The pediatrician is the strongest advocate for the
child.
I am indeed happy to participate in the 50th Annual
Conference of the Indian Academy of Pediatrics (PEDICON) 2013 at
Kolkata. I understand about five thousand pediatricians from all over
India are participating in this annual event. I am happy to note that
the association has a membership of over twenty thousand doctors.
Friends, on going through the IAP Action Plan 2013, I am happy to note
that the IAP Mission Uday mainly focuses on reducing under five
mortality rate in our country. Another very important project that
interested me was the training of untrained child health paramedics. My
greetings to all the members who are spearheading these projects. When I
am in the midst of medical community, the topic for the discussion, I
have selected is "Child care is indeed heavenly mission."
Pediatrician- A Doctor With Kind Heart
Friends, I have a message for the all of you
participating in the Annual Conference of IAP and also doctors who are
not participating. Friends, name and money is associated in many fields
of healthcare. I realize, Pediatricians are not always on top of the
money making doctors. But throughout the world in medical circles these
physicians, that is yourselves, are some of the most giving and caring
individuals and I can say this from my experience. Pediatricians are
those with largest heart ever-ready for selfless service. These doctor’s
tender loving care renders lifelong benefits. Good pediatric care is the
most return-on-investment (ROI) in any country. I congratulate
you and your profession.
Dear friends, when I see you all pediatricians
assembled here, I would like to refer to a discussion I had with my
friend Dr Jogi Pattisapu of UCF College of Medicine, Florida USA, a
Pediatric Neurosurgeon. He suggested, pediatricians play a key role on
three major aspects of a child’s life knowingly or unknowingly. One is
protection, second is prevention and third one is perfection. These
three important roles are played by each Pediatrician, either actively
or passively. Naturally, the former with spirited involvement yields the
best and long-lasting results. We have seen this in the west over
decades of combined effort, now offering good rewards of lessened infant
mortality, prevention of communicable disease and many laws
safe-guarding our precious commodity that is the children.
Be At Peace With Yourself
Dear friends, I would like to share with you one
important event which happened in the clinical experience of one of my
neurosurgeon friend. I would like to narrate the incident. He is an
experienced professional and reputed neurosurgeon in the world. He was
treating a 2 years old baby who had a brain tumor in the most vital part
of the brain (brain stem). He had removed over 90% of the lesion and
thought the child should improve or at least remain stable. But child
had serious issues, it appeared the tumor had caused other untreatable
and permanent problems-spinal fluid circulation issues dominated his
condition. After several unsuccessful surgeries, it seemed he was on a
slippery slope. He simply could not enter the child’s room and leave
without crying. He felt weak, so unable to fulfill his duty for the
first time and then he gave up.
His lowest (burnout) moments came, and he became
depressed for days on end. People around him (especially his wife)
noticed and felt quite concerned – some felt that he might quit forever.
The doctor friend, has become increasingly quiet, withdrawn, and his
movements were slowed down. He could not talk for five minutes without
mentioning this hopeless situation during conversation.
Then a miracle happened. A letter came from the
child’s mother. The letter goes like this. "Dear Doctor, be at peace
with yourself. My child, my loving child has been under your care for
the past few weeks, and now he is your child too. But he is in God’s
hands, now and always. Yes, the tumor could be taken out, but the spinal
fluid problem was sent to help you realize yourself. Surely you will see
through the problem into the solution beyond."
This support from the mother and the child’s family
gave the doctor great strength, and he decided to look for alternative
methods of controlling the hydrocephalus situation. He and his team
simply cannot control the fluid buildup properly, and their terribly
risky surgeries only marginally manage the situation. It took almost 15
months to stabilize the hydrocephalus (after additional 8 to 9 surgical
procedures) and all fell into place for this child. He finally recovered
(mostly due to the family’s wonderful love and care), and recently
graduated from high school and now attending college – yes, he has
residual deficits, but dreaming of big plans like any other youthful
fellow. To teach the brain how to absorb its own fluid has been the
way to be at peace with him (Doctor).
