ZAGREB, 26 June 2022 - As many as four Croatian healthcare innovation projects are included among 20 projects from central, eastern and southern Europe selected for financing by the European Institute of Innovation and Technology (EIT) under the Regional Innovation Scheme.

Eighty projects have applied for funding, and four Croatian ones have been selected, more than from any other country in the region, the Večernji List (VL) daily said on Sunday.

The EIT Health Regional Innovation Scheme supports the development of  innovation in healthcare in the countries of central, eastern and southern Europe. The consortia behind the selected innovations will be granted up to €75,000 for further development of products or solutions, mentoring, a place at a bootcamp, and access to potential investors and partners through EIT Health, a network of top healthcare innovators in Europe.

The selected Croatian projects are: MEGI, PsyFlux, StressLyft and the Human-Machine Interface.

MEGI aims to develop an AI-enabled virtual cardiovascular health assistant that uses personalised protocols to remind patients to take medication and measure their blood pressure at home.

The PsyFlux consortium is developing a telemetric intracranial pressure monitoring device that can be used outside the hospital without infection risks, allowing the patient to partake in everyday activities.

StressLyft is an educational course about workplace stress and stress relief skills, based on interactive video content, which companies provide for their employees to prevent work-related stress.

The gesture-based human machine interface for guided orthopaedic surgery aims to develop novel medical devices that help surgeons to make millimetre-precision measurements during hip replacement surgery and possibly other types of operations.

"Our aim is to find the best ideas and early-stage innovations in the region and encourage players from business and academia to build consortia and turn their concepts into realities," Mónika Tóth, EIT Health InnoStars RIS Programme Manager, was quoted as saying.

For more, check out our politics section.

June the 19th, 2022 - The much-talked-about Croatian Immunology Institute is one step closer to coming to fruition now that the involved ministries have chosen a location for the future facility.

As Poslovni Dnevnik/Marija Crnjak writes, through the joint efforts of the Ministry of Health, the Ministry of Physical Planning, Construction and State Property and the Immunology Institute, a solution was reached by which the Rugvica business zone near Zagreb will become the permanent home of the new Croatian Immunology Institute, the Ministry of Health reported recently.

''In the context of legal challenges we faced with the previous chosen location, we've made a significant step forward in continuing this strategic project and have shown the strong will and determination of the Croatian Government, the Ministry of Health and the Croatian Immunology Institute to remain committed to revitalising the Immunology Institute as an important institution in this country,'' said Health Minister Beros on the occasion of this decision.

With this decision, the Municipality of Rugvica, as the owner, donates to the Croatian Immunological Institute, land in the Rugvica working zone - north, 69,761 m2 with a potential minimum minimum size of 20,000 m3 for the construction of an entire biological drug factory, the construction of a separate plant for antitoxins, and plants for the production of animal immunosera intended for both human and animal use with the primary purpose of producing antitoxins for the venom of European snakes.

This Decision was preceded by a statement from the State Attorney's Office of the Republic of Croatia, the Ministry of the Economy and Sustainable Development, and the Ministry of Physical Planning, Construction and State Property found no legal obstacles in terms of Article 391 of the Property and Other Real Rights Act.

The construction of the entire factory will begin in no later than two years time, while the estimated construction time to the stage of functionality is nine months from the positive completion of the public tender, ie the selection of all of the contractors by tender. The method of construction of the production plant will be prefabricated modular segments of clean rooms designed and built outside the building and connected and formed inside the building, preceded by a series of preliminary works, from obtaining the necessary permits, evaluating the conceptual design and final design of the main project.

At the same time, a public tender has been prepared for publication for the construction of a new biopharmaceutical plant for the production of animal immunosera, ie drugs intended for both human and veterinary use with the primary purpose of producing antitoxins for European snake venom.

As the Croatian Immunology Institute has permits for animal testing, as well as breeding permits, there are some basic preconditions for building a plant for processing hyperimmune equine (horse) plasma within the new factory, as a complete unit in one location, where the processing, filling and equipping would take place. The existing resources on the farm in Sveta Nedelja will be used for all of the above.

"The Croatian Immunology Institute is the flagship of our science and deserves all possible interdepartmental efforts. The easiest thing in the world to do is to simply declare the end and throw in the towel at the first sign of any obstacles that understandably appeared due to the complexity of this project. We've chosen a harder but more correct way of going about things, we've taken an additional step forward and together we've found a solution to continue the revitalisation of the Croatian Immunology Institute.

