Science

UMCG surgeon sacrifices holidays

Pro bono in Paramaribo

During his holidays, UMCG surgeon Robert Porte travels to Paramaribo to perform free surgeries on poor Surinam patients. ‘This is why I became a doctor.’
By Thereza Langeler / Photography by Reyer Boxem / Translation by Sarah van Steenderen

Robert Porte is a surgeon at UMCG. He operates on the liver, bile ducts and the pancreas. It is a complex area of medicine, and the surgeries take a long time.

In 2012, Porte took a sabbatical in Surinam. He had been longing to work in the tropics for a while and was fond of Surinam.

Due to a lack of expertise and manpower, complex surgeries cannot be performed in the Academic Hospital in Paramaribo. But these are exactly the kinds of surgeries that Porte can perform.

He goes back to Surinam several times a year to operate. He does not want to be paid for it. ‘These people’s gratitude is pay enough for me’, he says.

The long waiting lists that transplant patients in particular face frustrate Porte. He argues for better information concerning organ donation: there are too many horror stories making the rounds currently.

Sometimes Porte fantasises about starting his own clinic in Surinam. ‘Maybe I’ll go after I retire, who knows?’

Reading time: 8 minutes (1,311 words)

In a hospital in Paramaribo, a Creole woman is waiting. She lives in the inlands of Surinam. Months ago, she found herself in this same hospital, about to be operated on by a Dutch surgeon. And now that Dutch surgeon has come again. The moment she sees him she runs up to him, overjoyed. ‘Doctor, doctor! Do you remember me?’

Back in his own office in Groningen, Robert Porte smiles warmly as he talks about her. ‘This woman had come all the way from her village to the city, just to see me. That’s a journey that takes hours. Just because she wanted to thank me for her surgery.’

No fee

Porte is head of Hepatopancreaticobiliary (HPB) Surgery at the UMCG. He often swaps Groningen for Paramaribo and operates on people such as the Creole woman mentioned above – pro bono. ‘Poor Surinamese do not have to pay my fee.’

He specialises in the right side of the peritoneal cavity: he operates on the liver, pancreas and the bile ducts. Most of his patients have some form of cancer, but Porte also performs liver transplants. As far as he is concerned, there is no doubt about it: the right peritoneal cavity is ‘the greatest area in surgery’.

‘Technically and anatomically it presents a great challenge, and I love that’, he explains. ‘Colon surgery or a hernia: those are kind of routine. HPB operations are a lot more dynamic and difficult. They’re longer, too: they can last up to seven or eight hours.’

Fixing up organs

Moreover, his surgical field is still growing. ‘We’re always working on the frontiers of medicine. There are still so many problems that research needs to find a solution to.’ Research such as this has yielded results such as the organ perfusion chamber, where donated organs can be ‘fixed up’. Porte talked about it in De Wereld Draait Door last year.

But how does a surgeon from Groningen end up in Paramaribo? ‘There were two things that I’ve always wanted to do’, says Porte. ‘Working in the tropics, and sailing. I grew up in Rotterdam, close to the Nieuwe Waterweg. As a small boy, I used to watch the container ships that sailed by and I would fantasise about where they were going.’

In love with Surinam

Porte came to Surinam for the first time when he visited an old university friend who lived there. It was love at first sight for him and the country. ‘The tropical weather, the tropical pace. The amazing food. All the nice people. Surinam is a real melting pot, but the people exist so harmoniously. In Paramaribo, a synagogue and a mosque stand side by side. They sometimes have festivals together.’

In all of Surinam, there are only ten surgeons

A sabbatical in 2012 was Porte’s chance to make two dreams come true simultaneously. He could work at the Academic Hospital in Paramaribo for a few months. ‘And to top it off, I found out that there is a shipping company in Groningen that sails cargo ships from Rotterdam to Paramaribo every other week. So I called the director and explained the entire story to him. And the guy said, ‘You know what, we’re not really supposed to take passengers, but we’ll work something out.’ Eventually they listed me as ‘crew’.‘

Porte embarked from the same harbour from which he used to longingly stare at the ships leaving, now on his way to working in his beloved tropical Surinam. The country turned out to be in great need of him.

Long term

‘In all of Surinam, there are only ten surgeons working. But there are half a million inhabitants’, Porte calculates. ‘And the surgeons that do exist are lacking certain expertise.’ Operating on the liver and pancreas is impossible. These are operations that have been performed in the Netherlands for years – operations that Porte is an expert in.

‘This is why I became a doctor’, Porte says about his work in Paramaribo. ‘The thing I excel at is exactly the thing that wasn’t happening over there! I remember operating on a young woman and realising afterwards: if I hadn’t been there, she wouldn’t be here anymore, either.’

We need a structural solution

Ever since that sabbatical, Porte has returned to Paramaribo a few times each year. He alternates visits with his colleague Marieke de Boer. They do varied work, from the outpatient clinic to the operating theatre. And they have begun training local surgeons ‘for the long term.’ ‘It’s nice that we operate on people every once in a while, but there needs to be a structural solution.’

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The weeks in Surinam are deducted from his own vacation time. He never asked to be paid a dime for it, and refuses to now. ‘I don’t need it. My work in Groningen pays really well. The gratitude of those people and being able to help them is pay enough for me.’

New donor law

Porte sometimes misses that feeling of having meaning in the Netherlands. The lack of staff and money and the administrative fuss are often a pain. ‘If someone comes to me with a tumour and I have to tell them that I only have a spot for them in two months, I really hate that. Imagine having to wait two months, knowing you’re incredibly ill! It’s inhumane.’

We’re so used to everything being fixable that we can’t even accept death anymore

And two months is nothing compared to the years patients sometimes have to wait for a donor organ. The cause of the endless waiting lists is known: there are simply too few donors. The solution, however, is less simple. For instance, Porte is not holding his breath when it comes to an active donor registration (ADR) system, where people have to say that they do not want to be a donor rather than the other way around.

‘At first I thought: it certainly can’t get any worse’, he says. ‘A few other European countries already have this ADR system, and they do have more donors than the Netherlands. But when I see how vehemently people reacted on social media…’ Porte fears that the controversial law might have the opposite effect, if it is indeed passed. ‘Existing donors might withdraw their registration in protest, because they think that the government owns their organs.’

Porte cannot hide his scorn. ‘DWDD has these classes sometimes, where someone talks about a particular subject for about half an hour. When I was on the show last year, I asked Matthijs van Nieuwkerk if I could do one of those classes to talk about organ donation. I would quash all the prejudices and horror stories in that half hour.’

Learning from Surinam

He believes that those horror stories are the biggest reason that people are hesitant to donate their organs. ‘They come up with the craziest things, like the doctor might try less hard to keep you alive if they know you’re a donor, for instance. Complete nonsense.’

In some ways, he feels that Dutch patients can learn a thing or two from Surinam patients. ‘I once had a patient with liver cancer. I examined him, but it was too late. The cancer was inoperable. You know what he said when I told him? “Thank you, doctor. Now I can go home and die in peace.” A Dutch person would have demanded a second opinion. We’re so used to everything being fixable that we can’t even accept death anymore.’

If it were not for responsibilities keeping him in the country, Porte would just as easily trade the Netherlands for Surinam indefinitely. ‘I would start my own outpatient clinic in the inland and just be a simple, hands-on doctor. Although I might start to miss the CT scans’, he muses. With a smile, he adds: ‘Maybe I’ll go after I retire, who knows?’

Nederlands

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