Professor Grgurić: "Children are our future which for them begins today"

Interview with Professor Josip Grgurić

Marina Knežević Barišić
Mozaik fotografija profesora Grgurića
UNICEF
03 November 2021

We wanted to celebrate the 75th anniversary of UNICEF by talking to a special man - Professor Josip Grgurić. Our professor Grgurić, as we all call him, has been linked to UNICEF from early childhood. He was born in Skrad in Gorski Kotar, Croatia into a large family of six children.

"My father was an electrician and my mother a housewife who took care of everything. We lived modestly, but caring and supporting one another all the time," Professor Grgurić said, as he shared with us his childhood memories, adding that he holds his first memories of UNICEF from that time:

"I first met UNICEF immediately after the Second World War, when I was a beneficiary of their various forms of assistance. Like many families back then, we received UNICEF packages, primarily food. I remember very well the distinctly yellow cheese, but also something else very special. The first chocolate I had ever tasted."

In Skrad, our professor completed primary school, and on the invitation of his brother, who had already finished university and was employed and had his own family, he came to Zagreb.

"In Zagreb, of course, everything was new and different. My brother showed me, through his example, how much I needed to learn, that I had to be diligent, because he had finished secondary school and university having to work alongside his studies. No special words were needed here, I learned about life by watching it. His role in my life journey is extremely important, as is that of my parents and of course my wife and daughters who have always been there for me. My parents instilled in me something that I consider very important, and that is moral and ethical values that have always guided me, and which is probably why I have been tackling social issues throughout my working life. The most important thing a person should have is respect for others and a desire to create. And this encompasses creating a family and creating for the benefit of the community, and I try to pass that on to my grandchildren as well,” Professor Grgurić told us.

He attended grammar school in Križanićeva, where he was the best student of his generation, and then he decided to enrol in the Faculty of Medicine in Zagreb. After he successfully completed his studies there, he wondered what to do next.

"It was 1964 and international cooperation was very much alive. I had the opportunity to go to work in Algeria and I decided to take it. This was a big step for me, whose first trip abroad was when I was 21, when I went to Trieste. And it really was a huge step. I applied for a competition, they chose me and I went to Algeria. There were a lot of unemployed people there, and it was a difficult situation. My place of work was on the edge of the Sahara Desert. Efforts were being made to supply the towns with water, and I was the coordinator of healthcare in the camps. I treated children and dealt with various health problems of the local population. I was in Algeria for nine months and the time spent there pushed me in the direction of paediatrics and the preventive and social dimension of healthcare,” recalled Professor Grgurić.

After returning to Zagreb for military service, he landed a job at the children's hospital in Klaićeva. But he was drawn to see what paediatric healthcare was like abroad, so he applied for another competition, this time announced by the Government of the French Republic. Although the competition was intended for some other professions, there were not many people who spoke French at that time, and Professor Grgurić had studied French at school and then perfected his knowledge in Algeria, so he managed to win the scholarship and went to Paris for further training at L'Hôpital des Enfants-Malades, the first children's hospital in the world founded in 1802, during the time of Napoleon. It is an extremely prestigious institution which at that time, in addition to its top experts, was also known for its humane approach to children and its open door-policy for parents. Professor Grgurić thus specialised in paediatrics in Zagreb and Paris, the memories of which he still holds dear.

"Paris, where I spent nine months, fascinated me. It is a beautiful city, but my scholarship was only enough for the essentials, which was why I got involved in some professional projects in which I was happy to participate. I learned a lot from both the projects and the top doctor-mentors. Upon my return to Croatia, I saw this huge difference, where I thought the approach here was really inhumane towards both the children and their parents. Visits were then allowed twice a week for an hour, unlike in Paris, where even schools in hospitals were starting to open. This encouraged me to continue educating myself in that direction and to encourage changes in our country for the benefit of children. Even today, I address these topics through the project "Bringing a smile to a child in hospital" implemented by the Union of Societies "Our Children", the Croatian Society for Preventive and Social Paediatrics, the Paediatric Society of the Croatian Association of Nurses, and the Croatian Medical Association. Staying in a hospital is a tough experience for children: their daily lives are interrupted, they are surrounded by many strangers, and they acutely sense their parents’ worries and concerns. Therefore, how the medical staff communicates with children is very important, but so is the overall atmosphere in the children's wards and hospitals. Interestingly, some studies have even shown that in children treated in hospitals, positive changes in immunity can be encouraged by paying more attention to them. We now have kindergartens and schools in hospitals, but there is often a big battle over parents staying in the hospital with their child, with certain disagreement among some of the health professionals. There is also a new rulebook that introduces improvements, but some things remain the same so that parents still have to fight in certain situations to stay with their child. It is important that we are all guided by the best interests of the child. Many say that a child can get accustomed to anything. It's true, but they also never forget," says Professor Grgurić.

