Abstract
We are hereby not only presenting and documenting the achievements of Dr. Khalaf Al Mouteary, which are great and unprecedented, but drawing lessons from his life and striving to develop and improve a system of neurosurgery practice and training in Saudi Arabia. Over 30 years of his dreams, sacrifices, hard work, vision, successes and failures in neurosurgical medical services, training and education have brought us to the position where we are in today, as one of leading countries in neurosurgery in the whole Middle East. It was only one dream Dr. Khalaf Al Mouteary had and shared with us; to raise the neurosurgical practice and training level in Kingdom of Saudi Arabia to the highest possible international level. That vision and mission experienced tremendous success at the hands of his determination, strategy and effort. Challenges are inevitable and it’s how we learn and progress from them that define our viability. It was said that, truly you can not have bright future unless you consider the roots and appreciate the core values of giving and working for patients, to relive their pain and to open the sky for younger colleagues to fly beyond what you may expect. It is important in order to crystalize and publicly affirm the values that define and recognize the role of leaders and pioneers.
Differences which make differences
It is possible to agree or not to agree and to like or dislike a pioneer in any field, but it is not fair and a major drawback to deny his/her role in the development of that field. There is no doubt that Dr. Khalaf Al Mouteary was a pioneer and leader of the major development in neurosurgery in Saudi Arabia since 1984. What we enjoy today is based on that strong foundation which was built and structured in different centers in Saudi Arabia in the late 1980s and 1990s. This great period deserves to be studied, analyzed and learned from.
What Dr. Khalaf Al Mouteary did and how he did it is important. It is more important, however, to know what drove him and the reasons behind all his great achievement. This is the message which should pass from our generation to the following generations.
In order to appreciate the role that Dr. Al Mouteary played in the restructure and development of the neurosurgery service and training in Saudi Arabia, we must analyze his impact on health system, education programs, post graduate training, and the vision and strategy of the high education authorities. There is a significant and distinctive difference in education strategy and planning between re-constructors and developmenters. Both are needed very much for the suitability of the development, and push the whole country and societies forward. Education, training and man-power development in medicine and health care sectors are based on previous experiences, research and following successful examples and models. Creating new conditions or restructuring the system rarely needs previous experience or research but instead require those who are willing to act beyond the gathered data and without benefit of guidance of empirical research. Creating a new system calls for dreaming, clear vision, faith, logic, wisdom and intuition, at least to a degree that calls for disciplined actions based on facts that are structured on a strong foundation.
The challenges
The challenges were enormous however his determination and commitment to achieve our goals were unwavering. Therefore, careful plans, meetings and consultations were intensively conducted with Dr. Khalaf’s office as the center of all the communications.1 The start was to identify the problems, obstacles and form key questions that had to be answered in order to start the process of creating or restructuring education and training systems. These questions were:
What are the new programs or system we are aiming to build up?
Can we do it? Is it achievable?
Should we do it? Is it the right time for that? Are the minimum required resources available?
How do we do it? How to start? How to monitor the progress? How to critically analyze the development and training and the health care services?
How to path the procedure and process smoothly to other teams for further development?
