After talking about his passion for thoracic surgery and dedication towards tuberculosis in part 1 of the DocScopy session, welcome to the 2nd part of this interesting conversation with Dr. Ravindra Dewan, Professor and Director of National Institute of Tuberculosis and Respiratory Diseases [NITRD] and MedBound Times [Parul Soni and Dr. Aarti Nehra]

Dr. Aarti: Privatization is going on in everything, corporate system is everywhere just like in the US. But can government healthcare facilities bring in that level of care to the public? what can we plan to improve our healthcare system...

Dr. Dewan: Despite my institute being well-funded, I'm never satiated. I need more funding for various facilities. Government efforts alone will not be enough for a huge nation like ours, Moreover, 80% of people seek medical care from the private sector and go to corporate hospitals. That’s why we thought about a Public-private partnership program in 2004, where if any private practitioner or corporate hospital is looking after a sputum-positive TB patient,  and if the doctor agrees then the patient can be enrolled in this program and can avail all the drugs needed for the treatment. All private practitioners can take part, but a standard treatment protocol has to be followed, as I have observed that different practitioners treat TB in a very irrational manner.

We found in our survey which was done in 1995 in a small area around our hospital that 80 different treatment regimens for Antitubercular drugs were being given. We need to have a standard regimen, a system that needs to be followed. we are willing to train and retrain doctors to follow a standard & uniform drug regimen. Modules have been developed to achieve success in treating TB and preventing drug resistance. The use of the drug Bedaquiline (which has the most success rate in TB) is still not permitted in private practices to prevent it from being overused and ultimately becoming a resistant drug, as has been the case with most of the drugs previously prescribed.

Research is underway to allow the private and government sectors to work together, however, as the disease mainly affects the poor, the role of the government sector will be more important.

Parul: What is your view on "Access to Health Care" and the health care system in India?

Dr. Dewan: I don't need to be politically correct. There are serious challenges to our healthcare system. There are severe deficiencies in the quality of the education that is being provided because of commercial interest having entered the healthcare field.  Corporate sector hospitals have done a great service to the nation by bringing in cutting-edge technology but as such to the general society, it has caused certain harm.

There are many serious challenges, to the profession that need to be addressed in a collective manner.

• As healthcare has become commercial, it loses the core objective of taking care of patients.

• The admission process to medical colleges is undergoing complex changes and medical education is losing its charm. Medical education is a part of the knowledge that we gain, plus the skills we develop as clinicians and human sensitive attitude towards looking after patients which can be achieved only under the mentorship model.  This model is getting strained because of the current education system.

• This profession is becoming less and less lucrative as it takes a lot of years to settle down. The best talent is not getting attracted to the medical profession as it used to get earlier.

• Another thing is the increase in the incidences of violence against Doctors across the country. This is hurting the morale of Doctors and is stopping people from taking up medical courses.

• We need to change with time as patients and their expectations have changed, and so much information is readily available on the internet, … We need to think about how to professionally utilize that knowledge.

Dr. Aarti: Sir, the recent thing about Medical teaching in Hindi language, what are your thoughts on that?

Dr. Dewan: It is absolutely unnecessary and futile. One good thing is that medical terminology will remain the same, but the structure of the language will be Hindi. But these are needless efforts, I think it is undermining our basic aim of medical education. Of course, Hindi language needs support and it should be done in academia and universities, along with development of all languages across the country, I am all for that, but mixing it with medical and technical education is unnecessary.

Dr. Aarti: Sir, can you tell us any one incidence you distinctly remember or any clinical case that has left an impression on you?

Dr. Dewan: [smiles] As a surgeon, I come across cases like those every day... If you insist, I will tell you about this case..

One patient came to me from the West Indies, don't know how! She had a small tumor in her lung. It was a difficult case of TB and a surgical challenge as the pulmonary artery had ruptured, I had almost no assistance other than the nurse. I got the pulmonary artery under control by opening the pericardium, took a suture behind the vessel and sewed it up and by the grace of God somehow it worked. We saved the patient.

