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When is the last time you remember having the entire OR
team give you a "standing ovation" for getting an IV in a child,
or the next week a neurosurgeon telling the OR team in a loud voice that
"perhaps we should have the American Fulbright Professor (you!) give
a try at the artery catheter insertion" in the five year old for
a craniotomy…and then giving a conspiratorial wink when it (fortunately!)
went in on the first try! Think Fulbright Fellowship…
What's a "Fulbright" and where is Ljubljana?
Read on; a chance to go somewhere else from the "day-to-day"
routine you have at present and yet do what you do… teaching, research,
and staying involved in pediatric anesthesia. All this under the auspices
of the US State Department -administered by the Council for the International
Exchange of Scholars (CIES). You are still paid a salary, airfare, some
living expenses for the other country, and you don't have to make an extended
commitment.
I first heard about the Fulbright Fellowship on a train
out of Florence years ago, while chatting with an American about her trip.
She told me she was in Italy for 6 months "on a Fulbright".
She was doing research on whether Italian high school graduates made more
money than those who dropped out. A few years later I was experiencing
the usual "what am I doing in my life" and I remembered her
and looked up the Fulbright Program on the internet (http://fulbright.org).
To summarize, the State Department-funded Fulbright program
sends American teachers and/or researchers overseas and brings similar
people from other countries to the US to train. You pick the country and
the type work you want to do, you set up your program (teaching, research,
either or both) and if selected, the US Government pays a salary, transportation
costs, and the local country contributes to housing costs and living expenses.
There is also additional money available for purchasing books, supplies,
and research costs. See the Internet address for details. You are eligible
if you have a doctorate (MD, PhD, JD, etc), some letters of reference
about your teaching or research prowess, and an institution that is willing
to take you. While the application is a bit formal, my experience was
that once accepted, the sky was the limit and most of the programs ended
up being different from what we had expected or anticipated.
The research can offer unique opportunities to explore.
For example you can choose a place with pathology that we don't encounter
frequently in the continental US (e.g. malaria, Chagas disease) or you
can choose a country where infrastructure problems provide a basis for
devising innovative techniques (e.g. no ventilators for postoperative
care). The Fellowship can range from doing state-of-the-art research in
Paris or at Oxford, to introducing pediatric anesthesia techniques to
very unsophisticated medical practitioners in more primitive areas.
My background is rather typical. I had trained in pediatrics
and anesthesiology and done a fellowship. I was married, in private practice
at Denver Children's Hospital, and had a clinical appointment in the Department
of Anesthesia at the University of Colorado. I was involved in some clinical
research projects and wrote an occasional paper. I had visited Slovenija
(the former northern part of Yugoslavia, bordering Italy and Austria)
once before, but didn't know much about the country. Philosophically I
wanted to bring my skills in pediatric anesthesia to a country where they
would be appreciated, perhaps needed, and where I might help integrate
the existing medical infrastructure into a modern practice. It occurred
to me that the former Yugoslavia, with which I was not very familiar,
might offer some opportunities and that specifically Slovenija, as the
most "European"-oriented country coming out of that breakup
would be the best fit for me. I knew they also had a pediatric department
with pediatric intensive care unit with which I could interact.
I wrote a generic letter to the Chairman, Department of
Anesthesiology at the University of Ljubljana Medical Center about the
possibility of me doing a sponsored Fulbright Fellowship (i.e. it wouldn`t
cost them anything…) at their institution and that's how it
started. The Internet site lists all the countries that participate in
the Fulbright Program (world-wide) and what type professionals they desire.
Some are restricted (one wants only policemen from New York City!) and
others are very generic. Countries usually have two to five positions,
and you will be "competing" against English professors going
to Oxford to study Shakespeare and lawyers teaching constitutional law
to newly independent countries! Determining what country and institution
to contact can be identified via friends in our profession, former fellows
from overseas, or off the Internet searching for names, addresses, etc.
