Every year, numerous urologists pass through Belgrade wanting to improve their skills. The reason is simple – Serbian doctors are way ahead of their colleagues in this field of surgery. That is verified through the conversation with Urology Specialist Dr Vladimir Kojović.
Only four days in Belgrade were enough for Petros Tsafrakidis from University of St Andrews in Edinburgh and Athanassios Oeconomou from University hospital of Larissa to come to two flattering conclusions. Firstly, even though it was their first time in the Serbian capital, they thought it was well worth a visit, a “must-see city in Balkans“ in which they felt culturally familiar and intrigued by local history. Secondly, being urologists, they found the Belgrade school of reconstructive urology very inspiring due to its vast experience and a large number of cases. Behind these impressions lies their host Dr. Vladimir Kojović, a Serbian urologist whom they called “world-famous“. Rightly so, it seems. We all met in the newly opened Euromedic hospital in New Belgrade where they were preparing to enter the operating theatre. “His experience goes far beyond any standard comparison. His great integrity matches the hospitality and warmth of Serbian colleagues and their humane approach. So, coming here isn’t about gaining just dry knowledge through a seminar or a course, it’s the whole package“, says Dr. Oeconomou. Mr. Tsafrakidis concurs that Belgrade school of reconstructive urology is peerless. „The procedures themselves don’t require any technological advances – they are pretty much the same anywhere in the world. So its success depends exclusively on the manual skills of the surgeon and you can’t put a price on that“, he concludes.
These Greek urologists are only a small part of urologists who come to Serbia every year to further their skills. Dr. Kojović says that two colleagues from South Africa are expected to come as well; a couple of them from Switzerland too. What Russia is for eye surgery and what Houston is for heart surgery, Belgrade is for reconstructive urology. In other words, a brand, a meeting point, the world capital of trans-gender surgery.
When asked about the context in which Serbia became famous in this particular regard, Kojović pins it to the long, pioneering tradition. ”The first official sex-change procedure in Belgrade was performed in 1987 by a true visionary, professor Dr. Sava Perović, practically the founder of Belgrade school of reconstructive urology. He had an immense energy, he thought about procedures literally all the time, he came up with techniques before they even existed. So having a 32 years long tradition is no small feat, especially since it was truly a pioneering work. Similar procedures were being performed only in a handful of other places. A lot of patients and colleagues have passed through Belgrade since then and now they are enabled to attend an official education in the field of transgender and genital surgery“, says Dr. Kojović, assistant professor of surgery at School of Medicine, University of Belgrade.
Numerous transgender surgeries are performed annually in Serbia. If conversion of genitalia is male-to-female, it’s a one-stage procedure. However, if it’s the other way around, a full conversion can take two to three procedures to achieve fully functional male genitals.
Dr. Kojović hesitated a bit when he used the term ”sex-change“. ”It’s really wrong to use that term, but it’s too frequent in common language. Medically speaking, we’re performing surgical conversion of genitals in order to match genitals with the real gender. It is officially legitimate to say ‘sex confirmation surgery’ which I think is the most appropriate“, he comments. The reason is simple – when a child is born, the society assigns a gender depending on its genitals. Most of the time, this works well. However, in a non-negligible percentage of around 0.6%, spread evenly across epochs and meridians, assigned gender is wrong. The reason – pure physiology. Male and female genitals have the same embryological origin – they come from the same “bud” which, at a certain point of intrauterine development, switches towards one of the two sexes. In some rare instances, this turn goes in the wrong direction and it then doesn’t match brain’s sexual imprint.
”It’s a congenital problem which disables any form of normal, happy life and it must be treated as such. For instance, some 41% of transgender people either commit suicide or try to kill themselves. Those who don’t usually don’t end up having a fulfilling existence. It’s a life-long battle that starts at a very young age“, says Dr. Kojović.
“Every patient I encounter deserves a feature film”, he says jokingly, but one in particular made a lasting impact, partly due to the fact that she came to him at the beginning of his career. It was a 27 years old Peruvian woman from Lima who was born as a man. She was only five years old when she realized she wasn’t what her parents thought she was. “See, in Peru, kids go to pre-school at that exact age, and classes are gender-exclusive. When she ended up in an all-boys surrounding, she fell into a shock. At that moment, she realized she was not what her parents thought she was”, says Dr. Kojović.
„A huge misconception about transgender people is that their state is a whim. Nobody suffers that much since early childhood because of a whim. They come from all over the world and from all sorts of backgrounds. I stayed in touch with many of the patients and I followed them through doubts, insecurities, tears of joy and social acceptance. It’s really important to note that sex confirmation surgery can’t be performed on under-age people and that it’s just a natural conclusion to a long process which starts with at least one year of psychiatric evaluation, followed by endocrinological hormonal therapy“, he adds.
National Health Insurance Fund covers the majority of costs for Serbian patients and foreign patients still pay less than elsewhere in the world. Economic aspect must not be underscored but the quality of work is what makes Serbia the world capital of transgender surgery. In a society as conservative as Serbian, Dr. Kojović admits to having had certain reserves. ”My professional path started with pediatric surgery and surgery of congenital urological anomalies and is still tied to those fields. I had some dilemmas but it took me one serious conversation with a patient to comprehend the scope of their struggle. From then on, I was only interested in helping them. One more instance had a big impact on the change of perception of transgender people and surgery – some twenty years ago, the late Serbian Patriarch Pavle had met with Dr. Perović and, after a talk, he decided to support medical treatment of transgender people. He blessed both patients and doctors in their huge struggle“, recounts Dr. Kojović.
The society still needs to accept what a Serbian church dignitary had accepted long ago. More importantly, the Serbian doctors are at the forefront of this process, the world sees them and pays them due recognition.
By: Slavko Stefanović