When I was 10 years of age, a wise man gave me this advice. He told me: “if you want to make sense of your life and be satisfied with yourself, you have to think three dimensionally”:

Level one: Is competing within your own profession. You should be one of the best in this level.

Level two: is below your level, and when you look down, you will be surprised to see the hands that have been raised up asking for help”. He continued: “There is no look nicer than the appreciative look you receive from somebody that you have helped.

Level three: is to look upward to get help from whoever is above you in order to support those in the lower level”.

I never forgot this advice and I have used this strategy throughout my entire life. By looking down all the time, I have shouldered the responsibility towards others and towards my surroundings including humanity, animals and all the environment around me. There is no better starting place than performing altruistic activities to the poor, like spreading green trees everywhere, and then turning attention to my endoscopy career. It is always the same strategy: To implant seeds of green every place then to see the growing mature green giving fruit to the environment.

There is no better feeling than to feel humanitarian, be willing to share yourself with others. This attitude for sure will overwhelm any project with an ethical spirit and a feeling of satisfaction.

My unit & places of work: 
Every week, I work four days in my center, One day in a hospital 10 km from my center, and another day I travel to our neighboring country, Lebanon to work in another hospital in a rural area. The trip takes two & half hours, including crossing borders. I teach and supervise the endoscopists there, see patients and return back home after 8 hours. In that center, each time, I teach one to two Lebanese doctors then send them back to their cities to practice in their own units. Both of these hospitals have almost the same teaching facilities as my center.

Most of the training in my center is hands on. Ethically, all my patients know that I have trainees working with me, doing procedures under my supervision. Having this special transparent, friendly and warm relationship with my patients gives me the ability to express myself freely. Some of them refuse to be endoscoped except by myself. They have the right. However, most of them agree as long as I am around. I am very proud of the respectful doctor-patient relationship and the level of patient satisfaction in our center. I have one main assistant who is almost another copy of me endoscopically. He has been working with me for the last 15 years and even does the 5 year colonoscopy surveillance on me. Every day we have 2-4 trainees. The training programs are of three types:

  1. The 3-4 weeks program: for routine endoscopy work. Usually we have two doctors and two nurses learning the standard endoscopy procedures, concentrating on quality assurance in all fields of the endoscopy unit. We specifically emphasize patient safety in our teaching , and we are pretty confident that the best way to achieve this is through the consideration of the patient’s concerns which we can achieve by dealing with patients like members of our families. The best day of the week is Saturday, the day of my own learning! I have one young chap who is from a city 300 km from my center. He continues to work with us every Saturday to keep himself updated. He has his (Updates and information) in his small pocket computer. We always have rapid answers to our questions when we have him with us.
  2. The second program is the two day workshop on specific procedures, especially biliary and gastro-intestinal tract Self Expanding Metallic Stenting SEMS, and endoscopic drainage for pancreatic pseudocyst, usually sponsored by a specific company. Of course in addition to the specific training, we also do standard polypectomies, mucosectomy , ESD, Argon Plasma Coagulator, etc.. Special training on new technology machines is another field of training in which we are involved. We do training on Pentax EPKi-HD and Fujinon 440 HD. In the very near future; special training on Spy Glass will be started. In a month time, these advanced students can leave our center with a license of complete colonoscopy including terminal ileum endoscopy. The license is recognized by AMAGE.
  3. The third program is the Workshop abroad: Where I go to another endoscopy center which collects specific teaching cases especially pancreatic pseudocysts for endoscopic drainage, SEMS and Klatskin’s for endoscopic management. I usually go to Pakistan, Iraq and Iran for this kind of program.

Procedures: in my center every year, We do around 1900 upper endoscopy, 1700 lower endoscopy and 850 ERCP. Special training of nurses and lectures are another important field of teaching. Lastly because endoscopy requires short anaesthesia time, special training is offered for Endoscopy Anaesthesia. I have 6 anesthesiology experts who are considered as distinguished references in this field. Of course all procedures are compliant with standard Guidelines.

The Live Endoscopy Workshop: Ever since the formation of the Endoscopy Branch of the Syrian Society of Gastroenterology SSGE in 1996, live endoscopy workshops have become an important and vital field of interest that have taken a good amount of time and interest of my career. Every year in Syria, we do two live workshops one international and the other local. So far; we’ve done 34 workshops all over Syria. In 2000, we did the first ESGE International workshop in the Middle East (SYRENDO 2000). Next year in April, we are doing the SYRENDO 2011 which is a category B ESGE workshop. I share every year many regional live workshops: in north & south Egypt, Iraq, Pakistan and Iran. Our important strategy for live workshops consists of these principles:

  1. Safety: of patients and Instruments.
  2. Ethics: patients have the right to know all the benefits, alternatives and side effects of the procedure. The patient’s anxiety must be respected by explaining the procedure and answering all questions, and lastly to keep their identity from the audience.
  3. Ethics: the referring physicians have the right to know the exact details of the procedure and how it went.
  4. Quality: only the highest level of quality is maintained along with evidence based standards.
  5. Lastly: an evaluation sheet is to be filled and analyzed for auditing purpose.

In summary: Think of Endoscopy Education as part of the global scene, the scene of altruism. Willingly share your expertise, knowledge and facilities, your nursing staff and equipment with those eager to learn and then have them go forth and practice the art of endoscopy.


Published in: WEO E-Newsletter Issue 12, September 2010