Stories of Ordinary Medicine: Milloj of Arabia

Do you have the medical profession in your family?
Yes, my father was a general practitioner in the countryside; he worked his entire life in Šitbořice and Hustopeče in the Břeclav region. However, our family comes from the Vysočina region. My paternal grandfather was born in Ždírec nad Doubravou and had eleven siblings. He became a teacher in nearby Sobíňov. In 1915, however, he was drafted into the First World War and was killed in Italy on the Piave, on December 20, 1917. My grandfather’s family and his ancestors had lived in Ždírec and its surroundings for several generations. I have learned a great deal of information about them only now, in retirement, when I have been working on our family genealogy and have traced it back roughly to the year 1650. My grandfather’s father, Antonín Růžička, was a landholding farmer and master stonemason, which is also written on his monument in the Protestant cemetery in Krucemburk. My great-grandfather’s father was named Jan Růžička and came from Kohoutov, which today is part of Ždírec. His brother Josef Růžička was a prominent Protestant pastor and teacher in Prague. He preached in the Church of St. Michael by Charles Bridge. Their father, František Růžička, was the son of Václav Růžička, who had come to Ždírec from the area of Radostín nad Oslavou. In nearby Kněževes nad Oslavou I have traced the most distant ancestor so far, Jakub Růžička. He was a blacksmith at the local fortress and had five sons, also blacksmiths. As for my mother’s side of the family, they came from Padochov near Oslavany.

Did doctors appear in your family only with your father?
My father’s uncle, Dr. Habanec, had already worked in Olešnice as a general practitioner. He was very well acquainted with the founder of the hospital on Žlutý kopec, originally the House of Comfort, the surgeon Jaroslav Bakeš. He used to travel by carriage to visit the Habanec family in Olešnice. Dr. Habanec’s son is Professor Boris Habanec, who founded the Department of Pathology at the Children’s Hospital and also served at the faculty as vice-dean. His wife is also a physician; she worked at the Children’s Hospital in the pediatric department. Both of them are now over ninety years old, and today their son, Dr. Tomáš Habanec, works at the Children’s Hospital as head of the pediatric infectious diseases department. In our family there was also a distant relative who was a dentist, and my father’s cousin, Dr. Jaroslav Čermák, in turn worked in the internal medicine department of the hospital in Nové Město na Moravě. At present, our daughter Eva Kovářová continues in the medical profession as an anesthesiologist.

So did you feel that you should also pursue a medical career?
I decided spontaneously to study at the Faculty of Medicine in Brno. I also considered agricultural fields, but in the end medicine prevailed.

How difficult was it to get into medical school at the end of the 1960s? Some of your contemporaries have told me that it was relatively trouble-free, at least compared to other faculties. In contrast, from an applicant’s point of view today, medical school is quite possibly the greatest challenge of all…
It certainly wasn’t easy, because there was roughly a threefold excess of applicants. The entrance exams were in chemistry, physics, and biology. In secondary school I studied in the humanities track — because of Latin — which meant that my knowledge of the natural sciences suffered somewhat. To catch up, I traveled to Brno to attend preparatory courses at the faculty. That helped me gain admission to medical school, although not without some difficulty.

How do you remember your studies in the first half of the 1970s?
The first two years were demanding for me precisely because of biology, physics, and chemistry — I really had to work hard. After that, studying seemed easier, and I no longer had to devote as much time to it. I passed all my exams on the first attempt, mostly with top grades; the only lower mark I received was a C in compulsory Marxism-Leninism. I did not have to repeat any exam.

Does any particular teacher stand out in your memory? Certain names tend to recur in interviews with your contemporaries…
In the first year it was Professor Oldřich Nečas in biology; in the second year Professor Jiří Slavík in chemistry; in biochemistry Professor Václav Kulhánek — he later committed suicide, and subsequently his son did as well. Later I worked as a junior research assistant in pathophysiology, which was headed by Professor Jaromír Vašků. He was renowned for being very demanding in examinations. At his department I took part in various experiments and operations on animals — as part of research into liver and heart transplants conducted there by Professor Jan Černý. That was also why surgery began to attract me. In the clinical disciplines, for example, there were Professor Jaromír Uhlíř and Professor Bohumil Potrusil at the First Department of Surgery.

