Afksendiyos Kalangos, M.D., Ph.D. - Interview

(Translation from http://portal.kathimerini.gr/4dcgi/_w_articles_kathextra_8_08/05/2009_278699)

Afksendiyos Kalangos, M.D., Ph.D.

The Greek heart surgeon who has saved 9.000 poor children.

By Anna Grimani – Pictures John Vastarthis

“The heart of a small child is like a ping pong ball” he said and held the little girl in his arms. “How are you my child?” he whispered to her in a moment solely theirs.
The heart surgeon Afksendiyos Kalangos, who a few days ago had saved the life of two year old Stavriana, is a modern missionary of Medicine. What forms the particular personality characteristics of the 48 year old Greek is not his brilliant career in the field of heart surgery, nor his position as Chairman of the Department of Cardiovascular Surgery at the University Hospital of Geneva. It is the fact that this internationally renowned scientist has operated with the help of his team 9000 poor children the last ten years!
With altruism that was “infused” into him by his great teachers Sir Magdi Habib Yacoub and Alain Frédéric Carpentier during the years of his postgraduate studies, Afksendiyos Kalangos is spending his life between Switzerland and the Third World. The charitable institute «Coeurs pour tous» (Hearts for everyone) which he established in June 1998 with a team of surgeons sharing the same ideals is offering priceless medical services to the forgotten of the world.
The doctor of poor children, of little Stavriana who posed for magazine “K” or of little Diana from Serbia whose picture traveled last year via the Internet around the globe, is traveling one week every month: Eritrea, Mozambique, Egypt, Algeria, India, Lebanon, Madagascar, Morocco…From his roots, the alleys of Istanbul where he grew up, an advise is following him, given by his father: “try to become someone that will offer to others”. So it happened. A talented person, visionary and tireless, Mr Kalangos is dedicated to his charity work showing proverbial will and persistence. “When I went to meet Yacoub, after great effort, and he left London urgently for an operation, I sat on a bench outside the hospital and waited until he returned”, he remembers…
He graduated in 1984, 23 years old, from the American Medical School of Istanbul, specialized as a surgeon in London and consecutively devoted five more years of studies to children and infant heart surgery in Paris and the USA. He finally became a regular professor at the University of Geneva at the age of forty. As owner, today, of the patent for the “Kalangos Ring” – a pioneer ring placed in children’s hearts for repairing the mitral valve which since 2005 until today has saved the life of 4000 children – he has assigned the rights to his charitable institute in order to further educate in Geneva doctors and nurses of the Third World countries. “I started studying medicine with the aim to specialize on heart surgery and was impatient as a student to finish university so I could carry on with my expertise”, he says. “But if I tell you when I first got the idea, you might laugh…When I was little, seven years old, my father, a pathologist in Istanbul, was sending me to buy him newspaper. One day in 1967 I read in the headlines the great event of the first heart transplant by Barnard in South Africa. I said to my father “when I grow up I will become a surgeon like him”. That of course was the expression of my enthusiasm and a child’s dream, but as I grew up I never parted from that dream”.
It is early in the morning at the University Hospital of Geneva and Stavriana’s parents, two young persons from Athens, are bringing their child that had left the hospital three days ago, to be checked by the doctor. The little one was an urgent case that had to be operated within two weeks otherwise her life would be at risk. In Greece no doctor wanted to undertake the surgery without transfusion, as the girl’s family was requiring due to religious believes. “We were told about Mr Kalangos, that he was the only one who would do the operation at this moment”, says the mother. “Our little girl’s illness was diagnosed as soon as she was born but for this particular, very determinative “repair” surgery, the support of the professor and this hospital were required. When we called him, he was at a surgery and his secretary told us he would call back. We were worried at the beginning that we would have to deal with the indifference we encountered in Greece and our child did not have any time margin.” Two hours later their phone was ringing. “Mr Kalangos himself called us. He heard about the case, told us immediately that he could undertake it and that it was a routine surgery for him – he tried to calm us down. He also told us to do some check ups and helped us with the procedural matters so we could arrive at the hospital in time since the oxygen in the blood of our child was diminishing day by day. He called us many times until we arrived in Geneva. We had never seen such a personal interest by any other doctor. We knew he was a very experienced and well-disciplined doctor but we were impressed by his attitude. Such an important person and yet so accessible and friendly.”.
Little Stavriana is crying while we are taking photos, her incision is still fresh, but when he talks to her sweetly she calms down…”Are you smiling my little one?”

