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  President’s address on the occasion of 22nd Annual conference of ARSI at Midnapore
Dr.S.K.Basu (28th Nov 2014)
 
     
  Respected Swamiji, Dr. Binayak Sen, Dr. De, Chairman of the organizing committee, dignitaries in the dais, Prof. Sukumar Maiti, Organising secretary, respected seniors and my dear friends and colleagues

Indeed it is a great honor for me to stand before you as president of ARSI at this very significant historical venue of Midnapore, famous not only for its innumerable prehistoric sites including the famous ancient bustling port Tamralipta near present day’s Tamluk but more than that Midnapore has glorious recent past. Midnapore is legendary for its tremendous contribution to the history of Indian freedom movement. It has produced a seemingly endless list of martyrs and freedom fighters that had bravely faced the gallows to free our motherland from the yokes of bondage. Willingly, they sacrificed themselves in the freedom pyre. Many names come in my mind. To name a few Rishi Rajnarayan Basu, Khudiram Bose and Satyendranath Basu, Hemchandra Kanungo, Birendranath Sasmal, revolutionaries like Bimal Dasgupta, Jyothi Jibon Ghosh, Pradoot Bhattacharya, Prabhakangsu Pal, Mrigan Dutta, Anath Bandhu Panja, Ramakrishna Roy, Raja Kishor Chakraborty,Nirmal Jibon Ghosh. They all are the sons of the soil of Midnapore. I salute them and remember them with reverence.

Truly speaking, at this moment I have a mixed feeling in my mind; some thrill and more of nervousness or trepidation. Thrill, for becoming the 9th president and that too from a different specialty- a gynaecologist in a surgeon’s den although ARSI does not discriminate between a surgeon and a gynecologist or an orthpedician or an ophthalmic surgeon. All have equal value. But more than that a lot of trepidation that has casted its effect on me, thinking about my ability to match my illustrious predecessors, whose vision, hard work and commitment made rural surgery movement a successful one and made it recognized as a specialty in our country. I fondly remember them with reverence and feel myself fortunate to get the opportunity to work with each one of them. They are my illustrious predecessors Dr. Balu Shankaran, Dr. NH Antia, Dr.Tongaonkar, Dr. Sitanath De, Dr. R.D.Prabhu, Dr. Banerjee, Dr. K.C.Sharma, and Dr. Sanjay Shivade. It is their efforts that have made ARSI to stand today on a strong pedestal. They steered this association safely from its juvenile state when it had to face a certain amount of disapproval, if not hostility from its own profession.

ARSI started its journey in 1992 under the guidance of Dr. Balu Shankaran, famous orthpedician and Ex. D.G.H.S. GOI and Dr. N. H. Antia, Senior Plastic Surgeon, Director F.M.R. and adviser to GOI on health related policies along with a group of seven practitioners. They had a vision and strong believe that future of India’s health care lies in developing rural surgery and since then through its members it worked relentlessly with its mission to provide good basic surgery at affordable cost in a humane manner at the doorstep of the rural population and peri-urban slums.

Today we are holding 22nd annual conference of this organization and with certainty we can say that by now this organization has achieved its adult hood and established its credibility in many fronts. The world is looking at the work done by the rural surgeons of India as a model in public health care which is both affordable and sustainable and not tied to corporate profits. As the world grapples with the cost of privatized health care facilities and the pitfalls of insurance, rural surgeons here have shown that it is possible for doctors to stop being driven by money and return to the values of their profession instead.

Today ARSI, to a great extent, has been able to convince health authority of our country that rural surgery is a felt need and the solution to the country’s basic surgical need more so for rural India which Dr. Antia use to call Bharat. Rural surgery movement made them recognize “rural surgery” as a specialty. DNB in rural surgery course is the result of that recognition. ARSI’s philosophy and its view point of solving the basic surgical need has been shared, acknowledged and adopted by surgeons of other need based countries. Formation of IFRS is the response to that philosophy. There are many overseas personalities whose efforts jointly together with ARSI’s effort made it possible. In this regard the first name which comes to my mind is DTC (German society for tropical surgery), whose contribution to ARSI’s growth and spreading the concept of rural surgery was enormous. They sponsored our members as well as members from other developing countries to attend regularly their meeting in Germany, as well in our country to exchange and share views amongst us. It will not be an exaggeration to say that this exchange of surgeons from various need based countries had showed the seed of internationalism in our thought. DTC was also responsible in a big way to spread the concept of rural surgery by sending our bulletin to many countries across the world. I humbly express my gratitude to DTC and specially Dr. Gabriele Holoch and Dr. Thomas Moch for their valuable help. My gratitude also to Dr Awojobi Oluyombo, presently the secretary of IFRS, who was not only instrumental in formation of IFRS, but also spreading the concept of Rural surgery uncompromisingly in his own country and other part of the world. He was successful in convincing his own colleagues about the need of implementing the concept. Formation of ARSPON in Nigeria under his leadership is the testimony of that endeavor. Though there are many to be named from overseas I would like to mention at least two more names whose contribution was unfathomable. Dr. Peter Rimst from Holland, presently the treasurer and a silent worker of IFRS and the other one was my close friend and also was past president of IFRS, Late Dr. Passience Kibatala from Tanzania. His passion and commitment for rural surgery was unmatched. Those who had attended IFRS conference in Tanzania must have realized that. His loss is a great loss for all of us. My sincere gratitude to all of them. I also take this opportunity to thank delegates from Bangladesh particularly Dr. Kader, Dr. Sohel Ali, Dr.Iqbal Hossain and many others who few years back made their own association, joined IFRS platform and expressed their desire to hold next International Conference of IFRS in their country. I am very happy to note that they have come here in large no. to attend this conference.

