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Rural Road to Health


Apr 30, 2024

Dr Jaka Strel is a rural family doctor from Slovenia.  Dr Strel and his team have built a very successful medical practice in Ziri, which has helped Ziri win the title of healthiest municipality in Slovenia.

Episode summary:

01.00  Dr Strel shares his journey into family medicine and rural health

05.15  Specialization of family medicine in Slovenia

08.45  How is the primary care system organized in Slovenia?

14.20  Who are the members of the family medicine team?

15.00  What are the characteristics of the community he is caring for?

19.45  What challenges is rural medicine facing in Slovenia?

21.40  What health challenges to rural communities face?

22.30  What is different about the approach they are taking in Ziri?

27.00  How did they make Ziri the healthiest municipality in Slovenia?

31.30  Who were the key partners to make this approach possible?

34.30  Were there any barriers and challenges to trying this new approach?

38.00  Will this approach with a focus on preventative care be expanded nationally?

39.35  How has the community responded to this approach?

40.30  What lessons has he taken from this experience?

 

Key messages:

His rural family mentors during his early years of training influenced his choice to become a family doctor.

Health system is organized into three levels: primary care, regional hospitals and tertiary centers.

Primary care includes family medicine, pediatrics, gynecology, dentistry and emergency medicine.  

Primary healthcare is organized around 60 healthcare centers, under the auspices of local municipalities.

“Concessioners” are doctors that have a contract directly with the National Health Insurance Company.  They can work within the local healthcare center.

20% are rural clinics, most of them are located in health stations which are part of health centers.  Some rural clinics are run independently by concessioners.

First health center in Slovenia was established in 1930 with the goal of uniting providers for primary care and preventative care.

The community has a positive attitude towards sports and physical activity which has been accredited to the local primary school and the educators there.  

There is a lack of rural medical education, at present education in this area depends on good rural mentors.  

There is no extra funding provided for rural practice despite there being higher expenses for work in rural areas.

Two challenges for the health of the community have been alcohol abuse and bone fractures in the elderly.

They work with different partners within the community such as the local government, schools and other community organizations.

Three important areas that they work on: prevention, flexible curative healthcare, good information support and optimized processes.  

ZirFit - a health promotion activity organized with sport experts, primary school leaders and people from industry.  Organized measurement of 12 parameters of physical fitness such as strength, balance and agility.  This happens every year on the third weekend of May.  Usually attended by about 100 people.  After the testing the patients receive advice from a kinesiologist and doctor on how to optimize their health.  This is the key to success - working with the community. 

The health center has made significant improvements to the health of the community - lower overall mortality, higher vaccination rates, high participation rate in preventative programs.  

Local companies, sport clubs, and community clubs were important partners who helped to support this approach to community health.  Relationships were established through individual meetings. 

It is important to be patient and think about the perspective of the people you are talking to so that you can find a united way to work on things with the community. It is important to meet regularly with all of the community partners.

There are always challenges, especially when you are doing something new.

Biggest challenge was to find suitably motivated colleagues with the right professional knowledge and personal qualities.  Decided to grow the team gradually.  It is important to have a good team and take care of their wellbeing and opportunity for personal and professional development. 

Challenge of COVID-19 pandemic, stopped many preventative activities.

Challenge with funding of their programs for preventative care as there is no national system funding for these activities.  They have had to find alternative sources of funding to do this.

There has been a positive response from the community.  

Lessons that he has learned on this journey:

  • The importance of having a supportive family and team, colleagues that you can rely on. 

  • There  is always a way forward, perseverance and some times stubbornness is necessary.

  • Patience and prudence.  

 

Top tips for people thinking about a rural health career:

  1. Take care of yourself.  We work hard and we have to rest both physically and mentally.  Take care of physical fitness and mental health, it is essential

  2. Have a hobby that relaxes you and helps you clear your mind.

  3. Important to have a team of colleagues who are prepared for different scenarios, that are dedicated to their work and are adept at collaboration.  

  4. Collaboration with the local community is crucial.  Relationships with the community must be nurtured.  

 

Thank you for listening to the Rural Road to Health!