Macedonian Medical Association – Seventy Years from Its Establishment, 1945-2015

AIM: To present the phases of development and activities over the 70-year period of existence and work of the Macedonian Medical Association, from its establishment in 1945 to 2015. METHODS: A retrospective study based on available archive materials, encyclopaedias and other sources of information and reviews of the relevant literature, and personal experiences and observations of the author. RESULTS: Macedonian Medical Association was established on August 12, 1945, with science and health educational mission and program. Dr Boris Spirov was elected as the first president of the Association, one of the main initiators and facilitators of activities in health care sector, including the establishment of the Faculty of Medicine in Skopje in March 1947. Over the past 70 years, the Association is the main carrier and has a key role and contribution in continuing medical education, vocational and scientific advancement of medical staff and improvement the dignity and reputation of the medical profession. The journal of the Association Macedonian Medical Review has contributed to spreading and advancement of knowledge and skills of modern medicine, as well as presenting professional and scientific achievements of physicians in the past 70 years. Macedonian Medical Association is a member of the World Medical Association and many other international associations and organisations contributing to international collaboration in education and science and promoting the Republic of Macedonia in Europe and worldwide. CONCLUSION: Macedonian Medical Association over the 70-year period of its existence has been one of the pillars and lighthouse in the healthcare system in the Republic of Macedonia with great contribution to the advancement of medical and related sciences and continuing medical education, strengthening of health services and health care for the population and overall socio-economic development of the Republic of Macedonia during the past 70 years.


Introduction
Macedonian Medical Association (MMA) was established on August 12, 1945. In 2015 MMA celebrated its jubilee -70 years of existence with a successful and fruitful work and versatile huge contribution to the development of the health system and health care of the population and overall social development in the Republic of Macedonia [1,2]. Immediately after the World War II, the then People's Republic (PR) of Macedonia faced a very difficult economic, cultural and health status of the population. Besides devastated and ruined country, poverty and hunger in the exhausted predominantly agricultural population with cultural regression and poor economic conditions, the health system was underdeveloped with very weak human resources. At that time there were only 120 doctors, a few stomatologists and less than 100 high-school dentists and dental technicians, 96 pharmacists, for about 1,200,000 inhabitants in PR Macedonia. On average, there were 1 doctor and 1 nurse per 10,000 residents. The health condition of the population was very poor with neglected pathology, the unfavourable hygienic-epidemiological situation with many endemic spots and high morbidity and mortality from respiratory, diarrheal and other communicable diseases, especially in infants and young children [3][4][5]. Basic demographic and health http://www.mjms.mk/ http://www.id-press.eu/mjms/ indicators of the population and network of health institutions and health workers in PR Macedonia, immediately after the World War II, are presented in Table 1. In such extremely unfavourable conditions, in 1945, the newly-formed government, with official authorities but an insufficient number of health personnel, entered the gigantic battle against diseases, poverty and centuries-long regression, as well as an affirmation of national identity and autonomy of PR Macedonia. Adverse conditions and problems had to be overcome, centuries to be bridged and PR Macedonia to become not only de jure but also de facto an equal member of the fraternal community of the Federal People's Republic of Yugoslavia. It was necessary to take urgent measures to establish organised health services for to improve the health status of the population and in-depth examinations of national pathology, particularly widespread infectious diseases as a health problem of the highest priority. One example of creating a foundation for organised work is the activity of uniting highly educated health personnel (doctors, dentists and pharmacists) in a professional association through the formation of Macedonian Medical Association [1,3,5].

Establishment of the Macedonian Medical Association
In the postwar period with adverse health and social circumstances, but in the setting of emphasised enthusiasm and sincere desire of each person to help his people and country, the Macedonian Medical Association (MMA) was established as an association of doctors, dentists and pharmacists in PR Macedonia. The mission of MMA was to promote the medical and related sciences, to protect interests of doctors and to contribute to the growth and dignity of the medical profession, as well as development of the educational system for health professionals toward improvement the quality and accessibility of healthcare services and health status of the population. Pharmacists separated from MMA in July 1947 and dentists in June 2004 and thus formed their own special associations. Dr Boris Spirov was playing the key pioneering role as one of the leading initiators and founders of MMA [2,3,11,12]. The general medical conference was held on August 12, 1945, and MMA was founded with science and health educational mission and program. Dr Boris Spirov was elected as the President of MMA, and Vice-president was Dr Done Miovski. In the first composition of the Board, there were elected 9 members, including doctors who later on became professors at the

