You'reGoing You're Going Where?! Where?!

Travel & elective in the Czech Republic

Edward Fitzgerald
n impenetrable language, very cold weather and a cuisine largely based around dumplings. As the train rattled north towards the airport I sat back in my seat and asked myself, not for the first time, why on earth I had ended up choosing winter in the Czech Republic for my elective. Perhaps it was a subconscious rebellion against the quarter of my year that thought Australia would be an "adventure", as only another westernised country speaking the same language can be. Or perhaps it was a rejection of the sun-seeking brigade planning to spend eight weeks revising their tanlines on a beach in the Caribbean. Either way, these options had come to look infinitely more attractive over the past month as, day by day, I checked the weather for my destination and found that once again it was a scorching -16C. Sun-tan lotion would not be required where I was heading.

els, but I'd always longed to venture behind the former Iron Curtain. Liberec seemed like an ideal base from which to drink vodka-Martini whilst recruiting beautiful double agents for MI6. Hmm... My travel to Prague was uneventful, other than my travelling companion loosing her passport and the flight being cancelled due to 1 mm of snow at Heathrow. Miss Moneypenny efficiently re-booked. When I finally departed a week later, the in-flight entertainment was provided by a group of skinheads on their way to a stag-weekend and some "easty-beasty"

action. Their most memorable comment was actually very amusing, though sadly they didn't even realise. An attractive blonde in the aisle opposite was being lewdly chatted up after disclosing she was a masseur. Their response to her description of a full body massage: "Gluteus maximus wasn't he in Gladiator?" Perfect. Sadly their elaborate floorshow ended prematurely when the cabin staff indicated they would have to start flapping hard if they wanted to remain airborne. Thankfully the flight continued and I skilfully evaded the searchlights and flak over Dresden to pilot us in smoothly at Ruzyne airport in the

With the medical-world as my oyster for an elective destination, Liberec (pronounced Lee-ver-ess) in the Czech Republic had caught my attention for two reasons. Firstly, students who'd been there before recounted brave tales of daring-do in the operating theatres, with ample opportunities to perform a variety of surgical procedures themselves. This sounded like a great opportunity to hone my practical skills. Secondly, I'd always wanted to explore Eastern Europe. Perhaps I'd read too many Ian Fleming spy nov68 Gazette

Czech capital, a very modern and sophisticated affair that made many of our own look distinctly impoverished. Prague Kafka described Prague as "the cute mother with her clutches who never lets you go". I have my doubts about "cute" being an acceptable word to describe ones mother, metaphorical or not. However, I do share the sentiment. The centre of the city remains a shining gem of largely untouched architectural beauty, from cubism to communism, renaissance to revivalism. I reflected that this probably had much to do with the 170 litres of lager per person per year rendering the population unable to touch anything. This figure is a genuine fact and does not exclude children and tee-totalers. Impressive stuff. Star M_sto is the beautiful old-town district, with a history lesson at every turn. Dark cobbled roads take you off the tourist routes and amongst narrow streets that once housed the medieval merchants who brought the city its' fortunes. Karluv Most, the famous Charles Bridge, links Star M_sto with Hrad_any district. Here, on a hillside overlooking the spires below is the splendour of Prague Castle and St. Vitus' Cathedral.

The main shopping district is now much the same as any other European city, with Marks & Spencer jostling for space between Next and Nike. Everywhere I went it seemed that another film crew were using the picturesque streets as a movie backdrop. This proved particularly unnerving when I happened across a pseudoReichstag building draped in swastika banners and surrounded by Wehrmacht troops. I was worried I may have happened across a meeting of the Young Conservatives, but thankfully a gun-totting actor put me at ease. Everywhere I went it was also unnerving to have dubious locals asking to exchange currency. Luckily I was wise to the local scams. This latest trick involved a criminal offering to swap your pounds or dollars for Czech koruna at a special rate. Regardless of whether you accepted this offer, you would then be approached by police asking to see your passport and money. Only these wouldn't be police and they'd "confiscate" your money and papers, never to be seen again. Future visitors beware. Walking through the scenic squares of Prague over the weekend was surreally reminiscent of Cornmarket Street, in that all the trinket shops were selling "Beckham 7" t-shirts and we were

