At times, it’s in order to eat your own words

It is worth remembering that one of the symptoms of the disease is loss of weight and it was known in Uganda as “Slimming Disease” until the cause was discovered. Eventually he passed away and as we all, his family and professional colleagues laid him to rest, the cause of death was considered to be a “needle prick” in the operation theatre. ILLUSTRATION | JOHN NYAGAH

What you need to know:

  • Surgeons and physicians are not shy of eating their own words, necessitated by new research. As Winston Churchill said, it had never given him any indigestion!
  • The 4 Hs fell in place. Haemophiliacs get it because they bleed frequently due to lack of coagulation factors in their blood and often need blood transfusion. Heroin addicts, because they sometimes inject themselves with infected needles and Haitians because Haiti is considered the “drug capital” of the world.
  • Homosexuals were a red herring because we were going through a phase of homophobia. This reminds me of a funny true story and if I relate it here, it will be a bold relief for my readers from this serious learning exercise

My readers tell me that they find that the ‘Surgeon’s Diary’ is educational, informative and entertaining. This time they might find that the first two aims are dominant but I can assure them that, if they persevere with it, they will be rewarded with a story in the end.

Surgeons and physicians are not shy of eating their own words, necessitated by new research. As Winston Churchill said, it had never given him any indigestion! After all, surgery is a living dynamic science and, therefore, remains in constant flux, ready to learn from its continuing research. Since we deal with human beings, who cannot be replaced, we are constantly in search of the truth. In our pursuit, we are assisted by pharmaceutical and medical equipment firms, who don’t do it entirely out of altruism. There is a lot of money at the end of a successful medical research. For example Pfizer, which first put Viagra on the market, made millions and are still reaping the fruits of their spectacular study.  

Take the story of statins, a drug used to reduce cholesterol in the blood and prevent heart attacks and strokes, amongst other vascular accidents. These companies have such robust marketing that everybody who can afford statin tablets is on them. It is only recently that serious doubts have been cast on the need to take them and doctors are talking about their side effects.

Talking of revising our views, I want to relate my own firsthand experience in the surgical treatment of breast cancer. For over a century, Halstead’s radical mastectomy which includes removal of the  breast with areola and nipple, the major muscle it lies on and all its attachments in the armpit held sway.

It left the woman grossly disfigured and deformed, so much so that men found the most attractive part of the female anatomy repulsive. Halstead was a famous American surgeon and as surgeons usually are, assertive and forceful and no one dared question him until evidence based medicine took over, which proved that survival results of this devastating surgery are dismal.

New research showed that conservative surgery causes less morbidity and mortality. Consequently radical mastectomy is relegated to history books and emphasis is now on breast preserving operations. Progress in chemotherapy and hormonal treatment, better understanding of the disease and women themselves played a major role in this change. Women insisted on keeping their breasts, the symbol of their femininity and forced us surgeons to rethink.

Now I come to the story based on the interesting metamorphosis our understanding of HIV and Aids has undergone. The very name of the disease betrayed our ignorance. All we knew was that the immunity of the patient was severely compromised and it caused symptoms which we did not understand and, therefore, collectively called them a syndrome. The religious amongst us thought that the disease was divine retribution for the permissive society we live in.

BETTER UNDERSTANDING

I remember with considerable embarrassment what I taught my students about it when it first erupted in the USA and infiltrated into our continent soon after. On the basis of evidence available then on the incidence of the disease, I told them that the disease was found only in homosexuals, haemophiliacs, heroin addicts and Haitians. Knowing that medical students have to memorise an enormous number of facts to pass their exams, I even told them to remember the 4 Hs to help their memory. It all seems so archaic and erroneous now when we know more about this disease.

With more research conducted on the disease, we learnt and in turn teach our new crop of students that HIV is caused by a virus which is transmitted through sexual contact, injection with infected needles, blood transfusion and handling infected material when the virus enters the body through a breach in the skin.

The 4 Hs fell in place. Haemophiliacs get it because they bleed frequently due to lack of coagulation factors in their blood and often need blood transfusion. Heroin addicts, because they sometimes inject themselves with infected needles and Haitians because Haiti is considered the “drug capital” of the world.