According to me; for any illness, the temporary
remedy is not a cure; we should see what the permanent cure is? It looks
to me; research has to be directed towards both control and cure.
Control of neurological disorders may be through populating quality
neurons in the brain using nanoscience and technology, whereas cure has
to be strengthened through innovation in research, possibly using
nanoscience and technology and stem cell intervention along with
psychological support by following an integrated approach.
Characteristics of the Indian Population
It is reported that Indians are genetically three
times more vulnerable to heart attacks in wherever they are than
Americans and Europeans.
Rheumatic heart disease: If you look at Rheumatic
heart disease, which leads to heart valve destruction, is peculiar to
the Indian community. This arises out of poverty and poor sociohygienic
living conditions of our population, which result into rheumatic fever
in young age, leading to one in every thousand child suffering from
rheumatic heart ailments in later years.
Congenital heart diseases: In India, over hundred
and fifty thousand children are born with congenital heart disease every
year. Out of these 85% of them die before any treatment reaches them;
approximately, 40% could be saved if timely diagnosis and proper
pre-operative preparation of the child is done. Pre-operative
preparation and the surgical intervention are time sensitive and vary
with the time of detection of the ailment. Due to lack of timely
detection and Medicare in not reaching the children leading to high rate
of mortality. With the present estimates only one percent of the 1.5
lakh children are saved after proper medical intervention. I would
suggest the child remedy for this situation lies in screening and
detection of the child, right at the birth, so that the parents can be
advised about the state of the child, when the child leaves the
hospital. I was told this type of screening is presently available only
in big hospitals. I would recommend that it becomes a routine medical
practice with all the hospitals in the country dealing with childbirth.
Now I would like to share about the contribution of a
doctor who has dedicated his life for tribal healthcare.
Reaching the Unreached
In the present circumstances and environment, it was
inspiring to see, how a MBBS doctor has put all his dreams in
mainstreaming the tribal citizens of Karnataka for the last 25 years
through Vivekananda Girijana Kalyan Kendra (VGKK), at BR Hills. When I
visited BR Hills in 1998 and subsequently in 2006, I could see
substantial new developments in that area. I could see that "New Tribal
Hospital", roads and education environment and above all the earning
capacity of the tribal citizens have been increased with the technology
resource center as a base. Dr H Sudarshan is the inspiring architect of
this societal transformation.
Dr. Sudarshan’s father died in a village without any
medical help when he was just twelve. This event followed by his reading
the biography of Dr Albert Schweitzer who worked in Africa motivated Dr
Sudarshan to take up medical profession and work in tribal areas in
India. Dr Sudarshan derives his philosophy of work in tribal Swami
Vivekananda’s teaching which states "they alone live who live for
others, rest are more dead than alive".
Dr Sudarshan starts his day at 4.30 am in the morning
with yoga, meditation and prayer with tribal school children. After his
breakfast at 7.30 am, he attends to administrative work for an hour.
From 9 to 1pm, he goes around the ward and sees the patients
individually. He has lunch with the tribal students between 1 and 2pm in
the afternoon. Later till 7 pm, he is busy in the clinic where he
conducts minor surgeries and visits tribal complex. Later, he performs
administrative work for an hour and half and has dinner with the tribal
students. He devotes one hour for study between 9 to 10 pm, so that he
gets updated information about medical systems. He spends large part of
his time in clinical diagnosis, laboratory diagnosis and treatment, in
addition to supervising, monitoring, teaching and carrying out research
along with his team members.
Dr Sudarshan pays particular attention to the special
problems of the tribals such as snake bite cases, mauling by bears,
pneumonia, tuberculosis and acute respiratory infections. The Soliga
tribal people suffer from sickle cell anemia and Dr Sudarshan has
developed a low cost electrophoresis machine for diagnosing the disease.
