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Welcome to the 17th SNI and SNI Digital Baghdad Neurosurgery online meeting held on September 4th, 2022.
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The meeting originator and coordinator is Samar Haase, University of Baghdad and Cincinnati
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The meeting title is sharing Iraqi neurosurgery experience in different cities, general neurosurgery, medical college status, micro neurosurgery and orbital surgery, September 2022.
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The speaker will discuss the status of neurosurgery in University of Baghdad, fundamentals of neurosurgery training in Iraq,
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Dr. Ali Al-Shalashi. Dean College of Medicine and Head of Neurosurgery at the University of Baghdad in Iraq.
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The introduction is by Professor A. Hadi Al-Khalili, the
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former chair of the Department of Neurosurgery at Baghdad University. And in this session, we have the honor of having leaders of neurosurgery in Iraq. And there are six of them. I hope the sixth
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one will join us, Dr. Ahmed Jaburi, but five of them are available here. And so they are from the Dean of the Medical School in Baghdad and the leader of neurosurgery at the neurosurgery hospital.
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a neurosurgeon and an orbital surgeon from Sashvat Naan and the leader of Kurdistan Erbil site, neurosurgeon Dr. Anjam. And Dr. Hassan is a neurosurgical leader in
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Basra.
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And we are waiting for Dr. Ahmed to his real
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well advanced surgeon in Iraq and Baghdad now. Can I invite Professor Ali Shatchi now to start please Professor Ali Shatchi is dean of the medical school and in the Baghdad university, the oldest
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and the biggest medical school in the country. It was established in
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1927 and he graduated in 1985 and qualified with the American board in 1985.
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Sorry, for neurosurgery 1995
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And the. He got, again, some higher degrees from Marcy, as from Dublin, Glasgow, and he is currently consultant neurosurgeon since 2008.
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So the floor is yours, Dr. Ali, please. Good evening, everybody. Good evening, everybody who's in Iraq, and they have night now. Good afternoon for these people who are in afternoon now, and
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good morning for who's early morning I am professor, do you see the clear now? I am professor Ali Shachi. I am a consultant, neurosurgeon, and a dean of College of Medicine of Baghdad. So this
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is the College of Medicine back at the university, as our professor of the Hadi, was our professor, and we admire him much. It was established at 1927. And
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then professor Ali Shachi, I am the dean of College of Medicine since 12.
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2014, before that I was the chief of the council of neurosurgery in the Iraqi board. The training of neurosurgery in the undergraduate and for the undergraduate students. Of course, this is the
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building of the dean office of the College of Medicine, it was since 1920. It hasn't changed. It's the same deal as Sandis and Pasha was here as the first dean of the College of Medicine Now, for
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our students in the undergraduate study, in the first attachment to the central level system is about in the second year, usually they got the neuroanatomy, they're about 20 hours of
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theoretical lectures and at one more than this time in the lab. These lectures are given usually by anatomists and we add neurosurgeon, we share some of these lectures with them. This is the first
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attachment for them in neurosurgery After that in the 50th year they have Theoretical and clinical sessions, the theoretical sessions about the 12 hours, it is about head injury, spinal cord injury,
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spine injury, and about intracranial spacer occupying lesion and brain tumors and congenital anomalies of the central nervous system and surgery of the spine and spinal cord tumors and subarachnoid
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hemorrhage. And also they have a small group teaching, small groups, clinical sessions, about 20 hours per year. They take about the examination of the patient, take going to the ward and see
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the ward of the patients and examining the patients, and also they have the opportunity to go once into the theater and see neurosurgical surgery
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alike. And
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this is the training center of neurosurgery for the undergraduate and the postgraduate This is now called the
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Shahid al-Azhi. Hariri Hospital, part of the medical city complex. It was called before, as Professor Abdehade said, it was called before the shade unknown hospital. In the sixth year, they
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have also 20 hours of training. It is mainly clinical training, and they have training on CT scan and MRI. This is about the undergraduate study for our students. Regarding the postgraduate study,
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we have the Arabian board of professors about the students who have them perfect body and perfect mind.
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And regarding the postgraduate study, it is in the In the
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shade Razi Hariri in a hospital. We have the neurosurgical unit. It contains 90 beds, half of them male and females, but also content. The part of it is the ICU unit intensive care unit is not
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run now by any statistics. Special statistics are now present in the ICU 24 hours They share the hours. It is important for the care for the post-operative patient and severely those very ill
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patients. This ICU is
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very, very advanced ICU.
