I was contacted by Dr. Alireza Haghighi in December on behalf of NIKI to invite me to be part of the 2008 NIKI visiting international faculty. Several e-mails followed shortly afterwards with regard to paperwork to apply for and obtain an Iranian visa. Paperwork done and returned, further questions about the trip and safety in Iran were all promptly answered via cyberspace and he also made himself available on the telephone to answer queries. We were asked to make our own travel arrangements and keep receipts, which worked well and our individual requirements were accommodated as much as possible. Visa was finally issued on the 1st page of a new Passport! And so it was that after working all day Friday, I left in the early evening for London’s Heathrow airport tired knowing that I would get little sleep on the airplane. Luckily I got a good seat with some legs-pace to stretch out and arrived in Dubai early the next morning and only just made my connecting flight to Tehran.
I was met by my driver Zia at the airport. Zia spoke a little broken English and promptly drove me for an hour to get me straight to Shaheed Beheshti University in the hills overlooking northern Tehran with snowcapped mountains behind, stopping once to buy me a bottle of cold water to refresh myself with.
On arrival, I joined a meeting of the NIKI faculty with our hosts at Shaheed Beheshti Medical University where each of the visiting faculty introduced themselves in turn and gave a summary of their background and special interests and how they might collaborate with counterparts at the University. We then went on to have group photographs and were presented by the President of the University with artisanal gifts (framed silver plated handcarvings, a specialty of Isfahan) and a book of the history of the University. Over a pleasant lunch thereafter, each of the visiting faculty met with their local counterpart and specialty hosts, and I was delighted to be introduced with Dr Nasser Simfroosh. I found him to be an energetic dynamic and hard working individual and he asked me to be present early the next morning in the operating room to observe a laparoscopic donor nephrectomy and several other smaller cases. We then retired to our hotel, where I was able to freshen up a little.
I was the driven by Zia to Labafi Nejad Hospital, which was a relatively modern facility housing the Department of Urology. There, I met the Hospital director and my host Dr. Simfroosh and after some refreshment, was taken to the operating room just in time to observe the critical aspects of the laparoscopic donor nephrectomy and see the recipient receive the kidney which pinked up immediately. Dr. Simfroosh is a world authority in live donor renal transplantation as I learned later, and an excellent technical transplant surgeon with advanced laparoscopic skills. He has an excellent team and a large number of fellows and residents from all over Iran. Later that day, I was asked to give a lecture on Retrograde Intra-renal Surgery in a modern lecture theatre. This was followed by a short video-presentation from my host on laparoscopic staghorn stone surgery and an interesting interactive discussion followed on both topics with the rest of the faculty, residents, fellows and students. During this time, I also met both Dr. Basiri (head of the Iranian Endourology Society), and the first lady to qualify as a urologist in Iran. I congratulated her on her achievement and she informed me that there were approximately 40 others now in Iran just like her.
At the end of a fulfilling day, I was thanked by my hosts and driven back to my hotel. That evening, we were driven to a lovely restaurant in the upper hillsides overlooking Tehran where the climate was cooled by mountain breezes and here, I got to know some of my fellow visiting faculty members a little. Since Iran is an alcohol free nation, we were able to celebrate our arrival with non-alcoholic beer!
On Monday morning, we were grouped together and driven to the University for a presentation ceremony celebrating the achievements of the faculty and here, the NIKI organizers and program were introduced to all attendees. I was impressed that the highest achieving faculty members are celebrated in this way every year at Shaheed Beheshti and rewarded with gifts. This is not something we often see in Western Universities.
After lunch, we were able to walk around the special university departmental science fair to see for ourselves some of the diverse projects under way in various departments of the University. Later that evening, we mixed with our hosts and the Dean and faculty of the University at the University Faculty Center for dinner and further discussions took place (in my case about the morality, practicality, and pragmatism of citizen-to-citizen live unrelated donor kidney transplantation, a novel national program instituted by Dr. Simfroosh).
