Day 13 -- Veli Loshinj & Krk

Charlotte: This morning we checked out of the hotel in Mali Losinj, and headed to a Theraputical Facility in Veli Losinj (pronounced VEL-ee Low-Shing) that focused on skin and respiratory diseases where we met Renata Zugic the director of the facility. She explained to us that the main things that they treat there are skin diseases such as psoriasis and other skin conditions and asthma and other related respiratory diseases. Their goal is to treat with natural remedies and not use drugs to control these aliments their main therapies include:

Thalassotherapy - inhalation therapy and respiratory kinesitherapy that helps bronchial asthma.

Heliomarinotherapy - ultra violet light and sea water therapy that helps psoriasis.

Aromatherapy - using herbs and essential oils to heal aliments.

We then went to the Town Museum at Place Fritzy in the town of Meli Losinj. Mrs. Zrinjka Ettinger-Starcic lectured us on the discovery and restoration of a statue of Apoksiomen that was found in the sea off the coast of Mali Losinj.

We then had lunch at Restaurant Leut in Belej, on the island of Cres. This was a very interesting lunch; we were served lamb cooked on a spit fire. It was an interesting new experience and some of our classmates were brave enough to try the delicacy of eating the brains, cheek, tong, eye ball and tail of the lamb. We then took a ferry to the island of Krk (pronounced KIRK), where we had free time for dinner and we proceeded to Njivice where we checked into our hotel.

Day 12-- Mali Losinj

Charlotte: Today we departed our mountain top hotel in Motovun, and headed for the coast! On our way to the coast, the Public Health students met with Helena Valcic, MD from the Medical Center in Labin. I can best describe this Medical Center with an American county health department and an emergency room all in one. This medical center included: primary care physicians, emergency department, OBGYN services, dentists, school heath, a dialysis center, a hospice, epidemiologists and public health inspectors for hotels and restaurants. We surprisingly got to tour every wing and saw several patients in the midst of their care. I did feel a little bit uncomfortable about seeing patients in the midst of their medical care, I felt like we were invading their privacy as comparison to the medical care privacy stands that we receive if we go to a doctor in the United Sates. While the public health students were at the Medical Center, the other students visited an old mine museum.

We then continued our journey by taking a ferry to the island of Cres (pronounced TRESS). Once on the island we stopped at a huge freshwater lake that is heavily protected by the government because it’s the only source of fresh water for the island. They have been very fortunate to have access to drinkable water on the island, many islands have to pipe their freshwater in from the mainland.

Drinkable water is a very important thing to think about when cities were designed. The five key aspects to water access include quality, quantity, proximity, reliability, and cost. All of these aspects must be accounted for when choosing where to live. Fortunately, Cres does have this lake to use as drinking water and the government and the people of Cres take great pride in keeping this water source free of pollutants. We then went to the historic town of Osor which is currently populated by only 68 people.

We then traveled to the city of Mali Losinj (pronounced MAL-ee Low-Shing) where we checked into our hotel. For dinner we went to a near by restaurant to try some local sea food. When we go out in a group we generally have a set menu that we are served and each course is usually some kind of a surprise. Our main course came out and it was whole fish was the heads and everything! I guess I looked a bit scared by the food and a server who spoke no English came over and slapped a fish down on my plate and started cleaning and preparing it for me to eat. The server then had to do the same for several other people on the trip. Once we got past the initial presentation of this food it was delicious.

Day 11 -- Pula

Charlotte: Today we visited the beautiful ocean city of Pula (pronounced Pool-LUH). Upon arrival we went straight to the coliseum, which is the second most intact coliseum in the world taking second to the coliseum in Rome, Italy. The architecture was amazing and to see it almost completely intact over thousands of years was unbelievable. We then went on a walking tour of Pula where we observed other beautiful buildings and arches. On completion of our walking tour we went to a lecture held by the Faculty of Humanities and Social Sciences at the University of Pula, on tourism. We learned that Croatia has many sites on the World Heritage list under UNESCO Protection a few of these sites include: the city of Dubrovnik, Plitvice Lakes National Park, the Cathedral of St. James in Sibenik, and Diocleation’s Place in Split just to name a few. Their main tourists population is made up of people from Germany 22.7%, Slovenia 11.2%, Italy 10.2%, Austria 8.9%, Czech 8%, Polish 5.4%, Dutch 4.8%, and Slovakia 4.0%. Their main tourist months are June through August and their main tourist locations are located on the Dalmatian coast. At the end of this informational lecture the University of Pula presented each and every one of us with a welcome gift, a leather bound, full size planner and journal, a pen and an informational packet on tourism and the University of Pula.

