Rural round-up: Dubrovnik - a temptation now and in history

Conference News and Reports December 2014 Working Party News

November, 2014

Tanja Pekez- Pavlisko is this month's author of rural round-up. Tanja is president of the Organising Committee of the coming WONCA World Rural Health conference being held in Dubrovnik, Croatia, from April 15-18. Here she reflects on the rich history of Dubrovnik and medicine.

"The vitally important need for health workers in rural areas is universally recognized. There are still enormous rural areas in the world without any proper medical aid, and without any preventive work. Even in the countries which have produced certain important results in public-health work there are still rural districts entirely neglected from the standpoint of health. The distribution of physicians is not made according to the needs of the total population; only a small percentage of them live in rural districts."(1)

These are words spoken by a Croat, a cofounder of the WHO, Andrija Stampar who said them in 1938 at Harvard Medical School. Due to his work, and the work of his colleagues, general practice was introduced as a specialty in the early 1960s in former Yugoslavia, and it was the first of its kind.

The difficulties for Croatian general practice

These days general practice has been neglected by many countries in this part of the world, except in Slovenia and to some degree, Croatia, which is (according to governmental organizations) at the dawn of a primary health care renaissance. Aside from a great number of positive changes happening in Croatia, there are still many difficulties in a GP’s work, especially in regards to paperwork, financial fines from insurance companies and lack of acceptance from other colleagues and patients. Colleagues outside of Slovenia and Croatia are also faced with low income and difficulties in professional development.

The economic crisis and post-war period in the region has led to increased violence (at stadiums, domestic violence) which also translates to general practitioners. Along with verbal abuse, there are plenty of examples of physical violence towards Croatian GPs. Therefore, an open letter was written to members of the Croatian Parliament, Ministries of healthcare and labour, and journalists on problems of violence against medical workers. Our next step is organizing a round table discussion on the problems of violence not just in our practices, but in society as a whole, with the aim to increase awareness of the entire population on this topic.

And, despite all of this general practitioners retain their faith and enthusiasm, and through their work and way of life, try to help their patients in these very difficult times for the entire region. Therefore, a conference in Dubrovnik should renew general practitioners’ vigour.

Dubrovnik – a rich history in medicine

The history of these lands, especially Dubrovnik is very old and rich. We would like to introduce you to the tradition of the city with a desire for you to contribute to the city’s history.

The medicine of Dubrovnik was never of the local character, nor was it ever isolated from the developments in this field from the rest of the world. It was always aware of the latest achievements in medical science and practice. Many famous physicians lived or were born in Dubrovnik. Furthermore, the citizens of Dubrovnik were aware of the significance of the latest public health and hygienic achievements for the development of their city. (2)

Near the east city gates “vrata od Ploča”, there is the building that has the greatest significance for the medical heritage of the old Dubrovnik. The complex of various buildings called “lazareti” represents the quarantine of Dubrovnik. In the period 1348-1374, many people were dying because of the plague epidemics in Dubrovnik. The solution to this problem was the suspension of trade with other regions especially those in the east from where the plague epidemics usually spread. Such a decision would have been fatal for the economy of the city. In July 1377, a measure was introduced that should have enabled both the protection against the plague epidemics and a free trade with the infested regions: quarantine. (3)

In 1317 at the premises of the Franciscan monastery in Dubrovnik, the first pharmacy was founded. Even today, in the premises of the monastery, there is a public pharmacy that still serves the inhabitants of Dubrovnik. In the 14th century the pharmacy was situated in the lower cloister and was connected by entrances to the street. A part of the inventory of that pharmacy can still be seen on display in the pharmaceutical museum in the monastery. (2) In Dubrovnik, as in the Orient, the preparation of pharmaceutical compounds was in the hands of the pharmacists, not with physicians as it was in the rest of Europe. (2)

Although we don’t have precise information we know that the beginnings of a hospital in Dubrovnik date to the period between 1347 and 1352, when it was a Shelter for poor and we know that in 1420 it had its own pharmacy. From 1540, it operated as a public state hospital inside the city walls until 1888, called Domus Christi. The old hospital of Dubrovnik, by the Senate’s conclusions of 1540, had the objective “to bring together poor people, sick of curable sickness and who sometimes die just because there isn’t anybody to take care of them or to help them” – “de faciendo ad cultum Domini Nostri Jesu Christi unum cenochodium seu hospitale pro usum pauperum infirmorum”.(4)

Rural hero

And finally, as we have our pioneer of general and rural practice, Andrija Stampar, so does every country. We would ask you to find among your ranks a colleague who gave a special contribution towards development of rural general practice and share their work at the conference. More on that and other information is available at the conference website.

IMPORTANT DATES

WONCA World Rural Health conference
April 15-18, 2015

Deadline for abstract submission
December 10, 2014

Early bird registration closes
February 10, 2015

http://woncarural2015.com

References
1. NEJM; 1938 (218) 34: 991-997
2. Lang. S.: A guide to the history of the medicine in old Dubrovnik, http://www.bolnica-du.hr/data/1234250283_745_mala_pov-med-vodi_OLD.pdf.
3. The text of this decree can be seen in Liber viridis (c.49 fol. 78) under the title “Veniens de locis pestiferis non intret Ragusinum vel districtum” (“It is forbidden to new-comers from the infested regions to enter Dubrovnik and its surroundings”).
4. Marinović, I.: From the history of the hospital in Dubrovnik From Domus Christi (14th century) to New hospital (1888); Acta med-hist Adriat 2005;(3)1:101—110; http://hrcak.srce.hr/file/149812 )