The happiness of saving a life
I am watching you doctor, with how much emotion you are looking this child. This moment there is nothing else around here for you…
I am touched from seeing her doing well. Do you know what her condition was? Her lips were black, her hands blue and now…how her color has changed! There is no greater gift than seeing in good condition children you have operated. It is a surgeon’s happiness!

Will she be able to have a normal life?

We created a connection between the right ventricle and pulmonary artery. After three to four years when her right ventricle has grown our aim is to seal this connection and place a graft. Then she will be able to live normal.

Can medical conscience be acquired?

Knowledge can be acquired and progress in a scientist’s life means severity and discipline. To be able to have total control in the operating room and know very well the facts. A surgeon’s responsibility is first of all psychical since it concerns another person’s life. You must feel that you are obliged to save the patient. Being a Chairman here at the clinic, I am teaching heart surgery this year to 15 doctors and I am telling them that “the patient is showing you trust, he is surrendering his heart to your hands in order to cure it. Do not tell me “sorry, I have made a mistake.” .Even if I forgive you he who has died will?” To answer your question, medical conscience is shaped through personal conscience. From the choices you make in your life and the awareness of the meaning of a positive act. This morning I saw the child…that was my reward.

How many hours do you work?

I have never counted and I do not want near me scientists that are looking at their watches. The needs of Medicine are not met this way. Look, I operated someone last night, today I have another difficult case, I have slept only one hour since yesterday and yet I am still here…

What have you been taught by your teachers Yacoub and Carpentier?

Yacoub was tireless he taught me that in deed. It is unbelievable but he had two to three surgeries every day and then he went to his clinic where from 10 pm to 2 am he was examining patients. If urgent cases occurred he would carry on – he was a man of commitment! You know, being a surgeon you can not say “no, I am tired, I can not” as this means you are abandoning the patient resulting in certain death. What you do is surpass yourself. Carpentier too was not only a great surgeon but also a great teacher. I stayed next to him four years and he gave me the “horizon”. “If you do not have the capability to treat an illness you must do research and find the solution”.

Where has that urge led you?

I started getting involved with research, initially relatively to the “ring” and then with another patent that will allow us to substitute ill heart valves with animal valves of new generation. We have concluded research on animals and will now proceed to clinical studies. In 1994 I went for a while to the USA and did a PhD in Chemistry in order to be additionally trained and develop those ideas together with other experts on this field.

What exactly is this pioneer “ring” which so many children “wear” and live with?

In simple words when someone is suffering from mitral valve inefficiency more blood is directed to the left ventricle and it becomes bigger. When the mitral valve is repaired the surgeon must put a “ring” in order to narrow the original valve ring. Some years ago there was no solution for small children regarding the “ring” and the percentage of repaired valves for them was very low. “Rings” made from titanium are very stiff and there were no sizes for children. For the heart of a child something had to be invented that would allow us to repair the valves rather than changing them. So we manufactured this new “ring” from another material called polydioxanone which within 6 months melts in the original ring of the mitral valve leaving its position to a peripheral wall which depending on the child’s age grows. The child does not have to undergo other operations.

The father’s example

We meet again in the afternoon at his office on the first floor of the University Hospital in Geneva. The room smells cinnamon! He is showing us the bottle with the perfume.“I always wear it after a surgery, it invigorates me”.