Our professors like to go to new places every year they do this trip and this year we were the gunnie pigs for probably the most unique experience ever! We went to Vodnjan, where we went to see mummies of the Saints! I truly thought this was a hoax and that it would be some tourist trap on the side of the road but it was actually at the local Catholic Church in Vodnjan. We took a tour of behind the alter, where the mummies are kept. We saw 4 whole mummies and body parts of other saints. This experience was truly eerie and one of my most memorable experiences of this trip. We were told the stories about why each of the 4 mummies was a saint and what made them famous, but it was really interesting to find out that they were not mummified. Their bodies were dug up from the grave and they their bodies were fully in tacked, two of the bodies even had elasticity left in their mummified skin. One of the nuns who was a saint had, an MRI six months ago and it was determined that her internal organs are still fully intact and that she is still giving on an energy. It is also said that she heals people with health aliments who visits. We were told of stories when a blind woman miraculously regained her vision by being there and praying and couples who were having difficulty getting pregnant have said that they were able to get pregnant after going to this site and praying to this saint. Maybe these events are miracles or merely hoaxes but it was defiantly and experience of a life time no matter what higher power you believe in!

After our mummy experience we went on the hunt for vampires! Well kind of… There was a legend of a vampire cursing a near by city for decades and we went to the location of the grave yard where he had been buried and explored. This stop on our trip was a bit disappointing. We could not see his actual grave because they keep building up the grave yard level after level when they get full and his level was near the bottom, so there was nothing really to see except for some really cheesy, Vampire Café Bar signs. After leaving we drove on a very scary, curvy road out to a country farm in the mountains where we had a very traditional dinner that was 7 courses! The food was unbelievable but the food just kept coming!

Day 10 -- Porec & Rovinj

Charlotte: This morning we departed Motovun, and visited the Euphrasian Basilica in Porec (pronounced Pour-eck) where we also met our tour guide for the next few days, Aleksandra Paic. We toured the Basilica and made the long trek to the top of the bell tower to get our first view of the coast. After a mini tour of the city we were given free time to explore. We had lunch in a fjord off of the Adriatic where we had the opportunity to try any sea food items we wanted.

After lunch we went to the city of Rovinj (pronounced Row-veen) where we visited another Catholic Church. We had free time in Rovinj and then we stopped at an abandoned castle outside of the city on the way back to the hotel. The castle ruins were really cool! The castle was abandoned many centuries ago due to plague. It was situated on the top of a mountain and the view was gorgeous! After we explored the ruins we traveled back to Montovun where we had dinner on our own.

Ben: I guess this is as good of a time as any to continue my discussion of pharmacy. In my previous post, I talked about the wide scale, macro view of pharmacy as it is in Croatia. Today I’m going to bring the scope in to a more micro, functional view of how the pharmacy operates. Again, I’m going to do my best to compare it to the American system, and then try to show you how all of this is relevant to public health.

We’ll start today where the prescription normally starts: the doctor’s office. Croatia employs socialized healthcare (about which I’ve heard a wide range of opinions, but I’ll leave that for someone else to touch on), so when you get sick, you go to whatever doctor you wish to see, and in most circumstances, they will write you a prescription. The physical prescription basically requires all of the same elements that are required on a prescription in America: patient’s name, date of birth, medication, dosage, frequency, amount, and refills allowed (so far so good). The piece of paper that each prescription is written on is also color coded to correspond to how the medication will be covered by insurance: Blue = free medication (completely covered), red = partially covered (copayment required), and a 3^rd (yellow I think) that the insurance doesn’t cover at all (these are special case medications that are usually very expensive).

Once a patient has their prescription, they take it to a pharmacy to be filled, just like America. However, that’s about where the similarities stop (and some of the health issues begin). Before I dissect the Croatian pharmacy, I want to point out that they are somewhat behind America in terms of technology in the pharmacy. A few decades behind, actually. According to what Mr. Pharm. Spec. Maja Bernasek told me in our meeting, all labels on prescriptions are written in by hand. No computer generated labels, just pen and sticky paper. This is not really a problem, unless the pharmacist has poor handwriting (such as me). The problem is that there is no continuous electronic record of medications that the patient is taking, and there is no medication cross checking run through a computer. This can potentially lead to many serious (and deadly) drug interactions, just because the pharmacists do not have an electronic record of what medications each patient is taking or is allergic to.

