REVIEW ARTICLE
30 YEARS ASSOCIATION OF DOCTORS IN ANESTHESIOLOGY, REANIMATION AND INTENSIVE TREATMENT (ZLARIL) IN THE REPUBLIC OF NORTH MACEDONIA

UDK: 061.231:616-089.5(497.7)(060.91)
https://www.doi.org/10.55302/MJA2481094n

How we started…  Nojkov J The disintegration of the SFRY occurred after a series of violent conflicts and military actions, primarily in the territories of Slovenia and Croatia and especially in Bosnia, followed by numerous civilian casualties. Slovenia and Croatia declared independence in 1991, followed by Bosnia and Herzegovina and Macedonia. The formation of the independent Republic of Macedonia took place in 1991 and passed without military action, but with accentuated inter-ethnic tensions.

The beginnings of the new state were followed by enthusiasm and numerous efforts for international recognition. Also important were the efforts to include the numerous professional organizations that emerged from the former state in the international associations. It was the same with the organization of physician anesthesiologists. In the Yugoslav federation, there was a so-called JUARIL (Yugoslav Association for Anesthesiology, Reanimation and Intensive Care) at the federal level, and in all republics there was a section of anesthesiologists as part of the Medical Associations. Congresses were held every 3 years, while intersectional meetings were held in different republics every year. Among the last activities of the Macedonian section of anesthesiologists was the organization of intersectional meetings in Skopje (Prof. Nikola Andonov 1979), as well as the 4th JUARIL Congress in Ohrid (Prof. Nikola Andonov 1980) and intersectional meeting in Bitola (Dr. Dimitar Sekulovski, 1988).  The last activities of JUARIL were the last 5th Congress in Belgrade in 1989, where, according to the system of rotation, the management was taken over by colleagues from Croatia, as well as the intersectional meeting a year later in Neum (BiH), which passed with only half the participation of anesthesiologists, and when already the atmosphere of war was felt it was obvious that the state was falling apart.

Macedonia declared its independence on September 17, 1991, when the Declaration of Independence was signed. Independence and Sovereignty were adopted based on the successfully completed referendum held on September 8 of the same year. This was followed by the formation of the Macedonian army and the national institutions in accordance to the new changes. The holding organizations also changed their names afterwards. First, the former Association of Doctors of Macedonia (ZLM) changed its name to the Macedonian Medical Association (MLD), and then its specialists’ sections became associations of doctors of certain specialties. Thus, the Section of Anesthesiologists of Macedonia became the Association of Physicians for Anesthesia, Resuscitation and Intensive Care (ZLARIL) with a decision brought on June 19, 1993, at the meeting held in Kriva Palanka. Then a decision was made on renaming, the new work regulations were accepted, and the management board was supplemented. The first management board of ZLARIL consisted of: Nojkov Jordan, president; Shuplinovski Zlatko, secretary; Krstevski Zvonko, treasurer, and members Sholjakova Marija, Miloshevska Violeta, Zlatko Petrov and Stojchevski Velcho. Zvonko Krstevski created the graphic solution for the logo of the association, which is still in use today.

In the following years, there was a struggle for admission of our Association to the professional international organizations WFSA, WFSICCM, ESA, EA and ESRA. First of all, it was important for us to be admitted to the world anesthesiology organization (WFSA), i.e. to its European section (European Regional Section – ERS), which was renamed in CENSA and later in ESA (European Society of Anesthesiologists) in 1994. The procedure started after the letter from the last president and secretary of JUARIL from Croatia Dr. Perushko and Dr. Shchap in which they informed us that the organization no longer exists or exists only as an organization of anesthesiologists from Serbia and Montenegro, but that they do not have any information about it because all connections between them and Belgrade have been severed. They also wrote in the letter that they have submitted their irrevocable resignation from their positions and recommend us to seek admission to WFSA as an independent association. Attached they sent an application form, which we filled in, and sent it to the WFSA secretary Dr. Saywan Lim on 1st of July 1992. The first contact with the president of the WFSA, Dr. John Zorab, was made by me together with Dr. Lazar Shendov in the fall of the same year in Hague, Holland, during the 10th WFSA congress. In the conversation we expressed our desire for membership as an Association from an independent state, we informed that our association had 137 members and that we agreed to fulfill all WFSA obligations. Dr. Z. Zorab admired our initiative and promised to put us in touch with the secretary of the organization. On January 13, 1993, a letter arrived from the new secretary of the WFSA, Dr. M.D. Vickers. In the letter, he welcomed our initiative, but stated that the problem was that we were not yet a member of the United Nations and were not recognized by the UK Foreign Office as an independent country. He also wrote that they had no evidence that JUARIL no longer existed and that it would be good if an official member of the leadership from Belgrade “liberated” us from membership in the former organization. One of the ideas he proposed was to establish some “correspondence form” of cooperation through which we would have complete information about the work at WFSA. In that sense, Dr. Wetchler, the president of the WFSA Executive Committee, would forward this proposal to the next meeting of the Committee, from where he, as secretary, would be entitled to take further actions. The problem was solved with the admission of our country as a member of the United Nations on April 8, 1993. Then followed a letter from the secretary of WFSA Vickers to the secretary of our Association Dr. Zlatko Shuplinovski that the WFSA Executive Committee approved conditional full membership of our Association until the holding of the General Assembly in 1996. Thus, during the holding of the 11th  WFSA Congress in the period April 14-20, 1996 in Sydney, Australia in the presence of numerous anesthesiologists from Macedonia, at the General Assembly ZLARIL was accepted as a full member of the WFSA.

