The Interview: Bookbag Talks To Saqib Noor

Sue laughed and cried when she read Surgery on the Shoulders of Giants: Letters from a doctor abroad, touched and humbled by a man who has provided medical aid in some of the most needy parts of the world. She had quite a few questions when author Saqib Noor popped into Bookbag Towers to see us.

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The Interview: Bookbag Talks To Saqib Noor

Summary: Sue laughed and cried when she read Surgery on the Shoulders of Giants: Letters from a doctor abroad, touched and humbled by a man who has provided medical aid in some of the most needy parts of the world. She had quite a few questions when author Saqib Noor popped into Bookbag Towers to see us.

Date: 10 July 2017

Interviewer: Sue Magee

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Saqib Noor: Although I initially wrote the letters to my friends and family, describing all that I was experiencing, I always imagined myself as an old man with a long straggling beard and a fading memory, reading through my own writing and wondering if it was truly me being described in those desperate scenes of the past.

However, since I chose to publish the letters, I am hopeful the book will resonate with many people with different backgrounds throughout the world.

I see members of the public, already engaged with the news and international affairs, following the plight of those less fortunate around us in lower income countries, struggling with poverty and disaster.

I see people who donate to charitable causes in times of emergency and wishing to learn the ongoings of emergency healthcare responses.

I see the bright eyed student, whether or not affiliated to healthcare or the humanities, wishing to believe in a better world - where people of all faiths and cultures can combine with heartfelt energy to improve the lives of others.

I see healthcare professionals with an interest in global health, currently considering, or who have already embarked on their own journies into volunteering, wishing to compare their experiences with mine and learning from my lessons and mistakes.

I see the curious traveller, midway through their own exploration of the planet, wanting to gain a different perspective, away from the glossy brochures and five star internet reviews.

Most of all, I see any reader wishing to be inspired by stories of heroic and brave people - those readers full of hope for a brighter and more equal world.

• BB: You've been to some of the most deprived parts of the world giving medical aid to those in need. Were you ever shocked by what you found? Did you ever reach a stage of being ready for the situation?

SN: Each environment and circumstance brings a unique challenge that is likely to shock and crush some aspect of your perceptions til you have a chance to reconfigure your shock-o-meter.

I do not think you can ever be fully ready, I believe it is more a matter of preparation - being prepared to be shocked and having the adaptability to ground yourself quickly and move forward in the project at hand.

It is like knowing you will be hit by an inevitable lightening bolt - you can either stand in the rain of an open field and get frazzled or you can put yourself in a safer position, minimise the electricity you will be hit with and make sure you are well enough to carry on. You are never truly safe from the thunderbolt though.

• BB: Your letters to your family and friends began much in the way of any young man writing home about what he has seen and done. Before long they're much deeper, more thoughtful and analytical. I felt that you were driven to share your thoughts and that it might have been necessary to your mental wellbeing. Were the letters a form of therapy? How else did you cope with the trauma?

SN: Writing was my escape - a chance to release every feeling that was building up within me. It is true that as the letters progress, one can palpate the crescendo of emotions rising and pouring out word by word. I am truly grateful to every person - in the past and to this day who has read my letters. It has allowed me to share my burden with many courageous readers and I can never thank a reader enough for that morale support.

My writings were most frequent in the acute disaster zones of Haiti and Pakistan, where each day's experiences were overwhelming - the sights, sounds and stories of poverty and strife often too much to bare.

I remember in Haiti, lying awake each night, drowning in thoughts of the previous twenty-four hours, and could only find sleep when I had managed to type out all my thoughts onto a very old phone, sending out my letters like a giant text message.

Equally, in Pakistan, one of the moments I truly broke down was when my laptop had been corrupted by the power supply, meaning I could no longer write my letters home.

• BB: I was shocked by the level of corruption in places like Pakistan, that people would put personal gain before the lives of their fellow countrymen. How can this be circumvented and do you think there's a cure?

SN: I believe there is a level of corruption in every country that has embedded into many governmental institutions, whether that be a high, middle or low income country. Pakistan was particularly discouraging as the corruption seemed so brazen and nonchalant, like it was an accepted normality and engrained into the political and public psyche.

Corruption can only be circumvented with transparency and honesty - with clear accountability from decision makers in the government to those implementing policies and practice within the country.

Within the charitable healthcare sector, I believe it is essential that all donations are fully accounted for, and robust checks and balances are implemented to ensure the medical provisions being offered are both providing good safe clinical care as well as maximising cost effectiveness.

