Bringing humanity back into medicine | Chris Giannou | TEDxThessaloniki


Translator: Dimitra Papageorgiou
Reviewer: Chryssa Takahashi (Greek) Good Day Thessaloniki and thanks to TEDx
for this invitation. The summer of 1982, I was stuck in the middle
of the Israeli invasion of Lebanon. At one point, I found myself
in a large public hospital that had been abandoned
by its personnel and had then been occupied
by about five thousand civilians. Entire families who went into the hospital
thinking that since it was a hospital they would be safe there
from the bombing and shelling. They were mistaken. With me, there were two
general practitioners and six nurses and we received tens
and then hundreds of wounded. The operating theaters were
located on the fourth floor and too exposed to shelling
to be safe to work, so we operated on the ground floor. Literally on the floor. For anesthesia we used Ketamine. Ketamine is a wonder drug. You can have full anesthesia
and do any sort of operation with it. You don’t need a special apparatus,
it’s given by injection. Either in the vein, or in the muscle. You don’t need an extra oxygen supply. The 20% of oxygen in ordinary air
is sufficient –It’s a very safe drug. It’s difficult to kill someone
with Ketamine. Which means, you don’t need
an anesthetist. Now, as a surgeon,
I appreciate anesthetists. I love a good anesthetist. But what happens, when there is no anesthetist present? Ketamine. So we’d give an injection to patient,
we would wait a few minutes for it to work and then I would start operating and before I finished operating,
a few minutes, I would tell the other doctor
to inject the next patient, I would hand over this one to a nurse
to do the bandaging, and we went on like this in a sort
of an assembly line of surgery. Ketamine is an old drug.
It’s more than 40 years old. And it is still the best anesthesia,
if you’re working after an earthquake or in a war zone. It’s better if you do have
an anesthetist and although it’s not used
very much in industrialized countries, it is still the basic form of anesthesia
used in most of the rural third world. Now, I am a general surgeon by training,
and war surgeon with 35 years experience, I have worked in difficult situations,
dangerous circumstances with limited resources. And I become used to this.
I’d probably find it difficult to work in a modern hospital in Greece,
in an industrialized country. But that’s fine. In my professional career,
in my lifetime, there’s been tremendous change
in the practice of medicine, in general surgery in particular. There’s been an introduction,
well, I love technology. In 1966 I was operated on my knee,
I spent five days in the hospital, I had the same operation in 2007,
I left the hospital the same day. In 1983, I had my gallbladder out,
— Cholecystectomy. And for five days in the hospital
I had tubes coming in and out of various parts of my body. Today with Laparoscopic Surgery,
the patient drinks the same evening and leaves the hospital the next day. It is perhaps in diagnosis that we’ve had
the greatest advance in technology. CT Scans, magnetic resonance
imaging, ultrasonography, very sophisticated laboratory analyses, and this is good. So we’ve had all of this. The mastery of this technology,
however, has become a challenge. Now, in spite of all the advances, alleviating suffering, prolonging many, many lives,
not all is progress. And the gap in progress, when
compared with medical technology is best exemplified by
the training of young doctors who tend today to become
medical technicians and no longer, physicians. They look at images, and numbers
in the laboratory, and forget to look at the human being, the patient. Technology can be alienating. Now it is not alway thus and there is another way
of practicing medicine. When I was a young intern, in Cairo, we had a consultant and we had a particular patient
with a very difficult diagnosis. Aches, pains, fever, this, on and off. We put him in a room on his own, and on grand rounds
we asked the consultant to come and examine the patient. He opened the door, stopped: “I smell typhoid fever.” Here’s a man for 30-40 years
of medical practice that smelled his patients. Now, I have not learned
to smell typhoid fever but the pungent odor of Cholera, yes. The stale, urine odor
of kidney failure, yes. The musty ammoniac odor
of liver failure, yes. The fecal shitty smell
of E. coli infection — and I have learned to distinguish
the good, bad smell of a clean war wound from the bad, bad smell
of an infected wound. During surgical conferences on trauma,
it’s very often an exercise, they present a case: Accident,
person is bleeding, etc, and they tell you, “The blood pressure is 96 over 62,
the pulse is 112.” Obviously to have such specific
detailed figures, somebody has read them off a monitor. I ask, “What was
the character of the pulse? Was it strong and bounding full
or weak and thready?” Nobody can tell me because
nobody felt the pulse. They read it off the monitor. Now, there is a difference when the body
reacts to hemorrhage, heavy bleeding, having a full pulse, or a weak pulse. You cannot put the fingers
of a doctor, into a machine. The physician must practice
what I call the eye, ear, nose, and ten finger whole body scan. You look at the patient,
you listen to the patient, you (inhales) smell the patient,
you palpate the patient from top to bottom,
there is a laying on of hands. It is an intimate act,
and it creates intimacy between the doctor and the patient. The patient tells the doctor
intimate things: “Doctor it hurts, here.” Pain is an intimacy not to be betrayed. It has been said that medicine
is an art as well as a science. The art is much like storytelling. I sit down with the patients,
and I listen to them. To what they want to tell me about their lives, their fears,
their desires, their pains. They tell me a story. It’s only then that I look at the images
and statistics and say, “Well, what’s going on?” and that storytelling is important. I am not the only surgeon who goes in
to the operating theater, and thinks that the body on the table
is a slab of meat. I can then cut into flesh,
it’s not, not a human being. And that’s normal for a surgeon. It allows you to cut into human flesh. It allows you to go from deathbed
to operating table and still be efficient. It’s only afterwards, during rounds,
that, that slab of meat becomes a human being again with desires and hopes
and human dignity. And it is during those rounds that
if I can make an amputee to laugh then I consider that my day is a success. Now, I spoke to you about Ketamine
and there are a number of other basic and rudimentary
techniques that have been used and are still used