Good students were supposedly pressured into joining the Communist Party. Were you also persuaded?
We were not forced to join the Party, but there was considerable pressure to join the Socialist Youth Union. At first we resisted, but toward the end of our studies it was no longer really possible. In essence, everyone joined; it also had to do with future employment prospects.

How did the youth union function, and what activities was it involved in?
At the faculty it was led by a classmate, a certain Dr. Duroň. I believe that after graduation he devoted himself to oncology, and supposedly he is still working somewhere in an outpatient clinic. He was a staunch Party member and put considerable pressure on everyone to join the union. Only those who were personally interested joined the Party itself.

Did you have to carry out any activities as part of the youth union?
Not particularly. I joined the foreign affairs committee because I had always been attracted to traveling. But the level of activity was minimal. Thanks to that, however, I was probably able, in my fourth year, to take part in a one-month internship in hospitals in what was then the USSR, in Kyiv and Odessa. Even so, in terms of healthcare, it was not very different from ours at the time — both were at a similarly low level in terms of buildings, equipment, instruments, and facilities. Perhaps only the cleanliness there was at a lower level. And professionally speaking, at that time there was not much to learn there.

After your studies, you found your first position in South Bohemia, in Dačice. From what I have heard so far, the hospital in Dačice at that time seems to have been a place that graduates from Brno were not particularly eager to go to…
We had to find positions ourselves, so I wrote to sixteen hospitals in Moravia saying that I was interested in surgery. I received offers from three of them. For example, in Svitavy the director told me to show him my hands. I didn’t know why, and he just said: “Those are hands that will do everything. We need a doctor in the dermatology department.” So I said goodbye. Then I arrived at the hospital in Dačice, where there was also a female graduate from Prague. The director was a surgeon, about a 150-kilogram man, Jaromír Beneš, and he said: “We have two positions. One in gynecology and one in surgery.” Then he said we would give preference to the lady and let her choose. She decided on gynecology, and so surgery fell to me — fortunately. If she had decided the other way around, I would be a gynecologist today. During my time at that hospital, I learned that such surgeons as Professor Jaromír Uhlíř and Chief Physician Jiří Ničovský from the First Surgical Clinic had started their careers there.

Did surgery begin to attract you already during your studies thanks to your work with Professor Vašků?
I was rather inclined toward internal medicine specialties, but in my final year I decided on surgery. I liked the combination of manual and theoretical work.

According to your résumé, you spent two years in Dačice…
I was there until April 1977, including one year of compulsory basic military service. I spent part of it in the Karlovy Vary region, in the training area at Doupov. It was a town that had ceased to exist after the expulsion of the German population following the war. Later it became part of the Hradiště military district. I served as a medic with the so-called “bigoši” unit. That was infantry intended to be shot up on the front line. Often less educated young men from across the country were drafted there, and if it turned out that they were physically or mentally unfit for military service, a review was conducted at a military hospital and they were sent back to civilian life. We at the garrison infirmary appreciated that, because they had to have an escort of two soldiers for the journey home — a medic and a regular conscript. If, for example, we traveled to Košice, it was a week-long train journey, during which I could spend four to five days at home, because from Brno onward the other soldier continued alone with the discharged man. We were able to identify soldiers suitable for review ourselves as part of our work at the infirmary.

Did you return to Dačice after the army?
When I was returning from the army, the director confronted me with the fact that they had a problem filling a general practitioner position in Slavonice, so they wanted to send me there and take surgery away from me. There was another colleague from my year there with me; at that time both of us resigned and started looking for positions elsewhere. I succeeded in a competition for a post at the First Surgical Clinic in Brno, where I subsequently began working.

