Operating is not the main part of paediatric surgeon Arnis Eņģelis' work

On 28 September, Professor and head of the Department of Paediatric Surgery, Faculty of Medicine, Rīga Stradiņš University (RSU), paediatric surgeon at Children’s Clinical University Hospital and head of the Clinic of Paediatric Surgery Arnis Eņģelis received the Professor Aleksandrs Bieziņš Award for lifetime achievement in recognition of his contribution to the development of paediatric surgery in Latvia and promotion of children’s health. This is the highest recognition in paediatric surgery.

Professor Arnis Eņģelis is among the most experienced and knowledgeable paediatric surgeons in Latvia dealing with abdominal diseases and rectal disorders. He introduced paediatric minimally invasive surgery in Latvia, by gaining experience in Germany, France, the Netherlands, Sweden and England.

The professor has 42 years’ experience in paediatric surgery, and he has been loyal to RSU and the Children’s Clinical University Hospital throughout all his professional career, the professor has helped thousands of patients and is the teacher of many students, residents and paediatric surgeons. Professor Eņģelis has taught study courses such as Paediatric Surgery, Paediatric Surgical Diseases, Paediatric Traumatology and Orthopaedics a. o. courses.

Arnis Eņģelis graduated from Kuldīga Secondary School No. 1 over two years with an aim to enrol at Rīga Medical Institute (now - RSU) prior to the age of 18 to sidestep a summer draft for the compulsory Soviet military service and have the opportunity to pass the institute entrance examinations. “I studied the 9th and 10th grade subjects and passed the exams in one year. My teachers supported my intention to graduate from the school earlier and enrol at Rīga Medical Institute, as they knew that I am a good pupil,” recalls Arnis Eņģelis.

Knowing that you are a physician, furthermore, a paediatric surgeon, how do you live with your surname (“eņģelis” – from Latvian “an angel”)? Has it helped you or, quite the contrary, inconvenienced you in life?

When I was little and went to school, I was teased because of my surname. I think I have felt greater responsibility for my patients and colleagues because of it.

How did you choose to study medicine?

Since I was good at mathematics, chemistry, physics and biology, my mother, who was a nurse, persuaded me to become a physician. Additionally, physicians were the social elite in Soviet times, and my mother wanted that her son have a good job.

You graduated from the Faculty of Paediatrics at the Rīga Medical Institute in 1976. What are you memories from your studies?

I was accepted into Rīga Medical Institute in 1970. We had to much to learn and we did not have the option to demand that the teacher teaches us everything during class, because we knew that we must study at home a lot on our own.

For the last three study years – since 1973 – I worked in the Children's Clinical University Hospital. Initially, I was responsible for the scientific organisation of the work and rationalisation proposals. On 1 August this year, my colleagues congratulated me on 45 years of continuous work in this hospital.

So I understood very early that I must stay in Rīga if I want to have a qualified job and get a good intership. I tried to implement this idea in different ways. I participated in the Students' Scientific Society and scientific student interest groups. Therefore, I was offered summer work in the Department of Physiology laboratory during the first years of my studies. Assistant Professor Juris Aivars worked there on his research. I assisted him in his experiments.

I remember that in our spare time after studies, my friends and I went river boating in Latvia. My study mates are neurosurgeon Arnis Ozols, paediatric surgeons Jānis Krasts and Gunārs Riņķis, who now manages the Blood Transfusion Unit, paediatrician Mārīte Jablonska, who works in statistics, leading surgeon of the Latvian Maritime Medical Centre Māris Skrubskis who is my best friend since our study days, head physician of the East Hospital Viesturs Krūmiņš, gynaecologist Dace Melka, internal medicine physician of the Latvian Maritime Medical Centre Astra Balode, ophthalmologist Inese Kovaļčuka and others..

Arnis Eņģelis (on right) with classmate Māris Skrubskis in the RMI student physiology group. Early 1970s. Photo from private archive.

Who are the teachers from your study days that you remember the most?

My first anatomy teacher Janīna Kiriloviča has made a particular impression on me, because she was very understanding and forthcoming.

I definitely want to mention Assistant Professor Juris Aivars, who was my supervisor in physiology. He was a smart man. I was a 2nd year student, when, while I was operating on an animal, I said: "Surgery, to a great extent, is manual work." And he replied: "It is cognitive work to an even greater extent." And this has stayed in my mind ever since!

