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“End practice on live patients!” – Interview

Hungary Today 2018.04.05.

Dr. András Csókay, the name of a globally recognized expert that has become renowned in recent months, has caught the attention of many readers, especially in Hungarian press coverage, due to his preparation to separate Bangladeshi conjoined twins, though he already entered the history of academic medicine long ago with his innovative techniques. Csókay, who returns annually to Nigeria as a missionary, spoke to us about the relationship between faith, science and creativity, the desensitization to death experienced by doctors, as well as the Hungarian healthcare system’s most excruciating illness: gratuity money.

This interview has been edited for concision and clarity and translated from the original Hungarian.

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photo: Péter Csákvári

Professor, in February of 2018, you joined Drs. Gergely Pataki and István Hudák, to undertake the separation of the Bangladeshi siamese twins that were conjoined at the head. This proved to be a unique feat across the globe, considering that only you volunteered to carry out the task. Why could this be? Is it because doctors in other countries did not possess – as stated in an earlier interview – the “Mozart virtuosity” necessary to perform such an intricate surgery?

While it may have appeared this way in so many places, the wording should be clarified. Presumably, we were the only ones who showed willingness to perform the surgery in a hospital in Bangladesh, because the parents did not want to leave the country. Elsewhere, they would not have been able to pay the institution the cost of the procedure. The twins were on the Web for a relatively long time but they hadn’t contacted us. When we accepted the procedure, three things occurred to me: what if, unlike the previous ones, we would separate the common carotid artery with an intravascular solution? You should know that this is usually the biggest problem of this type of surgery, because separating the brain is already a very difficult task, but separating the common carotid artery may result in a major stroke or bleeding, which may result in death. My second thought was about the world- renowned specialist who is known for approaching the brain through the cerebral vein, who is none other than my colleague, Doctor Hudák. My third thought was of the special microsurgical technique that I developed nearly ten years ago, that can completely overcome the physiological shaking of the hand. This allows for the separation of the brain, and the cerebral microvessels to be carried out very precisely. After several months of planning, we traveled to Bangladesh on the 25th of February, where, after a daring three, then five-hour surgery, Dr. Hudák successfully separated the twins’ venous circulation.

What are the chances that they can live a full life after separation?

It is difficult to forecast, but I think there’s about a 50% chance of survival, which is still terrible, but better than the previous 70-80% mortality rate. If they remain conjoined at the head, they risk subjecting themselves to such a psychological burden, that would make their life extremely difficult. The Iranian conjoined twins withstood thirty-four years together, but in their deep depression they tried to commit suicide, before finally they agreed to the separation surgery. They died during the procedure.

Taslima Khatun with her conjoined twins, Rabia and Rukia (photo: Abir Abdullah / EPA)

According to your biography, you originally studied civil engineering, even began your career in this path, but later enrolled in medical school and eventually took the neurosurgery exam at the age of 38. What was the main motivating force for this change?

Healing was my childhood dream, but I did not dare to apply to medical school because I was afraid they would not accept me because my grades in biology were poor and because I would be drafted in the army for two years. I was young, these things are to be expected. I applied instead to the Technical University, where I completed my degree, but I could not find my place in the profession. Over time, as I became a more serious, I realized that I wanted to be a doctor. Relatively late, at the age of 33 I completed my studies at medical school, and I was 38 years old when I took the neurosurgery exam. I was deficient in experience for my age, but maybe by now that has changed. If you go to a major world conference, you encounter a vast number of highly respected professors who have so much experience and an inconceivable number of surgeries in their repertoire. In this case, one would probably say to himself, “my God, how can I compete with that?!” Well, that was especially true for me, as I was eight or nine years behind schedule. But since I had been regularly  operating on freshly deceased cadavers for the past 15 years, that routine, which I got out of the most difficult situations of Cadaver practice, was able to provide me with a lot of experience in innovation, as well as in brain surgery.

photo: Péter Csákvári

You completed volunteer missionary tasks in Nigeria and in Bangladesh which is considered to be a relatively rare thing. On what basis do you decide where you will offer your aid?

The fact that I could visit these countries is the result of my prayers being answered. In 2016, when I visited Medjugorje in Bosnia and Herzegovina – which is where the modern day apparitions of the Virgin Mary occured – I met a Nigerian Father and we prayed together, then we spoke much of the country’s situation. It became clear as day that there are huge problems in Africa. Let me share with you some details: 70 neurosurgeons are allotted for Nigeria’s 200 million inhabitants, while 120 are for Hungary’s population of 10 million. For Europe’s population of 500 million, the skills of 10 thousand neurosurgeons are at the ready, while the 1 billion 200 million people of Africa have to rely on 488. It’s astounding. Not to mention the need to pay for the very poor quality of Nigerian public health, so the simplest brain surgery costs $300, and a CT scan costs $100. People cannot pay this amount. However, until someone puts down a deposit, they can not get any attention. They’re left to die. It’s dramatic.

So was it for religious reasons that you began your travels?

There is such a thing as a calling. This is a kind of inner voice, which I call the voice of the Holy Spirit. He called me to organize a mission there. By now I’ve volunteered three times in Nigeria, each time for two weeks. Meanwhile, I tried to organize an international team using motivational, encouraging letters that I sent out to five thousand neurosurgeons. I even pinned these flyers in congress buildings, but I see the European medical profession is having a difficult time stepping out of its comfort zone.

What is the reason for all of this?

The terrible problem of the whole of Europe, is that it left Christianity. European doctors say to themselves, “Why should I be the one to make a sacrifice? Am I’m stupid? I go to Nigeria and put myself in danger too? Why would I do something like that? “This is the problem. Europe has forsaken the love of serving others, because it has thrown away Christianity. It is characterized by lack of empathy, selfishness, and loneliness. This is true of parenting as well. If this birth rate keeps up, mathematically, the last European will die in 400 years, while the last Hungarian will die after 200 years. In Europe, it’s not the denial of God, but the indifference towards God which is most troubling.