The journey that brought the neurosurgical practice and training to where we are in 2018 and beyond
Dr. Al Mouteary was born in Taif, Saudi Arabia in July 1st 1948.2 He graduated with Honors from Taif secondary School in1966. He went to study medicine in Germany, where he successfully finished his medical education. He spent a year as house officer in Shilden Hospital. In 1975, he returned to Saudi Arabia and Joined Riyadh Central Hospital (shemasy Hospital) as a resident in the Department of Surgery. Dr. Khalaf was very ambitious. He wanted to receive the best possible training as a cardiologist. He planned to go back to Germany and upon his return home establish an advanced unit of Cardiology! He went back to Germany in 1978, joined University of Hanover, to be trained in The Department of Cardiology. He was not aware that a different path was waiting for him there. The day before starting his training in Cardiology he had a hospital trip (round) and visited the operating room to see stereotactic operation (thalmatomy) for a Parkinson patient, he was completely taken by observing the patient’s immediate improvement. The unshakable decision was taken in that moment “this is my future, this is my task for the future”. Dr. Khalaf Al Mouteary made his decision. He changed his training post and moved to the Department of Neurosurgery to receive his training with Prof. Dr. Herman Dietz, the Chairman of the neurosurgery department, Hannover University. In 1983, Dr. Al Mouteary successfully finished his training in Hanover and obtained FACHARZT (Figure 1). Dr. Al Mouteary returned back to Saudi Arabia to join Riyadh Armed Forces Hospital as Senior Registrar in Neurosurgery. At that time, he was the only Saudi Qualified Neurosurgeon in Saudi Arabia. There was no Department for Neurosurgery there. So, he worked with his colleagues and life-long friend Dr. Saleh Al Deeb (neurologist) to create the department of neuroscience. He decided to work hard, not only to serve his patients, but also to increase the number of good and well-qualified Saudi neurosurgeons. Therefore, in 1987, he joined the newly developed program at that time named “King Faisal fellowship program in Neurosurgery”. Dr. Mouteary succeeded in forming a good team offering good neurosurgical services to hundreds of patients every year. Dr. Mouteary did not forget Stereotactic thalamtomy which brought him in Neurosurgery. He established the first Functional neurosurgical Services in Saudi Arabia, and added to it Radiosurgery unit. He not only receives patients not from all over the country, but also from neighboring countries.
Dr. Khalaf Al Mouteary with Prof. Dr. Hermen Dietz and other colleagues in Hannover, Germany 1984.
Carrier highlights
Director of Neurosciences RMH, 1987
Member of King Faisal Fellowship- Neurosurgery Training Program, 1987
Honorary Assistant Professor of Neurosurgery, King Faisal University, Al Khobar, Saudi Arabia
President, Pan-Arab Neurosurgical Society, 1996
Arab Representative for Neurosurgery EANS Training Committee, 1995
2nd Vice President World Federation of Neurosurgical Societies, 2001
Continental Vice President World Society Stereotactic & Functional Neurosurgery, 2002
Adjunct Professor of Neurosurgery, Balamand University, Lebanon, 2004
1st Vice President World Federation of Neurosurgical Societies, 2005
Chairman, Military Neurosurgeons Committee of the World Federation of Neurosurgical Societies, 2009
Dr. Mouteary as educator
Dr. Mouteary was a true educator. He hosted and organized several international courses and workshops in neurosurgery and neurosciences in Riyadh Military Hospital, on average 2-4 courses every year in the period between 1990- 1996.
King Faisal University Fellowship- Neurosurgery
The Department of Neurosurgery at King Faisal University planned and structured the King Faisal University Fellowship Program in Neurosurgery to be the first Neurosurgical Training Program in Saudi Arabia. Again, with no hesitation, Dr. Moutaery joined the team and put all his experience and facilities to make this program successful. It has been a very successful program. A few years later he led a group to launch the Saudi Board Program in Neurosurgery. The team at King Faisal Specialist Hospital (Dr. E Sequira, Imad Kanan and Maher Hassouna) were the partners in that badly needed and successful program.
Saudi Board in Neurosurgery
The curriculum, logistics of the Saudi Board was all written in his office. The Saudi Board program showed major development within years. The number of Saudi Neurosurgeons is exceeding 70 well-trained neurosurgeons and there are at least 100 departments of neurosurgery in different places in the Kingdom.
Dr. Mouteary as researcher
Dr. Mouteary built up a neuroscience research lab in the military hospital; he led several projects about head and spine trauma, stem cells, radiosurgery, and epilepsy. Dr. Mouteary has published 147 scientific articles in international journals, and he presented 273 talks in different national and international Neurosurgical Conferences all over the world. He was invited as guest speaker many times in different countries.