Was that one of the places you had written to right after graduation?
No, I didn’t even try for a position at the clinic after finishing medical school, because those posts were reserved for graduates who had backing from their parents or through the Party…

How was it that two years later there was an opening?
I don’t know, but I remember that at the time they were looking for three physicians. The First Department of Surgery, which was headed by Professor Potrusil, was quite specific. He was very demanding toward the staff, sometimes even vulgar; he would throw instruments and shout when something didn’t go well. But he had a very good sense for the people he surrounded himself with in the operating room. He always hired more doctors and every year dismissed two or three people from the clinic. Usually, however, he found them another position… In short, those who proved themselves stayed, those who did not, left. It was demanding, but it worked. Later, abroad, I came to understand myself that this is the only way to train high-quality staff.

You were one of those who remained until the Revolution, that is, some thirteen years. What was that period like for you professionally?
In Dačice I learned to operate on appendixes and hernias — basic procedures. At the clinic, they initially looked down somewhat on us from the provinces, as if we knew nothing, and they didn’t want to let us do anything. Gradually, however, I realized that although there were top surgeons there, many others did not know much, were not interested in innovations, or were simply riding the Party line, so to speak. At that time, it was customary for general surgery to be truly all-encompassing. Today, everyone focuses only on a segment — one does thoracic surgery, another vascular, someone operates on the liver, intestines… Whereas I became involved in everything. Mainly abdominal and thoracic surgery, because Potrusil primarily operated on chests — lungs, hearts. I was the third or fourth assistant on his team and in time I was promoted. We also implanted pacemakers, performed trauma surgery on bones and muscles, which today is done by orthopedists… When Associate Professor Vladimír Klimecký, who performed vascular surgery, could no longer keep up, the head told me that I would have to take up vascular surgery. Klimecký was a heavy smoker — he smoked eighty cigarettes a day and even interrupted operations to go and light up. I was sent for three months of training to the Institute for Clinical and Experimental Medicine in Prague, and afterward I began performing complete vascular surgery myself. Looking back, I now think that I was slowly preparing for what awaited me abroad in the future.

What exactly do you mean?
In 1985 I completed my Candidate of Sciences degree, and in 1990 I habilitated; in both cases the topic of my work was diseases of the pancreas. At that time, no one operated on the pancreas; isolated operations were performed in Prague — by Professor Vladimír Balaš and Professor Marie Pešková. At our clinic, operations were done in such a way that the abdomen was opened, a senior surgeon put his hand inside and said: “There’s a tumor on the pancreas; we can’t do anything about that, let’s close it.” The only successful pancreatic resection was performed around 1986 by Dr. Ničovský. However, since I knew from the literature that such operations were being performed in the world and often successfully, I took up this issue as part of my Candidate thesis and habilitation. Including operations on dogs. Today that would be unthinkable, but we operated on dogs experimentally; I myself operated on about eighty of them. Today you would be lynched for it, but only thanks to that did I learn to operate successfully on the pancreas and gradually proceed to operations for chronic inflammations and tumors in humans. At first there were few operations, one or two per month, but their number increased.

After the Revolution, however, your professional career took an unexpected turn, didn’t it?
A change came. They wanted to remove Potrusil as a Party member and part of the old structure, and a competition was announced for new leadership of the clinic. I applied as well, but I lost by one vote to Professor Jan Wechsler from the trauma hospital. Soon afterward, however, there was also a competition for doctors and nurses to go to Qatar, where they were at that time opening practically the only new hospital. Around six hundred people across the country applied; from those, the Qataris selected about eighty and invited them to Prague for the final selection. From that, roughly sixteen were chosen in the end. They wanted experienced specialists, mostly from clinical departments. Among them were, for example, Professor Ladislav Bařinka from plastic surgery, Professor Miloslav Uhlíř — a gynecologist, Professor Rathmír Rath — an internist, and Professor Miroslav Slavík — a renowned orthopedist. Real heavyweights! I had just become an associate professor, which probably helped, so in 1991 I took unpaid leave in the Czech Republic and left for Qatar.

