Miracle Man

In normal circumstances I would have begun this waxing lyrical about a great man who performs miracles on a daily basis. Given Mr. Conal Austin's personality however, glorification seems out of character. His is a much understated personality, although there is a weariness in his face. It's the face of a man who's devoted his Ijfe to putting right the heat1s of little children but who's also had his fair share of failed miracles. They may have failed but they were miracles nonetheless: day in, day out. fixing little hearts, the size of almonds at times, giving life to new life. It is astounding work and work that goes largely unnoticed. As one of two paediatlic heart surgeons at London's mammoth Guy's and St Thomas' Hospital, Conal Austin FRCS canies out intticate and life saving heart operations on a daily basis.

Mr, Austin is also - literally and metaphorically - the very heart of Mercy Mission UK, a team of medical professionals who travel to Sri Lanka annually to perform free heart surgery on children with Congenital Heart Disease. The mission is headed by Mr Austin as well as Sli Lankan expatriate Jai Lameer and Mr Austin's colleague, renowned cardiologist Dr John Simpson, The team includes up to 15 medical professionals including anesthetists, theatre technicians and post operative care nurses and have performed dozens of operations in Sri lanka since 20OO. While Mr Austin and Dr Simpson spearhead the yeomen work, Mr. Lameer is in charge of coordinating all the logistics, from the air tickets to accommodation and transport. Today. the Mercy Mission s backed by the likes of BHS Supremo Sir Philip Green, the News of the World and some of the little patients have even been invited to Downing Street. Last year Conal Austin was rewarded for his work with a prestigious "Children's Champion Award" at a glittering ball hosted by the Blair's. The mission has become such a success in achieving a real sustainable difference that slots for the nursing staff on the mission are hotly contested among he nurses at the hospital.

At the head of all this is Conal Austin, an amiable and soft-spoken 45-year-oid Irishman, father of two young boys, Nicholas and Ashley. an avid surfer, renowned cook and collector of British sports cars. Austin's a graduate of Belfast University. Having received his training in Cardiothoracic Surgery in Belfast in the arly 1990's, the budding surgeon traveled to Australia to work at the prestigious Royal Children's Hospital in Melbourne as well as, no doubt, to enjoy some of that country's famed surfing spots. Following his stint Down Under Mr. Austin returned to London via Palis where he worked at the Broussais Hospital in Pads before being appointed a consultant in adult and paediatric cardiothoracic surgeon at Guy's and St Thomas' Hospital in Central London in late 1997.

In between operations Mr- Austin sits down for a quick chat.

You've performed quite a number of hole in the heart operations in Sri lanka; is this a common condition there? What causes it?

No one really knows what causes a hole in the heart. It could be down to genetics but no one has been able to pin point a cause, As it is a congenital heart disease, the problem occurs in the mother's womb so there's nothing to suggest that it could be down to diet or upbringing. And there's also no data to suggest that it occurs with more frequency in parts of the world such as Sri lanka relative to countries like the UK. We perform more than 350 operations on children here at the Guy's St Thomas' Hospital and a sizeable portion of those procedures are to rectify hole in the heart conditions.

You have an association with Sri Lanka that stretches back quite a few years...

Yes, the history dates back more than two decades. I had visited the Island many times before Mercy Mission began. I did a student elective in southern Indian in the early I 980's and once took a 3-week break. travelled down to Jaffna, on to Trincomalee and Arugam Bay for some surfing and I instantly fell in love with the place. And then after I got married I was based in Australia for a while and my wife was here in London and we would meet in Sri lanka several times during the course of year; she would come half way and I would come half way and meet in Sri lanka. We have a lot of fond memories of the country.

Tell me about how the Mission began

I met Jai back in 2000; I performed a quadruple by-pass on him and he was very grateful. After the operation he just told me if there was anything that he could do for me, to name it. And as a throwaway comment I just said I would love to go to Sri Lanka and perform heart surgery on children there. That was how the Mercy lission was born. Within the UK a lot of surgeons do voluntary work around the world. And the timing was perfect as well because at that point I had completed 3 years in my consultancy and was confident that I could get out of my comfort zone here at home and go overseas and work. John Simpson, one of the world's best cardiologists then came on board and the team slowly began to take shape. We did a lot of research looking into what was available back in Sri Lanka in terms of the facilities and expertise and I was pleasantly surprised at the high standards. Congenital Heart Disease is quite a serious problem in Sri Lanka: there's a very long waiting list of children awaiting procedures, and there are a lot of children who have already missed the boat because it's essential that diagnosis and surgery take place as early as possible. We initially did two trips to Colombo and then wanted to look at moving further away. In Galle we met a guy called Dr Namal Gamage, who has been phenomenal over the years.

