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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2005  |  Volume : 16  |  Issue : 3  |  Page : 383-396
My Journey in and with Nephrology

Professor of Medicine, Cairo University, Chairman, The Cairo Kidney Center, Cairo, Egypt

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How to cite this article:
Barsoum RS. My Journey in and with Nephrology. Saudi J Kidney Dis Transpl 2005;16:383-96

How to cite this URL:
Barsoum RS. My Journey in and with Nephrology. Saudi J Kidney Dis Transpl [serial online] 2005 [cited 2021 Apr 22];16:383-96. Available from: https://www.sjkdt.org/text.asp?2005/16/3/383/32871

   Prologue Top

I never knew when it sparked in my heart or brain, or where will this affection to the kidney take me in the exciting scope of nephro­logy. Perhaps the beginning was shortly after noon in a very warm day by the end of September 1956 when I took the fast train from my home town, Assiut, to permanently settle in the Capital City for joining the oldest and most prestigious medical school of its time, Kasr-EI-Aini. As part of the curriculum, a medical student was to spend one year in the Faculty of Science, to study the basics of physics, chemistry and biology. I was lucky to have excellent teachers, who fascinated me with their depth of knowledge and introduced me to the spectacular facts which constitute the essential basics of science in nephrology. In retrospect, I can now appreciate how important were those early days in directing my interest to chemistry, electrophysiology and cell biology.

Physiology and biochemistry became my favorite basic sciences in subsequent years. I received the Golden Medal in Physiology, and was granted a room at the roof of the bio­chemistry department to develop an electronic teaching model for the effects of neurogenic and humoral factors on cardiac and renal functions. I was also allowed to deliver a series of lectures to my peers in a small theatre in Kasr-EI-Aini premises. My mentor, late Professor Shafik El-Ridi selected me as a student member of the "Metabolic Unit" that included highly esteemed faculty members from the depart­ments of Biochemistry and Internal Medicine. Through this distinguished group, which used to meet every Monday, I learnt a lot about complex metabolic pathways and their relevance to clinical disease. The Chair, late Professor Anwar El-Mofti became my principal motivator in eventually becoming a nephrologist.

   The First Footsteps Top

I graduated in 1962, and got the Golden Medal in Internal Medicine. Professor El-Mofti called me by the end of my internship year, and offered me to be the first registrar in a new section that he has been developing, nephrology. At that time, kidney disease was virtually untreatable, and renal failure was almost the synonym of death; really gloomy. I wanted to become a neurosurgeon, and was about to decline the offer when he brought me a bunch of papers on the contemporary successes already achieved in dialysis and transplantation, and challenged me to cope with this growing specialty. His words still wobble in my ears; "you may become an extraordinary neurosurgeon, but here is a chance for becoming a pioneer". I decided to take the challenge.

The new department was literally empty when I made my first foot steps in the second floor of the Internal Medicine Tower of Kasr-EI­Aini University Hospital Complex. It was real fun furnishing the department, getting the equipment for the small laboratory, and moving the Kolff artificial kidney from the Central Stores to the dialysis room to be. Soon came the nurses, technicians and housekeepers and the department was ready for its chairman, Professor Ali El-Badry who has been on a senior scholarship in the USA, and its main dynamo, Dr. Abdel-Monem Hassaballa who has been on a training fellowship in Sweden.

It was early afternoon when I was called to meet Professor El-Badry, for the first time, in his old office in Manial University Hospital. On my way, I met Professor El-Mofti in the car park; he asked me if I thought I made a right choice and I answered "the days will tell". He replied "I also can tell". He left me with this short phrase and a smile, and died suddenly a few hours later...

Professor El-Badry was an exceptional man. He became a father figure to me, a real mentor and outstanding teacher. I owe him a lot in shaping my scientific background, professional values, and of course clinical medicine. He defended my professional career against a lot of barriers, and continued to inspire me until he died several years after I had become full professor.

Abdel Monem Hassaballa was a lecturer when he came back from Sweden and the USA, having trained with contemporary pioneers as Nils Alwall and John Merrill. He took my hand in my very first steps in the Nephrology arena. He was a talented clinician, intelligent technician and had a great reputation as the prime nephrologist in the country. We spent hours together in setting the scene for dialysis. We worked against an overwhelming skepticism among our peers, so that only very terminal patients were referred for the "Killing Machine" as it was usually called! No wonder that our first 8 patients died. The ninth was a 17 year old, son of an important diplomat, who attempted suicide with an overdose of barbiturate. His phenomenal recovery from deep coma after a 6 hour-hemodialysis echoed all over the city. The immediate next patient was a very important business man with ESRD who survived on regular hemodialysis for 6 months. Those two patients had an over­whelmingly positive impact on the reputation of "our" new treatment; the door became widely open to reference of patients with acute and chronic renal failure, poisoning, and indeed any critically ill patient. I remember that 18 year-old girl who was referred in deep coma, presumably due to the ingestion of a hypnotic. While the results of laboratory assessment were awaited, I kept her on a slow infusion of Dextrose 10% to keep a vein open. To my surprise, she regained consciousness even before we got the lab result confirming severe hypoglycemia. One can imagine the reaction of the anxious family in the waiting room when I walked in together with the patient, so much alive and well!!

