Young Doctor Palička: “Sudan Is a Country of Paradoxes”

Martin Palička went to Sudan as an exchange student. While there, he signed up for a weeklong mission where he visited remote areas with experienced doctors lacking any electricity. How did the doctor cope with such an adventure?

Sudan. An unknown land for most people. Can you introduce Sudan as a country to us?

Sudan is a country of many paradoxes and abysmal differences. Half a litre of water costs more than a litre of petrol, even when the roads are unbelievably full. Ironically, mobile Internet in the capital works better than in the Czech Republic, even though other things, such as waste collection, public transport, potable water, electricity and more, do not work there at all, in spite of the fact that there are hundreds of well-educated people who can speak different languages. For example, a university-educated engineer speaking perfect English and Spanish drives a taxi because he was offered a job that pays 2,000 pounds per month (about CZK 1,200) and the taxi earns him more money. Those are sad paradoxes. Otherwise, Sudan is a very diverse country. Most people are very friendly, helpful and fair.

How do people live there and what was your impression of them?

There are people with great education and insight, as well as people who cannot read and who do not know how old they are. Thousands of people live in the streets and then there are people that own huge homes installed with generators for use during power failures. Democracy definitely does not work there. The local government and the president keep power using military forces, 85 % of the budget goes to the army and security. And that is the beginning and end of all problems that Sudan has. Recently, there have been several uprisings and revolutions at the university but they all have been supressed. Soldiers are all over the place. The Sudanese, at least the educated ones, will tell you that they would like to leave the country. But they are also very proud of their country and they worry about the situation with the government.

What exactly did you do there during your internship?

I was assigned to a general surgery department, which I chose. I worked in the local hospital and got my first clinical experience under the supervision of local physicians. In the Czech Republic, a student of medicine does not get to the clinic much during the first three years. He or she has to learn a lot of information and get a lot of knowledge, and then get the experience of real medicine. I was excited about every new case. There were surgeries (amputations) of mycetoma, discharging hydatidosa abscesses from the liver, surgeries of tumours that grew to incredible dimensions when compared to Europe. I also assisted on some surgeries and did some basic procedures, such as cleaning and insertion of stitches.

You said that you participated in a weeklong mission during your internship, can you tell us something about it?

Our mission was huge. There were 120 members, divided into 4 smaller teams. Each team then visited a new village every morning. The teams had four units: the clinic, lab, pharmacy and focus group. Patients came, signed in and while they were waiting for the doctor, the focus group stepped in. Education about malaria, TBC, washing hands, the importance of female hygiene etc. After their visit with the doctor, the patients either received a prescription for medicine from the pharmacy, or a reference to the laboratory for testing. We also brought generators with us so we were able to do some basic examinations using centrifuges and microscopes. We also ran quick tests for malaria, typhoid fever, or pregnancy. Our mobile hospital was set up in a local school and there were a lot of children there, which we focused on. Education has the highest value and meaning. I spent the rest of the time in the clinic with Doctor Josiph, who translated everything for me and taught me how to identify illnesses. After a few days, I was able to identify skin issues when the patient walked in. On the other hand, other things were shocking and I will never forget them.

It had to be very difficult. Were there moments when you were barely coping, when it was too much for you?

The first three weeks in Africa were difficult. It is a completely different world, it is hard to get used to the different standards of quality. When I thought I finally learned do deal with it, the mission came. The last week was truly a purgatory. I tested my limits there, both physically and mentally. We drove to villages that were about 450 km southwest from Chartum, in a beeline. And since the mission management selects the most remote areas, we travelled through desert for three hours every day. Travelling in the African desert on a prototype Tatra from the previous century is not very comfortable. And if you want to serve all the patients, you need time. Our daily schedule was as follows: wake up at 4:30, brush teeth, load medicine, water and generators so we could leave at 5:30. The day in the village sometimes ended at 8 or 9 p.m. when we worked using the lights from our mobile phones. We got back between 11 p.m. and midnight. That depended on how many times we sank in the desert, which could be 8 to 10 times. And if someone was a bit spoiled like me and wanted to get cleaned up, then you went to bed at two a.m. But I don’t want it to sound like I’m complaining. The last week was an experience of a lifetime.

Working for others brings a strong feeling of satisfaction. Which moment will you always remember?