At this juncture I shall be failing in my duties if I do not mention two more personalities who, staying in the background like a playback singer kept the activities of ARSI alive, DR.Swaran Arora and Prof. Dr. Tehemton Udwadia. There cannot be another opinion about their keen interest in rural surgery. Dr. Arora volunteered and single handedly organized National conference in Pune that too immediately after attending the IFRS conference in Tanzania where again she took the entire responsibility on her shoulder to lead the largest delegates of Rural surgeons from India and again within a year time organized the international conference of rural surgery in Rajasthan, where we had the pleasure of having maximum no of foreign delegates from various countries. I humbly acknowledge the sincere effort of Dr. Udwadia in bringing out a special issue on rural surgery (unprecedented) in ASI journal (I am privileged to have my article in it as an obstetrician and gynecologist) and taking rural surgeons in Berlin conference in the face of widespread opposition to highlight the innovation, appropriateness, spirit of adventure and advances of the Indian rural surgeon to the international surgical community. All these are testimony to his fondness for ARSI and rural surgery movement. Every time, whenever I requested him to attend our conference he always responded positively in spite of his busy prior engagement. And now, I was told that he is in touch with Ratan Tata to get him interested in rural surgery affairs.

Dear colleagues even before ARSI was born many of you were aware of WHO’s declaration - Health for all by 2000AD in Alma-Ata conference held in 78. Primary health care was thought to be the key to achieve that goal. Regrettably because of various reasons that goal was not achieved. Then we heard of the Millennium Development Goals (MDGs) in2000 consisting eight international development goals, supposed to be achieved by 2015. Unfortunately there is general consensus in the international Community that while there has been some progress in achieving the MDGs, the majority of Goals will not be met by 2015. On the other hand the prophetic address by former WHO Director-General Halfdan T Mahler “Surgery and Health for all” has echoed without response since 1980. Even today the reality is that estimated more than 2 billion people lack access to surgical services when needed. The devastating effects of insufficient surgery added with poverty traps have already made a huge epidemiological shift with vast demand of surgical care need. And with that shift we can no longer afford not to treat conditions like abdominal emergencies, injuries, burn, obstructed labor, cataract, clubfoot, cleft palate, appendicitis, Hernia, trauma and many more. Jim Yong Kim, President of The World Bank, underlined current challenges in the delivery of surgical care: “the poor suffer due to a shortage of skilled personnel, inadequate infrastructure, and a pay-as-you-go approach to financing surgical care”. For obvious reason present scenario propounds a strategy for closing the global surgery divide. We do not know what the future is there in storefor. We do not know whether global surgery will face a turning point in post 2015 agenda in Sustainable Development Goals (SDGs), though there is also great cause for optimism. But we certainly know and realize that to address today's anachronistic gaps of surgical coverage, one of the primary requirements is good surgical skills and operative management with basic infrastructure. Therefore my humble appeal to my colleagues; let us develop that skill more and more, develop that infrastructure with our innovative skill, teach others as and when we get the opportunity and practice more and more those essential surgeries so that surgical coverage can be provided to those who need it and thus humbly contribute to close that gap of surgical divide. Essential surgery is an important challenge for the coming years. It is a basic, inexpensive, surgical procedure that can prevent lifelong disabilities and can be performed by a primary health care provider. These surgeries do not require advanced technology or expensive equipment commonly unavailable in basic hospitals or healthcare facilities. I am not going to talk of any particular strategy because different strategies tend to polarise around artificial dichotomies. Let the world health assembly decide on that. If needed, we will modify it as per our need of training, list and equipment. More over there is no vertical silver bullet for the complex challenges of surgery for all. Therefore just do it as much as you can, keeping human values in mind.

My dear friends, before I close I would like to quote some words of Dr. N.H.Antia. Dr. Antia used to say, I quote “ARSI does not represent an association of second rate surgeons who provide second rate surgery to second rate citizens in second rate rural India or urban slums. It represents those who despite the training and values inculcated in our medical colleges have retained human values and courage to swim against the popular tide which has engulfed many of our profession”. (Unquote) He always felt that the originality of our members which contributes to the success of their surgery at such low cost needs to be carefully documented and the experiences exchanged.

In one of the recent discourse by a saint that I attended, the saint was explaining about 2120 attitude. He said at 211 degrees...water is hot. At 212 degrees...it boils. And with boiling water, comes steam. And steam can power a locomotive. And, it’s that one extra degree that makes all the difference in life; it’s that one extra degree of effort that separates the good from the great. What I love about the 212° idea is that you can use it to fit your own needs. It may be 212° service that you’d like to reinforce, or attitude, leadership, or quality to differentiate you from your competition. My long continued association with ARSI made me convinced that majority of its members believes in that 212°degree attitude which they have already proved in many occasions. And with that spirit I have strong conviction that collectively we can take this organization much ahead to a greater high.

My message to my esteemed colleague is you have chosen your path superbly, and though you may not see it yet, you've already mustered the courage you had to muster, faced the fears you had to face, braved the storms, fought the battles, and exceeded every expectation you ever had for being the kind of person you hoped that you would be. Please keep it up.

I thank the organizers Prof. Sukumar Maiti and his team. Thank you all for coming and participating in our conference. Long live ARSI