These and similar success stories generated a vicious circle. The more patients we received from all over the country, the steeper was the climb of our learning curve, not only in hemo­dialysis, but also in peritoneal dialysis, fluid and electrolyte balance, and management of the critically ill. We used to prepare our own peritoneal dialysis fluids, multiple electrolyte solutions, peritoneal catheters, and vascular cannulae, before we had any access to contemporary commercial tubes. We did that with enthusiasm and content, in an extremely friendly atmosphere, led by Professor El-Badry.

I got my doctorate in Internal Medicine in 1969, and soon became a lecturer. During the following year, two important events happened, with long-lasting influence on my life: First, I met a final year medical student who captured my heart. Her name is Mona Tawfik who became my wife, companion and most intimate friend ever since. Second, Professor Hassaballa nominated me for a training scholarship with Professor Gabriel Richet at the Hopital Tenon in Paris, which was my first international exposure ever.

   Post-Doctoral Training Top

I arrived in France in May 1971, and Mona joined me a month later after having finished her final MB, BCh examinations. We had a wonderful time, moving from Vichy where we had intensive language training, to Paris, Lyon and Montpellier where I was supposed to have my training in nephrology. Professor Richet was an outstanding Frenchman of Charle De Gaule's style. Although the design of my training program at Tenon was not particularly useful, I learnt from Richet a lot. He was a firm leader, proud and highly ethical physician and a great clinician with a very strong background of basic science. Through him, I learnt that Nephrology is a vast specialty, far beyond my previous conception that it was mainly dialysis and fluid balance. While in Paris, I used to attend the weekly scientific meeting led by Professor Hamburger in the Hopital Necker, which was the Mecca of Nephrology at that time. My program in France included short-term training with Professors Traeger in Lyon and Mirouze in Montpellier, both of whom had a significant influence on my understanding of clinical nephrology.

I interrupted my training in France to take a locum Registrar job in the Urology/Nephrology Institute in London, kindly offered by Dr. Mark Joekes whom I had met earlier on in Cairo, and called for help from Paris as my training was hopelessly stumbling. I took the Job in January 1972, the same month when Mona gave birth to our first daughter, Noha. We had a great time in London, and my training extremely fruitful as I was given the full responsibility of a nephrology registrar. Dr. Joekes was not only an excellent clinician, but he was also a highly experienced pathologist. He had been the first to obtain renal biopsies in London; hence he had a large collection of histopathology slides that he allowed me to access and discuss with him and with the world known nephropathologist at that time, Professor Pugh.

During my 3-month job in London, I got my Membership of the Royal Colleges of Physicians (MRCP UK). I passed Part I a few days after arriving in Britain and had to decide whether I would take the chance of a single attempt to get MRCP UK in Nephrology from Edinburgh, or multiple attempts for MRCP UK in Internal Medicine in any of the three colleges. I wanted to have a degree in Nephrology, so I took the first option.

Mona, Noha and I took off to Edinburgh in our Beatle VW after sunset, and had to drive for 9 hours in a foggy and showery night. When I went to the written examination hall next morning, I realized that I was the only candidate for Option I! I did the papers in Internal Medicine and Nephrology, and next day the Clinical and Viva examinations in General Medicine. On day 3, I called at the Royal Infirmary for the Nephrology Examination. My senior examiner was Professor David NS Kerr, who suggested that so long as I was the only candidate, we could modify the exami­nation style a bit, in such a way that I would spend the whole day under critical assessment. I had my formal long case first, then I was required to comment on 20 histopathology slides during the coffee break, followed by a ward round comprising 6 or 7 cases on which I was required to examine and analyze. We were subsequently joined by a couple of consultants and a few registrars for lunch, when Professor Kerr asked me if I would mind having those colleagues attend the rest of the exami­nation. I welcomed them of course! After half an hour discussion about the anatomy and physiology of glomerular filtration, I was shown a number of X-rays for spot diagnosis. While afternoon tea was being served, David Kerr announced my success!

