Oculofacial plastic and reconstructive surgery in BiH according to top standards and guidelines She is a doctor specializing in ophthalmology and oculofacial plastic and reconstructive surgery, a scientist, academic worker, and publicist for whom ophthalmology is not just a profession but a love, passion, and vision that guides her through life. Although she grew up with the literature of philosophy and sociology, she still directed her life into the field of natural sciences. Dr. Nina Jovanović graduated from the Faculty of Medicine of the University of Sarajevo in 2008 and the Faculty of Public Health of the University of Iowa in 2017 and trained in the field of oculoplastics in Berlin (Germany), Iowa (Iowa), New York (New York), Valletta (Malta). , and Michigan (USA). He currently works at the Cantonal Hospital in Zenica and in a private ophthalmology practice in Sarajevo, and in addition to clinical work, he is actively involved in scientific research with a focus on eye injuries and oculoplastic and reconstructive surgery. So far, he has 17 published works and active participation in over 20 international congresses, and he is an international editor for ophthalmological professional journals and a member of the European Society of Oculoplastic Reconstructive Surgeons. Why medicine? While growing up, no close or distant member of my family was associated with medicine; they all dealt with social sciences, and I grew up with philosophy and sociology literature. My family gift for my 16th birthday was 20 volumes of Philosophical Chrestomatia, which I read with great pleasure. So, until the middle of high school, I was destined to study social sciences. However, my grandfather, who instilled in me impeccable work habits and discipline, felt from the beginning that my character was more suited to the natural sciences and that I would make a good doctor. So, at his persuasion, I ended up in the world of medicine, and I was not wrong. 
After completing your specialization, you spent a longer period studying in the USA. How did the relationship with the University of Iowa develop and what are your impressions of that education system? The connection with the University of Iowa dates back to my student days when the dean of the Faculty of Medicine in Sarajevo connected us with a group of researchers from the Faculty of Public Health in Iowa. Since then, I was their representative in front of the student organization, and later I was involved in the five-year national program for the prevention of trauma and injuries in BiH in front of the IPRC (Injury Research Prevention Center); otherwise, for the official program of the NIH U.S., as part of my engagement, I received a full scholarship for a Master of Public Health at the University of Iowa. From 2012 to 2016, I often and intermittently stayed at the university and completed graduate studies lasting four semesters. I graduated in 2017 during a course of study that included a very intensive program. I worked as a graduate research assistant, and I had the opportunity to attend oculoplastic education in the form of a short-term fellowship with Dr. Keith Carter, president of the AAO (American Academy of Ophthalmology) in 2019, and Dr. Richard Allen, Texas Children's Hospital. This entire experience of working at the Department of Oculoplastics, as well as studying and working on research at a leading university in the world, enabled me to have a distinctive view of medicine and public health. I used different work methods, approaches, and solving problems, communicating with patients, ways of financing grants, and research. I acquired the necessary skills to produce and publish quality research and learned how important a team and multidisciplinary approach are. I think this experience completely changed my life in terms of commitment to work, continuous education, self-improvement, and work ethic. After completing your studies at the University of Iowa, you returned to Bosnia and Herzegovina and continued working in a hospital where you had a clear goal to establish the Center for Oculoplastic and Orbital Surgery in Bosnia and Herzegovina and to strengthen and popularize this field of medicine. What is your experience during this process? The whole idea and reason for my departure was the return and application of knowledge and skills in Bosnia and Herzegovina. I had the support of my mentors from the U.S. in this process. With the support of the hospital management, we managed to establish the Department of Oculoplastics, the first hospital electronic registry for eye injuries, published several quality studies in leading international journals, and introduced more than 30 new procedures in oculofacial plastic and orbital surgery. My experiences are very positive, and I think the mission was successful, but it was not easy, and there is still a lot of room for improvement. 