When MPS Bernasek told me this, my jaw hit the floor. I cannot imagine working as a pharmacist and not having these tools at my disposal. I would love to see some statistics on the number of deaths in Croatia due to drug interactions, but as of now I have been unable to find any (in America, drug interactions kill thousands of people, injure millions, and cost the healthcare industry billions of dollars each year). The good news is that pharmacies are slowly trying to incorporate these computer systems into place (unfortunately, cost is a preventative issue).

Aside from an obvious lack of technology inside the pharmacy, the process runs about the same as it does in America: a patient drops the prescription off, the pharmacist fills it and then checks it, and then the pharmacist dispenses the medication to the patient. When they hand the medication over to the patient, the pharmacist counsels them on any pertinent information relative to the prescription. At this point, any information the pharmacist passes along to the patient comes either from memory, or from any medical text they might have on hand. Again, this is due to a lack of technology. In America, practically every pharmacy has access to internet based medical data, as well as computer-printed medication labels that automatically list any pertinent information the pharmacist should inform the patient about. Hopefully this will change with time.

There was one very important item that I particularly like about pharmacies in Croatia: patient privacy rights. In America, we have HIPAA (The Health Information Portability and Accountability Act of 1996), which, if violated, offenders can face criminal and civil charges. In Croatia, they have some very similar laws that require pharmacists to maintain discretion with sensitive health-related information, and violations of this are also punishable by law. This is definitely a step in the right direction, as it helps bolster the defense against disease-based discrimination.

So, to wrap this up for today, Croatia has a functional healthcare system that allows for any citizen that is in need of medical attention to be taken care of. Although the pharmacies may be lacking in cutting edge technology, the pharmacists themselves work very hard to ensure that the proper care is given to each and every one of their patients. They are a crucial cog in the healthcare machine of Croatia.

Day 9 -- Leave Eastern Slavonia for Istrian Peninsula

Colin: No one is sorry to be leaving Osijek for the Adriatic Coastal portion of Croatia today. Six days of very cold and wet weather are more than enough for anyone. We are cold, and tired, and are getting on each others nerves (and getting each other sick). But as we drove West towards the coast, the weather warmed, the sky cleared up, and at a rest stop the mood started to brighten as well. People started to laugh, kick a soccer ball back and forth near the bus and generally appreciate the change. We have left Eastern Croatia behind and have moved onto the second part of the trip.

Istria (pronounced IST-ree-uh) is a peninsula that sticks out into the Adriatic Sea and contains the oldest Roman ruins in Croatia. The climate is one more like the Greek islands and less like that of Central Europe. The local diet will be one more based on fish, olive oil, and figs, as opposed to the Central European-influenced meat (especially pork) and potatoes that we have been eating for the past nine days. However, we had one more meal of it as we dined for lunch on venison and dumplings at a restaurant in the small town of Fuzine, and afterwards we took a side trip to the cave that was discovered in the 1960’s but had been sealed for 100’s of thousands of years.

When we first saw the sea a great cheer went up on the bus. Our bus driver is named Franjo (pronounced Fran-YO) and we have become very impressed with his skill as he maneuvers the “Purple Horse” through a variety of locations with much skill and acumen. We have started to refer to ourselves as the “Purple Horse Gang” and have become one big happy, dysfunctional family. [Ben - the "Purple Horse" (of course, of course) refers to our gigantic purple bus.]

As impressed as we are with Franjo’s driving skills, we are less impressed with the skills of other Croatian drivers. Motor Vehicle Crash deaths and injuries (including those to pedestrians and bicyclists committed by automobiles) are the leading source of Emergency Room visits in Croatia. Many of the safety standards that we take for granted in the U.S. regarding mandatory safety equipment and speed zone enforcement either do not exist in Croatia or are not enforced. We are glad to be in the capable hands of our expert bus driver.

Our destination for the evening is the hilltop town of Motovun (pronounced Mow-tow-voon), where a group as large as ours cannot even be taken all the way to the top because the bus cannot climb that high, but must walk the last 500m up the narrow cobblestone streets to the Hotel Kastel. The town has a spectacular view of the valley below and many folks celebrated late into the night and were very happy with our new surroundings.