Mona and I celebrated the Membership by buying a Canadian Tent and all accessories, and took a most memorable camping tour in Europe, all by ourselves and our little Noha. We camped in The British Lake district, Holland, Belgium, France, Monaco, Luxembourg, Germany, Spain and Italy before taking the boat back to Egypt in July 1972.

   Back at Home Top

My duties as lecturer in Medicine included teaching, patient care and research. I was quite active in teaching internal medicine to under­graduates, nephrology and fluid electrolyte balance to postgraduates. I did my best to upgrade the renal services, obtained a lot of renal biopsies and worked with my colleagues in pathology to optimize methodology and interpretation. Although I was involved in a number of clinical and experimental research projects and eventually published over 200 papers, my primary focus was on schistoso­miasis. I collaborated with the Naval American Research Unit (NAMRU) team in Cairo in publishing the first paper in literature on Schistosoma- Salmonella More Details syndrome, and with several groups in Cairo University in publishing on schistosoma-associated amyloidosis, the role of IgA in the progression of schistosomal glomerulopathy, and the impact of associated hepatitis viral infection. I proposed a classi­fication for schistosomal glomerulopathies, which I presented in the International congress of Nephrology in Tokyo, 1992 and was officially adopted by the African Association of Neph­rology next year. Later on, this has become even more widely accepted at an international level. Working on schistosomiasis was the magic key which opened all doors in my way to writing in international textbooks, publi­shing editorials, delivering guest lectures and chairing or speaking in workshops and sym­posia all over the world.

   Military Service Top

In July 1973, a couple of months after Mona had given birth to our second daughter, Nadine, I was called to serve as a Colonel in the Armed Forces, in preparation for the 1973 War. Every­thing was routine in Maadi Base Hospital until the evening of October 4 th , when the Blood Bank was ordered to prepare 1000 bags of different groups to be sent in 24 hours to the Suez Canal Front. While many questions awaited an answer, three senior surgeons were called to report at Almaza Military Airport at noon on the 5th October. At 11 am on October 6 th , we were required to clear the car park which "could be used for air-borne emergencies and ambulance services". No body that I know believed this was at all serious, until 1:00 pm when the hospital was declared in red code; gates were closed; no one was allowed in or out. Shortly after 2:00 pm the Egyptian Broadcast conveyed the News that our troops are crossing the Canal under heavy fire and Air Force cover! The nephrology team developed a plan for screening all casualties, grading them according to the risk of acute renal failure and provided tailored prophylactic measures according to contemporary knowledge. We eventually screened over 1200 casualties, had a very low incidence of ARF compared to similar wars in Korea and Vietnam, and published this experience in a couple of papers in the Journal of Trauma, with a very rewarding international impact.

I was exceptionally promoted to Brigadier a few months before the end of my military service. I still have wonderful memories about the year or so that I had spent with my colleagues at Maadi. They were exceptionally knowledge­able, experienced, friendly and devoted. They conducted excellent research and published in the best peer reviewed international journals. Many of them remain as my models and friends to date.

   Upgrading the University Renal Unit Top

As I resumed my duties in the University, I designed and built a complete dialysis delivery system using local constituents. I presented this project in the First International Congress of Biomedical Engineering in Cairo, for which I was awarded a medal of distinction. I sub­sequently built two improved generations [Figure - 1] that were successfully used for thousands of dialysis treatments in three dialysis centers. The drawings of this system were displayed in the museum of Artificial Organs in Cleveland, Ohio.

The ground had been ready for transplant­ation when I sought a training scholarship in several centers in the United States. I was accepted as a WHO fellow in the most pre­stigious cotemporary program at the Univer­sity of Minnesota, where I spent three months during the spring of 1976 under heavy training by John Najarian and Carl Kjellstrand. Imme­diately after my return, I realized that the Mansoura team, led by Professor Mohammed Ghonaim, had successfully transplanted the first patient in the country during April. With the support of Professor Hassaballa, I brought together an excellent team from Kasr-El-Aini Medical School, which Professor Mohammed Safwat, chair of Urology led firmly and com­petently. In addition to Professor Hassballa and myself, the team included Dr. Abdel-Kader Kotb for vascular surgery, Dr. Moamena Kamel for immunology, and a number of junior collea­gues. We prospectively wrote our protocol in full detail, on the basis of studying those from leading institutions in the USA, UK and France. Our first patient, Kamel Metwally Mansi, successfully received a graft from his brother Mohammed, on October 6 th of the same year.