As a healthcare professional,  how are you able to synchronize religion with the cornerstones of your profession, such as proof of principle, supervision, defined authority, rationality, and empiricism? Can the two be separated from each other? Where can you draw the line between them?

Science does not create, but rather belongs to the created world. God creates, as He created science by creating man, who becomes familiar with the created world. A very simple example: did vitamin C exist before Albert Szent-Györgyi discovered it? Of course. Were there X-ray beams before people began studying them? Sure. The scientist cognizes the world around him. Saint John Paul II said during his visit in 1991 to the Budapest Academy of Sciences, that science and faith cannot contradict each other, because they seek to learn the same ancient truth, only by different means. To me this means that if I act according to my faith and maintain deep prayer, then it will help me to get deeper and deeper into the depths of my soul. In me, just as in every person, there is the image of God. This is true regardless of whether we are talking about a Hindu, Buddhist, Christian or non-believer. The deepest truths about living don’t originate only from faith or a moral standpoint, but also arise from scientific truths. The same can be said about the meditative process. Intuition and creativity comes from the same depths that people get to through prayer. This is why a lot of my good ideas come during prayer. The surgical innovations or the vein-tunnel technology was born during rosary prayers or the Jesus Prayer, not when leafing through biomechanical or neurosurgical books. But it doesn’t only spring from religion; there are situations when hearing a fantastic piano concerto can bring about such a spiritual spark that will allow one to enter a deeper truth, and come to a realisation about, say, his marriage, or for example, a workplace problem.

“We have to end the gratuities with fire and sword” – he said to the InfoRádio, and added that “the reason that young people leave for manual labour is not because of the salaries, but that there are not enough opportunities to perform surgeries.”  The Markusovszky Lajos scholarship has existed for 7 years, which provides wage supplements to medical residents. In your opinion does this help to remedy this problem?

Unfortunately, we are still at square one, and it cannot be eradicated with fine words. Eradication is a painful process, but in the long run it will have huge benefits for sure. Allegedly in Spain, using enhanced supervising and monitoring, they could put an end to it decades ago. We could achieve the same with actor patients. Gratuities inhibit education, teaching, and it creates a hierarchy in a negative way.

It seems to me that the professors and the chief medical faculty are the main obstacle preventing it from being eliminated, because they have the biggest interest to maintain the current system, although everyone personally protests against it. Unfortunately, the upcoming generation cannot help it either, because the newcomers get into this cycle as well.

It is obvious that if there was no implicit behavior, then the whole system could find balance, and would work in a way just like in the times of Hippocrates, but many people fail at a moment of temptation. From that point, like a crazy fatal poison, it makes people vulnerable in healthcare. We have to add that a Hungarian physician cannot ask for the same salary as an Austrian colleague. Realistically, it could be expected to have a salary of one-half or one-third of that, but obviously they do not earn that much either.  If a nurse would earn five hundred to six hundred thousand Forints, then they would not care how much the nurse in the neighboring country takes home.

photo: Péter Csákvári

Our healthcare system is receiving numerous criticisms from the whole spectrum, from the opposition and from experts. Some of our hospitals reach the Austrian level of quality; others seem to be the remnants of the nineteenth century. Would there be a problem if the eight years of leadership and the two-fold two-thirds of majority persists?

You can always get a grip on the healthcare system. Huge developments and improvements have taken place in the rural areas, but it is undeniable that the Central Hungarian region is lagging behind, but I see that it’s going to change. There should be a progression in everything, including health care, but it has to be taken into account that there was a terrible system for fifty years, after which Antall just began to make changes when the Communist party came back; and then the achievements of the ’98 Christian-conservative leadership have been destroyed again since 2002. In other words, overall the nationalist-Christian leadership was able to strengthen and lead the country just a little. I predict huge chaos if the opposition wins again, but it would be very important for Fidesz to be purified, because many anomalies occur.

On March 15th you received the Semmelweis Ignac Award as recognition for your high level of achievement in preserving health, preventing sickness and work in the fields of healing.

Sometimes we are not exactly sure why we receive an award, but in this case I am somewhat certain: as Semmelweis made his discoveries with autopsies in the morgue, this prize binds me to the autopsy rooms as well. My great plan was- and I worked on this for the past 15 years- to bring European medicine back to the autopsy rooms, especially in the difficult, manual field, and to stop practicing on living humans.

It is just as natural that an athlete trains every day, as it is for a violinist to practice everyday.

Of course, there are some manual fields, which you can learn from an assistant’s point of view. If someone cuts into an intestine or an aorta accidentally, the older colleague is there to help you, and there is time and a way for him to sew, or correct the mistake, so that the patient is not impaired. However, there are professions, such as cerebral microsurgery, which are a one-man job. If you make a mistake, even if you have the world’s best specialist beside you, you will not able to rectify the error. In these fields it would be desirable from both the patients’ and doctors’ point of view, if we were able to end the tragedies because of the “learning curves” and training times. The autopsy room could save us from these, where “ death gladly helps save lives”. But why are the autopsy rooms empty? How come Leonardo DaVinci was so interested in anatomy that he took home the dead, as did Michelangelo, even though they were not doctors?

What has happened is that the European and the American doctor is afraid of death, because they’ve lost their relation to Christianity. Indeed, in a morgue, where the doctor is practicing on the deceased, who is serving to teach the doctor, what are they thinking about? They think about death, about passing away, which is not a good feeling, unless they feel in their heart the Resurrection. And they can receive this only in the mystery of deep prayer.

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Reporting by Balázs Horváth

Translated by Gergely Edward Nagy


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