The sugar cubes behind your ears

Balancing two studies

After failing to gain a place in Medicine, Ağali Mert decided in 1991 to enrol in Health Sciences at Maastricht University (then still known as Rijksuniversiteit Limburg). It was a deliberate choice: problem-based learning was innovative at the time, and Ağali was drawn to the interactive, practice-oriented approach.

He enjoyed the course, but in his second year he noticed that, despite lectures and his student life with SV KoKo, he still had time left in his week. Should he spend it on more drinks and social activities, or challenge himself with something new? He chose the latter. On the very last day before the application deadline, he decided to try again for a place in Medicine. He jumped on his bicycle to the post office and sent off his application by express post, ensuring it would arrive before noon. His dedication paid off: this time he was admitted.

From 1993 onwards, Ağali followed two programmes at the same time. It was a demanding but rewarding period in which he managed to balance study, student society, and private life. In 1996 he graduated in Health Sciences, and in 1999 he finally achieved his long-awaited medical degree.

Adventurous twist

During his clinical rotations, Ağali realised he didn’t want to spend his life in a hospital. “I wanted to do something with adventure. To make a difference for people on a larger scale than just in the consulting room,” he explains. He explored his options: from Doctors Without Borders to the air force, navy and army. In the end, he chose the air force. “At the very first introductory meeting I found out you’d also get flying lessons. That was absolutely brilliant!”

And so Ağali trained as a flight surgeon. He not only received flying lessons but also took part in unusual training: from aeromedical evacuation to dealing with biological and chemical weapons. But working for the military also meant the possibility of deployments. For Ağali, there were two: one to Kyrgyzstan and one to Iraq. 

The mission to Kyrgyzstan brought an unexpected family reunion. “When I was leaving, my father said: ‘We still have relatives living there.’ Once I arrived, I met a group of Turkish taxi drivers. I told one of them that, according to my father, I still had family nearby. He asked for the name and said he would look into it. Three or four days before I was due to return to the Netherlands, I ran into him again. He said: ‘I know who they are.’ He drove us there. When we walked in, they looked at us a bit strangely: ‘Who are these people just turning up?’ But when I asked if they knew a certain name, they said: ‘Yes, that’s our grandfather.’ I said: ‘Then we’re family!’ We ended up having a fantastic evening together,” Ağali recalls, with a broad smile on his face.

Admiration for the vestibular system

After a few years in the air force, Ağali was given the opportunity through the Ministry of Defence to make better use of his scientific background and became involved in a remarkable project: together with TNO, he helped develop a unique simulator, Desdemona, the only one in the world capable of generating g-forces to study how the human body reacts to movement. It was here that Ağali’s fascination with the vestibular system began. He came to know it not only as a medical subject, but also from a physics perspective. For Ağali, this offered a refreshing view: “The physicists had a truly functional approach to the vestibular system, which I found a real breath of fresh air compared with the often purely medical angle. They started from the function: what the organ does and how it responds to accelerations. They translated that precisely into measurements and numbers. I thought that was really beautiful.”

This combination of engineering, physics and clinical science showed him what the vestibular system actually does. “Because I was able to work with TNO, I came into contact with fascinating equipment and experiments,” he recalls. “It became very clear how the vestibular system—such a tiny organ behind your ears—plays a major role in human functioning: how it is involved in all sorts of serious aviation accidents and illusions, and how we can deliberately induce different types of motion illusions. That was fantastic.” And so this intriguing mechanism became the central focus of Ağali’s work and research.

Orientation shift to rehabilitation and virtual reality

Inspired by the TNO project and supported by the Ministry of Defence, Ağali made the switch to rehabilitation medicine in 2005. It’s a field he finds deeply fulfilling. “The most rewarding thing about rehabilitation medicine is that you work with people going through a difficult time, often because of an accident or a condition that will never fully recover,” Ağali explains. “That’s precisely when you can help them get their lives back on track, or at least make life worthwhile for the time they have left. How do you ensure people are able and allowed to take part in life again, in a way that suits them? That's the beauty of this profession.”

He soon combined his clinical work with research. His PhD project, completed in 2011, focused entirely on the vestibular system and led to innovative treatment programmes using virtual reality and serious gaming. In 2011, Ağali and his team won the Dutch Game Awards (the Oscars of the Dutch gaming industry) in the category Best Serious Game for the game Body Posture. Initially, these programmes were run on large, expensive defence equipment, but together with a game designer he developed applications that could also be used on compact VR headsets. This made the therapies practical and accessible in the clinic. In his first published book, Dit spel verandert je leven (This game will change your life) (2014), he applied his expertise in (serious) gaming and virtual reality to the big themes of our lives: love, war and deceit.

Knowledge sharing: the vestibular system and dizziness

The vestibular system may be a tiny structure hidden behind our ears, but it plays a leading role in our daily lives. It allows us to walk upright with ease, direct our gaze and keep a stable image, and orient ourselves in space. It’s only when the vestibular system stops working properly that you realise how vital it is: walking becomes unsteady, driving can make you feel sick, and even sitting still feels restless.

You can experience the power of this organ yourself with a simple experiment: the office chair test. Sit on a swivel chair, close your eyes, and have someone spin you at a steady pace. After about twenty seconds, it feels as though you’ve stopped, even though you’re still turning. Then tilt your head forwards for two seconds and backwards for two seconds, and you’ll have the sensation of being flung head over heels. A tiny stimulus is enough to trigger enormous illusions of movement and disorientation. “That’s all the vestibular system at work,” says Ağali.

Precisely because the vestibular system is so important, symptoms are often life-changing. Yet a persistent misconception remains: that nothing can be done about them. “Even after ten years of symptoms, someone can still improve,” Ağali stresses. He recalls a man who had long believed his problems were due to brain injury. In reality, it was caused by loose crystals in the vestibular system. With a simple series of head movements, his symptoms disappeared within minutes—to the patient’s relief, and frustration.

The future in his own hands

When asked about his future, Ağali is down-to-earth: “You might have an idea about it, but in truth it’s impossible to predict. You also have to take life a little as it comes.” Whether he will always remain in rehabilitation medicine or one day focus on another specialism, he leaves open. For Ağali, it’s about more than just choosing a field: “The most important thing is to use your talents and do something that allows you, in your own way, to contribute to society. And you have to keep enjoying the things you do.”

Two things, however, are certain: Ağali will remain a doctor for a long time to come, and he will keep on writing. His next book is already in the making. “Alongside my work with people with dizziness, I also work at a large rehabilitation centre, where I’m responsible for arm rehabilitation—everything to do with the hand, wrist and elbow. And really, the hand is such a remarkable part of our body. We do everything with it: we work with it, we communicate with it, we love with it, we grasp and manipulate the world with it. It’s absolutely essential. So yes, my next book will be about the hand.”

Text: Janneke Haemers