I was promoted to full Professor of Medicine in 1979; when I was 38 years old. Professor Hassaballa was soon promoted to Deputy Dean, and he assigned me to lead the nephrology team in his absence. The year 1981 was historic in upgrading the renal services in Cairo University, when we were visited by a fact-finding mission from the Common European Market, led by Professor Arthur Kennedy of Glasgow. I made an integrated proposal for upgrading the unit comprising a full histopathology laboratory including equipment for immunosfluorescence and Electron microscopy, a cytoflowmeter, and 12 up-to-date dialysis machines. The proposal was accepted without any modification, and we became at the cutting edge of contemporary nephrology. This reflected on the quality of clinical and research work, leading to the presentation of at least 7 or 8 papers in each International Congress of Nephrology or EDTA meeting.

Professor Hassaballa maintained his enthusiasm and support to the renal unit despite his respons­ibilities and challenges as Deputy Dean. Through his influence and connections, he was able to move the renal unit into a larger zone in the University Hospitals, where we acquired a large dialysis unit, a well equipped laboratory, a good library, and a few Out Patient rooms. This unit is now known by the name Professor Hussein El-Ghonaimy, who was next to me in the seniority order when he died prematurely in an anaesthetic accident in the United States.

Professors Safwat and Hassaballa also worked on the development of a nephrourological unit to deal with the renal transplants as well as the cases of common interest such as post­schistosomal obstructive nephropathies. The unit took off when HM King Fahd of Saudi Arabia sponsored the construction and equipment of a separate building for this activity that still carries his Majesty's name. King Fahd's unit offered extensive facilities for out-patient and inpatient care, including full laboratory, imaging, isotopic, dialysis, surgical and ICU facilities. In this milieu, I and my colleagues had great opportunities in practicing modern nephrology, and conducting extensive clinical research. As a reflection, I supervised over 100 theses for the Doctorate or Masters Degree in nephrology, urology, biochemistry, biomedical engineering and nursing completely or partially conducted in King Fahd.

   The Critical Challenge Top

I became, in theory, the chief of Nephrology as Professor Hassaballa retired in 1988. Since my order of seniority in the Department of Internal Medicine did not rank me high enough to have a distinct physical section, the renal unit staff were randomly dispersed all over the 9 medical units. Each had his own assignments in internal medicine, but no formal commitment of any kind to Nephrology. I had no registrars, no interns, and was allowed only to appoint part-timers to run the dialysis unit. Our duties in King Fahd's unit regressed to merely running the dialysis unit and providing medical care to transplant patients. A few senior professors of Medicine expressed their sympathy, but no serious attempt was made to salvage neph­rology from collapsing.

My life-or-death challenge was to overcome this administrative sabotage, and rebuild the renal unit. I identified four targets: a) to maintain the integrity of my team; b) to substantiate our existence through teaching and uninterrupted provision of specialized medical service to renal patients all over the university hospitals; c) to acquire a physical section for patients with kidney disease; d) to formalize the academic and legal identity and autonomy of the renal unit in a way that would not permit this disaster to happen again.

I started by formulating what we called the "Nephrology Club", consisting of all staff members of the former renal unit. We gathered once a week in King Fahd's Unit, to present selected cases from anywhere in the university or private hospitals in a CPC format. I divided the staff into 4 groups, each being led by the most senior member and assigned a specific duty to each group, on a rotation basis. One group was to run the dialysis unit, another to oversee the transplant program, the third to supervise the outpatient services and inpatient consults, and the fourth to organize the scientific, teaching and research activities. My colleagues accepted to work within this frame on a purely voluntary basis; I had no authority to impose it. It was only the warm relations and common target that made it work.

A year later an inpatient section, called Section 35, formerly used for sick prisoners was about to be vacated for security reasons. I asked the Dean to grant those 10 beds to Nephrology. He approved despite tough resistance of the Chair of Medicine, who was strongly under the impression that I was plotting to acquire inpatient beds before my turn! We managed to raise some charity funds, refurbished the section, and used it as the first nucleus for a clinical nephrology headquarters. Through my personal relations with the director of King Fahd, I also managed to assign another 10 beds to clinical nephrology, and we were even granted an office for the staff!

Finally I could set up, with the help of my distinguished senior colleagues in nephrology, Professors Magdy Soliman, Maher Ramzy, Omar Khashab and Helmy Abou Zeid, the Kasr-EI-Aini Nephrology and Dialysis (KAND) Center as a distinct formal entity within the department of Internal Medicine with adequate administrative and academic autonomy. Only then was it possible to speak of a nephrology unit with clear boundaries, defined budget, structured professional and administrative personnel including residents and interns, and a distinct role in under- and post-graduate teaching. KAND became increasingly strong over the years, so much so that we were able to build a new, fairly large section for clinical nephrology in the Manial University hospital campus and to have a full inpatient zone in the New Kasr-EI-Aini Teaching hospital. By the end of my tenure in 2001, the nephrology staff in KAND comprised 10 professors and 12 other faculty members, in addition to over 15 registrars and other full time juniors.