Day 8 -- Day trip to Vukovar

Colin: I am not sure if the weather could have more perfectly matched the mood and subject matter of the impact of the “Homeland War” on the City of Vukovar. We were cold and wet and trying our best not to get sick. We had to stop to buy vitamins and warmer clothes in our best attempt to ward off any further sickness. And, while all of this was going on, we were being told about the 1991 siege of the city where 40,000 inhabitants held off the Serbian dominated Yugoslav army and its associated Serb militias for better than 3-months. We met the doctor who ran the hospital during the siege, Dr. Vesna Bosanac. She is a Croatian National Hero and a living treasure, who explained what she and her staff did to help the population during this time of crisis from the underground bunkers below the destroyed hospital.

After the siege ended, the entire population of the town was forcibly relocated or killed. Some were sent to prison camps in Serbia, while some were allowed to return to Croatian controlled territory. Others, however, were taken to places like Ovcara where they were shot and dumped into mass graves. Many of these graves were not discovered until after the Dayton Accords were signed in 1998 and Vukovar returned to Croatian control.

War not only has an impact on the physical health of populations, but also psychological repercussions. Refugees not only have the trauma of being subjected to the war, but also have the long-term impact of being displaced from familiar surroundings and from ones livelihood. Vukovar is a living example of the resilience of a community that is able to recover from such atrocities.

Day 7 -- Osijek and Eastern Slavonia

Colin: Today we left Zagreb on the bus for the Eastern part of the country. Our next stop will be the city of Osijek (pronounced OH-see-eck). The weather is getting worse. Everyone dressed much more warmly today, but there is only so much layering that can be done with the clothes that we brought. On the way to Osijek we stopped at the Jasenovac Concentration Camp memorial and museum. This is a museum that showed the atrocities committed by the Ustasha government against the Serb population and other ethnic minorities & dissidents opposed to the fascist WWII puppet-state.

One of the things that Croatia has done as a state is to acknowledge that not all of its history is pretty and that it has made mistakes. This is an important step in becoming a responsible member of the European and world community. One of the important aspects we will be looking at is the results that the recent war has had on the physical, social, economic and psychological health of populations. To fully grasp this, it is not only necessary to understand the history of the interactions between the combatants in the 1991-1996 Yugoslav War (called the “Homeland War” or the “Independence War” in Croatia), but one must also understand the socio-political history that preceded it.

Ben: Other stops along the way to Osijek, including a tour of Osijek, were cut short since it was just too cold and wet. We eventually made it to our hotel and were given a few minutes to settle in before leaving for dinner. After driving to a nearby restaurant, we were served a wonderful meal of local cuisine (including more cabbage salad) along with some entertainment. Our guide Zvjezdana taught some of our students a Slavonian folk dance as we all clapped and sang along! The girls were instructed to dance around in a circle, while holding hands, and at certain points during the dance, they had to shout something that sounded like "ee-yu-yu" very loudly. The entire performance was a riot! To the left is the best picture I could find of the entire ordeal.

Day 6 -- The Zumberak

Colin: Nothing is ever constant… including the weather. Today we were supposed to climb Samobor Mt. in the Zumberak (pronounced Joom-BEAR-rock) region but the freezing rain precluded our accomplishing that. Instead we went and toured Castle Trakoscan and saw the Austro-Hungarian influence in the region. Later we met Aleksander (“Alex”) Lukic, our guide, and a rural geographer from the University of Zagreb who is an expert on the region. We then went and met Dr. Medvan, a retired veterinarian, who moved back to the area to run a living history grain mill and vineyard. According to one of our Pilar Institute contacts, demographer Ivo (pronounced EE-vo) Turk, the population of the Zumberak is aging, and with the poor roads and lack of infrastructure improvement, there is some concern about the increasing elderly population being able to obtain proper and timely medical care. As of now, in order to meet their emergency and chronic health care needs, they have to drive a very long distance (almost 2 hours) to Zagreb, and the drive is not an easy one.

Dinner was scheduled at the Stepinac family vineyard. The family living there now is a generation removed from Cardinal Stepanic. He was a famous Catholic priest that saved many Jews and enemies of the state from the Nazi-backed Ustasha (pronounced OO-Sta-shah) government. The family welcomed us by serving us an absolutely amazing dinner. They are truly wonderful people. (The children range in age from 12 to 30 and are one of the few examples of young folks staying in the area rather than moving to the cities like Zagreb). The weather, however, was not working in our favor. Many of us had not listen to our guide Juraj and dressed much too lightly for the cold and wet weather. By the time we got to dinner, we were chilled to the bone. The Stepanic family took us and wrapped us in blankets and clothes to warm us up (the rakija also helped) and fed us some of the most wonderful food we have ever had. Next time we will listen better to the advice.

