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Welcome to the 16th SI and SI Digital Bagdad neurosurgery online meeting
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held on August 7th, 2022.
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The meeting originator and coordinator is Samar Haas of the universities of Bagdad and Cincinnati. The status of neurosurgery in Curtis Dan will be described by Professor Ari Sami of the Department
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of Neurosurgery of the University of Soleimani College of
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Medicine Soleimania in Iraq.
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Lecture 30 minutes, discussion is 15 minutes, over 100 attendees from 18 countries participated in this conference.
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There was a suggestion that to start Professor Ari at first,
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Ari is a graduate of medical school in 1984 and he is fellow of the Iraqi Board of Neurosurgery in 1994
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And he got his offer CS in 2012 and then he got his FACS and he's a fellow of the ANS in the United States. And he is the Professor of Neurosurgery at Soleimani Hospital in the north of the country
1:26
at Kurdistan.
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I know Ari from a long time and I am really proud of him and after a mere and the answer for what they are achieving now is going to tell us about the. I think the board in his area and his
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experience in that field. Thank you so much, Dixarari. Thank you so much, sir. Thank you so much.
1:53
Good afternoon, those on our side and good morning to the other sides of the world. I'm happy to be here with you. Thank you, for Dr. Summers. Thank
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you, Dr. Ladi Khaledi for the opportunity you gave me to talk about
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the status of neurosurgery in Kurdistan. So if you allow me, I will talk about the status of neurosurgery in Kurdistan, history, current situation, goals, and future directions. Just let me to
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start with some history. I have been privileged to and honored to be trained in neurosurgical hospital. and by that in 1990 to 1994. At that time, our training time was four years. I trained in
2:49
the neurosurgical hospital and in the surgical specialties in the medical city in Baghdad. In 1994, I had the Iraqi fellowship of neurosurgery. I had the privilege to be trained under the great
3:04
neurosurgeons at that time Professor, Dr. Saap, Professor Haley Lee, Dr. Samir, Dr. Raffet, and Dr. Parek. Dr. Jaffar, Dr. Hekma, and Dr. Samir, and Dr. Parek, and Dr. Parek, and
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Dr. Parek, and the one.
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In 1994, when I graduated from the board, I was, I assigned to a senior neurosurgeon,
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interspecial surgical specialties hospital in medical city under the supervision of my mentor, my teacher, professor Harili. I,
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with all our colleagues in this hospital, we spent more than nine years under his supervision with his teaching as the ethics, the neurosurgery and the philosophy of working as a doctor. Thank you
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very much, sir. Thank you, sir. Like
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Erica Kudusan is divided into four government rates, the Hoxley Mania Erbil, and nowadays, or the last year's the Halabcha, encompassing about four 40, 000 kilometers square with a population of
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more than six million people This for governorate is the.
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the parts of KRG, we call the Kurdistan region a clean or the region. After the 1990s,
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when August 2nd, the Iraqi invasion of Kuwait, and at that time, the 1991, the exodus of Kurds into the border between Iraq and Iran and
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Iraq and Turkey And then the founding of the northern non-fly zone and the southern non-fly zone, there were two sanctions on Kurdistan, first from the UN sanctions on Iraq, and the second one is
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the Iraqi regime and that's a time section on Kurdistan. So two sanctions were put on Kurdistan at that time
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So many is one of the governorate of the Kurdistan region before 2003.
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Patients with neurosurgery or neurosurgery complaints.
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from
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Soleimaniya, Erbil Dohok, and even from Kirkuk and Diala we are travelling hundreds of miles to get access to a new research in Baghdad, which was sometimes unaffordable for a significant number of
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them, either because of economical or non-special socio-political situation those days.
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Neurosurgical diseases and emergencies, most of them almost missed or mismanaged because there were no neurosurgical centers, except at that time, the 80s and the 90s, the Erbil Center, where the
6:16
termMuhammad Edithofid was practicing neurosurgery,
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of course, without any city machines at that time. So he did the trauma cases and the biopsy cases and the management of some of the cases. The first department of neurosurgery ever established in
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Swamani University teaching hospital. We also had a great day. against
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2003.