Activities and contribution of MMA shortly after the World War II
Activities of MMA in the period of postwar years were directed to investigation of health behaviour and to the eradication of harmful vices of the people, the study of the causes of acute and chronic infectious and endemic diseases and medicalsocial problems. Special attention was devoted to building the Macedonian medical terminology and popularisation of medical science, an organisation of medical courses and lectures, scientific excursions and medical congresses, the formation of medical libraries and exchange of printed papers, books, magazines, pamphlets and other propaganda materials.
Thus MMA became the core factor and carrier of modern ideas about the organisation of health services in Macedonia, with an orientation towards professional and scientific work and continuing education of health personnel, who at that time were of enormous shortage and badly need for society [5,15,16]. In the period from March 1947 to April 1948, the medical units of MMA in Macedonia delivered 170 lectures for doctors and other health personnel and 10,039 popular lectures on health education of the population. Popular medical lectures about the priority health problems were delivered by practitioners in the framework of organised weekly shares, mostly to members of the Antifascist Front of Women (AFZH) and of the Red Cross of Macedonia, such as malaria and tuberculosis prevention and control, kids' week etc. Some of these lectures were broadcast via Radio Skopje [1,5,8,9,15,16].

Educational activities and continuing medical education of doctors
The main mission of MMA is to improve the medical and related sciences, preserving and promoting the dignity and reputation of the medical profession and protect the interests of doctors. There is a wide spectrum with a continuous upward trend of the medical, educational and health promotional activities of MMA from the beginning of the newly created medical units of MMA (in Skopje, Bitola, Stip, Veles, Kumanovo, Ohrid, Strumica and Tetovo). Later on, with the increase in the total number of physicians and specialists throughout the 1950s and beyond, specialist sections and associations in MMA were established. Then a new period of intensifying the professional activities of MMA began. Over the past 70 years, MMA is the main carrier and has a key role and contribution in continuing medical education (CME), vocational and scientific advancement of medical staff and improvement of the medical profession. There were 18 congresses of all physicians and more than 70 congresses of specialist associations held, often with international participation, especially after the independence of Republic of Macedonia in 1991. The number of presented papers, printed in special collections of papers (proceedings) or supplements of Macedonian Medical Review exceeds the number of 13,000 articles. Specialist sections and associations have organised regular meetings with presentations and discussion about at least 3 professional themes, on average 4 times a year. In addition, most of the specialist associations practiced to organize additional professional and educational activities, such as specific schools (ultrasound, anesthesiology and resuscitation, allergology, health management, etc.) to improve the level of knowledge and skills of their members and other interested, first of all doctors who work at the level of primary health care [1,4,5].
Within the organisational activities related to CME, MMA has realised numerous activities. The most notable were the establishment of the Educational Centre for CME, production, translation and publication of several important manuals, tutorials, posters and other educational materials. MMA stressed the need to reactivate the CME centres in other cities besides already renovated centres in with the worldwide recognised approaches and evidence-based medicine [17]. MMA and the Section of Doctors of General Medicine had started an initiative and gained support for returning the name of specialisation of general medicine/family medicine [1,5]. Since 2009 MMA started to publish a professional informative and educational newsletter entitled The Doctors newsletter. It is a monthly magazine for free distribution to 6,000 doctors in Macedonia. Within the period of six years, more than 70 issues were published with circulation over 400,000 copies presenting activities of the units and bodies of MMA, specialist sections and associations, as well as activities related to international cooperation [1,2].

