News Report / Profile
António Gentil Martins – a morning walk.
Forty-one years ago he separated two Siamese babies for the first time. However, it wasn't the first time the country was waiting to know whether the Siamese twins he operated on would survive. Specialised in Plastic Surgery and Paediatric Surgery, as well as Paediatric Oncology, he combines surgical and oncological knowledge. He comes from a family of great doctors, it is in his genes. The grandson of Francisco Gentil, surgeon and founder of the Portuguese Institute of Oncology (IPO), his father António Augusto da Silva Martins, also a surgeon, died too young, when he was only 3 months old. Today António Gentil Martins is 88 and every day he goes to the IPO, a house which is like a family calling.
The IPO, also known as "Cancer Institute", was established due to the need for a specialised centre dedicated to cancer, an illness that grew more and more and whose results were worrying.
In 1934 his grandfather Gentil was already saying at conferences that "the patient was King", asserting that the patient was the most important aspect for any good Health professional. The grandson Gentil Martins tells a short story: Professor Gentil was visiting the hospital wards and asking who had recommended a certain patient, as at the time all of them were recommended by somebody. However, there was one without any recommendation. Then Francisco Gentil said it loud and clear: "this patient is now recommended by the Director". He followed the rule of good conduct that dictates that all patients are equally important, a behaviour he didn't only adopted himself, but also tried to pass on to others.
The first building in the world with radiation protection for professionals was built in the IPO, in accordance with the criteria established in the World Cancer Congress held in Stockholm. Even though the walls were thicker, they used barite instead of lead because the effect was the same, but it cost much less.
Francisco Gentil met Salazar while treating him for a femur fracture, admiring his serenity and courage in the cruellest stage of his illness, and their relationship turned into solid respect and friendship, despite him being a Republican. Since then they talked a lot and trusted each other, they had the opportunity to discuss the future of Healthcare in Portugal. These conversations were the cradle of the idea to create two university hospital centres - São João and Santa Maria - and to finally complete the Alfredo da Costa Maternity. His grandfather and Professor Gentil went on an official mission to see the best that was being done in Europe with regard to hospitals. After returning to Portugal and arranging everything with Oliveira Salazar, he met with the German architect Hermann Distel in 1938 and the construction of the Santa Maria Hospital began in 1940. It was also Distel who was responsible for the great IPO hospital pavilion.
As for him, Professor Francisco Gentil always defended the university hospital system, under the supervision of the Ministry of Education. It was only after his death that the IPO passed to the Ministry of Health.
His grandfather Gentil founded the Portuguese League Against Cancer", in order for society to step in when the State fails to do so". Years later, his grandsons Gentil Martins, Francisco, and later António became its Presidents. "The State can't always give everyone everything: tell the truth! We do the best we can with the available resources", he says remembering the basic principles he was taught.
Like his grandfather, he defends that Medicine cannot be like any other business and aim at making a profit but, nevertheless, it deserves fair compensation. It's cheaper to buy expensive if it's better, because in addition to benefiting from it from the beginning, it will last longer without the need for replacement. He also argues that hospitals should be managed by physicians, with help of competent administrators who take care of their financial balance. "Physicians, knowing the root of the problems, are better equipped to choose between priorities."
A Christian Democrat, he repeatedly makes it clear that he doesn't care about partisan colours, just knowing right from wrong. "Nowadays, a new government steps in and all that had been done before goes to waste. "If it was good, why not leave it? Why does it seem like we're constantly changing our minds?"
António Gentil Martins studied at the Faculty of Medicine of the University of Lisbon, still in Campo de Santana at the time. He was a member of the Student Association and its President in 1951/1952. He left behind 8 intensive years of violin, replacing them with Anatomy, which required him to study 12 or more hours every day. Even today he attends academic meetings and events at the Institution he once belonged to. In his time, he took part in performances imitating professors, he remembers one in which they were saying "neither Gentil is polite nor Pulido is gentle" (joking about the surnames of the most famous Full professors of Surgery and Medicine) and today he is in the audience for Medicine Night. He is critical about satire today, he thinks that society has lost its decorum and he doesn't refrain from saying it to anybody willing to listen. "I wouldn't like to see those attitudes in future Physicians".
