When Pathology Prevails

What changes have you witnessed in the practice of pathology in Serbia over the course of your career?
 

I became a pathology resident almost immediately after graduating from medical school at the University of Novi Sad, Serbia, in 1977. The pathology department I joined in Novi Sad was located inside the university hospital, which offered us very close contact with other clinicians – thus, our modus operandi differed from that of other university-based pathology departments, which were usually in separate buildings away from the hospitals and other clinicians. Otherwise, the conditions were primitive and we were heavily understaffed; I was the only resident for more than a year. The histopathology laboratory performed only standard H&E staining and a few special stains, such as periodic acid-Schiff, Mallory’s trichrome, and elastica van Gieson. We had limited access to foreign books and journals, so our principal source of information on recent advances in pathology were the yearly meetings of Yugoslav pathologists.

Since then, the situation has improved considerably. Most university pathology laboratories are well-equipped to perform contemporary testing with immunohistochemical – and even molecular biology – techniques. Staffing has also improved and, today, most Serbian pathologists are well-educated and well-trained.

You were one of the first Serbian pathologists formally trained in cytology. Did the introduction of cytology change hospital pathology in your country?
 

I learned cytology at the University of Zagreb, Croatia, which offered formal cytology training in a well-organized Master’s degree program. It was the only cytology course of its type in Yugoslavia. For me, learning cytology was essential because I was assigned to work in the Institute for Lung Diseases and Tuberculosis, where we handled numerous cytology specimens prepared from sputum, pleural effusions, bronchoscopy, and fine needle aspiration samples. At the time, there were no certified cytologists in Serbia; most specimens were examined by self-taught clinicians or even biochemists working in the laboratories. All vaginal and cervical smears were signed out by gynecologists with no formal cytology training. I was one of the first to introduce cytology as part of formal pathology training and I am proud that, today, cytopathology has become an integral and obligatory part of pathology training in Serbia. As a result, all Serbian pathology residents are trained cytopathologists.

Pathology training in Serbia can be completed in one of two ways. Most residents opt to spend six months exclusively in cytology during their comprehensive four-year training. Alternatively, they may complete their training in anatomic pathology and then spend another 12 months to obtain a diploma in medical cytopathology. Because one cannot become a cytologist without previous pathology training, we ensure that we have enough cytopathologists to meet an increasing demand for cytopathology examinations

How did the wars in the 1990s affect the practice of pathology in former Yugoslavia?
 

The wars had a devastating effect on the practice and organization of pathology throughout the region. Beforehand, we had a Yugoslav society of pathology and regional societies in most of the six republics. We organized regular meetings every fourth year in a different republic and numerous intersectional meetings in between. In the early 1980s, when I was learning cytopathology in Zagreb, I met many of my peers from other Yugoslav republics. We remained in constant contact (and on friendly terms) until the war broke out. Then, our connections were broken – and many of our colleagues emigrated to the West.

After the war ended in 1995, it took time and effort to re-establish those connections – most of which survived only through international meetings and congresses. Twenty-some years after those cataclysmic events, there are enough people in all the present states with the energy and goodwill to restore the relationships and collaborations we nurtured before. Many of those who have left the area make regular visits. We are making good progress; soon, we will have restored our profession to its full pre-war glory.

You taught pathology outside Serbia during the war years. What was that like?
 

I have fond memories of helping my colleagues in Bosnia and Herzegovina organize undergraduate pathology courses for medical schools in Banja Luka and Foča. In 1993, while the war was still raging on, I responded to an appeal from my Banja Luka colleagues, who needed help with teaching. Even though Banja Luka was 300 kilometers west of Novi Sad, I organized a car convoy and recruited eight professors and the Dean (who was a pathologist) to undertake the trip with me. We traveled for 15 hours through a so-called “demilitarized corridor,” which had to be periodically closed and reopened because of ongoing conflict. Once in Banja Luka, we held lectures in wooden barracks with no electricity or heating using only a blackboard and chalk. We stayed in a decrepit hotel – I still remember unheated rooms with flickering lights. But all this was compensated by the warm reception we received from the local medical students, who were very appreciative of all we were doing for them. This rapport with the students motivated me to remain on the teaching staff even after the war. I held a visiting professor post in Banja Luka until 2019 and watched many of them start their careers in pathology and cytopathology – some clinical, others academic.