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Most of we have a radiologic concession, sorry, a surgical department would contain CT scan and multiple MRs and angiography. All these facilities are now present in our hospital, so as difficult
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in the previous time We also have weekly MDT, which is the present where all the
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surgeons gather together with the radiology department, with the oncologist, and they have MDT for so the decision, and not anymore the decision of the surgeon. It is a multi-disciplinary team all
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give their ideas and share the ideas about the patient and the best that can be given to that patient
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This is an example of our MDTs.
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We have students from Iraqi and Arabic board. They are many years and they have
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a schedule to study because they start as simple and then they go more complex study. The other thing I would like to talk about is some specialities. Now everybody's talking about some specialities.
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We were before general neurosurgeons now about talking about some speciality. The first month has started some speciality Our unit in 2002 was a professor on the energy. We took a start, a step
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speciality about the orbit. He started the orbit clinic and the orbit world. And there was very nice results. And now our colleague Dr. Hyder Abilam is continuing the mission about the
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sub-specialty of the orbit. Regarding other sub-specialities that are there, neurosurgeons are taking now. They know the right way. They don't take turn on neurosurgeons before they take the
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subspace and they are giving magnificent results. There are people who are talking, thinking about the Parkinsonism, about deep brain stimulation, and these instruments are valuable now in our
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hospital, and it is dealt with by new neurosurgeons. The other thing is refractory epilepsy, and you are using the
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BNS, they can have a stimulation for these patients, and we have done more than 50 patients, maybe, or more than that, and this is usually done by, also our younger neurosurgeons who are taking
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this branch. We have also some specialty about the backrofane pump for those patients who have severe chronic pain, and it's also used by some other people. We have the spinal cord stimulation, we
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have the sacral stimulation, sacral stimulation, I have a few experience about two cases in the beginning, and now it's taken by us and the neurological department. We work together as
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a team for these patients and there's some speciality of sacral stimulation.
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The other thing, the gammonite, the gammonite is expected to be in this hospital, maybe in a few months we have started our teams, we have started our training for those people who would think
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that they like to take this session, I mean this sub-specialty as part of a neurosurgery. So it is now downtown of sub-specialties and we have the young neurosurgeons are going a magnificent job We
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are also planning maybe in the next year for
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angio and the angiography and those patients would that could catheterize those patients. We still know it is not present in our hospital, it is present mainly in the private sector but we think we
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will in a year of time it will be transferred to our hospital. So
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last mission, a truly getting your surgeon is hard to find and possible to forget Thank you very much for your time. ready to answer any question. Thank you very much, Mr. Chairman. Thank you,
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Dixa Ali, for this compact, collaborative presentation of the neurosurgery and your medical school. That will be really great. Their floor is open for any question. Yes, I may answer the
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question. Yes, Mr. LaZera. I'm sorry. Good afternoon and good evening to everybody, but even in particular to the people in Iraq and in neighboring nations, I mean, I understand it's late for
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you and we deeply appreciate your willingness. So Dr. Ali Salji, if I pronounce it correctly, your name, congratulations in your fantastic comprehensive effort, no? I mean, because we here in
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at least in the universities I know we don't have such a comprehensive education for the medical students, when medical students who may become interested in
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neurosurgery. Even our dean of the medical school is an outstanding neurologist. We don't have such a global compact approach to the students interested in a specific or
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particular branch of medicine. So congratulations on that. But how you foresee
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the future with the next 10 or 15 years of medical education, those are the students who are now who are taking the wave of functional neurosurgery with epilepsy, with deep brain stimulation. But
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what do you see as the needs? If you have to reorganize or organized for the next 10 years, would be. what will use stress on and that is I am I am curious about that. I don't have any any opinion
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about how things should be done.
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Thank you sir. Thank you very much sir. As I said you are planning for some specialities. Now we we have neurosurgeons the number of neurosurgeons is the high near and near is maybe 10 to 10 times
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that was 10 years before so there's no place for general neurosurgeons there's usually there's some specialities and also we have these new meetings the MDT now there's no no one who has and his own
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decision this is all always we have guidelines to work on and these guidelines it is by the MDT and and the meetings together to take a good take the right decision and we try to give this this to our
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new generation that in the future
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combine teams and working teams together
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Thank you, thank you, Professor, thank you. Dr. Ali Alsachi, I
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met you just a few minutes ago and I used to see you and
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I'm impressed with all the facilities you have and the centralization and organization is where he is. You can call me, Jim.
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What are the major needs
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that you have now and in the next five years? What things would you need to go or you want to go as Dean of the school? So the last sentence was not clear. What things do
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you need to have in the next years to allow you to progress as rapidly as you want? Well, so I think what we have established now, We have the right to go. the right stone or the beginning stone.