totally surrounded by English and American voices. It was clear to see the popularity of the city with tourists even in the off-season. The English were easy to pick out, with the chaps all wearing cord trousers and the ladies bottom's blocking out the afternoon sun. The English stag-night parties were even easier to pick out, with several gangs wandering around drunk in kilts and "Dave's not getting married in the morning" t-shirts. It made me proud to be British. By the end of the weekend it was time to move on. My MI6 cover was clearly blown: all the touts and beggars were addressing me in English. Did I really look like such a tourist? Into the Sudetenland I caught the coach to Liberec, a twohour journey north of Prague. Be it tram, coach or train, the clean and punctual public transport made me weep at the inadequacies of our own services. We headed north quickly, with the snow becoming deeper and the country side more rural. As Liberec approached it appeared to be the stereotypical image of an Eastern European industrial town. Yellow smoke drifted upwards from tall red and white chimneys, with low smog hanging over the area. As I struggled up the hill into town my view slowly
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changed. Snow laden clouds gave way to winter sunshine and the Communist buildings gave way to granite-sett roads with grand neo-renaissance houses and bustling shopping streets. Liberec now looked a lot more welcoming. The town itself lies at the eastern end of north Bohemia, at the junction of the German and Polish borders with the Czech Republic. It occupies a dramatic position in the Nisa Valley between the Jizera Mountains to the north and the Je_t_d peak to the south. First mentioned in 1352, the town has an interesting history. During the 18th century it developed a major textile industry and this brought the wealth of merchant buildings that still shape Liberec today. At that point the town ranked as one of the most important in the AustroHungarian region but by the early 1900's the town was in decline again, badly affected by war. During this era it was known by the German name Reichenberg, which it remained until 1945. The inhabitants were mainly Sudeten Germans and Konrad Henlein, leader of the SudetenGerman Party, oversaw Liberec's annex as part of the Reich and even a visit by the Viennese house painter himself. Following the war the German population was expelled and the elections of 1946 saw the start of the Communist era. Outside of Prague, Liberec was almost the only Czech town to see violence when the Red Army rolled through on their way to the capital in 1968, with nine inhabitants shot in the town square. The following two decades saw further economic decline, though thankfully things have taken a turn for the better since 1989. With a population of

130,000 the town has become a popular tourist destination for winter sports and hopes to once again become the metropolis of north Bohemia. After a brief circuit around the centre I walked up to the hospital to begin my neurosurgical adventures. Liberec is very compact, taking only a few minutes to walk across the centre. The hospital is conveniently located just on the edge of this. A sprawling complex reminiscent of the Radcliffe Infirmary, the buildings all have a utilitarian look to them. The neurosurgery department is at the top of a ten-story block in the middle of this, with excellent views over the town. On arrival I received the warmest of welcomes from the staff. In contrast to the slightly neglected feel to the buildings, the neurosurgical department is packed with new computers, high speed internet, LCD displays and video projectors. The influence of the charismatic boss was clear to see. Dr Petr Suchomel was delighted to see me, immediately asking Do you want to work, or do you want a holiday? Naturally I replied the former. The timetable he outlined was 90% assisting in theatres, with major cranial and spinal surgery every day. Next-door were the orthopaedic theatres, where I was also welcome to join in the hammer-and-chisel fun. Following this introduction my first afternoon in the hospital didn't quite pan out as expected. The neurosurgical registrar had heard of my University Wine Society shenanigans and shared my passion. Rather than take me on a tour of the wards we spent the afternoon visiting local Czech wine producers, ending up in the local brewery. I certainly had no

complaints! My accommodation was perfectly sandwiched between the hospital and town centre, either of these being just a minutes walk. Despite my initial trepidation as I approached the austere six-storey concrete block, my room was better than that provided in many Oxford Colleges. The building turned out to be a hospital staff hostel, with the interesting socialist dictat that it should provide equal accommodation for all hospital workers, be they cleaners or consultants. My month here cost just 30, less than a week at Magdalen. That night I ate in the hospital canteen. Only canteen wasn't the right word for it, resembling as it did something between a restaurant and a German beer cellar. When the menu arrived the drinks list alone ran to three pages, from Met et Chandon through tequila, port and whisky, naturally finishing with XO Cognac and a respectable selection of cigars. I had to slap myself to make sure I wasn't dreaming. I still wasn't convinced, so I asked one of the very attractive waitresses to slap me too. Unfortunately they charged extra for that service. Still, their rendition of the Cheeky Girls "Touch My Bum" pop-hit was free of charge and well worth six whole years of studying medicine just to reach that point. The food menu was five pages long with everything from Italian and Asian dishes to local Czech cuisine. For the second time that day I nearly wept at the inadequacies of our own country. How could I ever visit the John Radcliffe canteen again? For a few pounds I ate a fantastic meal and I'm not someone who thinks that Ahmed's kebab van should get a Michelin star. My Plzen beer arrived in a 0.5L jug and cost 50 pence, a sure-fire recipe for disaster. I could see this was going to be a lot of fun. Nemocnice Liberec Every morning started with a 7 am departmental meeting where you could choose which operations to work on. The team would talk furiously fast in Czech, downing black coffee and demolishing packets of Sparta cigarettes. As one of the previous elective students had commented, the stunning Czech nurses wear an outrageous uniform blatantly designed by a bloke. It's far too small to be called a

