What can medical journal editors do in war?
2002; Elsevier BV; Volume: 360; Linguagem: Inglês
10.1016/s0140-6736(02)11825-3
ISSN1474-547X
Autores Tópico(s)Economic Sanctions and International Relations
ResumoAna Marušić is a professor of anatomy at Zagreb University School of Medicine, Zagreb, Croatia, where she obtained her MD and PhD degrees. With her husband and colleague, Professor Matko Marušić, she edits the Croatian Medical Journal, an international general medical journal published in English. She is also the president of the World Association of Medical Editors (WAME). War is a major human disaster that affects all aspects of life, particularly the health of the population in the region of conflict. The war that broke out in Croatia in 1991—the first armed conflict in Europe since World War II—brought enormous destruction and civilian suffering. 20 000 were killed, 35 000 wounded, and 300 000 (of Croatia's 4·8 million) were forced to leave their homes. The deep humanitarian crisis in Croatia was further exacerbated when an even more brutal war erupted in neighbouring Bosnia and Herzegovina a year later. Tens of thousands of refugees poured into Croatia, seeking shelter, help, and health care. At one point, the refugees and internally displaced persons in Croatia made up almost a quarter of the Croatian population. In 1991, we were working on the first issue of a new medical journal, the Croatian Medical Journal. It was to be a general medical journal published in English, and the first issue was planned for the spring of 1992. Our goal was to pull Croatian scientists away from publishing only in national language journals and set higher standards for publishing in biomedicine. 50 years of a communist system of managing scientific research produced little mainstream science and left most Croatian scientists with few of the skills needed for publishing in international scientific journals. In the autumn of 1991, we witnessed how profoundly and quickly war disrupted the system of health care. Hospitals were directly and intentionally shelled, and the damage to health institutions amounted to US$200 million. Supply services and communications were seriously hindered because many health institutions were close to the battlelines. Patients and physicians were killed and wounded. When the city of Vukovar fell, after being under complete siege and constant artillery attacks for 3 months, more than 200 patients were taken from the city hospital, executed, and buried in a mass grave. In those horrible times, we were faced with a difficult question—what can we, as editors of a medical journal, do in war? Although the Croatian medical community had no experience in war medicine, the health-care system quickly adapted to the war situation and successfully provided care for the population at risk, without any epidemic or health crisis. Successful adaptation of the health system to the demands of war was possible because of the high level of professionalism of health-care workers, who were used to hard, disciplined work and round-the-clock shifts, to acting in an emergency, and to making rational decisions. Physicians practising civilian medicine had to learn about war surgery and post-traumatic stress disorder while caring for wounded soldiers and civilians. The times called for action, bravery, and voluntarism. For example, the medical corps of the as yet non-existent Croatian Army was born when a surgeon from a major hospital in Zagreb took the first-aid kit from his car and helped a wounded soldier on the road. 10 months later, the surgeon became the head of the medical service for more than 100 000 soldiers on the battlefields. We could not sit back complacently in our editorial office and just passively observe the suffering around us. Our colleagues and students were out on the battlefields, helping people in need. Preparing the journal's first issue and ensuring a normal teaching process at the medical school was just not enough. We joined a school team translating a manual on war surgery that was needed by physicians in the field hospitals. Talking with our colleagues, especially those working close to the battlefields, we realised that they had enormously important data related to different aspects of war medicine. Their greatest difficulty was that not only did they have no time, but they also had no skills with which to present their findings in a form publishable in domestic or international medical journals. A perfect job for us! We would help the physicians write medical articles, and thus perhaps teach them how to do it by themselves. So, along with preparing the regular issue of the Croatian Medical Journal, the two of us set out to work with our colleagues on the battlefields. One went out to look for potential authors and offer help with writing a report, which sometimes involved many different types of transportation and crossing battlefields to arrive in regions isolated by war activities. The other, being an anatomy teacher, helped the pathologists and forensic experts systematise and translate their autopsy reports. It was a busy time, and only now, more than a decade later, do we realise the magnitude of work and effort invested. The first collection of data was published in November, 1991, as a supplement to our still unfinished first issue. The 76-page supplement contained assessments of civilian casualties in the first few months of war, an account of mass killings of civilians, a statistical analysis of people displaced from war regions, and a description of a new type of external surgical fixator for bone surgery. The supplement was produced from scratch by the two of us and the journal's language editor and was printed free of charge by a major printing house in Zagreb. All this was done under incessant air raids and artillery attacks on the city. The journal's covers were printed during one of many air-raid blackouts. Under the dim light of a small torch we realised just in time that the colours had been improperly mixed, and the red cross on a photograph of a destroyed medical building was green! At the end of 1991, Vukovar fell, and its inhabitants were exiled to the free parts of the country. As our colleagues from Vukovar Hospital, which functioned until the very end of the siege, arrived in Zagreb as refugees, we gathered their testimonies and published them as a separate book, which appeared in December, 1991. The first regular issue of the journal came out on time in March, 1992, but our job to document medical aspects of the war was still not finished. We continued working with our colleagues from the field and published a second, 235-page war supplement in April, 1992. It was an extensively documented presentation of different medical aspects of war: psychological analysis of war trauma, child casualties, civilian deaths and massacres, health status of refugees and released prisoners of war, destruction of medical institutions, organisation of Croatian Medical Corps into four echelons, and a number of specialty reports. Later, we were the first to publish a preliminary report on the medical consequences of ethnic rapes. We also collaborated with editors of national journals, who translated a number of articles into Croatian and published them in their journals, so that they could reach the whole medical community in Croatia. The war supplements were important not only for the education and information of the medical community, but also as important documents for the legal proceedings at the International Court of Justice and the International Criminal Tribunal for the Former Yugoslavia. Preparation of the war supplements revealed that the greatest weakness of Croatian physicians was not their lack of professional expertise or knowledge, but their unwillingness and almost fear of writing for medical journals. While writing for the journal, most physicians were eager to learn and enjoyed discovering the excitement of writing an article. Through this intensive work with authors, a process we called author-helpful pre-review was born and became the hallmark of our editorial work. We worked with authors on presentation of their data until the report was suitable for traditional peer review. Our next step was to show our colleagues that they should not be afraid of sending their articles to our journal or other, more prestigious journals. This joint effort resulted in more than 100 articles on the medical aspects of the wars in Croatia and Bosnia and Herzegovina, published in prestigious international journals. Our journal also grew with our authors, the good articles we published gained the journal international recognition and visibility, and it was eventually indexed in Medline and other bibliographic databases. After the armed conflicts in Croatia and Bosnia and Herzegovina ended in 1995, our work with authors continued. We introduced a mandatory course, "Principles of Scientific Research in Medicine", to the Zagreb University School of Medicine's curriculum. Later on, the course was also introduced into the curricula of other Croatian universities. Also, workshops on scientific writing are offered to young clinical researchers as part of their continuing education. Editors of a medical journal can make a difference to the health of the population and to the medical community during a war. For us, the war was not only a time we remember with equal amounts of pain and affection, but also a time that left us a special legacy. We were not only journal editors but also, perhaps more importantly, teachers in the medical community. Excellence through education (Educatione ad excelentiam) became our motto. We hope to get it across to the Croatian and other medical and scientific communities.
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