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And according to the paper in 2016, where the global neurosurgical workforce published their paper, that in 2000, the global density of neurosurgeon was estimated at
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130, 000 population, which remains the most recent estimates of the global neurosurgeons workforce density. According to this, we started our department and we started to think that this
7:19
department should be a center for training of our colleagues for graduation of more neurosurgeons to be in the figure outed with this paper
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So accordingly, so many populations about 2, 000, 000 and a half. So 11 neurosurgeons should be there to cover all the neurosurgeonial diseases. Now, to end of everything, or every beginning,
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different obstacles and difficulties known for every beginning. For example, lack of facilities and zero team. So I returned back from Baghdad, 2003 There were no facilities, and there were no
8:06
assistant team for me to assist me in
8:10
the foundational of the neurosurgeon. So I started with the help of our friends, our colleagues. And none of these above negative or repulsive points could stop the mission. So with the help of my
8:27
seniors, my teachers, the staff,
8:35
the staff, the staff, the staff, the staff, the staff, the staff. We established to have a center of Iraqi board in Soleimaniya.
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Then with the help of Professor Sanehassana-Boud and Professor Walid, we established the Kurdistan Board of Medical Specialities, which is six years training. And
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the, nowadays the Torujan is the head of the program of neurosurgery in the Kurdistan board And we are the
9:07
official responsibility of the centers in Soleimani, Erbil, and Dok.
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All the neurosurgical department now is in the Shah Hospital.
9:21
During the last 19 years, tens of neurosurgical residents from Soleimani and other cities of Iraq, go trained in this department to become senior specialists. of neurosurgery, most of which return
9:33
back to their cities to serve their people nowadays. Now currently, just in the Soleimani province, we have 17 senior neurosurgeon inside the
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city of Soleimania, one senior neurosurgeon in Wania, and one senior neurosurgeon in Kalar. Those are towns belong to Soleimania and our colleague, Victoria Herro, is the
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FEMA neurosurgeons with the group. 13 residents and both students are in training nowadays. Neurosurgical ward in Shar hospital with 30 beds and 25 nurses, three physiotherapists, six nurses on
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duty 24 hourly. Department of elective surgery has two major operation theatres and one minor operation theatre with, three neuro-anesthesiologists, six anesthesia system nurses. five secret
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nurses and five round nurses with a radiology technician in the elective operation room.
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Emergency department with two residents and one senior specialist of neurosurgery on call 24 hourly. Emergency room operative room with a room allocated for neurosurgical emergency operations. ICU
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of about two or 22 beds in this hospital.
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Average of elective operative cases we do, six to eight spine cases a week, three to five brain tumors, four to six peripheral nerve entrapment cases, three to five injections for pain control,
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two to three pediatric cases, VPCs, meningomyelaseal. Most of these cases are done in the emergency room or emergency basis. The emergency department on average of 15 to 25 cases of neurosurgery
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is received daily. from minor traumatic brain injury to severe traumatic brain injury and multi-systems trauma, full-frame hydrotraffic accident, motor vehicle accident penetrating traumas and et
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cetera. Cases like extra-dural hematoma, acute subdural hematoma, chronic subdural hematomas large,
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ICH, the preschool fractures are upgraded in the emergency room within minutes to fill hours.
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New needs with spinal disravism from gynecologists and obstructing hospital pediatric cases diagnosed as brain tumor and having obstructive hydrocephalus from
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pediatric hospital, CVA from the neurology department with massive ICH or IVH complicated by hydrocephalus are referred and operated on emergency base by our emergency team on call. We have the
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discussions of the thesis of our both students in Slovenia with the help of our colleagues from Baghdad. We have visitors from outside Iraq from Jordan for the examination of the Kurdistan board
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students. We have weekly seminars, journal club meetings every week and we attended so many conferences here locally and internationally. We have symposium for our colleagues from outside Iraq,
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from Sweden, from other parts of the world here in Slovenia and we have online webinars, Sunday on 9pm every Sunday for our students, our colleagues, the seniors to discuss the latest
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points in neurosurgery worldwide.