Providing such accountability is very hard work, and for our project in Pakistan, I compiled spreadsheet after spreadsheet, well into the early hours of most nights. I remember colour coding every piece of data to keep me awake and look at a more colourful laptop screen - but I truly believed unless every action was accounted for, the work would lose its foundation and could collapse at any moment.

• BB: Of the countries you visited, which did you find the most personally rewarding?

SN: I fell deeply in love with Cambodia - where I wandered the streets for the first time in my life and felt I was home and that I belonged.

The hustle and bustle of Phnom Penh, the often comical scenes of street activities, the tolerance of its people, the sunshine and the monsoons, the international cuisine all made it a wonderful place to live and work.

The surgical centre I worked at made me feel like I had been there my whole life and indeed, my wife and I returned to Cambodia and the Children's Surgical Centre on our honeymoon in 2015. The staff at the centre organised a surprise wedding party for us, performing a full Cambodian wedding ritual, hiring Cambodian wedding clothes for us and a wedding photographer. We were "given away" by the CEO of the centre. The sincerity and joy the staff displayed on our Cambodian wedding day was incredibly humbling and one of the happiest days.

• BB: I loved the title of the book - Surgery on the Shoulders of Giants - with its nods to Bernard of Chartres and Sir Isaac Newton. What inspired you to take this as your title?

SN: Throughout my surgical training I kept a list of all my mentors who profoundly influenced my development as a person and as a surgeon. Without their wisdom and encouragement, I do not feel I would have progressed and perhaps I would have left the medical profession altogether.

It was when I was particularly struggling with the physical, moral and ethical challenges of surgery in the austere environment that I realised that it was these surigcal giants of my past that were keeping me strong - like I was truly standing on their shoulders. Perhaps I have not seen further than them yet, for I am not a visionary like Sir Isaac Newton, but if one day I can contribute to this field I am in, it will be only because of the surgical giants of my past.

• BB: I sensed that you gained a lot of support from your religious beliefs, but when you saw natural disasters did you ever feel that God had deserted us? I'm thinking particularly of Haiti here.

SN: During my travels, I continuously found a theme of hope, prayer and religion in all the lands I visited. I felt it was such a universal concept and I began to notice such incredible similarities between us all.

I began to see God in all people and in every land, and I found God nestled within the hearts of all those striving to assist those in need or working hard to make the world a better place for others.

I believe God is within all people, and so even though the external tragedy of the earthquake in Haiti, or the landslide that damaged a school where children were studying makes you question the existence of God altogether, I clung to the inspiration of those amazing people giving aid, and palpating the God of all religions beating within them.

• BB: Do you feel that we in the 'first' world are generous enough to others who don't have our advantages? How do you feel about suggestions that the overseas aid budget should be cut?

SN: Sadly we are far away from a universal health service where impoverished people throughout the world have access to safe care. The recent Lancet Commission in 2015 has stated that 5 billion people still do not have access to safe surgery.

It is only when you see operating room after operating room - with no sterile water, no anaeshetic machines, broken equipment and supplies, limited electricity and other gaping infrastructure problems that you know that the discrepancy between low income countries and the rest of the world is too much to accept.

Although the World Health Organisation, along with other stakeholders, has proposed a Global Surgical Programme to improve global access to safer surgery by 2030, the challenges and resources still required are enormous. Reducing the overseas aid budget is only going to make these discrepancies worse, promoting further inequality and disparity between all people of the world. This will only lead to more hardship, conflict and distress - which inevitably affect us all.

• BB: You've got one wish. What's it to be?

SN: Within my lifetime, I would like every human to have access to affordable, safe and robust healthcare. I desperately would like to eliminate this disease of poverty and neglect which is prevalent throughout the world - easily curable diseases being ignored so long that they become incurable, disabling and devastating to those suffering from them. It is unnecessarily heart-breaking and so easily resolvable.

• BB: What's next for Saqib Noor?

SN: I have now completed my orthopaedic training in the UK. I will be returning to Cambodia for 6 months this year to recommence my work in an austere environment whilst learning more about the global challenges we face as a surgical community.

I also hope to embark on a fellowship programme specialising in paediatric orthopaedic surgery, enabling me to complete my training to the highest possible level before continuing long term surgical programmes in a low income country. I believe I have a duty to be as qualified and educated as much as I can be in order to provide dignified and ethical surgical care to those in difficult circumstances.

As a writer, I hope with the encouragement I have received so far from publishing these letters that I will continue to pour out the words trapped within me onto paper for any reader wishing to join me on this lifelong journey. I hope we can travel together.

• BB: We hope so too, Saqib and we can only hope that your wish comes true. Thank you for taking the time to talk to us.

You can read more about Saqib Noor here.

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