By Matt Leingang
The Cincinnati Enquirer

Dr. Richard Azizkhan (left), chief of surgery and director of surgery services at Children's Hospital Medical Center, shows doctors, administrators, diplomats and journalists from Bosnia-Herzegovina a trauma bay in the emergency department. (Glenn Hartong photo)

CORRYVILLE - As Dr. Nesad Hotic walks the halls of Cincinnati Children's Hospital Medical Center, he offers this perception: "This place is like the space shuttle to me."

While the Cincinnati institution does boast a level of technology that puts it among the top pediatric medical centers in the country, Hotic, a pediatric surgeon from Tuzla, Bosnia-Herzegovina, is not easily given to hyperbole.

He works in a hospital that is still struggling to catch up to the 21st century and rebuild itself following the 1992-1995 Bosnian war, which ravaged medical services in its major cities.

To help get back on track, Hotic and eight other officials from Tuzla University Clinical Center are touring Children's Hospital this week as part of an ongoing medical exchange program.

They are guests of Dr. Richard Azizkhan, chief of surgery at Children's Hospital, who has made it a personal mission to help the country. He has made dozens of trips to Bosnia in the past nine years, performing hundreds of surgeries on children there, and arranging for many to be brought back for care.

"Tuzla is now in a phase where they can meet the essential needs of their patients, but they are now looking for growth," said Azizkhan, who, among other things, helped start Tuzla's heart surgery program.

Azizkhan said Tuzla's population is about 500,000, but has a metropolitan area of more than 1 million people - about half the size of Greater Cincinnati.

Hotic, 37, and the rest of the Tuzla delegation will be here through Saturday. Touring Children's Hospital gives them a glimpse of what they hope will be their future.

For example, Children's Hospital is fast becoming a "paperless" hospital. Doctors use computers to write prescriptions, and patient charts have also been digitized to include a patient's diagnosis, vital signs and whatever special care instructions are needed.

When the tour stops at the radiology department, the Bosnians take particular interest in positron emission tomography, also called PET scan, a tool that uses a radioactive compound to detect cancer and evaluate the effects of cancer treatment on organs.

"I can think of only three of these in all of Europe," says Dr. Nedret Mujkanovic, chief executive officer at Tuzla University Clinical Center.

"We feel very fortunate. Most pediatric units in the U.S. are not like this," says Dr. Lane Donnelly, radiologist-in-chief at Children's Hospital.

But before the Tuzla hospital can start purchasing this kind of equipment, it must figure out a way to make itself financially stable, Azizkhan said.

Before the war, hospitals were supported by the national government.

Now, they receive about 15 percent in federal funding, 35 percent from the state government and the rest must be made up through a still-developing private health insurance industry, philanthropic donations and corporate donations.

Continuing education for doctors and nurses is also problematic. "In my country, education is more expensive than equipment," Hotic said.

Children's Hospital also helps with that. About 20 Bosnian nurses and doctors have trained here in the past few years, Azizkhan said.

Azizkhan got involved in postwar care mostly by happenstance. He went there at the urging of Dr. Jacob Bergsland, a pediatric cardiac surgeon in Buffalo, N.Y., where Azizkhan worked before coming to Cincinnati in December 1998.

"I feel very strongly in the need to support their programs," said Azizkhan, who plans to make another visit to Tuzla in June. "Too me, it's all about making sure we maximize the potential that they can achieve."

E-mail mleingang@enquirer.com