Disciplined and rigorous, following a method instilled in his education and by his Father's example, he also qualified in shooting for the Olympic Games held in Rome in 1960 and he is currently the President of the Portuguese Olympic Athletes. He was also a national champion in volleyball and tennis (juniors - men doubles) and introduced badminton in Portugal. He was also recognized in the national rifle and battle rifle championships.
Like so many other events, he also attended the inauguration of the Aula Magna. I introduced myself asking him to meet me one day to tell me his story. Available, he immediately pulled out a paper folded in four where he had detailed his agenda, almost full until the end of the month. "Just please don't call me at 6 am, like a patient once did to schedule an appointment, because he had just left work... I always answer, but, if you can, please do it later".
Before our meeting today, we already talked a lot on the way out of the Aula Magna and that gave me some input about your way of thinking. Do you think we live in a falsely puritan society?
Prof. Gentil Martins: Nowadays, people don't have the courage to go against the tide because they will be accused of horrible things, of being fascists, xenophobes, and so on. Many unreasonable things are being justified, some people buy babies, others defend Euthanasia and medically assisted death, etc., etc.. I think we've lost the meaning of things. I think we live in a hypocritical society and that bothers me. We don't think about others any more, about solidarity, justice or common good, everyone thinks about themselves, money and power. There was a Minister of Education (surprisingly both before and after the revolution of April 25), Prof. Veiga Simão, who one day, in conversation, told me: "it's a pity that they destroyed God, Motherland and Family in the April Revolution; they just needed to add Freedom, which is the only thing we were missing". It's true that they added Freedom, but the rest ended, and they didn't even understand what freedom was.
You talked about "God, Homeland, Family". As for "Homeland and Family", your entire life shows answers to these causes, but maybe I fail to understand God. In all those surgeries you performed, when things were going well, did you ever wonder if it was your merit or whether God was helping you?
Prof. Gentil Martins: I never thought about that. I just wanted everything to go as smoothly as possible and it would bring me down when things didn't turn out for the best. I operated several Siamese twins, 41 years ago for the first time, but I would say that the hardest ones were those in Mozambique, who had been turned down in South Africa; it's been 19 years now. Nevertheless, the hardest surgery was the first one, because I didn't know what to hold onto. At the time I suffered and hesitated a lot. That operation lasted about 13 hours, but the following one, which was almost similar, took me half the time because I already knew how to do it. The Siamese twins from Mozambique were a tremendous case, because they were conjoined at the abdomen and hipbone. And the solutions we have as surgeons are limited by nature. Despite major difficulties, things turned out reasonably well but not entirely without problems, so I warned that, reaching puberty, they should be reassessed. Later I indicated several treatments that they didn't always receive, and I don't know how they're doing now, even though I tried to get in touch with the Official Health Services of Mozambique.
Do you know anything about your first Siamese twins?
Prof. Gentil Martins: They are doing great. There was a major news piece on them on the 40th anniversary of the surgery. They are just like you, they just have a huge scar on their stomach. You can survive if they take out your kidney or you are left with just fifth of your liver. It's the same when we have to cut out the intestine, what remains is enough. The only thing we can't do anything about is a shared heart. In that case, the heart is so badly formed that there are no chances of survival for either of them. Interestingly, there are more Siamese girls than boys, right? There are 5 girls for every boy, but we don't know why. On the other hand, nowadays Siamese twins are only born in countries with no prenatal ultrasounds, unlike in the countries we call civilised, where, incorrectly in my opinion, once the Siamese pregnancy is diagnosed, people choose an abortion.
Which leads us to abortion. I can see you're against it. Should we keep Siamese babies that are still in uterus?
Prof. Gentil Martins: Many Siamese twins can be separated and live normal lives. We should respect the natural evolution of the human being. Some time ago, a well-known endocrinologist said that there was never any doubt as to when human life starts, and that is when the ovum fuses with the spermatozoon. What gives rise to doubts is whether its value is equal to that of a child that is out on the world and growing normally. Now, my question is: who is more human? 9 months inside the mother's womb or 7 months here as a premature baby? Is one more human than the other? I would say definitely not! Look, once a baby is born, it will die if you don't feed it or take care of it. It cannot survive on its own and yet it is alive and a year away from talking and walking. Afterwards, in childhood and adolescence it also needs support and the same happens in old age. Human life is a continuum. The duty of the physician is only to help out in different stages of life.
