AVC7 talks Governance

It’s always a pleasure to be back in Egypt.A bond with my riparian brothers runs deep (on a personal level for reasons that i wont bore you with but are obvious to the social anthropologists amongst you ). I have been visiting as a Vascular surgeon for over 20 years.I remember my first trip at the turn of the Millennium as a member of the British Arab Medical Society when we supported a conference on evidence based medicine.It was an exciting time as we all struggled to get our heads around this new phenomenon .Little did we know that as a profession there was more to come.Egypt is rich in vascular surgeons and over the last 20 years I have both admired and winced at the pace of expansion of our beloved speciality especially in the Endovascular arena .For reasons understandable its development has outpaced that of that of open surgery ,much to my chagrin.

It is therefore no surprise that the combustible combination of a generation of enthusiastic able surgeons , patient choice and industry with deep pockets has seen a growth in the specialty.This seems however have transpired at a pace too fast for the regulatory and professional bodies to manage.The end product has been the availability of a myriad of services and providers.Some are world class whilst alas others fall short of the standards we aspire to as professionals.Like I said,my affinity to the pharaohs is indelible. My wife is half Egyptian and thus my children quarter so.I have skin in the game .

And so my recent invitation to attend and speak at the Alexandria Vascular Conference 7 was too good to miss.I had been to the first AVC (2003) held in the Alexandria Library conference hall,site of the first library in the world(since sadly burned down but rebuilt by a proud nation).It is always a chance to see old friends ,catch up and soak in the friendly andragogy in a way I cannot say I feel at western academic meets.

This year the session that caught my eye was the plenary session on Clinical Governance (CG) in Vascular Surgery. Sponsored by Alex’s patriarch ( and my old mate ; we first met over a stinker of a juxtarenal AAA together in Sudan ) Prof Rafat Naga .It was a breath of fresh air. Being British ,after Bristol,Mid-Stafford and recently Shrewsbury I sat with juxtaposed feelings of admiration and dread.Contributing were my fellow Brits Ahmed Nasser , David Shaw (both from Leeds )and Samer Koussayer who gave the American perspective.We spoke about the pillars of CG ,Clinical Practice Guidelines,EBM ,Clinical Effectiveness and Duty of Candour.As Brits we shared pour humble experiences and showed where “all he bodies are buried “( the pun is unintended ).How do the vascular surgeons of Egypt establish a national system of governance and quality assurance? Frank and sometimes uneasy discussions ensued.

And so it was ,this fraternity had started the uncomfortable process of self reflection.In the audience were young men and women aspiring to be like their professors .But they were being told they had to be better than they were.Furthermore, one of the key enablers of modern health transformation is the ‘activation of the citizen’. These citizens exist in abundance now in the MENA region.They have high expectations of their medical professionals.The unregulated status quo can no longer continue.

If my 26 years as a Consultant Surgeon has taught me anything it is that the road of Clinical Governance is full of terrible crashes often followed by some stunning scenery.The important thing is to stay on it . No health system is perfect but as my friend and mentor Paul Levy (former CEO of Beth Israel Deaconess ) once said to me ‘Isam , we want to be the best at getting better’.

So to my friends in Egypt I applaud you and say keep the faith.When the self reflection becomes difficult remember that our patients expect us to always try to do the right thing ,at the right time ,in the right way ,every time. Good Luck!