   General Medicine and Sound Nephrological Practice Top

I have always been a believer in subs­specialization. But I also knew that without a very good background in general medicine; one cannot become a strong specialist. While at the peak of our 1988 crisis, I declined the Dean's proposal to split Nephrology from the department of Internal Medicine, in the interest of quality and efficiency of future generations. When my turn came to chair a general Professorial Unit, I deliberately avoided converting it into a renal unit, with the intent of keeping the general unit sufficiently multi­disciplinary to provide adequate patient care and undergraduate education. The day-today cross-educational experience among the faculty members of different specialties, working under the same roof, was most enlightening and rewarding.

In 1999 I became the Chairman of the Depart­ment of Internal Medicine. I literally "forced" every young faculty member to choose a medical subspecialty for future career. It was easy to convince my senior colleagues to maintain the general nature of the professorial units by avoiding specialty clustering within their faculty structure. Meanwhile, I copied the KAND model in re-organizing 4 existing and developing 4 new specialties, thereby providing a format for their promotion and excellence. I was lucky enough to find enough room for all specialized centers outside the professorial units to emphasize the mission differences.

When I finished my tenure as Chair of Medicine, 80% of the medical staff belonged to a subspecialty, and there were 10 active specialized centers legally protected from crashes of the kind that had hit nephrology earlier on.

   Private Practice Top

The tradition in Egypt, like many other parts of the developing world, is to seek additional financial income through private practice at least three years after appointment as lecturer in the University. I launched my clinic in Bab-EI-Louk in 1972, and added a wing for private dialysis in 1975 using the second generation of my hand-made dialysis machine. I moved my dialysis unit to Al-Salam Hospital in 1982, where we started private renal trans­plantation a couple of years later. Then I switched to my own private hospital, the Cairo Kidney Center, in 1987, in which I tried to create my own little Utopia. With the help of my loyal assistant and friend, Mona Shenouda, we looked into every detail and computerized every possible activity to guarantee precision and conformity. Without encroaching on finan­cial viability, I kept high academic standards, developed training programs to all employees, organized scientific meetings to the medical staff and engaged in clinical research. We trained many fellows from Egypt and neighboring countries, and hosted 4 ISN fellows over the past three years. The center is currently staffed by 4 highly qualified nephrology consultants, 6 specialists and 8 registrars, in addition to supporting staff in urology and other related specialties. Over 18 years, more than 50,000 patients visited the center for assessment or treatment.

   National Outreach Top

Through my official academic positions in the University, I automatically became a member of a large number of national commi­ttees for education, research, staff promotion and medical care. This helped me a great deal in understanding the strengths, weaknesses, threats and opportunities related to medical practice in the Country. I also got to understand the needs and ambitions of the profession through my position as Secretary-General of the Egyptian Society of Nephrology (ESN) for 12 years and President for three. It was fun working with Professor General Zakareya El-Baz Rihan and his team to organize the first Egyptian Congress of Nephrology at the Maadi Armed Forces Hospital, in 1981. This became a yearly event of great national and regional importance in subsequent years. It is nice coincidence that my third daughter, Mireille, was born in the same year; her age has always helped me remember the sequence of the ESN annual meeting (sometimes the other way round!!).

During my tenure in the ESN, I organized a training course in Nephrology leading to the acquisition of full membership of the Society, in response to the increasing demand of trained personnel for the expansion of dialysis services all over the country. All senior nephrologists participated in teaching and training. This membership remained as the only post-graduate certification in Nephrology until Ain Shams University developed the respective Masters degree, many years later.

For those who wanted higher qualification, I made an arrangement with Professor Abdel­Meguid El-Nahas to help young physicians in obtaining their Masters in Nephrology from the University of Sheffield, UK, which we called the "Cairo-Sheffield Shuttle". Enrolled students would have about 40% of their teaching modules and clinical training in Cairo University before completing their study, submitting their thesis and sitting for the examination in the UK. By virtue of the same arrangement, the tuition fees and cost of accommodation in the UK was substantially reduced. Many Egyptian, Libyan and Sudanese students benefited from this arrangement over several years.