And what if I, as a patient, asked you to help me take my life, wouldn't you help me?
Prof. Gentil Martins: I don't think that's the physician's role. I wouldn't do it. There is no toll defining where life starts and ends.
I would like to broach another topic and that is your position regarding how new students are being admitted to Medicine courses. I know you've actually tried suggesting a new proposal for admissions to several faculties in the field, but only two replied and only out of cordiality. What is the proposal you defend?
Prof. Gentil Martins: I don't have a solution, I presented a hypothesis. Some time ago, the Santa Maria Hospital tried evaluating the students before admission. Since there were thousands of applicants, there were dozens of jury panels carrying out preliminary assessments. The thing is that they didn't follow the same criteria and the process didn't work out. We never did it again. I don't know what the solution is, but I believe that vocation is crucial, as well as the desire to help others. We need people who like people and treat them well. Patients need to trust their doctors , even if they're not acclaimed professors. They need to be good human beings who always give their best. That is what patients want, someone who cares about them, who, besides being competent, gives them attention. That is why considering only a grade is a complete nonsense. I can be a brilliant student and have no sensitivity or education to deal with "Others". I know, obviously, that grades are important. But besides that, applicants need to show that they like to help other people and to dedicate themselves to them. There should be an admission test with a pre-defined and well-publicized program. More than 10 years ago, I suggested that the admission to medical schools should take into account whether the applicants had demonstrably been involved in some sort of social volunteering programs while they were in high school. It would be a mandatory prerequisite.
When we met you also told me "Guidelines aren't God's lines". Are you referring to that?
Prof. Gentil Martins: Precisely that, and it has a fantastic meaning! Guidelines are very helpful, but they're not enough. I fought a lot after April 25,1974. The Portuguese Medical Association disappeared, and it was replaced by a Trade Union, drawing on the argument that a physician was merely a Health care worker and only needed to have his employment rights protected. I always believed that a physician is different from a conventional worker because he doesn't merely take care of his professional carrier, he takes care of People, healthy or ill. After a Meeting with more than 1000 physicians, I was elected Chairman of the Union Board (with 800 votes in favour and 200against), with the clear mission to put what Physicians wanted for their professional Organization to the vote. Of course, physicians have to defend their employment rights, and that is why I fought for an Association with union offices, a proposal that received 78.3% of the votes, while the unionists in power only got about 5%. That is how I got elected as the 8th Chairman of the Portuguese Medical Association (from 1977 to 1986). I really got involved in the Association, I took everything really seriously because I always believed, and still believe, that physicians need to be esteemed and treated well in order to treat their patients well. It's the same with nurses.
How do we solve this problem of successive strikes of nurses?
Prof. Gentil Martins: I honestly don't know what's going on, because nurses are saying they are complying with minimum services and the government says they aren't. I have no doubt that they are underpaid, lacking an appropriate Professional Carrier and wrongly regarded in comparison to other professionals. However, I'm against strikes in medicine. I'm completely against them. They always harm patients. In the past, I led a strike because of the Physician's Status, which was not accepted by the Government. Physicians worked in the Official Services without employment contracts and could be fired at any time. But it was an ethically correct strike, the only one I accept, but sadly inefficient, benefiting the opposite side. Our strike was writing on the staff attendance register "we are on strike", but then we would go to work as we always did. Besides, we had a group of physicians ready to take any call, free of charge, from anyone calling in need of support and who wasn't receiving it. For3 weeks we all worked for free, but we were going to work. The government was very happy with this strike because it was saving on general costs. You weren't paid during strikes, and the youngest doctors working only in public health didn't have salaries or savings aside to support themselves. So the strike was unsustainable, and it backfired on us. As if by miracle, one Saturday morning, after 3 weeks, the Secretary of State banned physicians on strike from entering hospitals. So we left, and there were only 7 physicians left at the São João Hospital in Porto! Do you know how a Hospital like that works with only 7 physicians? On Sunday morning the Pintassilgo Government held an emergency meeting to approve the Physician's Status. And the strike ended.
