Zulfikar Amirali Hassan Juma

Pioneering Nickel City cardiologist retires this month

Dr. Zulfikar Juma helped put Sudbury at the forefront of cardiology in the late 1980s and early 1990s

by: Jonathan Migneault, Northern Lights

Sudbury cardiologist Dr. Zulfikar Juma retires on April 30, but reminisced with Sudbury.com about a career where he helped propel Sudbury to the forefront of cardiac care in North America. Photo by Jonathan Migneault. When Sudbury cardiologist Dr. Zulfikar Juma looks back on his long career, his fondest memories are for his early years in the Nickel City, in the mid-1980s and early 1990s.

“When I came here things got really exciting,” he said.

Thanks to Juma and a team of cardiac surgeons, nurses, cardiologists, technologists and anaesthetists Sudbury's Memorial Hospital was at the forefront of cardiac surgery in North America during that time.

“During that time, Sudbury Memorial Hospital had the best outcomes in bypass surgeries (in Ontario),” Juma said.

In 1984, Juma became one of the first cardiologists in Ontario to treat a patient with the clot-busting drug Streptokinase – which is now commonly used to treat patients who have experienced a heart attack.

A 17-year-old Laurentian University student arrived at the hospital with the symptoms of a severe heart attack.

“This guy was so young that he had nice clean arteries,” Juma said.

But when he stepped outside on a cold January day after a workout at the Laurentian gym, the -20 C temperature shocked his system and caused enough arterial constriction that it sent him to the hospital with the symptoms of a heart attack.

Juma got permission from hospital administration to use Streptokinase, which was still an experimental drug at the time, and it immediately opened up the young man's artery. He made a full recovery.

The next month, Juma became one of the first cardiologists in Canada to perform a coronary angioplasty on a patient.

Now common, the procedure sees a surgeon use a balloon to widen blocked or narrowed coronary arteries.

The hospital's administration once again trusted him to try the latest medical interventions to help his patients.

Juma, who retires on April 30, was born in Nairobi, Kenya, and knew from a young age he wanted to be a physician.

His grandfather owned a store that sold second-hand furniture and books, which made him an avid reader.

When he was around 12 years old, he said he read a book about medicine, that featured a section about the medical school in Pavia, Italy, which was one of the oldest in the world.

He knew then that he wanted to study medicine in Europe.

But instead of attending the University of Pavia, Juma went to the University of Manchester, in England.

He graduated from medical school in 1972, and moved to Toronto where he did his residency at a number of hospitals.

While he was working at Toronto's Sunnybrook, his father died of a sudden heart attack at the age of 54.

His father's loss to a heart attack encouraged Zuma to specialize in cardiology.

After his residency he was offered a research position with the Ottawa Heart Institute, but turned down the job because he wanted his own clinical practice, and most importantly, to teach.

Zuma's mother was a teacher, and it was always important for him to share the knowledge he had gained with others.

“It was my way of learning and memorizing things,” he said. “If you want to be good at what you do, teach it to someone.”

While Sudbury's Memorial Hospital was not a teaching hospital, Juma often hosted informal sessions to teach new techniques to nurses and other faculty in cardiology.

When the Northern Ontario School of Medicine opened in 2005, he was one of the first physicians in sudbury to jump on board as an instructor.

In 2015, the school gave him a letter of recognition for the high praise he had received from his students over the years.

While he will close his local practice on April 30, he said he won't completely retire.

“Doctors never retire, they just fade away,” Juma said.

He and his wife plan to move to Toronto so they can be closer to their daughter and grandchildren.

Juma said he plans to teach in Toronto, and maintain a close relationship with the Northern Ontario School of Medicine.

Some of his patients have said they will follow him to Toronto for annual check-ups.

But while he never expected to be in Sudbury long, Juma now says it will be difficult to leave the city he has called home for more than 30 years.

“I'm going to miss this place a lot,” he said

Pioneer cardiac interventionist retiring

By Carol Mulligan, Sudbury Star

Tuesday, April 26, 2016 9:57:13 EDT PM

Cardiologist Zul Juma at his office in Sudbury on April 13. Juma is closing his practice after more than 30 years and moving to Richmond Hill where he is opening a small practice.(Gino Donato/Sudbury Star)

It was more than 30 years ago, but Zulfikar (Zul) Juma remembers it as if it were yesterday.

It was 1984, and Juma had been working in cardiology in Sudbury for four years. He was at Sudbury Memorial Hospital and had never seen anyone like the 17-year-old boy in front of him, who was having a massive heart attack.

Sudbury Memorial Hospital and Dr. Paul Field had been making headlines for years after Field performed the first successful cardiac bypass surgery in Canada there in 1968.

The teenager before Juma didn't have the characteristic buildup of plaque clogging his arteries that might have caused a heart attack. He was taken to the cardiac catheterization laboratory where dye was injected and an angiogram showed an artery at the front of his heart was completely clotted.

The teenager had been working out at Laurentian University, then walked outside into the cold air, and the thought was his artery went into spasm, allowing a clot to form.

Juma had read about the use of the drug Streptokinase by a German cardiologist in 1979, who injected it directly into an artery to break up clots.

Juma contacted Sudbury Memorial Hospital administrators Esko Vainio and Vickie Kaminski, seeking permission to try the drug that, at the time, was only being used to bust clots in blood vessels in the legs.

