Interview with Gun Gunsoy – Chief Executive Officer of Acibadem Sistina INTERVIEW GUNSOY: Acibadem Sistina has a significant role in the fight against the pandemic in Macedonia


Covid-19 pandemic has been one of the biggest health crises in recent decades. You are head of the Acibadem Sistina Hospital, which is part of the world’s second-largest hospital group (IHH). First of all, what is your opinion on the spread of the virus and the response of healthcare organizations and countries around the world?

As you have pointed out in the question, Acibadem Sistina Hospital is part of the second-largest hospital group in the world (IHH) and the largest group of hospitals in Southeast Europe, Acibadem, and all the steps taken by our hospital are in line with the decisions and the protection measures taken by the health giant Acibadem. What I can say is that we as Acibadem Sistina have literally intercepted the virus and our hospital has taken steps to ensure the safety and protection of patients, staff and visitors even before the first confirmed coronavirus case in the country. For the purpose of prevention, protection and safety of patients, a special movement protocol is implemented when visiting the hospital. All persons entering are required to pass the entrance control which includes a body temperature check and mandatory wearing of protective equipment, and hospital visits are limited to only one visitor at a time in order to adhere to the recommended social distance. Before being hospitalized in any of the departments of Acibadem Sistina, every patient must be tested for the presence of Covid-19, so that the risk of spreading the infection is minimized. Emergencies to be operated are tested with the new rapid molecular test, which yields results in less than 60 minutes. As a hospital, we fully respect the recommendations of the World Health Organization (WHO) and we will adhere to the established protocols and recommendations of the health authorities as long as the pandemic lasts. Each country has a different approach, but I think that the approach to which Macedonia adheres, which is implemented by almost all countries in the world in the fight against coronavirus, is appropriate and gives results.

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At the group level, i.e. Acibadem, how did you cope with this challenge and do you think you responded successfully? What were the key problems?
All Acibadem Health Group Hospitals fully implement the World Health Organization’s (WHO) recommendations. Protection and safety of patients and staff at Acibadem Hospitals are at the highest level, we have raised the measures for prevention and protection against coronavirus to the highest level following the recommendations of the Turkish Ministry of Health. The biggest challenge may have been to respond quickly to the changes “dictated” by Covid-19, which, like many other challenges, Acibadem successfully handles. All Acibadem healthcare facilities operate at full capacity and caring for our patients’ health remains our top priority.
How has this crisis affected Acibadem Sistina’s work, in terms of organization, number of patients, financial indicators and growth strategy?
Acibadem Sistina Clinical Hospital is currently operating at full capacity in all departments. The working hours of the hospital are in line with the start of the curfew in the country, while the Emergency Department for Adults and Children operates 24/7. From the very beginning, we have been implementing all the measures and security protocols for complete protection against coronavirus, both of the employees and of the patients and hospital visitors. I would like to emphasize that all services and interventions in our hospital are performed in compliance with special security protocols and that all visitors are maximally protected. The impact of coronavirus on the organization of the hospital operations was inevitable, and that meant that special protocols for movement and mandatory testing of every patient before hospitalization needed to be introduced. In terms of surgery, priority was given to emergencies. Unfortunately, the corona health crisis has also affected the strategy for expanding our hospital’s capacity and due to Covid-19 and, above all, the safety of our patients, we had to prolong the opening of the new Pediatric Center.

AcibademSistina rAcibadem Sistina Hospital in Macedonia has been in the spotlight over the Covid-19 tests. The hospital performs three types of tests (serological, molecular and rapid molecular). What kind of tests are those? What is their quality and how do you guarantee about the tests?

Acibadem Sistina Hospital is the only hospital in the country with a laboratory that performs three types of tests for Covid-19 – serological Covid-19 IgG/IgM rapid test, for which the results are obtained in 15 minutes, molecular PCR – SARS-CoV-2 test, for which the results are obtained in 6 hours, and the latest rapid molecular PRC test for the presence of coronavirus, for which the time required to produce the results is up to 60 minutes. It is an urgent PCR-molecular test designed to quickly diagnose emergencies and hospital patients. The system is patented and a proven gold standard. It is a closed system that automates and integrates sample preparation, amplification of nucleic acids, and detection of the target sequence in the sample or sample complex using a real-time polymerase chain reaction (PCR).