Publications
Published approximately 147 papers in international and national journals
Presented approximately 273 papers at local, national and international symposia
Books - authored, co-authored and edited
The Solitary Brain Metastasis
Neurosurgical Disease and Their Management (in Arabic)
Development of Neurosurgery in the Arab World
Six Supplements with Pan Arab Journal of Neurosurgery covering all aspects of neurosurgery
The regional and international contributions. World Federation of Neurosurgical Societies (WFNS)
In September 2001, Dr. Mouteary was elected as the second Vice President of World Federation of Neurosurgical Societies. Soon after that, he was appointed and elected as Continental Vice President, World Society for Stereotactic and Functional Neurosurgery. In 2005, he was elected as first Vice President of World Federations of Neurosurgical Societies. He was also elected as chairman of the fundraising committee of WFNS. He was determined to do his best to extend the modern neurosurgical services to all the developed countries. He was very interested in providing courses in different countries to improve the standard and quality of neurosurgical practice of the young neurosurgeons in different countries.
The founder of Pan Arab Neurosurical Society (PANS)
Dr. Khalaf decided to establish, with few of his friends and colleagues, the Pan Arab Neurosurgical Society. The road was not easy and the obstacles were many. It took 3 years of meetings and communications with all the Neurosurgical Societies in different Arab Countries. Several meetings were held in Riyadh between years 1991 to 1995 to reach a consensus about the Bylaws, membership, terms of services and other related issues. In December 10, 1995, the founding meeting was held in his office in Riyadh Military hospital, and attended by 24 neurosurgeons from different Arab countries, who all became the founders of PANS (Table 1). Pan Arab Neurosurgical Society was launched, and Dr. Al Mouteary was unanimously elected to be the first President and Founder of this new society. He took on his shoulders, with the help of very few others, the tasks of full editorial work, publishing and financing responsibilities to publish the Pan Arab Neurosurgical Journal. It was published as a bi-annual journal and first issue was published in October 1997 (Figure 2).
The list of the Founders of PANS, who met in Riyadh, Kingdom of Saudi Arabia in 1996
The first issue of Pan Arab Neurosurgery Journal.
The founder of Gulf Neurosurgery Society
Dr. Abas Ramadan, Chairman of the Kuwaiti Neurosurgical Society, consulted us in 2004, to develop Gulf Fellowship program in Neurosurgery, to provide a chance for comprehensive neurosurgical training for candidates from Kuwait, UE, Oman, Qatar and Saudi Arabia. On Friday, October 14 2005 (Ramadan 10), Dr. Khalaf Al Mouteary received Dr. Abas and myself in his house to discuss the different options and logistics to launch such a needed fellowship program. The meeting extended to the early morning of October 15. It ended with a plan to establish the Gulf Neurosurgical Society as first step to launch that training program.
The Gulf Neurosurgical Society was announced in Kuwait on 18 December, 2006. The Gulf Neurosurgery fellowship Program was written, however it never materialized for several reasons.
Membership / advisory board
Pan Arab Journal of Neurosurgery
Acta Neurochirurgica - EANS
Neurosurgery Quarterly - John Hopkins
World Neurosurgery - WFNS
Journal of Taibah - Saudi Arabia
Journal of Pediatric Biochemistry - Turkey
Asian Journal of Neurosurgery - Japan
Egyptian Journal of Neurosurgery - ESNS
Saudi Medical Journal - Saudi Arabia
Neurosciences Journal - Pan Arab Neurologic Society
The list of national, regional and international activities
Founding Committee Member, Pan Arab Neuroradiological Society, 8 September, 1994
President and Founding Member, Pan Arab Neurosurgical Society 1996 – 1998
Member, Advisory Board, Saudi Medical Journal, 2004-2007
Editor-in-Chief, RAFH Neurosciences Bulletin since inception October, 1997
Founder and Editor-in-Chief, Pan Arab Journal of Neurosurgery since inception April, 1996
Member of Editorial Board, Acta Neurochirurgica, April, 1999 – December, 2006
Co-Author – Neurological Diseases and their diagnosis (in Arabic)
Appointed Arab World Representative European Society of Neurosurgery and Member of EANS Training Committee
