Jonathan Fitzsimon interviews doctors who have managed to add interesting, adventurous and unusual aspects to their clinical careers.
Ron Hiles is a former president of the British Association of Plastic Surgeons. Since the early 1980s he has worked as a volunteer surgeon working in various countries such as Bangladesh and India. I caught up with him at his home on the outskirts of Bristol.
Jonathan Fitzsimon: Tell me about your route into medical school.
Ron Hiles: I came from a family of builders but my interest in natural history, science and anatomy made medicine sound like the right choice for me. From those early days at medical school I was certain that I wanted to be a surgeon.
JF: What were the main differences between your experiences of training in the 1950s to those of a young doctor now?
RH: The NHS was still in its infancy and there was a tremendous pride in this new organisation. I also
faced the prospect of National Service but I decided to pre-empt this. After my House jobs in Bristol I
elected to join the Royal Air Force for 3 years. Rather than getting sent to be an RMO (which sounded rather unfulfilling to me), I was able to get my first choice job working with a plastic surgeon. I was fascinated by this relatively new speciality and I remember presenting a paper in front of an audience that included one of the founding fathers of plastic surgery, Sir Archibald McIndoe. I criticised one of his papers for its incomplete classifications of Dupuytren’s contracture – a bold move for a junior doctor of any era but he took it in good spirit.
JF: There is much talk at the moment of surgical training and the hours worked by doctors. What was your own experience?
RH: When I finished my time in the RAF I went back to a general surgical post. I routinely spent the
entire week in the hospital, sleeping in a small hospital owned room above a local pawn shop. I
remember finishing a long shift and heading back to my room only to find a homeless person fast
asleep on my bed! I was happy though. I wanted a busy job and I knew that I was receiving excellent
training. I also had a fantastic amount of support from my wife, Jean.
My career progressed quickly. My plastics experience in the RAF enabled me to rapidly progress
through registrar posts and in 1968 I took up a consultant post at Frenchay hospital in Bristol and
remained there until 1994. At the start I was 1 of 3 consultant plastic surgeons in the South West
covering a population of 4 million people. Things were very different when I retired!
JF: Tell me about how you got involved with working in the developing world.
RH: Jean had almost gone to South America to work as a nurse but our lives moved on and it didn’t
happen. However we frequently discussed the idea of working in the developing world and I decided
that maybe I could offer something in my fifties that I hadn’t been able to offer in my twenties. I was
involved with a project to train promising surgeons from the developing world in the UK but less than
40% of these went back to their home country and the cost and resources involved per student were extremely high. I had some friends who were working in India and Bangladesh and on a visit home they suggested that I go out with them for a few weeks, so I did.
JF: Apart from the cultural differences, what were the practical differences that you saw?
RH: Training overseas doctors in the UK doesn’t necessarily help them in their home environment.
Differences in anaesthesia meant that they frequently had less time to do a procedure. Equipment
availability and staff training also played a huge role. It meant that I had to change my mindset from
showing people how to do things the way I did them in Bristol to actually understanding the relevant
circumstances and adapting to them accordingly. I came to understand how they lived and worked.
Clinics with a bed occupancy of 250% was a common occurrence. We didn’t have to worry about
layers of middle management. The only management system in place was crisis management and
that was done by the doctors.
JF: After those first few weeks, you returned to the UK. What were your initial thoughts when you got home?
RH: I had an extreme sense of pride in the NHS. Whatever its faults and inefficiencies, if you need
medical help in the UK, regardless of your ability to pay, you get that help. That is a wonderful asset to this country when you think that two thirds of the world’s population have no such care.
JF: What made you go back to Bangladesh?
RH: I have been back pretty much every year, using my annual leave in a way that many doctors find
unusual. The truth is that I feel I have benefitted enormously both professionally and personally from
my experiences. There are many obstacles to overcome. It can be frustrating to deal with
international, national and local politics that throw up so many barriers but I have always tried to
remain outside of these. When I first got involved in Bangladesh at the Dhaka Medical College
Hospital there were just 4 trainees and they received little hands on experience. A population of 120
million people had no specialist burns unit. Anyone suffering more than 30% burns had a 100%
mortality rate. These were depressing statistics. In the last five years however, the first burns unit has
opened. I proposed developing a visiting faculty of teaching to make use of volunteer skills from all over the world as well as encouraging the development of higher surgical training programmes for local surgeons and there are now over a hundred doctors training to be plastic surgeons.
JF: What advice do you give to these trainees and also to junior doctors in the UK?
RH: You can make a difference. You should enjoy your career but remember that the patient must
always come first. If you think of nothing else as a doctor then you must think that all of this is about
the patient. That way you never lose focus of why you are working so hard and it helps you to accept
both the good and the bad aspects of our work. All doctors, whatever their seniority and experience
should also remember that they have a duty to teach and train their junior colleagues. I have no time
for the thought that a junior colleague is potential competition, it is the duty of every doctor to pass on their knowledge and skills to the next generation.
JF: You are in your 80th year and it is 60 years since you started at medical school. What plans do you have now?
RH: Well if I can get my hernia op sorted out then I have been invited to attend the opening of an
operating theatre in Peru in April. And there is a trip to help in Cambodia planned later in the year.