He has also built the healthcare system on the strengths of traditional
knowledge available in the tribal areas. The secret of his service is
that he is empowering the people to manage their own health through the
provision of knowledge. He has trained tribal girls as Auxiliary Nurse
Midwife (ANM) and posted them in the tribal sub-centers. These nurses
undergo 18 months course. Thus the rural area is self-sufficient in
nursing resource. He has also developed low cost management system for
epilepsy in the primary healthcare centre (PHC). He has introduced
dental healthcare and cancer control in the PHC. He is providing quality
healthcare to the people by the introduction of low premium health
insurance for all the people living below poverty line. He suggests that
medical colleges should teach their students to develop sensitivity to
the suffering of the patients. They also need to modify the treatment
approach for the poor who cannot afford costly treatment. The aim of the
medical education should be to facilitate application of medical
technology for providing best care to the poor at the most affordable
cost. Dr Sudarshan says ‘the greatest joy’ he experienced was when he
resuscitated a patient whose lungs and heart had stopped and when he
sees the smile on the face of poor patients who come to the hospital
with blindness (cataract in both eyes) and walk out with full vision
after the cataract surgery. Country needs thousands of Dr. Sudarshans
for providing healthcare to our rural citizens.
When we see the life of Dr Sudarshan who championed
the course of "tribal healthcare", there are many other avoidable
healthcare issues that come in front of us? How can we avoid totally
malaria? How can we eliminate TB? How can we make IMR and MMR near zero?
In India, we have to ensure that there is no occurrence of infection
such as HIV/AIDS, Hepatitis B and C due to the re-use of syringe and the
needle. Can we free future generations from occurrence of heart disease
at an early age? Can we make artificial organs for giving quality of
life to those who need them? Can we provide better quality of life to
our senior citizens? How to educate people in preventive care? How to
keep the environment clean? How to reduce the costs of medicines and
make it affordable to the common man? How to ensure spurious drugs do
not enter the market? As you see, if you have to find satisfactory
answers to these questions, we have to address together many aspects
like medical innovation, training technology, sanitation, nutrition,
public awareness and ethics together. I am sure the Action Plan
initiated by the IAP will look into all these areas.
My Visualization of Great Healthcare Center
Dear friends, I visualize a great healthcare center/clinics
with the following characteristics:
1. Patient is the most important person in the
hospital. When the patient enters, the hospital presents an angelic
look and all the team members of the hospital always wear smiles.
The patient feels that "I am going to get cured."
2. The hospital consumes less electricity and
less water by adopting green building for all modernization tasks.
The choice of the power source is solar and wind.
3. The hospital premises are totally noise free.
4. All the test reports and treatment schedule
get attached to data base of the patient through electronic medical
record without the need of the patient or the relatives to search
for the reports. The data-base is updated and authenticated every
hour.
5. Maintains the database of all the cases
treated by the hospital in the past which are easily retrievable.
6. Patient is not subjected to diagnostic pain.
7. The surroundings of the hospital is green with
full of trees with seasonal flowers.
8. Further expansion of the hospital is in
vertical mode leading to fast movement of the patient and doctors
for medical treatment.
9. There is no case of hospital induced infection
to the patients due to bio-contamination.
10. The patients feel that this is the best place
to get treated.
11. The hospital is fully IT-enabled leading to
virtual connectivity of the patient to the doctor, nurse and the
chief of the hospital 24
7. Hospital is also networked with other
hospitals nationally and internationally for seeking expert medical
advice on unique cases.
12. The daily medical conference, attended by the
chief of the hospital, doctors, nurses, paramedics, and relatives of
patients of unique cases, reviews problems of the patient and find
intergraded solutions.
