Interview of Illyria with Dr. Rifat Latifi
Question: Dr. Latifi, in the last days of 2018, the Kosova College of Surgeons was established and you were elected its President. In addition you have taken on in resumption of publication of the only Medical Scientific Journal in Kosova, Kosova Journal of Surgery. Now you are leading a major effort to raise enough funds that secure the work of this crucial medical establishment for the next decade. What inspired this new initiative?
Answer: This inspiration was an easy one. Just looking back and what happen in surgery and medicine overall for the last 3 decades in our own countries, and one has to come up with a solution. So, the creation of the Kosova College of Surgeons and resumption of the publication of the Kosova Journal of Surgery reflects an important moment in the history of surgical science and practice in Kosova, which currently stands at a crucial time and at a crossroads. It fills a major void in our organizational and scientific processes for the more than 800 surgeons of Kosova as well as hundreds of other Kosovar surgeons practicing around the world. Until now, Kosovar surgeons did not have a place to gather and voice their concerns in a structured and peer-reviewed deliberate way. The College and Journal now is that place.
For over three decades the practice of surgery in Kosova has been eroded, destroyed and reduced to simple first aid and has served more than a “pass through service” for patients on their way to other surgical institutions in the region or other European medical centers. Complex and advanced surgical procedures have not been performed in our hospitals for decades and subsequently were not taught to our young surgeons. Moreover, complex and advanced procedures on Kosova patients were and still are being done in other countries, paid by both the Kosova Government, but mostly by our private citizens. Surgical science and surgical research were diminishing into becoming oblivious and non-existent. So, in a matter of 30 years, instead of traveling to the new horizons of the world of surgery, we have traveled back to the last century and in the opposite direction of the greater world of surgery. We did not perform complex surgery, and we did not publish. And, if we do not publish, we perish. What has ensued is surgical chaos. In this vicious cycle, new surgeons, other physicians, and even medical students are moving out of the country, even 20 years after the war has ended. In fact, as of late, this has taken epidemic proportion. For the last 20 years, the state of medicine and surgery did not change much and most importantly, the governments did not even take minimal measures to improve the work conditions in order to improve the future of the best and the brightest surgeons and surgery students. Every one of us, has a family member of a friend that has received and or sought surgical and medical help outside Kosova for the last twenty years. Most of us paid for it. So, it is an imperative that we build a sustainable healthcare system, based on science and not politics and self-interests.
Question: Here again, you are leading by example with a pledge to contribute half a million of dollars for the next ten years. This is a wonderful gesture of generosity, from your part, but also an act of faith in the importance and the capabilities of this College of Surgeons. How is this “scientific and advocacy body”, as you have described it in another interview, helping Kosova?
Answer: Each of us has to lead with our own example. As they say, we have to “walk the walk and talk the talk”. I have done that, but others have joined me, and I am hoping that others will join us too. We cannot ask only the governments and donor organizations to help us. We have to out our money too. The mission of the Kosova College of Surgeons is to unify all practicing surgeons, both in academic and public hospitals and institutions and those in private practice across the country, trainees of any surgical discipline, and medical students who will pursue surgery in the future. This will be done through structured continuous education, policy changes organized through various committees, the content and activities of which will be advanced over the next few years in order to improve the quality of surgical care, increase surgical access for all patients, reduce complications, and to improve the outcomes and lower the cost of care for all.
The main mission of KCS will be to become a partner of the Ministry of Health of Kosova and Chamber of Doctors of Kosova in ensuring provision of the highest quality of care by creating transparent protocols for surgical care across the spectrum of hospitals and specialties. Increasing the quality of surgical care nationally will reduce, if not entirely obliterate, the transfer of patients to the other countries for even basic surgery. The objective of the KCS is to become the accrediting body of quality both for individual surgeons as well as hospitals of the country and services that they provide using the latest evidence based surgical care.
