Conversation with John Sciarra, MD on ISGE, FIGO, maternal mortality and his life and work

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Dr. Daniell: "It's my great honor to be here in Montreal to have the chance to interview for OBGYN.net one of the real pioneers in women's health care, one of my heroes and now my good friend, Dr Jack Sciarra. He's always busy; you are returning to the place of your greatest triumph, because Montreal was where you were the President for the ISGE. That was a real zoo; this time you can walk around real nicely. Give us your recent memory of how it was to run the meeting here in Montreal when you had 10,000 people."

Dr. Sciarra: "Montreal in 1994 was the FIGO World Congress, and at that time I had the privilege of serving as president. We had no idea when we set the meeting up - since we planned for 6,000 people - that we would have the large turn out that we had. So it was a nice problem to have, but it really made the meeting much more complex. My involvement, of course, as president was more political than educational or scientific; my main job at that meeting was to keep everybody else doing the things that they were suppose to do. Fortunately, everyone did everything beautifully and it turned out to be a wonderful meeting, but you're right, it was a much larger show than this one."

Dr. Daniell: "We know the ISGE is very, very lucky because we've been able to recruit you to be our incoming president. Do you think that you'll have 10,000 physicians at the ISGE meeting in Chicago in 2001? That would really say something for your skills to take it from 1/2 of 1,000 to 10,000."

Dr. Sciarra: "But Jim, that's not our goal. Obviously the ISGE, which is a specialty-oriented organization, has totally different goals and objectives than FIGO. So I think that what we would like to do in Chicago is to have a quality meeting - a first class scientific meeting - that would showcase the state of the art of gynecologic endoscopy at that time. My guess is we'll probably have about 500 people; if we have more, then that would be a great success but our target is around 500."

Dr. Daniell: "Many of you who may not be familiar with Professor Sciarra's background should know that he has three offices. This is true - you have three offices in your department or in your domain in Chicago, and he stands up behind his desk and goes from office to office. Tell us how you get everything done through the day, it's amazing."

Dr. Sciarra: "I think that's fair, but lots of people have more than one office. I happen to serve as Chairman of the Department of Obstetrics and Gynecology at Northwestern, and also as Head of Obstetrics and Gynecology at Northwestern Memorial Hospital. These are two separate but interlocking organizations and I divide my time - actually my academic time - between them. Then we also have a faculty group practice, and I have an office there where I also have the office of the International Journal of Gynecology and Obstetrics. But they're all close and they're all within walking distance. I think it makes it relatively easy to migrate back and forth between them."

Dr. Daniell: "In addition to the work you've done on behalf of the women in Chicago, you've done tremendous work in third world countries. Would you fill in the people who've logged on to look at this on your reason or goal that you embrace; what you have done in third world countries, and fill everybody in on what you've done in Africa particularly, and also all around the world for women."

Dr. Sciarra: "My main interest when I was with FIGO, and that started in the mid-1980's, was to enhance everyone's understanding of maternal mortality, to try to move forward the safe motherhood initiative that had been introduced by the World Health Organization. FIGO was a strong supporter of that; I think it's a well-known fact now that every year there are over 500,000 women that die in childbirth around the world and 97-98% of those maternal deaths are in developing countries. As we've tried to move this initiative forward, we also individually became involved in different projects. The area that I felt was most important, at least from my involvement, was in the training of obstetricians and gynecologists in the third world. We were fortunate in the late 1980's to have a sizable grant from the Carnegie Corporation in New York to develop a training program using indigenous resources in West Africa, and the country that we were working in was Guyana. We had two teaching hospitals there in A-cron and Ka-moss-ee (Kamakusa) where we developed a residency program based on the U.S. and the U.K. model. The reason for this was that for many years prior to our involvement - prior to the 1980's - the Guyanan physicians were sent abroad by the government to have specialty training in obstetrics and gynecology in the United States or in the United Kingdom or in other countries, and the majority of them never came back to practice in Guyana. So we put forth the concept, with the help of the American College and the Royal College and a group of interested professionals led by a man who's now deceased - Thomas Elkins - to develop a training program using the local hospitals, but with imported talent for the teaching for the first few years until such a time as individuals that were trained could then stay on and train others. It was a ten-year program; it began in the mid-80's and it's phasing out now - phasing out in terms of international support - but the program has been eminently successful and showing as a pilot project what could be done in a under served situation with a proper plan and with the help from the developed world. So I spent a fair amount of time during those ten years in West Africa being a part of this program. I think that sort of sums it up."

Dr. Daniell: "You had a lot of physicians spend a little time in Chicago, and some of those you were instrumental in making or encouraging to go back to West Africa and not stay in America, I understand."

Dr. Sciarra: "Right, as part of this program we had Guyanan physicians who were training in obstetrics and gynecology come for short periods of time to either the United States or to the United Kingdom for what would be considered specialty or subspecialty rotations. I was also fortunate in having one of the native Guyanan physicians who'd come to Chicago for training, want to go back to Guyana, and was also a part of this program on the local scene. I think that was a great help also in making it a success."

Dr. Daniell: "In addition to the work you've done for the women of the world, I think from my personal experience from reading the Journal of FIGO, you've really turned that into a very obscure journal that really nobody read, to something that, I think, is very important as making statements and communicating good common sense information to people around the world. Say a few words about your role with that journal, and your thoughts about what that effect has had on communication between Ob-Gyn's around the world."

