Up Close and Personal with Prof Datuk Dr Russell Strong

An interesting article by Thean Lee Cheng taken from the Star newspaper on June 2, 2012 on the work of Professor Datuk Dr. Russell Strong on liver transplant at an event organised by MAHSA University College.


WHEN asked what motivates him, Datuk Dr Russell Strong, an illustrious surgeon from Brisbane, Australia who pioneered several liver transplant methodologies, paused a few seconds.
“I know what annoys me. Mediocrity. Most people are mediocre because of certain reasons but people who accept mediocrity (sigh, shoulders droop a little).
“You may not always achieve. You may aim for something, and generally, as with most of us, you may not go as far as you wish in the end. But you must aspire to do your best. That is how you derive satisfaction from what you do. That is what you are striving for!

“I also don't like politicians who cannot stop telling lies or twisting the truth. They annoy me. They have so much power and it is acceptable!”

Semi-retired, Strong was in Kuala Lumpur to give a talk on Evolution of Liver Transplantation organised by MAHSA University College's chancellery office.
Because of the mismatch between demand and supply for deceased donor organs, Strong pioneered various methodologies of liver tranplants including reduced-size grafts for children in 1987. He also pioneered split-liver transplant where one liver is split between two recipients to overcome organ shortage. He performed the world's first successful living-related liver transplant in 1989.

Despite huge opposition and skepticism about transplants among children and concerns about “stunted growth,” Strong says he used adult liver in children because “there will never be sufficient children's organs.”
His youngest patient is a 24-day old baby. Many of his young patients move on to lead fulfilling and meaningful lives today.
“When I consider my masters, the surgeons I had learned from, the view then was the liver was sacrosant and it must not be touched. But when you have injuries or a diseased liver, and when you gradually get around the technicalities, you do it.”

Challenging transplant
Based on his experience and ground-breaking work in surgery methodologies and the setting up of what is today a world renowned liver centre in Brisbane, Strong was invited to guide in the setting up of liver surgery and transplant centres. Singapore, Hong Kong and Malaysia are three countries in Asia that sought his help.

He was awarded a datukship in 2010 for his work in Malaysia by the king. Strong was in Malaysia in 2004 and 2005 to help set up the liver centre at the Selayang Hospital.
“My wife loved it here and actually took six months to settle down when we returned to Australia. I settled down back home very quickly.
“The biggest obstacle (in Malaysia) is the lack of donors. There is a lot of death trauma (as a result of road accidents) so there should be a lot more organs. Is this lack due to religion? Or is it culture? There is no clear reason from a religious point of view, I think. So a lot of it has to do with culture.

“The Japanese have very few deceased-organ donors too. I was told that there are many reasons for this, so I was surprised when a Japanese tourist who died in Australia became a donor. This means it is not the public, but the doctors (themselves).”
While the lack of donors is an issue, there are other issues that need to be overcome in order to support transplantation as a form of treatment. The lack of intensive care beds is one. Other forms of support are necessary as transplantation work involves many disciplines. It is a team effort.

“Transplantation in Malaysia will evolve over time, but it has a very long way to go.”
Strong is known to have “inspired a whole generation of surgeons” having trained more than 80 in hepatobiliary and liver transplant surgery, including eight from Malaysia.
Strong's career path is not as straight forward as it seems.
When he was young, his mother read out his report card. The results were not good.
“I still remember the details of the report but I don't know exactly when it occurred. The report came and I remember mum reading it out to me: This boy will never get anywhere he's too interested in sports.'”
That incident changed him.
“It made me determined to work hard and to try and achieve something.”
The second in a family of four children, Strong says his family was not well-to-do.
“My mother sacrificed a lot to enable me to go to school. She wanted me to go to university. So I had to qualify for a scholarship.”
He won one. At high school, he won a bursary which helped him.

