A passion for pathology

Iraq-born Ibrahim Zardawi has a passion for pathology and a desire to see the discipline flourish, particularly in regional areas where the challenges of working alone are balanced by the ability to do a lot of good.

The shortage of regional pathologists and the centralisation of coronial autopsies in New South Wales are causing a vacuum in medical students’ education, says Professor Ibrahim Zardawi.

Professor Zardawi, now with Laverty Pathology in Port Macquarie and a conjoint/honorary professor at four universities, including the University of Newcastle’s School of Medicine and Public Health and the University of New South Wales, said that is practically significant, in view of the fact that the hospital autopsy has all but disappeared.

“All coronial work is being centralised to Sydney or Newcastle”, Professor Zardawi told the MJA.

“The hospital autopsy is almost non-existent now and the rare autopsies that are being performed belong to the perinatal group, which can be very complex and regional hospitals are not appropriately equipped to do these postmortem examinations.

“Autopsies are important tools in teaching anatomy and pathology, as these disciplines do not feature strongly in medical courses these days.

“At an educational level that is a loss, but at a clinical level it is a loss as well, because no matter how much you investigate [using other means] you don’t always know the whole truth of the matter.”

Professor Zardawi’s passion for pathology began early. As a third-year student in Baghdad in his home country of Iraq, he was fascinated by the discipline.

“I was so impressed with anatomical pathology as an undergraduate in about 1970 that I thought that pathology was for me, and I never really changed my mind about that”, he said.

“I found during my one-year internship that I had too much empathy. In those days, most of the children I saw with cancer or renal disease would die and it was very hard for me to deal with.

“I decided that if I could remove myself from that situation and instead help other doctors who have the temperament to deal with it, then that was what I would do.”

Professor Zardawi left Iraq at the height of the civil war in the late 70s, and worked at the University of Leicester in England until he immigrated to Australia, arriving on 26 January, 1983.

He sees teaching and mentoring students and junior doctors as his “duty”.

“It is important to expose medical students to pathology to see if it is for them”, he says.

“For some of my residents it has been a real eye-opener and some of them are now in training pathology programs. Some of my former students took up pathology and are now prominent and successful pathologists because I believe I motivated them to go into the field.

“We need to make pathology a living, relevant science to clinical practice.”

Professor Zardawi said pathologists practising in regional areas faced some unique challenges which were contributing to the current shortage.

“Working in the regions is very rewarding but it can be very challenging as well”, he said.

“You have to be an all-rounder because very often you are working solo and doing procedures that city pathologists don’t have to do — like bone marrow biopsies and blood gases, for example.

“You need to know your stuff because you are everything to everybody.”

Professor Zardawi said sending new graduates to the regions may not be the best solution to the shortage.

“You can’t send someone who has just qualified”, he maintained.

“A regional pathologist has to be self-reliant and independent. In many ways you are a big fish in a small pond — a resource, not just for students and junior doctors, but also for your colleagues and other specialists in the region.

“On the other hand it is very rewarding because you can make a much bigger difference in a regional setting than in the city. You learn a lot, and you help a lot.”

Professor Zardawi has never regretted his decision to stick with anatomical pathology.

“I was good, near the top of my class as a medical student and I could have done any specialty I wanted”, he says. “My mentors were disappointed I chose pathology — in those days it was quite frowned on and was not high profile at all.

“Even my mother said ‘I thought you were going to be a doctor’. I told her I am a doctor, I still wear a white coat, I just don’t need a stethoscope.”