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October 26, 2020

 

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Romani doctor in Czech Republic: As long as we never appear in such positions, nothing will change

10.6.2020 11:05
Jakub Jarý (PHOTO: Petr Zewlakk Vrabec)
Jakub Jarý (PHOTO: Petr Zewlakk Vrabec)

MUDr. Jakub Jarý comes into practically daily contact with patients who have not just advanced COVID-19, but also other highly infectious diseases. He says his work is more meaningful at this moment than ever.

Born in 1988, Jarý is from Ústí nad Labem. In 2015 he graduated from the Charles University Medical Faculty in Plzeň.

Jarý works as a doctor in the Infections Diseases Ward of the Masaryk Hospital in Ústí nad Labem. Currently he is preparing for his certification in infectious disease medicine.

Q: Some people here are downplaying the COVID-19 pandemic and comparing this disease to the flu. What is your professional opinion?

A: The symptoms of both diseases can be similar, but sometimes they are actually drastically different. Especially in the beginning we mistook COVID-19 patients for flu patients. The onset of difficulties with the novel coronavirus can be gradual and can run like common respiratory tract infections, but after several days they can suddenly become a severe condition requiring oxygen and mechanical support and hospitalization in the intensive care unit. For more severe forms of flu the course of the disease is difficult from the very beginning and patients begin in intensive care.

Q: Do you believe the enormous media attention paid to the novel coronavirus is proportionate?

A: Here in the Czech Republic, essentially, deaths soley due to COVID-19 are fortunately not happening - the patients dying with the novel coronavirus already have, for example, cancer-related diseases. Most of them are more elderly or are more seriously ill to begin with. We are practically unable to estimate whether this wave will ever absolutely subside, or whether, on the contrary, we are anticipating a second wave. Likewise, we cannot tell whether patients who have survived COVID-19 will then have any consequences for their health - ones that do not necessarily have to appear immediately, but might appear after five or 10 years. Even though the deaths are not happening here, I am convinced that COVID-19 certainly deserves attention because we do not know how this novel coronavirus behaves, or how to treat it, and we don't even know how to prevent it, because currently there is no vaccine for it. That is most probably the main reason many of us are so scared of it. It is quite possible that we are, for example, just being too hyperprotective, but in any event this belongs to a bigger group of viruses that are located everywhere, and the seriousness of the diseases they cause drastically differ. Today we know several others like COVID-19 that have already spread as epidemics, such as MERS or SARS, and their mortality rates, their courses, and those diseases overall are incomparably worse.

Q: The epidemiological orders issued by the Czech Government were meant to slow the spread. Can we assume that the novel coronavirus will eventually affect all of society anyway?

A: That can be assumed, but preparing for it in advance is not very possible, we would have to prepare our immunity, our defense mechanisms, which have to learn to combat it and create antibodies to it. We do not know if, for example, warmer weather will stop the replication of the virus or even absolutely destroy it. We don't know if that second wave will arrive, or whether this will become a seasonal disease like the flu. It can even become an endemic disease in a certain area. It is rather possible that most of the population will be exposed to it, because one can have the virus without showing symptoms, and we won't even know that if we are unable to test the entire population for antibodies.

Q: That means there is still a lot we don't know. What can we base our understanding on?

A: Only on the situations in China, Korea, Italy, Spain or in England and the USA, those are practically the only available information sources we have. Here in the Czech Republic, for the time being, things appear optimistic - unlike Italy, for example, where many patients needed to be put on respirators. We were afraid of that in the beginning, but a similiar situation did not develop here. So that is another possible indicator that in our conditions, the virus behaves absolutely differently than it does in Italy or Spain, but naturally that can also be because we adopted measures in time, or because we were more consequential about following the epidemiological orders - but now, nobody will be able to determine that with certainty.

Q: The doctor Soňa Peková has mentioned more than once in the Czech media that she believes the virus was artificially created. What is your opinion about that?

A: I'm not equipped with the scientific knowledge on which to base the creation of any kind of opinion about that, especially because viruses can only be observed with electron microscopes, and there are just a few of those in the Czech Republic. No virus can be observed through an ordinary microscope. Even if the average doctor or biologist had electron microscopes and knew how to work with them, it would not be the case that they would be able to tell something about a virus just by looking at it. That field is comprehended by the very specialized scientists who have dedicated themselves to virology. I am unable to assess, therefore, whether COVID-19 is an artificially-created biological weapon, or whether, on the contrary, it is a natural virus arising through natural mutations, like the flu, which also mutates naturally several times a year.

