Diplomacy: Bridging Oral Health
Vladimir Ivanovic, DDS, MSc, DDSc (Phd), SDS
As editor of the column “Global Health Through Oral Health,” I would like to introduce the concept of global health diplomacy and how its power bridges interpersonal relationships and mitigates hostility in order to improve trust and provide resources for global health protection and promotion. Often, we consider diplomacy a governmental foreign policy tool. Yet, diplomacy also can be used by the citizenry to foster relationships among and with people living in areas of conflict.
In this issue of Compendium, we are privileged to learn about long-standing efforts by dentists who have been actively engaged in oral health diplomacy—in this case, among clinicians in the countries of the former Yugoslavia. Vladimir Ivanovic, a Serbian professor of restorative dentistry and endodontics, describes how individuals have brought dental associations closer together, as nongovernmental entities. These individual efforts slowly but surely appear to have synergized larger groups through seminars, symposia, workshops, and larger gatherings as they focus on enhancing the greater good of their respective populations and their health needs.
Whether in the US, Europe, the Middle East, or elsewhere in the world, there are ongoing instances in which oral health professionals are taking the lead. We intend to bring these examples to our readership as building capacity for health diplomacy is growing increasingly evident. To achieve a more harmonious world, we need to engage every level of society. What better way than through initiatives to improve health and well-being?
Lois K. Cohen, PhD
Paul G. Rogers Ambassador for Global Health Research
After the unfortunate events in the region of the Socialistic Federative Republic of Yugoslavia, interrelationships and collaborative activities among medical and dental professionals and schools were interrupted. It is imperative that these relationships and collaborations be restored. Through joint projects in dental education, research, and healthcare programs, I believe that everyday relationships—the bridges—between the people of Serbia, Croatia, Slovenia, Bosnia & Herzegovina, and Macedonia can be rebuilt.
In 1991, one of the most tragic conflicts began between different nations and religions in the former Yugoslavia with its six republics (Slovenia, Macedonia, Montenegro, Bosnia & Herzegovina, Serbia, and Croatia). Before this, intensive and fruitful joint collaborative research and educational activities thrived, particularly among university dental schools. These efforts included summer exchange, postgraduate studies, and various continuing education programs, along with joint projects in basic and clinical research. In addition, collaboration through dental healthcare programs (mostly preventive), personal engagement in small projects, and official research projects between state institutions (supported by the World Health Organization) were common. Six major dental journals were publishing joint research: the Slovenian Zobozdravstveni Vjesnik (Dental Health Courier); the Croatian Folia Stomatologica and Acta Stomatologica Croatica; Stomatološki Vjesnik (Dental Courier) from Bosnia & Herzegovina; Makedonski stomatološki pregled (Macedonian Dental Review) in Macedonia; and Stomatološki glasnik Srbije (Dental Herald of Serbia); and Acta Stomatologica Naissi in Serbia.
Dental symposia and meetings by republic or regional societies were attended by participants from other Yugoslav republics and societies. The Association of Dentists of Yugoslavia was an active, important decision-making organization. Every 4 years, the association held excellent congresses in locations in the former Republic of Yugoslavia. The last meeting was held in Ljubljana, Slovenia, in 1988. In addition, for more than 20 years, congresses of the Association of Students of the Medical and Dental Schools of Yugoslavia were held annually in different cities—the last one in Sarajevo in 1991. This meeting is unforgettable, as the attendees did not realize how serious the local situation would become only weeks later.
After 1991, this chain of collaboration among dental professionals was broken—but not all relationships were cut off immediately and definitively, especially the personal connections. Unfortunately, the more severe the conflict, the harder it was to “rebuild and revisit bridges” among healthcare professionals. Yet throughout this period, there were areas where our connections remained solid.
In Montenegro, all undergraduate and postgraduate dental students continued to study in Serbia (Belgrade, Nish, and Novi Sad). The Association of Dentists of Serbia and Montenegro, founded in 1993, held meetings biannually until 2006, when Montenegro became one more independent country.
Currently, professors and colleagues from Serbia and the University of Belgrade School of Dentistry are organizing the first dental school in Podgorica, the capital of Montenegro. We are still closely engaged in lectures, courses, and organizational matters. Because of our personal and professional relationships, these links were never broken.
One of the most important steps to rebuild these “broken bridges” via the dental profession was the founding of The Balkan Stomatological Society (BaSS) in 1994. It was not a completely new idea to join—or rejoin—Balkan nations and countries, even in a diaspora. Dentists from Serbia, Bulgaria, and Greece were the organizers, with the first congress held in Thessalonica in 1995. With every annual meeting, more participants from former Yugoslav republics and other Balkan countries attend BaSS congresses, “rebuilding” relations, “revisiting” former friends, and finding new ones. Colleagues from non-Yugoslav former republics (Romania, Bulgaria, Greece, Turkey, and Albania) also have played an important role in helping connect and reconnect dental professionals from the former Yugoslavia. The Journal of The Balkan Stomatological Society regularly features articles by colleagues from all Balkan countries, with significant engagement of authors from former Yugoslav republics.
There was no armed conflict with Macedonia, as this former republic left Yugoslavia rather peacefully under the supervision of international peace forces. Therefore, the Macedonian Dental Association was open continually for collaboration through lectures, courses, and joint meetings. For several annual meetings of the Macedonian Association of Dentists, lecturers from the University of Belgrade School of Dentistry and Serbian colleagues were invited to give presentations or lectures, especially after 1998. Members from the Macedonian Dental Association were regular guests at the anniversary celebration of the University of Belgrade School of Dentistry and symposia or meetings organized by the Specialist Sections of the Serbian Dental Association. While the intensity and quality of this professional cooperation may not have remained the same, the people involved—dentists and non-dentists—have remained connected. Official state policy requires no visa between the two countries, which encourages people to revisit still-solid “bridges.” In addition, on the student level, exchange during summer break is an officially organized activity between two schools (Skopje and Belgrade). These youths make a significant number of acquaintances. In the last 3 years, PhD students from Skopje University School of Dentistry have regularly spent several months at the Belgrade school experiencing different research laboratories and departments.