Homosexuals were a red herring because we were going through a phase of homophobia. This reminds me of a funny true story and if I relate it here, it will be a bold relief for my readers from this serious learning exercise. It relates to the time when I was a trainee surgeon in Banbury in England.

There was a Polish doctor there who had come over when his  country, Poland, was invaded by the Nazis. He was very happily settled in Banbury and was like the fixtures and furnishings in the doctors’ lounge where he had a reserved chair. I was therefore surprised when one morning I heard the conversation between him and a British houseman.

“I intend to leave your country soon,” he announced.

“Pray why?” asked the bewildered houseman.

“Because when I arrived here homosexuality was frowned upon and punishable by law. In time, homosexual men and lesbians were tolerated. Gradually they were accepted in society and even acquired a more respectable title of ‘Gays’. Then the Church and Westminster allowed gay marriages and they could even adopt children.”

As the English doctor wondered where it was leading to, the Polish doctor added his punch line: “I want to leave before homosexuality becomes compulsory!”

Reverting to the main story, I lost a valued professional colleague from HIV and Aids. He was a brilliant surgeon, a very articulate lecturer in surgery and his death was a great loss to the surgical and teaching faculty. Fortunately for him and his family, cases were being recorded of health workers getting the disease by non-sexual modes of transmission like dealing with infected dressings and surgeons in particular could get it by operating on HIV positive patients and sustaining accidental needle pricks. Though measures were proposed as to how to prevent this happening, they had not come into force yet. It was therefore euphemistically believed that he was infected by one of those modes of transmission.

SLIMMING DISEASE

Naturally, because of professional loyalty prevailing, we all supported the notion that our colleague died of HIV and Aids because he contacted the virus while he was operating. I have a different version, based on evidence, which I can reveal now and since it has a moral and is based on the theme of revision, a result of newer research, with which I commenced this story, I will elaborate.

As I have mentioned in this column, The Association of Surgeons of East Africa, now converted into a College of Surgeons, at some stage quite wisely decided to hold its quarterly Council meeting at district hospitals in the rural area of the constituent countries where a majority of our people live. The Council meetings were converted to mini-scientific conferences for the benefit of surgeons who worked in the hospital as well as its vicinity.

These meetings took surgery to the people, touched the grassroots and made people feel that we were not working in an ivory tower and they were our main concern. The constituent country, whose turn it was to host the meeting, was given the privilege of naming the place. The Ugandan members of the Council nominated Bushenyi, which had gained sudden fame because Milton Obote entered his country from that point after Idi Amin fled Uganda, forced by the Tanzanian army, aided by Ugandan exiles. Like the Pope, Obote kissed the soil as he entered his motherland to take over the regime in what came to be known as “Obote Two Regime”.

Bushenyi was not even on the map and did not have facilities to host such conferences. That did not deter us and I remember being put up in primitive lodgings by our hosts, where I had to sleep on the floor and was given enough water to fill an empty whisky bottle for my morning ablutions. As I was getting ready for the meeting in the morning after a sleepless night caused by bugs in my mattress and mosquitoes in the air, I realised that there was no soap in the room.

Aware that this colleague of mine was lodged in the room next to me, I knocked on his door to see if he had soap and the poor man readily opened it wide without knowing that it was me.

I was horrified to see a young woman lying on his mattress on the floor, in a state of semi-nudity. Judging by the embarrassment written all over his face and the woman’s overtures, as if making up to the next client, I guessed that she was a lady of twilight. It was before we knew that HIV and Aids was a sexually transmitted disease and we were still in the 4H era.

From then on, the poor surgeon started losing weight. At this point it is worth remembering that one of the symptoms of the disease is loss of weight and it was known in Uganda as “Slimming Disease” until the cause was discovered. Eventually he passed away and as we all, his family and professional colleagues laid him to rest, the cause of death was considered to be a “needle prick” in the operation theatre.

As said before, I had my doubts and remembered the famous words of my late colleague, Prof Imre Loefler: “Please avoid needle pricks because, if you get HIV and Aids, it will be difficult to convince your patients whether you got it “on duty” or “off duty”!