At the Molecular Diagnostics Department at Acibadem Sistina, a regular RT-PCR coronavirus SARS CoV-2 detection test is also performed, with the samples being prepared the same day until 8:00 pm. The methodology and sensitivity of both types of molecular tests are identical. Both are molecular PCR processes (open or closed system) that allow us to detect a specific target – a target gene of the SARS-CoV-2 virus in real time.

Serological Covid-19 IgG/IgM rapid test is performed using blood sample to detect IgG/IgM antibodies produced as a result of a previous contact with the SARS-Cov-2 virus. The tests were procured by the company “Sistina Farmacija” through a Dutch company with which they have an exclusive cooperation agreement, and the company is the exclusive distributor of Biozek tests produced by Inzek International Trading B.V, a company also from the Netherlands. The procurement of the tests by the hospital that was completely legally regulated and confirmed was based on our information that these tests have been approved for production and use by the Dutch Ministry of Health, and Acibadem Sistina has also direct confirmation that the specific brand of tests is confirmed for professional use and is actively used in the EU, UK, Russia, America and other countries that are known to have extremely restrictive and cautious healthcare regulations. In particular, 250,000 Biozek tests have been procured and are in use in the UK, and more than 5 million tests of this brand have been distributed and used in many countries around the world. This brand of tests is registered by CIBG (Dutch Ministry of Health), No. 000010557911, under the name Inzek international trading, and in our country this brand of tests has been approved by the Agency for Drugs and Medical Devices (MALMED) and has received a decision to be registered in the Register of Medical Devices under number 14-3559/2.

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How much profit do you make from those tests?
The purpose of Acibadem Sistina Hospital is to introduce testing for Covid-19 detection to help prevent the spread of coronavirus, which is our responsibility and obligation as a healthcare institution and there is no room for any business interests. Therefore, I would like to emphasize that Acibadem Sistina, as a proven serious healthcare institution, performs operations that cost ten times more than the total value of all tests together. I am telling you this as an example to better illustrate and emphasize that our intention is not to make profit but to contribute to dealing with the coronavirus as quickly and successfully as possible. In the fight against Covid-19 Acibadem Sistina contributed with a number of equipment donations, as well by offering our partner Orka Holding’s “Ibis Style” and “Ibis Skopje City Center” hotels to be isolation centers, in which nearly 8,000 stays have been realized so far and whose capacities are still full.
How much interest was there in them, how many tests have been performed so far?
There is great interest in the tests, especially in the new rapid molecular test that yields results in up to 60 minutes, but testing with the standard PCR molecular test and serological test is also performed daily. So far, a total of over 4,500 tests have been performed. Patients have confidence in our brand, and know that they receive the most professional service in our country in every way.
Do you cooperate with the competent institutions in the country, with the Ministry of Health, and what is their position regarding the tests you perform?
Acibadem Sistina Hospital has been following and implementing the recommendations of the Ministry of Health since the first day of the announcement of the of SARS CoV 2 epidemic, turning into pandemic afterwards. Together with Orka Holding, we were the first to transform our hotels into state quarantine facilities in which Acibadem Sistina’s medical staff cares for people in isolation 24 hours a day. From the very beginning, we have given up of all our free facilities and mechanical ventilators in order to strengthen the accommodation capacity for patients with COVID-19. We also offered 5 fully equipped mobile hospitals with a total capacity of 70 beds. We implement all measures and security protocols for complete protection against coronavirus of medical staff, patients and hospital visitors.
Regarding the implementation of the tests, I would also like to emphasize that the laboratory where the tests are performed operates according to world-recognized standards and is verified by a commission of the Ministry of Health, thus meeting all safety and quality criteria for test performance.
What are the results, how many of the tests were positive for antibodies and what does that prove?
Serological test results performed at Acibadem Sistina so far indicate that 19% of the tested have antibodies to the virus. This percentage only confirms the need for mass testing of the population, since many of the tested that are positive have no symptoms and in fact they are the most dangerous coronavirus carriers. Serological tests are of great importance in assessing the immune status of the population.

AcibademSistina rMany countries have already started mass screenings of the population with these tests and health authorities here are also announcing mass testing to see how many citizens have actually contracted the virus. Why is this important? Will you take part too?

According to WHO recommendations, a lot of countries have already undergo mass testing, and we can witness that countries in the Balkans have already do mass testing. The greatest challenge in preventing the spread of coronavirus epidemic is detecting the asymptomatic cases. An effective way to detect those silent carriers is mass testing using rapid serological tests that detect antibodies the body has produced against the virus. The real number of patients is revealed this way, and it gives opportunity for proper management of the epidemic in the following period, i.e. gradual cancelation of the restrictive measures.