You work in the Cantonal Hospital in Zenica and in a private ophthalmology practice in Sarajevo. How do you achieve all that, how does your working day begin and end? Exactly. I work a lot, and my working day never ends after I get home because at home I read a lot, work on research and publications, and write professional articles. I am also employed at the Faculty of Medicine in the Department of Ophthalmology as an assistant, so my working day consists of a minimum of 12 to 13 hours of work, writing, reading, and answering emails. To maximize all the time, I try to listen to educational video materials while driving or during training, for example. treadmill watching videos of surgeries or other educational content. Contact with patients, students, and residents is very important to me, and I spend a lot of time in that communication. Fortunately, my partner has the same academic-scientific tendencies, so I have full support from that side. What was your first surgery like? Did you have stage fright? During my specialization, I had the best mentor, Dr. Bruno Abramušić, who taught me the basics of surgery in ophthalmology and was always the wind at my back. Thanks to him, I quickly became independent as an operator because I knew that he was always there for me and that I could call him if the case got complicated. This is very important for a young surgeon—to give you freedom but also security and support. So every nervousness was tolerable but also useful—adrenaline is often great during operations. Also, all operative methods for which I was educated in the U.S., Malta, and elsewhere, upon my return to Bosnia and Herzegovina, I had Dr. Abramušić, who was with me when we implemented them for the first time. Without him, I probably wouldn't be where I am today. Can you tell us what your greatest successes in the practice were and what were your most difficult moments? You become attached to individual patients, and their treatment becomes personal to you. I would single out one patient from Drin Home who underwent three operations with me; one of them was with a microscope that lost stability during the operation and could not stand on its own, so the resident and a fellow technician held the very heavy head of the microscope for an hour while I operated the eye. In the end, the patient, who came to the first examination without sight in both eyes and in a wheelchair and was completely dependent on other people's help, walked independently in less than a year and returned to normal activities and inclusion in the community. I think that the moment of her independent entry into the doctor's office and excellent visual acuity in both eyes is the kind of success that makes my job considered one of the most beautiful. At the beginning of this year, you organized the First International Symposium on Oculoplastic Surgery in BiH and the Educational Week in Oculoplastics. The guest of honor of the educational week was Prof. Dr. Alon Kahana, one of the most eminent oculoplastic surgeons in the USA, and president of the North American Society of Academic Orbital Surgeons (NASAOS). Together, you operated on about a dozen of the most difficult cases of your patients, where you were educated on the spot for such difficult surgical procedures, the so-called hands-on surgery method. How did this initiative come about, what were the results and what are your personal experiences? In 2019, I was on a fellowship at the Kellogg Eye Center, University of Michigan, in oculoplastic surgery, with a focus on orbital pathology. My mentor was Prof. Kahan, whom I met at the ARVO meeting the year before. I also worked with the head of the oculoplastic section, Prof. Christine Nelson. The entire department was motivated to help the development of oculoplastics in my hospital, so they offered me many forms of cooperation and funded my complete education as well as practical work on cadavers every weekend. I worked with them on research projects, and in the end, we published four studies, one of which we later presented at the Meeting of the American Association of Oculoplastic Surgeons (ASOPRS) and the American Academy of Ophthalmology in San Francisco. That's where the idea came up that ASOPRS members would occasionally come to BiH to my hospital and work with me to strengthen oculoplastics in our country. In this sense, Prof. Kahana came in January 2019, when we organized an educational week for all young ophthalmologists and specialists from Bosnia and Herzegovina, and we successfully operated on my most difficult cases, which otherwise would have had to continue treatment outside the country. It was the first education of this kind, and I am very happy that we had guests from all over Bosnia and Herzegovina. The results were very positive for all participants, especially for Prof. For Kahan, it was his first experience in Bosnia and Herzegovina. Unfortunately, as the visit took place in January, he was unable to see the landscape and beauty of our country due to particularly dense fog and smog on those days, so he will have to come again. 