That must have been a leap into a completely different environment, wasn’t it?
We entered something entirely unfamiliar to us. I already had some international experience from Leeds, Sheffield, Budapest, and Vienna, where in the second half of the 1980s I had done three-month fellowships focused on the pancreas. I wanted to see how pancreatic surgery was performed at other institutions. It helped me enormously, because I discovered that every center approached it somewhat differently. In Budapest, pancreatic surgery was led by Professor Szechenyi, a famous surgeon from an aristocratic family; in Vienna, the team was full of Czech surnames; and in Leeds there was Dr. Mike McMahon, the best pancreatic surgeon in Britain. So I had the opportunity to see true leaders in the field. In the end, I formed my own view from it and came up with my own approach. Gradually I began performing these operations in Brno. My collaboration with Professor Petr Dítě, who headed the gastroenterology clinic — first at St. Anne’s Hospital and later in Bohunice — helped me greatly. Professor Dítě focused on chronic pancreatitis and pancreatic tumors and began referring his diagnosed patients to me for surgery.

What was the prevalence of pancreatic tumors at that time? Recently, their numbers have been increasing…
The question is whether they are increasing, or whether they simply were not previously diagnosed. I started at a time when we were in a poor state in terms of diagnostics. For example, gallbladder disease was diagnosed using oral cholecystography, where the patient swallowed tablets, the contrast agent was excreted into the bile, and an X-ray was taken. Or by intravenous cholangiography, where the contrast agent was injected into a vein and excreted in the bile. No one uses these methods today. We have ultrasonography, CT scans, magnetic resonance imaging… Thanks to CT, we could suddenly see whether a patient had a tumor, how large it was, where it was located, whether there were enlarged lymph nodes around it. Until then, we had known none of that. We simply had to open the abdominal cavity and determine the condition directly inside.

With what level of experience in pancreatic tumors were you leaving for Qatar?
Before I left, I had operated on fewer than ten cases. But in Qatar I naturally also operated on routine cases — gallbladders, hernias, whatever was needed, because we were in the only large hospital in the country. Interestingly, that was the time when laparoscopic surgery was just beginning, first on the gallbladder. And the person who came there to teach it was McMahon from Leeds. The meeting was a surprise for both of us. In the end, however, doctors from the United States and Egypt began to push us out of the hospital in Doha, and I had to decide what to do next.

Under what program did you actually go to Qatar?
The Ministry of Health of Qatar approached our ministry to ask whether they could organize a recruitment drive for doctors and nurses in our country. The advertisement was published in medical newspapers and journals. So it was assistance within the framework of international cooperation, initiated by the Qatari government. In fact, the hospital in Doha only truly began functioning in the 1990s; until then, medical care in the country was practically nonexistent. If someone felt seriously ill, they received cash from the ruler and, if they managed in time, traveled for treatment — usually by ship — to Egypt or India. They wanted to change this system, so they began looking for experts who would be able to operate directly there.

And at the same time teach local doctors…
Yes. There were hardly any local doctors. There was no university there, so prospective students were sent abroad to study. They had started doing that about five years before we arrived, so those students had not even completed their studies yet. In our surgical team, almost everyone was a foreigner. There were two young Qataris, and we trained them. Only in the following years did local doctors gradually replace the foreign ones.

How did you function outside the hospital?
At first we were accommodated in a hotel; later we were offered apartments or villas paid for by the hospital. Soon we had to buy cars with our earnings, because apart from taxis there was no public transportation.

