By Oana Maties MD, MRCP, FRCA
OM: I remember meeting you during the early weeks of my career at UCSF. I was still settling in, an outsider from a foreign land, and our friendly and helpful discussions became an anchor for me. Little did I know then what you had already accomplished, or how much more you would achieve over the next twelve years. I’ve had the privilege of being one of your many mentees and getting to know you better. Today, we’re here to talk about you being honored by the ASA with the Nicholas M. Green Award for Outstanding Humanitarian Contribution.
Your nomination letter highlights your many honors from around the world, recognizing your steadfast commitment to advancing our specialty globally through mentorship, teaching, research, and fostering international collaborations. You’ve authored over 400 publications, edited five textbooks, served on twelve editorial boards, and held leadership roles such as Chair of the Department of Anesthesia at Western Ontario and Vice Chair of the Department of Anesthesiology at UCSF, plus leadership of international organizations, all alongside a lifelong dedication to volunteering and humanitarian work.
So, how did it all begin, and what drives your commitment to humanitarian work?
AG: Early in my childhood, my parents had difficulty finding stable employment, so in a short span, I attended five different schools. It made me understand what it was like to be the new kid, the lonely one, and the one who got picked on. This experience gave me a deep sympathy for the underdog, and I often find myself asking,” How would I feel if I were in their shoes?”
I also developed an early interest in different religions, particularly in the principle they all share: Do unto others as you would have them do unto you. As a teenager, I was influenced by a passage in the Old Testament, Leviticus: Do not harvest the corner of your fields, and whatever falls on the ground you should leave, because they are for the poor and the foreigner. I found that concept so beautiful, and it stuck with me. When I became a department chair, I integrated this idea into the department budget by setting aside a small sum of money each year to support people from less fortunate countries. It gave me immense joy to see those individuals subsequently rise in their own countries and departments. Some even came back to thank me, saying, Thank you for showing me how you run a department, how you handle cases, how an operating room functions.
I remember a saying: The reward for doing a good deed is simply having had the privilege to do it. That feeling of doing good for others is what drives me. Some call it ego, but we all have egos. The important question is, how do we harness our egos to benefit ourselves and the collective good?
I’ve also realized that 90% of success is just showing up, but the crucial other 9.9% is actually doing something. When I commit to volunteering, I feel the obligation to act. I can’t separate what I can do from what I should do—though I don’t necessarily recommend this approach. But that’s how I’ve been asked to lead so many projects and take on public roles.
OM: There’s a wonderful combination of wisdom and grace in what you’ve shared so far. How does one gain wisdom?
AG: George Bernard Shaw said, Wisdom is wasted on the old. Wisdom comes from experience and reflection. One of the individuals who influenced me as a teenager and young adult was the Indian philosopher Jiddu Krishnamurti. From his writings, I learned the importance of watching oneself in action—being able to step outside yourself, reflect on what you’ve just done, whether it was good or bad, and what motivated that behavior. I try to apply this to my own life and encourage others to reflect on their day. There’s a beautiful quote from Naguib Mahfouz, the Nobel laureate Egyptian author:’ You can tell a man is clever by his answers. You can tell a man is wise by his questions’. I encourage residents and colleagues to think about the questions and examine their practices with a focus on their own and their patient’s safety—both physical and psychological.
OM: How do you inspire the moral compass, curiosity, and compassion needed to step outside one’s comfort zone and evaluate one’s impact on others?
AG: I’ve simply made it part of the job requirement. You measure physiological variables to ensure patient safety, but you also need to think about your approach to safety—not just for patients, but for yourself and your colleagues. While there are many demands on one’s time, taking just a few minutes each day to reflect on your actions can be powerful. It doesn’t need to be a negative exercise—you can ask yourself, What is one good thing I did today? This can also be done as a team activity at the end of the day. Once you do that, you’ll inevitably think about areas where you could have done better. This simple reflection increases the likelihood of doing something good the next day. Setting aside a little time for reflection is important. I like a line from the poet WH Davies – “what is this life full of care/ if we have no time to stand and stare”
OM: Introspection does require curiosity.
AG: Yes, it does. I’ve always considered myself a curious person in all senses of the word—perhaps a bit of an oddball, an outlier. Even as a kid, I loved going to someone’s house and browsing their bookshelf or paging through whatever encyclopedia they had. As a medical student and later as a resident, I spent hours at the library exploring topics that didn’t directly impact my practice but piqued my curiosity. To this day, I still browse PubMed on various topics, just to stay informed about what’s happening in healthcare.
