John Hadfield: Passage to Pakistan

93-14-01-1997c

By Zubeida Mustafa

 John Hadfield has been visiting Pakistan every year without fail since the late sixties. He has lost count but Is certain that his latest trip to this country this month was his thirtieth. If not more. He says he Is happy here and feels at home, In fact when he was very ill a few years ago, his wife helped him get to his feet by urging him to recover fast so that he could undertake his annual pilgrimage to Pakistan. ‘It was a bit of psychotherapy she tried and It worked,’he remarks.

His mission? To conduct post-graduate surgery courses for Pakistani doctors. These courses are held every year in Karachi, Lahore and Peshawar and according to a rough calculation at least a thousand Pakistani surgeons have benefited from his training. A number of them have attended his courses in Britain and two — the late Haziqul Yaqeen (of KV SITE Hospital, Karachi) and Mahmood Chaudhri (of Sheikh Zayed Hospital, Lahore) — have actually worked under him as his registrars. What is more, Mr Hadfield (the British conventionally do not prefix the title doctor before a surgeon’s name) does not charge a penny for the courses he conducts here. He even pays from his own pocket for his air ticket from London.

And yet when John Hadfield applied for a visa for one of his umpteenth visits, his application was turned down by the visa officer in the Pakistan High Commission in London. He had described the purpose of his visit to be to conduct a course which was not considered to be a valid enough reason for a trip 5,000 miles away. A senior official was more sensible and Mr Hadfield was allowed to come. The following year he simply described himself as a tourist and was promptly issued a visa.

As any surgeon would testify, these courses are indispensable. Surgery is a branch of medicine which involves practical skill and one cannot learn it from a textbook. But even today not many courses at the post-graduate level have been devised and not all countries have one. England itself did not have a post- graduate surgery course when Hadfield was training in 1946-48 for his FRCS. “I constructed my own course by hanging around senior surgeons, asking them questions and taking on extra duties to gain practical experience,” he recalls.

Pakistan has been fortunate in this way. When Dr Haziqul Yaqeen invited Professor Hadfield to come here and establish a post-graduate course in surgery, a nucleus of surgical training was established. Today Pakistani surgeons preparing for the College of Physicians and Surgeons membership and fellowship exams at least have the facility of an excellent course available to them.

Structured around a one-hour slide presentation to introduce the subject, the course envisages a two-hour case presentation, followed by a two-hour demonstration of procedures, a one-hour question answer problem solving session and an hour of surgical pathology with the help of slides and specimen.

John Hadfield’s 41-year-experience of surgery has equipped him with the surgical skills that have made his career so outstanding. He entered the profession in 1946 as a House Surgeon at St Bartholomew’s Hospital, London. He retired nine years ago as the Senior Consultant Surgeon at the Stoke Mandeville Hospital, Aylesbury. In between, he had stints with the Royal Infirmary Bristol and Sloane-Kettering and Memorial Hospital, New York (where he worked on a fellowship). He was also a surgical specialist in the British Army. Today a procedure in breast surgery is named after him — Hadfield’s operation. But it is not the fact of his being a front rank surgeon that makes him feel proud of his achievements. It is his success as a teacher that he cherishes most.

“My philosophy in life is that if you have a talent you must pass it on to others. It was that which got me interested in taking courses at the Royal College of Surgeons of which I later became the vice president. I come from a family of teachers. My father and grandfather were doctors who also taught. Hence teaching is in my blood. Besides, for me it was not so important that I trained surgeons pass an exam. The charm lay in producing a progressive surgeon,”  he remarks.

What does he mean by a progressive surgeon? Anyone who feels motivated to progress. Hadfield complains that many teachers fail to create the frame of mind in young people to make them desire to continue to progress. This motivation is not inculcated in them at a sufficiency early age. According to him, a skilled teacher doesn’t teach just one generation. When he teaches he reaches out to the next generation as well by motivating his students to pass on their talent to the generation which follows.

For him it is important that he gave young surgeons opportunities and encouraged them to progress. He learnt this from his senior colleagues, of which he specifically mentions Professor Milnes-Walker, Professor Sir James Patersorffloss and Dr Frank Adair, who not only;taught him but also inspired and encouraged him by giving him opportunities.

This is the man with whom so many luminaries in the surgical profession in Pakistan have been associated. You suddenly realise that the gift Professor Hadfield has passed on to this country is invaluable. “I have taught my students not only to be surgeons but more importantly to enjoy being surgeons. It is that deep sense of involvement that a surgeon feels in his work that makes all the difference. If he likes his work he relates to his patients on a personal level. If surgery Is merely a job for him his patients are like clients for him,” he says.