You remind me of Istanbul and what is said there, that cinnamon is bringing people close.

But everything inside me has to do with Istanbul…

Talk to me about your father.

He was a pathologist, senior doctor at the paediatric hospital Baloukli in Istanbul. When we lost our mother, very early, he gave up and said he only wanted to raise his children. I was ten and my sister eleven years old. It was a difficult choice, because he was young and could easily make his life again and also evolve as a scientist. He had the talent. In Greece we had a detached house where he established his clinic. From morning to late at night he was with his patients and twice a week he was examining poor people for free. He was giving them money out of his pocket so they could buy medicine.

Therefore you have experienced charity.

He was a true philanthropist. My father was reading under the light of candles in order to study. My grandfather had lost everything during the destruction of Asia Minor so he could not afford to buy Medicine books. He was telling me “your goal should not be money but acts. Do not turn your back to other people’s needs”. In his whole life he never earned money.

What kind of person are you?

I am deeply faithful. I come from a religious family. I try to do good things because this satisfies a sensitive aspect of my character. I have never closed my eyes towards others. I say that God is giving all the rest when you have a positive orientation in life.

Surgeons have power over other people, some kind of omnipotence, how does this affect your character?

That is a good question. However in heart surgery there are sometimes complications. When that happens, you start wondering at what point things went wrong. When a doctor has conscious of his responsibility he is constantly in a state of self-judgement in order to improve his experience and diminish the possibility of complications. He is not carried away by the feeling of that power.

Thus, difficulties act as a surgeon’s limits.

Exactly, power is gained not by success but by knowing your limits. As a surgeon one has to face problems and complications with absolute consequences: you may loose the patient and sometimes those patients are children. Then the psychological burden is enormous. When on the other hand you are successful, like for example today’s case where the chances were 50-50, you feel joy. I forgot all my fatigue and said…”ok, you had another white night, but you did the right job and save a life”. If the surgeon does not feel that it means he has lost something very important from his being.

Are there any moments that you are longing for escapes?

Yes, my two aunts from Istanbul that are now living in Athens and have no children. I feel responsible towards them and I am trying to spend with them some time in Greece which I adore. Then, in the summer I travel to Italy, Verona in order to watch the opera and visit Etna.

You visit the volcano?

(He is laughing at my surprise). Yes I visit the volcano. It has huge energy, emits smoke constantly…I like to watch it. I stay in a hotel facing the volcano. If you could see it at night, the smoke is creating a white panorama, it is amazing! When you look at the smoke you can feel the power of earth. And the contradiction of the universal world, that has no boundaries, and our limited personal world.

And what happens then, does this view affect you?

Yes. And I am thinking about the evolution of man. What is it that makes a person leave a positive state and enter a negative one? When I feel the need to focus on matters other than my science I take my notebooks and write. At the volcano it is only me and my ideas, on an island far away…It is the only time I interrupt for a while my contact with the hospital.

Have you ever had dilemmas concerning the direction of your life?

No, I had one direction, that of positive acts and contribution to the world. During that course only questions relative to the metaphysical dimension of things have been born.

Do you accept that?

Yes indeed. And I am trying through reading and personal thoughts to achieve some kind of meditation. However this is not a retort to my professional life. In my life as a scientist I have rules, conditions and strict self-control. It is a totally different reality. Medicine demands a realistic approach. I only know that outside that reality a metaphysical dimension exists.

In what language do you write?

In French, since I have read many philosophical books in that language. In Paris I had the time to read other than heart surgery books. I like Sartre, “the devil is the others”. I do not believe in the so called “judgement” or “condemnation” after death. God is love, he is not “there” to judge us, judgement happens here.

Which is your main ideal?

Family. The story of my family begins at the 8th century. A Byzantine family evolved until modern time. As an expatriate Greek I would also say country.

How do you manage time?