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So we have to emphasize our work. We have to be more clarified in our work because although we are thinking about subspecialties, but it's not the clear now subspecialties because most of our
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neurosurgeons, including me, are still thinking as general neurosurgeons. Now we have the facilities. So if we have the facilities, we don't have the excuse to be a general neurosurgeon. We have
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now the idea that everyone must take away like our colleague Samar. He took the way off of vascular neurosurgeon. We think now at this time we have reached the place where each one must take his
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role, take the right way to go with and not keep us general neurosurgeons. So we think that since the facilities are present now, since everything is okay now, I think we have to start and think
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after five years, there will be no one is called as general neurosurgeon, there will be a vascular neurosurgeon, there will be a functional neurosurgeon, there will be a neurosurgeon who work on
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gamma-9, and that's it. Thank you. Yeah, I'm sorry, Dr. you may have forgot about pediatric neurosurgery.
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I was, I was, I was, I was a pediatric neurosurgeon by the, when I was working with Professor Abdehadej Elihi, he advised me to take this branch, but they had the conurosurgery I endorse that
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presentation, sorry.
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It would seem like, like all countries in the world, you have 7 million people in Baghdad and 40 million people in Iraq. Some areas need general neurosurgeons, and other areas need specialized
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neurosurgeons. When we visited Brazil
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in the past, which they had a similar problem, I also had too many neurosurgeons. And what they did is developed a stage system of care, depending upon the hospital facilities in the area and the
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number of neurosurgeons, which then prevented overspending and competition for a very short dollar, a very short money that's available. Do you have a vision of
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that for the future? You have a rapidly expanding medical system which most countries don't face. How are you going to approach that?
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Yes, as you said, it depends on the facilities of the hospitals. Till now, in Iraq, the main facilities are present in the capital. Yeah, I know that you're right. Maybe in the governance,
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they are not going to work. like they are roping back, that in Negef Eister, they have started vascular neurosurgeon, they're doing a nice job, and Hilda also they are doing a nice job, and
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could the son, I'm sure they have started. So it mainly depends on the facilities, and the number of neurosurgeons, the number of neurosurgeons now is a little bit enough. So we can establish
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this way, especially if we have the facilities. If these works are successfully, I think this will be a general approach All the governance will work in the same way as you are working in Baghdad
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and these special tertiary centers. I think that's right.
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Any other questions?
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Dr. Ali, how can you manage between your duties as dean and your commitment as a neurosurgeon? Well, it is very difficult. Well, usually I
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start working by 6 am. and I end by 10 pm. done half job in my clinic because I know that they have this meeting, so it's as many, the family is paying. Well, I admire your commitment to both.
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You might be interested in Horace and I are, travels around the world. It seems, and this is true in Latin America, we saw this in Europe Obviously, you're showing us this
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in Iraq. But the people who wind up being involved in not only their practice, but in the country, politics and healthcare
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are the neurosurgeons. And so it's true everywhere. I guess the neurosurgeons have an image of people who know how to get a lot of things done of things done with a lot of challenges at the same
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time. You're in that mode. Yeah, more absolutely. Can I come in?
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Is there, is that, may I ask you one more question there? I saw the picture of your auditorium. It sounds, it looks like there's 100 or 200 seats in the auditorium for the students. Is that miss
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a big auditorium? So my question is how many students are in each class? So we have, we have inflation of students now If we take the six year, it is about the 300. But if we take the third year,
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it is about 800. So there is inflation of students and we are working hard for this to accumulate with this big number because the number of people are increasing and are increasing dramatically in
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our college. So now the problem is about maybe hazardous the third year. The problem, maybe in the college has been managed by working more and making the. that people stay till afternoon. But
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the problem will be, will be met with difficulty, will be in the hospital after that, because the hospital may not be able to tolerate this big number. We are trying our best now to tolerate this
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number. We are using our colleagues who are in the, working in the health, in the health government to also to share and teaching our students in the hospitals So it's now, getting bigger and we
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have this, this is our main problem in the college now, is the increasing number of students in our college.
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We've read that's a population of Iraq by 2100 will be a hundred million people. So the size of the country will almost triple.