Whereas Professor Leja, when I was writing my thesis, said that I should not part with my „thick hat” so soon, because I can still get knocked on the head for quite a while. [Smiles.]

Why paediatric surgery?

I hoped to have an opportunity to work in adult surgery, but unfortunately back then it was not possible due to tough competition from those who were already working there. As I had already started working in the Children’s Hospital and I was offered to stay there, and so I did. Therefore I had to transfer to the Faculty of Paediatrics, despite the fact that I had been studying at the Faculty of Medicine for five years. I have no regrets that it turned out that way…

Back then a surgeon’s profession was seen as a male-dominated occupation …

Now things are different, as there are females in the military service, they work as taxi drivers etc. There is gender equality..

However, though I see myself as a supporter of gender equality, I think that a surgeon’s profession is tough – many women are forced to sacrifice something.

What is the toughest thing in paediatric surgery?

Methods and instruments. The profession of a paediatric surgeon is no less physically demanding than adult surgery as it may seem, bearing in mind the fact that an adult is bigger than a child. When operating the abdomen of an adult, everything is large and clearly visible, whereas, in case of a child, everything is tiny and fragile. Therefore, a paediatric surgeon must deal with a great deal of stress.

What is the most important instrument in your profession? Is it still a scalpel?

No, it is a pen and PC keyboard! [Laughs.] Today physicians have to deal with extensive paperwork. In comparison with this, surgery is like a wonderful hobby. But it’s the same everywhere in the world.

Previously, a surgeon only performed operations, however now there are new safety requirements, surgeons have to speak to parents, fill out documents and carry out research projects. We have to deal with so many other things, thus, operating is not the main part of the work.

Who were your teachers of surgery?

My first mentor or educator, who invited me to work in the Children's Hospital – and later was my thesis supervisor – was Professor Jānis Gaujēns. He was a long-term director of the Paediatric Surgery Clinic.

1971. Arnis Eņģelis (second from left) un Prof. Jānis Gaujēns (first on right). “I haven't started work in the Children's Hospital, and the Professor and I have not been officially introduced ,” tells Prof. Arnis Eņģelis. "First on the left is the head of the RMI Student Scientific Association Igors Stepānovs. At the time Prof. Jānis Gaujēns was mentor to the Studentu Scientific Assocation." Photo author: Paulis Cīrulis. Photo from the RSU museum archive.

I should also mention the head of the Children's Hospital Department of Paediatric Surgery, Ēriks Jēkabsons. He taught me how to operate. Ēriks Jēkabsons knew his work and did not operate inside the abdominal cavity as a bull would behave in a china shop, and that is what I learned from him.

Many other colleagues from that time are the teachers that I learned from.

The study trips left a great influence on me, starting from the 1990s, when I spent several weeks or months in Germany, Sweden, the Netherlands, France and the United Kingdom, where I had an excellent opportunity to learn from famous surgeons.

Can any young adult who is enrolled at RSU – and wants to be a surgeon – become one?

They say that anyone can be taught. The same as anyone can be taught to play the piano somehow, everyone can be taught to operate somehow. One person will be more talented, another person – less, but also the talented one needs training. If one has no talent, they must learn and train thoroughly. But talent without training is like a naughty hobby.

Do you think you had talent?

I have always enjoyed manual work. There were many craftsmen in my family – watchmakers, organmakers and well diggers both among my maternal and paternal great- grandparents. I myself was interested in electronics and radio engineering at school, and I was always assembling and making something.

Prof. Arnis Eņģelis (second from left) in 2007 on an exchange in Amiens (France). “It is one of the partner cities of Rīga. You can see my good friend Jean Pierre Canarelli in the photo on the right, wearing glasses,” remembers Professor A. Eņģelis. Photo from privāte archive.

You have introduced minimally invasive paediatric surgery in Latvia. Please tell me more about it!

It all started with my three month training in minimally invasive surgery in Germany. Since then, from 1990 onwards, I travelled studying it several times per year – both at congresses and clinics.

