‘Damage control is our current reality’: Team of doctors translates English-language trauma textbook


November 2, 2016

There is a book beside Dr. Wasl al-Jarak’s operating table. When a trauma patient arrives, Dr. Jarak quickly parses through its pages.

Published in 2004, Top Knife: The Art & Craft of Trauma Surgery by Dr. Asher Hirshberg and Dr. Kenneth Mattox, provides surgeons with quick, detailed summaries of surgical approaches to trauma injuries.

Dr. Jarak is one of five physicians who collectively translated the guidebook in order to distribute Arabic versions to Syria’s surgeons in opposition areas.

“The book reflects the reality in the areas where we work,” Jarak tells Syria Direct’s Celien Baker. “Areas where all types of weaponry are used against the Syrian populace.”

 Dr. Wasl al-Jarak. Photo courtesy of Abu Hassan al-Moutaz Bellah.  

The 31-year-old Jarak trained as a general surgeon, graduating from Aleppo University in 2009. He remained in west Aleppo until his fourth year of residency, when he fled to adjacent Idlib province in light of the worsening security situation.

Now in the rebel-held Idlib countryside, Jarak says he relies on Top Knife to provide information on surgical fixes for trauma injuries such as shrapnel injuries and severe burns. 

“Our approach is damage control,” Jarak says.

“We need to bring this idea to Syria because, tragically, this is our current reality.” 

Q: Could you speak to the team’s skills? Do they have experience in translating medical texts or interpreting?

This is the third book I’ve translated. As a surgical resident, I translated my first book, 100 Surgical Cases.

[Ed.: 100 Surgical Cases (2007) is an education textbook for residents and junior doctors with detailed case studies for 100 common surgical situations.]

For the rest of the physicians, this is their first time, but they are all skilled surgeons and English speakers. Dr. Eyad Baath completed his residency in England in pediatric surgery. He and I reviewed the final translation three times.

Whenever one of us runs into difficulties with phrasing or an expression, we collaborate in a chat room and all our decisions must be unanimous.

Q: Why did you choose this specific book, Top Knife, to translate? How does your choice reflect the current medical situation in areas like Idlib that are frequently hit with shelling?

I first learned about Top Knife at a conference in Turkey and its relevance to doctors within Syria was clear.

The book reflects the reality in the areas where we work, areas where all types of weaponry are used against the Syrian populace.

We have a limited medical capacity, a lack of specialized medical centers, and few experienced surgeons to deal with trauma injuries. Surgeons can search through this book for guides on treating those complex cases with heavy blood loss and life-threatening injuries. Our means are modest, so we use the simplest surgical fixes.  

With trauma surgery, our main aim is damage control. With each case, we prevent damage, complications, and deterioration. We need to manage these traumatic injuries particularly during the phase that’s called the “triad of the death.”

[Ed.: The “trauma triad of death” is the simultaneous appearance of three complications: hypothermia, acidosis (increased blood acidity), and coagulopathy (lack of blood clotting). These three factors compound one another and result in high mortality rates. Once all three conditions appear, damage-control surgery is necessary to prevent the situation from deteriorating.]

Our approach is damage control more than definitive repair. We need to bring this idea to Syria because, tragically, this is our current reality.

 Top Knife: The Art & Craft of Trauma Surgery. Photo courtesy of TFM Publishing.

Q: With the frequency of shelling, how are you able to complete this project? What difficulties stand in your way?

The biggest challenge is distance. It is difficult to coordinate between all the members of the team. There is a shortage of medical personnel, so we are short on time.

Also, there are five doctors working on this project and it’s a challenge to find one language to voice all of our opinions. We have the medical knowledge and the practical knowledge, but this is a challenge we have to bear together.

Printing is another discussion and a challenge in itself because we want to distribute the book for free. We have sent requests to several printers and we want to formalize distribution through the Idlib Health Directorate.  

Q: How have you specifically benefited from the information presented in Top Knife?

Dr. Ahmed al-Jarak and I once treated a surgical patient with multiple stab wounds, several in the abdomen. We used the book to understand how to maneuver around the vital, internal organs and identify the simplest surgical approach to treat the case.

[Ed.: Idlib-based surgeon Ahmed al-Jarak is a member of the translation team.]

Q: Are there any medical translation projects planned for the future?

We are now working with a comprehensive, English-language book on pediatric surgical care and are close to finishing. Dr. Eyad Baath is supervising the translation, as he is a specialist in pediatric surgery. We need to have a doctor whose specialty lines up with the subject to supervise the translation.

We are determined to translate books that relate to our current situation, so we are now looking at two choices for the next book: gynecological surgery and vascular surgery.

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