At the Institute for Mother and Child in Zagreb, which UNICEF helped to establish, which is today’s Clinic for Children's Diseases in Klaićeva, he first worked as head of the Paediatric Gastroenterology and Nutrition Ward, which remains his scientific domain to this day. He was particularly concerned with recurrent abdominal pain in children, the prevention of avitaminosis, overweight children, and the health benefits of breastmilk. Professor Grgurić visited the whole of Europe and a good part of the world for training. He also joined professional associations that advocated change for the better.

Life, the professor adds, is constant learning, because we can never know when we will need something, and lifelong learning, he believes, greatly enriches a person.

"I joined the Association for Paediatric Education in Europe. The Social Paediatrics Centre was set up in Paris after the Second World War. Many paediatricians went there for training, including ours from Croatia, many with the support of UNICEF. This is where the holistic approach to the child stood out. A movement of a return to nature emerged, led by the French and Scandinavians who emphasised breastfeeding and breastmilk as extremely important for the growth and development of the child. In Paris, I attended evening classes in social paediatrics. Involvement in these new organisations and movements brought some humane values to the profession, a vision that was for the benefit of children and that was important to me. I returned to Croatia and that is when I realised what makes a good paediatrician. It is a doctor who has some human assumptions, empathy for the child, and who understands the environment in which the child grows up. It is important to work on yourself, develop your knowledge and expertise. I read somewhere that a good doctor is someone who is also a good human being. I believe that this is true and very important, especially when it comes to the youngest," adds Professor Grgurić. We spoke to him a lot about the history of UNICEF in our region, which is fascinating.

In the period after the Second World War, UNICEF implemented numerous programmes here and encouraged and helped build the educational, social and healthcare systems. One of UNICEF's top priorities was the protection of mothers and children through the Mother and Child Programme, as infant mortality was extremely high in the decades following World War II. In 1950, 118 children per 1,000 births died in Croatia, and in some parts of the former state, such as Vojvodina and Kosovo, the situation was even worse. At the same time, in Slovenia the situation was much better. With the great involvement of UNICEF and cooperation with the competent institutions, the number of infant deaths was reduced in two decades in Croatia to 36.6 per 1,000 births, and investments in further improvements to the quality of healthcare continued.

There was a lot of work to do. On UNICEF’s initiative, demonstration and education centres were built and equipped with the aim of providing healthcare for mothers and children. The first such centre in Zagreb opened in 1956, and from 1953 to 1960 UNICEF provided equipment, medicine, and training for staff abroad for 36 dispensaries for children and women, 37 laboratories, 42 school dispensaries, 22 stationary school clinics, 11 demonstration dairy kitchens, 101 counselling centres for women and children, and 19 laboratories for school clinics. From 1963 to 1970, equipment was provided for mobile dental clinics and intermediary centres throughout Croatia – in Bjelovar, Čakovec, Split, Karlovac, Rijeka, Knin, Zadar, Virovitica, Pula, Slavonski Brod, Osijek, Našice and Dubrovnik.

UNICEF also helped improve healthcare for premature babies and educate health staff, and, as there was a major shortage of health staff at the time, UNICEF encouraged high-quality education and equipped schools for nurses and midwives. Many do not know that the Centre for Mother and Child (now the children's hospital in Klaićeva) in Zagreb was opened with the great support of UNICEF, just like the once world-famous Institute of Immunology.

"Croatia then had the capacity to produce world-famous vaccines. For example, the Edmonston-Zagreb strain of measles vaccine was developed by immunology experts, and thanks to cooperation with UNICEF, hundreds of millions of doses of this vaccine were provided for children in about thirty countries around the world. Millions of lives have been saved thanks to the work of local experts. Today we live at a time when many neglect the danger of infectious diseases that have disappeared thanks to vaccination," says Professor Grgurić.

UNICEF has also helped open a number of dairies across Croatia so that children in schools could be provided with a free dairy meal. With UNICEF’s support, diseases have been eradicated that most people today do not even know existed in our region, such as malaria in the Neretva region, brucellosis in Istria, then trachoma, eye disease in Međimurje, Zagorje and Posavina, tuberculosis, scalp fungal diseases in children, and mass caries control has been put in place because about 70 percent of children had caries.

We asked the professor about some specific memories from Klaićeva, of a child, a family that remains particularly close to his heart.