Improving the quality of surgical care will lead to greater access for patients, fewer complications, and better outcomes, thus lowering the cost of care. Over the next five years the quality improvement programs will improve quality in trauma, cancer care, emergency surgery, and overall, in all surgical disciplines.
Over the next 10 years the Kosova College of Surgeons (KCS) will work very closely with international colleges and surgical associations/societies across the globe, as well as industry partners to foster relationships, improve the leadership of the College, improve education, work on research projects collaboratively, and increase the quality of surgical care. The IVeH and academic partners (American College of Surgeons, New York Medical College, Westchester Medical Center, Valhalla, New York and others) will assist with this project for at least the next five to ten years using our own strategy Initiate-Build-Operate-Transfer (IBOT) that we have used and successfully employed in creating telemedicine programs in Kosova, Albania, Cabo Verde, and Vietnam. Our goal is to make the KCS the main driver of the quality improvement programs and transformation of all surgical disciplines, establish the mechanisms of creating leadership in surgery that will lead the College to new heights of modern surgery, establish full transparency of quality of surgical care, and make KCS a solid partner of the international surgery community.
Questions: What platform have you created to ensure other surgeons’ involvement in the Kosova College of Surgeons?
Answer: The KCS will be modeled based on the American College of Surgeons (ACS) which was created in 1913, and other colleges around the world, such as Royal College of Surgeons of England, Australia and other countries and regions. For nearly 106 years, the American College of Surgeons (ACS) has led national and international initiatives to improve the quality of hospital services in the field of trauma, cancer, bariatric surgery, geriatric surgery, and surgical quality initiative. These initiatives have measurably improved the quality of care, prevented complications, reduced costs, and saved lives across the globe. For example, I will step down as President in September 2021 during the Clinical Congress and new president will be installed for the next two years, together with most structures. Only the administrative structures will be the constant and long-term staff. So, everyone in the membership, will have an opportunity to contribute. In particular we will pay attention to involvement of young and female surgeons.
The work of the College will be led and organized around 13 committees. Other working groups and committees will be added as needed and as the College increases its activity and content.
- Committee for Quality and Patient Safety
- Committee for Trauma
- Committee for Emergency Surgery
- Committee for Geriatric Surgery
- Committee for Cancer
- Committee on Advanced Technologies and Information Technology.
- Committee on Surgical Research
- Committee for Continuous Education and Membership
- Committee for Diversity and Inclusion
- Committee for Ethics and Disciplinary issues
- Committee for Medical Students in Surgery
- Committee for Residency and Fellowships, and
- Committee for Health Policies and Advocacy
Question: Other members of our community have joined your initiative, by pledging their contribution for the next decade. Who are some of them and what has been their approach?
Answer: Yes, many prominent members of our community have endorse the idea and some of them including Harry Bajraktari ( 100K), Rrustem Gecaj(100K) and Xhafer Gecaj (50K) have committed and already have sent the first contribution to the International Virtual e-Hospital Foundation (www.iveh.org) for the Kosova College of Surgeons. I am looking forward everyone to join us. When it comes to health everyone can help, because every one of us is affected aready or it will be affected.
Questions: How much do you hope to raise for Kosova College of Surgeons and how will these funds be used?
Answer: I am hoping to raise $10 million dollar for next 10 years. The IVeH isseeking $ 10 million U.S. dollars for the next 10 years (2020-2029). Funding for this project will be managed by the International Virtual e-Hospital Foundation (IVeH) and will be used to:
- Establish sustainable leadership infrastructure, professional administrative support, and a technological and administrative environment adequate to run the KCS;
- Build a Clinical Research Center in Kosova with research and academic human capacities across the surgical disciplines and beyond;
- Creation of a Research Peer Review Process and editorial capacities through structured educational programs;
- Publish the Kosova Journal of Surgery, as an official journal of the Kosova College of Surgeons, a peer review journal with the goal that in 5-7 years it will be cited in PubMed and other research engines;
- Initiate accreditation program for a variety of surgical disciplines such as trauma, cancer, vascular surgery, and other programs for the Ministry of Health;
- Establish the advocacy programs and capacities to represent the KCS in governmental agencies, and international collaboration;
- Create educational programs for patients and family support for those with surgical diseases;
- Advanced Quality and Patients Safety Programs in all surgical disciplines in order to improve the quality of care, based on American College of Surgeons quality; improve programs and patient’s safety;
- Execute the work of the College through around 13 committees outlined above. Other working groups and committees will be added as needed and as the College increases its activity and content.
