Welcome to the second part of this extraordinary journey of Dr. Surya Kant with Dr. Purnoor from MedBound Times. If you have not read part-1, click on the above story to check it out.

Dr. Purnoor: How do you stay up to date with the latest developments and breakthroughs in respiratory medicine?

Dr. Suryakant: You see, whenever you become a well-known personality because once you become the national leader, you are accepted as a good orator. Then of course people demand various lectures.

And during Covid, I think more than a hundred webinar lectures I have delivered. So when you want to speak, you have to prepare. So that is now not my choice. That has become a compulsion for me in the last decade I have to learn. I have to update, I have to prepare.

And even if you see now, it has become very simple, there are so many around 500 prepared lectures. What I want to do once I'm getting the same topic, I have to update what happened in the last two years, three years, that's all. So one way of updating is by presenting the various lectures in seminars, and webinar conferences.

This is number one. Number two is panel discussion is also very important learning because, for example, you are in an international panel discussion, so you are getting input from the international fraternity. You are getting the panel input from the national faculty fraternity and different kinds of, it's almost 360 di degree type of learning when you get the learning from various panelists.

That is another thing is that when you are guiding these students, so they are writing the thesis and you have to guide them. So that is also another way of updating and of course, then you are publishing the articles. Whenever you write an article, of course, it has to be updated. These are the ways and means by which you can update.

And then, of course, there is a public domain demand also, I used to write in media, and I've written books also. I've written 19 books till now. Out of the 19 books, seven books are in Hindi. So when you are writing something for the public or public you know, they will correct you using Google searches quickly. So then, of course, this is also your compulsion that you have to be updated.

Dr. Purnoor: Are there any specific challenges in the field of respiratory medicine?

Dr. Surya Kant: Yes, coming to my specialty, I would say again, the formula of three decades. Three decades ago, respiratory medicine was called Tuberculosis and Chest Diseases, and 70–75% of the focus was relatively on tuberculosis.

Everybody thought that these people were dealing with a very infectious type of disease or social stigma disease, and that's why even the specialty was considered untouchable.

"Oh, this is a TB, doctor; stay away from him! Don't go to his ward. Don't go to his hospital. Only TB patients are staying there. Doctor Sahab is always surrounded by TB patients."

So, in the last 30 years, this specialty has evolved into the respiratory medicine or pulmonary medicine specialty.

Several diseases, beyond tuberculosis, have emerged as major respiratory health concerns in recent times. While some of these diseases existed previously, they were not as prominent or widespread. Chronic obstructive airway diseases like asthma, chronic obstructive pulmonary diseases, interstitial lung diseases, lung cancer, and allergic disorders such as allergic rhinitis, skin allergies, and food allergies have now become prevalent. Additionally, smoking-related disorders, occupational lung diseases, environment-related diseases, and numerous other respiratory disorders have also come to the forefront.

When you increase urbanization, there is a lot of construction, which leads to infrastructure development. So in three decades, due to increasing urbanization, modernization, and industrialization, a lot of air pollution has come in a big way, and that's why lung disorders and respiratory system disorders have increased. Not only have they increased, but now there is also a public awareness that for this we need a specialist, which is called a pulmonologist or a respiratory physician.

Now, whatever has happened in the last three decades has happened more in the last three years. During the COVID era, the public understood the significance of the respiratory physician and the importance of breathing. What is the importance of oxygen? What is the importance of the lung? What is the importance of a lung specialist?

At that time, 30–40% of doctors were also COVID-positive. There is a scarcity of manpower, and nobody will believe that Dr. Surya Kant utilized even the dentists to work in the COVID.

Now I can declare and open my secret: even the dentists at my university I trained, and then I utilized them as healthcare workers during the COVID era. There was no option.

When I asked my Vice Chancellor, "Sir, I don't have doctors for duties." He said, "Dr. Surya Kant, I'm the Vice-Chancellor; you are in charge. I don't know how to manage; you have to manage." So I have to manage. So that was the time when the specialty grew up.

Second, interventional pulmonology has emerged as a new branch. Advanced lung function is a major thing.

Tuberculosis has been picked up as a national health problem. It has become a national health program.

Very importantly, infrastructure has developed. So that's why we people are also known as the managers and the administrators of tuberculosis treatment as part of the national health program.

So, whatever the legacy we built in terms of tuberculosis, we are continuing it in various ways. We have become modern. We have an online portal for registering TB patients; we have the free diagnosis and free treatment; and we are giving 500 rupees per month as nutrition support to all TB patients.

So many things have happened in the last few years. And we have developed new diagnostic tools.

When I was an MD student, there were only two important investigations. One is the sputum examination. Second is the chest X-ray; that's it.

Now we are doing not only basic pulmonary functions but also advanced lung functions, bronchoscopy, and thoracoscopy. So these are the developments.

Now, challenges for respiratory physicians: The number one challenge is that people are increasing or contributing to air pollution and all kinds of pollution. Then, of course, the burden of these diseases goes to respiratory physicians. The problem is that India doesn't have many respiratory physicians right now. The increasing prevalence of smoking and, of course, the burden of lung diseases falls on the respiratory physician because of urbanization, industrialization, and modernization.

Or so that's why I have a few patients, even after a good treatment, who become RESPIRATORY-CRIPPLED. I use this term. This is the real challenge. One example I will give you is of a rickshaw puller developing pulmonary tuberculosis of the lung. He got treatment from the national health program by virtue of the honorable Mr. Prime Minister; he got free tests; free treatment; he got five hundred rupees per month; and within six months he got cured. He has been treated successfully and has been cured, but now his lungs are weak. He has post-tubercular fibrosis of the lung. Now he cannot pull the rickshaw. So the current issue is vocational rehabilitation. There is no government or public agency that cares for these patients, and they will return to the respiratory physician and say, "Doctor, I followed your advice religiously, I completed the medication course. But what do I do? I am still breathless when I walk."

Additionally, they say, someone else did the deeds, and someone else has to pay for them. Like if you are smoking cigarettes, you are contributing to air pollution. But now you want the respiratory physician to treat everything magically. Who is responsible for major construction projects leading to particulate matter in the air? In construction, usually engineers are involved. A contractor is involved, or if it is for a government facility, the government is involved. If it is a private project, the public is involved, but never the doctor. There is air pollution due to increasing infrastructure. There is an increasing number of expressways, all leading to excessive construction and increased pollution. Adding on to all this, there is vehicular pollution these days. Only two people live in one house, but these two people own four cars. So much chemical pollution is there; laboratories release chemical fumes. Ultimately, we are polluting our atmosphere, and we are bound to breathe polluted air. Because of the polluted air, we are having a lot of lung diseases. So contributory factors are outside the medical fraternity, but ultimately the burden comes to respiratory physicians.

So these are the real challenges for a pulmonologist, a respiratory physician.

Thank You for being part of this journey till now. The story hasn't still ended yet. Stay tuned for the last part to know some interesting clinical and career-related situations faced by Dr. Surya Kant.