In order to restore its reputation and further position it on the international map of leading manufacturers of vaccines for various purposes, as well as other products in demand in this market segment, in the first phase, vaccines against measles and rubella will be produced, as these are products needed by both the Croatian and world markets,'' concluded Minister Vili Beros, adding that this country now the opportunity to meet the preconditions for its own production of antitoxins, which would make Croatia self-sufficient in the production of snake antidote, which is especially in demand during the summer tourist season when bites are more common.

For more, make sure to check out our dedicated lifestyle section.

ZAGREB, 15 May 2022 - Health Minister Vili Beroš said on Sunday, ahead of a strike of non-emergency ambulance drivers set for Monday, that he supports any protest that is in line with the law but that he will not tolerate patients being denied the right to health care.

Some of the non-emergency ambulance drivers have announced a strike for Monday, to last until their demands are met and a regulation is adopted that would make their wages even throughout the country as currently they differ up to HRK 1,500, depending on the county where they work.

The minister said a solution was being defined with all the relevant stakeholders, recalling that last year the government and the health ministry launched dialogue with unions and showed the will to resolve the problem.

He added that there was therefore no reason to strike or take action that would be to the detriment of patients and that he expected local clinics and non-emergency ambulance drivers to continue providing regular services so that a solution to their problem could be found in a constructive and peaceful atmosphere.

For more, make sure to check out our lifestyle section.

ZAGREB, 4 May 2022 - It should be possible for every woman in Croatia to terminate pregnancy even after ten weeks if there are medical reasons for that, the Health Ministry said on Wednesday after the media reported on the case of a 39-year-old woman whose second child in the womb has an aggressive brain tumour.

The ministry called on all health institutions to timely and accurately inform their patients of their rights and possibilities that exist in Croatia.

Mirela Čavajda, whose second child got an aggressive brain tumour in the womb, told the Index web portal, which was the first to publish her story, that all hospitals in Zagreb she contacted had refused to do a termination of pregnancy despite the fact that doctors told her that the tumour was so big the child most likely would not live long, and even if it did, it would never have a normal life.

The doctors she talked to convinced her they would be happy to help her, but they said it was illegal in Croatia to do an abortion after week ten, Index wrote.

The parent tried to seek help in all Zagreb hospitals that could do a termination of pregnancy -- Sveti Duh, Merkur, Vinogradska, and last Friday they sent a request to hospitals to establish a committee which should by law approve a termination of pregnancy, but they still have not received a response.

Čavajda added that she therefore launched a procedure in Slovenia, where she was told after an examination that the diagnosis was very bad, that there was nothing disputable about her case and that the decision was up to the parents, announcing that an ethics committee would make a decision on the request next Tuesday.

In a reaction to that case, the Croatian Ministry of Health said that a termination of pregnancy was possible after week ten with an approval of the committee and with the consent, that is, at the request of the pregnant woman, in cases where there are medical indications, or when the conception occurred as a result of rape, intercourse with an incapacitated person, intercourse by abuse of position, intercourse with a child or incest.

In order to ensure the woman's right, the Ministry of Health has enabled the establishment of a second-instance committee at the KBC Zagreb Hospital, in case the first-instance committee denies her request, it was said.

For more, make sure to check out our dedicated lifestyle section.

April the 17th, 2022 - The much more rapid and efficient listing of HZZO medicine could end up saving the already enfeebled Croatian healthcare system another billion kuna.

As Poslovni Dnevnik/Marija Crnjak writes, the Croatian healthcare system could save an additional one billion kuna per year if the policy of putting generic and biologically similar drugs on the lists of the Croatian Health Insurance Institute (HZZO) was improved and accelerated, according to Croatian pharmaceutical generic companies within the Croatian Employers' Association (HUP).

Currently, the system saves about 300 million kuna a year with the use of this HZZO medicine, but the potential is significantly higher, said Jerko Jaksic, president of the Association of Drug Manufacturers at HUP, at a briefing for journalists which took place on Thursday.

According to data from back in 2019, 61 percent of the volume of prescription drugs in the Republic of Croatia is made up of generic drugs, which is slightly lower than the EU average of 67 percent. The situation with biosimilars is much worse, they accounted for a modest 13 percent of the market in total consumption of biological drugs.

Although further growth is expected in the coming years, in addition to education, it's necessary to accelerate their application when they are registered with the European Medicines Agency and the Croatian Medicines Agency.

As the manufacturers have explained, the HZZO procedure for listing a drug, which is purely administration and paperwork, takes an average of four to six months, during which time money is directly lost that could be saved by using generic instead of innovative therapy.