We work very closely with him and he has been immensely helpful. There is heart surgery taking place in Sri Lanka but not in a sufficient enough volume for the children. The wealthier families can either get it done in Colombo or Madras. But a majority of the population can't. For example, a lot of our patients come from refugee camps in the East.

You had a long term vision when you launched the mission ...

When we set up the Mercy Mission the one thing that I didn't want this to be was a flash in the pan thing. We didn't want to be surgical tourists. What I wanted to do was to impart some of the knowledge that we have acquired here to some of the Sri Lankan medical professionals that we work with. We wanted to do cases that they wanted us to do. cases that they found too difficult to perform and that's what we've been doing. When we are not operating we are conducting lectures. Dr Simpson is constantly teaching while he's out there. In the operating theatre Dr Gamage comes and watches so that he can refine his techniques. With Congenital Heart Disease. there is a multitude of things that could be the problem; up to 30 different variants. Compare that to adult heart disease which has about 5 different variants. So accurate and early diagnosis is essential in our success. That's where Dr Simpson comes in.

The logistics must he daunting ...

Aside from the fact that we didn't want to be surgical tourists, we also wanted the team to be all encompassing; we had to get the diagnosis right, we had to get the anaesthesia. One of the other ideals was that the team had to be all encompassing; we had to get the diagnosis right, we had to get the anesthesia right we had to get the surgery right. we had to have an anaesthetist. after you've had a heart operation you are very sick for about 40 hours. We had to have intensive care specialists, scrub nurses, technicians, the whole lot. Jai handles the logistics. We are unusual in that we take out such a large team; but then that poses quite a few problems as well. We have to take time out from work. The trip lasts for 10 days and I'd like to go for longer but I've got commitments here as well with a young family and my consultancy. I'd like to go twice a year but I can't at the moment as well. We lose two days to traveling. Before we go in we already have some children lined up for surgery as a result of scans carried out by John before hand. We leave the hospital about 36 hours after the final operation so that gives the children time to recover.

How much equipment or drugs do you take with you from here?

We don't take a lot of drugs with us on the missions. One of the goals of the mission was not to bring so many resources from the UK: allowing the local doctors to say that we were getting good results because of the equipment and so forth. We set out with the idea that we would do all the procedures with local operating tools and equipment. The only things that I take out with me are the things that make me feel comfortable in the theatre like special scalpels and knives and stuff like that.

And what do you make of the facilities in Sri Lanka?

The facilities there are excellent and in fact I think the NHS can learn a thing or two about how they run their hospitals in Sri Lanka. There are very high standards in terms of theatre hygiene, ward hygiene. They are very strict about maintaining those standards as well. It was particularly impressive how careful the nurses were about passing on infections.

How many operations do you perform on an average mission? What dictates that number?

The number can vary but the average is about 3 operations a day. That number though is dictated by a lot of different factors: some children take longer than others to recover which takes up beds in intensive care which then forces us to adjust the timings of the children that are waiting to have procedures done and it's very much like a game of chess. In terms of the procedures that we cany out we also need to consider what the local surgeon wants to do, what he wants us to do, where he wants to learn the most from and what we enjoy doing the most. There are a lot of factors that come into play. We are also guided by what Dr. Gamage wants us to do.

It must be harrowing knowing that even you can only do so much ...

That can be difficult particularly towards the end of the mission knowing that you only have a limited number of slots but all these children are there. Then there are the instances where the decision has been made for you; last year, we prepped a child and he developed a temperature the morning of the procedure so we couldn't operate. He passed away.

What do you want your legacy to be in Sri Lanka?

Aside from the learning and the healing I think we are achieving an even broader aim of getting parents out of the poverty trap. Children with congenital heart disease require round the clock care in some cases, which may force one parent to stay at home, or the parents to blow large amounts of money for treatment, or travel great distances to receive that treatment. All of this contributes to families plunging deeper and deeper into poverty. There is great enthusiasm for what we are doing in Galle and I think it's rubbing off on everyone. When we are there Dr Gamage has a huge weight lifted off his shoulders because he performs more than 900 procedures a year waking up at 3 in the morning every day. He can relax learn rather than constantly operating. The anaesthetic techniques have been improved, the ICU nurses learn a lot from our nurses. But I think the most important thing that they have learned is the need to work as a cohesive unit the benefits that team work bring. They were surprised at the level of cooperation and dialogue among our team: I consult constantly with Dr Simpson and the other medical technicians and that gives me the luxury of having an accurate picture of the situation before and after the procedure. Dr Gamage on the other hand doesn't have that luxury: while I get Dr Simpson's diagnosis first hand and I can discuss with him what the best course of action is, Dr, Gamage receives his cardiologists' diagnosis in the post. There's no dialogue or communication. I'm hopeful that this will improve in the future.