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And of course, the social life outside in Elvig population, about three millions. This is in 2020, an average of three new researchers. While nowadays there is about 29 with female new
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researchers and they are distributed among the governor of Arabic.
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And when I search for the hold, I come across this paper in
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2016. Well, this group of volunteers published a paper, neurosurgery in Iraqi Kurdistan, an example of international neurosurgery capacity building 2016. And they wrote in this paper that the
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medical infrastructure of Iraqi Kurdistan as semi-autonomous region in the northern part of Iraq lacks this proportionately behind many of the otherwise booming industrial advances of the region.
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Although neurosurgery training is available, the local population lacks trust in its own neurosurgeons. Medical facilities suffer from a lack of basic resources such as high-speed drills, entropy
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and pressure monitoring and still a taxi to care for the research of patients. A part of ERK, good to start, the hope is financially well-endowed, largely because of the national resources of oil.
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It's infrastructural glands with modern roads, buildings and bridges, basic amenities of life, including electricity, water, shelter and clothing, ubiquitous internet and cellular surfaces are
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widely available and affordable, yet development of
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medical infrastructure like
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this version behind the otherwise booming industrial advances of the region. I think this was true for the other government rate in Sremania and Erbil also at that time We like the, the, the, the
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infrastructure of the
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neurosurgery department. But nowadays, we are getting better.
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And at that time, the hospitals appear aged and validated medical equipment, dispersed training programs are meager, and doctors like the broad training that's often taken for granted in the United
15:43
States. Further, the local culture of medical practices in stark contrast to the round the clock standard of patient care in the United States. And this was true in the late 2000s
15:56
and 2010. But nowadays, this situation is different. We,
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in Soleimani, we have so many private hospitals that, for example, foreign medical city. Nowadays, we have a very well-equipped department of neurosurgery with
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modern instruments like
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neural navigation, endoscopy, microscopes and so on. The other hospitals in the private sector, they are starting to have their department and in every hospital there are so many neurosurgeons or
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colleagues working there. In the future directions and missions, subspecialty is at the door and even started in the form of endoscopy. We have two to three colleagues that are starting endoscopics
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called day surgery and we have a fellow, one of the colleagues, a fellow of neurobascular surgery. Here he's getting his fellowship from Finland and one of our colleagues started the ability
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surgery, Dr. Hallet and hoping to step towards the following sub-specialties in the close future like which are very highly needed. We started to have some of the functional neurosurgery, the
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vascular neurosurgery, neuro-intervention, one of the colleagues that the lung came back from Australia, and he started the
17:34
catheterization or the intervention and geography, and we need peripheral nerve repair.
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And thank you.
17:46
Thank you so much, Professor Arri, for this wonderful presentation. And we admire, really, all of us, I think. We admire your struggle and your hard work to establish such expanding in your
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surgical department and services from start, from zero, in fact. Thank you very much. Really, we are very proud of what you've done.
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Dr. Osman, do you have any question or comment, please? I think he's done a fantastic job in 20 years to have started from nothing and to build what has happened. I did not like the article that
18:27
was published. I think I've traveled around the world and I've seen people at various stages of development and they're doing the very best they can and
18:42
what he has mentioned was just outstanding, tremendous accomplishments and great strides and everybody needs to do better. But I think you've done a phenomenal job and should be congratulated for it.