This experience was fundamental in setting the scene for further scientific collaboration with the UK, when the Egyptian Medical Syndicate invited the Federation of the Royal Colleges of Physicians to hold the final clinical examination (PACES) in Egypt. I was requested to run this examination in Cairo University thrice for rehearsal, before the agreement was signed and MRCP Egypt became a reality. I was subsequently appointed chairman of the Clinical Examination Coordinating Committee and the local Board of Examiners. With the outstanding help of Professors Hady Gobran and Hesham Tarraf, four Egyptian Members of the Royal Colleges, six clinical demonstrators from the Department of Internal Medicine, eight medical students who played patient surrogates, we organized 2 diets each year over the past 4 years, through which over 80 candidates successfully got their Membership.

I was honored by many Egyptian authorities and universities. What I consider most presti­gious was my appointment as Chairman of the Supreme National Committee for Education in Internal Medicine. I was the recipient of medals and shields of recognition from 5 Universities, 3 national societies, The Egyptian Medical Syndicate, Egyptian Military Academy and several governorates where I helped to establish renal centers or dialysis units.

   Regional Outreach Top


In 1985 I received a circular from Dr. Robert Schrier, who was by then Treasurer of the International Society of Nephrology (ISN), inviting several African national societies of Nephrology to organize the first regional ISN meeting in the continent. I welcomed the initiative and wrote a proposal including scientific, political, social and financial aspects. A few months later, while participating in another meeting in Nairobi, Kenya [Figure - 2], Klaus Thurau, the president-elect of ISN and Bob Schrier conveyed the News that our application had been accepted, and that ESN would be granted seed money of 30,000 US dollars to support the meeting.

I obtained the names and addresses of all major African universities from the respective embassies in Cairo, and sent out over 50 letters to the respective Rectors requesting nomination of renal physicians for the event. Only 17 replied, but I thought this would be a good start. With the help of my outstanding assistant, Mona Shenouda, we organized the meeting in February 1987, including delegates from 13 African countries and speakers from Europe and the United States, including Donald Seldin, who has been the ISN president, Klaus Thurau, Bob Schrier, Wadie Suki, Beppe D'Amico, Heinz Valtin and other international big shots. During the meeting, the African Association of Nephrology (AFRAN) was announced, and the broad lines of its constitution agreed upon [Figure - 3]. The Rules and Bylaws were ratified 3 months later while most of the founders were participating in the International Congress of Nephrology in London. The signing ceremony was hosted by the Royal College of Physicians in Regent's Park, where I was announced as the "First and Founding President". AFRAN has continued to flourish ever since, encom­passing over 25 African countries. It holds regular meetings in different regions, has an official journal, a newsletter, a dialysis registry, and lots of other activities.

Following the success of the ISN meeting in Africa, other presidents supported similar conferences in Asia and Latin America. Eventually, ISN established its Commission for Global Advancement of Nephrology (COMGAN) under the leadership of Barry Brenner and John Dirks. Stewart Cameron, then president of ISN, appointed me Co-chairman of the subcommittee for Africa, along with Professor Jean Pierre Grunfeld of Paris. Through this position, I visited many African countries in fact-finding missions and developed acquaintances and friendships with many colleagues in the Sudan, Kenya, Uganda, Tanzania, Mozambique, South Africa, Nigeria, Algeria, Tunisia, and Morocco. I was subsequently invited as a visiting professor or speaker in the national meetings in many of those countries.

Arab World

On a spring day in April 1986, I was among the group of Arab Nephrologists who met in the Nile Hilton for a Cyclosporine launch meeting [Figure - 4]. The idea of establishing the Arab Society of Nephrology and Renal Transplantation (ANSRT) emerged and was enthusiastically adopted. A steering committee was formed, leading to the formal launch meeting in Amman, Jordan a couple of years later. Professor Hassaballa was elected president, and my late friend and colleague El-Hussein El-Ghonaimy Secretary General. I was not involved in the leadership of the society until ANSRT and AFRAN held the 1995 joint meeting in Tunis, where Dr. Mohammed Abou-Melha was supposed to end his term as the second president. Owing to lots of controversies, and the lack of a written procedure, there were no formal nominations for his successor. The presidency was left open for ad hock proposals and vote during the General Assembly. Dr. Yassin El-Shahat pro­posed my name against three others. I was really thrilled when my competitors succe­ssively withdrew in my favor in such a collegial way, and I was unanimously elected. During the same meeting, Professor Riad Said was elected Secretary-General.