For the Fulbright application I had to provide a copy
of my curriculum vitae, the usual letters of recommendation, fill in some
essay-type questions providing an idea of the type of teaching I would
be doing (…rather geared to PhD semester lecturing concepts that
I modified to lectures and OR teaching of anesthesia residents) and I
proposed a research project looking at the effect of cigarette smoking
on children during anesthesia measuring carboxyhemoglobin levels.
The application deadline is usually August for positions
starting the following year and most appointments range from 6-9 months,
usually during the "academic year" (September to June). My group
in Slovenija was primarily affiliated with the University of Ljubljana
and/or the Josef Stephan Institute for about 6 months from January through
June 2001. It included a biomedical engineer (research), a lawyer (teaching),
a chemist (research/teaching), myself and two guys (with whom I had no
contact) in economics and physics in other parts of the country. Previous
Fulbrighters there were in journalism, history, law, etc. I was the first
medical doctor, and the Embassy people were delighted to have someone
"different" in the program. A list of previous Fulbright recipients
by specialty (e.g. medicine) and country can be obtained off the internet
site.
I was notified in January 2000 that I had made the first
"cut", and sometime after April that I had been accepted for
January-June 2001. I was sent a check for $1,500 to come to Washington
DC in June for a 3 day orientation when about 200 of us going to Russia,
the "Stans" (Kazakhstan, Uzbekistan, etc.) and the Baltic countries
were brought together. There were a series of speakers talking about the
Fulbright program itself and the political history of those parts of the
world. Then we spent time with Fulbrighters who had just returned from
the specific country where we would be going to give us the "true
skinny" about what we were getting in to (clothing, food, transportation,
people, etc.). It ranged from the philosophically serious (how safe is
it?), and practical (what kind of computer can I use there? Is there internet
access? Do I need to bring transformers? to the sublimely ridiculous ("My
CD boom-box was the best thing I took over…").
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The $1,500 was for transportation, accommodations, and
meals; the nice thing was they just gave the money you could fly/drive,
stay at the hotel where the meeting was held or with your "aunt Alice"
in town. They didn't care, and didn't require receipts, etc. It was quite
interesting. Imagine chatting with a woman economist who had just spent
9 months in Sophia, Bulgaria and had really enjoyed the social life there,
or a sociologist going to Bosnia to study how neighbors from that area
had changed so dramatically "within a few months" resulting
in genocide, etc. I didn't even know what countries were next to each
other! Obviously the location where you do your Fulbright will determine
what it is like; primitive in some places, quite sophisticated in others.
Take your pick to do what you want … I didn't want to be in an area
that had no resources, where I had to have a translator for every conversation,
and where I knew that as soon as I left everything would revert back to
the way it had been before I arrived. My wife didn't want me getting "captured
or killed" and I personally hoped to get as much out of going there
as what I had to offer…
Slovenija is a lovely country with mountains and seaside;
it is about the size of New Jersey and became an independent republic
in 1991. The capital city is Ljubljana, and most of the country is located
within two hours drive from there. It is the sort of place where usually
someone speaks fluent English, which the kids study in school, yet you
can be the first American many of the people have ever met, especially
when you get out of Ljubljana. The language is Slovene - rather unique
("good morning" is "dober jutro!" and "thank
you very much" is "hvala lepa"); so no one really expects
you to speak it. The country is a nice mixture of modern European (my
apartment had cable TV with movies in German, Italian, and English often
with Slovene sub-titles!) and yet a bit of residual socialist influence
(no private hospital rooms with TVs here!).
