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Geopolitical stakes are high in North Macedonia's upcoming election

July 14, 2020

ASU professor breaks down the history and politics of the July 15 election that could be pivotal for the region

North Macedonia’s parliamentary elections on July 15 will be critical for the country’s European Union accession. It will also showcase the state of play in great power rivalries in the Western Balkans. 

With the contenders offering very different future paths, and with COVID-19 quarantine increasing the power of online disinformation campaigns, the stakes are high for the country and the region.    

Keith Brown, politics professor and director of Arizona State University’s Melikian Center, briefed the new U.S. ambassador in February 2020, ahead of the original election date. He also spoke to ASU Now about why this election matters for democracies elsewhere.

Man in glasses and tweed jacket

Keith Brown

Question: Why is North Macedonia holding parliamentary elections now, during the COVID-19 pandemic?

Answer: These elections were originally scheduled for April 12, 2020. Prime Minister Zoran Zaev of the Social Democratic Party (SDSM) called those elections after France blocked the country’s EU accession process and in the process weakened Zaev’s credibility among North Macedonia’s citizens.

Following a law that was introduced in 2016 to support free and fair elections, Zaev stepped down 100 days before that election date, with a “technical” caretaker government taking over during campaigning. Parliament was also disbanded. Since COVID-19 forced the postponement of the election date, this temporary multiparty government has been in charge of the country’s emergency response. All parties have agreed on the July date, recognizing the need to elect a new government and reconvene Parliament.

Q: Which are the leading parties, and what are their platforms?

A: Since the country’s independence in 1991, the two most successful parties among Macedonian voters have been SDSM and its main right-wing nationalist opponent, VMRO-DPMNE — whose full name, Internal Macedonian Revolutionary Organization-Democratic Party for Macedonian National Unity — barely anyone remembers. The country is ethnically diverse — after Macedonians, the next largest community is ethnic Albanians, who constitute approximately 25% of the population and who have tended to vote for their own political parties. VMRO-DPMNE was in power from 2006–2016, and for most of that decade governed in coalition with the leading Albanian party, the Democratic Union for Integration (DUI). By 2016, though, VMRO-DPMNE’s increasing authoritarianism and xenophobia had alienated Albanian voters. Although VMRO-DPMNE narrowly outpolled Zaev’s SDSM in December 2016, the party was unable to form a governing coalition. Instead, DUI joined SDSM in government.

SDSM focused on foreign policy: Their signature achievement was the Prespa Agreement with Greece, which cleared the way for NATO and EU membership by adopting as his country’s new constitutional name the Republic of North Macedonia. NATO membership was finalized on March 27, 2020, and EU accession talks continue. This approach marked a sharp break with the previous 10 years of VMRO-DPMNE’s policy, which was confrontational rather than diplomatic toward the country’s EU neighbors Greece and Bulgaria. In addition, rather than undertake internal reform to prepare the country for European accession, VMRO-DPMNE relaxed financial and legal regulation to pursue business deals with Russia, China and India.

VMRO-DPMNE’s current election campaign is primarily nationalistic and negative. Ignoring Albanian voters entirely, and also presenting liberalism and pluralism as threatening to core Macedonian values, the party is framing the Prespa Agreement as an act of betrayal. This is at the core of a relentless attack on Zaev himself as unfit to lead, which also accuses the SDSM leader of financial crimes and abuse of power. VMRO-DPMNE originally came to power by appealing to a deep vein of anti-communist and anti-elite sentiment, especially evident in the country’s small towns and villages outside the nation’s capital. Even though VMRO-DPMNE held power for 10 years, and former leader Nikola Gruevski has fled the country to avoid jail time for proven corruption, the party’s leadership are offering their supporters a familiar diet of grievance-based populism.

SDSM has chosen to focus on pluralism and inclusion, and the foreign policy accomplishments of the past two years. Their campaign also includes one significant and potentially game-changing innovation: In prior elections in the country, SDSM have battled VMRO-DPMNE for Macedonian votes, and rival Albanian parties have competed with each other to win the most parliamentary seats in Albanian-majority areas; after which the lead Albanian party effectively operates as “kingmaker,” joining a Macedonian-led coalition after securing the best possible terms. 2020 marks the first where an Albanian party, BESA, has declared a preelection coalition with one of the Macedonian parties, SDSM. BESA’s leadership has recognized that SDSM’s priorities match those of Albanian voters, and VMRO-DPMNE’s do not. 

Q: What drives voter preferences?

