A distinguished career, abreast of change Pathways of experience Profile by Khairya Khairy photo: Randa Shaath It is almost impossible to believe now that once upon a time neurosurgery was Sayed El-Guindi's bugbear. Yet he is perfectly happy to admit that up until his fourth year at Ain Shams medical school he "did not like neurosurgery". It is a dislike that had its reasons and they happened some time in his first year at college when he was handed a skull by an English professor, one Dr Derry, and asked to name its parts. He could not, and subsequently received a fail grade. Such an inauspicious beginning must now seem a long time in the past for the man who is known affectionately among his colleagues as either the doyen or the omda of Egyptian nuerosurgery. Fortunately for his future profession that initial failure was not repeated. He succeeded in his finals, though short of the grades which would have allowed him to become a registrar at the medical college. He therefore opted for the military medical corps, in which he enrolled as a first lieutenant. Immediately following the outbreak of the 1956 War he found himself posted to the front in Sinai, confronting experiences that would be repeated in the 1967 and 1973 wars. However traumatic such experiences, there is the possibility of at least some light at the end of the tunnel. In the case of Sayed El-Guindi it was in the management of mass casualties that whatever salvation war brings might be found. In one instance he turned the kitchen of a sporting club into an operating theatre. And it is out of such war-time service that he is credited with establishing a coherent protocol for the treatment of large numbers of wounded soldiers. Under his direction neurotrauma cases were dealt with by both military and university neurosurgical departments. Delays in attending to cases were cut to a minimum and mortality rates reduced from 50 to 9.5 per cent. The attitude of Dr A Zohdi, 48 and himself a distinguished neurosurgeon, is typical. "Dr Guindi," he says, "has been an inspiration ever since I was in medical school. When, at 23, I was recruited by the army and became a resident doctor at the Maadi Military Hospital I worked for a year under Dr Guindi. He is a stickler for discipline. It is either black or white with him. He has no grey zones. He is clear- headed. He takes clear-cut and immediate decisions in surgery... what to do, what not to do, how far to go." In the aftermath of the 1956 War Sayed El- Guindi felt an urgent need to consolidate his neurosurgical skills though at least one expert in the field attempted to dissuade him. It was by the merest chance that he came across an advertisement in an English newspaper announcing a vacancy at the Old Church Hospital in Essex, England. He forwarded an application, admitting what he perceived to be his shortcomings in neurosurgery and quickly received a reply, the gist of which was just come along. At the time he was a member of the presidential medical team, a prestigious position that he felt his father would not approve of him abandoning. But when he told his father of his plans he received nothing but encouragement. Without hesitating for a moment his father urged him to go. During his two years residency at the Old Church Hospital he undertook a regular neurosurgical programme, guided mainly by Dr J Andrew. "He took me in hand as would a tutor," says Guindi, with obvious gratitude. From there on Sayed El-Guindi's career grew from strength to strength. His private practice expanded and he has been instrumental in the introduction to Egypt of many advances in his chosen field. He advanced the local application of micro and laser surgery and introduced ultrasonic aspirators alongside a host of technologies that are now an everyday part of nuerosurgical practice. He has been indefatigable in his efforts to keep abreast with the most recent developments and regularly attends national and international conferences and visits neurosurgery centres around the world. For the record he has been to Zurich, Berlin, Hanover, Marseilles, Moscow, Paris, Tokyo, New Zealand, and has attended some 75 conferences. His promotion of neurosurgery extends to the departments he established in several military and private hospitals. Foremost of his achievements, Dr Mamdouh El-Mahdi, head of the Military Academy stipulates, is that, together with a group of consultants, he laid the foundations of the Military Medical Academy, a medical institution that maintains a level of excellence comparable to any of the medical faculties attached to Egyptian universities. Dr Abdel-Hakim, dean of Ain Shams Medical College, is equally keen to give Dr Guindi his due. "He was the first non-university staff member to sit and appraise the doctoral dissertation of a medical student." And according to Dr El-Mahdi he is the leader of his generation of neurosurgeons. He is a founding member of the Egyptian Society of Neurological Surgeons (ESNS) and one of its most active members. It is his enthusiasm that turned the society into an organisation with an international reputation. Through the ESNS Sayed El-Guindi represented Egypt, the Arab world and the continent of Africa, eventually becoming an honorary representative of the World Federation of Neurosurgeons. A distinguished career, then, but not one without its hiccups, some of which occurred even before that incident with the skull. And in allocating credit Guindi's mother must head the queue for it is she who was responsible for setting him on the course of medicine in the first place. As a youth he was inclined to join the Faculty of Agriculture -- a decision of which his mother did not approve. She saw no future in farming, certainly not under what she assumed, with commendable foresight, would shortly be a new regime, despite the fact that her husband was a landowner. And then there is his father, who encouraged him in his plans to quit a secure job and venture abroad. And last but not least is his silent partner, his wife, who has been ever supportive to her workaholic husband. He, for his part, has been mindful to make sure she accompanies him on many of his trips abroad. The couple have two daughters and four grandchildren. Each year they spend a month and a half together at the remote summer resort of Obayed, 22km beyond Mersa Matrouh in a white washed house perched on a cliff overlooking the Mediterranean. The houses of neighbours can be seen at a distance. Olive and fig trees and dry bushes are left untouched to lend the place a sense of wilderness. Below the cliff a gold sand beach is lapped with transparent water which extends to the open sea turning first turquoise and then azure where the sea touches the sky. It is in this atmosphere of peace and tranquility that Dr Guindi unwinds. He also finds respite in a large network of friends, among whom are counted leading businessmen, economists, artists, writers and film stars. Nor should his occasional forays into cultural journalism be ignored. And he has built up an impressive collection of contemporary Egyptian art. Yet it is, perhaps, only when summer ends that Sayed El-Guindi finds himself back in what must have come to seem his natural element, operating in the morning, attending to his clinic in the afternoon and socialising in the evening. At 72 he continues to approach his work with customary zest and has lost none of his enthusiasm for keeping abreast of the most recent developments. Not that he is in the business of mystifying his chosen field. Indeed, quite the opposite: in one medical journal he is quoted as saying that "neurosurgery is not that difficult if you know your anatomy, physiology, pathology and neurology to a good standard and in the future it will become easier as technology advances." In 10 or 15 years, he predicts, open surgery will have become an exception. "They will be the days of endoscopic surgery. By passing an endoscope through a small opening tumours can be removed. Other technological developments will allow doctors to identify tumors far earlier than at present. Open surgery will only be used for open injuries." El-Guindi shares his expertise with his fellow neurosurgeons mainly by lecturing in medical colleges in Egypt, the Middle East and Africa, though he has published some 50 papers, 19 of which appeared in international journals. Calm, respectful of others, open to learning, such are the qualities that many colleagues cite as underwriting Sayed El-Guindi's success. He is also said to possess a marked degree of equanimity. But though he is unassuming "he can be hard and can be very kind," says one colleague. Quite whether it is a result of his army experiences, or simply a matter of temperament, the fact is that he does not tolerate any slackness on the part of his staff. He has no qualms about reprimanding those guilty of what he might deem negligence and will make amends only when he is sure that the person concerned has got the message. Does he ever get emotionally involved in the cases he is handling? No, never is the answer. "This is why I would not accept to operate on any of my friends," he says. And on his own approach to his practice? "When I am operating you could consider it a kind of instinctual activity that follows years of training and practice. If you distract yourself by worrying too much about the operation it will not be so successful." So says the man described in one medical journal as "one of Egypt's medical pioneers, a neurosurgeon extraordinaire."