The medical community is much more sophisticated than
I had suspected. It turned out the anesthesiologists there were doing
heart and liver transplants, using sevoflurane (but not desflurane) and
doing thoracic epidurals for post-op thoracotomies. My Department Chairman
was an MD, PhD who was interested in having her residents speaking English
on a daily basis (to facilitate entry into the European medical community),
teaching in a less didactic and more "interactional" format
than was the older tradition of lecturing in the university, and exposing
her staff to the current situation in the US vis-a-vis research issues
(e.g. IRB protocols, consent issues, funding, etc.). I was provided an
office with internet access, welcomed into the operating rooms, offered
unlimited access to the university facilities, and invited to many social
gatherings (opera, art exhibits, parties, hiking on weekends and into
the residents' and faculty homes for dinners). Fulbright Fellowships in
Slovenija are seen as quite an honor, and as a recipient I was treated
with much greater respect than I get in Denver (e.g. I was introduced
to the President of the country and the Mayor of Ljubljana)! The charming
city has a lovely river in the middle of town, a castle, a university
(30,000 students!), and lots of history. It's neither Paris nor Prague,
but then where in Denver would I sit with junior faculty and their families
on a Saturday afternoon having wine in an outdoor café along the
river…
My research project fell through when the US company making
a pulse oximeter-like device to measure carboxyhemoglobin couldn't get
the accuracy within an acceptable range and called things quits just before
I departed to Slovenija! Unfortunately while six months seems a long time,
it almost takes that long to get acquainted with everyone and learn how
their system works. Had I been there longer I could have set up another
project, and gotten it going; nonetheless I'm helping them write a paper
on treating trauma that we hope will be published in the American literature,
and I reviewed several of their manuscripts for submission to English-language
publications.
While I did not physically practice anesthesia by myself
(I didn't speak the language and I didn't want to be used as a warm body
cranking out cases!), I was teaching side-by-side with the residents and
faculty pretty much like I would in Denver. They would ask how I would
do things and how the "system" was similar or different in the
US. One example is that tonsillectomies in Slovenija are a three-day affair,
coming into the hospital the day before surgery and staying the night
after! While at first this seemed very inefficient, it was actually quite
pleasant not having to deal with late arrivals or no shows, nor having
to deal with NPO or URI issues at the last moment and having desired laboratory
data readily available…). Depending upon the trainees' level of experience
I would adjust my teaching accordingly e.g. talking about MAC of various
anesthetics in children of different ages with some, and about hypotensive
techniques during spine fusions with others. I would discuss some of the
more important papers in the American and English-language literature
about pediatric anesthesia that they may not have had available, and get
them to be more comfortable with discussing issues in English (which they
had studied and could read the literature), but usually did not speak
very frequently. I also did lots of case-study types of teaching e.g.
a two-month-old ex-preemie with hernia or a three year old with obstructive
sleep apnea for T&A… And of course I would toss in other pediatric
variables like having Duchenne's muscular dystrophy or WPW syndrome! It
was exactly what I had been doing "back home", but I felt a
lot more enthusiastic here. Of course I had to plead ignorance of the
literature in the other languages that they read easily (e.g. German,
French, Italian, etc.) so it became an interesting "give and take"…
While I was in Ljubljana doing my Fellowship, a Slovenian
woman Ph.D. in Civil Engineering was in Colorado doing her Fulbright at
the University of Colorado. We met both in Slovenija and Colorado, and
I had lunch with her mother (a lawyer) who had also done a Fulbright at
University of Wisconsin during the 1960s! It becomes a very small world;
two of the physicians in Ljubljana had completed Fulbrights in the US,
one learned to do liver transplant surgery and another interventional
cardiology. There is also the option to encourage physicians overseas
to use the Fulbright Program to join your Department for their training!
I'm happy to chat with anyone about the Fulbright program
that worked very well for me and the other Fulbright Fellows in Slovenija
during my time there. Specifics on the general program can be obtained
off the Internet or by email or telephone from the people who run the
operation (CIES staff). For me this was a very appropriate and pleasant
experience, and I would recommend it highly.
Adijo!
John E. Morrison, Jr., MD, FAAP
The Children's Hospital, Denver
Klinicni Center, Ljubljana
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