An Englishman in Zagreb: An EFPT Exchange to Croatia

By Howard Ryland

Vrapče Hospital presents a very elegant prospect to any visitor.  A grand central building, set in pleasant, grassy grounds.  To the visiting trainee it was a very welcoming home from home.  I was generously provided accommodation onsite, with meals included! I had been attracted by the prospect of gaining experience in a psycho-sleep clinic. Not something that I would have been easily able to pursue in my own training programme. I spent a week in the sleep clinic, before spending my second week rotating around the many other departments of the hospital. On arrival I was issued with my very own white coat, which helped me to feel like one of the team straight away. Throughout my stay I was very well looked after by the local coordinator Marina Fistonić and the other local psychiatric trainees, who made sure that I felt welcome and answered any questions that I had.

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Dr Danilo Hodoba was a fantastic supervisor with oodles of experience in the field of sleep medicine that he was keen to share with me.  As a forensic psychiatrist, I am not used to seeing complex neurophysiological equipment in my daily work.  It was fascinating to be able to see the sophisticated electronic wizardry that would be hooked up to people’s heads.  I was amazed that any of the patients under investigation were actually able to get a wink of sleep with all that equipment attached.

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The work of the department was split between the outpatient clinic and the sleep laboratory. In the clinic patients would be reviewed, often with the results from their polysomnography tests.  These appeared as a seemingly incomprehensible series of squiggles on a concertinaed scroll of paper, which Dr Hodoba was amazingly able to interpret with ease.  Attending the lab meant going in the evening, when all the patients would arrive for their overnight assessments.  While the rest of the hospital was relatively quiet, the lab was a buzz of activity, with patients being checked in and the nurses ensuring that all the necessary monitoring was in place.

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In my second week I visited a whole range of the other services offer, including the forensic services, addictions unit, emergency centre and general wards.  Despite my hopeless lack of Croatian, I was helped to find patients who spoke English and so was able to speak to them directly.  It was very interesting to hear about their experiences of their mental health problems and the Croatian mental health system. I was also able to see the various therapeutic activities that were offered, which included some really enjoyable looking sessions.

A visit to the hospital museum was also a highlight.  This had just been renovated and reorganised, with a list of the 14 previous names that the hospital had had in over 140 years since its founding.  These reflected both the changing political landscape of Zagreb, but also evolving attitudes towards mental health.  There were also some highly realistic dioramas representing the history of the hospital and its work over the years.

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I was introduced to many members of staff, including the Director of the hospital himself, who invited me to give a lecture at the weekly meeting of the medical staff.  This was a nice opportunity to talk about psychiatry in the UK, focusing specifically on my area of special interest in forensic psychiatry.  This allowed an exchange of ideas and was also a way for me to pose questions to the audience to find out more about how services work in Croatia.

Of course it was not all work!  Zagreb is an awesome city, with a beautiful old town filled with ornate buildings, peaceful squares and plenty of ice cream parlours, restaurants and bars.  The ice cream came in particularly handy as the temperatures were well in to the 30s during my stay. I was able to use my weekend to travel further afield, fulfilling a long held ambition to visit Dubrovnik.  This surpassed expectation and truly warrants the soubriquet of the ‘Jewel of the Adriatic’. I also visited Plitviče Lakes National Parks, which were a revelation as they are certainly not as well-known as they should be.  The parks encompass a host of interlocking lakes and cascades, with water of a particularly appealing luminous hue.

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Wherever I travelled in Croatia I was struck by the welcoming and open nature of everyone I met.  I would wholeheartedly recommend the EFPT exchange programme there as a great way to gain a broader clinical experience, see another health system in action and meet some great people! For more details please visit http://efpt.eu/exchange/m/croatia/.

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