I worked hard for ASNRT, created several chapters and formed many committees, with the objective of involving as many as possible of the membership in the society's activities. With the help of Professor Abdel-Meguid El-Nahas and Dr. Amin Soliman, I launched the official journal "Nephrology Forum". I worked with Professor Aziz El-Matri on revising the Constitution and Bylaws, and with colleagues in Lebanon to hold the 1996 outstanding Congress in Beirut. It was a delight to help in the establishment the Pediatric Nephrology Section in ASNRT, under the leadership of Essam El-Sabban, which held its first international congress in Cairo by the end of 1996 [Figure - 5].

Middle East

In my mail on one of the early days of 1990, was an unexpected letter from Turkey, signed by Professor Mehmet Haberal, suggesting the establishment of a Middle East society for organ transplantation. I expressed my concern that this may conflict with ASNRT, but Mehmet convinced me that the scientific and geographical scopes are different. I participated in the steering meeting held in Ankara later during the same year, and became a member of the Executive Committee and eventually Vice-President.

Most members of the Executive eventually became presidents, but when my turn came, I had to decline because of many other commit­ments that would not have allowed me to effectively run this important society. In addition, the conflict between ASNRT and MESOT was escalating, and I felt I was supposed to send a signal to which side I belonged. The Council met in Tunis in my absence, and Aziz El-Matri's name was proposed for the presidency. In an unprecedented gesture, Aziz insisted on phoning me in Cairo during the Council meeting to make sure that I was unwilling to take the position. I thanked and blessed him, and he became one of the most effective presidents of the Society.

I was subsequently honored by MESOT on several occasions, and remain in close association with its admirable principal founder, Mehmet Haberal.

   International Outreach Top

By the end of my training in London in the early seventies, Dr. Joekes asked me about my target in future career. I answered "to be a good local nephrologist". He replied, "why not international?" I had no answer, but the question remained echoing in my ears ever since. International recognition requires ambition, focus, and patience. Joekes triggered my ambition, and also suggested the focus. He advised me to spotlight on one local topic, work on it in all possible depth, try to publish inter­nationally and keep publishing regularly. That is precisely what I did with Schistosomiasis.

It did not take long before I got that invitation from the Editors of Oxford Text Book of Clinical Nephrology to write the Chapter on Schistosomaisis. I could not sleep that night out of excitement! I spent long nights collecting data, preparing the manuscript and choosing the figures. I must have written the chapter 10 times and revised it 20 times before submitting it! The editors liked it, and I became a regular author of this chapter in all subsequent editions.

In 1986, Carl Kjellstrand was presiding the Congress of the International Society for Artificial Organs in Chicago. He invited me to speak on the management of ESRD in the Developing World. Since this was my first experience in presenting in an international meeting; I made every possible effort to bring up something original. So, I sent out a question­naire to colleagues in Africa, India, China, Southeast Asia and Latin America, asking about any available epidemiological data, clinical trends and prevailing treatment modalities. When I assembled the answers, I had a unique comprehensive report on ESRD in the developing world. Yet, due to my lack of experience, I did not finish my talk during the allotted time, and I asked the Chairman, Eli Freidman, if I could have a few more minutes. To my astonishment, he said, "by all means, take as long as you wish; we really need to know more about the other side of the world". I took 10 additional minutes and was greeted by a long applause! My presentation was subsequently published in the Artificial Organs, and I was elected as Vice President of the Society, a position that I held for almost a whole decade.

These two landmark events, the Book and the Congress, paved my way to international recog­nition. I was invited to write chapters in 18 international textbooks and monographs, in addition to being a guest editor, solicited author, and member of the editorial boards of 10 inter­national and regional journals and a reviewer in 16. I was invited as a visiting professor in many universities in the USA, UK, Sweden, Austria, many Arab and African countries, and as a guest speaker in many international, regional and national meetings. My peak was the plenary lecture on parasitic nephropathies in the International Congress of Nephrology in Sydney, 1997. In recognition of contemporary achievements, I received the International Award of the National Kidney Foundation of the United States in 1992.

   International Society of Nephrology Top

I was elected to the ISN Council in 1993, representing Africa and the Middle East. This was indeed an exciting experience, particularly as it coincided with the increasing commitment of the Society in supporting the developing world. I was then promoted to the Management Committee, which was responsible for running the business aspects of Kidney International.

John Dirks was Chairman, and Sarala Naicker was a member of the ISN Nominating Committee in 1997. During a planned breakfast meeting in one of the international congresses the following year, they talked to me about my possible nomination for Secretary-General. I was quite excited about the challenge, though I knew that my chances were quite meager. I was so cynical that I did not pay much attention to gestures from John Dirks and a couple of members on the Executive Committee, suggesting that I was being considered seriously.