Q: What is your perception of the fact that the person heading the Czech Health Ministry is not a doctor? The first reports from the ministry arrived in a very confused way, chaotically, and the politicians mutually contradicted each other ...

A: I don't want to get into the politics, it's not my cup of tea. The public certainly was able to perceive that the first orders were issued quickly, sort of "shoot first, ask questions later", and they were frequently adjusted. However, I'm not absolutely able to say that I would have made a better decision, or a more correct one, when nobody knew what we could anticipate from this. For example, Spain and Italy behaved absolutely differently than we did, and the impact there was different, an enormous number of people were infected, and the situation in those countries was even more tempestuous than here, there were far more victims than the northern countries reported, for example, that were also not as restrictive in their measures. Naturally, an erudite physician could be at the head of the Health Ministry, one with experience of epidemic waves in the past - but we probably will never find a person who can make correct decisions on everything.

Q: Diseases that are even more serious than COVID-19 are on the rise. Which cases do you encounter on a daily basis?

A: At our infectious diseases intensive care unit we replace the functioning of several different bodily organs with machines for some patients because they have ended up in serious condition. The saddest cases, for example, are those of meningococcal sepsis in adolescents and children. Viral diseases are generally more infectious than bacterial ones. Rotaviruses are also contagious and easily infect families, hospitals or collectives of children. We encounter scabies, which is highly catching, health care personnel or teachers are those most frequently infected with it. Two years ago we lived through a big epidemic of hepatitis type A. Whooping cough is also recurring. Last year there was an epidemic of measles, and tuberculosis is also serious here.

Q: The attitudes of parents refusing the compulsory vaccination of their children are well-known. Do you believe vaccinations make sense?

A: For some diseases that continually recur, such as mumps or whooping cough, the error is not that the person was vaccinated, but that the effect of the vaccination changes. The body does not maintain antibodies as long as we once believed. With respect to vaccinations for tuberculosis, while I am decidedly not in favor of those opposed to vaccination, basically that is one of a very few vaccinations that has been discarded. The use of many vaccination materials has had to be postponed because the tuberculosis vaccine is aggressive, wounds were not healing correctly after being vaccinated with it, infections developed, that demanded time, and then other important vaccinations had to be postponed as well. That is how tuberculosis vaccination became an optional vaccine that parents can buy for their children here. The epidemiological situation in this country is constantly developing and it does not appear to have had a dramatic impact on society that we have stopped vaccinating people against tuberculosis across the board. There are more cases of it from abroad, associated with large-scale migration and inexpensive travel. On the other hand, we have added meningococcus vaccinations, because that is a very serious disease that endangers children's lives.

Q: What is your view of the planned vaccinations against the novel coronavirus?

A: Right now we are examining our patients for antibodies and we are interested in those who have gone through this despite having a negative test result in the beginning. The fast tests that have appeared in the Czech Republic are unreliable, the more exacting examination method that we are using is new and we immediately included it in our algorithm. It is quite likely that the outcomes of the across-the-board tests will be surprising. However, as far as vaccination is concerned, I dare say that it will not be across-the-board at the beginning, it will take some time for the research and the patent to be paid for. For a certain time, therefore, patients will have to pay for this extra vaccine. Whether it will have an effect I don't know, but if we want to have even the slightest opportunity to avoid this disease, vaccination makes sense. From experience I know that flu vaccinations are accessible and don't cost much, but people avoid them anyway, although  approximately 1 000 people here die of flu annually and the courses of some of those cases can also be very difficult. Senior citizens can get the vaccine for free, even.

Q: I recall interviewing you as a first-year medical student. Back then you had no idea what specialization you would decide to undergo. What eventually influenced your decision?

A: It wasn't until almost my final year that I decided. Paradoxically, I was influenced by the time I had spent before entering medical school, when I studied biology and chemistry at the Faculty of Natural Sciences in Ústí nad Labem, because those were the fields that had always interested me and I think I did pretty well in them, overall. During my studies I encountered microbiology, which is about bacteria, viruses, molds and fungi, and other micro-organisms. That was what amused me about medicine most of all. Today I see that was the thread I decided to follow into the future. After that it was purely pragmatic, I know we had an Infectious Diseases Ward in Ústí, and naturally that was another aspect that decided it.

