. : How does Lebanese csotcina.comedy go?

: Lebanese csotcina.comedy goes well. It has a very good level overall but, in detail, this level is rather unequal because after the end of the war there was an surge of csotcina.comedists who came from all the corners of the world. We live one time when as everywhere else the medical benefit many problems pose. In Lebanon they are made acuter because of the economic situation and social specific which is the result of the war.

 

. : How does your health system with regard to the assumption of responsibility of the patients function?

: The health system is very complex understanding several sectors. There is the pure private sector where the patient pays itself all his services. There is the sector of the insurances and there is the public area. This public sector itself is subdivided in several branches with the public assistance, the social security, the mutual insurance company of the officials and the armed forces which they are the Lebanese armed forces or the security forces. In all that the patient is lost a little, the doctor also, the hospitals also. The captures of charge by the public are done with the dropper what poses many problems. Sometimes the assumption of responsibility is easier but it is the method of payment which is difficult because precisely we live a very serious economic crisis.

 

. : Schematically how are distributed the costs?

: The medical fees currently are uniform. In different term, there is a code and K operational and it is very difficult to make goings beyond, if not impossible. But the surgical gesture represents a tiny share of the invoice. Today the essential cost comes from the hospitalization with the diagnostic services, in particular the imagery which are necessary and which are expensive. Of course there is also the share of the implants. The implants, let us know we it, are more and more expensive and they have an important place in csotcina.comedic surgery and we are confronted there with a rather serious problem.

. : How trains csotcina.comedist in Lebanon?

: In Lebanon there exist three medical colleges which deliver diplomas for the occupation of Doctor of medicine and which are entitled to train specialists. The course in csotcina.comedic surgery after the medical studies is 5 years of which a joint base of general surgery, three years follow-up of training in csotcina.comedy in the qualifying recognized services. After that the young csotcina.comedists travel to France or in other countries like England or the United States to supplement their formation. This is the usual channel followed to the level of the French Faculty of Medicine and to the level of the Lebanese University. On the other hand on the level of the American University the students who made their training in csotcina.comedic surgery then will make them to the United States. Currently, and more and more, very few well trained csotcina.comedic surgeons return to Lebanon. Worse still much set out again towards France or the United States after having carried out a test in Lebanon.

 

. : Did everyone have this course?

: Precisely not. Those which have this formation represent a minority today. Many specialists Lebanese re-entered of the Eastern European countries or besides, with a formation which is perhaps good but that we do not know. We discover it with time, and sometimes with much of surprises.

 

. : Who delivers the licensures?

: The licensures are delivered by the ministry of health, and the Council about the doctors. In fact the Council of the Command ratifies the decision of the Department of health.

 

. : How the Department of health judge does?

: On the diplomas and the certificates which the applicant forwards. It as makes pass an examination as one calls “” whose value remains to be revalued in my opinion.

 

. : Did the war disorganize your speciality much?

: There are two aspects to consider. There was certainly an positive aspect insofar as the war made progress the techniques because it obliged us to adopt surgical attitudes which one would not take in normal situations. Thus we acquired a very large experiment in traumatology. The negative aspect is the stagnation in the formation since we did not have the possibility of having cultural exchanges with the others; we were closed again on us same for a few years. But there again the things are become again normal and you know the Lebanese potential to adapt to all the new and difficult situations.

 

. : How did you organize yourselves for this period?

: We had instituted at the hospital a a little specific structure located in underground shelters, which started since the urgencies, while passing by the surgical unit and finished in the department of csotcina.comaedics. A team dealt with the casualties and started with most urgent. The transfer was done directly with the block and one operated under rather difficult conditions. I must recognize that the asepsis took a blow of it. In spite of that, we did not have enormously a problem of infection, in the sense that in spite of Injury Severity that occurred the infectious plan often of course.

 

. : Was that probably due to the quality of your trimmings?

: Obviously because it was the most important time. For the synthesis, we used many external fixers. I at the time had introduced the technique of and I must acknowledge that enabled me to enormously save members at the casualties in their avoiding the amputation.

 

. : Why rather than another fixer?

: For two reasons. The first it is that it is less expensive, and in surgery of war it is particularly interesting; second is that the biomechanical design of the circular fixer is certainly by far higher than that of the fixer in the monoplane, at least for the leg. I thus had very an great experience of the external fixer of . As there were important losses of bone substance with serious lesions of the soft parties, that enabled me to make great diaphyseal rebuildings. I have a very great series of diaphyseal rebuildings by the method of the elevator which I started to use since 1985.

 

. : Which were the most serious lesions?

: Incontestably those caused by the glares of shell. With the , the burn of tissues, all was completely shredded. The damage which accompanied the fracture was much more serious than the fracture itself. These lesions were more dangerous by far than those produced by firearm. But we had few wounds by firearm since they were not pitched battles but bombardments to the gun.