The next day, I was up early to visit Dr. Simfroosh’s department again and went to the operating room, this time to meet and mingle with the fellows and residents and some of the younger faculty members. We discussed a challenging stone case that was about to be operated on and I was able to share some problem based learning with them while the surgery was taking place. I was then asked to sign and comment in the official visitors’ book by my hosts and this was followed by group photographs. I returned to Dr. Simfroosh’s office to discuss future needs and collaborations, while his secretary compiled some of his more important publications in International Urology Journals and some of his operative videos. He also gave me copies of the Iranian Journal of Urology, which he and Dr. Basiri edit and started.
We agreed that I would help some of his residents attend educational activities run by the European Association of Urology. I also offered to help mediate regional contacts with prominent academic urologists in both India and Turkey so that they could be involved in academic and research programs and projects beyond the confines of Iran. We also agreed to try to develop short exchange visiting programs for each others’ younger colleagues, so that each could learn certain sub-specialist techniques from the other. He also told me of the hospital’s plans to develop a daycare diagnostic facility and I was able to share with him my experiences on the benefits of a daycare diagnostic and treatment centers, flexible endoscopy and of multidisciplinary working.
We parted with warm goodbyes, happy in our new friendships and with a strong desire to establish future collaborations, realistically with small steps first and to build momentum from there.
Zia, who had waited patiently for me then drove me to Tajrish Hospital, also affiliated to Shaheed Beheshti University in Tehran. There, I was greeted by Dr Jalil Hosseini and his faculty in the Department of Urology. I was given presentations from each faculty member about their activities and research projects and was asked to critique them in a constructive manner. The department obviously had strong leadership and a diversity of ages and talents amongst its faculty, along with keen and articulate young residents. We finished the session with a short talk from me about my role in education and developing research under the aegis of the European Association of Urology Research Foundation. We then said our goodbyes and over a brief lunch on my way to the airport, I sat with Dr. Hosseini and one of his young colleagues who had trained for a time in Paris, and discussed ways in which I could help the Iranian Association of Urology, which Dr. Hosseini heads, both with regard to their upcoming annual meeting and finding a speaker from Europe in Andrology and Infertility, and with regard to establishing a database of current research activities in and profiles of the top dozen or so university urology departments in Iran. In this way, it may be possible to then involve them in future multinational clinical trials which may be developed through the European Urology Association Research Foundation. All too quickly, it was time to leave once more and after making our goodbyes, Zia drove me to the domestic airport in Tehran to meet up with the rest of the NIKI international faculty so that we could make our way to the northwestern city of Tabriz.
On arrival late in the afternoon, we were greeted at the airport by staff from Tabriz University and taken to a very modern hotel for our stay in Tabriz. The trip from the airport to the hotel took in some marvelous surroundings with red sandstone hills and snowcapped mountaintops in the distance. After a short walk to explore my hotel surroundings, take some pictures, and enjoy some fresh air, we gathered for dinner in a revolving restaurant atop the hotel and some more important faculty bonding sessions.
The next morning, I was taken to the Urology department at Tabriz University Medical Centre to meet members of the department. Once again, there was a live donor nephrectomy taking place in the operating room, done by one of Dr. Simfroosh’s protégées who had recently joined the faculty there. After an introductory session with the senior staff, I met the chief resident, learned a little about the residents facilities and training, and then toured the department to see some interesting and challenging cases where my opinion on management was sought. We had a frank exchange of ideas and practices in urology, particularly focusing on areas of innovation and specific expertise, and current research and teaching. I met another female qualified paediatric urologist. Once again, a large focus of the department was renal transplantation, reconstruction, and stone disease, while there was little in the way of Day Care Surgery and flexible endoscopy, which should be an area for future development.
