‘We are all spine surgeons’
INTERVIEW WITH ANEELA DARBAR
AO Spine Pakistan Council member Aneela Darbar chose neurosurgery and trained in the US at a time when sending your daughters abroad alone was unheard of in her home country. She tackled taboos and glass ceilings and became the first US-trained female neurosurgeon in Pakistan. Today, she is a sought-after international speaker who has given more than 100 talks on neurosurgery and on empowering women.
Here, Darbar explains what drives her and sends a strong message to aspiring spine surgeons as well as AO Spine.
Why did you choose neurosurgery?
I was always fascinated with the brain, intrigued by how the left half of the brain controlled the right half of body, and especially how the brain and the eyes function! We see everything upside down and mirror image. From early on, these questions gravitated me towards the brain and neurosciences.
I was fortunate to do my initial medical residency training in the early 2000s in a hospital which had a superb neurosurgical training program. It helped me to clarify my vision to pursue neurosurgery. During my sixth year of training, a very dynamic spine surgeon joined our hospital. I spent an entire year doing spine surgeries with him. He helped me learn different procedures and complicated scoliosis surgeries. Although my fellowship was in brain surgical procedures, spine has always been a big part of my practice.
AO Spine is the one platform where I feel that ortho and neuro come together and strive for the best. I feel no discrimination.
How did you find AO Spine?
I got involved through the local spine chapter, Dr Amir Aziz, and the fellows. I attended an AO Spine course and really liked it. Next, they invited me to become faculty. I realized that I really enjoyed teaching and being part of AO Spine. Then the country council position for neuro was announced, and the rest is history!
The way AO Spine has designed the local chapters and given them responsibility to run courses—both local and international—with world renowned faculty is very special. The AO faculty are willing to come to low- and middle-income countries and teach. This is a commendable thing that AO Spine started.
We are role models for the next generations in what they can become.
In many parts of the world, including Pakistan, there remains a tussle about whether orthopedics or neurosurgery should do the spine surgery. I just think the best people should do it. AO Spine is the one platform where I feel that ortho and neuro come together and strive for the best. I feel no discrimination between ortho and neuro in AO Spine—we are all spine surgeons. That is what attracts me to AO Spine.
Who have been the biggest influencers in your career?
You only become successful by standing on the shoulders of giants. There is no way you can be somebody unless you have people in your life to support you.
My initial big support, of course, comes from my father who believed in me. I come from a conservative Pakistani family and sending girls abroad on their own to study was unheard of. But my father trusted me, believed in me, and supported me both emotionally and financially.
You only become successful by standing on the shoulders of giants.
In those days only 1.5 percent of United States neurosurgeons were female, and this was another glass ceiling to conquer. I am thankful to Dr Charles Hodge for giving me the opportunity. He didn't think of me as a female or a Pakistani. He just saw that this girl has the passion. Otherwise I would not be here today.
During my residency, I had another mentor, Dr James Holsapple, who has supported me throughout my neurosurgical career, and during my fellowships I found Dr Charlie Teo from Sydney, Australia, and Dr Saleem Abdulrauf from Saint Louis, Missouri. They all helped me become a better neurosurgeon.
Health care technologies are advancing rapidly. How is this affecting your work?
I think technology helps a lot, using navigation to put in screws or computed tomography scans in the operating theaters. And minimally invasive spine surgery (MISS) has changed people’s notions of spine surgery. People used to be afraid something would happen to their legs, the scar would be huge, they'd be left with never-ending back pain, or be paralyzed. Due to new technologies, we have much smaller incisions, shorter operation times, and less hospitalization. I feel patients are more comfortable and the entire perception has changed. Now, when you say, "Let's do spine surgery," people react in the same way as if you were talking of an appendix or hernia operation.
The other thing that has changed, and what COVID-19 has highlighted even more, is teleconsultation. I had experience with this when I worked in Saint Louis and we directed a surgeon in Rome through surgery. A specialized surgeon can help another surgeon with surgical procedures even in another country. This is also something AO could pick up: Anywhere there is a lack of good surgeons, they could help with teleoperations.
What are the biggest challenges for spine surgery in Pakistan?
Spine surgery in Pakistan is not standardized. Big private hospitals have most of the instruments needed and hire surgeons trained in the United States, United Kingdom, or Australia. You will be able to do surgery by international standards. In public hospitals, unfortunately, it's a different story. You can count with your fingers the hospitals where you would want to refer your relatives or friends.
I am trying to set up this hospital with high quality standards and ethical practice at a low price.
There is no national health care system, and people pay out of their own pockets. It is the saddest thing, when almost 90 percent of the population lives below poverty line. These people will sell their houses, or sometimes, to save one child, they would sell their other children to pay the hospital bills.
What is your next goal?
I recently took a new job in Multan, and I am the medical director of a newly built hospital. I am trying to set up this hospital with high quality standards and ethical practice at a low price. I aim to set up this hospital with the same quality and standards as my hospital in Karachi.
