UPDATE! Surgery on the Shoulders of Giants: a review and an article on Global Health

“And I have sat silently, gazing up at this night sky, counting endless and uncountable sparkling stars as they greet me one by one, palpating the infinity of the universe beyond and accepting my place in it.”

This is not something that one would typically expect to find in a book detailing the journey of a doctor as they progress through their rewarding, yet stressful training. For this reason, Surgery on the Shoulders of Giants, a wonderful book by Saqib Noor, is unlike any other medical text that I have read before.

Saqib Noor is a qualified orthopaedics and trauma surgeon, and the book features a collection of letters, detailing his travels abroad for both emergency support after natural disasters and for development work. He describes the hard work and commitment that he and numerous other incredible people (from health workers to the leaders of charitable organisations) put into the projects that aimed to improve the lives of the impoverished patients of the area (whilst remaining incredibly humble about the achievements). On the other hand, the letters also act as an account of the immense emotional toll and frustration that comes along with working in emergency situations abroad, where donations are an important source of equipment and patients often present to a clinic when it is too late to successfully treat them. The use of language means in some instances, the despair is palpable and one feels that all hope is lost. This is reflected well when Noor writes:

“How do I tell our patients they deserve so much more than they ever got or are ever going to get?”

Noor explains that in many of the countries he travels too, the lack of sufficient supplies and equipment that we have access too here in the NHS means treatment is difficult. But to counter this, the book also shows how human spirit, compassion and never giving up means that the incredible health care staff talked about in the book provide what they can for patients to make them as comfortable as possible. In this sense, the book is incredibly warming.

‘Surgery on the Shoulders of Giant’ is made even more amazing by Noor’s descriptive ability. It makes feel as if you are following him on his journeys. The letters intricately depict his travels, from the violent cases he sees in the trauma rooms of South Africa, to the vibrant and optimistic nature of tuk tuk drivers in Cambodia (there really is a range of emotions, people and settings in this book!). The animated nature of the countries he describes so well is almost palpable with the amount of detail that is included. His tales of the cultures and cities he experiences, interspersed with the medical cases, is something that makes this book a truly unique and enjoyable read.

Whilst heartbreaking at points, this is an overall uplifting read, with Noor’s words providing comfort and belief in love and the goodness of people. For me, this was a breath of fresh air – with incredible and often poignant cases described, nuanced with gratitude and humbleness. The book provided me with a lot to think about as I progress through medical school, however, the majority of the ‘lessons’ here apply to everyone: the importance of words and comforting those who are distressed; the importance of not taking those we love for granted; a reminder of how life can change in one split second – all of these are prominent themes that are extremely important in this crazy world.
Medical books often have a very specific focus on life changing moments from a doctor’s career, and whilst I thoroughly enjoy these books and their stories of woe and joy (this book also included such narratives as stated above), I loved how this book examined the bigger picture, incorporating philosophical themes, such as the fragility of life and the human spirit. One particular quote that stuck with me throughout the whole of the book was this:

“I have learnt our lives are fragile and therefore they are precious. I have learnt your life and those of the ones you love must be cherished, as one just never knows when it may change.”

This book is an absolute must read for everyone, as it delves into thought provoking topics that will make you feel hope, joy and sadness. I would whole-heartedly recommend this enriching book, and in fact I think I will be reading it again in the near future (that is how much I enjoyed it).

Hello everyone, I hope you enjoyed my write up for this wonderful book. Just a quick disclaimer, I was sent this book to review, however, all of the ideas in this are my own and I can honestly say that this book was a very enjoyable read.

Until next time, Catherine.

UPDATE: an article by the author Saqib Noor

Title: Global surgery and the global medical student

Over the last few decades, the emphasis on surgery within medical school curricula has been slowly fading with more focus being placed on community healthcare and a shift toward general practice(1). Once occupying a significant portion of the undergraduate timetable, surgery and the art of the scalpel has been largely relegated to a niche post graduate speciality. A recent study suggests senior medical students do not possess simple surgical and procedural skills (2).

Although workforce patterns and demand in the western world seemed to have gently pushed students away from a career in surgery, there is a global healthcare crisis within surgery that has for many years been under reported, neglected and now in a deep, chronic stagnation.

It was the Lancet Commission on Global Surgery (2) which finally lifted the lid on a plethora of heartbreaking surgical statistics across the world. 5 billion people in the world lack access to basic, safe, affordable surgery whilst many impoverished people are bankrupted if they undergo any form of surgical treatment. Surgically treatable conditions account for 30% of the global burden of disease yet there is a manifest lack of trained surgical and anaesthetic providers worldwide, along with a dearth of robust surgical facilities in large swathes of the world, resulting in an overstretched, under resourced surgical capacity. The surgical system is not at breaking point, for it is already broken, and has been for many years.

There is however a growing movement to resolve some of these discrepancies, not just by the traditional good will of surgical ambassadors doing what little they can with what little they have, but a government led, international level commitment, powered by the World Health Organisation to resolve some of these issues by 2030.

I qualified from medical school in 2004 and have been fortunate to pursue a career in orthopaedic surgery, whilst gaining some real exposure to some of the appalling statistics of global surgery described earlier. Small projects during natural catastrophes in Haiti and Pakistan in 2010 as well as longer visits abroad during my surgical training has broadened my understanding of the magnitude of this clinical and social inequality. During my medical school years, I was never quite taught how to operate only using mobile phone light, to reuse the same gloves because of a chronic shortage in the hospital or how to remove flying insects from the alleged sterility of an operating room. When we learned about communication skills in medical school, we were never taught how to counsel patient with tumours the size of footballs or injuries so needlessly neglected there was no treatment other than amputation. However, these scenarios are occurring across the world every day and it is only with the commitment of multiple governments and surgery focussed healthcare professionals will significant improvements be made. A passionate group of medical students are also providing much needed energy and focus with a number of initiatives, with organisations such as Incision and Global Surgery Student Alliance leading the way.

Perhaps exposure to surgery in medical school will continue to fade with this current trend and perhaps it is true that with more advanced surgical techniques and less opportunities for students to scrub in, the attraction of a career in surgery will never be as palpable as it once was. But without doubt, there is a massive worldwide need for safe surgery that urgently needs to be addressed, and even if its not within the current medical school curricula, I would urge all medical students to spend some time delving deeper into the issues surrounding global surgery and perhaps for the inspired few, develop careers in surgery and anaesthesia, with the aim to become future leaders in solving this crisis.

References:

1. Agha RA, Papanikitas A, Baum M, Benjamin IS. The Teaching of Surgery in the Undergraduate Curriculum—Reforms and Results. International Journal of Surgery. 2004 May 1;2(2):74-6.

2. Davis CR, Toll EC, Bates AS, Cole MD, Smith FC. Surgical and procedural skills training at medical school–a national review. International Journal of Surgery. 2014 Aug 31;12(8):877-82.

3. Meara JG, Greenberg SL. The Lancet Commission on Global Surgery Global surgery 2030: evidence and solutions for achieving health, welfare and economic development. Surgery. 2015 May 1;157(5):834-5.

Author: Saqib Noor is an orthopedic surgeon who blogs at his self-titled site, SaqibNoor.com. He is the author of Surgery on the Shoulders of Giants: Letters from a doctor abroad.

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