska medal for humani- Medicine (PRM) was introduced in Croatia in tarian services rendered to his country. In this es- the early 1950s, when the first physicians com- say, I do not intend to merely review my activities pleted their specialization and obtained the ti- leading to the award. Rather, it is my intention to tle of physiatrists. Having acquired the tools of put in writing several personal statements which physical therapy, physiatrists focused on patients I can leave behind as an affirmation of whatever with diseases of the musculoskeletal system for it is that I stand for. whom these tools proved useful. This initiated I was born in Osijek, the capital city of Slavo- the strong tie between PRM and rheumatolo- nia, the northeastern part of Croatia. My moth- gy, and gave the priority to physical therapy and er tongue is Croatian and I remember, with af- musculoskeletal conditions within the specialty, fection, always conversing and corresponding almost totally ignoring the need of rehabilitation, with my parents in that language, wherever we except in the field of developmental disorders in were. At the end of 1948, I immigrated to Israel children, particularly that for complex impair- shortly after the proclamation of state, still fight- ments – stroke, traumatic brain injury, ampu- ing its war of independence. I have resided in Is- tation of limbs, spinal cord disease and injury – rael ever since. I am its proud citizen and owe to which cause catastrophic changes in the life of it my professional education and training, as well the afflicted and require comprehensive care. In as my career. I converse with my daughters and Croatia of 1992, the latter was not adequate (1) grandchildren in Hebrew. and I realized that, in addition to financial sup- More than 40 years later, in the spring of port from abroad, rehabilitation services in Cro- 1992, I returned to Croatia, heading the World atia needed a change of concepts and attitude, as Health Organization (WHO) mission, to map well as an organizational reform. Rehabilitation the needs and types of rehabilitation services for restores or improves function in people with dis- war casualties. I visited hospitals and rehabilita- ability and reduces the economic burden disabil- tion facilities for 10 days, studied problems and ity imposes on the individual, family, and society; capabilities, and then submitted a report on the it plays not only an important medical role but basis of which the WHO obtained an agree- also has a valuable social duty. Having been active ment of the Swedish government to support the in the rehabilitation field in Israel and as consul- much needed project of war casualties rehabilita- tant to WHO during the previous 10 years, I felt tion in Croatia. Thereby I began my involvement strongly motivated to contribute to its advance- in scientific and educational activities in Croa- ment in Croatia. www.cmj.hr 801 Croat Med J 2006;47:801-804 I regarded it essential to explain to my Croa- tion professionals, using my mother language, or tian colleagues that the terms physical and reha- what was left of it, to explain my views and em- bilitation medicine, although often used togeth- phasize the necessary changes needed to meet fu- er, were not identical. The former is concerned ture challenges. She also asked me to contribute with the diagnosis and treatment of physical dis- the first two chapters of an extensive book on orders of the musculoskeletal system, the use of Physical Medicine and Rehabilitation in Croatia, neurodiagnostic techniques, and the therapeutic of which she was the main editor, thus giving me application of physical agents. The latter, a broad- an additional opportunity to explain my views to er term, is concerned with functional disorders the country’s rehabilitation professionals (2,3). I and the assessment of motor, sensory, and cogni- thought that medical students had to become active skills. It aims at enhancing function, altering quainted with the management of persons with behavior, and seeks to maximize the function- disability in the community and that the current al and psychosocial abilities of persons with dis- curricula in medical schools of the country were ability and improve their quality of life. I thought not adequate. Through Matko I met Zvonko that it was also necessary to emphasize that prob- Rumboldt, the Dean of Split Medical School, lems encountered in rehabilitation relate to sev- who agreed with my view and gave me the op- eral body systems and affect many aspects of life, portunity to take part in the School’s curriculum outgrowing the competence of a single physician. reform and be responsible for teaching PRM Hence the necessity to include additional reha- during two academic years (4), closely cooperat- bilitation professionals trained to teach patients ing with Tonko Vlak who heads the PRM de- new skills and work as interdisciplinary teams. partment at the Split teaching hospital and now Third, I knew that it would be possible to attain teaches the course. I also felt that it was impor- advances in the practice of rehabilitation in the tant to bring together PRM specialists active in country only by organizational change, aiming rehabilitating different complex impairments, in at incorporating inpatient, outpatient, and com- order to induce them to cooperate and to study munity-based treatment in one system. some of the problems together. We first studied I was fortunate to meet influential Croatian the impact that the 1991-1995 war had on re- colleagues who appreciated my views and expe- habilitation in the country (5), then analyzed its rience. First and foremost, Ana Bobinac-Geor- state and practice in 2003 (6), and proposed an gievski, the head of the Institute for PRM at the organizational reform of the medical rehabilita- Holy Ghost General Hospital in Zagreb, who tion framework (7). Inspired by the study on im- accompanied me in 1992 and later became the pact of the war, I proposed to Miroslav Jelić, the Chairperson of the Croatian Society of Physi- head of the Institute for Rehabilitation and Or- cal Medicine and Rehabilitation. She introduced thopedic Devices in Zagreb (the national referral me to Matko Marušić, professor at the Medi- facility for rehabilitation following amputation, cal School in Zagreb and editor-in-chief of the whom I met through Ana, and who also became Croatian Medical Journal, who was to become a close friend) to join me in the study of the as- my main sponsor and, like Ana, a close person- sociation between wars and rehabilitation in his- al friend. The two urged me to undertake many tory; the results of the study appeared as a review activities and inspired me with their own exam- article (8). ple of selfless service. Ana gave me the opportu- The other field in which I became involved nity to share my views by inviting me to make was that of quality of care improvement, an is- introductory presentations, from 1997 to 2000, sue in which I have been interested since the late at six scientific meetings of Croatian rehabilita- 1980s. Each year medical care has more to of- 802 Cover Page fer, yet often at high cost and seldom without their assistants, charged with QoCI activities and increased risk. Hence, there is rising concern was invited to address The First Croatian Con- about its quality, both among patients and pro- gress of Preventive medicine (on assessment of fessionals. Continuous improvement is required quality in preventive medicine), both held in Za- to provide acceptable quality, which – given the greb. On Matko’s instigation, I wrote a book on resources available – minimizes the risk and max- quality of care, in Croatian, which I intended for imizes the benefit. Socialist governments thought medical students and physicians who wanted to that the quality of care in their country was the become engaged in QoCI activities (10). From best in the world, and it was not possible to dis- October 2001 to February 2005, I contributed cuss it or conduct any quality of care improve- to every issue of the Croatian Medical Journal a ment (QoCI) activities. In the early 1990s, po- column covering the main theme of that issue; I litical reforms, financing, and technical assistance wanted to show that every topic also had the as- from the West enabled the introduction of these pect of quality of care. Our aim was to inform the activities into former socialist countries of Cen- readers of a general medical journal about the ap- tral Eastern Europe. In Croatia, however, this proaches to QoCI activities and show that such was delayed because of the 1991-1995 war, and activities should not be assigned to specialists in the first activities began in the late 1990s. Hav- health care research but that all practicing doc- ing introduced the subject into Israel and being tors should know how to measure and improve involved internationally, I felt induced to con- their work. In 2005, the collection of 22 columns tribute to its implementation in Croatia. A pro- was published in a book (11). In July that year, I gram for improving the quality of care started was invited to address management aspects of within the project of reforming the health care QoCI activities at the Summer School in Moto- system, approved by the Croatian Parliament in vun, on challenges n quality mangement.

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