The benefit of admission to the World Organization of Anesthesiologists was manifold. We received notices of all professional events through letters, and the newsletters “World Anesthesia” and “Update in Anesthesia” in the coming years reached about 50 copies to our members. At the request of the editor in this journal in 1999, I wrote a “profile” of our association in which the history of our country, the historical development of anesthesiology, the method and program of specialization, the most common used anesthesiology techniques, as well as the prevalence of surgical health network were noted. A slightly modified text with similar content was published the following year in the newsletter of the European Academy of Anesthesiology. These were small but significant steps in the struggle for the international emancipation of our country. Also, in those years we received regular invitations to the meetings of the presidents of the European anesthesiology societies which were usually held in conjunction with the annual meetings of the German Society of Anesthesiology (AGAI). Our members regularly participated with their papers in all major scientific meetings (World congresses in Sydney 1996, Montreal 2000, Paris 2004, Cape Town 2008, European congresses in Jerusalem, Frankfurt, Lisbon, Florence, Bermingen, etc.)

Admission to the WFSICCM (World Federation of Societies of Intensive and Critical Care Medicine) went easier, but the cooperation was not so intense. It all started with our request for admission on April 6, 1993, and the admission itself was carried out in Madrid on June 15 of the same year at the meeting of the General Assembly. The participation of our colleagues in the professional meetings of WFSICCM was modest, but the members of ZLARIL benefited the most from the distribution of the magazines of this organization” Intensive Care World” and “Intensive & Critical Care Digest”, which for several years came to our home addresses free of charge. I would like to mention here that in the previous two organizations we were members as an association and we provided the membership fee through sponsorships, which was often a problem. The third international organization we collaborated with was the European Society of Regional Anesthesia (ESRA). The relationship started with my contact with its president A. Van Steenberge who then invited me as a lecturer at their annual meeting in Brussels. The following year (May 23-24, 1997) in Ohrid, together with Zoran Guchev, we organized the Zonal ESRA Meeting, in which they participated or taught alongside their own colleagues and colleagues from neighboring countries, Bulgaria, Serbia, Belgium and Italy. It is important to note that in the coming years we have also established a relationship with the UEMS (Union Europeenne des Medicins Specialistes, Section Anaesthesiology, Reanimation and Intensive Care), which is a specialized body of the European Union for coordinating and harmonizing programs and regimes for the education of staff from our specialty. Since we were not members of the EU, our representatives (Maria Sholyakova, Jordan Nojkov) had the status of associate members with the right to participate, but without the right to make decisions. As head of the Department, Maria Sholyakova was the most active in this field, and as a result of her advocacy, we were among the first in the Balkans to start organizing cycles of FAEPA courses for the European diploma. The cooperation with this body also resulted in changes in the program and the length of the specialization in anesthesiology and intensive care, which we aligned with European recommendations.

