The first question that I must answer is that Why
I chose Pediatrics? In this context I am reminded of Mother Teresa’s
answer to "How did you pick up your first destitute patient ?" The
answer was – "He happened to come in my path. I also picked up
Pediatrics, because it came in my path. In the MBBS final I had scored
fewer marks than another classmate who opted for Medicine. As the only
paid job that could enable me to do postgraduation was in Pediatrics, I
had no choice. To tell you the truth, I wept, on that day. But we are
unaware of Gods plans for us. My journey in Pediatrics was far happier
and smoother than of my friend who got Medicine. Prof J N Pohowalla, was
a very encouraging mentor and not only taught me pediatrics, but also
shaped my character. He told me "You will be a happy man for giving up a
Duchess and choosing a girl in rags." So do not curse your luck on an
occasional failure but get up and start your work with a new vigor. You
must do what you like and love what you do. Being in the wrong
profession is like being in an incompatible marriage, with the
additional disadvantage that you cannot change your path because you
have already invested many years in it. I have no doubt, that it was my
love for the kids that carried me the distance.
I joined the department of Pediatrics, at MGM Medical
College, Indore in 1955. The department had only four members - a Reader
(Dr JN Pohowalla), a Demonstrator and two House-physicians. The work
load was heavy with an outpatient of about 150 patients and 18-20
admissions every day, for which the staff was grossly inadequate.
Despite these constraints, Dr Pohowalla took upon himself to organize a
conference of the Indian Pediatric Society, which placed a heavy load of
work on all members of the staff, especially Dr Pohowalla. The
conference was attended by about 60 delegates, but it left all of us
exhausted. After the conference, one day I asked Dr Pohowalla, whether
all the hard work he had put in was worthwhile and what was achieved as
a result thereof ? His answer taught me an important lesson. He said "it
is important to educate the medical educators and administrators." As
regards the achievement, he said "We have taught the literate population
of Madhya Pradesh how to spell Pediatrics."
Pediatrics used to be a unit of the Department of
Medicine with a Reader as its head. A much respected Reader from the
Department of Medicine, tried to dissuade me from joining pediatrics
department by telling me, "You will not find it interesting. There are
only two diseases that afflict children, diarrhea and pneumonia and
there are only two medicines, oxygen and saline." Despite this
well-meant advice, I joined Pediatrics and have never regretted my
choice. In the last 50 years, Pediatrics has grown into a stimulating
and exciting discipline which attracts some of the brightest students
from the profession.
A matter of great concern in those days was that
Pediatrics was not represented in the MBBS final examination and
therefore students paid little attention to the subject. Our batch was
posted for one month to the pediatric unit, barely three months before
the 3rd professional examination. One of the students was not regular in
her work in the ward. One day Dr Pohowalla asked her why she was
neglecting her patients. She said our Pathology examination is so near
so I am focusing on that. Dr Pohowalla told her "I can understand your
pathological attitude to Pediatrics." The student retorted "No Sir, it
is my physiological attitude to Pathology." Except the Nagpur Medical
College and All India Institute of Medical Sciences at Delhi, Pediatrics
did not find a place in the MBBS final examination till 1995.
In 1992, the Medical Council of India (MCI) formed a
Committee to review the MBBS curriculum. Dr BNS Walia and Dr Jon Rhode
who was the UNICEF representative in India were the two pediatricians in
this Committee. This Committee recommended that Pediatrics should be a
separate subject with a theory paper and practical examination. Dr B C
Chapparwal who was Vice-President of the MCI, steered the proposal
through the Executive Committee and General Body of MCI to make real a
four decade old dream of every academic pediatrician.
During your professional life, you will come across
numerous hurdles. Every hurdle is a challenge and every failure also has
a lesson! Remember every hurdle does not require confrontation. Many of
these obstacles can be bypassed and a lot of energy and effort can be
saved. To give you an example when preparing the proposal for Advanced
Pediatric Centre at Chandigarh, I was sure that if neurology and
nephrology were included in the proposed plan for Pediatric Centre, it
would be strongly opposed by the heads of adult departments of neurology
and nephrology. Therefore, I chose the strategy of dressing up neurology
with the name Developmental Neurology and avoid including nephrology
altogether.