"There are a lot of stories, a lot of children, their families. Many more children were dying at that time. When you see that a child is dying… one always wonders if we could have done more, and done it better… There have been both difficult and happy moments. Perhaps I especially remember the story of a boy who came to me with his mother. The child had a severe infection, and it was really a question of whether he would survive. The mother would come every morning after my rounds, practically to see if her beloved child was still alive. I told her I would do my best. We hadn’t reached a diagnosis yet, and the child was wasting away. I read, asked for information, for these were different times when there was no internet or the possibility of quick communication as there is today. I found information that in Switzerland they made a special type of food, a semi-elemental food. I managed to establish a contact in Switzerland and asked if they could donate at least a few boxes to us to begin with to see if the changes would be for the better. It was on Christmas Eve. The food arrived and the boy's general condition improved by the New Year. I told my wife we wouldn't be able to go away for the winter holidays, I couldn't leave. When we used up the boxes we had received, the boy’s father went to Switzerland for more. Then he experienced problems at the border; they did not let him back into the country and wanted to report him for smuggling. Then I wrote to the customs and explained what this was all about. We managed to get hold of the extra boxes and that food, but the problem was that the healthcare insurance did not cover it, and that food was expensive. The boy’s dad worked at ZET (Zagreb Tram Company), and they organised things and raised the money. Newspaper headlines proclaimed that for the first time in Zagreb, food for astronauts was used in a treatment because that was its primary function. In the end, I managed to make a diagnosis and for years the boy was under my care.  I even received an invitation to his wedding. But I had not done anything special, just what was needed and what I could do to make him feel better," Professor Grgurić recalled. 

We moved on to more recent history, the time of the Homeland War. Professor Grgurić worked in Klaićeva at the time and was the head of the Commission for the Child in the War. The Commission had the role of providing healthcare to children in wartime conditions, and collecting and distributing humanitarian aid. The work of the Commission was also supported by Cardinal Kuharić, with whom Professor Grgurić met several times. The Commission included professional societies, professional organisations, and organisations such as UNICEF, the Red Cross, Caritas, Merhamet.

"We met every Wednesday and the meeting was short and functional, just reporting on what was done so that everyone involved was informed. I would like to emphasise that during the Homeland War we did not have a single major epidemic, which is not accidental, but the result of preventive work. It is interesting that UNICEF was the first organisation that came to provide assistance and support, even before the international recognition of Croatia, which carries great diplomatic weight in such times. They sent Dr Vesna Bošnjak to Croatia, who founded the office in Croatia," recalls Professor Grgurić.

UNICEF then provided emergency humanitarian aid such as stoves and fuel for heating, baby hygiene kits, medicines, vaccines. The first funds provided by UNICEF ($ 50,000) were used during the evacuation of mothers and children from Osijek, for the heating costs for children in resorts where they were accommodated, psychosocial support and education of experts in all fields, the procurement of textbooks and school supplies. After the war, UNICEF in Croatia was engaged in educating children about protection against mines and explosives, and advocating for children's rights. Professor Grgurić also launched the "Towns and Municipalities – Friends of Children" programme in Croatia, intending to bring about positive change for children, and for him, as a subspecialist in paediatric gastroenterology, the "Baby-Friendly Hospitals Initiative" programme and the promotion of breastfeeding are of special importance.

"As the coordinator of the Baby-Friendly Hospitals programme, I learned a lot about collaboration, about perseverance, and about how just a little connection is needed for progress which does not happen in leaps and bounds, but in small but important steps. Although all public maternity hospitals in Croatia bear that name, this is not the end of the story. It is a great challenge to achieve the necessary standards, but also to raise them in terms of improving the practice in maternity hospitals so that it is more favourable for mothers, and raising the level of care for premature babies. There is also the issue of the Code, which was adopted 40 years ago and is still not applied," says the professor. He adds that at the beginning of September 2020 he had the honour to give an introductory lecture to medical students in Zagreb:

"It is a great honour to speak in front of younger generations, in front of future doctors. Prof. Štampar and Prof. Perović were those who gave their introductory speeches to my generation.  What I wanted to convey to these young people is that medicine is something between a craft and an art. Everyone can be a good craftsman, but not everyone will be an artist. I told them to bring that artistic thread into learning and work and that medicine is life, and life is constantly changing. That is why one should learn what is written in the small print, because one can never know when it will be needed," explained Professor Grgurić.

Finally, we asked the professor about the current situation, about the pandemic:

"On one occasion I listened to a wise epidemiologist in Paris. He said we’ve become complacent, believing we have all the tools to fight viruses and bacteria, but you have to know that viruses and bacteria are phylogenetically older than humans. You can’t beat something that’s been here longer than you, but there is something we can do. We can create conditions for coexistence. As a society we should work on resilience in every sense. And something that is especially important to me to emphasize, to separate a mother from a child she has been carrying for nine months because she is positive for coronavirus is neither humane nor necessary.The child has protection through the mother's antibodies, especially breastfed children," Professor Grgurić shared with us and added something that has guided him as a leitmotif throughout his life:

"Every child is an unexplored potential that needs the support of the family and the community where the child grows up, because children are our future which for them begins today!"