How the Kosova College of Surgeons was created?
Letter from the President of the Kosova College of Surgeons / KCS’ Bulletin (Volume 2, Issue 1)
While we are starting the second five years of work since the establishment of the Kosova College of Surgeons, we have considered that this issue should be dedicated to the very idea of the establishment of our organization and the surgeons who became part of history and joined to establish the Kosova College of Surgeons.
The idea to create our College, as a call that echoed from every cell of mine, was born when I participated for the first time in the largest surgery Congress in the world, i.e. the one organized by the American College of Surgeons, and I was accepted as a ‘fellow’. Now after my name were those four golden letters ‘FACS’, which means ‘Fellow of American College of Surgeons’. I became a member of the largest body of surgeons in the world, although a relatively new organization (founded in 1913) compared to ‘The Royal College of Surgeons of England’, established as ‘The Company of Barber-Surgeons’ in 1540. In 1745, ‘The Barber-Surgeons Company’, at the request of the surgeons, but with the decision of the English Parliament, was divided into two bodies, in the ‘Corporation (Company) of Surgeons’.
Two hundred and sixty years later, in 1800, this company became the ‘Royal College of Surgeons of London’, and only in 1813 it was transformed into the ‘Royal College of Surgeons of England’ [1]. A century later (1913), the American College of Surgeons was established [2], while a century and five years later we established the Kosova College of Surgeons.
With more than 84,000 members, the American College of Surgeons is the most powerful surgical organization in the world. The day I became a member of the American College of Surgeons, and I saw all those flags from all over the world, with their representatives standing proudly when their country’s name was called, it made me see our flag flying among all other flags. That’s what I needed! Our flag being among those countries that the men and women of these countries presented. I could not see our flag, there was no other Albanian (that I knew). In that world, I knew only one Albanian surgeon in the USA, the now deceased Philip (Filor) ÒȘaushaj. I had met him at the Brigdeport Hospital, while I was a surgical resident in the 4th and 5th years of my residency at Yale University. He was a colorectal surgeon, and we often operated together while I was on duty (rotation) at this hospital. In 1999 he suffered a heart attack but pulled through. Last year, Fillori left us all, while the Kosova College of Surgeons made him an honorary member “post mortem”.
I didn’t know other people of our own in surgery. But this only increased my goal to create the College of Albanian Surgeons. It was a very early idea, it could be called naive, because I had no idea how such a thing should be done. It was the after-war time in Kosova. We were still counting the dead, the burnt houses were still smoking. Years passed. Kosova was always in transition during two decades. I kept the idea in my throat, like a hidden treasure, but when I talked to several surgeons from different times, it was seen as a dream. “We are not ready, in fact we are nowhere”, was the answer.
Those years we were building the Telemedicine of Kosova, but even this was not “accepted” by our doctors, especially by some of the leaders of surgery of those times. However, we continued our work, and during the years 2007-2016 I led the new Telemedicine network in Albania. As a result of the work in telemedicine and teletrauma, we did a large study on the state of trauma in the hospitals of Albania, which was published in the World Journal of Surgery [3]. This paper then paved the way for another study [4], and then the creation of an organization of trauma and emergency surgery in Albania [5]. The first meeting was held very successfully in Tirana. We also published the magazine [6].
We, a group of surgery representatives, gathered and talked about the need to create an all-Albanian surgery organization. We all agreed. We started with the first scientific meeting in Tirana, so that next year we would go to Tetovo, and then to Pristina. We agreed that we will launch the College of Albanian Surgeons in Pristina.
Standing up, from the left: Erion Spaho, Zamir Demaj, Agron Dogjani, Kushtrim Gashi, Muzafer Kaci, Floren Kavaja, Rrustem Celami;
Sitting down, from the left: Skender Zatriqi, Edvin Selmani, Engjellushe Jonuzi, Rifat Latifi, Bedri Braha
Instead of Tetova, the meeting was held in Ohrid (!!!), while, when on behalf of the Kosova delegation I expressed that we are ready to hold the next congress and to form the College of Albanian Surgeons, the meeting was interrupted, and without my knowledge and of many others, the leader of this meeting warned that the next meeting will be in Tirana, like all other meetings of this organization, and not in Kosova. The disappointment was great. Anger too. I insisted, and together with the group of Kosovar surgeons present at this conference, we decided to create the Kosova College of Surgeons. After many meetings, physical and virtual, and the passage of several months, on December 20, 2018, we created the Kosova College of Surgeons. This was a great achievement, but I was always not 100% satisfied.
