CELIAC DISEASE – A CHALLENGE FOR PEOPLE AFFECTED IN THE HERZEGOVINA-NERETVA CANTON

Abstract

Celiac disease is a chronic disorder of the digestive system caused by the intake of gluten in genetically predisposed individuals. It is characterized by a high prevalence and often delayed diagnosis due to nonspecific symptoms, such as chronic diarrhea, vomiting, loss of appetite, fatigue, and anemia, which are frequently pushed aside, or misattributed to other conditions. The disease often occurs in association with other autoimmune diseases. Having in mind a complex administrative structure of Bosnia and Herzegovina, there are also significant differences in the healthcare system among cantons, which ultimately affects the position of patients, as well as the availability of adequate healthcare. The aim of this paper is to present celiac disease through the perspective of the condition itself, as well as the challenges and opportunities faced by patients in the Herzegovina-Neretva Canton. The paper contains a theoretical overview of the disease, an analysis of the availability of gluten-free products, the offer within the hospitality sector, patients' healthcare rights, and finally, a presentation of the experience of a person living with celiac disease. The right to gluten-free foods in Herzegovina-Neretva Canton is granted to patients suffering from celiac disease (K90.0 morbus coeliacus) in the amount of 200 BAM per month, if they belong to the pediatric age group, if they are unemployed, or retired. At the same time, patients suffering from celiac disease who are employed are not entitled to gluten-free foods at the expense of the Health Insurance Institute of Herzegovina-Neretva Canton (ZZO HNK).  In the city of Mostar, four contracted pharmacies participate in the distribution of glutenfree food supplies covered by the Health Insurance Fund of the Herzegovina-Neretva Canton, while in the other parts of the Herzegovina-Neretva Canton there are another five pharmacies which are involved in distribution (territories of Čapljina, Čitluk, Jablanica, Prozor, and Konjic). The analysis of the three retail chains with the largest number of stores demonstrated that these retailers provide a diverse range of gluten-free food products. Restaurants in Mostar do not offer a satisfactory selection on their menus, which undoubtedly makes the social life of individuals with celiac disease more difficult, especially younger, socially active individuals who travel and work. Even dishes labeled as gluten-free on their menus are recommended to be checked with staff before ordering if they are being prepared under controlled conditions, and whether there is a possibility of gluten contamination from the preparation of other meals. A significant contribution to improving the quality of life of people with celiac disease is provided by the Association of People with Celiac Disease “Gluten free” in the Herzegovina-Neretva Canton, through various activities and initiatives addressed to city authorities, which has resulted in noticeable improvements in the quality of life of people with celiac disease over the past two years since the association was founded.