OM: What accomplishments are you most proud of, and what do you consider your most impactful contribution to humanitarianism?
AG: Those are tough questions. On a general level, I’m proud of the people I’ve mentored and helped. I can’t name them all, nor can I track every achievement they’ve had, but I know I’ve made an effort to guide them and help them help themselves. I do take pride in the outcome. Occasionally I meet someone who thanks me for my time—sometimes the previous interaction was as simple as a brief conversation that helped them clarify their thoughts.
In a broader sense, I’m proud of my contributions to neuroanesthesia education, though it’s hard to measure the impact of shaping how people think about case management.
One of my most significant achievements is leading the International Standards for Safe Anesthesia Practices project for the World Federation of Societies of Anesthesiologists. It has been endorsed by ministries of health, including Romania and Mongolia, and is recognized by the European Society of Anesthesiologists in their Helsinki Declaration as suitable for Europe.
The standards have sparked discussions worldwide, especially in lower-resourced countries about their feasibility and applicability. Additionally, I helped create a checklist and a capacity assessment tool that has been used in at least eight countries to evaluate anesthetic capacity at the national level. This project stands as a tangible achievement with a global impact.
OM: What advice do you have for anesthesiologists looking to contribute on a global scale?
AG: Do something! As I said, 90% of success is just showing up but it’s the other 10% that determines your impact. There are always opportunities to volunteer—organizations are always looking for active participants. However, I’m not an advocate for short-term mission trips, as they don’t build lasting healthcare infrastructure. Mission teams may do great work for a small group of patients but then depart, leaving the local team, which may have been out of their jobs and income for the duration of the mission, to deal with any complications that arise.
If you choose to volunteer for mission trips, make sure to include a component of capacity-building and commit extra time to teaching workshops that are relevant to the local context. There’s no point in running an ultrasound-guided regional anesthesia workshop in an area where ultrasound machines aren’t available.
To me, that’s what separates a meaningful humanitarian effort from a traditional mission trip. It’s about teaching people how to fish. You don’t even need to leave your country—there are many underserved areas in the United States that could use your expertise.
OM: What are the most pressing challenges in global health that anesthesiologists can address?
AG: I believe the biggest challenge is political: convincing healthcare leaders to recognize the vital role anesthesiology and surgery play in healthcare. Surgically amenable diseases account for 30% of the global disease burden, and anesthesia is critical to that. There is a huge need for effective anesthesia leadership at the national level. Leadership training that includes negotiation and mediation skills would be as valuable as any technical course in anesthesia. Another challenge is creating a well-trained anesthetic workforce. The only realistic solution in most countries is to develop an anesthetic care team, with standards set by national anesthesia societies. There are many opportunities to contribute to training anesthesiologists, particularly in low-resource settings. The WFSA has a platform where you can volunteer to teach in various courses.
OM: If you could look back at your life and your contributions, is there anything you would do differently?
AG: In retrospect, I probably should have said no to a few things. A lesson I’ve learned is to be careful with what you agree to take on and manage your time wisely. One common sentiment among people my age is, I wish I had spent more time with my family. It’s hard to know at the time what the right balance is, but perhaps I could have declined some commitments sooner or spent more time stepping back from roles I’d outgrown. It’s a challenge many of us face—once we’re committed, it’s difficult to step away and climb off the stage.
OM: It’s an interesting image, climbing off the stage—it suggests a struggle.
AG: Yes, it’s both an internal struggle and an external one. Organizations often don’t want to let go of a committed volunteer, so leaving can feel like climbing off the stage.
OM: What does receiving this award mean to you?
AG: It’s one of the most meaningful recognitions I’ve received because it acknowledges the breadth of my work, from helping individuals to supporting organizations and countries.
OM: What’s next for you?
AG: More of the same. I’m still keen to learn and expand my understanding of patient safety, human factors engineering, and medication safety as well as how to implement them. I hope to make a few more contributions in these areas. But eventually, I look forward to a graceful exit into retirement, where I can continue traveling, though less for conferences and more for the sheer joy of it.
OM: Thank you for your authenticity and for your generosity with your time and wisdom. I enjoyed talking with you and I have learnt a thing or two, as always. Your steadfast commitment to our profession, to our patients and in general to improving the lives of others continues to be an inspiration to me and to generations of anesthesiologists across the world.