NIKI 2008 REPORT

 

It was a privilege to be invited by Dr Alireza Haghighi to participate in the NIKI April 2008 Academic trip to Iran.  My acceptance came easily for two reasons.  Firstly as a Plastic and Reconstructive Surgeon with a subspecialist interest in microvascular breast reconstruction I was personally interested to see how women diagnosed with breast cancer were managed, particularly in terms of reconstruction. Secondly as an Iranian woman who has trained in the United Kingdom I was excited at the prospect of having the opportunity to understand the Iranian healthcare system first hand and be able to offer my experience and services where possible.

 

The two week academic trip was very well organised and during this time we visited three universities; the Shahid Beheshti University of Medical Sciences (SBUMS)in Tehran and the Tabriz University of Medical Sciences  (TUMS) and the Arak University. On our first day we attended a nationally televised welcoming ceremony hosted by SBUMS. Each of the NIKI faculty (40) participants gave short presentations of their speciality which served a dual purpose. It allowed our University counterparts to identify the individuals they would like to collaborate with, as well as giving us an excellent opportunity to meet our fellow international faculty members, some of whom are world leaders in their area of expertise.

 

Following our presentations I was introduced to Mr A Afsharfard a Vascular, Breast and Reconstructive Surgeon at the 15^th Khordad Hospital and Professor P Mafia Head of the Department of Plastic Surgery at SBUMS, and was invited to visit their respective departments. The following day with two of my NIKI colleagues form Germany we went to 15^th Khordad Hospital where we were met by Mr A Khalantar Hormozee. We were shown around the hospital and I was delighted to meet the Heads of Department, Residents, Interns, Nursing Staff and particularly the Patients. The 15^th Khordad Hospital is fairly modern with a large Plastic and Reconstructive Surgical Department incorporating the only government subsidised Aesthetic Surgical Unit in Tehran. It immediately became evident that they provided a comprehensive range of high quality expertise from complex craniofacial reconstructions to the most common aesthetic procedure in Iran – rhinoplasty. Reconstruction for congenital anomalies forms a large bulk of their workload as a result of a high number of interfamily marriages between 2^nd degree relatives. From an aesthetic perspective the prevalence of rhinolplasties in has been extensively reported in the media with 35,000 procedures having been performed last year. In fact on the streets of Tehran rhinoplasty seems to have become somewhat of a fashion status symbol, with young girls and boys donning their nasal splints. The 15^th Khordad Hospital is also an academic leader through the pioneering work carried out in its Plastic Surgery Research Unit. They have recently developed an autologous fibrin glue which is currently undergoing clinical trials.

 

 

As part of the timetable I participated in grand rounds at the University where were we had to opportunity to discuss the management of some challenging cases.  I was invited to deliver my lecture entitled “An overview of breast reconstruction”. This generated a lot of discussion predominately focused on the areas of their practice that could be further developed and refined. We identified that their multidisciplinary team needed to be more comprehensive with the introduction of a breast care nurse and that all women diagnosed with breast cancer should be offered immediate breast reconstruction when advisable. In addition the reconstructive service could be further expanded in the area of microvascular autologous breast reconstruction. To assist in the development of these areas we hope to establish short observership programs for Surgeons and Nurses at our Plastic and Reconstructive Surgery Unit at St Thomas’ Hospital in London. 

From Tehran the NIKI faculty flew to Tabriz where our visit was hosted by the Tabriz University of Medical Sciences (TUMS), a public medical sciences university. TUMS operates over 10 teaching hospitals and is a major medical care provider in East Azarbaijan  and the surrounding provinces. During our 3 day trip I visited Seena Hospital with my colleagues from Germany. Seena Hospital has both a Plastic and Reconstructive Unit and a very impressive Burns Unit with Intensive Therapy Unit, a High Dependency Unit, as well as Paediatric and Rehabilitation facilities. Again I had the opportunity to take part in a ground round on the Burns Unit and was extremely impressed to see their protocol for the acute and chronic management of burns. Impressively they quoted low infection rates and with the implementation of stringent antibiotic protocols were able to minimise the development of multi resistant organisms. The Head of the Unit had organised an academic morning (supported by continuous medical education (CME) points) where we presented our lectures. This produced a great deal of discussion since the breast reconstruction service at Seena was still in its infancy and seeds were sewn to assist its further development. I was honoured and surprised to see how my presence as a female Plastic and Reconstructive Surgeon generated excitement and motivation amongst the female Interns, who were aspiring to follow a career in Plastic Surgery. They sought career advice and in particular reassurance that the path they were pursuing was worthy of the sacrifices they were making. I could only respond in one way “If I had my time back I would do it all over again!”

 

 

 

At Tabriz University Professor Mike Larvin, Mr Steve Nixon, Mr Asif Haq and I were honoured to set up the first Basic Surgical Skills Workshop based on the Royal College of Surgeons of England model. This was headed by Professor Larvin who is the Royal College of Surgeons of Englands Surgical Tutor. Tabriz University has a very modern and sophisticated surgical skills laboratory where ALS, PALS and Venipuncture courses have been well established. This process was particularly rewarding because of the enthusiasm of the participants and the Head of the Surgical Department. Following our visit this essential course will be further developed and integrated into the Surgical Training Program. We are hoping to revisit Tabriz University next year to ensure that this process has gone smoothly and help with any teething problems they may have experienced. In addition we can work with them to set up more Specialist Training Programs.

 

 

 

 

 

 

Following a short return to Tehran we were back on the road heading to Arak where the University of Arak hosted a half day academic program for their faculty and trainees in our honour. The NIKI team delivered their key note lectures which were very warmly received and generated a lot of discussion. I found this particularly interesting as it was the first time we had the opportunity to present our work in the same forum, giving me a greater understanding and admiration of the fabulous work my NIKI colleagues were involved in back home. Through informal discussions it became apparent that Arak had no expertise to offer women with breast cancer any form of reconstruction, however they were in the process of establishing an Oncoplastic department and were very keen for me to be actively involved with this concept. Once again my presence as a female Surgeon generated much excitement amongst the female Medical Students. They demonstrated a contagious hunger for knowledge and a deep seated passion to become Doctors. 

 

 

 

At the end of our short trip to Arak it was time for our faculty to disseminate in different directions. A few of us received a privileged invitation from Dr and Mrs Farivar to visit their breath-taking home in Kashaan. On our arrival the sayings “home sweet home” and “home is where the heart is” came to life. The love that Mrs Farivar had ploughed into renovating her family home oozed from every corner of her house and gardens. Whilst there Mrs Farivar took us to visit one of the many Orphanages that she has set up for children orphaned by major disasters. It was a humbling and inspiring experience to see the strong bond which has formed between these young boys and the dreams that they hold for their future, none of which would be possible without their guardian angel – Mrs Farivar.