18:58
Thank you very much, sir. Thank you. Absolutely. Yeah. I would like to add, I had the opportunity, the owner to visit Erbil and Suleimania, but back in 2009 And,
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um, So when the beginning of your, of your program, I, I was in a, in a operating theater in Erbil. And the, and the plan was to develop something for the mile of meningostellists because,
19:28
because of the chemical effect of the war that you had 20 past years ago was apparently increased the number of the spina bifida cases in Kurdistan, no?
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And my impression was that, at least in Erbil, and then I traveled to Solemania. We traveled by car to Solemania. And
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my impression was that even, of course, you are being
20:04
strong in your assessment of your own abilities. But I came very impressed of the talent that I've seen in a bill. I'm talking back in 2009. And with a few, unfortunately, I mean, I do have the
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cards in here. I will copy and send them to you. I was involved in any neurosurgical cases, but my wife in Soleimaniya was involved in the United States, she's a neuroanesthesiologist. And she
20:34
was involved with the anesthesia team, with a strong anesthesia team. So Soleimaniya was more on anesthesia And although it's right that you do, that you are critical of your own accomplishments
20:47
and difficulties, and you always feel that you are not up to par, believe me, when I came back in 2009, I told my colleagues in the United States, how would you wear? And furthermore, we were
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talking with a transplant surgeon, with a liver transplant surgeon, in another type of the conference conversation.
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And my wife and I insisted that the human capacity that we saw in Kurdistan, I'm talking about 15 years ago.
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30 years ago, help me with the math, it is incredible. So congratulations for what you have achieved, but as an outsider, I can tell you, you will, you will rot if you continue like that in
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five, six or seven years, you will be top of the world You have the human material. Thank you very much, Dan. Thank you, thank you. Oh no, I'm just telling the truth. Yeah, this is what I
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want to say that from that paper, that before that time, we suffered the because of the sanction. And it is true that 10, 2, 003, There were no neurosurgery, the world or neurosurgery
22:11
services here in the north of Iraq. And nowadays, the thing is different with the, I don't think it's obvious our parents, our colleagues, which they are very eager to learn, eager to do
22:25
neurosurgery in
22:32
a proper way And I think now the situation is very different from that paper, which published in 2016. Thank you.
22:43
I have a question, Dr. Ari. Did you say that you are training in the world for six years? Yes Could you sign board this? Six years. In the first two years, the branches, we extend our services
22:60
or our training courses for some of the branches for more than months. We think that this is helpful. It is six years, sir, yes. Nice. And I think that by one year like a houseman, after
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graduation from medical school. Yes, of course, yes, of course. So it will be a seven year program? Yes, sometimes more than seven years, yes, yes. Yeah, okay, thanks. Dr. Netanyahu,
23:30
can I ask you a question? Yes, please. You mentioned about the number of the meningomy illicit and normal tube defects. As you know, I'm sure all of you know that the folic acid is recommended to
23:43
the pregnant woman. Are your general practitioners or gynecologists considering this because that has shown that it lowers the number of the defect. although there are many other causes, maybe
23:56
because of the war and the chemicals, which was involved. Are they considering that also to lower the number? Because that has been a major shift in pediatric neurosurgery. Yes, sir. Actually in
24:11
the late 2009 or 2010,
24:14
I think, around these years, we had with my colleague, Dr. Nagas and Dr. Nasa, we had a paper of Spanish Befida in here in Soleimania. And we found that point is very interesting. So we
24:24
started that, all the
24:31
cases, and we contact with the gynecology and the obstetricians to start this pholic acid to all women. Yes, now the trend is to give pholic acid to women, yes. Thank you, sir. And we had, by
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the way, we had that paper, published under. If you want, I can send you the link for many of the minus fields in here in Suleiman, yeah. Yes, please.
25:02
Any other question from our colleagues? Sir, how can I say inshallah? Here, here, sorry? Shall I say inshallah? Yeah, yes, yes, you can say inshallah.
25:19
The problem is never. Insha'a I would like to hear, really, from our wonderful female ladies, the ladies, zenab, or hibbe, or hibbe, or vatma. Just contribute, just ask a question, if you
25:32
want. Any question?