Appointed Chairman, Neurosurgical Fellowship Training Programme, Saudi Arabia, for Saudi Council for Health Specialties
Chairman of Committee on Child Disability Services, RAFH
Chairman Therapeutic Commission “Neurosurgery” – Saudi Chapter of Epilepsy
Arranged for many international renown neurosurgeons to visit RAFH, on a locum basis, to lecture and teach operative procedures
In May, 2001 commenced Functional Neurosurgery Programme for the treatment of Parkinson’s Disease and tremor in RAFH
Nominated for 2nd Vice President (at large) WFNS, April, 2000 and appointed September, 2001
Elected and appointed Vice President, World Society Stereotactic & Functional Neurosurgery, September, 2001
Published Special Supplement on Neurostimulation and Neuromodulation in October, 2001
Member of Editorial Board Neurosurgery Quarterly, November, 2001
Member of Advisory Board Egyptian Journal of Neurosurgery
Chairman, Fund Raising Committee, WFNS, January, 2002 – June, 2005
PANS Award – Abu Kassis Medal 2002
Co-authored Special Supplement (208 pages) on Spasticity: A comprehensive Approach, October, 2002
Co-authored Special Supplement (110 pages) on acute Cervical Spinal Column & Cord Injury, October, 2003
Member of American Congress of Neurosurgeons, September, 2003
Appointed Adjunct Professor of Neurosurgery, Balamand University, Lebanon – March, 2004
Elected Continental Vice President World Society Stereotactic & Functional Neurosurgery, September, 2004
Authored Book “The Development of Neurosurgery in the Arab World” September, 2004
Forward Special Supplement “Skull Base Surgery” authored by Prof. Ossama Al-Mefty, October, 2004
Member of Eastern Mediterranean Association Medical Editors, March, 2005
Co-Investigator “A comprehensive study on Saudi scorpions with special reference to development of an immunodiagnostic assay and therapeutic modalities, 2004
King AbdulAziz Award (First Degree) for contribution to Saudi Arabian Armed Forces Medical Services Department, January, 2005
Elected 1st Vice President, World Federation of Neurological Societies, June 2005 for a term of 4 years
Nominated Vice President Elect World Federation of Neurosurgical Societies – September, 2003 to be appointed 2005 for a term of 4 years
Founding Member of the Gulf Neurosurgical Society 18 December, 2006
Forward Special supplement “Approaches for Spinal Fusion & Instrumentation” edited by Prof. Patrick W Hitchon, et al, January 2007
Member, Editorial Board, Asian Journal of Neurosurgery, December 2007
Member, Editorial Board, Journal of Taibah University: Medical Studies, 2007
Review Board Member, International Liaison & Advisory Panel, J Neurosurgery – July, 2008
Forward Special Supplement “Pediatric Neurosurgery”, edited by Dr. Bermans Iskander, et al, October, 2008
Member, Advisory Board, Acta Neurochirurgica, 10 February, 2009 (3 years term)
Chairman, Military Neurosurgeons Committee of the World Federation of Neurosurgical Societies, September, 2009
Member, Senior Advisory Panel, Policy & Development, of the official journal of the World Federation of Neurosurgical Societies; World Neurosurgery September, 2009
Member, Journal Content (Middle-East/India), of the official journal of the World Federation of Neurosurgical Societies; World Neurosurgery September, 2009
Member, Reviewers Board, Journal of Pediatric Biochemistry, October, 2009
Awards
King AbdulAziz Award (First Degree), 2005
PANS Award - Abu Kassis Medal, 2002
Riyadh Neuroscience Club ‘Man of the Year’ Award for 1999
World Federation of Neurosurgical Societies (WFNS) Medal of Honour - Recife, Brazil, 2011
Dammam University Gold Medal 2012, (Figure 3).
Figure 3Dr. Khalaf Al Mouteary receves Dammam University Gold Medal For his lifelong achievement in neurosurgery, from The president of the University.
Family man
Dr. Mouteary enjoyed a happy family life. He was married and had 6 children. He found the desert to be a quiet place to escape to from time to time to relax, recharge his power and enjoy the clear night sky and bright stars there.
In conclusion, there are many who may work hard and have a vision of serving their societies in particular and the humanity in general, but only a few succeed in turning their dreams and vision into reality. These people are able to look back on their achievements with satisfaction. Dr. Khalaf Al Mouteary is certainly one of these few pioneers. His life is full of lessons which should be studied, respected and learned from.
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