4. 9. 2020 |

The new principal investigator of the research team Kardiovize 2030 of the International Clinical Research Center of St. Anne's University Hospital Brno (FNUSA-ICRC) became Juan Pablo Gonzalez Rivas MD. Congratulations on obtaining this prestigious position, and because the journey of Dr. Rivas from Venezuela to Brno was not easy, we asked him for a short interview. We had no idea how complicated it really was, and without exaggeration we dare to compare it to a Hollywood thriller. Equally interesting and extremely ambitious, however, are the plans of the Kardiovize 2030 team for the coming years. When everything goes as it should, not only the inhabitants of the city of Brno will feel it, but it will have a positive impact on the quality of life of the entire Czech population..

1. From Venezuela to the Czech Republic. This is a real change and certainly not just geographical. What surprised you the most in Brno?
I can say that the biggest surprise is that there was not a big surprise. There are obvious differences between a highly organized country, like the Czech Republic, and a highly disorganized country, like Venezuela, including transportation, security, economy, and so on. Because of the rich history of the Czech Republic, we expected a huge cultural difference with my natal country, but this was not completely true. Czech Republic is highly globalized, you can find in Brno all the products, brands, and services that you can need in America or other parts of the world, this facilitated our adaptation, for example, we found in Brno “Harina Pan®” a pre-cooked white maize product that we use to prepare “arepa” the most typical food of Venezuela.

arepa

Of course, there are different custom between both countries, for example, the since my first Friday in my new job, and then every Friday, my co-workers ask me “what are you going to do this weekend?”, in my country, when you make that question represents that you are planning to invite this person to do something on weekend or you want that this person invites you to share the weekend. “Nothing concrete”, I replied “I’ll be available for any option”, and their answer was “good”. Then, on Monday, “What you did on weekend?”, they asked, and I was thinking “what the hell, why do you want to know? I was expecting your message, and nothing happened”, but I said, “nothing relevant, reading, and working a little bit”, “working?” they say, with surprise! I was a little shocked about two aspects, why each Friday and Monday they make the same question? And why the surprise about working on weekend? Then, I realized that here there are a lot of beautiful places, not only the usual touristic places, but those surrounded by nature that you can visit very often because are very close and cheap. Additionally, there is all kind of diverse activities in downtown that involve beer (Pivo – a keyword in Czech for foreigners) and wine. People here have all the weekend programmed with diverse funny activities. That was the reason for the question, they have a genuine curiosity about your planes on the next weekend, what kind of adventure, very different from work, is expecting you. With time, I started to discover the diverse places around, and I started to do the same question each Friday “what are you planning to do this weekend?”.
When you sum all the different customs you create a culture, and you understand that there are differences with any part of the world, but when you look deep into it, there is not any real difference. I believe that the differences that you will find in other places different than your native country are those that you take with you. We see mirrors, you only see those things that you carry on.

2. How did you find out about FNUSA-ICRC?
That was thanks to the partnership between FNUSA-ICRC and the Mayo Clinic. Jose Medina Inojosa is a Venezuelan researcher of the Mayo Clinic that works in partnership with the Kardiovize project in ICRC, I met Jose doing a meta-analysis and then he shows me the open opportunity in Brno. The needs of the team fit perfectly with my experience and abilities, which facilitate me a lot the integration with the job.

3. Just so we can imagine - what were the formalities of your transfer like and how long did it all take?
You have no idea hahaha. Venezuela is in a humanitarian crisis due to the narco-government that took the power two decades ago, and the opposition self-created a second president, in consequence, we do not have almost any embassy in the country. The Czech Embassy is in Bogota, Colombia, but the frontier between both countries open and close intermittent. To arrive in Bogota, from my city Merida, I had to take a bus ride of 4 hours to the frontier, then cross the frontier to the city of Cutuca walking, crossing the river “illegally” because the Venezuelan frontier was “close”, pay between 500 to 1.000 CK to the paramilitary forces that control the area, so the “allow me” to cross, and then you arrive to Colombia. The first time that I did it, I arrived at the frontier at 4 am, without any light in the side of Venezuela because there was an electric blackout (very common), I pay 500 CK to a teenager and he drives me in his bike to the border, when we arrived, I pay 500 KC more to the paramilitary forces to let me cross, but one of them stop me, they are dressed like regular people, they are a combination between the members of Las FARC (the Colombia paramilitary forces that control drug traffic in Colombia) and Venezuelan soldiers (Now the “military forces” of Venezuela are the main drug distributors in Latin America), and he asked me “are you a cop? Because you look like a cop and we kill cops here”, I replied “If I would be a cop, I could cross the frontier by the bridge, not by the river” After he checked if I was carrying a gun he let me cross the river. Then in Cucuta, you must take the bus to Bogota, around 14 hours more across the Andes. I had appointments for two embassies in Bogota, to the Czech Embassy to came here, and to the US Embassy to attend to the Bernard Lown Program at Harvard for a scholarship that I was awarded. The people working in the Czech Embassy were aware of the two appointments and recommend me contact them after receiving my US visa. After two weeks, I did it, and then my appointment to the Czech Embassy was suspended because the lady in charge was living out for vacations, so they re-schedule in three weeks. I lost my travel to that embassy in that opportunity.
I did that travel three times more, thank God, the frontier was open, and I cross through the Bridge, those three times with my family, however, it is not easy to cross one of the most dangerous frontiers with your family so many times...
On the first picture is my wife sleeping at 6 am waiting for the opening of the frontier, and one of my daughters with her Teddy. Next photo - now, we are in Brno extremely happy surrounded by great people :)