25:38
No,
25:40
there is nothing to be shy. Some questions may not be very already now. Go ahead.
25:50
Hey, but do you hear me?
25:55
I have a question. If they gave the woman when they are pregnant, folic acid, did that work? Any cases of pain, do you still have the lowering down or spine of the fitter? That's a very good
26:13
question.
26:16
Aria, do you have an answer for that? Yes, sir. Actually,
26:21
there is no evidence based that the folic acid that just only in practice or just in the literature, would say that the folic acid deficiency may contribute to the development of the spinal bifida.
26:36
We, in our
26:38
paper, we found that this is a very interesting point. So many cases of those women who were with spina befida, they didn't take the fallic acid properly. So we started, yes, we started the
26:55
instructions to give fallic acid to the females of that age After that, I can see you to have something to ask.
27:08
Hi, professors, good to see you. Good afternoon to all and good morning to the other side,
27:17
as Dr. Ari said. Actually, I've listened to Dr. Ari and I feel proud about what he did in court this time. I just had to have this question about, as I'm a student from Baghdad,
27:32
the competition what they studied in the fifth decade right here. medical student at an university in Baghdad, if I'm
27:42
in a competition with another called the Stanley student, so how how the competition is and how can I accept and be in your surgical residency with you? A very practical question. Yes, thank you.
27:59
Can I answer? Of course. Yes, please. Thank you. Well, as my colleague, the Mayor said, we have the Iraqi board. We have an equation. And according to your ability for the examination of
28:11
preliminary or when in the introduction to neurosurgery,
28:21
the examination results, the your results in the college. And this all the equation
28:29
will be the sum of the degrees you have and day. According to that, you'll be accepted. Good. Yes, are we going to now, we
28:42
didn't
28:44
have any difference from north and south. I was from North, and one accepted in Baghdad, and was trained in Baghdad with my colleagues. And we have, as I said,
28:56
we have so many colleagues from other sites, from Mosul, from Kirkuk, from Baghdad, they trained, from Ramadi, from Ambar, they trained here in Slovenia, and you are welcome. And as the talk,
29:14
let me say there's an equation you should be accepted or not. If you don't mind, I have one question. Thank you, please. If you don't mind. About the answer to Dr. Habbe, the lady who asked
29:27
about the fluency, I said. Although Dr. Lazaref know more about it because the topic we teach at UCLA together, the study was done in Canada, and it showed that the folic acid decreases the
29:42
change of the neural tube defect, and it was published in New England, you know, medicine years ago Either you will check on the New England, or I'm sure Lazaref has more experience in that. Yeah,
29:57
because I'm sorry to interrupt, there is an article in this issue of the New England, in today's issue By Burma, Niskandar, and they are saying, Folic acid is the answer, but it's not all
30:14
the answer. They're saying, careful with giving too much, but it's in today's. Today means today.
30:21
And also because it's the standard of care we give to all the pregnant women in America. That's right. All of them, they have to be on follic acid regularly. And also the CDC and FDA recommends
30:35
all the pregnant, all the ladies who may become pregnant should be on follic acid supplement in case they get pregnant. That's the standard up to today. Maybe today the article changes So just the
30:48
only thing to answer that lady's question. Take the wrong comment on that. I just want, I thought there was a young lady who had her hand up and I don't think we answered, did we answer her
31:01
question or did she ask her question? Yeah, about the follic acid or something else? No, I think after, after was another student. Sorry, I haven't seen that. Yeah, it's okay, I guess we
31:15
missed it So I think, uh, We'll talk about that a little bit about the future, but I think you've accomplished a tremendous amount. Absolutely. Can I ask? It's good to have competition too.
31:31
Yeah.
31:33
Do you have something? Yeah.
