World Orthopaedic Concern Book Review – 25.08.17

World Orthopaedic Concern (WOC) is an organisation dedicated to improving the standard of orthopaedic and reconstructive surgery in all developing countries — in the tropics, subtropics, and anywhere where there is a need. It is an organisation I have been involved with in the UK for many years and my visit to Ethiopia in 2016 was part of a dedicated WOC project. I was therefore truly humbled to read a review of my book, “Surgery on the Shoulders of Giants”, published in the most recent World Orthopaedic Concern Newsletter.

The review is written by Michael Laurence, editor of the World Orthopaedic Concern newsletter and a dedicated, passionate orthopaedic surgeon, committing to many developing world projects over many years. It is an incredibly thoughtful and comprehensive review and I am very grateful for his insights and feedback into my writing.

I enclose the full book review below. I would like to personally thank Michael for this touching review, perhaps the most meaningful review to me – as it comes from a vastly more experienced colleague in the field of orthopaedic surgery, a career I am only just settling into. His words of encouragement will stay with me, especially during the times I may be struggling to write amidst this baffling world of neglected healthcare.

Surgery on the Shoulders of Giants – Review by Michael Laurence

From World Orthopaedic Concern Newsletter, number 207 (all newsletters archived here)

It should be required reading for every medical student in his last year, or soon after qualification…Saqib reveals an enquiring mind into history, geography and into each community to which he was devoted. This is clear from the richness and detail of his observations, thoughts and actions.

Dr Saqib Noor qualified from Nottingham in 2004. In August 2008 he was at a personal crossroads (which he does not elaborate upon in his book) but at one stage he had contemplated abandoning Medicine altogether. In his Preface he describes his inspirational decision to move for a year to Empangeni, Kwazulu – Natal, in the Eastern Cape. He first appeared on the pages of this Newsletter, in September 2013, (NL Issue 135), working with Jim Gollighy. (q.v.)

His story of the year 2008 in the third world, and his series of visits to remote and neglected parts of the world, spins along smoothly in the form of letters home. His time as a clinical student in Nottingham, reflects well on his tutors, for he shows profound gifts of observation and empathy.
Remote visits punctuated his orthopaedic training. Soon after Natal, the earthquake occurred in Haiti, then the floods of Pakistan, then to Cambodia, Ethiopia, Myanmar and back to Haiti. These were seminal interruptions in his surgical training, and I suspect the most formative. They took him far beyond orthopaedics, on which he is continuing his training, in paediatric work in the far East.

Historically there has long been a need for the sort of manual to guide the prospective surgical visitor. During a young doctor’s early years, before he or she has made definitive career plans, there is a need to see as wide a variety of styles of medical practice as possible. Ignorance of “elsewhere” cramps that search. Publications such as the National Geographic do little to clarify, and western medicine is confined to western disease.

These letters, have the freshness of an unedited diary, revealing keen observation, richly coloured with metaphors and profound sensitivity into the emotions of the patients, their relatives, and Dr Noor, himself.

Knowledge of sub-Saharan Africa (s-SA) has previously been restricted to brochures and television. Dr Noor has filled an important need in writing the best introduction the subject of s-SA medicine. It is not a technical instruction, nor a list of pathology, nor a picture book of the pornography of chaos, but the personally observed details of a human experience which will change all who read it. I expect it will attract many in the field of literature as a piece of high-class journalism; it should be required reading for every medical student in his last year, or soon after qualification.

Noor is selling nothing; it has no feeling of a text-book. He displays optimistic curiosity, which might repel some but excite others. Over a period of surgical training he made six foreign visits, firstly to learn the elements of treatment, then to participate, and finally to lead.
Apart from the excellence of his writing, this book does much to add to the dimension of personal involvement to the whole subject of medical education. He does not instruct as to how to do anything; indeed facilities are so variable that general instruction beyond principles is not possible.

One faint disappointment relates to the title of this work. This reader recognised the reference, but the “Giants” are not named until very briefly on page 119. The name of Paul Rollinson (Kwazulu-Natal) is quoted, and on the following pages, Carwyn Hill, in Haiti, and Abdul Wahab, in Pakistan. These most effective individuals are identified not by their international fame, but by the quality of their product.! Help provided by the author was quite different in each site, emphasising the importance of flexibility and ingenuity.

I suspect Saqib had always been a dedicated diarist. He reveals an enquiring mind into history, geography and into each community to which he was devoted. This is clear from the richness and detail of his observations, thoughts and actions.

Recent Conferences on the subject of “victims of mass catastrophe” have been filled to standing room only in western cities; but this book is also for sociologists, journalists as well as budding surgeons.

Visit the World Orthopaedic Concern (international) and the World Orthopaedic Concern UK websites by clicking the links.

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