As the only hospital in the country with three types of coronavirus tests at its disposal Acibadem Sistina Hospital offers the opportunity for mass testing, and not only at the hospital. We have trained mobile teams and testing equipment for any settlement in the country, upon prior request by companies, institutions. Thereby the hospital contributes to preventing the spread of the virus, as it is available for testing virtually to anyone interested.


How have you organized the Hospital during this time of pandemic?

Actually, it’s a situation that has been a challenge for all healthcare systems in the world, changing the way we have live, and of course the way companies have operated, particularly including the healthcare institutions. COVID -19 pandemic has completely changed the operation in the whole hospital and increased the level of caution to the highest level. We prepared protocols and new procedures of work in just a few days. We restricted movement through the hospital and undertook special protection. We also set up a Crisis Staff that had emergency meetings on daily basis. The management was completely focused and analyzed the response to each challenge every day. We reacted promptly and immediately changed our operation plan to maximally protect the employees and patients. The shifts were organized according to recommendations by the Ministry of Health. Acibadem Sistina Hospital is accredited by JCI standards that guarantee safety to patients and staff under any circumstances. Everyone can be assured that we have all necessary protective equipment and excellent working conditions.

You established the Pediatric Cardiac Surgery Department, and you said that you aspire to become a reference center in the Balkans. The operations that were performed during the pandemic, you say, make the hospital stand out. What are the future plans, how many such interventions can be performed per year?

In a few months of operation the Pediatric Cardiac Surgery Department has shown excellent results. We have developed this department very carefully according to the experience of Acibadem from Istanbul. We have performed very serious interventions in newborns and children successfully. We are really proud for becoming a reference center in the Balkans in a very short time. However, it is just the beginning… soon, in a few weeks, this department will get a new place, huge capacity, a modern pediatric cardiac surgery that has never been seen before in the Balkans. It would be the first Intensive Care Unit for cardiac patients of pediatric surgery and pediatrics. It would have five beds for intensive care (two intensive care rooms in isolation with negative pressure as well as two apartments). All interventions of this type from all surrounding countries are planned to be performed here. It is estimated that we will have about 100 children who will undergo heart surgery per year. Doctors from Turkey, who share their experience here, make a significant contribution as well. Together with Dr. Vladimir Chadikovski they have created a concept for a leading pediatric cardiac surgery department. The interventions are covered by the state Health Insurance Fund. Even in conditions of pandemic, we operate at full capacity, i.e. all interventions take place smoothly.

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You have also announced investments in a new larger pediatric center. Can it be accomplished now in such conditions?

Acibadem Sistina Hospital has been dedicated to a major serious project for a long time; it is a new pediatric center that will be the largest in the region by its capacity and infrastructure. I can freely say that soon a new pediatric clinic will be operational, covering completely the pathology in newborns and children. We have created a team of professionals, established doctors in their field. The center will hire about 30 doctors who will be able to provide all healthcare services to the youngest. The facility, already in its final stage, is made according to all world standards; we have equipped it with the most modern equipment, but what I want to emphasize is that this center is designed to be unique since the children will not feel scared about coming to the doctor. Our strategy and approach to children is special. All the details are taken into account, while the doctors’ approach is important. I have said that this center will have everything, in the true sense of the word – an outpatient clinic, a day hospital, a ward and an emergency department. A team of pediatricians, subspecialists in cardiology, pulmonary allergology, neurology, gastroenterology and nephrology will be available at the department for any specific diseases.


What are your plans for the coming period? Have you changed your growth strategy and operation plans in accordance with the new reality? Are you expecting a second wave of the virus?

We have really serious growth plans. Citizens and our patients are aware that we operate in emergencies where uncertainty is a major feature. Moreover, uncertainty is the most considerable enemy for companies especially when it comes to planning. However, Acibadem Sistina Hospital has successfully adapted to the new reality and we hope that this situation will be overcome soon. We have entered a serious investment cycle that I have already talked about. We will not back down and there will be no serious deviations from the initial plans. I think that there will be a tested vaccine next year to defeat the disease.

We remain committed to the citizens’ health and I can set out my expectation for increasing the number of patients because we are constantly investing in new equipment, modern technologies and a multidisciplinary method of treatment.

This year the Hospital celebrates ten years of its existence, a period in which we have proved that we are the number one healthcare institution in the country and in the region. It creates a great responsibility since the primacy must be maintained and we must prove ourselves at a higher level in accordance with the rapid medicine developments.