With discipline. Here in Switzerland, if you want to have an academic life, you must publish many papers and that specific hospital is requiring a lot of work in clinical field. I spent all weekends of my life studying so now I can direct and pass on to my students everything I have learned.

What have you sacrificed?

Contact with my children, a more positive control on their lives which can be achieved only if you spend time with them. Unfortunately I could not do that. Create that relation. Constantine is now 22 years old, he is studying Low in Sorbonne and Alexander is younger, he is still attending school.

What corresponds to your sensitivity?

The particular moments of happiness experienced when seeing the smile of cured children. Tomorrow as you know I will fly to India at 4:30 am, I arrive there at 2:00 am local time and next day in the morning at 6:00 am I have to be back for surgery.

How many operations will you perform there with your team?

It depends on the need. Sometimes even five simultaneously.

How are you keeping fit?

I am not exercising, I don’t have the time. I used to run five kilometers every day but I quit. However I do not smoke, I eat healthy and little – an apple in the morning, no lunch and dinner, usually grilled fish with vegetables.

What is your favorite Asia Minor food?

It is… (he is laughing) imam baildi, I enjoy it whenever I visit my aunts. The aubergine must soak into water for some time in order to loose all its bitterness, otherwise it does not taste good.

Well, Greeks of Asia Minor are full of secrets…about cooking, about life…

That’s it! One way of life, the mentality of our secrets…

The time is 11:00 pm and we exit together the Hospital in Geneva. The interview has finished, it lasted one and a half days including the intermissions for surgeries.

Every moment you are dealing with life and death. Have you found at least one answer to your questions?

What I have felt is that God has given me a certain life, some days that are my existence in this world and a positive nature of love. I understand that He is asking me to give meaning to that life, building something positive, not only for my personal life but for others also. I know that when a person grow older he/she takes a look at the past, makes a report of acts: “where did I start from and where have I reached”.

What is your “answer” to God?

That I meet him everyday through my personal constitution because a surgeon is balancing always two possibilities: either do a mistake with devastating consequences or save a life. The right decision, for the appropriate technique he will practice, is based on his scientific knowledge and his internal power.

When you are in the Third World, in forgotten parts of Earth, how do you feel?

I believe I have found there something that could build the meaning of my soul. Countries like Switzerland do not need me. Today I leave the Chairman’s position, tomorrow someone else takes my place. But at those places where there is no potential of training, our presence has great importance. No one can understand, if he/she does not live the experience, the immediate need children have in these countries for people that are willing to offer, even in dangerous situations. I have never thought about danger because I don’t fear anything. If I didn’t have a family I could even abandon everything and live there. As far as the final existential answers are concerned, only God has them and this is the good side of life. Through quest we can reach a higher spiritual level by doing positive acts and giving motivation to others to help. Then we can one day say “I did something that will last”.

The institute “Coeurs pour tous” was a Swiss organization that was reestablished as a charity institution in June 1998 by heart surgeon Afksendiyos Kalangos and a team of doctors and nurses from the University Hospital of Geneva. Aim of the institute is to operate for free poor children in Third World countries, develop hospital infrastructure and train on heart surgery doctors from those countries. Two months after the institute’s foundation a pilot program was implemented in Georgia, where the first children’s heart surgery clinic was set up in Tyflida. Essential equipment was sent while doctors and nurses from Georgia were trained for one year in Geneva. Other countries followed: Mauritius, Eritrea, Morocco, Egypt, Algeria, India, Venezuela and Madagascar. In Mozambique the institute is acting in collaboration with the British institute of Sir Magdi Habib Yacoub “Chain of Hope”.
The institute “Coeurs pour tous”, which has given until today a new life to 9000 children, is financed by big donations and the revenues from the “Kalangos ring” patent. Each year around two to three million euros are required for its activities.

Source:http://aromatherapycosmosen.blogspot.com/p/afksendiyos-kalangos-md-phd-interview.html