Before gaining practical experience, I already noticed and understood in congresses that minimally invasive surgery is a fantastic thing, because the idea is to have as minimal a surgical scar as possible for the patient. As we know, surgery for a patient is both treatment and a trauma at the same time. However, when, previously, a long abdominal incision was required, now, a surgeon-endoscopist makes three little perforations that allow one to insert 5-7 mm-sized instruments.

Whenever possible, I tried my best to learn new skills. Following the change of management in the Children's Hospital, Prof. Aigars Pētersons, who is now the RSU rector, became director of the Paediatric Surgery Clinic. He knew about minimally invasive surgery and understood its advantages, entrusting my "abdominal" team to introduce it in Latvia. Additionally, the hospital had purchased the tools to be able to start work. We were ready immediately! There were other additional learning opportunities, and that’s how it all began. Prof. Aigars Pētersons addressed us in autumn 1996 and we already performed our first operation in spring 1997. For such a technically complicated method as minimally invasive surgery, this is a very short period. Now it is routine surgery.

Is the level of paediatric surgery in Latvia the same as in Europe?

The requirements in Latvia are the same as in Europe. Of course, we can state that we don’t have enough funds or our resource base is not sufficient, however, we use the same treatment methods as in Europe. The only difference that comes to mind is the fact that there is double the amount of nurses in Europe. We lack nurses due to low wages and people are not willing to work and earn such a low wage.

At the World Paediatric Surgeons' Congress in India in 2010.  "At one of our poster presentations," explains the professor. Photo from private archive.

In 2014 together with your colleagues you filed an application for a patent on the method for detecting the possibility of a risk of gangrenous appendicitis in children aged 7 – 16.

The patent application was submitted through RSU. This finding is a part of the study carried out by my doctoral student Astra Zviedre, and those of us involved in the study are co-authors of the patent, i.e., Prof. Aigars Pētersons and myself.

A patent – it is an innovation, and for the university it is essential to make it public, as this is an opportunity to demonstrate our ability and gain recognition.

What are your current scientific interests?

Our team is researching a topical issue, for which we as a small country have a sufficient number of patients to make the study valid. It is a complicated intra-abdominal infection or suppurative abdominal inflammation, that can be avoided if detected in time and the disease that causes it is treated.

Are you planning to participate in the RSU Scientific Conference in April 2019?

Of course, I will take part. I am planning to present the previously mentioned study.

Prof. Arnis Eņģelis a the 2007 RSU Scientific Conference. Photo from the RSU museum archive.

Do you, as a professor with extensive work experience, still need to learn?

Everyone needs to learn, I do too! As soon as you stop learning, you start counting down your days. [Laughs.]

Who do you admire?

I admire technical progress. I remember watching a film at elementary school about the great villain Fantomas who took out a brick-sized transmitter from his pocket and used it for communication. Now, each of us has a tool such as this in our pockets, and it is incomparably smaller, lighter and more powerful. We do not even know everything that has been discovered and created in the field of technology. For example, we can now attach a video camera to the back of a fly, yet we still cannot force it to fly where we want! [Laughs.]

What is the basic condition for maintaining good health?

The basic condition, in my opinion, is that a woman carries and gives birth to a healthy child. Then there is every opportunity to raise a healthy child nowadays.

September was Poetry Month in Latvia. Have you ever tried to write a poem?

I have not written a poem, however, there was a short period during my school years when I wrote songs making use of poems. Back then I learnt the piano and took singing classes at music school.

Who will you vote for in the Saeima elections?

I will vote for New Unity (Latvian: Jaunā Vienotība), as my youngest son Kārlis Eņģelis, is a member of this party.

Arnis un Ludmila Eņģelis in 2004 attending the graduation of their eldest son, Rudolph from Oxford University. Photo from private archive.

What do you do in your spare time?

I spend it with my family – my wife, my sons and grandchildren. When I have time, I listen to the music of my youth. It takes me back to the 1950s. Nostalgia …

Some facts about Arnis Eņģelis

• In 2013, he was awarded the Andrejs Priedkalns award for his contribution to the development of paediatric surgery.

• Author of more than 100 scientific publications.

• Author and co-author of many books and brochures.

• Family is the most important thing in life – your wife, children, grandchildren, your children’s families.

• Hates paperwork, but “there is more and more of it.”

• Prof. Arnis Eņģelis does many things at the last minute. “Motivation is at its highest then. There is never enough time.“