Path less travelled
When he eventually entered university, the family had to scrap through in order for him to go. Strong took up dentistry.
There were various professionals who went to talk about their work and the dentist impressed him the most. Secondly, it was a four-year course and that attracted him.
“If you do medicine, it is six years and you had to go to Sydney. I used to hitch-hike a lot. Before I finished dentistry, I decided I wanted to be more expansive, not in terms of space but I wanted challenges.”
He thought about going into facial surgery.
“(But) many ideas don't transpire. I learned that you could earn a pretty reasonable income in UK's National Health Service and I thought that is where I needed to go.”
He fell in love with his wife, Judith, and they went to UK for their honeymoon.
“Not everybody gets a three-year honeymoon. I had two children there, a lot of degrees and no money. What a honeymoon!”
Judith worked as a pharmacist and Strong worked with some of UK's famous surgeons. Still in Britain, he wondered how he was going to get appointed for anything on his return to Australia.
He landed work at Princess Alexandra Hospital in Brisbane, a teaching hospital. It was a busy job. There were many emergencies as a result of road accidents. He stayed on for 30 years and it was during his time there that the tide changed for him.
“We had a lot of blood trauma (accidents). One night, we lost two members of the same family and I had to relate the bad news to the family. It struck me that we didn't deal with this (high fatality rate as a result of road accidents) as we should. A quarter of the blood passes through the liver.
“I decided to learn anatomy better. For six weeks, I visited trauma centres to see how they managed and it was no better. I set out on a mission to improve the results. Over the next few years we had the best results in the world. All these were part of the evolution of the progress with liver.”
Having saved the lives of thousands, Strong says one of the most moving of his many encounters with patients involved a lad. It was on a Saturday morning in 1997, at about 9am. He received a phone call from a hospital about 25km away from Brisbane.
“It said: Can you come quickly? We have a car crash, five boys. They stole a car in the wee hours of the morning, and three of them have to be operated on.'”
“I jumped into my car and drove there. I remember walking down the corridor. A woman was there, looking anxious. I wondered: Is this the mother?'
“I go into the theater and there was a lot of blood. I began to scrub.”
One of the boys was very badly injured. We transferred him by helicopter to another hospital. That night, Strong had another call.
“The hospital said : He is bleeding again.'”

Unconditional service
“I went in. He was in the intensive care unit for three weeks. When he came around, he would not look at me in the eye. He never responded and never said a thing.”
“One morning, he said: You've had a hair cut.' I said, Yes, what do you think?' Not much!'
Bit by bit, we became friends. I was not there to be judge and jury. We still had a lot to go through.”
When his patient was on the mend, Strong had a chat with him.
“I said: You've got to turn your life around. I want you to turn your life around.' He recovered. When he was discharged from the hospital, he came to see me. So this is where you work?'
“I told him: You are to contact me on every anniversary of your accident.' When he did not, I rang him. You promised me you will ring.' I didn't hear from him but three years later I got a card from Europe. He was representing the Australian under-18 soccer team. It was very emotional for me, to think that here he was, near death, and now he was representing the country.
“He went on to become a social worker.”
Strong has not heard from the young man since.
That encounter still moves him today. “We are not here to be judge and jury. Whatever the race, religion, or colour, it is your job to do the maximum, as if he were the king, or the prime minister. He is an individual.
“When treating someone who has self-inflicted himself, you still do it because you are not God, judge or jury.”
Looking back on all that he has achieved, Strong defines success as a journey, not a destination and is best measured by the obstacles that have been overcome.
“That is your obligation. You don't always succeed and that is tough. But you try. Sometimes, I think I am mediocre. What worries me is people tend to accept the lower standard than is normal. If you do that, then you are a failure in medicine.
“You don't know the background or the circumstances of everything. But, you can do the things you can do and you do your best with what you have and that is important. When I look back in retrospect, I may wish I had done better but I don't think I was negligent in the sense that I was not doing my best.”
Born: Lismore, new South Wales, Australia in 1938
Personal: Married with two daughters, 47 and 45
Favourite Food: enjoy most food but loves a banana in his cereal every morning Favourite Place: I love Brisbane. Subtropical and relatively safe. I have lived here for 40 years now.
Favourite Sport: Golf for 25 years I was not able to golf. now that I am sort of semiretired, I am trying to look like a golfer. But I will never be a Tiger Woods.
Values: you may have high standards and it may not be possible to attain all your ambitions. But you should try. If you don't try, that is mediocrity for me.
What I hold dear: My family. My wife has been an enormous support. I would not have achieved all that I have achieved if not for her. My children. I could never give them the time they deserved because I was so busy. Once, my younger daughter, then 12, went away for a few days for some school thing. When she came back, I said I missed you.' She looked at me and said, dad, I miss you everyday.' That hurt. now I give more time to my grandchildren.
Inspiration: As a surgeon, I try to give people a better quality of life. A lot of things I did, I did because I was in a position to do so.