The next day (the first day of the weekend in Iran), I returned early in the morning and gave lectures about the future of minimally invasive and natural orifice stone surgery of the upper urinary tract as well as about multidisciplinary team working in management and research for patients with urological cancer to a packed house. I also provided insight into training and educational activities available from the European Association of Urology. I was exposed in return to a good discussion around all my lectures’ content and an enthusiastic audience which included a bright and articulate young local medical student who had contacted me in advance while in the UK by e-mail about a potential novel hypothesis and related research project relating to prostate cancer.
Later that afternoon, we gathered for a de-briefing session with the University Chancellor and senior colleagues which was long drawn out round table affair with an opportunity of each of the NIKI faculty to feedback on their impressions of their visit to Tabriz University.
After a relaxed informal visit to the Bazaar where we tasted (and in my case bought) some famous Tabriz honey, a famed local delicacy, we had a relaxed informal dinner that evening. The next day was the end of the weekend and a well deserved day off for sightseeing which took some of us into the high country and lunch at an interesting hotel next to beehive-shaped dwellings carved into the mountainside called Kandovan.
Unfortunately for me, my visit was cut short by the need to return to the hotel and pack for my return to Tehran and on to my international flight back home the following day, so I had to make hasty goodbyes to my new NIKI faculty friends and in particular Dr Alireza Haghighi and Dr. Mohammad Farivar, without whom this wonderful unique trip would not have been possible.
I am extremely grateful to both of them and my fellow faculty members, many of whom will remain as good friends for years to come. I was also sad to bid a fond goodbye to my driver Zia, who went to great lengths to take good care of me on all our travels together in Tehran.
Soon after my return to London, I was invited to be the guest speaker at the Annual meeting of the Iranian Association of Endourology by Drs. Simfroosh and Bashiri but unfortunately was unable to attend due to a clashing engagement. However, I was able to provide a substitute in the person of Professor Tarik Esen. He is an individual of high standing from the European Association of Urology from the neighboring country of Turkey, and President of the Turkish Association of Urology. I have also recommended a guest speaker from Europe in Andrology and Infertility at the request of Dr. Hosseini for the National meeting of the Iranian Urology Association. Through these and future contacts, I hope to be able to include some academic centers of excellence from Iran in EAU Research Foundation Multinational Clinical Trials.
In the future, I hope to see more trainees from Iran at the annual European Urology Residents Education Program, and to establish short exchange visits in both directions which could be funded by the European Urology Scholarship programs. I have already been pleased to hear that one of the residents I met with has signed up to attend the European Urology Residents Education Program (EUREP), which is free of charge to all attendees and hosted by the European School of Urology.
I found my hosts in both Tehran and Tabriz, were extremely kind and gracious and eager to interact. The overall quality of medical care was excellent, with good scientific approach in many areas and pockets of real expertise that were world class. The days were long and tiring for most of us, but rewarding nonetheless.
I have suggested to all my colleagues in Iran that in the future, there needs to be some work on developing robust databases around clinical care and expansion of innovative research methods. There also needs to be an environment that fosters greater multi-disciplinary team-working, both in the delivery of care and in establishing high quality research projects around developments in basic and clinical science.
Overall, the people of Iran were delightful and very gracious hosts to the whole NIKI group as well as to individuals, and I discovered that the Western "stereotype" of life in Iran could not be further from the truth of the reality I encountered. In many instances, I learned that we all share similar problems and issues in our daily professional lives as well as the wider issues in our respective societies. Young Iranian women seem to have a high incidence of plastic surgery to their noses, an interesting cultural trend which I discovered to my surprise, particularly as most of them are already very attractive despite religious dress restrictions. Moreover, I also learned that up to 70% of the current medical school intake, were young women, which should make for a greater number of future women in surgery!
Finally, I would like to put my hands together and applaud NIKI for the way it had organized this visit for us, the quality of the experience which we have gained from our visit, for enriching our lives with new found friends, and for achieving the goal of establishing key relationships between key individuals from different backgrounds even in short visits, by cutting through a lot of the red tape and reaching directly into the heart of the Iranian University system by direct contact with the Chancellors of major Universities. Keep up the good work my friends and I look forward to our future collaborations for the benefit of all.
