Interview




Answering the call to heal the sick

 

Callan Emery speaks to Dr Abrar Khan, senior consultant and director, Transplantation and Hepatobiliary Surgery, Sheikh Khalifa Medical City, about his life, inspiration and the organ transplant programme he was invited to establish in the United Arab Emirates.

■ Callan Emery: Can you tell me a bit about yourself – where were you born, educated and where and when did you train as a physician?

Abrar Khan: My family migrated to the United States in the late 1950s and has been there since then (of course I wasn’t even born then!). During the ensuing years most of my extended family settled in the Seattle area, starting with my paternal uncles and then my older brother in the early 1960s. The family members grew in number slowly over the next few decades – again mostly in the Seattle area. My parents moved to Africa when I was only 8 months old and I spent most of my early years in West Africa (Ghana) and in Zambia. When I was 10 my family moved to the US – again back to Seattle. My middle school years were spent in Seattle and then I moved to California, which then became my home state. I lived in the Bay Area (San Francisco) for many years – that is where I completed my high school (Berkeley High School) and College (University of California, Berkeley). I majored in Neurobiology at Berkeley – a fascinating field to study.

I did, however, have a bit of a tough time from the age of 11 years onwards as my parents were both ill and there was no source of income in the family. Thus, when I moved to Seattle during my middle school years, I actually lived with my paternal uncle. When two years later I moved to Berkeley, California, my brother, who was himself a student and lived in Berkeley, helped me negotiate the quotidian hurdles of life. We lived together and tried to make the best of things. My brother helped me tremendously in steering me in the right direction during my high school years. When I started college at University of California, Berkeley at the age of 16, I was fortunate enough to get a scholarship and thus became self-sufficient (at least financially). Of course, all through college, to earn enough money I also worked some odd jobs such as a clerk or scrubbing fish tanks – a very smelly affair at best. I remember University of California, Berkeley very fondly and believe that whatever I have accomplished in life, it is due to my brother’s guidance and the University’s financial and intellectual support of my academic endeavours.

■ CE: What inspired you to become a doctor?

AK: There was no real moment of revelation or a particular role model that I looked up to that helped me decide to become a doctor despite the fact that my father was a physician. In fact, I don’t really recall him ever saying to me that I should become a doctor. However, I do remember my mother mentioning it frequently – “well…you must be like your father…you should certainly become a doctor”. She really wanted me to become a doctor. Additionally, other extended family members always used to say to me that I would become a doctor. So, in the end, as I was growing up, it seemed that I was just supposed to become a doctor and I don’t really recall challenging that notion even once. Fortunately, I really like being a doctor, so in the end it all worked out well.

■ CE: What prompted you to follow your particular specialty?

AK: As I mentioned, I was very intrigued with the human brain which is why I majored in Neurobiology at Berkeley. And in fact, that is one of the reasons why I wanted to go to McGill for medical school because the Montreal Neurological Institute was part of McGill Medicine. In fact, when I went to medical school I didn’t even want to be a surgeon. However, as I gained more experience with neurology patients I realised that I would never be happy as a neurologist. You see, the algorithms for diagnosing people and pinpointing where the neurological lesion was located were exquisite and quite a bit of fun. But most of the time we could never do anything to cure these patients – and that was frustrating and I lost interest in Neurology. When I did my surgical rotation I felt even more bored as all we did as medical students was round on patients, do a lot of drone work such as gather data, do the menial work, and prepare rounds for the chief resident. I was in a quandary. What would I do after medical school? Then one night when I was on call during my surgery rotation there was a twenty-year-old girl who came in with a bicycle accident. She was in the emergency room and as it was “just a bicycle accident” she looked okay, she was lying in a room after all her blood tests had been sent. At some point, I just had this feeling that I should go see her and I did. She didn’t look too good. Being just a medical student, I didn’t really know exactly what was wrong but I knew something was wrong. I called my Chief Resident and asked him to come immediately. In the mean time I checked her pulse and blood pressure and they were both very abnormal. The Chief Resident arrived, looked at her, looked at the numbers, then looked at me and said, “I think you just saved her life. Let’s get her to the operating room immediately.” Then we began to rush around like mad men. We wheeled her right away, took her to the operating room, and transferred her to the operating table. The Chief Resident looked at me and said: “Well, your case, you open the abdomen.” I will never forget that moment in my life. My heart was pounding very hard and I don’t recall a point in my entire life when I was more nervous. I had never opened the abdomen of a human being before – in fact all I had done during my surgical rotation was boring paper work and drone work like all the other medical students, and observed a few surgeries. I accepted the scalpel from the nurse who had a bemused look on her face. As soon as I took the knife and started opening her abdomen something strange happened. It felt like I had been doing surgery all my life, it felt natural, it felt smooth. As soon as the whole abdomen was open from top to bottom, I saw a huge amount of blood welling up. Instinctively, I grabbed sponges; like I had seen other surgeons do before the few times that I had watched surgery as a student, and started packing the abdomen. She had a ruptured spleen and was rapidly bleeding to death. Both the Chief Resident and I were able to take the spleen out and save her. It had been a rush of adrenaline and a flash of time that went by in a second, but in reality we were there for about two hours. As we put the final dressings on her abdominal incision and the nurses wheeled her out, I just took a deep breath and sat down on a nearby chair – emotionally and physically drained. As the enormity of the event sank in I realised that I wanted to be nothing else but a surgeon.

■ CE: Can you tell me about your work as a physician / surgeon before you came to Abu Dhabi? Where did you practise? What challenges did you face and how did you overcome them?

