Estonia, officially the Republic of Estonia (Estonian: Eesti Vabariik), is a small coastal country located in North-Eastern Europe. It is bordered to the North by the Gulf of Finland, to the West by the Baltic Sea, to the South by Latvia, and to the East by Lake Peipus and Russia. Across the Baltic Sea lies Sweden in the West and Finland in the North. The territory of Estonia consists of a mainland and over 2000 islands and islets in the Baltic Sea, covering 45,339 km2 of land, and has a population of just 1.3 million. It is a Finno-Ugric language closely related to Finnish and the Sami languages, and distantly to Hungarian. Estonia’s UNESCO world heritage capital city Tallinn was granted city rights in the 13th century by the King of Denmark and it is the best preserved medieval city in Northern Europe.
It is a democratic parliamentary republic divided into fifteen counties. It is one of the least-populous member states of the European Union (since 2004), Eurozone, the North Atlantic Treaty Organisation, the OECD and the Schengen Area. The local currency is the Euro.
After centuries of Danish, Swedish, German and Russian rule the native Estonians started to yearn for independence during the period of national awakening. Established on 24 February 1918, the Republic of Estonia came into existence towards the end of World War I. During World War II, the country was then occupied by the Soviet Union in 1940. Estonia restored its independence in 1991.
Estonian Song and Dance Celebration is the local signature event and a reason why Estonians are often referred to as the “singing nation”. The ongoing tradition of having national song festivals dates back to 1869. These are among the largest amateur choral events in the world, held once every five years, in which >30 000 singers perform to an audience of 80 000. The uniqueness of this mesmerising event has even earned the song and dance celebration a place at UNESCO’s prestigious list of Intangible Cultural Heritage.
Highlighting, University of Tartu is the only university providing higher medical education in the country and also the biggest and most prestigious university in Estonia. Indeed, there are about 890 medical students studying in Estonian language, and about 67 students studying in English. Additionally, there are 140 students in dentistry, 127 in pharmacy, 65 master students in nursing sciences, 46 master students in health care studies, and altogether 199 PhD students in medical sciences.
Most of the healthcare in Estonia is paid for by the Estonian Health Insurance Fund, but there are also some private clinics offering outpatient services. Estonian health insurance is a social insurance and it relies on the principle of solidarity: the Health Insurance Fund covers the cost of health services required by the person in case of illness regardless of the amount of social tax paid for the person concerned. The Fund uses the social tax paid for the working population also for covering the cost of health services provided to persons who have no income with regard to work activities.
We are proud of our Electronic Health Record which is a nationwide system that integrates data from Estonia’s different health care providers to create a common record for each patient and present it in a standard format allowing the doctor to access a patient’s records easily from a single electronic file as soon as the test results or image files are entered. Patients have access to their own records, as well as those of their children. By logging into the Patient Portal with an electronic ID Card, the patient can review their past doctor visits and current prescriptions. On 1 January 2010, an IT solution was applied to Estonia’s health care—a digital prescription system. Electronic prescriptions are sent to a central database and the patient can get his medication from any pharmacy of the country.
There are 154 neurologists including neurophysiologists, paediatric neurologists and neurorehabilitation doctors in Estonia. In 2011, there were 9.4 board-certified neurologists per 100 000 inhabitants in Estonia.
There is only one national specialist training system and the specialty training (residency) is funded from the State Budget through the Ministry of Social Affairs. After graduating the 6-year study period, young doctor may choose to apply for residency in neurology. The duration of the residency program supervised by University of Tartu is four years. The first year involves working in emergency medicine, cardiology, rheumatology and neurology departments, with 4 months in each. The remaining 3 years include 11 months of work in a neurology department, and 2-3 months of working in each of the following: radiology, neurophysiology, rehabilitation medicine, neurosurgery, neurointensive care, neuropaediatrics and psychiatry. After successful completion of the program, the resident has to pass though oral board exam and if successful in this, become a fully qualified neurologist. The medical and neurological educational training is provided in Estonian.
Combining expertise of classical neurological examination with most advanced modalities of imaging and laboratory methods, also incorporating scientific methods in clinical training makes neurological services in Estonia highly competitive.
Modern scientific developments in the field on neurology are mostly related to research activities of the Department of Neurology of the University of Tartu, in collaboration with other neurological departments of Estonia, and partners from other universities abroad. The mean topics of research have been stroke, neurodegenerative disorders, movement disorders, epilepsy, neuroinfections, and in neurosurgery – neurooncology and neurotraumatology. Importantly, stroke has been a long-standing neurologic research topic, and the group of Prof. Janika Kõrv has been active in international level collaborating with other research groups, and organizing local and international meetings. Epidemiology of stroke in Estonia has been studied repeatedly, and guidelines for management of stroke composed, followed by audits with an aim to standardize treatment strategies and improve outcome of stroke. In the initiative of the Stroke Group of the Estonian Ludvig Puusepp Society of Neurologists and Neurosurgeons, innovative treatments have been implemented, and clinical network for thrombolysis therapy of stroke has been created in Estonia. Estonia is included in the international stroke registry. New topic in the field of cerebrovascular diseases is focused on stroke in the young.