In the middle of a meeting of the COMGAN Subcommittee for Africa in the ASN meeting of 1998, I was asked to see the ISN president, Kiyoshi Kurokawa who was chairing a meeting of the Executive Committee next door. I went in, took a seat at the far distant end of the table, anxiously facing the smiling faces of all 10 members of the Committee. Kiyoshi said: "Rashad, the Executive Committee has unanimously voted to offer you the position of Secretary-General of ISN for 6 years; will you take it?" I was completely taken by the statement and remained silent. A minute or two later, he exclaimed, "No?!!" I quickly replied, "Oh not at all, Yes by all means; thank you very much".

The Office transition took six months, and I became the official SG in Buenos Aeries in May 1999. By virtue of this position I was also to chair the Fellowship Committee, and as the years passed by, I chaired many other Committees including the Publications Com­mittee, the Website Editorial Board, The COMGAN Advisory Committee on Tropical Nephrology and the Clinical Practice Guide­lines Committee.

I worked hard for all these positions and got encouraging positive feedback from every­where. It was fun working with very distin­guished colleagues from all over the world in the Executive Committee, Council, Chairs and members of different ISN Committees and Presidents of national societies in over 100 countries. I had a very special relation with postdoctoral fellows from over 70 countries and their home and host mentors. I was lucky to work with a wonderful administrative staff in the different ISN Offices in Amsterdam, Toronto, Atlanta, Brussels and my own in Cairo. In this respect, I mention with admiration and gratitude, the enormous support that I got from my Cairo Office Director, Dr. Soha Sobhi.

With the help of all these individuals we were able to make strategic changes in the Fellow­ship program, launched the international net­work of past-fellows, known as the "Global Fellowship Club", and the "Fellows' Matching Initiative" which aims at helping potential fellows to identify suitable host institutions. We generated a format for the past-fellows to display their work in the International Congress of Nephrology, competing for prizes and awards. We re-structured and computerized the process of selection for ISN Fellowships and Travel Grants.

With the help of my Amsterdam Office Director, Ilja Huang and the talented computer programmer in the Netherlands Academic Medical Center, Onno De-Boer, we launched the ISN Website in late 1999, and upgraded it several times.

The most recent version which will be launched shortly is the Nephrology Gateway developed by our new publishing partners, Nature Publishing Group. ISN was the first International Society to experience voting on-line, which significantly augmented the number of voters to over 1,500 in the 2005 Council ballot.

In 2002, I was invited to participate in a new International Initiative of the National Kidney Foundation of the USA to involve a Global Board in the development of certain K/DOQI Guidelines. After an initial meeting in London, in January 2003, it was decided to split this board from NKF into an independent organi­zation under the name "Kidney Disease: Improvement of Global Outcomes (KD:IGO)". I was elected to the Board of Directors, and chaired the Implementation Committee for countries without existing clinical practice guidelines. The first such meeting was held in Beijing in June 2004; others are pending in different parts of the world.

Late in 2004, KD:IGO sought adoption of its guidelines by the ISN, at a time when I was appointed as chairman of the Guidelines Committee. I was uncomfortable serving on both sides when ISN was looking into KD:IGO guidelines, and suspended my activities with KD:IGO to avoid conflict of interest. This attitude helped a great deal in maintaining transparency and objectivity of the whole procedure that ended up in a positive decision.

As John Dirks was approaching the end of his term as COMGAN Chair, an ad hock committee chaired by Robert Schrier proposed certain changes in its scope and leadership that were approved by the ISN Executive and Council in November 2004. In the new COMGAN structure, the ISN renal Sister Center Program [Figure - 6] will have a central focus and will receive a lot of funding. I was appointed as the incoming Chair, which faces me with a new challenge that I am looking forward to meet as I end my term as Secretary-General.

   Epilogue Top

One more year to go before I complete half a Century on the road for this exciting journey. I am content with its outcome, including the hardships and failures as much as the successes and rewards. In many areas, my achievements have exceeded the most extravagant of my ambitions, thanks to God's will, the support of my family and the help of all those mentors, colleagues, students and assistants. If I am to grade the order of what gives me the highest pride, I would put at the very top those successive generations of students that I had the chance to teach or train, who still remember the days or years they spent with me in the University or elsewhere, and care to mention my name in meetings or private conversations, to call me for a seasonal greeting, or to send me a Christmas or Easter Card. May God bless them all.

Correspondence Address:
Rashad S Barsoum
Professor of Medicine, Cairo University, Chairman, The Cairo Kidney Center, P.O. Box 91, Bab el Louk, Cairo 11513
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PMID: 17642809

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