“So-called drug penetration into the system should be significantly quicker, which is even more significant when it comes to biological drugs, as biological drugs are very expensive. We have announcements from the Croatian Health Insurance Fund that this process could be accelerated, and we're very happy about that. There's no reason why a drug shouldn't automatically be on the list immediately after its registration, and it would be very good if the new procedure comes to life by the middle of this year because patents for some drugs expire soon,'' Jaksic said.

In particular, these are diabetes related drugs, and the potential for savings is 30 percent for the healthcare system, with the release of patient participation. With proper application, in 2023, 15 percent more patients could be treated for the same cost in this segment alone, HUP pointed out. The data also shows that biosimilars have increased the availability of biologic therapy.

For example, in the immunology segment, 67 percent more patients were treated for only 19 percent more. Back in 2021, 2.5 times more patients were treated with the chemotherapy mitigation drug than in 2019 for approximately the same total cost. In 2020 alone, biosimilars provided savings of 200 million kuna. However, the biggest shortcoming in the drug policy in Croatia is still poor cost control, due to insufficient therapeutic guidelines and measuring the effectiveness of therapies, they added from HUP.

Patient registries exist only for a small number of diagnoses and a large role in this is played by patient associations, which are as such fighting for the better availability of some drugs, but for most patients and diagnoses, not all treatment parameters are systematically monitored.

For more, check out our lifestyle section.

ZAGREB, 3 April 2022 - About 150 people in Croatia are annually diagnosed with acute myeloid leukemia (AML), and the survival rate is about 5% below the EU average, a round table on the treatment and quality of life of AML patients heard earlier this week.

"In Croatia, every week three persons are told they have AML, which is 156 annually, according to data from the Cancer Register for 2019. The five-year survival rate is 12.6%, compared to the EU average of 17.2%, which shows that there is considerable room for improving treatment", the participating doctors and patients said at the round table.

AML is the most common type of acute leukemia in adulthood and the most frequent age at diagnosis is 65 years, with increasing incidence after 65 years of age. It has the lowest survival rate compared to other types of leukemia and is treatable in about 40 per cent of patients aged under 60 years, most frequently by bone marrow transplantation from an unrelated donor.

"In Croatia, we have 70,000 bone marrow samples and we can find an unrelated donor relatively quickly, which is why nearly every patient in Croatia has a chance to get a transplant and be cured. The number of transplantations has reached one hundred annually, which is within the European average," haematologist Radovan Vrhovac said.

For more, check out our dedicated lifestyle section.

ZAGREB 6 March 2022 - Breast cancer mortality has been falling in Croatia for the fifth consecutive year, the Croatian Public Health Institute (HZJZ) said earlier this week ahead of Daffodil Day, noting that the disease was no longer the leading cause of mortality in women.

Breast cancer is now the third leading type of cancer causing death in the female population, after lung and colon cancer.

In terms of breast cancer mortality, Croatia ranks 15th in the EU, which is better than average.

Daffodil Day will be observed this year for the 26th time, on the first Saturday in spring, to raise awareness of the importance of preventive breast examinations.

In 2019, Croatia recorded 2,999 cases of breast cancer (143.2 cases per 100,000 population), and 722 women died of that disease in 2020 (34.7 deaths per 100,000 population).

Due to population ageing, it is forecasted that more women will be diagnosed with breast cancer.

Most cases are diagnosed in older women, with more than 80% of new cases consisting of women aged 50 and over. Even though younger women, too, can be diagnosed with breast cancer, such cases are more rare. This stresses the importance of breast examinations as soon as one reaches early adulthood.

The drop in breast cancer mortality is partly owing to the implementation of the national programme for early breast cancer screening and detection, launched in 2006. This initiative includes invitations to mammographies to all women aged between 50-69, every two years, it also includes better diagnostic and treatment methods.

According to the 2019 European Health Interview Survey, 77.3% of Croatian women aged 50-69 underwent screening in the past two to three years.

During the COVID-19 pandemic, mammographies were put on hold for only three months, in the spring of 2020, during the lockdown. However, all women who missed their check-up at the time received a new invitation to a new screening apointment in the autumn of 2020.

Around 150,000 women a year respond to invitations for mammography, and so far more than 7,000 new cases of breast cancer have been diagnosed through this initiative.

For more, check out our dedicated lifestyle section.

28 February 2022 - Health Minister Vili Beroš said on Monday that Croatia would provide health care for refugees from Ukraine, as well as all necessary medical assistance for the wounded if the need should arise.