What was the cultural difference like — after years spent in socialism, arriving in a country that did not know what to do with its money?
It was a big change, certainly. It took us some time to get used to it, and that was only the beginning. But it was still something of a preparation for what awaited me in the following years. We will get to that…

Your first Qatari period ended with the Americans…
…pushing us out! I don’t want to speak ill of them — there are honorable exceptions — but most of them behaved in a superior manner toward other foreigners. They think they know everything best and are difficult to work with. So after almost two years I returned to Brno, though not to Pekařská Street but to Bohunice. I worked there until 2001. We began performing pancreatic surgeries on a large scale. At first about twenty a year, then forty, as Professor Dítě kept sending us patients from his department. In the end, we were performing about one hundred and twenty operations a year for chronic pancreatitis, in addition to operations for pancreatic tumors. These are five- to six-hour procedures, so I did almost nothing else. Then the hospital director decided to split the surgical clinic and create a separate Department of General and Digestive Surgery under my leadership. Associate Professor Tomáš Skřička, who focused mainly on intestinal diseases, left with me, along with about ten other physicians. We were performing about two hundred pancreatic operations a year alone.

You returned to the Middle East again during the 1990s, though…
I had a sort of interlude when Professor Bohumil Kašťák, who had gone to work in Kuwait, wrote to me to see if I wanted to come for a four-month locum — essentially a temporary replacement. So in 1996 I went to the Kuwaiti Cancer Center. They later offered me a permanent position, but that wasn’t for me. The Kuwaitis preferred to travel abroad for surgical procedures, so I was doing about one operation a week. Moreover, life there was quite monotonous. Kuwait is one big city surrounded by desert. So I returned to Bohunice. At that time, however, a new hospital director decided to merge the two surgical departments back into one under Professor Jindřich Vomela. This arrangement wasn’t optimal, so I looked for an escape route, and eventually I received an offer from the director of the Masaryk Oncology Institute, Josef Drbal, who offered me the position of deputy for surgical departments. I accepted it.

How long were you at Žlutý kopec? Until the turn of the millennium?
Until Director Drbal left. I applied for his position, but again I lost. So after Drbal, Professor Jan Žaloudík took over. The atmosphere he established did not allow for meaningful collaboration. Even though I had spent many years going to Žlutý kopec to operate on complicated cases that others were hesitant to tackle, it was no longer possible to work there. I found a position as a surgeon at Delta Hospital behind Lužánky. Some surgeons there were intimidated by complex operations on the pancreas, liver, and similar procedures, which had not been performed at that hospital before. I stayed there for about two and a half years before moving to Bakeš’s Surgical Hospital at Žlutý kopec.

In your profile, you mention that you are also a vascular surgeon, but I’m not sure when you had time to focus on vascular surgery. You mentioned Associate Professor Klimecký in this context…
That’s where I started with vascular operations. We performed abdominal aortic surgeries, peripheral bypasses, and varicose vein operations — using a new method I learned at IKEM. The procedures had better cosmetic and functional outcomes, so mostly women, who more commonly have varicose veins, began seeking these operations. Essentially, I performed vascular surgery on peripheral vessels in their full scope. While I was working at the First Department of Surgery, I also assisted Professor Potrusil in open-heart operations, including at the cardiac surgery center that he also headed.

Why did you leave Delta, and how did that lead back to the Arab countries…?
I performed many major and routine surgeries there, but postoperative care wasn’t optimal, so I considered my next steps. First, I left for a short period to Bakeš’s Surgical Hospital. One option after that was to go work in the United Kingdom, where foreign doctors were welcomed. I even became a member of the British Medical Association and looked for job postings. Then an agency offered me a position in Saudi Arabia, in Riyadh. The hospital director came to Prague, interviewed me, and offered me the post. I accepted and went to Riyadh to a medium-sized hospital as a general surgeon. They had a consultant-based system, like in most Western countries, where a consultant is essentially the head of a small team of junior specialists working semi-independently. But we were only two consultants for the entire hospital, which meant fifteen shifts per month. Emergency surgeries could happen at any time during a twenty-four-hour shift. It was both physically and psychologically very demanding.

