Magdalena Kincaid: Surgical training in Palestine

Magdalena KincaidDecember 2009 heralded an unexpected start for a surgical course. Our family holiday in Jerusalem and the West Bank was predictable enough: visit the Old City, and to the children’s delight, Bethlehem. Who could have predicted that the antics of our three young children would became a magnet for an ad hoc conversation? Many Palestinians stopped and talked to us. Palestinians of all walks of life: in cafes, the souq, in restaurants, and on shaded benches. We discovered a vibrant people, slowly rebuilding civil society after severe blows had been dealt to it over decades.

Returning home to Cornwall bought into focus a very human response: could we help in some way? My husband and I are both surgeons, hence the choice: surgical training. It is definitely in demand and apolitical, simply addressing need where need is found.

An enduring image from the trip was of ambulances waiting in long lines of vehicles at checkpoints. Clearly patient transfer from peripheral hospitals to specialised care takes a long time in the West Bank. The junior surgeon’s grasp of basic surgical skills (e.g. tie off a vessel, join bowel safely etc), therefore becomes crucial for patient survival.

What happens in UK? Junior surgeons attend the Basic Surgical Skills (BSS) Course for safe attainment of core skills. And so our idea shaped up – we would take the BSS Course to Palestinian surgeons. It would create an unprecedented link between a UK Surgical College and Palestinian colleagues…but was it a bridge too far? Someone said that if the course ever happened, it would feel like a life event. One question loomed large: how does one set this kind of wheel in motion? Ask and hope, seemed a natural choice.

2010 was amazing for born optimists. The United Nations Relief and Works Agency (UNRWA) in the West Bank confirmed the course was needed and gave firm assurances of support. The Juzoor Foundation got behind the course. In September 2010 the Royal College of Surgeons of Edinburgh (RCSEd) had the vision to endorse the course for Palestinian surgeons. We also had a committed team: 4 other surgeons joined us as well as the manager of the Surgical Skills Lab at the RCSEd. Several funding applications later, on that old rollercoaster of refusals and generosity, came the wonderful Karl Storz Endoskope donation: a laparoscopic trainer box, camera, and instruments.

In late April 2011, days before the course started, everything was ready. We had a “wet” room for animal tissue demos, a “dry” room for theoretical stations, dissection kits, sharps boxes, and a large fridge. My husband toured abattoirs with an anatomy-loving UNRWA driver for sheep bowels, cow aorta, goat and turkey legs.

The first BSS Course for Palestinian surgeons, as endorsed by the RCSEd, was delivered in the Augusta Victoria Hospital, East Jerusalem, in May 2011. The 19 participants, surgeons from East Jerusalem and the West Bank, attended 16 stations over 2 days and performed all the tasks from the RCSEd course diet.

Palestinian surgeons were keen to learn. Their warm welcome, teamed with relish for professional interaction, made the course come alive. While the RCSEd convener handed out the certificates, we were asked: “Will there be a course next year?” Each participant knew of colleagues who would benefit from the BSS course.

The good news is we will be there in 2012. The first turn of the wheel has been completed, but sustained input is needed for Palestinian surgical training to gather momentum. Other courses are needed, especially a laparoscopic one.

Wanted: someone with a bit of time to give and a lot of enthusiasm…is this you?

Magdalena Kincaid graduated from the University of Dundee and did her surgical training in Scotland.  She is currently based in Cornwall and is working as a vascular staff grade.