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So that's a tremendous burden of trying to prepare for that How do you select the students? to first to go to the college and medical school. There's obviously a selection process. You say there's
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an inflation of numbers. How do you select those? And I'm sure not everybody goes into neurosurgery, but how do you
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manage that? Well,
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the selection of the students is usually not done by us, usually they have examined the sixth year of the secondary school And those who have the higher results, they come to them, they have the
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right to choose their college, and usually they could choose the medical college. Of course, we tried after that, many have been trial that the patient, the, sorry, the candidate has to have a
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meeting before or many introductions of, or was so ever before
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that, before he can go to medical college, but it all didn't succeed really So still, it is an examination in the 60 and the higher. those who get the high grades are the people who are going to
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get to that medical college after they have a simple medical examination, some that they have no, no, not, not a cripple to be not to be able to continue in medical college To add to what the
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party was saying, the high school, the final high school year, they have the national exam, all over the country, and those who score higher marks, they're eligible to go to the medical school
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And we saw this, we saw this in Japan, and I think it's in China, and for the student to get into the college or the upper educational system becomes very competitive and they have to work very
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hard to pass those examinations I'm sure it must be the same in your system Yeah. So that's a complicated problem while you're looking to add more doctors you want to add more quality doctors. Yes,
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is that correct? There's another problem which is more important than this one really we have not you don't have a new hospital because you don't need to graduate doctors if you don't have hospitals
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where they work so there is a problem in Iraq now there are there are no new hospitals these hospitals who are going to take the newly graduated doctors now the number of doctors is much below the
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real need of the country but the number of hospitals is much much much lower than we need in our country yeah a complicated complicated problem and now by the end of this I think Dr. Ali thank you
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for keeping the time including the discussion thank you thank you so much may I ask Professor Osmond now to just tell us all about.
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SI back that please program because not many people of the new audience, they know about it. I just put a briefly on it. I'll just take a minute or two 'cause I know you wanna keep on time. SI are
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surgical neurology international. We established it as an international journal that's free to everybody and all over the world. We're written 239 countries by 30 to 40, 000 people a month we get
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papers from all over the world. We have no characteristics by which any paper is judged. We don't know the authors, we don't know what country they're from and nothing matters except the quality of
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the work. And if the work is really good, we will help them try to, if it's not,
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what we think is a good level, we will help them work with the paper and make it better And so that's what we've done. We've been around for 12 years, we haven't advertised and I think it's known
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around the world has practical information. I think that the information in the 21st century for the students is going to change. This is going to change from two dimensional information to three
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dimensional information. So we've established a foundation and the foundation is the one that owns the journal and it now owns what's called SNI digital, which puts on this meeting And it allows
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audio and visual information to be transmitted, for example, not only conferences like this, but talks that a honey
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is given elsewhere and Sammers given elsewhere. And people over the world that have interest and we will peer review those and rate them. So we're going to start that within the next we've worked on
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it for over a year We started in the next few weeks, and that's what it is and it's for the young people so that they have a chance to pre to express themselves. They're the future of the world. We
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want to we want to help them grow and grow in the right way. Thank you for asking. Thank you, sir. Samar, did you have any comment on Dr. Ali's talk? Yes, sir. I will do it shortly. First,
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thank you, Dr. Ali, for this concise presentation. I would like here to say that I'm proud of you as the Dean of the College of Medicine by that university that I graduated from, and being a
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neurosurgeon as a Dean for the College, and to have this
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reaction from a well-known neurosurgeon, like Dr. Osman, Dr. Lazarov. For me, I feel the proud of it. And at the same time, I should state that Dr. Ali, at this stage, Dr. Ali Ashalchin,
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offer a
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very, like, advancement step by doing more with this. So, Actually, we have a practical example of it. He invited us as a vascular team from the neurosurgery teaching hospital to attend a
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surgery with him on his patients who have like a ruptured aneurysms. And we operate as a big team and in his hospital and his department. And it was a very nice invite And the most important, he
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made this to make his student and his resident to learn more about even some surgery that they are not doing in the department. So his approach, I think is unique. And by this example, the future
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is there for all the air act. And I should thank him at this stage. And thank you. Thank you very much, Dr. Salman Of course, this was the second opportunity before that. We started with the
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people with
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the ENT. We did for them the trans-nasal approach of pituitary gland, which was maybe not done before in our hospital. So they come, the people with the ENT, and we have a working tip. I think
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that with the more of these working teams together, the more our students would benefit from, and the more our students will get experience above, so that the students maybe who is in a place where
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there are no all surgeries, but if you advise, if you, sorry, invite other people, work together, and this will be a great, a great opportunity for our students to get this benefit, and we are
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really proud of your presence with us for these surgeries, which we have, most of them with very excellent results. Thank you very much. Yeah, I like the word team. One Indian friend, he was
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saying that team means together, everyone achieves more
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So that that quantum is team.
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The video editors were Mustafa Ismail, College of Medicine, University of Baghdad, and Fatima Ayad, fourth-year medical student, University of Baghdad
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We hope you enjoyed this presentation.
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Please fill out your evaluation of this video to receive CME credit.
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The series is supported by the James I. and Carolyn R. Osman Educational Foundation, owner of SNI and SNI Digital and the Waymaster Corporation, producers of the Leading Gen Television Series,
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silent majority speaks, role models, and the Medical News Network.
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This recorded session is available free on SNIdigitalorg.
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Send your questions or comments to OsmanSNIdigitalorg. Thank you.
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