My story about teaching in Foča is a bit different because it started after the peace agreement was signed in Dayton. Foča is a small town 80 kilometers east of Sarajevo. During the war, a group of medical and dental school professors from Sarajevo moved to Serbian-controlled territory and formed a university. They had heard about my teaching in Banja Luka and invited me to teach at their facility as well. There was no fighting like that in the corridor to Banja Luka – but, to reach Foča, my car (with Serbian registration plates) had to pass through Bosnian-controlled territories in which we were frequently accosted and stoned by the local population. To avoid such potentially dangerous encounters, we drove on side roads that were often covered by deep mud or snow. Instead of the expected six hours, it took us 14 hours or longer to reach Foča. Nonetheless, assisted by three of my junior colleagues, I taught in Foča from 1998 to 2014, when we concluded that locally trained students could take over.

Many asked why I did all this. Why did I drive so far from home every weekend, over dangerous and poorly maintained roads, through mud and snow, usually for little or no pay? My answer was simply that I wanted to do it, that I was in a position to do it, and that I felt an urge to help young people who were in need and abandoned by almost everybody else. I felt – and still feel – that my efforts were not in vain. Today, when my former students recognize me in the street or in a store, they greet me with elation and gratitude that cannot be described in simple words – and what a pleasure it is! It only reinforces my deep conviction that it was all worth it – from both a professional and a purely human point of view.

Do you maintain contact with your pathology colleagues and former students?
 

Today, I have friendly professional and personal relationships with pathologists from all five former republics of Yugoslavia that are now independent states (Slovenia, Croatia, Bosnia and Herzegovina, Montenegro, and North Macedonia). Even during the worst of the war, I tried to meet and socialize with them during intermissions or evening hours. My former trainees and students, many of whom are well-established in their specialties, still consult with me and respect my diagnoses. They also invite me to their meetings and congresses, which gives me a lot of pleasure.

What are you most proud of in your extensive career as a pathologist, educator, and leader?
 

I am a pathologist and cytologist who has invested quite a bit of time and money into my education so I could best help my patients and colleagues. I have used my knowledge, leadership, and organizational skills to advance the practice of pathology and cytology in my country and in the surrounding western Balkans. Socially, I have been active in various local and regional pathology and cytology organizations, as well as in Europe and other major international organizations.

Nonetheless, I am most proud of my contributions to undergraduate and postgraduate medical education. By that, I mean not only helping pathologists (or students intending to specialize in pathology), but also physicians in other specialties. Without false modesty, I take credit for having attracted some of the best students of their generations to pathology and cytology, thus helping transform pathology into a sought-after specialty in my country. As a result, I have received two major awards for my role in education – the Lifetime Achievement Award from the Serbian Physician Society and the Plaque for the Advancement of Education of Young Physicians by the Council of Medical Doctors of the Republic of Serbia. I am proud of the new generations of pathologists in Serbia, who are well-educated, hardworking, future-thinking, goal-oriented young physicians enchanted by the specialty they have chosen.

What message would you like to give to graduating medical students who are considering a career in pathology? 
 

If you like my lectures, if you see how much fun I have practicing pathology, or if you want to make a real contribution to healthcare, consider following the same career path. My love for pathology has motivated many of my best students to enter pathology – why not join them? My other message to students considering pathology is, “Love it or leave it.” And don’t forget to build bridges throughout your life – with your teachers, your colleagues in the clinic and general medical practice, with your patients, and with your students.