As for himself, his approach to everything around him exudes his surgical talent. I watch fascinated as he packs a delicate Iranian jar he has received as a gift. The scalpel, bandages and dressings are not there but he applies the same skill in wrapping bubble paper round the handle as he measures it to do a neat job.

Another dimension of his work which he enjoyed immensely was the human relationships he forged in the process. “That is something I have missed immensely after I retired from hospital practice. I operated on a large number of cancer patients whose lives, I saved or helped prolong. It was the cancer follow- ups that gave me immense satisfaction. They became a part of my life. Many of these people had looked to me for reassurance and support at a critical juncture when they had entrusted their life in my hand. When I retired I remember how terribly upset my patients were,” he reminisces.

For him the personal relationship is what matters most. He feels a personal bond with his patients. He recalls a Caribbean woman whose tumour he had removed. She stopped coming for her follow- ups after five years. Professor Hadfield believed he had lost her. When sometime later he met her in a store, he was delighted to find her alive. He does not perceive his patients to be his clients or customers, he says. On this score he is very clear in his mind. He denounces the commercialisation of the medical profession very vehemently.

Since human relationships mean so much to him, it is not strange that he feels at home in Pakistan’s oriental culture which still sets great store by family values. Professor Hadfield has made many friends here. When he retired nine years ago, he decided to slow down his pace of life for  health-related reasons and : spend more time at home with his wife Beryl in Devonshire. He gave up his hospital practice and stopped teaching courses in England. But he was unwilling to discontinue his courses in Pakistan and so he has kept coming here. This is an honour for the country he has come to regard as his other home. “I will continue coming here as long as I am wanted and I feel that I am making a contribution,” Professor Hadfield promises.

He speaks of the “components” he has collected from different people he has worked with. “As long as a person is receptive and willing to receive advice from others, his components come from anyone he may come in contact with,” he explains.One of his components comes from Milne-Walker from whom Professor Hadfield learnt to be extremely quick and precise in his surgery. “He would do only that which had to be done and he would do it fast. No wonder the recovery rate of, his patients was exceptionally high,” he says.

In the Sloane-Kettering Memorial Hospital Professor Hadfield learnt the art of organisation and management which he thinks the Americans excel in.

“From my Pakistani colleagues, I have learnt that in spite of heavy odds one can create the scope to achieve what one wants to,” he says as he goes on to add, “I am thinking of people like Dr Adib Rizvi and Anwar Naqvi who set up and run the Institute of Urology which is as good as any in the world.”

Now 73-years-old, Professor Hadfield says he has liked every moment of his professional life. His father and grandfather were doctors and never wanted to be anything else. His mother wanted him to join the army but unfortunately for her and luckily for him his weak eyesight disqualified him for the armed forces. The closest he came to fulfilling his mother’s wishes was when he entered the medical corps as a captain. He was sent to Burma and Southeast Asia. He landed up in Karachi in 1948 when the ship carrying him and his colleagues to the Far East broke down in the Arabian Sea.

“In Karachi, I was in the transit camp for a few days and then we went by train to Burma,” he recalls, “There was nothing to do and I use to laze around the whole day reading the Chamber’s English Dictionary because that was the only reading material around.”

Of course, those were different times. Now he has friends here, a large number of them. He feels he can come here just to sit and chat with them. Besides, the ever-widening circle of surgeons he has trained helps him establish human links something he cherishes most. I can see how important that is for him. Only a few months ago when his arthritic hip made hip replacement surgery inevitable he opted for the operation at the local hospital where the orthopaedic surgeon had been his student and registrar. “The president of the Royal College of Surgeons who is an expert in hip replacement surgery and has operated on the Queen’s Mother offered to take up my case. But I didn’t want to go to London for my surgery.

Nearer home was better since it did not dislocate the family. They could visit me in the hospital,” he adds. The hip replacement procedure has eased his pain and the only tell-tale sign of the surgery is the limp in his walk. He has a problem negotiating the stairs when coming down since he has no sensation in his hip. “I have to hold on to something. I ask someone who is close by if I can hold on to him,” he says and quickly adds with a chuckle, “of course someone who is known to me.” His typical British humour has not deserted him.

But there was a price tag attached. He has had to give up cruising which he has done eversince he was eight years old. No, not because his metallic hip may get rusted but because the motion of the boat could dislocate his hip. He talks of his foreign travels and keeps you enthralled with his stories of yore laced with his humour as he mimics dialogues. But all said and done, he is a person you can’t help but treat with utmost respect. He is a surgeon with a heart who not only organises surgery courses for several generations of surgeons. He teaches them to love their job and forge human relationships with their patients.  

Source: Dawn 14-01-1997