Boosting ICU capacity during the COVID-19 pandemic in the western Balkan region, The Republic of Srpska experience

Background

Response to the outbreak of poliomyelitis in mid-1950 led to recognition and consequent development of critical care. Seventy years later the humankind was struck by COVID-19, another major challenge for critical care medicine which was especially big in Low-Resources-Settings where more than two thirds of the world population live, including the population of the Republic of Srpska (RS).

Design and methods

The main aim was to show an overview of all interventions in order to boost hospitals' capacities to the level which is sufficient to manage high amount of critically ill COVID-19 patients in the RS. A before-after cohort study design was conducted to evaluate the effects of interventions for increase in preparedness and capacity of ICUs for admission and treatment of COVID-19 critically ill patients in nine hospitals in the RS. Results: Following interventions, the biggest and university affiliated hospital in the RS has increased ICU capacities: total number of ICU beds increased by 38% and number of ventilators by 114%. Availability of machines for veno-venous extracorporeal membrane oxygenation (vvECMO) increased by 100%. Number of doctors who were involved in treatment of critically ill patients increased by 47% and nurse/patient's ratio reached 1:2.5. Similarly, all other hospitals experienced boosting of ICU beds by 189% and ventilators by 373% while number of doctors increased by 108% and nurse/patient's ratio reached 1:4.

Conclusion

All interventions implemented during COVID-19 pandemic outbreak in the RS resulted in increasing capacity for treatment of critically ill patients, but the education of health care professionals was identified as the most important conducted intervention.

Initiative for ethical media reporting about mental health

Introduction

As a part of continuous destigmatization of mental illness and paople with mental disorders significant importance has media reporting, especially in modern times.

Objectives

Media reports about mental health (MH) are still an issue of a great discussion concerning their content especially in ethical matters. Many initiatives in different countries resulted in various changes in attitudes and influenced on this topic. But the image of mental illness as well as psychiatry in general are still burdened with the shadow of stigma.

Methods

To show development of one of initiatives in Bosnia and Herzegovina (BH) supported by policy makers through the creation and broad distribution of recommendations for ethical media reporting about mental disorders.

Results

In 2019 Task Force appointed by both entities’ ministries of health in BH developed an publication with recommendation for ethical reporting about mental health topics with special highlights on specific mental disorders (schizophrenia, depression, suicide, addictions, etc.). It was widely distributed to media and health institutions in the country and was officially adopted as the recommendation of the national Regulatory Agency for Media. Trough five rounds of educational workshops in 2019 and 2021 more than 150 media and mental health professionals were introduced with the publication as well as practical implementation of this recommendations (as is exercises of giving statement).

Conclusions

In BH is developed very useful tool for more quality media reporting about MH topics as one of important ways for reducing the stigma and discrimination of people with mental disorders as well as promotion of good mental health

Disclosure

No significant relationships.

New mental health laws in bosnia and herzegovina- step towards in our practice

Introduction

Establishing broad spectrum of new mental health services in whole Bosnia and Herzegovina (BH) existing mental health laws in both entities needed to be upgrade according positive results of the mental health reform in the country. Previous laws were exclusivelly oriented on protection of rights of the people with mental health disorders in (mainly) psychiatric institutions and were progressive and new in the period of their implementation (2001-2004).

Objectives

Since 2010 main reform processes had direction to community mental health care and developed positive movement with implementing new services oriented to patients and their needs/continuity of care. For example case management and occupational therapy are part of daily work in whole country and standards established trough accreditation process lead to uniform approach in community work in the area of mental health.

Methods

Comparative analysis of laws in BH concerning mental health.

Results

Carefuly and good preparation for pronounce of new Mental Health Law both in Republic of Srpska and Federation of BH were supported from both entities (task forces, drafts and proposition of the law and public discussion) and they are formaly supported in both entities parliaments in 2020 (prolonged since COVID-19 situation). In both laws is more emphasised role of commnity services, prevention, and post-hospital rehabilitation as continuity of care. Book of rules that follow the laws will be establish no longer than the end of 2020.

Conclusions

New mental health laws in BH are path to better protection of mental health of all population in BH and rights of our patients’ recovery.