Isaac Azzopardi meets Prof. Kevin Cassar

You are credited with revolutionising the management of arterial problems. What drove you to make these changes?

Vascular surgery emerged due to two main factors: advances in endovascular techniques and advances in technology, notably ultrasound, both of which required new skill sets.

I returned from Scotland in 2007, where I had been working as Consultant Vascular Surgeon and since I was the only vascular surgeon in Malta I was able to focus on implementing these developments, which led to drastic improvements. New minimally invasive procedures and new technology meant less risks for the patient, increased treatment options and ultimately a higher rate of success. A telling statistic is that locally, major amputations have gone down from an average of 130 a year to a little over 50 last year.

Can you tell me something about the setting up of the vascular lab?

I remember having to borrow the ultrasound machines from the X-Ray department at St Luke’s to conduct my work after hours, but as the vascular workload increased the need for dedicated vascular sonographers became more pressing.

In 2011, we introduced the Masters in Vascular Ultrasonography in collaboration with the University of Malta, which helped attract qualified radiographers to train in this field. On completion of their training the vascular lab was set up. This is now well-established and well-equipped with high quality ultrasound scanners and excellent sonographers. The lab offers vascular ultrasonography services covering carotid, aortic, venous and peripheral arterial scans. The lab also provides bypass graft surveillance and aneurysm surveillance programmes.

Today, along with my consultant colleagues Dr Pejkić and Dr Petrovic, we provide a comprehensive vascular service to the whole country.

What can you tell me about the foundation programme?

Led by Dr Tonio Piscopo and myself, the programme was launched in 2008. After reaching an agreement with the UK Foundation Programme Office we now have an affiliation to offer the same training programme in Malta and it is recognised as equivalent to that in the UK. As a result of this programme we have managed to retain the vast majority of local graduates allowing them to contribute to the local health service while receiving high quality training.

The Foundation Programme was introduced to tackle the brain drain that reached a peak between 2005 and 2007, but equally important to improve the quality of training. The Programme itself has brought about a lot of changes, but at its heart, it helped cultivate a culture of training and assessment where consultants and senior doctors contribute significantly to the training of junior doctors. I am sure that this culture change has contributed significantly to the whole of the health service.

The number of doctors who choose to join the Malta foundation programme and work in our health service after graduation has increased substantially, and the programme now also attracts foreign doctors. The foundation training inculcates in our trainees the concept of lifelong learning – an essential mindset in this day and age, where medicine is constantly changing. I believe that this is the best way of ensuring that doctors continue to develop their skills and competences to be able to provide the best care to our patients.

Can you tell us something about your schedule?

My alarm goes at 5:15am. I do 15 minutes of exercise, and try to get to work by 6:30am. Since we are only three vascular surgeons, we are on 24/7 call on a 1:3 basis.

On theatre days we often work till about 7 or 8pm, and try to use all our disposable time … the truth is that I spend a lot of my time here, at the hospital – between my work with the Foundation Programme, surgery and other activities. So, yes, I would like to take some time off for other interests.

I have three children, all of whom are now teenagers. Obviously I would like to dedicate more time with them, but given the nature of my work, sometimes it’s not possible.

An activity which I enjoy is running, and although I don’t run very often, I try to run a half-marathon at least once a week, usually early on a Sunday. I think it’s a very important part of my routine, as I believe that as doctors we need to keep healthy. It’s a little difficult to give advice to someone about their health, when you’re living an unhealthy lifestyle.

What do you think about The Synapse?

I think The Synapse has become an institution in Malta. Every doctor knows The Synapse and the huge efforts made towards creating its content; The Synapse was very helpful to us to develop e-learning modules for the Foundation Programme. It is unique in that it has Dr Wilfred Galea who is full of energy and enthusiasm, with a lot of new ideas. So I believe it’s good that first of all, people in the profession make use of the resources offered by The Synapse and secondly, that as Maltese professionals we should appreciate the importance of having a resource that is local and addresses local issues.