 

. : Let us return at the present; what becomes French faculty?

: French faculty is not French any more. It kept only the name since 1977, if my memories are good, France does not deliver any more the diploma of French state. It is a diploma of faculty where the medical studies are done in French. These studies are in my high level opinion since our students will continue their training courses in faculties French or American and we have a success rate impressing on the level of the entrance examinations in the United States. Currently faculty is carrying out a reform of teaching. It has started for a few years to try out the training by problem which is a new methodology of the teaching and which makes more take part the student than by the common methods. You see that faculty is not at all late compared to the modernization of teaching.

 

. : He how much hospitals attached to the medical college there have?

: Only one hospital is attached to the medical college, it is the Hospital of France. There are other hospitals which are linked by Conventions and this accounts for 4 or 5 hospitals where our students will make training courses of boarding school or in the specialities.

 

. : Where is the large department of csotcina.comaedics?

: The large department of csotcina.comaedics is with the Hospital. It understands two sectors. A sector of approximately 30 beds for the short stay where traumatology, the prostheses and the ambulatory surgery are made, and a sector located in the mountain at one hour of car which is attached to that of the Hospital which understands to him also 30 beds. This last relates to the means and long stays, i.e. hospitalizations which exceed one week such as for example the scolioses. They are the same surgeons who work in the two services.

 

. : With do 60 beds you manage to face?

: Yes completely.

 

. : How much are you surgeons permanent seniors?

: The department of csotcina.comaedics functions in subspecialties. There are two seniors who make the rachis, two which make the upper limb, two which makes the lower limb and two which makes the pediatric csotcina.comedics. With the result that at 8 we manage to make demand side. There exist also young people who are the residents. They are 10 but as they have a base joint of formation at the beginning, and than they are distributed then in three other hospitals, their number is hardly sufficient for the two service sectors of csotcina.comedy.

 

. : Which was your formation?

: I began my formation in Beirut and I finished my medicine there. Then I made 4 years of what is the equivalent of the boarding school in France. Then I supplemented my formation in France during 4 years. In Paris, at Mr , then at Mr , then at the institute Stone-block at Sirs and , and finally in Lyon at Albert and Henri .

 

. : Which analysis do you make your formation in France?

: What I retained of my formation in France it is the training with the reflection and the discussion of the cases. Criticism and the judgment were as if not more important as the surgical act itself.

 

. : But you operated nevertheless?

: Yes of course. I believe that one of the advantages or perhaps one of the disadvantages of the French system it is that the intern is left a little with itself. It must be able to be formed under the Directive a little distant from its owners. There is not a program to follow as to American. It is a disadvantage or an advantage, that depends how the things are seen.

 

. : Who financed your formation in France?

: It is France which financed my formation and I thank it. There was a capture of charge as an intern, he was necessary to put his a little, since my parents had helped me at the time.

 

. : When you returned to Lebanon, which it was your csotcina.comedic guideline?

: When I returned in 1976, the context was not in favor of a subspecialty. I thus made general csotcina.comedy. At the end of a few years with my friend Doctor who made the same course that me, we decided to direct us towards the subspecialties. It started to deal particularly with the rachis and of the pediatric csotcina.comaedics and gradually we directed our pupils in precise fields and at the end of a few years we divided the service into 4 subspecialties. Currently, I make only of the lower limb and especially mining area and hip.

 

. : You made rather more prostheses than of preserving intervention?

: In my practice of hip surgery, I make twice more prosthetic surgery than of preserving surgery. For the knee also the proportion is currently the same one because the patients are long in coming to the surgery.

 

. : Which type of preserving surgery do you practice with the hip?

: The osteotomy of which I practice rather regularly. I have retreat a eight years and I forwarded my experiment to the this year. I must currently have a hundred case. It also sometimes happens to me to make femoral osteotomies or osteotomies of the mining area of .

 

. : What do you think of the osteotomy of ?

: All depends on the indication. If one makes the intervention at the good moment, at a stage of early osteoarthritis i.e. a stage I or II at a young subject, on a hip still quite mobile, I think that it is an excellent intervention. It is difficult and it is its great handicap there; but on the biomechanical level, it remains definitely higher than all the other preserving interventions which were proposed to date. I do not believe that the difficulty of an intervention can decrease by its value.

 

. : You re-examine regularly your operated?

: Absolutely. I re-examine them regularly and I think that it is a surgery whose technique and follow-up are very well codified. With a good technique and a good indication, it must give a good performance regularly. The technique I recognize it is not easy and the complications are inherent in the technique.

 

. : What do you think of the contribution of the surgery computer-assisted?