A: The country’s economic problems dominate in survey responses. People are concerned with unemployment, especially among young people; with “brain drain,” as many seek education and employment opportunities elsewhere; and with corruption. SDSM is staking its success on the promise of a future in Europe; and the expectation that voters will see the negative VMRO-DPMNE campaign as evidence of the party’s lack of program or vision.

But VMRO-DPMNE supporters have already demonstrated fierce loyalty. Despite clear evidence of Gruevski’s and VMRO-DPMNE’s misuse of public funds and disregard for the rule of law, they delivered the party a narrow electoral win in December 2016. They largely boycotted the public referendum on the Prespa Agreement in September 2018; and they forced a virtual tie in the first round of presidential elections in April 2019. The party’s base — over 350,000 voters — are convinced that their party is the solution to SDSM’s treachery, and outside threats. Conspiracist thinking is widespread, (claiming that) Zaev’s backers include, among others, George Soros, the deep state, the Albanian mafia, the EU’s LGBTQ lobby, and the Greek diaspora’s influence in Washington. These narratives circulate widely through a variety of formally private and independent media outlets in the country, and share style and content with stories on Sputnik and RT. European and U.S. observers see Russian-backed disinformation as a major factor in the coming election.

Q: What is at stake for the U.S. in the North Macedonian elections?

A: When Zoran Zaev and Greek Prime Minister Alexis Tsipras met to sign the Prespa Agreement in June 2018, it signaled a shared commitment to transform Balkan politics. As Nikola Dimitrov, one of the negotiators, wrote in June 2020, the two sides “turned history from a prison house into a school for the future.” Europe’s leaders agreed, as did the U.S. State Department: General James Mattis was among international figures who visited the Republic of Macedonia to urge citizens to support the deal. And while President Trump had previously triggered criticism when he appeared to question the value for the U.S. of Montenegro’s joining NATO in 2017, he supported North Macedonia’s accession earlier this year.

Recent polls indicate that the SDSM-BESA coalition holds a slight lead over VMRO-DPMNE. If that lead holds, and Zaev is able to assemble a majority in the 120-seat parliament, it will confirm the country’s will to leave behind the destructive and divisive politics of populism and score-settling. It will also show that citizens in North Macedonia can see through the malign disinformation and false narratives peddled by those who put personal or party interests above broader benefits for country and region.

But if VMRO-DPMNE wins, despite their record of corruption and intimidation since 2006, and despite SDSM’s substantial foreign policy achievements of the past two years, the lesson will be clear; Russia’s capacity to conjure election victory for its preferred candidates is as real in 2020 as U.S. and British intelligence agencies discovered it was in 2015 and 2016.

Photo illustration of North Macedonian flag courtesy of Pixabay

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ASU acts fast to help nurses transition to ICU

July 14, 2020

Edson College of Nursing, Office of Applied Innovation and The Learning Enterprise collaborate on free, online continuing education course

Despite all hope that warmer weather might allow for a brief respite to the rapid spread of the coronavirus, temperatures aren’t the only thing soaring in Arizona this summer. In late May, not long after businesses began to reopen and residents began to let their guards down, the number of cases in the state began to climb at an unprecedented rate.

The alarming and — so far — consistent upward trend has only underscored the urgent need to bolster the ranks of our hospitals’ ICU staff. Nurses of all backgrounds and training specialties are promptly transitioning to care for critically ill patients suffering the devastating respiratory and other effects of COVID-19. It’s not an easy task, though, and usually takes a good deal of time to train nurses for such a transition: Aliria Rascón’s own ICU orientation lasted eight weeks, and that was with four and a half years of medical-surgical nursing experience.

“If you’re coming from a traditional, medical-surgical unit where you have four or five patients at once and you see them maybe every hour or two hours, now in the ICU you are caring for one or two patients and you're seeing them sometimes every 15 to 30 minutes,” said Rascón, a clinical associate professor at ASU’s Edson College of Nursing and Health Innovation. “So it's a culture shift and it's a skill set shift. And there is a lot of training that goes into that, even in a regular environment,” never mind a pandemic.

Fortunately, thanks to the swift work of Rascón and colleagues at Edson, the Office of Applied Innovation and The Learning Enterprise — a new division of the university formed to facilitate ongoing learning — nurses can now be supported in their speedy transition to the ICU under urgent circumstances. “Introduction to Adult ICU Nursing and Mechanical Ventilation” is a free, seven-module continuing professional education course that is accessible online for nurses to take at their own pace and includes an “ask an expert” feature to discuss related issues or questions that might not be Google-able. As of July 14, the course already has more than 1,295 registered nurses enrolled.

