Prague, Czech Republic (Exchange Stories!)

Hola, CIMSA! #2

Dobry den! My name is Zulhilmi Syarif, a joyfully active Gadjah Mada International Medical Student batch 2014 who fortunately got a grand opportunity to have an outgoing exchange clinical clerkship for Summer period from the 3^rd to the 28^th of July at neurosurgery department of University Military Hospital – First Faculty of Medicine in Charles University, Prague, Czech Republic.

Hola Zul! So first thing first, what kind of activity are you in?

I attended the neurosurgery department with two of my colleagues; Grace Iva Susanti which is from the same university as me, Gadjah Mada University; and Rebecca Yen Hwei from Pelita Harapan University. We spent the first two and a half week in the surgery room, while the rest of the week we went to the ambulance (terminology for outpatient clinic). from 8 am to 2 pm.

How were the early days of exchange going?

The first two-and-a-half-week we mostly spent our time in neurosurgical room, but we attended the room without any supervisor since our supervisor is currently ill at that time. However, we met a very generous and genius neurosurgeon residence named dr. Martin Majovsky who kindly and voluntarily managed to teach us about neurosurgery, explain on everything that he had done during the surgical procedure, and answer all of our basic questions regarding everything that we curious about; from the basic surgical procedure things like the using of cauterization and other basic surgical tools until why the room is getting dark when they were checking the border of the tumor of glioblastoma.

That’s sound exciting! How kind of clinical cases had you gotten there?

We usually spent around 6 hours in the hospital per day. We had seen various cases like pituitary adenoma, meningioma, carotid endarterectomy, cerebrospinal fluid liquorrhea, vestibular schwannoma, cranioplasty, stereotactic biopsy, trigeminal neuralgia, but most common case that we almost met in every morning is glioma (astrocytoma, ependymoma, or oligodendroglioma). We once attended the spinal surgery room, the case was L4-L5 stabilization, but it wasn’t really interesting since we barely saw the spine.

Can you tell us the process of one of the cases?

In glioma case, usually after they anesthetize the patients, they will start cutting off the hair, peeling off the skin scalp, drilling up the head skull, dissect the duramater and stitch it, and then before start cutting off the tumor tissue, they have to locate the location of the tumor first usually by using a device called “neuronavigator”. After they had marked the location, they will use a microscope to perform the surgery. They start to suck up the tumor tissue by using ultrasound aspirator, or just cut the tumor tissue if it is resectable. In attempt to do so, there must be abundant of blood that is leaked, so they will cauterize the blood vessel using bipolar coagulator to stop the bleeding. They often to use the fluorescence imaging to show whether the tumor tissue is still there or not by making the room dark and the tumor tissue will be shown as pinkish appearance, due to beta-livulinic acid an amino acid that is usually present in glioma case. After the tumor had been resected, before stitching up the duramater and the scalp tissue, they will do the final checking to make sure that the tumor is definitely gone by using Magnetic Resonance Imaging that is available in the surgical room itself (this is the only hospital in Czech that has intra-operative MRI).

Then, how’s the rest of the weeks?

On the third week, we finally meet our supervisor who was previously suffered from prostate cancer but now has recovered, his name is dr. Jaroslav Plas. He was very wise yet humorous old man who loves to teach so much even in his elderly age. He is very genius, he even taught us the way of how MRI works with its physical hydrogen proton rotating on its own spin and creating such a magnetic field in the way that we barely understand.

We usually spent the rest of the week in the neurosurgery ambulance. We met a lot of patients with various cases. Some of the cases are normal pressure hydrocephalus, pituitary cyst adenoma, Berry aneurysm, carpal tunnel syndrome, internal carotid artery stenosis, acute subdural hemorrhage, meningioma, and still many of glioma cases.

While there’re so many things happened, what’s you favourite cases in the clinical times?

My favorite case is about the cranial nerve palsy.  The patient was a young man, 24 years old, accidentally fell off from his bicycle without helmet and hit his head on the ground. He had acute subdural hemorrhage and the neurosurgeon decided to perform decompression craniectomy. He then hospitalized for 1 month. Now he has oculomotor accessories and abducens nerve palsy due to intracranial herniation, also facial and mild vestibulocochlear nerve palsy because fractures in pyramidal bone causing damage in the surrounding nerve. He came to the ambulance with wearing a helmet to protect his skull-less head (due to decompression craniectomy), and always closing his left eye with his left hand to prevent dizziness that is occurred due to diplopia since his rectus lateral muscle of the eye is not working as consequence of the damage of abducens nerve. His left pupil is also different from his right eye; it is more dilated since it is not innervated by n. III accessories. Moreover, he also needed to protect his left eye because it cannot close completely (lagophthalmos) since he has half of the muscle in the left side of his head is paralyzed due to facial nerve palsy. Now our doctor suggested him to perform cranioplasty; a surgery to place the skull back to his head. Our doctor suggested to use his own previous bone but unfortunately the skull is no longer available since it had already fractured into pieces. He then suggested to use an artificial bone but it costed quite expensive. Poor young man.

What kind of benefits that you had gotten other than clinical studies?

Following this exchange program is not only about studying neurosurgery, but also to learn new cultures from diverse part of country and continents with meeting new people and establishing new friendship throughout the world. There are about 50 incomings in Prague and we did a lot of social program together. Although the Local Host itself is not that really helpful (most of them are out of town, so we were like abandoned there and have to survive by ourselves) yet we can manage it by creating some events and parties on our own. We started with meeting up in Charles Bridge on the second day of our arrival, then continue to have chit-chats on the bar and going to the pub. We mostly talked about how the things are going in their country, comparing and tell a story on each side of country. They are really warm and welcome to each other, they seem to also like creating new friendship. The next week we went to explore the beauty of Prague city by going to Petrin Hill, and then some beaches and parks. We once tasted Mexican food together and often they went to Mexican club to dance Salsa. On the last day, we had an “National Food and Drink Party”. So everyone must bring some foods or drinks that is locally based from their country and they will share it to everyone so that everyone can taste every food from every country. It was so nice. And after we had a good time in the park sharing our foods, we then went to that Salsa Club to dance together. One of them even taught me how to dance Salsa. After all, it was such a great experience to meet various people from different ethnicity.

This Summer, I really had a remarkable moments and unforgettable life-changing experience. This is my first time to travel really far away from my country, the first time to get lost out of my country, and the first time to discover a whole new great adventure across Europe. They say, extraordinary things will be happened when you are trying to get out of your comfort zone. And none of it would be happened if I’m not applying the professional exchange program provided by SCOPE CIMSA UGM from the first place.

Na shledanou!