AK: Later on, as I progressed through my surgical residency, I realised that I loved the complexity and combination of Immunology and surgery and the only field that truly offered that combination was transplantation surgery. During my residency (at University of California, San Francisco and Irvine), I decided to study Immunology in more detail and ended up with a Physician Scientist Award from the National Institutes of Health, which I received at Harvard Medical School while working on some of the initial transplantation models of tolerance. This was extremely rewarding and working with some of the best minds in Transplantation Immunology was, without exaggeration, exhilarating. A lot of the work I did, however, was cellular Immunology and I wanted to learn more about the molecular aspects of Transplantation Immunology. That is when I joined the PhD programme in Immunology at Yale University. I worked on the molecular biochemistry of Human Leukocyte Antigen – molecules which are of paramount importance in Transplantation. Fascinating stuff! Somewhere in all of this, I also managed to do a multi-organ transplantation fellowship with Drs Thomas Starzl and John Fung at University of Pittsburgh. That experience was, without doubt, the toughest time in my training. It was quite routine not to sleep for two days and the longest I went without sleep was 5 days. I still recall the end of those five days – I couldn’t tell if I was walking or sitting, talking or silent, dead or alive. However, I do know one thing – after I finished this fellowship I knew I could take care of any patient in the world no matter how complex his/her condition might be, because we took care of some of the sickest adults and children I have ever seen.

■ CE: What brought you to Abu Dhabi?

AK: While I was towards the end of my PhD at Yale, I received an offer that I just couldn’t say no to. It was to be the Director of Transplantation at University of Vermont. Additionally, I was to create the infrastructure for basic science research in Immunology within the Department of Surgery and was given significant resources to this end. I was extremely busy for about four years and both the clinical and basic science endeavours were quite successful. We did unprecedented numbers of transplants every year and I also started the pancreas transplant programme – in fact I did the first successful pancreas transplant in the state of Vermont. I was quite happy that I was able to create these programmes and help as many patients as I did. Towards the end of these four years, however, I realised that even though I had been successful in establishing the clinical and basic science infrastructure I was lacking in administrative skills. I had been given directorship of a transplant programme right out of fellowship – in fact I was the youngest ever Director of Transplantation as far as I know. Thus, negotiating the transplant programme through the hospital politics and hierarchy proved to be very difficult. After much introspection, I decided that I needed a totally different set of skills. I applied to Yale School of Business and joined them in 2007. However, only six weeks into my MBA, I was asked to help start the transplant programme at Sheikh Khalifa Medical City (SKMC), which is managed by Cleveland Clinic (the United States - based medical group). SKMC is a SEHA (Abu Dhabi Health Services Company) facility. I was very reluctant to leave my MBA and come to the Middle East. However, I was persuaded to visit Abu Dhabi and really liked the Emirate. I visited Sheikh Khalifa Medical City and saw another challenge. My mind started racing again – I knew the landscape would be challenging. There was absolutely nothing in terms of transplantation infrastructure at SKMC – a worthy challenge indeed. My family also thought it would be interesting to work and live outside the US, so we moved to Abu Dhabi. I still, however, wanted to continue my MBA so one year after starting at SKMC, I joined the MBA at London Business School.

■ CE: Can you tell me about the transplant programme at SKMC? When and why was it started?

AK:
The UAE had no transplant programme in the entire country when I came in 2007. Thus, the goal was to create a transplant programme that would serve the needs of the UAE. This would include kidney, liver, pancreas, and eventually small bowel transplantation. The challenges were daunting as we faced an array of logistical hurdles that come with starting a large project completely from the ground up. The transplant team that we eventually assembled was very good and together we worked really hard to build the programme with the support of SEHA.

To date, we have performed 34 kidney transplants and will be starting liver transplantation next year. The only challenge left is the brain death law – whose passage will allow us to start performing cadaveric organ transplantation. That will be the beginning of the end of putting the major pieces into place. After that, it is just a matter of hiring the appropriate personnel to make cadaveric donation a reality. To this end, SEHA=, HAAD, and various federal government agencies have worked very hard to make cadaveric donation a reality.

While my team and I were setting up the transplantation programme in Abu Dhabi, I also finished my MBA. It was one of the best experiences I have had. Now, of course, an MBA doesn’t suddenly, after just two years, make you a brilliant leader. Not at all! However, what it did do was help me look at things through a totally different framework. And all the phenomena that I had observed in hospitals over the years I was suddenly able to categorise and neatly place into theoretical frameworks. That helped me realise and see the big picture.

● Abrar Khan, MD, MS, MPhil, FACS is a regular contributor to Middle East Health. He has written on a range of subjects – such as Human Resources management in hospitals, Change Management in GCC hospitals, Brain Death and Hospital Resource Management and organ transplant-related legislation, among others – with a view to improving healthcare in the UAE and the wider region. He is senior consultant and Director, Transplantation and Hepatobiliary Surgery at Sheikh Khalifa Medical City-Cleveland Clinic Foundation (SKMC), Abu Dhabi. He is a multiorgan Transplant Surgeon and Immunologist and has successfully started, from the ground up, two multiorgan transplantation programmes – one in the United States and one in Abu Dhabi. He is the author of many clinical and basic immunology papers, and has been educated, trained and employed variously at University of California - Berkeley, McGill University, University of California - San Francisco, Harvard Medical School, Yale University - Graduate School of Immunobiology, University of Pittsburgh - Starzl Transplantation Institute, University of Vermont - School of Medicine, and Columbia University (NY). He also holds an MBA, with Distinction, from London Business School. He came from the USA to Abu Dhabi in October 2007 to help start the Transplantation Programme at SKMC.


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ate of upload: 19th Dec 2010

 

                                  
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