The pair gave him permission to use Streptokase for a different purpose if there was a chance it would save the teenage boy's life.

Juma froze an area of the boy's groin, and inserted a thin catheter into the artery, infused the drug and watched what happened.

He was relieved to see the clot breaking into smaller pieces and moving through the artery. "We could see the heart muscle coming back ... and that saved his life," Juma said in an interview at his Sudbury office.

While Sudbury Memorial had earned an international reputation for heart surgery, the use of Streptokinase in the teenage boy was ground-breaking and would lead to Juma developing the interventional cardiology program there.

They were exciting times for the young doctor who was born in Nairobi, Kenya, went to medical school at the University of Manchester in the United Kingdom and was advised to go to North America to practise because there were better opportunities.

He did a general medicine internship at The Wellesley Hospital in Toronto and was a junior medical resident at Sunnybrook Health Sciences Centre. Juma had intended to specialize in an area of medicine and he decided what field that would be at Sunnybrook. He received word his father had died of a heart attack when he was only 54 years old. The loss helped Juma decide to specialize in cardiology.

He became a cardiology fellow at Toronto's St. Michael's Hospital and later a research fellow at the University of Miami Medical School. But Juma's heart was in clinical practice and he wanted to teach. His mother was a teacher and so were several of her siblings.

Zuma talked about his spiritual beliefs when recalling his 32 years of medical practice in Sudbury. He is closing his Sudbury office at the end of this month and moving to Thornhill. He will run a small practice in neighbouring Richmond Hill and some of his Sudbury patients intend to follow him there.

When he was developing the interventional cardiology program at Sudbury Memorial, Juma did so seeking guidance from The Divine.

Watching the clot in the teenager's artery dissolve after Streptokinase was administered was a religious experience. "That whole atmosphere was so spiritually charged for me, to see the clot actually melting away," said Juma.

A protocol was established after that in which people suspected of having heart attacks were taken first to the cardiac catheter lab. The use of the blood-clotting drug advanced to the point it could be given intravenously with the same effect on a clogged artery as directly injecting it. Sudbury Memorial participated in an international study on the results of using Streptokinase to break up clots in arteries in the heart.

More interventions would follow at Sudbury Memorial and in the world of cardiology -- the use of balloons to open narrowed or clogged arteries among them. Juma performed the first angioplasty in Sudbury in February 1984. Later, stents would be inserted to keep arteries open after they were expanded. An acrylic paperweight on Juma's desk contains what looks like a small spring but is actually a cardiac stent.

"For me, it was tremendously exciting, but tiring. Really tiring," Juma said of those days. "Emotionally it took a lot out of you, and physically. You're at home, you're sleeping, dreaming. You've got a patient in the emergency room, so now you get into the hospital, mobilize the cath lab and the whole thing takes two hours."

Cardiac care has evolved to the point that today more angioplasty and stenting is being done on patients than bypass surgery and the need for heart surgeons is declining.

Juma had been informally teaching his colleagues at Sudbury Memorial Hospital and family doctors in the community about interventional cardiology. Ten years ago, he began teaching officially at the Northern Ontario School of Medicine when it opened. What he loves most about teaching is explaining complicated medical issues in simple language that students and other learners can understand.

In more than three decades in Sudbury, Juma was involved in several research projects and received several awards. One of his most cherished is a letter from NOSM commending him for his teaching.

"Your efforts contribute to the growth of NOSM as a recognized leader in distributed, learning-centred, community-engaged education and research," Dr. Robert Smith wrote in September 2015. Smith is an assistant professor and division head of clinical sciences at the medical school.

Juma believes teaching can only make a person better at what they do. "You can't teach if you can't understand what it is that you're doing."

At 69, Juma looks a decade younger. He has no intention of retiring and is moving to Thornhill to be close to his daughter and her family.

He still starts his days, as he has most of his life, at 4 a.m., praying for 30-45 minutes -- "just quiet reflection, contemplation, meditation, thinking spiritual."

He is one of about a dozen Ismaeli families in Sudbury, a sect of the Shia branch of Islam. The Ismaeli spiritual leader is the Aga Khan, whom Juma says is the 49th direct descendent of the Prophet Mohammed. A picture of the spiritual leader sits on a credenza in his office.

Juma believes if there is something in life you want and are passionate about it, "you become it and it becomes you. But going beyond that, it's almost as if the heavens are coming together to conspire to make it happen for you."

He often told medical colleagues there was a good reason he came to Sudbury. "I had to meet you and you had to meet me, and you had to all come around and make things happen for me. Because it wasn't just my effort, it was the team together all the time, the right people the right time."

Juma enjoys the quiet of the very early morning. "That's the time when everything is at its lowest, the hum of the world, the distractions, your metabolism is slower, there's no distraction ... Everything is just quiet and still."

He goes to bed early and gets up without an alarm clock.

"He who is above all else wakes me up," he said.

Juma often tells medical colleagues that when great discoveries are made, all that has been done is uncovering what is already known.

"The cure for cancer and the cure for heart disease is already known, it already exists," he said, "but we human beings have not discovered the cure yet. But it's there.

"So the day you discover it, you have to be humble. Humility is important because, when you discover something, all you've done is open a really small window in your understanding of the totality of creation. Because the answers are there, the answers are there."

CMulligan@postmedia.com

Twitter: @CarolDMulligan