Croatia already helped treat the wounded from Ukraine in 2014 during the annexation of Crimea. At that time, we offered help with taking care of a total of 10 wounded persons, and eight of them were treated at Zagreb's KB Dubrava hospital, mostly persons with gunshot wounds to arms and legs, who arrived in Croatia in the final phase when treatment had to be completed and rehabilitation carried out, the minister recalled.

The manner of caring for the wounded will be agreed at the European level, and Croatia is willing to participate because Croatian doctors have extensive surgical experience in treating such patients, Beroš told Hina, adding that he also talked about it with the Ukrainian ambassador to Croatia.

Beroš considers that it would be more functional to establish a health centre for the wounded near the Ukrainian border, for example in Poland, and have medical staff, including Croatian doctors, participate in the treatment at that centre.

As for health care for Ukrainian refugees coming to Croatia, it will be provided to everyone from the place of entry in Croatia to the place where they will stay for a longer period of time.

Medical triage at points of entry into Croatia

Therefore, in addition to the government's interdepartmental working group for the reception of refugees, an expert working group was established at the level of the Health Ministry to provide specific health care to those people.

Beroš said that medical emergency teams would provide medical triage at points of entry into Croatia. These will include county institutes of emergency medicine and public health institutes since the COVID crisis has not ended yet, refugees have to be tested and their vaccination status has to be recorded, he said.

Ukrainian refugees fill out a questionnaire from the Croatian Red Cross upon entry, answering also questions about recovering from COVID, vaccination and chronic diseases, so that they can receive all the necessary care.

January 12th, 2022 - Those who have left Croatia but keep using Croatian public healthcare at the expense of the state will soon be removed from the HZZO database

As many as 300.000 Croatians could soon have their public health insurance policies cancelled by the Croatian Health Insurance Fund (HZZO), reports Novi list. Namely, Health Minister Vili Beroš has announced that the HZZO would be cancelling the policies of those insured whose residency or employment status does not grant them the right to free health coverage anymore.

Most of that list consists of citizens who emigrated in the last decade and now work and reside abroad, but retain their Croatian public health insurance at the expense of the state on the basis of being unemployed in Croatia.

A large number of such policyholders prefer to use the services of GPs or dentists when they visit Croatia, as they find it much more affordable than the equivalent service in the country they currently reside in. It’s estimated that two thirds of Croatian emigrants avail of their health insurance benefits in such a manner.

The HZZO states that a considerably large number of people benefit from the rights guaranteed by their public health insurance despite not paying the compulsory insurance contributions. The exact number could become known in a month’s time, once HZZO and the Croatian Employment Service (HZZ) have merged their databases.

All citizens who are not on file with the HZZ, but avail of the free compulsory health insurance on the basis of their unemployment status, will have their health insurance policies cancelled, as well as their dependents.

According to the director of the HZZO Lucian Vukelić, those citizens who are not registered with the HZZ as unemployed persons could lose their free health insurance policies as early as in February 2022, once the two institutions have signed the data exchange agreement.

In recent years, many Croatian citizens have left their homeland in search of work; while the number of HZZ applicants dropped significantly as a result, they mostly remained on file with the HZZO and held onto their free health insurance.

A number of Croatian emigrants were removed from the HZZO database in the summer of 2021, after a data exchange with the Ministry of the Interior showed which citizens had cancelled their residency in Croatia.

According to the HZZO, at present it’s nearly impossible to find out which Croatian citizens work in other countries where they also pay their health insurance contributions and where they should thus avail of public healthcare as well. Even though it’s illegal to have public health insurance in two countries simultaneously, there still doesn’t exist a unified EU database that would reflect where citizens have contributory health insurance and use public health services.

‘Considering that there’s a bunch of different insurance providers in most countries, it’s impossible to obtain the data. You would have to search all over Europe for each policyholder individually to find out if they’re insured in a certain country. It so happens that no one in Croatia ever cancels their health insurance; [employers in] most EU countries are obligated to insure their workers upon employment, and so we end up with an enormous number of people who work abroad and are insured in Germany, Austria or Norway, whereas in Croatia their public health insurance remains covered by the national budget’, said Vukelić.

The HZZO does not have the exact figures regarding potential savings for the national budget if Croatians who are not factually unemployed were removed from the HZZO’s list of unemployed policyholders.

However, if we were to consider the 300.000 people in question, based on the health contribution rate of 16.5% of a monthly gross salary of e.g. HRK 5,000, the state is HRK 2,7 billion out of pocket each year. This does not even take into account the annual costs of health services in Croatia that such policyholders avail of.

The HZZO will also look to cancel the policies of Croatian citizens who have not left the country, but use the benefits provided by their health coverage even though they are not paying the contributions.