December 20, 2018, Telemedicine Center, Prishtina: Frederik Ăuperjani, Xhevdet Ăuni, Sinan Rusinovci, Mergime Loxha, Violeta Zatriqi, Syheda Latifi, Bedri Braha, Dafina Mahmutaj, Vjollca Binqe, Dugagjin Spanca, Belinda Pustina, Mentor Gorani, Saudin Maliqi, Agon Rrusta, Faton Hoxha, Sadik Llullaku, Defrim Koçinaj, Skender Zatriqi. In the middle of the screen is Prof. Dr. Rifat Latifi, telepresent from Katonah, New York, through the telemedicine network of Kosova.
The idea was different. The name should have been different: College of Albanian Surgeons.
However, for me it is one of the happiest days and the most sublime starting points that I have undertaken together with the other founding members, whom I thank from the bottom of my heart, as each of them became part of the same vision and will. I am very grateful because these men and women believed in my vision, my dream, so that we too can be part of the world’s surgery. Now we are.
*October 17, 2022, San Diego, California, USA, The Clinical Congress of the American College of Surgeons
Five years later, the flag of the Republic of Kosova was among all those countries whose flags I have seen for years on the world’s largest surgical stage. There was our College, the Kosova College of Surgeons. Professional, national and spiritual satisfaction was boundless. “Bac u kry”, I spoke aloud to Adem Jashari.
The Kosova College of Surgeons was created based on the model of the American College, with the sole purpose – to lead the way for the transformation of Kosovar surgery, bringing together all practicing surgeons throughout the country, as well as residents of every surgical discipline and medical students who will pursue surgery in the future.
The achievement of our mission for transformation will not only have an impact in the field of surgery, but will also affect other medical fields, as an example of the necessary changes for the transformation of the Kosovar health sector as a whole, and will serve as a model for the Balkan surgery.
We all know that surgery is the cornerstone of the Modern Hospital system and the Modern Academic Health System, and as such it must constantly transform itself and surgical practice.
Therefore, we started this work with the understanding that transformation should not be a passive and waiting approach, or based on scripts previously prepared and not re-evaluated for decades, but should be based on an active process of construction and re-evaluation , taking for reference the newest scientific and technological advances, as well as the analysis of clinical data and indicators. This transformation must come from within, led by the surgeons themselves and all other members of Kosovar surgery, and must be based on the strategy of improving quality and patient safety, increasing the recruitment and retention of qualified clinical surgeons and research staff, to advance the clinical and academic mission that we owe to ourselves and our descendants, but also to those who taught us.
Achievement of the mission, vision and scope of the Kosova College of Surgeons to improve surgical standards and transform surgery in Kosovo will not happen overnight, nor in a few years, but eventually it will happen.
At the same time, to achieve this goal, each of us as individual surgeons must change and evolve over time. Moreover, we must be able to anticipate, adopt and evolve with these changes ahead of time, and constantly stay ahead of the process. We, the members of the Kosova College of Surgeons, must make the College a perfect platform to start and implement this transformation for the sake of the future of surgery, the future of our people, our country.
This issue of our Bulletin will remain in our history, and one day will be jealously guarded by future generations. We must write our own history, not someone else, because history must be written prospectively, not retrospectively, or based on hearsay. The Kosova College of Surgeons must first fight medical neocolonialism in our country, from the so-called partners. And the best way to fight medical neocolonialism is to become good surgeons, to teach our generations to respect themselves, as well as their teachers and students.
But now we know very well that every beginning is difficult. We still do not have the contribution of every surgeon in Kosova, and we are still kept alive by the donations of those who want this national institution to survive. This way we canât build neither our College nor the state. We must help and finance our own College.