Q: What do your parents make of the fact that their son will be an infectious disease specialist and virologist?

A: Mom has dissuaded me and I think she has not absolutely accepted it to this day, because she is afraid of me being in that spooky Infectious Diseases Ward, which is just chock full of disease. The pandemic, naturally, has bolstered her concerns. It is true that those around me are afraid and still perceive me as being more at risk than if I were to to work in a different department. I calm them, naturally, by telling them that by the time patients reach us, we know the results of their cases within a rather brief time, we know what we're dealing with, how to cure them. and how to protect oursevles from catching the diseases. My colleagues in emergency medicine are in far greater danger, because those people do not always have the kind of information that we get about our patients. My partner, fortunately, is not afraid and is reasonable, but I have the feeling that Mom fears for me more and more.

Q: Most college-educated Romani people are frequently the first generation of their family to access higher education. Was that your case?

A: As far as a college education goes, I am the pioneer in our family. I managed this thanks to support from the Roma Education Fund and Verda. My brother who is four years younger than me has graduated in chemical engineering. I believe that when he saw me literally lying in a pile of books, what the requirements were of us and how much I had to study, it may have had a deterrent effect. He may have imagined that all colleges are like that, but the study of medicine is specifically demanding and practically requires lifelong learning.

Q: What was your journey to an academic title like?

A: Both of my parents apprenticed, but they always emphasized how important education is in a person's life and that this is the only way we can be better off than they were. They instilled in us that if we achieve a certain level of education, then we will be better off on the labor market. To tell you the truth, our parents didn't have to keep either me or my brother on a short leash for us to go to school and study. We did well in school and we didn't have to overwork at all to stay afloat and get good grades. The desire for an education was spontaneous in our case. I see this among the Romani youth around me whose minds are open, who want to live their own way, and mainly who want to do something to achieve that.

Q: Do you believe society's attitude toward Romani people is changing?

A: One changes the circles of people one is in during the course of one's life, one's social bubbles change, so I could answer by saying the attitude is improving. At the same time, however, I am aware that I especially have people around me who have a better view of our minority and who do not suffer from prejudices like everybody else, but actually that's just my bubble. I believe the situation is not developing much, unfortunately, it remains the same as it has always been. I would be quite naive to believe that because I personally feel better, the attitude of society toward Romani people has changed.

Q: Do your Romani colleagues in health care have a similar experience?

A: I met a student who was two years ahead of me and then worked as a gynecologist at a hospital. As far as I know, the people in his work environment there did not accept him and he left after a while. I know from my colleagues that there might be one other Romani doctor in Hradec Králové, in surgery, but I don't know to what degree he has grappled with prejudice because of his Romani origins or whether he even presents himself as a Romani person.

Q: Do you yourself encounter prejudice from your colleagues or patients?

A: I have and I certainly will again. When I began, my fellow doctors, the nurses and the patients didn't know me, and I ascertained that they basically were unable to imagine that a Romani person could become a physician. I heard commentaries that were not made to me directly, but that were about Romani people in general. They are unaware that such behavior has no business in a hospital environment, to make a long story short. In their view, there are no Romani doctors. They assumed I was a foreign national or somebody with a suntan, but it never occurred to anybody that I am Romani. Maybe my Czech surname was also responsible, my father is half-Romani. However, today I don't experience this problem, my colleagues are perfect, we get along very well together and I can say the same of my patients.

Q: I believe you. It's interesting that it would never have occurred to them inside the hospital that you are Romani, but if they were to encounter you on the street they most probably would be clear about that right away.

A: In the beginning it sometimes used to happen that if I was introduced to somebody and that person asked where I work and I answered that I work in a hospital, the next question would be whether I am a janitor or a paramedic. People still are not aware that we could work in positions such as a doctor, lawyer, journalist, scientist or teacher, for the time being they are just unable to see us that way. As long as we never appear in such positions, nothing will change and they will believe that when you say you work for the radio, it means you clean the offices, instead of asking you what program you work on - and in my case, they will ask whether I clean the hallways or drive an ambulance instead of taking an interest in which department I work in as a doctor.

First published in Romano voďi magazine. 

 

Rena Horvátová, translated by Gwendolyn Albert
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COVID-19, Hospital, Romano voďi 2020, Zdravotnictví



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