An example of this are undeclared workers who neither pay for the coverage nor are they on file with the HZZ, but retain their free health insurance. Such persons will need to register with the HZZ and find legal work, i.e. pay the relevant taxes and contributions.

https://www.novilist.hr/novosti/hrvatska/hzzo-cisti-evidenciju-besplatno-osiguranje-moglo-bi-izgubiti-300-000-ljudi-radi-se-mahom-o-iseljenicima/
Ljerka Bratonja Martinović

December the 30th, 2021 - The Croatian public health system is faced with a lot of criticism, much of it is unfounded, here's my story.

Last spring was promising me yet another wonderful, very long, carefree and rejuvenating time down by the sea. Retirement is a blessing. It offers freedom of movement (plus freedom of speech if you enjoy it properly) and, especially, total command over one’s time. That's the bright side of it.

Time is man’s only true possession - everything else is precarious, ephemeral, temporary or illusional, much like our own bodies and physical states, for example. They're precarious, ephemeral, temporary, limited, and certainly not a supporting companion to our soul. I think that babies start crying seconds after their birth not because they are terrified by the new environment, but because they experience physical pain. Pain is man’s first experience of the world. Our body is not our friend, and it is less and less so as time goes by.

Health of course is tied to what one does on a daily basis to try to preserve it. Some attempts are futile, most aren't. Some people understand that early on, most don't.

I'm proud to say that my life allowed me to sin for a major part. A lot. Heaps more than most people I guess. I have seen more dawns than twilights, so to speak. Because life in general was generous to me (well, even during the war it was rewarding in many ways when I think of it), serenity prevailed by far over all of my days. When you're young, you are supposed to be all kinds of things when you grow up and you can of course do anything, including becoming an ''adult'' while still underage, because you need to keep up with the boys from your quarter, all of whom are your seniors by quite some years.

You cannot afford to be called a sissy if you didn't smoke, which you would be. At least back then. So I started smoking when I had barely reached the ''ripe old age'' of 16, when of course I knew everything there was to know about life, as did you, I'm sure. Later on, in the long years of studying and then freelancing around the world, partying and booze came into the picture, too, inevitably. Not that I'd get wasted every night, of course, but, well, there was lots of partying and many dawns, and many an estranged taxi taking me to where my bed was while missing my sunglasses and a bottle of water most desperately.

I remember discovering ''The Memories of Hadrian'' somewhere in my early twenties and re-reading that book several times over. Among quite a few memorable points, despite myself being young and utterly healthy, my mind recorded that moment when Hadrian started to become tired of his body which was becoming a nuisance, a traitor, limiting and disabling him. Almost one half of a century later, Hadrian has come to my mind so many, many a time. What a piece of work is man, Master Shakespeare wondered. Indeed.

When you think how you hated your granny (and your mother, and aunt and practically every adult around) who scorned you for not wearing a sweater, not having your shirt tucked in properly, sitting on cold concrete that would certainly make your kidneys ''go bad'', for going out (on a date possibly) with your hair still wet from the shower as a safe way of getting meningitis and inflamed sinuses, not to talk about lessons on how bad smoking is for you and how alcohol damages your liver… But who would listen? All of those irritating pontifications might have been true, but they had nothing to do with you whatsoever in your mind.

And then, how many times have you heard that somebody died of ''a sudden heart attack''? Sudden!?  It took almost all my life so far for me to learn that there is no such thing as a sudden heart attack. Such events, rare as they are, are freak ones. Every stroke or heart attack has its silent and deadly history built up in the years, it has its progress and, especially its cause(s) that live with you for a long time before that. You pay no attention, and then you're suddenly being transported to an emergency ward. Genetics play a role of course, but the cause is - you. Or, in my case - me. Also because my granny got on my nerves so much. 

The experience I had was more than terrible, and I want to share some of it.

I was in London some eight years ago when the very first rays of warning shone up inside my brain. One day I was walking from an underground station to the house of my friends where I stayed. It was an everyday routine, nothing special, and quite a short distance too. I might have been less than 100 metres from the house when I felt my right calf suddenly become stiff, further steps were oddly difficult, I started limping and hardly made it to the gate. The remaining several days were highly marked by that. I had pains when walking, I could not walk for long, either. It was sudden. It was frightening. That is when I was reminded of the not-so-good genetics pertaining to arteries in my family. There I was. It has caught up with me despite my lack of attention. I should have listened.