“As COVID-19 increases demand on intensive care units, resources like this course can help health care facilities quickly address critical staffing and skill shortages by retraining their existing RNs to help care for patients made ill by the pandemic,” said Andrew Nelson, program manager for strategic network advancement in the Office of Applied Innovation.

Each module in the course covers a different subject related to critical COVID-19 patient care, and in addition to basic content, each includes an assessment quiz and supplemental resources, such as videos, the “ask an expert” discussion board and the opportunity to give feedback.

While sourcing and developing content for the course, Rascón solicited feedback from nurses taking the course and nurse educators to ensure the content was accurate, comprehensive and consistent with their needs.

Candace Keck, a faculty associate at Edson and an ICU nurse educator at Honor Health with over 20 years’ experience, said she was happy to provide feedback, calling it “instrumental in developing a plan for these nurses.”

“As critical care nurses, we are asked to do highly technical, labor-intensive tasks more so now than ever before,” Keck said. “Guidelines for many things are changing daily. Nurses are patient and family advocates, so it is important that we stay current. It is also important to stay current for our own safety.”

Since the beginning of the pandemic, she and her fellow nurses have had to rethink even the simplest everyday tasks, like how to get in and out of a patient’s room for supplies, since every time the door is opened, there is potential for exposure.

“As you can imagine, that is a lot of personal protective equipment (PPE). So now, in this new era as a nurse, we need to ‘cluster’ our care. Before, we could complete our assessment, go get medications, come back later and give a bath and so on. Now we need to complete these tasks all in one setting. So now we plan more,” Keck said.

In addition, they are taking on tasks that they may not have normally performed in the past in order to decrease exposure to ancillary staff.

“We draw our own labs, we do our turns without the help of a patient care tech (CNA). Sometimes we are giving breathing treatments for respiratory therapists.”

Course content was also vetted by a team of experts led by Managing Director of Health and Clinical Partnerships Dr. Susan Pepin.

Arizona is hardly the first state that has had to quickly train nurses for the ICU, though, and there are already a lot of training courses available, including one Rascón helped develop at the behest of New York City’s Mount Sinai Hospital.

“There was already a lot of stuff floating around out there, so we were trying to be really conscientious to not be duplicative or redundant and really identify a gap where we could meet a need,” Rascón said.

“Introduction to Adult ICU Nursing and Mechanical Ventilation” differs from other offerings because of a couple of things: its emphasis on educating nurses, in particular, and the “ask an expert” feature.

“That was a really important distinction to make, because I'm a nurse; I'm not a respiratory therapist or a physician or a nurse practitioner. So we wanted to focus on the role of the practicing, registered, bedside nurse, new to the ICU environment. Which seems like a pretty narrow focus, but there are millions of practicing, bedside, registered nurses in the U.S., and many of them could benefit from this course if they’re asked to quickly serve in an ICU setting during this pandemic,” Rascón said.

“And then, with the ‘ask an expert’ platform, I was just trying to think about all my friends working in the ICU right now. … You can take all the classes you want, you can watch all the videos you want. You can take all these quizzes that say you're competent, but there will come a day when you walk into your shift and you see something that you haven’t seen a module on. Human beings are unpredictable and they don't always follow the algorithms. So we wanted some way to support the nurses who are taking this course with those kinds of questions.”

The roster of experts includes Rascón, a handful of Edson clinical faculty specializing in critical care, Edson alumni with at least two years’ career experience and several nurses from around the Valley who volunteered to help out.

With 2020 having been named the year of the nurse, Rascón is merely happy to be able to help in some way.

“It's really nice to not only be the one to educate new nurses and send them out there, but thinking about all of my colleagues out there who are facing this pandemic, who have limited supplies, who are stressed out and scared — to be able to support them in this way is huge,” she said.

Nelson said it’s just another example of ASU doing what it does best.

“This course is an example of ASU fulfilling its charter and taking fundamental responsibility for the overall health of the communities we serve,” he said. “Given ASU’s leadership in online learning, we were well prepared to deliver this world-class content from our incredible faculty in a safe, scalable manner in the middle of a global pandemic. Now, nurses everywhere can freely access this course for as long as the information is needed.”

Introduction to Adult ICU Nursing and Mechanical Ventilation will remain available to any registered nurse, regardless of location, as long as there is an ongoing need for the information. While the course is intended to support nurses orienting to the ICU at a rapid pace during a crisis, it is not intended to train nurses to be ready to work in the ICU as a result of taking the course alone — all nurses intending to work in the ICU will need a site-specific orientation as well as other support.

Top photo courtesy iStock/Getty Images