How long were you in Riyadh?
Two years. Then they told me the hospital would be completely privatized, and only private surgeons would operate, while we would provide supplementary support. I refused and left. I didn’t want to return to the Czech Republic — I was professionally burned out at home. My employment agency found me another position: a four-month locum at Sheikh Khalifa Medical City (SKMC) in Abu Dhabi, United Arab Emirates. Before starting there, I spent four months back at the Second Department of Surgery on Pekařská Street to refresh my vascular surgery skills. At SKMC, I was to work as both a general and vascular surgeon. They again had a consultant system, with six of us, each taking responsibility for a segment of general surgery. I got involved in general, vascular, and eventually thoracic surgery. However, my prior experience with pancreatic operations ultimately helped me advance further.

What do you mean by that?
A patient arrived with obstructive jaundice caused by a bile duct blockage due to a pancreatic tumor. We diagnosed him, and the question arose of where he would be sent for surgery. Usually, such complex cases were sent to London, or to clinics in the U.S., like the Cleveland Clinic, or perhaps to Germany. I said, “Why send him anywhere? We can operate on him here at SKMC.” “You can do that?” they asked. I told them I had already done a few hundred such operations. The head of surgery, a Canadian of Estonian origin, agreed, and ten days later the patient went home fully recovered. It ended up that I gave a lecture there about the operation, and three months later they offered me to stay for another two years. I gladly accepted. The other consultants each focused on their specialized segment of surgery, while I did everything, which surprised them. In the end, I was the busiest, and whenever someone didn’t know what to do or was hesitant to perform an operation, they said, “Send it to Růžička.” There weren’t that many pancreatic surgeries — four or five per year — but the outcomes were excellent.

When you mention the agency that arranged these positions, can you explain how it worked?
It was run by a man from Britain, with a Czech woman working with him — later they married and had a son. They searched the world for hospitals that needed doctors and then supplied them. The agency received a commission from the hospitals — equivalent to two salaries of the doctor in question.

And you already had Middle East experience from the early 1990s, so they kept attracting you there? Were you always sure you wanted to return?
It’s said that once someone works in the Middle East, they want to return. That’s how it worked, and Abu Dhabi is the best location in the region, so I returned gladly. We also enjoyed it as a family. The hospital provided a large apartment, we traveled a lot, and in the end I spent fourteen years there. By performing nearly all types of general surgery, including the most complex cases that others didn’t want to do, I built a strong position. One day I might operate on a massive hernia that others couldn’t tackle laparoscopically, the next day on a ruptured and bleeding abdominal aortic aneurysm, and the day after a pancreatic resection. These are six- to eight-hour surgeries. Once a colleague — a highly trained Indian surgeon educated in the U.S. — came to me and said: “I spent five years at the Cleveland Clinic in the U.S., but I’ve never seen a surgeon who one day operates on a ruptured aneurysm, the next day does a pancreatic resection, and the third day handles an ingrown toenail!” (laughs)

You were well trained for that back in Czechoslovakia!
As I mentioned, it felt like I had been preparing for this kind of work my entire life. In the last five years in Abu Dhabi, when the surgeon responsible for breast surgery left, I volunteered to take over until they found a replacement. I had already operated on such cases in Brno at the First Department of Surgery and later at Žlutý kopec. When they saw at SKMC how well I handled these operations — again with very good results, both for benign and malignant cases — they stopped looking for anyone else. Patients came to me for surgery from all over the Emirates.

How do they manage today, now that you’re no longer there?
Well, they had to find a replacement. (smiles) But today, with the growing population, new hospitals are also appearing. One large hospital is managed by the Cleveland Clinic, another by the Mayo Clinic. They recruit their own staff. In addition, more smaller private hospitals are being established, owned by both local and foreign investors. The hospital staff come from all over the world. Even in our hospital, there were doctors and nurses from fifty different countries. The number of local doctors is also increasing, because there are now several medical schools in the Emirates. Only nursing remains mostly a foreign profession, because local Emirati women don’t usually do this work.