4. In Brno, you work in the field of cardiovascular health in the Kardiovize team. Can you tell us what you are working on right now?
Since July, I’m the Principal Investigator of the Kardiovize team, and we are focused on three aims:
1. Publications of high-quality epidemiologic studies using the most innovative approaches, for example, we are presenting the prevalence of obesity using the new concept proposed of adiposity based chronic diseases (ABCD), this new approach is going to change obesity as we know it, because the term of obesity is highly related to stigma and lack of action from the patient and the doctor to treat more intensively this disease, with the data of Brno population, we are going to be the first group of researchers in the world presenting the validation of this concept. I will tell you more when the publication is ready.
2. Design and execution of intervention programs. We are extremely worried about two components that are affecting the Czech population. One is diabetes, thanks to the improvement in the health care system in the country the number of deaths related to heart diseases and stroke is reducing, but not diabetes, deaths related to diabetes increased by 68% in the last decades. We want to adapt and implement a lifestyle intervention programs to reduce the burden related to diabetes, the pilot of this intervention will be in the first semester of 2021. The second is hypertension, despite the reduction in cardiovascular deaths in the country, around 5900 deaths occur each year in the Czech Republic in subjects younger than 70 years old consequence of hypertension, these deaths can be and should be prevented, and the main reason that is creating these deaths is that 7 out of 10 persons with hypertension in the country are not controlled, we aim to increase the rate of control of hypertension in Brno from 30% to 80% in this decade. We need to design and implement an intensive program to achieve this ambitious goal. Any person in the city, researcher or not, interested in helping us to save thousands of lives in Brno increasing the rate of control of hypertension can contact us, we are in the stage of the program design, we welcome all kind of help.
3. As a highly organized country, Czech Republic is in a good position to help to improve the cardiovascular health of people in developing countries. I’m a Lown Scholar of the Cardiovascular Health Program of the Harvard School of Public Health, we are focused on improving the health of people in underserved areas. Two months ago, we applied for a grant to help people in Uganda to increase the rate of hypertension control. In this country, for every 100 persons with hypertension, 98 are not controlled. A collaboration between Brno and the population of Kizissi in Uganda can contribute to save many lives in this country.

5. A recent article you co-authored on cardiometabolic risk factors in Venezuela. Is there any significant difference between the Venezuelan and domestic populations?
We recently published the results of the EVESCAM study in Venezuela, this is the first national cross-sectional evaluation in the country, we assessed 3420 subjects (https://doi.org/10.1016/j.pcd.2020.07.006). It was a wonderful experience.
The comparison between Venezuelan and Czech Republic shows interesting differences, because both countries are exposed to different levels of environmental stressors, and a huge different health care system. Brno population tend to show better cardiovascular health than Venezuelan population, mostly driven by better dietary and physical activity habits. When we analyze in more detail, Venezuelan women tend to be more obese than Czech women, however, Czech adults show a higher frequency of high cholesterol and higher prevalence of smoking habits.
These differences express huge health inequalities between both populations, and its analysis help to understand the aspects that can be improved in both populations.

6. What are your plans for the future?
This September 2020 I’m having my first year in Brno and FNUSA-ICRC, this year was mostly about adaptation and help to the team to clarify ideas and provide them tools to release all their potential, you did a couple of interviews to one of our youngest members of the team and she reflects how we are improving things. Now, we are a strong team with clear goals. For 2021, we plan to implement the pilot interventions in the city commented before, to continue with the publication of high-quality papers, and expand our network worldwide. If everything goes to the plan, in 2025, Brno patients with obesity, prediabetes, and diabetes will have access in diverse places offering lifestyle programs based on the best scientific evidence, with this they can let behind these diseases. Can you imagen the face of some of your friends living in Brno that is diagnosed with type 2 diabetes and you can tell him “in Kardiovize we have the program to let behind this terrible disease” that will be great. In that year, the face of hypertension in Brno will look different, we are planning to surpass the rate of control of 60% by then.

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