Scalpel in the Sand is an autobiographical account of a young British-Chinese surgeon during his ten years (1979 – 89) working in Riyadh, Saudi Arabia.
His time in Arabia coincided with the expansion of medical and surgical care in the country. He worked within the environment of an ultra-modern hospital with state-of -the-art facilities, the Riyadh Military Hospital. He had to adapt to the very different epidemiology of surgical diseases of a Middle Eastern country. There were many opportunities to participate in innovative and challenging projects and activities:
1. The kidney transplant service achieved international renown;
2. The nutrition support service was the first comprehensive and hospital-wide service in the Middle East;
3. The seminal research of the Riyadh Intensive Care Program on futility in intensive care caught the medical world’s attention.
4. Setting up the Major Disaster Response Plan for the King Khaled International Airport, Riyadh which was put to use in the First Gulf War.
5. It is a time capsule of a period, twenty years ago, when great changes were taking place in Saudi Arabia. The stories of my close and daily encounters among, and interaction with, the local people, colleagues, students, patients, and members of the Saudi royal family provides observations of a way of life and a culture very different from what is familiar in the West.
6. I present a view that is often contrary to the conventional wisdom of the West and in so doing I hope to adjust perceptions that will bridge the gap between the West and the Muslim Arab peoples
7. I had the privilege of teaching the first group of women doctors to graduate provided a rare opportunity to make observations of the issues confronting Saudi women in their struggle for emancipation, their ‘green shoots’ of success and their continuing problems.
8. ‘Back to Beginnings’ is a stand-alone chapter at the end of the book which puts the author in context: my family background, growing up in the mixed cultures of colonial Malaya, relocation to the UK for my medical and surgical training.

• What is the Chang sign in kidney transplant?
• What has kidney transplantation to do with motorway design?
• What converted the author to holistic medicine?
• What ethical issues were encountered as a surgeon in Arabia?
• What happened at the Mecca Siege?
• How do Saudi Arabians behave in formal and informal occasions?
• How to capture the Middle Eastern market in enteral nutrition?
• Why is the prediction of death more useful than the prediction of survival?
To satisfy your curiosity, read “Scalpel in the Sand”

Preface
Acknowledgements
Illustrations
Abbreviations
Author’s Note
Contents
1 First Impressions
2 Broadening Horizons
3 At Work
4 Kidney Transplant Programme
5 Nutrition Support Service
6 Riyadh Intensive Care Program
7 Seizure of Al Masjid Al Harm
8 Major Disaster Response Plan
9 New Women of Saudi Arabia
10 The High and Mighty
11 Colourful Characters
12 At Play
13 Idiosyncrasies and Oddities
14 Goodbye
15 Reflections
Back to Beginnings
Glossary of Medical Terms
Further Reading

Brief CV
Name: René Wen Suen Chang
Address: 7 College Gardens
Dulwich
London SE21 7BE
Telephone: 020 8693-3714
Email: renechang@ntlworld.com
Degrees and Qualifications:
BSc (Special) Physiology, King's College, University of London
MB BS, Westminster Medical School, University of London
F.R.C.S. (England), Royal College of Surgeons (England)
Master of Surgery, University of London
Awards: Entrance Scholarship to Westminster Medical School
Federal Scholarship (Malaysian Government)
Bernard Sunley Research Fellowship, RCS (England)
Present Appointment:
Director, Useful and Fun Things Limited
Past Appointments:
1. Founding Director of Transplantation, St George’s Hospital, London
2. Lecturer/Senior Registrar, Academic Surgical Unit, St Mary's Hospital, London
3. Consultant Surgeon, Riyadh Military Hospital, Saudi Arabia
4. Clinical Tutor (Postgraduate/undergraduate), King Faisal University, Damman, King Saud University, College of Medicine, Riyadh
5. Consultant Transplant Surgeon, St Helier Hospital, Carshalton, Surrey
6. Scientific Advisor/Consultant to 2nd Consensus Conference of the European Society of Intensive Care, Fujisawa GmbH, Eli Lilly, Hoffman La Roche, Glaxo-Wellcome, Qinetiq, Intensive Care National Audit and Research Centre, UK,
7. Chairman, South Thames Transplant Group - 1992-1994
8. Visiting Professor, George Washington University, Washington DC
Teaching Experience (Undergraduate and Postgraduate):
King’s College, Strand, University of London
St Bartholomew's, Westminster, St Mary’s Hospitals Medical Schools, London, UK
King Saud University Medical School, Riyadh, Saudi Arabia
King Faisal University Colleges of Medicine, Al Khobar, Damman, Saudi Arabia
Conferences and Workshops (Organised):
Monthly Nutrition Support Service Workshop 1980-89
International Symposium on Intensive Care. Riyadh 1982
2nd International Middle East Symposium on Organ Transplantation Riyadh, 1984
Nutritional Care of the Critically Ill Patient. International Symposium at Riyadh 1987
Symposium on End-stage Renal Disease and Renal Transplantation at Riyadh 1988
Symposium - Practical Problems in Transplantation, St George’s Hospital, London, 1996
Societies: British Transplantation Society
British Medical Association
Intensive Care Society (U.K.)
European Society of Intensive Care
Society of Critical Care Medicine
American Federation for Clinical Research


Publications and presentations:
Peer reviewed articles and chapters in books on tumour immunology, renal transplantation, surgical nutrition, surgical audit, intensive care, and disaster response planning.
Interviewed by international (Germany, Austria, Singapore, Malaysia, Australia, USA, Canada), national (UK) and local radio (London, Scotland), television stations (BBC Today, GMTV, BBC News 24, Cologne TV) and newspapers (Times, Independent, Guardian, Telegraph, Evening Standard, Daily and Sunday Express, Daily Mail, Sun, Stern, Frankfurt Zeitung, Straits Times, Sydney Morning Herald).
Educational Videos:
I scripted, directed, and produced the following educational videos:
“A day in the life of a Nutrition Support Service”.
“Renal transplantation in Saudi Arabia”.
“Carry On Feeding”.
Computer Programs:
I designed and wrote the following computer software programs:-
Editorial Office Manager Version 1.0. 1984.
Nutrition Support Service Manager Version 2.0. 1986.
Riyadh ICU Program Version 2.30 2004
Renal Data Manager Version 3.0 2009