31:38
In short, I'm very thankful for Dr. Arsen for this nice presentation, orienting and giving us how effort or how come one can build capacity from A to Z, exactly. I appreciate that. I have a
31:54
question from my little experience on Vascular because I know Dr. I think Dr. Amman Jali is, I think he's the only
32:06
one from Iraq that spent six months with the Johar Herniz Nimi And yeah, I think he's very well trained so. with with all the capacity that you have. I'm definitely asking for the future, but I'm
32:21
comparing that. Is it the same thing that and Baghdad and all the other government? If you have a rapture in your gym, actually, we don't have emergent treatment on the same day on the
32:36
governmental hospital. Is that the same state with the Soleimani? Yes, yes. Still, we know that
32:43
we try to have Angela in the government hospital, but actually in the far of mythical city, which is the private one, all the equipments and the students is there, and I think you came there one
33:00
time, I think so. You came there, and you saw the equipments and the structures. I upright my first aneurysm ever in Faroque,
33:12
medical city, I know it's very well equipped, but the question is that you might point there for that for our people that if anybody have a subrachmadi homogeneous now and back that he can have a
33:28
treatment in some way or another but the typical emergency treatment within the first first day or the first three days is not there is not there in the system yet so it's not here yeah yeah still
33:42
still yet the same situation here but we started as I said we started vascular surgery we started functional one of the colleagues started functional epilepsy surgery and one of our colleagues is now
33:57
he's interested in the pediatric neurosurgery two to three of us interested in spine And, we are,
34:08
we are, we are, we are, we are. trying to give the step for the subspecialty in the future. Yeah, congratulations. Actually, we are proud of you, sir. No, I'm sorry, my apologies for the
34:22
young lady who raised her hand. I didn't see her. She's ready now to ask the question. Tabarik, if you have a question or you have the same question in mind, you can
34:35
ask now. Tabarik, so, yeah, I think. Hi, hi, Dexter Oh, there she is. My apologies for not knowing that you raised your hand. It
34:46
was not good.
34:49
I want to ask Mr. Summer and Mr. Abdramir about me as a female medical student. I want to be a part of medical research and neurosurgery. So what's the chances on how you could support medical
35:06
students, female medical students Thank you.
35:13
Dr. Ablamir.
35:20
Yes, yes,
35:24
yes. Are you a medical board student Victor? No, she's medical school, medical school.
35:34
Yes, you know that the board is
35:42
not BHD and we are not academic
35:49
We are
35:51
not academic board. The country such as USA medical students in medical school can have a chance to observe how, how, how could the medical thesis and medical research be done So I was asked if I
36:08
can observe about not write a research as a whole. You know that in Iraq.
36:18
medical college they have the degree of master and PhD
36:26
for basics and all the clinical branches they have no master and PhD they have board and the board is different from even their their thesis is a thesis different from PhD their
36:53
research is very practical this is different and in countries they have
36:59
BHD,
37:02
MD, BHD and they have training for surgery and they have research and to give you and the BHD and
37:12
MD who are only give our our our certification and our training is not academic. Yeah, Summer, do you have anything to add? Yeah, actually from a lower profile point, I know Dr. Professor
37:28
Abdramer answering this on the official research, but from a low profile position, let's say, that we are doing this for medical students to involve them in our research. It's, let's say, a
37:44
general research related to education, but definitely it's not in the let's say, and it's not as part of the official academic pathway as Dr. Abdramer described, but for the future generation,
38:03
this may find these courses and workshops. It's not what we are doing alone. There is also another people try to, make students more and more involved in research, and yeah, we will definitely
38:20
include you. I have something to add, Tabarek. You may go to the basic sciences research labs in the neurophysiology and physiology in general or anatomy, and we did a lot of work in that
38:35
department, the basic research work. So if you show your interest to the professors of physiology, I'm sure they will involve you with some projects doing that masters. You can help masters
38:49
students or PhD students, and then you get acquainted with the research spirit. If there is no more questions, I'm going to move to our last distinguished speakers.
39:08
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39:19
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40:01
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