Back in Zagreb I hardly made it upstairs, dragging a suitcase along with me to my apartment at the same time. All alarms then began ringing inside me. This was no pulled muscle, and no self-resolving, passing ailment. One or two calls to my friends sent me to a hospital right away. There was a clog in my artery that had stopped the flow of blood to my leg almost completely and the operation, performed under local anaesthesia, was carried out by a young doctor who I made laugh heartily while he dealt with the clog.

When you must not move an eyelash for almost two hours, it feels much longer than it is.  I was alone in a spacious room, I had a TV, my own internet and actually had a good time within the circumstances, however ''disturbed'' by frequent check-ups and controls by medics. The care was total and complete and made me feel safe and comfortable. It was proof that the Croatian public health system, while underfunded, was beyond excellent.

This happened somewhere exactly around Easter Day and I was glad I could avoid traditional lunches and coloured eggs. That’s for kids, I find. Five days later I was back in the normal world with a clean artery and feeling quite good, quite normal again. I avoided driving and public transportation and walked everywhere I could. That is how you control cardiovascular diseases which only require conservative treatment. I soon forgot about that.

Pain gone and experience fading, I soon regained my old lifestyle. A thousand parties and no work, as Gertrude Stein defined the Thirties in Paris. Well, almost. Freelancing allows for that, as anyone who has dabbled in that knows well.

As a heavily addicted smoker, I wasn't aware of what I was silently but lethally doing to myself. Friends and family would warn and rebuke me, some strongly. I continued believing that the slogans on tobacco packages about death, cancer and other pretty things could not possibly affect me. Larger than life I was. Isn't cognitive dissonance a strange thing?

I could not bring to my awareness that getting out from a warm restaurant into freezing rain just to have a smoke made my granny turn in her grave while my arteries were getting more and more clogged by the day, by every single puff on a cigarette, by every single drag. My life was so good again, so why should I listen?

Some years went by, the uneasy feeling in my legs was growing once again, slowly but constantly, until I reached the stage when I could barely make a distance of 50 metres and was in almost constant discomfort. My calf writhing with each step as my body desperately tried to transport adequate oxygenated blood. In vain.  

It was a wonderful evening with a gang of friends of an international composition, with so much fun, laughter, totally uninhibited by ''Weltschmerz'' and the futility of life. When we had to change the place because of a rapidly approaching closing time, I realised I would hardly make it on foot.  The other place was less than 200 metres away. The final alarm was on. Again.

One call to a doctor friend put me in hospital almost the same day. During the first check-ups it seemed it was to be an easy intervention, then they took some blood, did some tests and found out that my blood sugar was above 20. It was too dangerous to operate. I was diabetic too, apparently. I had no idea what my body was suffering from, how could I have been so detached? How dare I feel surprised by my neglect? It was almost one week before they managed to bring it down to an operable stage.

I had peripheral arterial disease. An incurable but controllable arterial disease which affects the limbs, mainly the legs. My femoral artery was entirely clogged, and so were some others. Well, there we go. Another operation, a big one this time, with general anaesthetic and consent forms galore. I woke up after some hours, the doctors couldn't believe how brilliant my readings suddenly were, how my body which obviously was in dire need bounced straight back after being given what it needed. Instead of a longer sojourn in intensive care, I was taken quite quickly back to my room to recover. Yet again, more very good care at the hospital, another operation gone well, expertly well. It made me think of all those accolades Croatian medicine has been getting from all over the world. It is very deserved. Take it from me.

A few more years passed by. My left leg still had a few problems, some due to nerve damage following surgery, but it was truly nothing in comparison to how I felt before that last operation. I got used to stopping when I walked, waiting for a minute or two when I experienced claudication, and continuing. Naturally, I didn't feel enthusiastic about walking at all. My legs felt heavy and not willing to be exposed to any strain. Because of the pain it caused, although that pain was actually my saviour which would help to treat my disease, I started avoiding going anywhere on foot.

Unlike that first time, the famous blue Zagreb trams became my favourite way of moving around the city, and driving too. Then, my doctor scolded me, telling me that I must walk, walk and walk some more. By walking and straining the legs, you help your body develop more collateral blood paths, you help your heart, you help your - everything. I did reduce my nicotine intake, with lots of effort and self-control, but I could not abandon it altogether. By the way, for all you dirty smokers out there - I reduced the number of cigarettes by allowing myself to smoke only on the terrace, outside, never  inside the house. It helped. Maybe you could try that, too. It was quite an achievement for me who once smoked 40 per day, but I still couldn't quite kick it to the curb. Idiotic, I know.

