Friday, June 1, 2007

A Closer Look at Healthcare

We had an opportunity to meet with a physician at the PolyClinic in Makarska on Friday. This is a unique experience for us, as most of us know that it can be much more difficult to arrange this type of meeting in the Sates!
Dr. Ivanda described for us the system of health care for children in Croatia. Physicians at the PolyClinic conduct thorough and comprehensive exams for all children in Makarska and surrounding areas. There are only 2 physicians in the clinic and they are referred to as ''school physicians''. In addition to conducting physical exams and administering vaccines in the outpatient clinic, they also travel to the schools in the area. Their exams are extremely detailed; they assess not only physical health, but also childhood development, food intake and diet, progress in school, and social skills and dynamics. Dr. Ivanda told us that they also routinely conduct health education programs for teachers and students in the schools.
Methods of administering care and records-keeping are very organized and thorough. Pediatric health care begins for each child, when the parents bring the infant to the clinic for a well-baby check-up. All children in Croatia must also undergo a physical examination and must receive vaccinations, including DPT, MMR, polio, tuberculosis, and Hepatitis B prior to entry in the school system. Documentation completed by the physicians is kept by the PolyClinic, by the Ministry of Health, and by the child's parents. These records are updated by the school and family physicians until the child reaches the age of 26. Following that, they are always kept on file by the Ministry of Health. This is extremely important, since the lack of data in developing nations is one of the biggest problems in international public health intervention and research.
Dr. Ivanda reported to us that many of the health problems that exist in the pediatric population in Croatia mirror those that we find in the U.S. There is a rising incidence in childhood obesity, with a corresponding risk for juvenile diabetes. Diet has changed relatively little over the years, but is consistently high in fat and carbohydrates. The rising rates of obesity therefore, may be related to inadequate physical activity in conjunction with this high-fat diet. Though I had always thought of eating disorders as primarily an American phenomenon, I learned that rates of anorexia and bulemia are increasing in Croatia as well.
There are also problems with aggression in both younger and older age groups. Dr. Ivanda relates this to the fact that children regularly see acts of violence on TV and video games. Cigarette smoking and alcohol consumption are also problems among youth, just as they are among the adult population. Physicians administer anonymous questionnaires to assess the extent of alcohol and tobacco use with this age group.
Dr. Ivanda told us that overall, she is pleased that the system of health care in Croatia has been successful in avoiding the epidemics that sometimes occur in developing nations. However, she also relayed a frustration with an apparent lack of progress in decreasing aggression in children.
So, as you can see, we have had the opportunity to interact with some wonderful health professionals and we are learning a lot!
We're working on getting some more photos posted!

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