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.

Day 1 and 2 Pictures

Ben: Well, I've been messing around with our computer for a few hours now, trying to make it cooperate, but I'm not having much luck. So, cross your fingers that this works...

Anyway, here are the referenced pictures from our 1st and 2nd days in Croatia!

The first picture is of the National Opera House. Our walking tour guide took us around the exterior of the building and told us about the many plays and operas that take place there. We also had a group of our students attend a ballet there on the 3rd night we were here.

The second picture is of the courtyard at Pilar Institute. This is where we started our walking tour.

The third picture is a city worker using a high pressure steam gun without wearing his safety mask in the right position. It was just one example of many that we saw of workers not following simple safety guidelines.

The last picture is of some students in the public health class right after our first class meeting. Don't we look so happy?

That is all the the blog will allow me to post at the moment. There will be many more to come later.

Day 2 -- Classes Start!

Colin: Our first full-day on the ground in Zagreb and we start it by having classes over at the Pilar (pronounced PEE-lar) Institute for the Social Sciences. Each of the 4 classes met today and those that were not in class got a chance to explore downtown Zagreb a bit. The public health class met first for the day, and then we got a chance to explore ourselves before lunch. Here is the HPRB5160/7160 class after leaving our first class:

(see post above)

Charlotte: After class Colin, Ben, and I had some time to explore the city before meeting back up with the class for lunch. We found that many of the city construction workers were not practicing safety measures when they were working. We documented many of these observations (see the pics after the break). After class we ate lunch at the Restaurant Obrtnicki dom where we enjoyed a nice meal of Croatian dishes. In the afternoon we took a very long and jam packed walking tour of down town Zagreb. On completion of the tour we were given a free evening to explore Zagreb on our own with our new friends.

Ben: Classes started the next morning at 9, with the Public Health class meeting first. This was very interesting to me, because it takes a completely different view of healthcare and implementation than what I am currently learning in pharmacy school. After class (which I felt completely unprepared for; note to self: read syllabus in more depth next time), the 3 of us took the scenic route back to the hotel, taking pictures of various acts of people being unsafe in public (see pics above). I’ve already started picking up on things that I wouldn’t normally think of as pertaining to someone’s health and well being (in pharmacy school, its all about the bugs, the drugs, and how the 2 interact). After lunch, we took a walking tour of the Zagreb historic district(s) and learned a great deal about the history of this beautiful place, and burned a minimum of 10,000 Calories in the process (it was intense)! The tour was conducted by Dr. Vedran Perlogovic from the geography department of Pilar Institute. On our tour we visited the opera house, we learned about Ivan Mestrovic (pronounced MESH-tro-vich), a famous Croatian sculptor who combined Croatia folk art with classic sculpture techniques. We saw a variety of statues around Zagreb and learned that Croatias and leaned that they honor their scientific and artistic leaders more than their political and military leaders with statues. We learned the history of the original hill top cities of Zagreb. “Za-Greb” means “behind the ditch” because it referred to the people who lived behind the ditch of fortifications that surrounded the town. We also saw the painted tile roof of a very historic church that had been restored due to the damage from the 1991- 1996 Yugoslav civil war. In addition to seeing these historic buildings we also visited several of the cities green squares around the city, that are in the shape of a house shoe they provide leisure time space throughout the city of Zagreb for their residents. Lastly we were able to see the outside of the Catholic Cathedral where Cardinal Stepinic (pronounced Ste-PEEN-its), who is buried in the cathedrals, do to a current mass in session we were not able to visit this site or take pictures with in the church. Below are pictures of these events:

(see post above)

Later on in the evening, a few of us went to a pub near the hotel, and had the wonderful pleasure of interacting with some local folk who showed us a great time. We learned a great deal about their interests and backgrounds, and we made plans to meet with them again later in the week. Hopefully I can use this to get some decent health related information out of them…