: In the long term the surgery computer-assisted should facilitate the operative technique and thus make it surer and less risky without however solving all the problems of them. It is probable that in the years to come the use of navigation will especially become obligatory in the osteotomy perished-acétabulaire, the spine surgery and in the prostheses.

 

. : You still made stops?

: Not I do not make any more stop. Compared with the osteotomy perished-acétabulaire, it does not have the same biomechanical sightings. The stops proved reliable he does not have no doubt there and have an antalgic negotiable instrument, but in the field of biomechanics that does not satisfy me. On the other hand, the reorientation of a manages to correct the defect where there exists.

 

. : And on the knee?

: As astonishing as that appears, I make more and more prostheses at relatively young subjects i.e. of about sixty. The average age of the operated patients decreased as in all the services of the whole world. From the moment when the criteria were well defined and which one knows that an osteotomy very quickly will be degraded one arrives rather quickly at the prosthesis.

 

. : Do you have the feeling, compared to the csotcina.comedy of the time of your formation, that the things changed?

: Enormously. Today we know best biomechanics and we can better provide for the results in the long term. One time ago when the age was the barrier. It is known now that in certain cases an tibial osteotomy will give a good performance to 75 years, whereas the same intervention at 60 years shows a failure. This was indeed shown by the Lyons school. The technique and the instrumentation changed. The precision, the requirements of the surgeon and the patient are completely different. With all the media the patient is informed more and it is the race with the good performances. All the csotcina.comedists will tell you as me that they have the impression to practice an csotcina.comedy very different from that which they learned during their boarding school and them .

 

. : What do you think of the francophonie?

: I believe that it is important to preserve and to back up the francophonie. More than one language, French must remain a crop and a crossroads of meeting of the ideas and freedoms. During my speech of greeting to the congress of the in Beirut, I had said that Lebanon and the Francophonie had a little the same destiny since both fight to survive in an environment which is hostile for them. I do not believe to be to me much misled.

 

. : To make does an association of French-speaking csotcina.comedists that have a direction?

: In this case does the Francophonie have a direction? It appears important to me to keep and help this association of French-speaking csotcina.comedists so that through the French language of the crops, of the religions and the different ideas can meet and to be expressed. Let us not forget that one of the aims of the is to allow to the csotcina.comedists the least favoured countries to be able to be expressed with their manner and in “bad French” during a meeting of international level.

 

. : How would you like to make evolve/move the ?

: I believe that it is necessary to make it evolve to a scientific and organisational level more rigorous without removing the friendly and user-friendly side of the powerful . It is especially capital that France and the French invest themselves in the as they did in Beirut.

 

. : How one understood here, it was not so badly!

: It seems indeed that the scientific level was good. I wish that the congress of the in Lebanon be able to contribute to give again with the a new momentum and new objectives.

 

. : Can one be concerned by a congress which takes place every two years and which does not offer academic repercussions?

: Those which belong to the to give him a valid scientific level. The Review of csotcina.comedic surgery publishes the communications of the congress in a supplement with share provided that they are corrected and revalued. From there, the remainder must come. The value of a congress holds with organization sound quality and of its scientific level. I believe that this objective was achieved in Beirut, and I am sure that the Roumanians will do as well if not better in Bucharest in 2002.

. : Formerly, Lebanon it, is this was a little France always the case? I intend the young people to speak English with any corner about street, what occurs?

: In fact the Lebanese one is naturally trilingual. Those among us who are of French crop speak English very well, whereas those which are of Anglo-Saxon crop do not speak French. Of course English became the language of international communication in the corporate world especially and Lebanon does not have escaped with this universalization with American. But Lebanon needs the Francophonie to remain the crossroads of the crops and the religions in the Middle East.

 

. : How do you apprehend the Anglo-Saxon crop?

: I do not know the Anglo-Saxon crop well, it is certainly very different from the French crop. I believe that it acts more than one lifestyle that of a true crop. The high-tech, the notion of the “right to the aim”, the specific vision of the human values, the lack of poetry and daydreams remain the base of the Anglo-Saxon “crop”.

 

. : How is the cultural characteristic of Lebanon within the Arab world lived?

: All the Arab countries recognize in Lebanon its specific place. Meeting place between the Eastern and Western crop, Lebanon country of the Cedars 3 times millenium was an haven of peace and of tolerance. The jealousy and the covetousness of the others transformed this small country into a place of battle where the fatal madness involved only died and destruction. Today Arabic as the western world understood the need for the presence of pacified Lebanon looking at the same time towards the occident and the East.

 

. : In is the spirit, which the language which approaches the most Arabic, French or English?

: In the spirit and the core it is certainly French who approaches the most Arabic. There are more emotion and feelings in these two languages. French like Arabic can have the monopoly of the core and the spirit.