In the first years after independence, we worked with great enthusiasm. The state was visited by many officials from Western countries, among whom many were from the field of health. Aid in equipment and medicines also arrived through several countries and organizations. Our Association was active in the field of professional development of the membership through the organization of numerous meetings, symposiums and seminars. In the first four years alone, 20 meetings were held, as well as the 1st Congress of Anesthesiologists of Macedonia. Most of these meetings were intended for our members, but there were also joint meetings with transfusiologists and hematologists, with microbiologists, and with surgeons on interdisciplinary topics (therapy with blood and blood substitutes, thromboprophylaxis, interhospital infections and rational use of antibiotics, preparation of patients for surgery, etc.). Among the larger gatherings were two symposia, one on pain treatment and the second on cardiopulmonary resuscitation intended for a wider group of doctors and held within the framework of the “Medicine” fair event. I would like to mention here that the anesthesiologists were the leading educators for CPR (cardiopulmonary resuscitation) of the doctors in our country, starting from the eighties of the last century until today. Among the meetings there were also two of a solemn nature. One was in the occasion of the ceremonial commissioning of the new department for intensive treatment at KARIL, and the second in the occasion of the 30-years existence of the anesthesiology service in Bitola. The crown of our professional activity was the organization of the 1st Congress of Anesthesiologists of Macedonia, which was held in May 1995 at the “Desaret” hotel in Ohrid. Organizing such an event with international participation was a big test that we successfully passed, at least according to the echoes that could be heard among the participants and the medical public. At that time, 160 anesthesiologists worked in Macedonia, and the Congress received as many as 130 papers from domestic authors and about sixty from foreign participants from Bulgaria, S.R. Yugoslavia, Slovenia, Denmark, Germany, France and Japan. At the Congress, there were also 5 accompanying symposia and a very rich social and entertaining life. Even seen from today’s point of view, it can be said that the Congress was oversized because the previous Yugoslav congresses served us as a benchmark, but it can be said with certainty that it served as a standard for many professional congresses long after. After this Congress, six more congresses followed (in 1999, 2005, 2010, 2014, 2019, and the presidents of the congress committees were Violeta Milosheva, Mirjana Sosholceva, Jasmina Nanceva, Biljana Shirgovska and Maja Mojsova, subsequently. All of them were at an enviable professional level.

The events in the professional field were also accompanied by significant social activities. The frequent meetings of the Association contributed to the development of the feeling of togetherness among colleagues and to the improvement of personal contacts. The meetings were held in almost all cities and tourist places in Macedonia, and colleagues from the interior presented their professional papers much more than today. There were many trips by organized bus transport, and the attendance was high. At the meetings, members also received information about personal events, such as completion of specializations, masters’ or doctorate degrees, or retirements. Also, the meetings served as a place where information was shared about upcoming international professional events, which was a replacement for today’s Internet. The meetings always ended with a joint lunch and many times with a music program.

Published Works of Importance for the History of Macedonian Anesthesiology

  1. Andonov V, Sholjakova M, Nojkov J, Nikolova-Todorova Z, Shosholceva M, Kartalov A, Kuzmanovska B. History and development of anesthesiology (with resuscitation and intensive medicine) in Republic of Macedonia. Contributions. Sec.Med.Sci.XXXV 2; 203-217, 2014.
  2. Andonov V, Sholjakova M, Nikolova-Todorova Z, Nojkov J, Shosholcheva M. The History of Mechanical Ventilation in Macedonian Anesthesiology Practice. MJA, vol 4, no. 2, June 2020.
  3. Nojkov J. Prof. dr. Risto Ivanovski (1914-2013), najstariji anesteziolog na Balkanu. SJAT (Serbian Journal of Anesthesia and Intensive Therapy) 2013, vol. 35(5-6), str. 317-318.
  4. Nojkov J, Kvolic S. Prof.dr. sc. Risto Ivanovski, prvi specijalista anesteziolog u Hrvatskoj. Lijec. Vjesn., 9-10: 280.
  5. Nojkov J. The Oldest Anesthesiologist on the Balkan Peninsula, Dr. Risto Ivanovski, Died. MJMS 2013, September 15; 6(3): 296-298.
  6. Џочков Ј. Наслов: Доајени. Проф. Др. Владимир Андонов. Vox Medici, Скопје, 2011, 70 (20): 32-5.
  7. Нојков Ј. Од истoријата на македонското здравство. – Др. Ристо Ивановски. Основоположник на анестезиологијата во Македонија и Хрватска. Vox Medici 2013     dек. 81(4). 36-39.
  8. Nojkov J. Anaesthesiology in Macedonia. World Anaesthesia. (The Newsletter of the World Federation of Societies of Anesthesiologists) vol. 3, Number 2 1999, p. 47-48.
  9. Nojkov J. Anaesthesiology in Macedonia. European Academy of Anaesthesiology. Newsletter No. 12, May 2000, p. 7-8.
  10. Book of proceeding. 5th Congress of of Macedonian Anesthesiologists. 2-5 October 2014 Simposium: History of anesthesia in Skopje, Shtip, Veles, Strumica, and Kavadarci. (Abstrakts, in Macedonian) Autors: Andonov V, Martinovska K, Josimovska V, Eftimova B, Nojkov J, Leova M, Baldzieva A. and Karovska-Pavlova M. p. 151-160.