The same nurse accompanied me to Armenia for several surgical cases. We were a team of doctors of different nationalities who went to another country to perform surgery. A very unforgettable experience of my journey.

Dr. Aarti: Great! That was a success, can you please share, what were the disappointments in your journey where you feel something else could have worked or you could have done it differently?

Dr. Dewan: From the very beginning I kept a log of wherever I failed, such as to keep a record of mortalities. There were several people who came into my care, who succumbed due to lack of early treatment. They could have come earlier. I lost 8 patients on the operating table due to hemorrhage; I did my best to save them. Whenever a surgeon loses a patient, that is a terrible experience. We must keep a faithful record, and transfer all learnings we gathered from our experiences, for better patientcare.

Now we keep an excel spreadsheet to keep track of patient success and mortality. We exchange techniques for better results. I was appreciated by the fraternity for presenting my failures in an honest manner.

But it is not easy and it’s heart-shattering. It’s a part of the surgical journey.. It’s a part of learning..The fact is not to get disheartened by it but to learn from it and move on…

Parul: As a director and a thoracic surgeon what message you want to send across the medical community including juniors?

Dr. Dewan: Don't take any surgical procedure lightly even when it’s a small procedure, as we are dealing with human body, for example, chest tube insertion, mostly done by juniors. It causes so much pain and unnecessary morbidity, so I teach my students the procedure of putting in a chest tube, or removing dressing, etc. and that these things are as important as surgical procedure. I always tell them that once you do the basics repeatedly very well, the complex surgery also becomes easier. That is why I say apprenticeships/mentorship are very important parts of medical education which is undervalued in the present scenario. 

Parul: What are your goals in coming years, what next?

Dr. Dewan:  My aim as a director is to strengthen this institution. Then we are working on several projects in collaboration with international associations, WHO and the Central TB Federation of India. I will continue to work and strengthen this system to the best of my abilities.

My ultimate goal is to work towards TB eradication program, and to be as useful as possible.

Parul: What would you like to do after retirement? Would you like to travel or continue working or take rest?

Dr. Dewan: I have never undervalued the importance of rest in my life even when I am working, work-life balance should always be there. Of course, being productive or happy means that you continue to work in some capacity that is useful and meaningful.

Dr. Aarti: What would you have done if you were not a doctor?

Dr. Dewan: My wife is a professor of English literature; I'd just be reading all the English novels, the good literature... [laughs]

Dr. Aarti: What does your wife have to say about you?

Dr Dewan: My wife likes that I am a committed doctor. She's very supportive, and we've always had similar plans and visions.

Dr. Aarti: How do your colleagues / students describe you?

Dr. Dewan: Sometimes I'm unfairly labeled as a strict person, but I have a firm attitude when it comes to patient care, I take everything seriously. All my students have great regard for me.

Dr. Aarti: Kindly mention a few positive traits about yourself?

Dr. Dewan: I am very passionate about my work. I also analyze problems quickly as an administrator, I have the ability to cut down on clutter in the medical field and get to the root of the problem quickly.

Dr. Aarti: If your life was a movie, what would be the title?

Dr. Dewan: My life is too boring to make it into a movie.

Dr. Aarti: If you had a choice of eating only one thing for an entire year, what would it be?

Dr. Dewan: A simple dal chawal is all I need.

Parul: What do you do in your leisure time?

Dr. Dewan: Reading books, listening to Hindi music and socializing with people.

Dr. Aarti: Are you interested in politics?

Dr. Dewan: yes, I am interested in politics.

Parul: What is your favorite quote that you can relate to?

Dr. Dewan: "Terrorists are killing people, Paper bombings are happening, but i believe that the human story far from ending has just begun!" These words have influenced me as we saw the computer revolution and many more improvements happening after 90s...

MedBoundTimes is extremely grateful to Dr. Ravindra Dewan for sparing his time and talking to us.

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