For success in your mission, you must know where you
are going. The direction is more important than the speed of journey. Do
not hesitate to get started. Every journey, howsoever long or arduous,
starts with the first faltering step. Do not hesitate to change your
course. Go on in the face of opposition. To quote Prof Pohowalla once
again, he used to say "Let others do their dirty tricks, but they cannot
stop us from working." Avoid conflict within the department as well as
with other departments unless an important principle is involved. This
is possible, if we are humble enough to acknowledge that, when we
ourselves are not perfect, it does not behoove well of us to talk ill of
others.
Pediatrics was well recognized in Ayurveda. There are
chapters in the ancient texts dealing with illnesses of children. Modern
Pediatrics in India was born in Mumbai in 1927, with Dr George Coelho,
an outstanding physician taking over charge of the B J Wadia Hospital
for Children in Mumbai. Numerous of his students like PM Udani, SM
Merchant, MP Bhagat and JN Pohowalla, built on his legacy. Dr Coelho was
a gentle soft spoken man. In spite of being bound to wheel chair, as a
result of poliomyelitis, he found enough time to take care of children
in the hospital, look after his busy practice and yet find time to edit
the Journal of Association of Physicians of India!
Another giant who strode like a colossus in Kolkata
was Dr KC Chaudhury. He set up his clinic in Kolkata on return from
Vienna where he received his postgraduate training. I was told by Dr
Pohowalla, who was a very close friend of Dr K C Chaudhury, that from
the day he opened his practice, he started putting the fee received from
the first patient of the day in a piggy box, which would be emptied
periodically and the money transferred to a special bank account. It was
this money that enabled him to buy land for the Institute of Child
Health, Kolkata. His passion for building the Institute was such that he
drained out his own bank account for construction of the Institute to
the extent, that a cheque issued by him as payment for an Ambassador
car, bounced. Here was a man with a clear goal who was willing to make
any sacrifice for the sake of children of our land.
A few months after I joined the All India Institute
of Medical Sciences; Dr PN Taneja took over as Head of the Department of
Pediatrics. Prof Taneja was ‘energy’ personified. He was an inspiring
leader not only of our team but soon assumed important role of
Professor-in-Charge of College Section. No Dean or Sub-Dean had been
appointed so far at the Institute. Prof Taneja established the entire
system of curriculum plans of all departments for postgraduate education
and for conduct of examination. He used this opportunity to persuade the
Academic Committee to accept his proposal for introducing an examination
for pediatrics in the MBBS final. This was a path-breaking innovation in
the undergraduate medical curriculum and became possible only because of
Dr Taneja’s persuasive skills.
Ability to tackle a crisis is one of the important
tests of leadership. On one occasion, the safai karamcharis of
the Institute went on strike from midnight. Before the men on duty at
zero hour left their place of work, they choked the water closets with
rags and gunny bags. When we came to work next morning, the drains were
blocked and water spilling out in the corridors. Dr Taneja saw the
situation and told the sister in-charge of the ward to bring some
gloves. He donned the gloves and put his hand into the muck-filled water
closet to take out the rags that were blocking it. Seeing him do this,
Dr OP Ghai filled a bucket of water and I took a broom to wash the dirty
floor. The place was clean in a few minutes and we resumed work. Other
departments followed suit and the safai karamcharis had to come
back to the negotiating table. Prof Taneja used to say you can influence
the decision making in an organization only by working for it. If you
willingly take additional responsibilities, you will be listened to. One
of his famous quotes was "Energy can never be destroyed; it can only
be transformed for a worthwhile purpose."
Unfortunately, Prof. Taneja resigned from his post
after two years and academic pediatrics lost a charismatic leader. The
pediatrics training programs for the undergraduates as well as
postgraduates established by him are still being practiced with minor
variations at the All India Institute of Medical Sciences. And that is
the legacy of a man who combined outstanding clinical and teaching
skills with leadership. After Dr Taneja left AIIMS, the Institute
invited Prof Alex Stiegman of Mount Sinai Hospital, New York as a
Visiting Professor. Prof Stiegman not only further improved the teaching
program but also gave us important instructions for working as
consultants or as departmental heads of the future. His advice that a
departmental head has the additional duties of raising resources for the
department and enabling younger members to achieve the departmental
goals stood us in good stead at later stages of our career.
Pediatrics in India owes a tremendous debt to some of
these stalwarts. There are many others like the ones mentioned in this
narrative. We all pay homage to them in this 50