The Texas-Czech Physician Exchange Program
Background, Current Status and Future Prospects
The View from Houston, February, 1999

Joel B. Kirkpatrick, M.D. and Tomas Klima, M.D. (Texas Medical Centre, Houston, USA)

Americans were astonished as well as pleased with the disintegration of communism and the sudden access to previously closed societies of Eastern Europe. The groups best prepared to interpret and capitalize upon this historical turning point were the recent immigrants and refugees from those societies to the United States. They shared the language of the mother country and many still had family and professional contacts there. There was a powerful and sincere desire to reach back to the home country, to lend assistance for the coming integration into western society. Our group, the Texas-Czech Physician Exchange Program, was one manifestation of this altruistic attitude. It was established in 1991 for the purpose of bringing young Czech physicians to the Texas Medical Center for short periods to observe modern American medicine at work, and to experience some of the traditions and problems of a democratic, capitalistic society.

The Texas-Czech Physicians Exchange Program is operated by a voluntary, unpaid group of practicing physicians at the Texas Medical Center. Most, but not all, are of Czech heritage. The founder, and still its charismatic leader, is Dr. Tomas Klima. Other members of the Board of Directors have played stron supporting roles. Dr. Joel Kirkpatrick has been Dr. Klima´s main assistant at the Medical Center and has done most of the correspondence. Dr. Arthur Jansa, as president of the Harris County Medical Society was able to append our group to that framework for accounting purposes. This saved us a significant expenditure for legal fees, and documents our receipt of donations and expenditures in a legally acceptable manner.

Dr. Richard Stasney has provided meeting space and hospitality. Dr. and Mrs. John Haenosh and others have hosted receptions to honor guests from the Czech Republic and donors. Mr. and Mrs. Rudy Klecka have hosted numerous dinners for the fellows. Dr. John Stavinoha has helped with reception of newly arrived fellows. Dr. Kenneth McClain has developed a successful research collaboration with one of the former fellows, Dr Petr Kavan of the Second Medical School at Motol. Always the driving force in TCPEP has been the persistent and persuasive leadership of Dr Klima. He and Dr. Marcela limova have served countless meals at their home for visiting fellows and local supporters of the program.

An early decision was to have the First and Second Medical Schools of the Charles University in Prague choose the fellows. This freed us in Houston from the important and sometimes contentious gatekeeper function, and has assured us of very high quality fellows. As of February 1999, with the program in operation for almost eight years, 68 visiting Czech fellows have come to the Texas Medical Center for visits of three months. We establishedn that a budget of USD 3500 for each fellow would cover air transportation, shared living accommodations at Favrot Hall on the campus of the Texas Medical Center, a USD 1000 cash allowance for food and incidental expenses while in Houston, and medical insurance. This does not amount to luxurious maintenance of our Czech guests. They have shared close quarters in a double room at Favrot Hall and have had no automobile, a significant impediment in the broad expense of Houston. But Dr. Klima assured us that Czechs were "great at coping with adversity" and our fellows have done that without complaint. To interject a sociological observation, there have been remarkably few incompatibilities betweed the paired fellows, even though most have not been close friends before coming to Houston. In some cases, lasting professional and persosnal relationships have been established.

Funding has been provided mainly by voluntary individual contributions. Almost a quarter of a million dollars has been raised during the eight-year existence of the program, mostly from physicians at the Texas Medical Center. We have sought foundation and corporate support but have been largely unsuccessful, except for grants from the McGovern and Fondren Foundations and from KLM Royal Dutch Airlines. All these sources are "drying up" because of increased competition for commercial and charity funding. There is, in addition, the perception (right or wrong) on the part of our prospective donnors of a less critical need, with the improvement of the economy in the Czech Republic.

