Dr Maja Bozinovska has an unorthodox view of what it means to live a balanced life. “Work plus work,” she says. “If I stop working I am without balance.”
The compulsion to work has propelled her onto the frontline of stroke care transformation in North Macedonia, where she founded and leads the Macedonian Association for a Fight Against Stroke, and champions change in and beyond her own city.
It can seem like a Sisyphean task in a poor country plagued by unstable coalitions and early elections and a dilapidated public health system. Because frequent changes in leadership make it hard to access support or continuity, Dr Bozinovska keeps her decade-old association at an arm’s length from politics, relying on EU assistance via the Stroke Alliance For Europe (SAFE) and the European Stroke Organisation (ESO) to fund projects and symposia. The volunteer-run association doesn’t only educate the public about stroke but also trains doctors and nurses and procures equipment for hospitals such as Doppler ultrasound scanners, ICU monitors and physical therapy aids.
“Frustration keeps us going,” Dr Bozinovska says. “We know we can do it; it is so simple, and we seem so close, but we just cannot get there.” It takes small steps and an inexhaustible supply of enthusiasm and goodwill.
It helps that as well as a worker she is a dreamer. “She is that one physician who has held on to the dream of universal access to quality stroke treatment that doesn’t depend on circumstance but on a well-established management system,” says Angels consultant Maria Sheverdina who has been working with Dr Bozinovska since November 2023. “There are many difficulties in Macedonia, and when you find someone who never stops believing that change is possible, you have found a treasure.”
A balanced life
The story of how Dr Bozinovska became a treasure began right here in Ohrid where she lives with her husband and two daughters aged five and 13. She recalls an idyllic lakeside childhood spent in boats and on beaches in the former Yugoslavia where her mother was a jurist and her father an orthopedic surgeon in an efficient public healthcare system.
Although her daughters don’t enjoy quite the same freedoms, Ohrid remains a family city which is the reason she returned here after completing her neurology specialization in Skopje and gaining more experience in neurophysiology in Ljubljana, Slovenia.
It was after she returned and discovered the gap in stroke care that she started her patient and family support association at a strategic distance from the capital, with the intention to be “happy with life in a small city and help the country”.
The need to work at something meaningful and beneficial to the community was the reason she became a doctor in the first place, opting to use her energy “in the right way”.
She became a neurologist through circumstance when an opportunity in anaesthesiology wasn’t immediately available. She is happy with her choice: “I like it.”
She is only the second neurologist at Ohrid’s Special Hospital for Orthopaedics and Traumatology St Erasmus, arriving after an interval of 15 years. St Erasmus doesn’t have capacity to build a stroke unit but, with support from Maria Sherverdina, Dr Bozinovska is lending her expertise to organizing the stroke pathway and establishing a stroke unit at the General Hospital of Ohrid.
In the pursuit of a balanced life, Dr Bozinovska takes care of her patients during working hours and and in her free time strives hard for equal stroke care throughout Macedonia. “It’s like a hobby,” she says of projects that include a two-year study of the prevalence of stroke and risk factors in the population of southwestern Macedonia. The research went hand in hand with awareness education and preventive examinations and a subsequent survey showed that stroke knowledge among the region’s elderly population had increased by five percent.
The humanisation of stroke care
Dr Bozinovska is a board member of SAFE and actively involved in local implementation of the Stroke Action Plan for Europe, a pan-European project that seeks to lower the incidence of stroke and enhance the quality of life for survivors. By assisting developing nations it aims to lessen global inequality, but Dr Bozinovska points out that the connection goes both ways. “We are guided towards improvement but the guidance doesn’t only go in one direction,” she says, suggesting that countries elsewhere in Europe can likewise benefit from the resilience and adaptability displayed by their under-resourced neighbours.
She also has a sense that East European medicine is more likely to be patient-centred than medicine in Western countries.
“It’s better to speak of person-centred medicine,” she says. “It’s about the humanisation of medicine and of stroke care and the idea that high-quality care should be modified by individual needs, desires, experience and expectations so ideally each person is able to fulfill their personal goals. But for decisions to be mutual, patients and their caregivers must be very well-informed.
“What I have in mind is that we have an obligation to not only share the good stuff but also the bad stuff. Some decisions have side-effects and can have unwanted results. In person-centred medicine the patient is well enough informed for mutual decision-making and shared responsibility. But for person-centred medicine to succeed, you first need to educate the public.
“This is particularly important in neurology where many conditions are incurable, and it is necessary to explain this to the patient so they can understand and accept it.”
In Macedonia, she says, it’s not unusual for an older patient to address their doctor as “sweetheart” or “my child”. This informality, so at odds with healthcare cultures where patient deference is the norm, fosters closeness and democratises the doctor-patient relationship.
There’s one more national characteristic that favours Dr Bozinovska’s project.
“Macedonians are fighters,” she says. “We have the ability to accommodate ourselves to a situation, and make the best of a bad story.”
In difficult circumstances this chameleon-like adaptability keeps hope alive while she and others write a better story about stroke care in Macedonia.
