SNA Interview: Seychelles' first specialist paediatric surgeon

Fanny, who received his final results in June, is presently working at the Seychelles Hospital. (Marvin Fanny)

(Seychelles News Agency) - Marvin Fanny became Seychelles' first specialist paediatric surgeon after he completed a fellowship from the College of Medicine of South Africa and a master of medicine in paediatric surgery with the University of Pretoria.

Fanny, who received his final results in June, is presently working at the Seychelles Hospital.

SNA met up with Fanny to learn more about his area of specialisation.

SNA: Tell us a little bit about yourself and how you came to become a paediatric surgeon?

MF: I am 41 years old and I grew up at La Louise though I currently reside at Bel Ombre. I wanted to become a doctor since I was 10 years old and all the studies I did led me towards this goal. I went to study in the twinning programme at the Malaka Manipal Medical College, which falls under the Manipal University of India. I did my clinical and internship in Malaysia for two years.

I came back to Seychelles in November 2009 and started work in January 2010 as a senior medical officer. When I came back, general surgery was in dire need of doctors - there were only two consultants running the unit so I went straight to the unit. At that time I already knew that I wanted to do my specialisation.

I wanted to become a general surgeon and applied to different countries among which was Malaysia. When I completed my internship, they offered me a three-year contract, saying that I would get the chance to specialise.

Specialisation is quite difficult and at the same time, there isn't that much post for training. I was told that I would have to wait for three to six years before I could get the opportunity to do general surgery. I tried South Africa based on the advice I got and Cape Town and Pretoria told me that for general surgery it is the same thing but they needed a registrar - a specialist in training - at the department of paediatric surgery. I applied for it as I didn't know if I would get general surgery. In 2013, l Ieft Seychelles and started my studies, and came back in 2019.

SNA: What is a paediatric surgeon and what is the age of your patients?

MF: Paediatric surgeon is basically a surgeon for children from birth but the limit depends on the country or the hospital. Where I was doing my specialisation, we went up to 12 years. In Seychelles, there isn't really an age limit as the specialty did not exist.

What makes the limit 12 years in Seychelles is because this is the maximum age that a child will be admitted to the paediatric ward. This does not however mean that I cannot operate on a 17-year-old or even an adult, because the principle of surgery is the same. It is just that certain technicalities and conditions that children present with are different from what an adult would. You need the skills to deal with such conditions. For example, if you take a neonate - children from zero to one month, they usually present with a congenital condition, defects that happened during development.

SNA: What is the condition that you have seen the most during your journey at the moment?

MF: The most common condition among children is hernia - either in the umbilical or in the groin area. Any paediatric surgeon will tell you that this is a surgery that they perform the most. It is the same for Seychelles. Let's look at umbilical hernia. During the development of a baby, the intestine is outside of the belly.  At around 12 months, the intestine goes back in and the hole is closed. At times, this hole does not close completely, which causes the belly button to bulge - either the intestine or the police of the abdomen goes through the hole, causing the belly button to bulge.

SNA: How common is surgery on children here in Seychelles?

MF: It is difficult to say how common it is because we haven't been fully operational since I got back and this is due to COVID-19. We were only doing emergencies and weren't running our outpatient clinic. This is not the norm. Right now, I am trying to deal with my backlog, where I am looking at a case or two each week. If I feel that, even though my case is not an emergency, but it is urgent, I have a discussion with the director of the hospital outlining the reasons why I need to do the surgery. So far, I have had the chance to do surgery on all my patients. 

SNA: What would you say are some of the biggest challenges in the field, since getting back to Seychelles?

MF: I would love to get more theatre time, which is not really easy because we are running only three theatre rooms and there are different specialties that carry out surgeries. So far, I do that once a month on a Friday, but I do also book patients every Thursday. 

SNA: Aside from when you are in the theatre, what is a typical day at work for you like?

MF: When I am not in the theatre, I run my clinic on Monday afternoon. I do my rounds, meeting patients on the ward. There are days that I am on call, where I basically work for 16 to 24 hours. Then there are days that I continue with my learning, linking up with my colleagues in Pretoria and Johannesburg, South Africa. 

Fanny said he would like to have more theatre time. (Marvin Fanny) Photo License: All Rights Reserved

SNA: During your training and here in Seychelles, what is the most challenging case that you had to work on?

MF:  There has been a lot of challenging cases, but one of the most challenging was a case where the child presented with a kidney tumour. The tumour was so advanced that it had almost taken over the whole abdomen. All of the internal structures were stuck to it and I had to separate them. That was quite challenging and I remember I had to call in my professor to come in and help complete the surgery.

Good doctors should know our limits. There aren't any heroes and as such if you feel that you cannot do something, you call in the person who has more experience than you. There have been instances when I had to refuse a case. There are certain surgeries that I do not have experience in even if I saw the procedure being done. Due to the fact that they are rare cases, I didn't get the chance to do them myself. In circumstances where I feel that the patient will not get the best outcome in my hands, I inform the ministry that in that case, it is advisable that someone with more experience or based in a specialized centre carries it out. At the end of the day, you need to give your patient the best care and this is part of it.

SNA: What benefits do you bring to Seychelles with being a paediatric surgeon?

MF: In the first place they have a person who knows surgical conditions in children on another level and this helps to better identify cases, and better manage them. This is a benefit for parents and children. There is also the cost-benefit for the country. to send a child for treatment overseas costs a lot. Other than the treatment itself, there is the need to pay for flights, accommodation, for both the child and a parent. It saves the country a lot of money. Before I came back, they were sending children to Reunion, India, and Abu Dhabi for treatment.

SNA: What are your expectations and plans for the future?

MF: I would like to see an improvement in the service that we offer. To achieve this we need human resources, equipment, and support. In regards to my plans, I currently find myself in a dilemma where it is good that I am in Seychelles helping children, but the fact that we are a small population, the number, and variety of cases I see is not the same as I would have in South Africa. This in itself is a bit depressing as you are not doing the amount of work that you should be doing. This is a constraint in a way. Should I work in another country for a said period of time during the year, and come work in Seychelles for another period of time? This is not an arrangement that the ministry considers usually. I will need to make a decision on this but for now, I will be in Seychelles.

SNA: Any last comments?

MF: I would like to encourage parents to observe their child and should they see any issue, they need to seek medical help. The most important thing is to ask questions. There are many people who go to the doctor but they do not ask what they are suffering from. It is the obligation of the doctor or physician to explain what you have but if the person doesn't it is your right to ask.