in many places of the world. And it’s a simple technology. And this is where human
imagination comes into play. You invent, you improvise, you adapt. Recycling of surgical gloves. After the operation,
you wash off the blood with a chlorine solution you then wash them with water,
you dry them, you put in powder, and you re-sterilize them,
and re-use them. Sometimes you have to do a skin graft. You take skin from one point of the body,
to cover another part of the body. And you want to mesh it so that
it increases the surface area. Pizza-cutter. Serrated edge, much cheaper than
what you usually find in the market and in modern hospitals. Plaster of Paris, — (Greek) gypso–
is very old technology. And you don’t have to be a specialist
to put on a bridge cast. And this is a locally made bridge,
made in any automobile workshop. And with this, you don’t put
anything into the body of the patient, you can have access to the wounds
to change dressings, put in a graft, and the patient can walk about. You have to fight
something called hypothermia. People who have undergone
trauma or burns, lose body heat. Carton box, to preserve the body heat, create a cushion of hot air
around the patient. In many hospitals in Africa,
they make their own intravenous fluids. Intravenous fluids are sterile,
but it’s salt and water. Sugar and water. And it doesn’t really make
much sense, to transport tons of sterile salt and water, hundreds of kilometers
over an African road. So they distill the water,
they sterilize etc, they make their own. And if you don’t have
enough blood for transfusion, you can recuperate the blood
from the chest and the abdomen and give it back to the patient. Now, this is sort of a throwback
to a simpler way of doing things but it is also, a throwback
to another way of dealing with ones patients. This is when medicine
was a vocation and a calling and not just a profession or a job, and another way of making a lot of money,
or gaining social prestige. And I am not alone in thinking this. Dr. Mohamed Hadeeb is
a general practitioner in the Palestinian refugee camp
of Shatila, during a major battle. No hospital, no equipment,
not a surgeon, and he had many wounded. The only treatment he had,
in the sweltering summer’s heat for his patients, was to fan them
and speak gently to them as they died. Dr. Abouhassan is a Syrian surgeon
in the city of Aleppo. Earlier this year, working in
an underground hospital he spent 48 days, without seeing the sun. Dr. Denis Mukwege is the director
of the Panzi Hospital in Bukavu, Democratic Republic of the Kongo. He is a gynecologist,
and amongst his patients are thousands of women
who have been raped some quite savagely
and they have obstetric fistula. And they tried to assassinate
Dr. Mukwege a couple of years ago. He had to leave, continue his therapy,
he returned, and today his defense,
in his hospital, is thousands of women. A human shield. These people demonstrate
empathy and solidarity. and technology will not solve
their problems. Now, in medicine, the humanitarian will
to alleviate suffering and protect human dignity, is the goal. It is the solution. Technology is only a means. And sometimes, this reality
only becomes apparent in extreme circumstances. But you don’t need
extreme circumstances of war or earthquake
to prove the proposition. Working with limited resources,
doesn’t occur just in earthquakes and war. It is the everyday experience
of many doctors and nurses around this globalized world where sophisticated technology
is simply not available. And that’s when you go back
to your imagination, improvising and inventing. Now, don’t mistake me.
I am not a Luddite. I don’t want to smash computers
and mobile telephones. Sometimes I do want to smash
mobile telephones. (Laughter). But I’ve written several books
using a computer, and I’ve used the Internet, without which I could not have done
the necessary research. But I am not a slave to the technology. I am its master. I use modern technologies
in my professional work and my everyday life. But I remain in control and I don’t allow
the technology to determine me. I’ve talked about the role of technology
in the medical sphere and said about the great
change that occurred and we’ve heard today
about the mobile revolution and supposedly we have
great rapid changes. All true, but we’ve had rapid changes
for the last 200 years. It’s just the industrial revolution. Think back: Steam power,
internal combustion engine airplanes, electricity!
The first people who saw electricity! We had then telegraph,
telephone, radio, television, nuclear weapons and nuclear energy. We talk about a globalized world today. Well, today we are only reaching
the extend of a global integration that the world already knew in 1914. The emergence of China and India. In the year 1800, 75% of all manufacturing in the world,
was done in China and India. What is new? What is a beginning? It may simply be
a continuity, or a repetition. And we may think that
there are very rapid changes today, and this is different, but this
may be a western perception. There are still several billion people
in the world who do not have access
even to a mobile telephone. That will change,
but we are not there yet. Now, technology must be appropriate and our response to technology
must be appropriate. We must not allow it to alienate us, to create distances between people
and between peoples. We must remain the masters, and not the alienated slaves
of material progress. Someway this has always been the case. Here there is nothing really new, and our perceptions of newness
may simply be misapprehensions. No beginning, no end,
only a continuity or what the writer
Tom Bissell once called: “Deep cyclical changes embedded
in natural processes.” We human beings
are blessed with imagination. We invent new approaches
to old and new problems. Sometimes we re-invent the wheel. We use old ways of doing things but if the result is possitive
then so be it. Imagination creates intimacy. It creates solidarity. Imagination creates
humanity, community. And in fact, perhaps, our capacity
for imagination –to imagine, is what best defines us as human beings. Defines what it means to be human. And we must maintain our humanity. The challenge is how
to harmonize our lives with this technology. The challenge is how to maintain
our humanity, when faced with a new technology. And that has been the case,
since Prometheus. Technology is neither
the problem nor the solution. We human beings, we citizens, we are, and have always
have been the problem. But we humans, we citizens,
in the richness of our imagination in the diversity of our humanity,
we are, and must be the solution. I thank you. (Applause)

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