Czech pediatric surgeon on the highs and lows of his field missions for MSF


Doctor Jan Trachta is a pediatric surgeon who has spent the last five years working for Doctors Without Borders (MSF). This week he was back in Prague for the launch of his first book Tichý dech in which he shares his experiences from field missions in the Congo and Haiti. He visited Radio Prague’s studio this week to talk about his life and work.

Jan Trachta, photo: archive of Jan TrachtaJan Trachta, photo: archive of Jan Trachta “Well, I have done seven missions with MSF and the book that I’ve just written is concentrated on the eastern Democratic Republic of Congo where a civil war has been raging for 15 years and the Haiti earthquake in 2010. From my seven missions I chose those particular two because they were quite crucial for me and I could use them as examples of the humanitarian work that we do and realize in the field.”

What made you leave a well-equipped hospital in Prague and seek work in humanitarian crisis areas?

“It was probably a dream I had when I was much younger –challenging adventure and fulfilling the original vocation of the medical profession which is to alleviate suffering and help the people that really need it. This is something that it gives you, besides the things that it takes from you, you do feel that you are fulfilling the original vocation and you feel really useful in these fields, conditions….”

More so than here? The feeling is more powerful there?

“Yes, it is more palpable, it is more fulfilling, more emotional and more straightforward. Here in European hospitals you sometimes feel like a little wheel in a big mechanism. There, in the field, you look after the patient from admission to discharge and you are the only one responsible for him so there is space for a much deeper relationship with your patient because it is more personal.”

You must have had some expectations when you headed out. What were your expectations and how did they compare with the reality that you found –especially on your first trip out?

Photo: archive of Jan TrachtaPhoto: archive of Jan Trachta “Well, obviously I was a bit naïve as is everyone who goes out for the first time which is absolutely aright because you need to go through the reality and the phase when you hit the reality and the difference is that when you are sitting in an armchair back home and you are dreaming about your mission in the field you think it is going to be a great adventure, you are going to manage everything well and arrive back home as a hero. But when you get there you find that there is a daily strenuous job that is extremely tiring. You have double the work load you have here in a Czech hospital and you feel exhausted in a week’s time and you feel like going home in a week’s time and you think why the hell am I here? This is not what I dreamt about. This is extremely difficult, tiring, I don’t have anyone here to help me and I feel like crying. So this is what can happen to everybody and I had a crisis like that after two or three weeks. I talk about it in my book quite frankly because that was an important moment for me.”

What helped you overcome this crisis?

“The team. The team of expats who have had a similar experience themselves in the past.”

So what made you stay?

“Their support, the friendly, emotional support they gave me and the strong belief that the project we were working on – that is opening a small hospital in the mountains where there had been no health care for ten years –made deep sense. It was a great project and we wanted to finish it even though it was difficult. So you stay, because you don’t want to give up, do you?”

Photo: archive of Jan TrachtaPhoto: archive of Jan Trachta You said that this work gives you something and takes something away – can you be more explicit?

“What you get is strong emotions, a fulfilling job and even though you often feel weak in the field you feel a little bit stronger back home and with every success you feel that much stronger. You think, well, I did it this time and next time it will work out too. You feel refreshed coming back from the field and have a new perception of the things that are happening around you, for example in the Czech Republic. So it gives you all these things and what it can take away from you is the feeling of home, you can lose your friends, you can lose your career here –these are the dangers that you are trying to avoid and many of the expats in MSF fall into this trap. “

You said it changes your perception of life here – how has it changed you inside? Do our problems seem petty to you on your return from such a mission?

“I have been asked that many times, but no, I don’t think so. On the contrary, I feel that if anything has changed then I have gained a deeper perception of people and their problems. In a way I think that finally I have become a little bit more sensitive to the people around me.”

Have any cases or patients stuck in your mind?

“There is always something. Every field mission that takes between four weeks (a short one) and three months in MSF –ever mission has a patient who becomes a symbol of the whole mission for you. So I think I can name in every field a patient whose case was complicated and whom I looked after day-to-day. There was one girl whose legs were torn by a grenade – an infection set in and I had to amputate her several times and she was fighting death. So I had her in the operating theatre very often during those six or seven weeks. I won’t say her name here, but I do remember her name and I do remember her smile and I remember when she was in agony her asking me for milk because milk was the best memory she had from childhood. So things like that you certainly do remember. “

Photo: archive of Jan TrachtaPhoto: archive of Jan Trachta Are some of those patients in your book?

“Yes, some of them are there. There’s another one I write about in the book –a 16-year old boy called Moize with severe head burns, burns right down to the skull, whom we looked after for several months.”

So what will readers find in this book – your impressions, your frustrations over the conditions you worked in, your emotions plus these human interest stories of your patients?

“Yes, certainly it is a mixture of all that, though not as dark a picture as you paint. There are many positive moments. I believe I have been able to capture the great friendships and positive emotions that we had in the team because we were working together on a goal that was quite clear. Everyone is on board and that is a fantastic feeling. Also we had excellent relations with the national staff, the national nurses and doctors with whom we would go out in the evening for a pint of beer and those were fantastic evenings, because you feel you had a great day, you did a great job and now you can relax with the people you like. So there are many positive things.”

But you also found yourself operating in the street at certain times?

“In Haiti, yes, but that was an extreme, not a standard mission which is also why Haiti only appears briefly in my book because that was a natural disaster –one of the worst earthquakes in human history – and the situation was exceptional in every possible way. So it is not a typical picture of an MSF field mission.”

In addition to sharing all this with your readers- did this book help you digest what you experienced there and come to terms with what you saw?

Photo: archive of Jan TrachtaPhoto: archive of Jan Trachta “Yes, absolutely, that was one of the reasons why I started to write it. It is mentioned in the book too that I felt I was living in two parallel worlds that had nothing in common –like eastern Congo a few thousand kilometers away with a completely different society, different people and it felt like a dream when I arrived back home and the same way my home in Prague felt like a dream when I arrived there – but it was still me shuttling back and forth between those two worlds. It was still me in between those worlds and I wanted to find out who this guy was and why did I feel so estranged, why did I feel that those two worlds were not compatible…and I was also trying to digest the experience as you said, and I tried to select, from a huge amount of memories, the important ones. So it was a process of creative selection in telling a story, because I believe there is a story in our life although we don’t usually see it and to discover that story is probably what is so exciting about writing any book.”