Since the war ended in 1995, Dr. Cerkez has helped guide the development of the Bosnian CBR system from its ad-hoc beginnings to its current incarnation as a network of 38 standardized clinics spread throughout the country, each providing a surrounding population of about 60,000 people with local, completely integrated rehabilitative care. Bosnia did not set out to develop a CBR system; their rehabilitation systems simply evolved into what we call CBR as the Bosnians sought a way to treat an incredible number of amputees as cheaply as possible while maintaining quality and comfort. National pride played no small role either—Bosnians wanted the ability to not only treat their wounded immediately, but to care for them over the long term. CBR was the answer.
Each of the 38 clinics offers basic
rehabilitation services free of charge for any person injured during
the war and for all landmine victims, regardless of when their
injuries occurred (landmines still cause 80–90 annual casualties in
Bosnia). An estimated 684,000 patients filter through Bosnia’s clinics
each year, receiving hot, cold, electro- or kinesiotherapy according
to their needs. Trained professionals also provide psychosocial
rehabilitation in every clinic, so patients who require both physical
and mental assistance need not venture all over town. These clinics
can’t solve all of a patient’s rehabilitation problems—they have no
anesthesia, for example, so doctors do not conduct surgeries of any
type. CBR clinics aren’t meant for major operations, but “if you need
continuous, daily treatment, you can do this in your community—and
that’s an advantage,” for both patients and nations, claims Dr.
A few numbers express the economic advantages of CBR quite clearly. The 38 standardized centers take up just 150 square meters each, and the whole project cost a bit over $5 million (U.S.)—a pittance in the healthcare realm. Dr. Cerkez states, “If you compare it to the cost of one big center, it’s about the same amount of money. It’s clear that [CBR] is the better investment.” CBR makes economic sense for patients, too. Travel costs quickly become prohibitive if patients must travel daily, or even weekly, to a distant rehabilitation center. CBR eliminates such voyages, allowing the patient to remain closer to home, within his or her own familiar community. Mountains of anecdotal evidence point to the rehabilitation benefits that regular contact with family and friends—in other words, a patient’s community—can bring. When people are comfortable, they are happier, and that leads to higher attendance at therapy sessions—quite necessary for an effective rehabilitation program. Numbers can’t adequately show the psychological advantages of CBR, though they may be most significant of all.
Still, some patients seek rehabilitation services outside of Bosnia. They go to Slovenia or Croatia, always looking for better care. They (or the government) have to pay for a plane, for accommodation and for the services themselves. “They think that in other places they can be treated better than here,” Dr. Cerkez laments, though “in our analysis, less than 10 percent of our patients are not satisfied with their prosthesis.” The grass is always greener on the other side, especially in Bosnia. Only a very few, extremely complex cases must receive help outside of the country, and that will not change for several years. But the majority could easily find needed help within Bosnia. Dr. Cerkez would prefer that money spent to transport such patients instead be invested in developing Bosnia’s internal capacity.
But there are others he’d be more willing to
send abroad: young surgeons, technicians and other medical personnel.
Like many other professionals in Bosnia, the current crop of doctors
has a great deal of hands-on experience but little formal training.
“We need to exchange people and knowledge” to build up Bosnia’s
internal abilities. That way, “we can support ourselves after
international support is gone.”
*Photos courtesy of the author.