Dr. Sciarra: "The International Journal has always been the official journal of FIGO, and it was started over thirty years ago. I became the editor in the mid-80's and at that time we tried to outline a mission for the journal, which was actually twofold - to publish articles from developing countries, particularly from those countries that did not have an ob-gyn journal of their own; and secondly, to publish articles from developed countries that would have relevance in the developing world. As part of this, we made an agreement or understanding with the American College of Obstetricians and Gynecologists to allow us to publish their educational bulletins and other material from ACOG that would, in our opinion, facilitate and enhance the practice in other countries. The third thing that we introduced, which I think was helpful, was a literature review whereby every month we reviewed a large number of internationally oriented journals and selected abstracts that we thought would be of interest to people in the developing world. Our journal is primarily a library-based journal with about 500 of our subscriptions in libraries in over 100 countries. We hope that by having a library focus, it will allow more than one reader to benefit from each issue. The publisher estimates that with library subscriptions, each issue reaches ten people rather than one person in a personal subscription."

Dr. Daniell: "Right, in those countries those people can't afford a journal, and it's probably very difficult distribution systems. It's interesting that you, I think, are responsible for probably one of the most important journals worldwide that gets out to the hands and to the minds of some people that otherwise have had no access. But on the other hand, you also publish, at least Ob-Gyn's heaviest journal, which is the six volume gynecology obstetrics. Where are you going with that over the next decade? There's so much new information just in endoscopy here at this meeting, but other areas of medicine as well. How do you keep making that current? Because you do, you have so far; I guess the secret is in what you'll tell us here."

Dr. Sciarra: "Right, that's a totally different production as you know. The loose-leaf series was begun now over fifty years ago, and I became the editor in the 1970's. At that time, we decided that the approach would be along subspecialty lines so that the six volumes are actually divided quite nicely among the various subspecialties that are disciplined, and each of the volumes has one or more associate editors. The concept is loose-leaf that we would replace about 10% of the series every year, and of course, add new material as it becomes relevant to clinical practice, which you know is not only endoscopy but it's every other area as well. And so, what we do at the beginning of each editorial year is we go through the whole series, myself and the associate editors, and decide on material that has to updated or changed, and what void areas have to be filled in that year. At that point, it becomes a solicitation process to search out and find the best person to write the chapter or to revise the chapter, encourage them to do it in a timely fashion, get the material in, edit it, assemble it, and send it off to the publisher so that it can be distributed in the spring of every year as a series of loose-leaf pages to be inserted into the set. It's worked reasonably well up until the present time, however, as you know the world is changing, and for the past two years now we've had a CD-ROM version which has proved to be quite popular particularly among our younger subscribers. Hopefully, we will continue with the electronic format one way or another for those people that wish to use the material in that fashion. The interesting thing that we've been able to do with the electronic format is that we have 21 journals that we have been able to abstract and include with our regular printed material so that, for example, if you are reading a chapter on laparoscopic sterilization and you want to see all of the references that have come out in the Green Journal, the Gray Journal, and Lancet - the British journal in the past five years, that material is also on CD-ROM. So it's a little added feature that we've been able to move into the electronic version, and we've been able to use some video clips, some 9-second video clips as well, and a lot more color in the electronic version. So, it's been an exciting change actually."

Dr. Daniell: "Certainly the people that are seeing this interview are going to be the one's that are most knowledgeable and up-to-date because on OBGYN.net of course, you're getting the computer users in the world. There are many, many people in the world that don't have access to the opportunity to come to a meeting like this and hear the presentations or to even come to FIGO, so through electronic information transfer it now becomes possible for you to sit and people who don't know you have a chance to hear you talk. For those who don't know that much about Dr. Sciarra, you should know that he became chairman when he was just a child, 36-years-old. He was appointed chairman in Minnesota, stayed there for six years and made an interesting career move, he actually moved to Chicago to become chairman and director of a hospital that wasn't even completed yet. Isn't that right? Being built, right?"

Dr. Sciarra: "That's right."

Dr. Daniell: "He's been there for 25 years, the President of the Central Association of Ob-Gyn America - which is a very prestigious organization, President of FIGO - which is the most prestigious world wide organization, and now is the President-Elect of the International Society for Gynecologic Endoscopy. He's had many great achievements and has been a quiet man. And I've never seen you raise your voice or be irritable toward anybody and you lead by example. I think you've been a great example to a whole generation of physicians and not just in North America but also around the world. I personally congratulate you on your career and for being a great role model to many. I sound like Larry King now."

Dr. Sciarra: "You certainly do."

Dr. Daniell: "Of all your accomplishments besides driving your Corvette very fast - what are you most proud of what you've done?"

Dr. Sciarra: "I think the thing that I'm most proud of are the people that I've had occasion to have with me in my department, not only at the student level and the resident level but also my colleagues, many of whom have gone on to meaningful academic positions at other institutions. I think that this is a legacy that will continue to educate generations of future obstetricians and gynecologists."

Dr. Daniell: "That's interesting because a very famous Nashville physician who died recently, Dr. Thomas Frist, Jr., who founded the world's largest hospital corporation - HCA said, "Good people beget good people." I think what you've done in your career has been a good example of that, so on behalf of those who trained in America, I say thank you, and half of those people around the world who have met you thank you. You're still a young man and a lot of miles to go; with your ability to juggle so many balls, I'm sure you'll have a lot more things going. Speaking on behalf of the people who have enticed you to become a leader in the ISGE, we thank you for taking us into the next millennium, and we look forward to being in Chicago with you. So thanks so much for taking time out to meet with us, and thank you OBGYN.net for letting us do this interview with a leader in Ob-Gyn and in the world today."

Dr. Sciarra: "Thanks Jim, and we invite everyone to Chicago in the year 2001 - I think it will be an excellent and exciting meeting."

Dr. Daniell: "Great, thank you very much."

Dr. Sciarra: "You're welcome."