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I am very happy to be addressing
this gathering today for more than one reason. We are in a unique
state of Tamilnadu that is said to be the abode of Lord Shiva. It
has produced great thinkers like Thiruvalluvar, C. Rajagopalachari
first Govener General of India, S. Radhakrishan our past president
of India, Dr. A.P .J. Abdul Kalam the current President of India,
and great political leaders like Kamaraj Nadar and Anna Durai. Vivekananda
and Ramana Maharshi had their enlightenment in this state. State
language Tamil, is one of the very oldest languages of India. Secondly,
this is a unique conference. For the first time the Association
of Rural Surgeons of India and the Association of Surgeons of Rural
India, a section of ASI have come together in a conference. For
the first time a past president of International Federation of Obstetricians
and Gynaecologists, namely Dr. Shirish Sheth from Mumbai is participating
in our conference. We have the Secretary of the Association of Surgeons
of India, Dr. Kamaluddin with us. We have Dr. Fred Finseth and Christine
from USA Dr. Thomas Moch and Prof. Hagelmaier from Germany, Dr.
Peter Reemst and Dr. Ham from Holland with their wives, Dr. Vincen
Mubangizi from Uganda and Dr. Kibatala and his wife from Tanzania.
It is wonderful to have you all here with us; I welcome you all.
During this conference, I would like to remember some of the
wonderful people whose contributions have been responsible for
the recognition and development of rural surgery in India. Many
attempts made in the past to focus attention on rural surgery
met with very little success. The first meaningful step taken
in that direction was perhaps in 1975, during the ASICON in Bangalore,
where Dr. Talwalkar organised a seminar on rural surgery. But
the real break came only in 1987, when Dr. N. Rangabashyam, as
the president of ASI, took a bold and historic step of creating
a Rural Health Care Committee. In the following year, 1988, President
Dr. Udwadia gave even more support and importance to rural surgery
despite strong opposition from some office bearers. His commitment
to rural surgery needs no better proof than the special issue
of Indian Journal of Surgery on rural surgery a year ago. These
two great persons brought together many rural surgeons from all over
our country. Later on many more rural surgeons joined hands with
us.
Unfortunately, Rural Health Care committee, later called Rural
Surgery committee, was in doldrums for the next 4 years. Just
when we all were getting disheartened, there arrived two more
important personalities on the scene. Dr. Antia a well known Plastic
surgeon, Director F.M.R. and adviser to GOI on health related
policies and Dr. Balu Sankaran, a retired Director General of
Health Services of India and who had worked for the WHO. They
both not only encouraged us but also joined hands with us. They
too believed that future of India' s health care lies in developing
rural surgery. I heard Dr. Antia say to a senior surgeon that
India has no future without rural surgery. ARSI. Was formally
launched on 29th of November 1992 in Shimoga. Dr. Sankaran became
the first president and Dr. Antia the second. During the initial
difficult days of ARSI Dr. J.K.Banerjee was very generous in sharing
large amounts of his DANIDA funds for promotion of rural surgery,
and that included ARSI. Then came a big donation from Pirojsha
Godrej Foundation and then onwards we have been doing well. Today,
I thankfully remember all these people and institutions for their
role in the development of ARSI.
People have started taking note of Rural Surgery now. ASI kindly
started the section that is with us here to day. The Indian section
of International College of Surgeons, is honouring rural surgeons,
and is now going to have a separate session on rural surgery during
its next, golden jubilee conference. All these are encouraging
developments for rural surgery.
In my opinion, any national body or association of any profession
has two primary obligations:
- to look after the
interests of its members and the profession it represents;
most of the associations do this any way.
- to ensure that its
activities and programmes are in tune with the interests
of the nation and fellow citizens.
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I am happy and proud to say that ARSI has been discharging
these two obligations from the beginning. Like any other association,
it has its annual conferences, C.M.E.s and workshops. In addition
ARSI also makes every possible effort to solve the problems faced
by its members. Let me give one good example. The introduction of
blood bank rules suddenly closed availability of safe blood to most
of the rural patients and rural surgeons. Our agitation lead by
Dr. Tongaonkar, was a major factor in the introduction of Blood
Storage centres or the satellite blood banks. We are continuing
our attempts to have permission to perform UDBT, i.e. fresh blood
transfusion from donors to patients without storing it in a bank.
We also encourage our members to update their knowledge and skills.
In the fast changing medical scene, this is essential and so ARSI
has instituted Shimoga Jhargram scholarship, for this purpose. Our
members have been learning newer techniques with this scholarship.
The second obligation is very important too. But unfortunately
very few associations focus on it. National Human Development
Report 2001 reports that less than 20% of our population has access
to allopathic medicine, and even less than that, to the emergency
surgical care. While this is the scene at home, we hear of the
proud claims that Indian doctors form the backbone of health care
in many other countries. Recently, medical colleges and corporate
hospitals met in Singapore to "export" health care services,
that too with blessings of the government. It almost sounds as
though we are happier serving the foreign nationals in preference
to serving our own patients. Financial gains are taking priority
over service to the nation. I wonder how many of you approve of
such attitudes. We are proud that ARSI gives priority to providing
the basic and emergency surgical care to the nearly 80% who are
denied of it. The best way for us to achieve this is to modify
the current surgery in to one that suits the needs of our people.