Question: I am sure there are other Albanian-Americans who would like to contribute for this noble cause. What should they know and how can they help?
Answer: Anyone who wishes to help us can do it. Everyone. Our organization is a nonprofit organization (501c3), established in the state of Virginia in the United States of America (www.iveh.org). The IVeH was created to help rebuild the medical system in developing countries by introducing and implementing telemedicine, e-health, and virtual educational programs through the concept of the international collaboration and building local infrastructure, local capacities and ensuring sustainability. IVeH is managed and governed by an international Board of Directors. Since its establishment in 2001, IVeH has worked tirelessly to create a recognized model of rebuilding medical systems using telemedicine and virtual education networks, which can serve as an affordable and comprehensive model for developing countries. The IVeH network combines a unique model of telemedicine and intensive virtual educational programs through international collaboration to build and develop the human capabilities to independently manage telemedicine and e-health in those countries. Everyone who contributes will get the breakdown of every penny of their contribution and for want it was used.
Every penny will be used for the program. You can donate money or in kind donation.
For example, construction companies can build or help building the research institute.
The IVeH has created the first telemedicine program of Kosova (2002), which is now part of the Ministry of Health, telemedicine of Albania and in many others countries around the world, including Africa (Cabo Verde), Asia (Vietnam), and South America (introduced telemedicine in Amazon, Peru, Brazil).
Since 2001, the IVeH has been continuously funded, with numerous grants from the European Union (European Agency for Reconstruction- Phase I Telemedicine Program of Kosova), United States, Department of State ( Establishment of Phase II of Telemedicine of Kosova); Blue-Cross and Blue-Shield, Arizona( Establishment of Teletrauma in Southern Arizona); United States Agency for International Development (USAID) – a multi-year project (2009-2017) to establish Telemedicine Program of Albania and to reform trauma and EMS services in Albania ); Government of Slovenia (Establishment telemedicine of Cape Verde) and WHO- Medical training program in Albania. The IVeH has been funded by the European Union, USAID, State Department, and other private donors. We plan to wage an aggressive campaign to search for funding sources from private individuals and foundations, U.S. government agencies, and other governments involved in Kosova. Any amount will help but needs to be spread over the next 10 years. This was a suggestion of Xhafer Gecaj, that I liked a lot, and so everyone else.
Question: Dr. Latifi, we have been living through an unprecedented pandemic. You have faced COVID-19 in your everyday work as a Chairman of Department of Surgery of New York Medical College, School of Medicine and Director of Department of Surgery, Westchester Medical Center, in Valhalla, New York, but also a patient and survivor. What advice do you have for our readers?
Answer: Many from our own community have been inflicted by their disease, and many have died from it. The COVID-19 is a deadly constellation of symptoms, and we need to be very careful with it.
Question: Kosova too has been one of the hardest hit corners of the globe. How has the medical community faced this challenge based on your information?
Answer: Yes, as of January 24, 2021 almost 60 thousands have been infected and 1,440 have died. I am not sure we managed with the most seriousness that this disease deserves. In Albania, on the other hand, 72 thousand have been infected and 1,310 have died. Moreover, it has exposed the state of healthcare system, that has been ignored for last few decades in both countries. Not acceptable any longer.
Question: What is your prognosis for the New Year 2021? What is your message?
Answer: With the vaccination of every one, we eventually will get over this, but the disease will not go away 100%. We will get used living with it, but for sure the world has changed forever.