Day 5 -- Lectures & The Pharmacy in Croatia

Ben: We started the day bright and early with a (very) brisk walk to the Faculty of Architecture (Colin - a "Faculty" is what in the U.S. we would call a "Department") for the University of Zagreb to hear some local students give presentations on ideas for rebuilding Vukovar (pronounced VOO-co-var), which we will be visiting in a few days. The students did an outstanding job (even though they looked terrified to speak in front of us). After the presentations, everyone was free for the day except the public health students. We had another lecture to attend at the Stampar Institute. We met Dr. Zdenko Sonicki, who gave a lecture on some special cases of health issues in a particular region in Croatia. He did a great job, and the material was very interesting. After the lectures, we had a short class and then were free for the day. I was not in attendance at this class because I had a meeting to attend, which I will now tell you about.

As I stated in our first posting, I will be reporting to you all on my findings about pharmacy in Croatia. Well, thanks to our amazing guide/translator/liaison Juraj, I was set up with an appointment to meet a local pharmacist who turned out to be the director of the City Pharmacy of Zagreb’s laboratories. She oversaw the labs that produced many different herbal and homeopathic medication applications (creams, ointments, balms, capsules, tablets, etc.) In Croatia, this is actually controlled by the Government, but more on that later. I met with Mr. Pharm. Spec. Maja Bernasek * for a little over 2 hours last Friday (pictured on the left), and I am beyond grateful for her time. Before I go off on a tangent about everything I learned in my meeting, I feel like I should give you a breakdown of how I’m going to break this down. I took a few pages of notes during my meeting, enough for a few posts in fact. So, instead of making one gigantic update, I am going to break my information into sections, and work it into my understanding of public health as best I can.

Ok, so with that said, today I’m going to start with giving you a wide-scale view of the pharmacy industry in Croatia, and do a little comparison to the American system. The Croatia pharmacy industry has two basic components: Industrial Pharmacy, which covers drug production and national distribution, and Pharmacy, which is practically everything else (retail, hospital, long term care, etc.). Drug production occurs in only 3 factories in Croatia: in Belupo, Pliva, and Jagdren. The industrial side of things is controlled by the Agency for Drugs, which is a loose counterpart for the FDA in America. They oversee drug production and ensure quality and safety in the drug supply. Since Croatia is such a small country, they can’t make 100% of the drugs they need for their citizens. Because of this, they import many drugs from other countries, not only from Europe but from America too. There is a government agency associated with the national social insurance in Croatia (I apologize, because I didn’t catch the name of this agency/ministry) that has developed a list of every drug that is approved for use in the country. What makes this interesting is that the agency that provides insurance to the entire population is also the one in charge of approving these drugs, and because of this, every prescription drug is covered by insurance! There still might be a co-pay from time to time, but they never have to worry about not being able to afford a drug because it isn’t covered by their insurance plan (the insurance does not cover OTC meds though). Easy public access to medications, especially when they are guaranteed to be covered by insurance, is an excellent way to bolster and improve public health.

Well, because there’s only so much you can stand to read about pharmacy in a foreign country in one day, I’ll cut this post off here for today. I’ve got a lot more to write up, so keep a look out for the next one.

* - Mr. Pharm. Spec. is the title given to pharmacists in Croatia. I believe it stands for Magister Pharmacy Specialist. This is not equivalent to a doctorate in Croatia. For comparison, in America, Pharmacists are now given the title of Pharm D., which is Doctor of Pharmacy. The lack of a "doctor" title can have a large effect on how pharmacists are viewed in this country, and what people will use them for.

Colin: This evening we had a chance to go visit an anarcho-punk artist "squat-house", an underground establishment that was semi-legal, made up of unemployed artists, street musicians, and supporters who live in an abandoned factory that taps into the electrical power of a neighboring youth center, but the government is currently turning a blind-eye because of the stable nature of the community. One of the things that we have noticed on our exploration of Zagreb was the amount of graffiti (something I also noticed in Vienna and Ljubljana on my trip to Croatia). We were told that much of this "tagging" was the result of disaffected unemployed youth. Here was a place where those with artistic ability could come and express themselves. We were able to see this sanctuary, and interact with its inhabitants, thanks to the efforts of Pillar Institute researchers Dr. Ben Perasovik and his research assistant Ivana, without whom this never would have happened.