My close friend, Lauren, started to force me to walk. We'd take long walks, not just to a cafe. She would get me to do it daily, again and again. I felt better. The splendid Maksimir Park offers infinite combinations and paths to stroll, for as long as you can or want to. I was forced to make at least 6000 - 7000 steps each time. For orientation, I could make some 200 in one go. Imagine the effort! I had to stop many times, but I did it. Never without losing my breath, panting or anything, never feeling that my heart was suffering. But to tell the truth, my physical condition was not exceedingly good. To put it modestly.

Fast-foward to April 2021. The leaves on the trees were turning green, everything was in blossom, Maksimir Park looks truly fabulous at that time of year, permeated with the birds’ twitter and the gentle breeze in the thick tree tops. As nice as all that is, as a Dalmatian from Dubrovnik, I was craving the sea. Addicted to the sea and, especially, to swimming - at least for 6 months a year, usually - I started coining my plan to go to the coast much earlier than usual and to make the ''summer'' a very long one indeed. I decided to have myself checked properly, to be sure I could spend several months in a village, far from my doctor friends in case, God forbid, I needed one. 

I contacted my friend, a renowned vascular surgeon from Zagreb, and asked him if he would be willing to check me up ''properly'', with scans and the works, as I really wanted to know what was going on inside me, especially inside my arteries. At one of those check-ups, I ''demanded'' that he check my heart. Without any apparent sign of anything. I just wanted to be sure. It might have been genetic hint from some of my ancestors from ''up there''. I had no cardiac symptoms that I could discern, it just came out of the blue.

How unfortunately right I was! My blood pressure was through the roof. I was suffering from hypertension which is high blood pressure, a common condition in which the long-term force of the blood against your artery walls is high enough that it may eventually cause heart disease. The ultrasound not only found some other little flaws in my heart, but three main arteries were more or less clogged. I needed a triple coronary bypass in an emergency procedure. I was ordered to stay in the hospital that same moment. In other words, I had to be under permanent custody, linked up to various monitors, as my heart could collapse under the strain at any moment. How and why I had not had a massive heart attack during those thousands of steps in Maksimir Park will remain a secret forever. A miracle, in fact, as told to me by my doctor.

An important reminder: there are very, very few sudden heart attacks. They only hit suddenly, when the silently struggling heart can no longer cope.

I did not have a heart attack, as the intervention occurred just before the inevitable happened, and I did not fear one. I told myself I should have that operation as soon as possible in order to be able to - go to the sea. Baby steps.

I spent two weeks in an utterly nice, freshly renovated ward, feeling alright under the constant telemetric control. I became used to the idea that I must remember the cables attached to me round the clock. To me, there were no signs or signals that my heart was penting up to provide enough oxygenated blood to the rest of me. Once again, to praise the Croatian public health system, it is so good when there is a bunch of communicative doctors and, especially, nurses with who you can share a laugh or two. 

I loved the sliding doors that saved everybody from being woken up by doors slamming somewhere down the corridor. I ignored the fact that I was confined, in detention, it was for my sake and for my good. I also ignored the fact that the pandemic and the inability to have visitors made this period of isolation more conspicuous, in some cases even very cruel. I had all the care I needed, my doctor friend (from another ward) would visit sometimes bringing with him absolute confidence and peace to my soul.

Tests, scans, readings, as the big day arrived. Taken by an ambulance to the central hospital to be operated on, an efficient nurse accompanied me to my new room and a new roommate, and luckily a very funny one. Sarcasm is one of my favourite assistants. New doctors, kind and caring nurses. Preparations for the operation, some not pleasant at all, but all done with patience and total care. The Croatian public health system succeeded very well in making me feel safe, despite all the huge question marks and worries hovering in the air and above my own head. 

The surgery was done. I woke up feeling that I was tied to a bed in an unknown space. It was so dark, just one lamp offered a slip of light somewhere in the distance, at some corner or something, my anaesthetic-induced blurry vision and confusion limited my understanding of my surroundings. My throat felt as if it had been cleaned out by a bit of aged sandpaper. I needed water. I tried to yell, but I produced no sound. I realised I was still intubated. I was helpless. I needed water. There was an attentive nurse on the sentinel who discerned my growling sounds in the dark. It wasn't just water this time, it was the blessing of all the Gods that ever existed to me at that moment. Sleep. More water. Several rounds, a few tests. After some indefinite time, they rolled me back to my room. 