Social and professional activities and initiatives
After the World War II, a huge shortage of qualified and trained medical personnel in PR Macedonia was recognised. The need to start with an intensive education of medical professionals was perceived the earliest by the MMA. For the rapid development of health care and health care facilities, it was necessary to initiate the establishment of medical faculty as educational, medical and research institution in PR Macedonia. In 1946, the Government of PR Macedonia, besides numerous operational decisions, passed an important strategic decision with long-term significance for improving the health status of the population and development of the health service and health system in Macedonia -to make immediate preparations for the establishment of the Faculty of Medicine in Skopje. The first meeting of the Teachers Council was held on 17.03.1947 and that date marked the formation and the beginning of the real existence and academic activities of the Faculty of Medicine in Skopje. More than 17,000 students were enrolled and about 12,000 doctors graduated at the Faculty of Medicine till 2015 [3,[19][20][21][22][23].
MMA actively monitor the situation and changes in the health sector and participates as initiator and advisor in the creation and improvement of legislation in the field of healthcare and social protection, but also broader in the sphere of education and science, and other organised forms of professional and civic action in the overall social life. Members of MMA have been engaged in the state bodies for creating health policy and social development, in the political, cultural and sports life, in political parties, other professional and scientific institutions, civil society and free associations, as well as in the highest scientific institution -Macedonian Academy of Sciences and Arts [5,24].
After the independence of the Republic of Macedonia in 1991, MMA has launched an initiative for the establishment of the Doctors' Chamber of Macedonia (DCM) as a professional institution with powers to perform control and assessment of knowledge and skills, to deal with accreditation and licensing of doctors for medical practice in the prevention and treatment under modern advances in medical science and evidence-based medicine. DCM was founded in June 1992, when the constituent assembly was held at the Military Hospital in Skopje. At the beginning, the members of DCM were medical doctors and doctors of dentistry. In 1995 dentists separated and formed a new special Dental Chamber of Macedonia. DCM is the successor of the Doctors' Chamber had existed in this region in the third decade of the last century in the then Kingdom of Yugoslavia. The seat of the Chamber, which covered the former "Vardar's Banovina", was in Skopje. All doctors and dentists were obliged for membership in the Chamber http://www.mjms.mk/ http://www.id-press.eu/mjms/ in order to gain liability for public and private practice [25].
Among other things, under the operation of MMA as a contemporary medical association, several key documents were prepared i.e. the Statute of MMA, Rules for the operation of specialised and regional associations, Criteria for evaluation of the activities of associations, Rules for conducting elections etc. Recently, a decision for the establishment of the Academy of Medical Sciences (AMS) in MMA was adopted, which is to be realised in the near future.

Cooperation with other institutions and associations
The today the Republic of Macedonia has a highly developed medicine with a broad network of health institutions at all levels of the health system and healthcare delivery. According to the official data from the Institute of Public Health, the total number of doctors in 2015 was 5,975, employed in the public (3,803) and private health sector (2,182). All of them are members of the MMA. About 70% of doctors in the public sector and 47.7% of doctors in the private sector are specialists in various fields of medicine. They cover a wide range of activities involving over 100 specialities and subspecialties, with advanced equipment and superior expertise in their professions. Most of them have international experience and recognition. MMA successfully cooperates with the Ministry of Health, Faculty of Medicine and the Doctors' Chamber of Macedonia [1,4,5].
MMA membership is organised into 22 regional or local associations in larger cities in the Republic of Macedonia and more than 90 specialist and subspecialist sections and associations (58 specialist associations are members of the relevant international organisations, and some of them are founders of Balkan regional and South East Europe associations). MMA is a member of the World Medical Association (WMA), the European Forum of Medical Associations (EFMA), the World Health Organization (WHO), and Forum of the Medical Association of Southeast Europe (SEEFMA) etc. Through their specialist associations, MMA is a member of more than 70 international specialist associations. Through international collaboration and active participation of members to professional and scientific meetings abroad MMA contributes to the promotion of the Republic of Macedonia in Europe and worldwide and to advance its process of Euro-Atlantic integration [5,18].
In conclusion, the establishment of MMA in 1945 as the core factor and transmitter of advanced pursuits in the organisation of health care services and improving the health status of the population was an exceptional event of crucial importance for the further development of educational, scientific and highly specialised health care activity in the Republic of Macedonia.
In the past 70 years, MMA asserts itself as a lighthouse and one of the pillars of the Macedonian health care system. MMA is a factor that gave and continues to give great contribution to the advancement of medical and related sciences and continuing medical education, safeguarding the dignity and reputation of the medical profession and protect the interests of doctors, as well as the development of health services and health care for the population in the Republic of Macedonia. Especially significant is contribution to the advancement of quality standards of health services and the application of good medical practice and evidence-based medicine. In a broader sense, MMA has had a continuous contribution to the overall socio-economic development of the Republic of Macedonia during the past 70 years.
Contribution and merits of MMA members are recognised and valued by granting numerous certificates, awards and honours, including the highest award of the medical profession -Charter "Dr Trifun Panovski," which is traditionally given to the most deserving practitioners every year during the celebration of World Health Day -7 th of April. In 1976 MMA received high federal recognition -the Order of Merit of the people with silver rays. On the occasion of 60th anniversary of existence, MMA received a prestigious national award in 2005 -the award "St. Kliment Ohridski". Also, MMA has won the state award "October 11" and the Prize of the City of Skopje "November 13" for outstanding contribution to the advancement of the organisation of health services and health education of the population, as well as successes in the training of professional staff in the Republic of Macedonia.