Which brings me to cultural customs and religion. Did they affect your work in any way?
It didn’t complicate the work at all. But you have to have good results. If you fail even once, word spreads, and there can even be lawsuits. You have to carefully monitor diagnoses, surgeries, and postoperative care… Of course, complications occasionally occur, but oversight is so strict that you’re constantly aware that something could go wrong. Either you’d be sent home, or someone could sue.

Did any of your colleagues experience that?
When they built a new hospital for the Cleveland Clinic, their doctors came and wanted to perform everything laparoscopically, using modern techniques. They performed laparoscopic pancreatic resections on three patients; two died, and within two months, the surgeons were gone. That was unacceptable — two out of three operations ending in death.

Did you notice that the patient-doctor relationship was different in the Middle East than in the Czech Republic?
Yes, they highly respect foreign doctors. They want to be treated by doctors from Europe or America, preferably white doctors. In our hospital, even the country’s top officials were treated. I treated the sons of the first president, Sheikh Zayed, and their families.

Tell me more!
The United Arab Emirates was formed by the union of seven emirates in 1971. The first president, Sheikh Zayed, had nineteen sons with four wives; daughters are not counted here. Since everything is hereditary, from those nineteen sons came the new president, new ministers, and others leading major offices and companies. When any of them had a health problem, they sent for a doctor, who came to their palace. I went several times with two nurses to examine or treat prominent members of the ruling family. At their homes, you were received with generous hospitality, followed by medical examination or treatment, and possibly recommendations for further care. For serious conditions, however, the ruling family usually goes abroad for treatment.

How did the training of their own doctors change over the three decades you spent in the Middle East?
In the first years of my stay, all the doctors studied abroad. Today, there are at least four medical schools in the Emirates, and more are likely being established. Students used to come to us for practical training. After graduation, their postgraduate training is a single-step process, modeled after European and American education. These doctors — residents — spend five years in the hospital and then take a final exam. During those five years, they work with teams in the hospital, in outpatient clinics, on operating tables, take night shifts, and so on. Always under the supervision of an experienced physician, on that physician’s responsibility. Dozens of doctors have gone through our hospital this way, literally trained in our profession. (He pulls out a photo album.) Here I have a photo of a colleague who came to us as a medical student, then was a resident here, then went to Germany for five years, where she became a consultant in plastic surgery. When she returned to the Emirates, she became head of plastic surgery at SKMC. In other photos, you see team colleagues — for example, a French colleague of Syrian origin, an English colleague of Sudanese origin, a Pakistani, the head of surgery from Egypt, and colleagues from India, Italy, Jordan, Iraq… Male and female residents from Sudan, Syria, and many locals.

What was the status of female doctors in the Emirates?
Completely equal to male doctors. They study in the Emirates and abroad, and work in positions equal to men. For example, I had a colleague who completed medical school, did her residency, and became a consultant. She also managed to have six children. At home, she had six Filipino maids, one for each child, so she could manage everything without problems. And she valued every good piece of advice for her work.

The UAE is probably the most liberal country in the region in terms of women’s emancipation, right?
Oman is similar, but yes, probably.

You mentioned that your family was with you in the Emirates. What did your wife do there?
My wife is a teacher, and at the beginning of my stays, she was still working. She would come to visit me during school holidays. Our four children were also school-aged. Later, in Abu Dhabi, when the children were at university, she spent more time in the Emirates. She commuted between the family at home and me in Abu Dhabi.