Little Heart Foundation of CARE Hospitals
Now, I would like mention about a doctor who has
initiated innovative schemes to channelize the good-will of people to
help poor patients getting expensive medical treatment. Dr Soma Raju is
one of the founding members of society for biomedical technology (SBMT),
an inter-ministerial initiative of the government of India to develop
affordable medical devices and technology. He has been instrumental in
shaping the development of cardiology and cardiac surgery in Andhra
Pradesh in the private sector. Dr Soma Raju founded CARE Hospital and
setup a bench mark in providing affordable cardiac interventions and
cardiac surgery. In one such scheme namely Little Heart Project, free
corrective surgery were performed on 1080 children born with congenital
heart defects. The unrelenting work of Dr. Soma Raju has won him many
accolades and awards. He is currently Chairmen and Managing Director,
CARE Group of Hospitals, Hyderabad having 2000 beds at 12 centers. As
per Dr. Soma Raju, the driving force behind his continuous contribution
to treatment of patients, medical education and institution building is
the inner voice which keeps on calling him to remove the disease and the
pain of the people.
"Can Serve Children" Project
Recently I participated in a programme "Can Serve
Children" Project" organized by the Devika Institute of Oncology,
Madurai. CAN-SERVE project at Madurai in association with the District
administration is aiming at providing linear accelerator treatment free
of cost to all children belonging to economically weaker sections of the
society suffering from cancer. Certainly this initiative will enable
early detection and cure of children from cancer in the region. The IAP
can interact with this Devika Institute on Oncology and other such
institutions to spread such types of missions for children.
Conclusion: Six Virtues Medicare Giver (Pediatricians) Must Possess
Friends, in conclusion, I would like to share my
experience with Choakyi Nyima Rinpoche, the Chief Monk in Kathmandu and
a medical researcher. After nearly a kilometer of walk, I reached the
white kumbha where the chief monk and his disciples were waiting to
receive me. After reception the Chief monk said, let us go to our study
room and I followed him. He climbed the first floor, the second floor,
the third floor, the fourth floor, and the fifth floor, just like a
young boy. Probably the life style has a positive impact on the mind and
body. All along I was following and following. When I reached his
chamber, I saw a laboratory and a spiritual environment overlooking the
Himalayas. What surprised me was, his research students come from
different parts of the world. Particularly he introduced me to his
co-author David R Shlim, MD who is working on a research area, Medicine
and Compassion. The chief Monk Choakyi Nyima Rinapoche and myself
exchanged few books. The Monk has written with Dr. David R. Shlim a book
titled "Medicine and Compassion". I liked this book and read it during
my journey from Kathmandu to Delhi. This book gives six important
virtues which a medical practitioner has to possess towards their
patients.
First virtue is generosity; the second virtue is pure
ethics; third is tolerance; fourth is perseverance; fifth is cultivating
pure concentration; and the sixth virtue is to be intelligent. These
virtues will empower the care givers with a human heart. I am sure,
doctors assembled here will have these six virtues that will reinforce
confidence of the citizens in the healthcare system.
Friends, we need good hearts to treat the ailing, we
need helping hands to remove the pain, and we need beautiful minds to
give happiness to the patients.
There was a meeting of cured patients, their doctors
and a few social workers in a hospital. One important point emerged
during the interaction was, that the relationship between the patient,
doctor, nurses and paramedics extends to patients’ family. This in turn
transmits effective messages from one family to another family on advice
to prevent disease, necessity of periodic checks, the dietary habits and
the need for life style changes including exercise for good health.
Actually, I believe this good contact between the doctor, nurses,
paramedics and patients is very valuable. I request every one of you to
become a teacher for the families of patients.
With these words I inaugurate the 50th Annual
Conference of Indian Academy of Pediatrics (PEDICON 2013) and I wish
success to all the members of IAP in their mission of providing quality
healthcare to the children at affordable cost.
May God Bless you.
Oath for medical professionals
1. I love my medical profession- particularly
child health a noble mission.
2. I will play the role in preventing contagious
disease among children by education and proper immunization.
3. As a doctor for child health, I will be a good
role model always striving to be best and allowing the child to
imitate.
4. I will follow the motto "Let my care, Remove
the pain and bring smiles".
5. I will always radiate cheer to give confidence
to patients and their families.
6. I will be a lifelong learner, I will practice
what I learn and I will train my team to be competent.
7. I will deliver quality care with high
standards irrespective of whom I am treating.
8. I will not introduce any diagnostic pain.
9. I will work with integrity and succeed with integrity.