India had a wonderful scientific Indian system of surgery in Ayurveda,
developed by Sushruta over 2600 years ago. Though it was perhaps,
the most advanced surgical science at the time, for various reasons
it has remained neglected and greater parts of it are not useful
now! Undisputedly the modern surgery is far superior and irreplaceable.
But I believe that it has to be modified according to the needs
and constraints of our people. We are convinced that it is possible
to evolve a simpler, feasible and affordable technology even in
modem surgery. It may be called the "Indian surgery"
if you wish, and rural surgery as we know now would certainly
be the essence of it. This may then be accepted every where in
our country .I have noticed that once a rural hospital is started
in a place, the specialty services tend to follow soon; and advanced
surgical care also becomes available. The primary need therefore
is a rural surgeon in a rural hospital performing "Indian"
surgery.
Unfortunately in the present days of globalisation, the popular
"mantra" in academic circles is quite the opposite. It
is to go for the so called 'very best' and 'the latest' under the
veil of academic perfection though they may be inaccessible and
unaffordable. Even Charaka the other great physician had said thousands
of years ago, that "effective treatment without frills should
be given to those who could not afford the full treatment."
(Dr. Valiathan, "Charaka and his legacy"; O.L.P.Ltd. p
X). This statement is valid even today. Unfortunately modern mantra
makes surgeries costlier and out of reaches of the common man. Thus
globalisation defeats the very aim of taking surgery to rural areas;
and the surgeons fail to satisfy their important second obligation;
that is, to serve the nation and people through their vocation.
Such surgeons tend to lose their respectful places in their community.
“Prãjnasya moorkhasya cha kãrya-yoge
Samatvam abhyeti tanuhu na buddhihi.”
Quality of a person's action (surgeon's action in our case) is judged,
not merely by the physical quality of the action but by the intent
of that action
| Bhasa,
in “Avameer” drama |
The certificate course
in rural surgery, (CRS), by the Indira Gandhi National Open University
was expressly developed to achieve this goal; that is, to simplify
and to popularise a meaningful rural surgery in the service of the
nation. CRS can enable any fresh surgical graduate to feel confident
of venturing into remote areas to practice. Not surprisingly, there
was opposition to this. I was even told by a leading surgeon in
my state that this is a retrograde step, but we believe that this
is a step in the right direction. If the same programme had come
through a Royal college I expect everyone would have welcomed it
with open arms. Surgery
can be made affordable in many indigenous ways. We have even instituted
a Antia-Finseth cash award for useful innovations that will help
improve rural health care. For example, one innovation that reduces
the cost of hernia repairs is the use of nylon mosquito net. It
costs only a Rupee or two compared to over Rs. l000 of a Proline
mesh of similar size. The nylon mesh, which in fact is a polypropylene
mesh, is found to be an extremely satisfactory and viable alternative
to the Proline mesh. Here too some professors have raised objections
even without making any detailed study of it. The protagonists
of high tech gadgets and investigations must realise that the
western health care industries place their own commercial interests
far above the health and welfare of other people. Ramachadran's
article in 'Frontline' of Apri12004, describes in detail how "India
has become a dumping ground for obsolete or poor-quality Western
devices that are discarded abroad owing to their adverse effects".
We proudly decide our health care standards on such "imported"
equipment and also use such costly drugs. We neither have the
authorities to check this trend nor the desire to accept the fact
that we are being robbed! However we in ARSI believe in simplifying
surgical care to cut all such unnecessary costs. President A.P.J.
Abdul Kalam has rightly said that unless India stands up to the
world no one will respect us. We can prove that in fact, such
Indian Surgery is, not only feasible and practical, but also viable.
But first our own colleagues must change their outlook and accept
it. Then the world too will accept it.
1 am happy to say that even
when our own colleagues were unhappy with our starting of the
ARSI, the German Society for Tropical Surgery called DTC in Germany,
encouraged us in many ways. DTC deliberates on surgery in developing
countries similar to our rural surgery. Our members are regularly
sponsored by DTC to participate in their meeting in Germany. I
thank DTC and specially Dr. Gabriele Holoch and Dr. Thomas Moch
for their help each year. ARSI too sets apart some funds each
year to entertain some delegates from other countries like Africa
in our conferences. This exchange has sowed the seed of internationalism
in our outlooks. Now we are on the threshold of launching International
Society of Rural Surgery. The rural surgery is equally relevant
to Africa and other developing countries. Indian Surgery as described
earlier, with modifications to suit each of the countries could
be the rural surgery for any of the developing countries. Hopefully,
in due course of time more countries will be interested in the
international society. We are thankful to Dr. Thomas Moch, and
Dr. Banerjee for their leadership in initiating the idea of International
Society and hope that it will be supported by all.
I thank you all for coming here today. Do participate in all our
deliberations in this conference and enjoy your visit to this very
interesting town, Sivakasi.
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