There was one moment that I will never forget. There was everything in that moment: emotions, joy and sadness. A mother with two heavily malnourished and dehydrated children came to our office. A boy and a girl, 17 days old. She delivered them at home, full-term, and both babies started crying right after the delivery, which is a good sign. However, the mother stated that they were throwing up, had diarrhoea and refused to eat in the last two days. The children were apathetic, had a fever, dry mouths and tear ducts. Both children immediately needed a peripheral vein, antibiotics, water and hospitalisation. But what could we do? It was half past six in the evening and our improvised office was getting dark. So we took the tables and went playground in front of the school. We had a limited number of small cannulas. The first attempts are unsuccessful. Both children have very thin veins, which are also very fragile due to malnutrition, and the cannula easily breaks through. We manage to insert one in the boy. He gets antibiotics. It is more complicated with the girl. Each attempt is unsuccessful and we are running out of the cannulas. There are a lot of curious onlookers around us. They push one another and at one point one of them knocks the cannula out of Doctor Josiph’s hand. It is useless. At that point, I lose it due to the fatigue and emotions. I get up and start yelling at the people around me in Czech. “Get out of here! All of you!” I don’t care that they don’t understand a word I say. Fortunately, an older man understood and became a supporter and protector and he didn’t let anyone closer to me. Doctor Josiph was calm, he didn’t move a muscle. And that’s why I admire him. It was dark as we administered the last cannula, the girl’s last chance. If we miss, it’s over. However, Josiph doesn’t want to give up, he rinses the cannula in disinfectant and tries it again and again, until he securely attaches it in the vein. With a light from a mobile phone, exhausted. My role can be summarised with the following words: hold, hand and give me a light. We are happy, we give one another high fives with the bloody gloves, smiling. But we both know that it’s not over yet. The children need to go to a hospital. We only gave them time, little time. The completely resigned and maybe even illiterate mother might not even understand what Josiph has been explaining to her for many minutes. We get on a motorcycle that takes us to the edge of the village where the truck with the rest of team awaits us. Josiph recaps the whole case one more time and his calm story ends with the words: “We did our best, be god with them.”

You are now back at home, how was it when you returned? Isn’t it a bit uneasy to come back from a place where people get by with so little?

Everything in Africa is delayed. No-one takes time too seriously, so I wasn’t even surprised. Everyone at home welcomed me as if I wasn’t going to return, or as if I were gone for two years. I don’t feel uneasy. People in Sudan don’t know how we live here. Just like we don’t know how they live. We have prejudice, fear and I don’t know what else. Their lives are not like others. They are more complicated. But they don’t complain. They don’t want to run away to Europe. They live their lives with what they have. Sometimes maybe better than we do. And those of us who have seen it and experienced the difference, need to be grateful for what we have. I won’t say what exactly, simply everything.

Every experience like that changes you a bit. Do you feel that something has changed? And what exactly?

I do. I got used to everything in the month. I don’t try to solve everything, I simply take it as it comes. They are usually silly things. An hour-long traffic jam on the highway doesn’t mean anything to me. A stinky toilet at the petrol station? So what! A WC is a luxury. Holes in the road? At least there is a road. So, that’s how I think now, I enjoy small things. On the other hand, I don’t think that long stays in Africa is the best that a spoiled European like me can do. One starts slacking in many areas. Such as hygiene, which seems useless when you are bathing in water that is dirty. When you live in an apartment with dozens of cockroaches and huge ants that are impossible to kill. When you have to leave trash out in the street because there are no trash cans. You simply have to resign and after a while, you are almost burnt out. So, one has to be careful with staying in such a country for a long time.

A lot of people are willing to help, to amend injustice, but there only few who actually have the strength to do something. Do you have any advice on where to start?

Don’t talk too much about it, don’t look for reasons why not to do it. Just do it. I signed up for Sudan about six months in advance, at a time when I had difficult third-year exams ahead of me, which older medics as well as lecturers warned us about. I reduced the time for preparation by one month and risked not passing the exams. I hated myself for that many times. I was afraid to depart for Africa. Everyone was warning me. My family, my girlfriend, even the doctor at the infectious disease department in Ostrava where I had all my immunisations done. And the result? The greatest experience and adventure of my life.

Martin Palička is a 23-years-old student in his third year at the University of Ostrava Faculty of Medicine. One of his initiatives is the foundation of an educational and charitable project for his classmates, friends, as well as the public called the Chocolate Heart. It was organised under the auspices of IFMSA, a student organisation. He has become more and more involved in the activities of this organisation and this year, he was elected the Local President of IFMSA CZ Ostrava. His internship was also made possible thanks to this organisation.

Updated: 27. 09. 2018