The Czech fellows come to the USA with a "J" visa, which means they are visiting scientists, but cannot practice medicine or treat patients directly.This leads to some understandable frustration because capable, active, "hands on" physicians must be registered as an official visitor to Baylor College of Medicine or the University of Texas, which provides the identification badge required for entry into conferences and buildings, and for use of the library. The fellow must have a health interview, and must verify or obstain medical insurance. Then the fellow is introduced to the host service, which will have the same practice specialty as his position in the Czech Republic. Many of the host physicians have had repeat visitors and almost without exception the experience has been positive, both for the host department and for the fellow. Early in the visit it is important for a member of the Board (usually Dr. Klima) to monitor the fellow´s progress and level of satisfaction. Sometimes it has been necessary to recommend additional interaction by the host department or make other arrangements. It cannot be exmphasized too strongly that the fellow must come with highly developed English skills. Only a few of the thousands of people at the Texas Medical Center speak Czecg or German so the fellow gains English practice and fluency quickly in this situation. The fellows attend rounds and conferences, many of which serve breakfast or lunch. Then the afternoon may be available for clinics, research projects, or library work. Most of the fellows have gained access to a computer in the host department or the library. In addition to the medical literature databases, the internet and e-mail are available on these computers.

Many fellows have made visits to New Orleans or Grand Canyon, and some have attended national medical meetings. We have no facility to house additional guests, but many fellows have had spousal visits and trips. Siome have considered this a distraction from the medical studies, but Americans are tolerant of the need for recreation. We do not discourage the practice, but also do not fund it.

At the outset of the program there was general recognition that scientific medicine had lagged under the communism, so that an early need was simply to expose the fellows to modern methods and equipment. This resulted in the establishment of some new techniques in Prague, including the use of ultrasound in cardiac catheterization, and bone marrow transplantation. Rapid progress in the Czech Republic during the past decade has evolved from introducing new methodology to sharing experiences and approaches. This has a broadening effect on both the fellows and on the host physicians. Some of the importat lessons for fellows have come not only from the medical practice but also from administrative methods of scheduling, work-up and insurance collection for large numbers of patients.

Currently the Texas-Czech Physician Exchange Program is at a crossroad. Despite our considerable past success, funds are increasingly difficult to obtain. We are amateurs, of course, at raising money, and a possibility would be to hire a professional fund raising consultant. However, this would alter the voluntary character of our participation and would raise overhead expenses (now almost zero) considerably. We will certainly continue to seek foundation support.

More important even than funding is leadership. Dr. Klima, who has been our vital "spark-plug" in all elements of program activity, is now semi-retired. Dr. Kirkpatrick is also semi-retired and both spend considerable time abroad. Other board members have heavy practice schedules, which prevent their taking up the fun tions thus posponed or by-passed. So the most critical issue facing us is to identify new leadership in Houston and "pass the torch" to them. Frankly, it is not so much administrative skill that is needed as it is commitment to the program.

Future Projections. Despite this dour analysis of our situation at the present crossroad, several issues point to the future. Some funding has already been raised in the Czech Republic. Every successful effort in this regard is a significant help in raising funds in America, both from individuals and from foundations. Some fellows may want to finance their own visits. We can make provision for this.

If new leadership for the Texa-Czech Physician Exchange Program is not forthcoming, it would be possible to meld its operation onto the larger programs for visiting physicians, which function through the large international offices of Baylor and the University of Texas at the Texas Medical Center. This would have the effect of letting each visitor make his own arrangements. This would be facilitated by the good reputation. already established, by the long series of Czech visitors. Czech doctors are recognized as being intelligent, cooperative, and ambitious.

Other improvements can be discussed, such as broadening the range of visitor specialties, to include scientists, administrators and paramedical personel. Better feedback is needed for both host and visiting physicians. Constructive criticism would identify weaknesses and suggest improvements in the program. What specific ways could American physicians contribute to the further development of medical infrastructure in the Czech Republic? What experiences and lessons can Czech medicine suggest to American medicine as the latter moves from private practice to more structured options? Should fellows obtain and "H" visa and pass the FLEX exam before coming, in order to participate more directly in medical care? There are many other possibilities of interaction; make a list, discuss it; make proposals.

Several physicians from the Texas Medical Center have visited Prague as guests and have received a very generous welcome. We should encourage others among our supporters to make such visits, since it improves communication and demonstrates the continued justification for the program.

In conclusion, out two major problems are continued funding and renewal of leadership. This paper lists some of our future prospects and challenges. Can it be done? Can we rise to the occasion? A "No" answer will be self-fulfilling and will terminate the program. But it is too early for abject pessimism. We have been at low points in the past, and have pulled through with a renewed burst of optimism and effort. Thus an optimistic, enthusiastic "Yes" is the only answer we can give. We will need to supplements our optimism by hard work and forward thinking on both sides, and with your help we can do that.

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