Day 4 -- Plitvice Lakes

Colin: Today we left Zagreb in the early morning for our trip to Plitvice (pronounced Plee-VITZ-uh) Lakes National Park. We hiked in to the Lower Lakes and the Korana canyos at the park where we observed the beauty of the 16 large lakes throughout the park. Unfortunately, it started to rain as soon as we had gotten to the base of the biggest waterfall in the park. We then hiked up to one of the larger lakes and took a ferry ride across it. While on the ferry, we were able to observe nature and relax on our way to lunch at the parks lodge.

Every day is a new experience for us, and lunch today was no exception. We were severed a wonderful tomato based soup with mushrooms, a salad, and a variety of meats to feast upon. After arriving back on the bus, we were informed that the wonderful tomato soup with mushrooms was not, in fact, a wonderful tomato soup with mushrooms. What we thought were mushrooms turned out to actually be pieces of cow lung, which we were told is a delicacy in this area of Croatia. Some of our classmates were not happy with this new information, but as a whole our group loved it! (Ben - I would definitely eat it again!)

On our way back from the National Park, we went on a hunt to find a "spa" in Lesce. When we arrived at this "spa" we were surprised at what was considered a spa here. It was basically a pool in the ground that was only filled to about 1 foot of water (picture to the left). The spa is filled with a natural hot spring under the pool and people use this pool to heal aliments such as arthritis among other things.

Our last stop today was Bosiljevo castle, where we met with the mayor of the town. The castle had been abandoned since the 1980’s and it was falling apart, but we were able to explore the grounds anyway. At the conclusion of our exploration, we spoke with the mayor who explained to us that the castle was owned by a family before the Yugoslav Communist era. Under the Communists there were not supposed to be class differences between the people, so little or no money was given to upkeep such reminders of feudalism. Since the creation of an independent Croatia, the family has regained full ownership of the property. They apparently have no interest in restoring the castle, but anybody who wants to pay $2 million, and do the extensive work necessary, the castle is there for the taking.

Day 3 -- Classes and Lectures

Colin: The agenda for the day was classes and lectures at the Pilar Institute for the Social Sciences & the Andreja Stampar School of Public Health. At Pilar our sponsor Sasa gave us an overview of where Croatia (known in Croatian as 'Hrvatska') sits as a transitional country both in term of its development economically but also as a country that is in the process of “ascension” to become an EU member state. Croatia sits at a definitional cross-roads between Central Europe and Southern Europe and between Eastern and Western Europe and her lecture explained the benefits and challenges that Croatia has in joining its neighbors to the north in economic and travel union.

Afterwords, the director of the Pilar Institute, Dr. Ljililana Kaliterna Lipovcan, gave us a presentation about the history of the Pilar Insitute and then we went to meet Dr. Bojan Baletic, one of the University of Zagreb Provosts, who lectured about the “Bologna” method of educational standardization and integration allowing for students to transfer between European Universities and be confident that they have the proper training necessary no matter where they are to succeed. This is an important step in the EU integration process and was something that we knew nothing about. After this we had a lunch that consisted mainly of meat and potatoes (something that we would find was the standard in our travels), and then broke into individual class groups for the rest of the afternoon.

The Public Health students got to ride the tram and went to the Andreja Stampar School of Public Health. Andreja Stampar (pronounced Andre Stomp-er) was an important figure in the field of “social medicine” in the 1920’s – 30’s, was one of the founders of the World Health Organization (WHO), helped create the concept of community participation in health planning, and promotoed the idea that “top-down, one-size-fits-all” approaches to rural public health were not only ineffective but counter productive. One of the most important things that we learned from the lecturers at the Stamper Institute on this day was that Croatian medical students are required to be well versed in public health (~ 10% of their curriculum is made up of public health classes), and we also learned how everyone is covered by a Basic Health Care Insurance in Croatia that covers almost 80-90% of their potential health care needs. This coverage is paid by people’s employers. For the unemployed this is covered by the government. There is a supplementary insurance available which covers everything that the Basic does not cover and costs about 80 Kn (about $16) per month.