The research group on movement disorders leaded by Prof. Pille Taba has been an internationally recognized pioneer in research on toxic parkinsonism caused by methcathinone abuse, and clinical and animal studies are conducted in this area in collaboration with research groups from London, Uppsala, Turku and Helsinki. New projects on neurodegenerative diseases including Parkinson’s disease and amyotrophic lateral sclerosis are carried on. The Estonian Movement Disorders Society is active in organizing educational meetings, and presentations by our experts have been included in the international conferences.
Research projects on the fields of epilepsy and neurophysiology have been leaded by Prof. Sulev Haldre, a head of the Estonian League Against Epilepsy. There are several more neurologic groups, working on specific areas, including autoimmunological disorders, pediatric neurology, and societies focused on subspecialties in the field of neurology, e.g. the Estonian Headache Society and the Estonian Society of Neurophysiologists, responsible for educational activities and research in a specific area.
In neurosurgery, research activities of Prof. Toomas Asser’s group are focused on neurooncology, neurotraumatology, vascular neurosurgery and management of Parkinson’s disease. A project on glioblastomas, candidate markers of radioresistance, and outcome of radiotherapy and supplemental treatments, is carried on, in collaboration with the Departments of Oncology and Department of Radiology. Estonia is closely involved in activities of the European Association of Neurosurgical Societies.
The name of our national society is the Estonian Ludvig Puusepp Society of Neurologists and Neurosurgeons (ENNS) and has 174 members.
In 1920, the Hospital of Nervous Diseases of the University of Tartu was founded by Professor Ludvig Puusepp, a world-famous Estonian neurosurgeon. In 1922, he established the Estonian Society of Neurology , and also founded Folia Neuropathologica Estoniana and Folia Neurochirurgica Estoniana, the scientific journals that contained articles in German and French, by Tartu scientists but also from foreign contributors including Bekhterev, Guillaine, Marinesco, Dandy, Walker etc. Ludvig Puusepp participated in the 1st World Congress of Neurology in Bern in 1931 as a representative of Estonia, and made contacts with various universities through the world. Several well-known scientists were honor members of the Society, among them Pierre Marie, Babinsky, Cushing, Marinesco, Bekhterev, Pavlov, and others. In 1965, the Society was named The Estonian Ludvig Puusepp Society of Neurologists, Neurosurgeons and Psychiatrists, and after separating of psychiatry in 1989, continues for development of neurology and neurosurgery, being a member of the World Federation of Neurology, the European Federation of Neurological Societies and the European Association of the Neurosurgical Societies.
The president of ENNS is Prof. Pille Taba, the vice president is Prof. Toomas Asser, and the members of the executive board are from all main neurological centres of Estonia – Prof. S. Haldre, Prof. J. Kõrv, Dr. K. Brems-Neuhaus, Dr. K. Antsov, Dr. A. Kreis, and Dr. K. Gross-Paju. The regular academic meetings of ENNS are organized twice a year, and additional topic focused meetings of the stroke group, epilepsy, movement disorders groups etc, in order to follow and support continuous scientific and professional work of the members.
The University of Tartu (UT) being the only classical university of Estonia is the leading centre of research and training belonging to the top 3% of world’s best universities. As Estonia’s national university, UT stresses the importance of international co-operation and partnerships with reputable research universities all over the world. Research at UT focuses on subjects as diverse as medicine and philosophy, genetics and computer science. The only national specialist training system in medicine is coordinated by the Faculty of Medicine of UT. Our department of neurology since establishing 100 years ago is quite exceptionally linked to the department of neurosurgery, the weekdays start with a joint morning handover from the on-call doctor attended by the whole department, including neurology and neurosurgery consultants so both neurologists and neurosurgeons have the opportunity to learn from each other.
Being among the least densely populated countries in Europe, about 50% of Estonia’s territory is covered with forest. This makes Estonia a great place for hiking and exploring the well-kept wildlife. Although mostly uninhabited, Estonian islands tend to be rural, with some holding traces of local Viking and medieval culture.
Estonia has been among the fastest growing economies in the European Union and is a part of the World Trade Organization and the Nordic Investment Bank. Estonia is also known for its rapidly developing information technology expertise being described as one of the most internet-focused countries in Europe. In 2007 it became the first country to allow online voting in a general election, Estonian programmers have been behind the creation of digital brands such as Skype, Hotmail and Transfer wise, and 95% of Estonians file their annual tax returns online. Estonia has declared internet access a human right, it has a thriving IT start-up culture and has digitally streamlined an unprecedented number of public services for citizens and businesses.