Earlier in our conversation, you told me that free Healthcare for everybody is not possible and you were saying "don't lie, tell the truth".
Prof. Gentil Martins: I'm all in for universality, but according to a different model. Why aren't they studying models that are better than ours? France, Germany, Belgium or Holland have a national health insurance system, not a State system Russia and Venezuela have State Systems. England also started with a State System and has changed it completely several times!
Even though you never lived with your father, you claim you couldn't possibly measure up to him. In what sense, sports?
Prof. Gentil Martins: For sure! As a matter of fact, not just in sports. Besides winning the world rifle championship, in 1928, two years before his death in a shooting range accident at the age of 38, he was considered a very prudent and cautious athlete, he was a Portuguese champion and a Record Holder in Weightlifting, Discus Throw, Javelin Throw, High Jump, Long Jump, Triple Jump and Relay Running 3 x300 relay. He was in fantastic shape mainly thanks to gymnastics. He was preparing for the Los Angeles Olympics (1932), and in a newsletter of the Shooting Federation where he showed a target where he had hit the world record, it read "António Martins, the future world champion", because he had made a target where he had beaten the world record. When my father died he was already a Hospital Surgeon and teaching at the Faculty of Medicine in Lisbon. Imagine how far he would have gone if he had lived longer... Egas Moniz, with whom he collaborated in cerebral angiographies, said he was the greatest person he had ever met. As for me, I was lucky enough to have a fantastic mother who passed on all his ideas and who he was to me. And I tried following his footsteps, but I was never as good as him.
Is there something you are afraid of?
Prof. Gentil Martins: (Remains silent for some time) No... (again silent) Not afraid... But I regret certain things. What I most regret is the fact that I underestimated my family due to my almost obsessive connection to the Portuguese Medical Association for more than 10 years. I was never home in those years. My exceptional wife had to handle it all by herself... And my kids could barely count on me.
How many kids do you have?
Prof. Gentil Martins: Only eight. And almost26 grandchildren.
Do your kids resent you not being there?
Prof. Gentil Martins: No! Not at all. But the fact is that I wasn't because I wanted to defend doctors and patients and change the Healthcare System and I lived only for that. As for the rest, in my life I did more or less what I thought I had to do, although now I'm starting to have doubts about many things and maybe I could have done better... But that's how it was.
António Gentil Martins treats his patients with extreme care and affection, it is clear that he has put his life at their service.
Proud of the charisma of the IPO, he regrets, however, not having a paediatric oncology surgeon ready to continue his year-long work and the fact that children have to go to the D. Estefânia Hospital to undergo tumour surgery. As we walk across the garden on a cold sunny morning, he tells me that he always worked in the IPO, which had the first Service combining Paediatric Physicians and Surgeons in the world. Even though he likes to listen to what his colleagues have to say, he believes that he is always the main responsible, from the very start until the very end.
Recently, after challenging an international protocol about leukaemia, he submitted it for approval. Once the work was accepted and approved, the Editor of the well-respected journal “Leukemia” called him asking him to pay €2080 to have his article published. The IPO Research fund paid the cost, something Gentil Martins wouldn't do, stressing that he doesn't have the profile to do marketing and regretting that Medical literature may turn into a business.
He stopped wearing glasses six years ago after a cataract surgery. Other than that, he has a pacemaker in order to curb his slight arrhythmias. He says that his88-year-old hands won't shake, in case he needs to operate. However, he doesn't do everything he was doing before, only what he believes he can do well. An operation can always go bad, nothing is ever 100% controllable, but he believes that age alone doesn't limit anything, only your specific capacities do. The basic and essential medical rule is that a Physician should only do what he believes he can do well. At the IPO he sees patients every Friday afternoon and he is available whenever he's needed. In his private office, he mostly sees patients for second opinions, where, fortunately, as a general rule, he confirms what was said. Patients return to the first doctor and don't come back.
We leave the garden, he is carrying a briefcase with a strap over his shoulder. I show him an app to call for a car to pick us up. I offer him a ride, telling him I will leave him wherever he wants, he refuses. He walks me to the car and smiles, "I also have my transportation here, (he shows me his pass), I go by bus and underground".