Why is the development of oculoplastics in BiH important for patients and what field of medicine is it? It is the area that deals with all the structures next to and behind the eye, including the bony framework in which the eye rests. The treatments of certain conditions in this region overlap with plastic, maxillofacial, or neurosurgeons due to the extensiveness and involvement of several regions, so multidisciplinarity in oculoplastics is a paradigm. Also, cooperation with radiologists, oncologists, and endocrinologists is crucial in the treatment of certain tumors or thyroid orbitopathy. Therefore, strengthening the segment of oculoplastics, which should bring together all these disciplines and guide the patient through the various stages of treatment, is of inestimable importance. You have developed very strong support and communication with leading experts in your field, but also public health. What is their role in your education? My mentors play an important role in my professional and personal life. Corinne Peek Asa has been with me since 2012, and all this time my cooperation with the University of Iowa has been going on through research, visiting professors in the U.S., access to all medical databases and libraries, and many other segments. Without her support, I think it would be very difficult for me to develop as an independent researcher. On the other hand, the support of clinical mentors in the field of oculoplastics such as Dr. Kahana, Dr. Allen, Dr. Nelson, and many others was crucial to my development as a surgeon. Their constant development and continuous pursuit of personal excellence are my eternal motivation and the fuel that allows me to never stop. Having mentors and colleagues who are role models for you in every way makes the days you spend at the laptop, in the surgery room, or overwhelmed with work, giving up time for rest and family easier. In your opinion, what is the international level of ophthalmology in Bosnia and Herzegovina? We have top experts in ophthalmology, but unfortunately, due to bureaucratic and political obstacles, we cannot be equal with other colleagues from the EU and the world. We are one of the few countries in Europe where ophthalmology specialists do not have the right to take the EBO (European Board of Ophthalmology Exam) because we do not have an Association of Ophthalmologists at the national level. Also, we do not have a legal system of subspecializations in ophthalmology. Because of this, it is very difficult, if not impossible, to go to later sub-specialist training because we do not have a legal basis, and usually, if we go to a longer education, we get fired from the home institution. If we do get leave, it is usually unpaid, and then we have to finance ourselves, which is very difficult with our salaries. As an example, I cite the subspecialization that I started in Tel Aviv in March of this year, which was paused due to the Covid-19 pandemic. Unfortunately, I bore all the costs of the subspecialization without any financial assistance, and it is practically an ascetic life of one year, which is why very few colleagues decided to do it. You are a member of the Bosnian-Herzegovinian-American Academy of Arts and Sciences – BHAAAS. It is a great honor for me to be a part of this renowned Academy that gathers the largest BiH. experts, scientists, and artists from the diaspora and BiH. My task is to strengthen ophthalmology within the Academy. We are currently in the process of developing the Ophthalmology online portal BHAAAS, which aims to connect ophthalmologists of Bosnia and Herzegovina and the diaspora to strengthen the profession, education, professional exchanges, and the help of our experts. The portal would catalyze future changes and progress in ophthalmology and oculoplastics in Bosnia and Herzegovina and will represent a platform for improving education, access to information, interdisciplinarity, cooperation, interconnection, and providing the most modern treatment to patients. We also plan to hold an international symposium in ophthalmology as part of the BHAAAS Day in Mostar in June 2021, which should be attended by eminent experts in oculoplastic surgery in the U.S., members of the American Association of Oculoplastic Surgeons (ASOPRS), and we hope that the pandemic will not disturb the plans. How do you view the departure of young experts from Bosnia and Herzegovina? The political situation the obstacles we encounter, and the complete lack of support from management structures are the main reason why most colleagues want to work in a better system that protects and supports them. Occasionally there are some positive examples, but that should be the rule, not the exception. Finally, what would you single out as your greatest professional accolade so far? I would say that it is the research Direct Injection of 5-Fluorouracil Improves Outcomes in Cicatrizing Conjunctival Disorders Secondary to Systemic Disease, the analysis and publication of which I worked on during my stay at the Kellogg Eye Center, and which later received recognition for the best research at last year's 50 ASOPRS meeting in San Francisco. Also, the therapy that Dr. Alon Kahana applied was a kind of revolutionary method in the treatment of severe forms of disease, and I am very happy that I had the opportunity to be a part of this study. 
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