Did she get bored there?
I think she managed to keep herself busy. There are many wives of doctors and other professionals. We lived about a hundred meters from the beach, traveled a lot, drove through the entire Emirates and Oman. We camped under the stars and explored the local nature and historical sites…

From your story, I get the impression that adapting to the local environment wasn’t a problem for you at all…
Not at all. When we weren’t traveling, we spent weekends at the beach, going to the cinema or theater, museums, or shopping centers… We also met with other expatriate families. Here, in this photo, there’s a family from South Africa who visited us in the Czech Republic two years ago, and now we’re going to visit them in South Africa in return…

Did you also learn Arabic?
No. If I had known I’d be there so long, I would have learned, but after the first two years, the American manager told us that all contracts would be for one year. If we worked well, they would extend them. So we lived with the idea that we could leave at any time. Besides, we didn’t need Arabic at the hospital; all documentation and communication were in English.

The Middle East is historically and geopolitically a rather volatile region. You were in the Emirates during the Syrian civil war and the rise of ISIS. How did the country view these events, and what was the security situation like?
We had colleagues from all over the region, except Palestinians. People fled from Iraq after the war — very smart and educated. There are also many Lebanese in the Emirates. In Lebanon, it’s common to go abroad, for example to Canada, get a second citizenship, and live alternately in both countries, or work in a third country. Almost all Lebanese colleagues had Canadian passports but still had homes and families in Lebanon, living a double life. Over all those years, I encountered only one Palestinian. Probably because Arabs don’t want them in the country. They see them as terrorists and fear that what they do in Palestine, Israel, and nearby regions could happen in the Emirates too. For them, it’s taboo, so you rarely see Palestinians there. I didn’t notice any influence from ISIS in the Emirates at all. They have very closed and strictly controlled borders, letting in only verified people. Also, work is so highly valued there that crime is practically nonexistent.

So you felt safe?
Yes, absolutely!

If the Czech healthcare system could be inspired by something from your experience in the Middle East, what would it be?
Healthcare systems today are similar everywhere. The difference is more about how medicine was practiced in my youth versus today. Back then, we approached medicine with ideals; we wanted to work in a field we liked. Salaries were almost the same everywhere, sometimes new people were hired, sometimes someone was let go. Today, medical students choose their specialties based more on expected salary. They prefer to work in private practice, avoid night shifts, and don’t want to work too hard.

Until when did you work in the Emirates?
I finished at seventy, as the oldest doctor in the hospital. Our contracts were originally until sixty-two, with the possibility of extension if needed. Mine were extended year by year, until suddenly I was seventy and COVID hit. The hospital became a COVID facility, and we mainly did acute cases. Then they told me no further contract would be given, so I stopped.

Permanently…?
Well, three months after returning, they called to ask if I could come back to help, again on a locum basis, because they didn’t have a vascular surgeon. We mainly did amputations for ischemic limbs and some acute surgeries. But with the crazy COVID measures, my wife also urged me to go home. Without COVID, I probably would have stayed another year.

How did the Middle East change you — personally or professionally?
I had only known burnout theoretically, until after 2000 I experienced it myself in the Czech Republic. I felt I no longer wanted to practice medicine there. All the struggles with hospital directors… I said enough, I have to make a change. The Middle East was like a professional restart for me. I was well prepared for it by our system and the broad range of skills I had learned.

Is this experience something you would recommend to younger colleagues?
Today it’s harder to get there. We went as a generation of specialists to a country that didn’t have them. Today, almost all fields have local experts, and foreigners are only supplementary. They mainly want specialists from world-renowned institutions — Cleveland and Mayo Clinic in the U.S., Cambridge and Oxford in the U.K., Munich in Germany, and so on. Nothing less than world-class is accepted.

Can they attract doctors with anything other than money?
Money is obviously important — they can pay anyone. But professionally, a doctor can also thrive there. You must be perfect and deliver results.

Traditional final question — does anyone in your family continue in medicine after you? You mentioned your daughter…
My daughter is an anesthesiologist at the Brno Military Hospital. Recently, she also completed a specialization in acupuncture and is focusing more on it. Through training, she gained experience in electroacupuncture and, as far as I know, achieves very promising results with her colleagues. In the next generation, we have nine grandchildren, so we’ll see if any of them pursue a medical career.

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