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dress, in fact it's so comical that it was hard not to stop and stare. The unisex theatre changing rooms and showers took a bit of getting used to in light of that. Once in theatre the surgeons lack for nothing, with all the latest equipment from ultrasound aspirators to Zeiss robotic microscopes. However, there are also some contrasts, such as the hospital trolleys being based around what seem to be rickshaw frames and old bicycle wheels. Just like Oxford, the anaesthetists do their best to spoil the surgeon's fun. One patient had low potassium, another too high potassium. The final patient had suspiciously normal potassium. When we finally started I was invited to scrub-up and perform the craniotomy with one of the junior surgeons. Confident or foolhardy, either way the surgical staff appeared to have a lot more faith in the rigours of the Oxford medical education than I did. After a brief struggle to recall my undergraduate anatomy, I successfully located the patient's head and cracked on. For lunch the surgeons would pile into the hospital canteen for a huge meal with beers. Then everyone tottered back to the theatres for the afternoon list. And so it continued. Over the course of the attachment I was able to assist with carotid endarterectomies, spinal discectomies, metastatic malignancies, meninigiomas, pavlovas and anything else that came their way. Throughout my stay there were always one or two Czech medical students around to visit the pub and banter with. Interestingly the students and staff were all much more laid back than their English counterparts. This confirmed a long standing suspicion that somewhere in the Oxford interview process is a secret check-box tutors must tick: Is this candidate highly-strung? Yes? Well lets offer them a place, they'll fit in well here... Outside of the hospital there was plenty to see. The very traditional Museum of Northern Bohemia was founded in 1873 and houses one of the most important collections in the Republic. At first it appeared to be a taxidermists heaven, though it also has a fascinating collection of decorative arts from medieval times to present day. As well as being a dramatic building, the Viennese-style town the-

atre has a very active stage, hosting plays, opera and ballet. During my stay I saw a stirring performance of Puccini's Tosca for just 3. Paganini, Barber of Seville and Romeo & Juliet were also scheduled. The regional gallery is a real treasure with a significant collection of 16th & 17th century Dutch still life (i.e. carefully positioned dead things). More to my taste, their holding also includes a contemporary collection from Czech artists and a beautiful display of French landscapes. The 20 pence entrance fee even includes an elderly Czech lady who'll shadow you all the way round at a discreet distance to ensure you don't get too close to the art work. Finally, the cultural highpoint: Tesco supermarkets have now reached northern Bohemia and should also be counted as one of the town's attractions, judging from its popularity with the locals. Wandering around the well-stocked store you could be forgiven for thinking you were back in England were it not for some subtle differences. Firstly, everything is covered in cigarette advertising, an interesting moral position I'd like to raise with their management back home. Other less obvious differences include the fresh fish stand being more of a tank, from where you choose dinner as it swims around. The wine section also has a distinctly monotonous Moravian theme to it, although bottles of vodka (industrial alcohol?) were only 2. But, for a little touch of England, it was great to be able to buy some tea during my stay. By the end of the month the weather had turned seriously cold. Being born in Yorkshire, I thought I had a good understanding of the term 'cold'. Liberec taught me otherwise. The cold was reaching bits of me that no other cold could reach, perhaps to be expected with a low of -18C. The town became an animal-rights protester's worst nightmare. Cold weather clothing meant one thing to the locals: fur, and lots of it. Mluvte anglicky? It was only here in Liberec that I encountered any language difficulties. In Prague everyone spoke English. In Liberec even the traditional British remedy of repeating what you said more loudly didn't help the locals understand. Thankfully I'd learnt

some essential phrases, so my pigeonCzech just about made me understood. I shuddered to think how bad my pronunciation must have been the English tongue just isn't designed to make some of the sounds the Czech language requires. GCSE German just about got me through when the Czech failed. However, as far as the written language was concerned there was even less hope. It's the only country where _ize_ has a meaning other than you accidentally dropping something on your keyboard. Thankfully things were different in the hospital, the boss having decreed that my visit was the staffs' opportunity to improve their English language. Golden opportunities In conclusion, my final report to M was that while I had failed to recruit any beautiful Czech agents for British Intelligence, I had enjoyed the most memorable elective. If you are destined to spend your career fiddling with prescriptions for hypertension and faint at the merest mention of sutures then this may not be the elective for you. For someone with a surgical leaning, who doesn't want to follow the sheep on elective or concentrate on perfecting their tan, I cannot recommend this placement highly enough. Brilliant hospitality, fantastic supervision, utter ease of organisation, golden opportunities to operate and sheer affordability all conspire to make this the best surgical elective available. My thanks must ultimately go to Ondrej Choutka, an Oxford medical student who first arranged this contact with his hometown four years ago. I do hope future students continue this unique link and enjoy the warm welcome and high standing we have now earned there. If anyone would like further information on this elective please contact: edward@oxfordwinesociety.org Or visit the Liberec & hospital websites: http://www.nemlib.cz http://www.infolbc.cz/ Other useful Czech websites: http://www.myczechrepublic.com http://www.locallingo.com Edward Fitzgerald is a final year medical student at Magdalen College

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