War conflict in Slovenia was intense, but short and localized. After an initial period of shock and adjustment, official invitations and lectures at the meetings began to be exchanged between the Serbian Endodontic Society and Slovenian Endodontic Society. In 1997, I was invited as the official guest from Serbia to address the participants at the Annual Endodontic Meeting in Bled, Slovenia. Two years later, the president of the Slovenian Endodontic Society, Associate Professor Franek Klemenc, gave his first lecture at the Endodontic Symposium in Belgrade. In 2001 he lectured again in Belgrade at the Annual Meeting of the Serbian Endodontic Society. Besides these official “revisits,” there have been personal meetings every year at either ESE Congress or at ESE General Assembly Annual Meetings throughout Europe.
Professors from the department of prosthodontics from the Belgrade school and Ljubljana have a joint project (EUREKA) on precious alloys and ceramic materials in conjunction with a large Slovenian gold company. This involves a great number of people of different professions, along with their families and friends—which again promotes the building of bridges and rebuilding and revisiting former connections.
Many Serbian dentists, dental technicians, and nurses moved to Slovenia during the first few years of the conflict. After passing the official examinations, they start practicing either within the National Health Service of Slovenia or in the private surgeries of their colleagues. Their experience encourages other people and professionals to foster their relationships with colleagues in Serbia and other former Yugoslav republics, particularly from Croatia and Bosnia & Herzegovina.
Croatia and Bosnia & Herzegovina
Unfortunately, the experience of our dental colleagues from Croatia and Bosnia & Herzegovina was much more difficult, because armed conflicts were more intensive, involving a wider area and resulting in many deaths. Our first “revisitings” with Croatian colleagues were at the international meetings and symposia. Initially, these reunions moved slowly and gingerly, but eventually they became less tense. In 1995, at the ESE Meeting in Tel Aviv, conversation with colleagues from Zagreb and Rijeka was distant. The first Balkan Congress in 1995 in Thessalonica was held unfortunately without our Croatian colleagues. Eventually, more and more people from Croatia attended ESE Meetings, and conversation became more relaxed and personal. With each new international meeting, our relationships grew and discussions became friendlier and longer. All these opportunities led to lecturers from Zagreb giving presentations at the Congress for Dental Adhesive Materials and at the Scientific Symposium dedicated to the anniversary celebration of the school of dentistry in Belgrade. While there, they reconnected with non-dental friends.
Sales managers from Croatia now regularly visit Serbia and—together with those of us from dental schools and manufacturers—organize promotions and presentations, thus spreading the sales network. Two years ago, the regulation allowing free movement across Serbo-Croatian border without a visa was passed. Citizens have begun to travel freely—even to dentists.
Our colleagues from Bosnia & Herzegovina did not have as many opportunities to reconnect, which is understandable considering the intensity of the war in their country, where three nations with three opposing religions were in conflict for almost 4 years. Even so, there were activities within the dental profession—common meetings, Balkan congresses, and meetings of different dental societies in the region of Bosnia & Herzegovina—with the participation of dentists and lecturers from Serbia, Croatia, Slovenia, and Bosnia. Exchange of postgraduate students, along with continuing education and professional development programs, and friendships, pushed the process of “rebuilding and revisiting” past the initial hesitation. The annual Congress of BaSS was held in Sarajevo in 2006, and present at most of those meetings and symposia were well-respected persons who established, rebuilt, and revisited many bridges.
As people from former Yugoslav republics move freely around Bosnia & Herzegovina, their wish for continuing the “rebuilding and revisiting” process can perhaps be encouraged by the example of these dental meetings, collaborations, and exchanges. The Official University Delegation, led by Professor Sedin Kobaslija, visited our school of dentistry in June, and subsequently many doors for collaborations in different professional and social fields were opened—or re-opened.
Unfortunately, Kosovo itself is still too “hot,” with fundamental problems still unsolved. Therefore, it’s a greater challenge, particularly because both Kosovo and Serbia were significantly damaged during the massive conflict, with great loss of life and property. Until the tragic events in 1999, I cooperated from time to time with colleagues from the school in Pristina in Kosovo. I hoped someday we could rebuild this bridge. This wish was realized in September 2007 at ESE Meeting in Istanbul, where I renewed my friendship with Professor Veton Hoca, who had left Pristina at the early 1990s and joined the dental school in Istanbul. Since then, we’ve met several times at various conferences. While our conversations are often nostalgic, our stronger intention is to rebuild communications and collaboration between professionals and dental educators. Along with Associate Professor Ferit Kochani, who had studied at the Belgrade dental school, the three of us have had open discussions, resolving that in the near future, representatives from Pristina and Belgrade schools of dentistry should meet. This group would provide leadership in restoring and rebuilding professional cooperation—with the ultimate goal to improve relations among the general population. Our idea appeared promising until Kosovo declared independence in 2008—a political step that caused a break in our communication. However, we met again at the ESE Congress in Edinburgh in 2009 and renewed our plans: the first steps should be invitations to dental meetings and dental schools, both in Serbia and Kosovo.
Could health diplomacy within the dental profession—spreading knowledge, ethical principles, and oral health worldwide—rebuild bridges broken by conflict? The immediate answer is: yes, if we keep up the good work and give our best.
About the Author
Vladimir Ivanovic, DDS, MSc, DDSc (Phd), SDS
Department of Restorative Odontology and Endodontics
University of Belgrade School of Dentistry
University of Belgrade