The time of colliding with reality, with the seriousness of my body, had come to me. Thank you, Hadrian, you were so right and I hope you were not this sick and unable. I felt like a broken piece of old furniture chucked out into the street from the fifth floor. One slightest move of any part of my body hurt like hell. I felt like I couldn't breathe properly. I needed air. I needed water. I could not get up. I was even afraid to move my head on the pillow so as to avoid more possible pain. I was just one huge battlefield of all kinds of pains spiced with a total lack of energy, breathlessness and a most absolute state of helplessness. I had done it. I'd reached the absolute pits of my life, the lowest point, a very, very miserable point at that.

All I wanted and could do was sleep, but the attentive staff would not let me enter into a deep and healing slumber, they were in every hour to check on me properly. The care was total, but also irritating. I should've been grateful, not irritated. Yet I was helplessly irritated and wanted only to be left alone. 

The very next day there was a guy of very athletic physique who had a very deep and commanding voice: ''Get up, we're going for a walk!'' the voice said above me.

''For a what? You must be kidding, I can hardly lie on this bed…''

''You must walk, come on, get up!''

I thought I would die right there and then, and the post-operation ordeal seemed totally pointless. He helped me out of my bed with his strong arms, I let out a shriek as my entire body stiffened into a complete and utter pain. My legs were shaky, insecure, pains probed me at random everywhere. We did two lengths of the corridor. I lay back on the bed, depraved of life, in brief. I felt I'd done a marathon. They kept coming in and checking on me and asking me about this and that, taking my blood pressure, my temperature, giving me some pills, pain relief, food, checking on my wounds, measuring this, that, asking similar questions over and over. Irritating at the time, but what amazing care from the Croatian public health system this was.

My sarcastic roommate was released and it made me very sad back then, how I longed to leave this environment. Then, finally the day came when they told me I was going back to my original room in the hospital I was checked in at first. There I found out - I who have been fit and slim all my life, had lost a massive 8 kg. I dared to look at myself in the mirror and immediately thought I'd qualify as a photo model for a labour camp. Even my eyes had changed, they were sullen, sunken, looking back at me hopelessly from some hollow spaces, somehow from afar. My greying skin seemed to have belonged to someone bigger, my arms were like two pieces of dry smoked meat. It was horrendous.

After some days, some more blood tests, some more tests, some more questions, I was tested for covid and then released home. It was the very end of June. The temperature outside was around 30º C. I could make it to the kitchen owing to the help of my hands and door frames only, from one to another, aiming with concentration and focus. I had family there to help me and they couldn't do enough for me, which was a God send. My doctor friend came to check on me, to remove my stitches, to check my wounds. I began to walk, each day a little longer, I began to take my body as seriously as it had so nearly taken me for my negligence.

As I'm writing this six months later, I've put the weight I lost back on and I feel I belong to another, far more normal world with that wonderful sensation when you bend to pick something up and nothing hurts. I have taken up exercise regularly, even physiotherapy (another utterly professional service in the very heart of Zagreb), I try to walk as often as I can, to use my Orbitrek and, well, to be happy, meeting with friends for coffees and lunches with all serenity and joy, remembering well what Hadrian had eerily warned me of such long time ago.

Albeit at times when, indeed, there were also my grandparents and parents and aunts and uncles that I would not listen to regardless of their gender, age or advice. I was young enough to know everything, wasn’t I? Weren't we all?

Do not wait to be hit all of a sudden, don't harm your heart until it says no more, check your health thoroughly and profoundly, give up smoking (I know, it's preposterous coming from a filthy ex chain smoker of like 40 cigarettes a day), but if I can stop totally, you can too. Have a drink and be happy for as long as it lasts, because there is an expiry date and more often than not, it comes silently. 

Say what you want about Croatian corruption, politics, the lack of funding, the lack of... well, a lot. But Croatian public health stepped up and saved my life at the very last minute. There are a great many truly extraordinary doctors and other medical personnel in this country. Just in case you read this article with a cigarette in hand not having moved around for a few days... just sayin’. But why should you listen to me after all I have gone through? I'm not your mother, for God’s sake, so let me just wish you a Happy New Year - from my heart!

If you would like further reading material and/or if you're trying to stop smoking, it's worth noting that cardiovascular disease kill more people in Croatia than anything else. That's right, even the dreaded cancer comes second to the silent killer. Did you know there is an artery called the widow maker? There's a reason. Cardiovascular disease is the leading cause of death and accounts for more than half the overall mortality in this country. Furthermore, cardiovascular mortality has been constantly rising since the 1970s due to our dire habits.

Despite Croatia's observance of World no Tobacco Day, smoking is still killing many here, and it is continuing to cripple the Croatian public health system. Hrvatski dan nepusenja (The Croatian day of non-smoking) is also prominent. Can we reverse the trend? Be a part of it before it's too late.