We must have professional independence, our building, our scientific research center, the Laparascopic Training Center, and that of clinical guides, the corner of the history of our surgery, the gallery of surgeons who fought and treated the wounded during the Kosova war, all those names of world surgery who are becoming Honorary Fellows in our College. We should write our own surgery textbooks for future surgical students. We must keep alive and advance our journal of Kosova Surgery (Kosova Journal of Surgery), we must have an administration that advocates strongly to the state and the general public.We need to be seen by the people and actually be their biggest supporter. We must ensure that the work of surgeons is always ethical, based on the latest evidence, and is never corrupt. We should not allow our surgeons to go to jail without legal process and in a dramatic media way, while others when they commit crimes we only read their initials. We need to create protocols for each disease.
This is the only way we fight corruption, fight medical neocolonialism, and reduce surgical inequality. Only in this way can we increase the level of health in Kosova.
We have analyzed the health system [7], and we have found that:
1) Kosova has the lowest budget in the Balkans and among the lowest in the world; 2) Up to 40% of the population have catastrophic expenses; 3) Lack of advanced clinical expertise and hospital infrastructure; 3) The doctor’s inability to train abroad due to visa restrictions; and 7) Corruption embedded throughout the chains of the health care system.
A multi-directional transformation strategy was created:
1)Modernization of hospital infrastructure; 2) Creation of seven pillars as a platform; 3) Creation of 12 advanced clinical centers of excellence, of which 9 are related to surgery; 4) 22 new advanced clinical sub-specialties, of which 14 are in surgical fields; 5) Sustainable medical diplomacy; 6) Change of legislation; and 7) Implementation of programs to improve the quality of surgical services.
In this five years that we are starting, we must create the center of oncology, of trauma, and of scientific research, with all the right components. This requires the dedication of each of us. We must also bring the business community to our (non-operative) table, so that they can help Kosova’s health and fight against medical neocolonialism.
After all, we must direct and govern our own destiny, and the people expect a lot from us. Like these surgeons who had the courage, and vision to join the idea of creating the College, and who have become an indisputable part of our history.
References:
- History of the Royal College of Surgeons. Royal College of Surgeons of England. Accessed on March 1, 2023. https://www.rcseng.ac.uk/about-the-rcs/history-of-the-rcs/
- Â History of the American College of Surgeons. American College of Surgery. Accessed on March 1, 2023. https://timeline.facs.org/
-  Latifi R, Ziemba M, LeppÀniemi A, Dasho E, Dogjani A, Shatri Z, Kociraj A, Oldashi F, Shosha L. Trauma system evaluation in developing countries: applicability of American College of Surgeons/Committee on Trauma (ACS/COT) basic criteria. World J Surg. 2014 Aug;38(8):1898-904. doi: 10.1007/s00268-014-2538-7. PMID: 24696060.
- Latifi R, Gunn JK, Stroster JA, Zaimi E, Olldashi F, Dogjani A, Kerci M, Draçini X, Kuçani J, Shatri Z, Kociraj A, Boci A, Donaldson RI. The readiness of emergency and trauma care in low- and middle-income countries: a cross-sectional descriptive study of 42 public hospitals in Albania. Int J Emerg Med. 2016 Dec;9(1):26. doi: 10.1186/s12245-016-0124-5. Epub 2016 Oct 7. PMID: 27718129; PMCID: PMC5055520.
- Albanian Society for Trauma and Emergency Surgery. https://astes.org.al
- Albanian Journal of Trauma and Emergency Surgery (AJTES). https://journal.astes.org.al/index.php/AJTES
- Latifi R. Transformation of the Healthcare System in Kosova and Medical Diplomacy. Kos J Surg. 2022 Jan 6:2:4-12. https://koscs.org/en/kosova-journal-of-surgery-volume-6-2-en/
âYou can read the full Bulletin, Volume 2, Issue 1, here: https://koscs.org/en/the-bulletin-of-the-kosova-college-of-surgeons-volume-1-issue-2-2/