Interview

‘Medicine is no longer seen as a social cause or calling’

Bhupathiraju Somaraju is a lot more than a doctor. A cardiologist, researcher, educationist and philanthropist, the 73-year-old chairman of the Hyderabad-based Care Hospitals has spent a lifetime devoted to — in the paraphrased words of one of his heroes, Tinsley Harrison — being of service to his fellow man and building an enduring edifice of character within himself.

Dr Somaraju, born to a farming family in a remote village near Bhimavaram in the West Godavari district of Andhra Pradesh, is set apart by his commitment to a calling that has become central in these turbulent and tragic times. He speaks here to Christabelle Noronha about his vocation and the immediate need to restore its vitality. Edited excerpts from the interview:

What can India and the world learn from the Covid-19 outbreak? And what is the pandemic telling us about the state of the human race and its future?

The Covid-19 outbreak is much more than a health crisis; it is a human, economic and social crisis. This crisis has laid bare the stark fragility of society, the agony and helplessness that is being felt by all at the death of hundreds of thousands of human beings. If not addressed effectively, the pandemic will increase inequality, exclusion, discrimination and global unemployment.

It is not easy to determine what has brought humankind to this state unless one analyses the causes. The way humanity has conducted itself over the years has been catastrophic. It has jostled to occupy the whole of Planet Earth, destroying many living beings, including plants and animals, and making survival extremely difficult for the rest of the species by consuming everything it desires.

We have disregarded the environment, pillaged natural resources and created a huge divide between the powerful and powerless. Because of all these aspects, and much more, today we face viral consequences.

There’s an age-old adage in medicine: “The bleeding always stops.” In due course the world finds a way to handle almost anything. This contagion will, perhaps, run its own course and we may learn some lessons on how to protect ourselves. However, it is about time humankind not only finds the answers, but actually resolves fundamental issues through focused programmes that are built on the foundation of human solidarity.

There is certainly a crying need to overcome the inertia in India’s public healthcare systems and to ramp it up in terms of resource availability, infrastructure, the competencies of healthcare service providers and, ultimately, service quality. Also, over recent years greed has led to private healthcare being managed as a business enterprise, where the focus has shifted from patient care to insatiable short-term profitability.

You hail from a family of farmers, you grew up in a rural region and, as a child, you walked many miles — barefoot it is said — to get to school. How did this background shape you as an adult and in your journey to becoming a doctor?

Growing up in the rustic villages of India did teach me many things in life. Walking for about 5km every day to school and many other experiences enhanced my physical, mental and emotional strength. When one only has the basic necessities of life and is open for the right type of guidance from elders, one has the innate advantage of vulnerability. Uncorrupted by the lack of abundance, one imbibes the right values and culture.

William Osler’s Aequanimitas has been cited as being the “guiding spirit” in your days as a medical student. What was it about the essay that influenced you so?

Osler is considered to be the founding father of modern medicine. He is also one of the founding professors of the prestigious Johns Hopkins Hospital [in Baltimore, USA] and is credited with introducing bedside learning for doctors. Aequanimitas was one of his most famous essays, delivered as a farewell address to the new doctors at the Pennsylvania School of Medicine in 1889.

Dr Somaraju, seen here attending to a patient, bemoans the neglect of India’s public healthcare system

In the essay, Osler advocates two qualities: ‘imperturbability’ and ‘equanimity’. Imperturbability was regarded by him as the most important quality of a good physician. He defines this as coolness and presence of mind in all circumstances, and clarity of judgment in moments of grave peril. My other guiding light has been Tinsley Harrison, who wrote the famed textbook of medicine, Harrison’s Principles of Internal Medicine.

There’s a quotation from the introductory chapter of the book that has shaped and influenced generations of physicians. It reads: “No greater opportunity, responsibility, or obligation can fall to the lot of a human being than to become a physician. In the care of the suffering he needs technical skill, scientific knowledge, and human understanding. He who uses these with courage, with humility, and with wisdom will provide a unique service for his fellow man, and will build an enduring edifice of character within himself. The physician should ask of his destiny no more than this; he should be content with no less.”

You are credited with performing the first balloon angioplasty in India, bringing the technique of surgery-free repairing of heart valves to the country, and with developing — in collaboration with APJ Abdul Kalam — the path breaking Kalam-Raju stent. How did these happen?

The credit for making the Kalam-Raju stent goes to many people, including my friend Prof Arun Tiwari, who was with the Defence Research and Development Organisation [DRDO]. In 1987, he was admitted to the Nizam’s Institute of Medical Sciences [NIMS] in Hyderabad for a heart condition. I was serving in NIMS then and that’s where I met Dr Kalam, who used to visit his ailing friend in the hospital and was instrumental in getting essential drugs from Germany for his treatment. During our conversations, Dr Kalam was seized of the necessity of making coronary stents at an affordable cost. Consequently, he enabled us to work closely with DRDO scientists as well as Prof Tiwari, which led us to produce, in 1995, an Indian stent that cost a mere 10,000.

While heart surgery was well established for mitral valve stenosis, balloon valvuloplasty was a novel procedure in those days. We were the first ones to do a prospective randomised clinical trial as a substitute for two forms of cardiac surgery. Our first patient for primary angioplasty was a farmer who had come to us after an acute heart attack. He was 54 years old and required immediate attention. We did not use stents; his blood flow was restored through balloon valvuloplasty. It was a first-of-its-kind intervention and a very satisfying experience. He lived a healthy life for more than a decade thereafter.

“[Humanity] has jostled to occupy the whole of Planet Earth, destroying many living beings ... making survival extremely difficult for the rest of the species.”

What explains your increasing involvement in later years in the social side of medicine and in medical education, particularly with the Care Institute of Health Sciences?

It is important that healthcare delivery systems allow one to administer the right treatment to a patient in order to alleviate suffering and pain. Unfortunately, medicine is no longer seen as a social cause or calling. The influx of equity funding into private healthcare has led to a focus on profitability. Also, aspects such as patient-centric care, medical education and the social components of medical practice have been progressively diluted in private medical practice. Coupled with the neglect and inertia of the public healthcare system, this makes it very difficult for right-minded professionals to do their honest best for every patient.

What would you prescribe to tackle the many ills impairing healthcare in India? Where would you begin?

The type of management that is being practiced in private hospitals needs a redesign. Due to the pressure of profitability, the focus has shifted from value-based care to a volume-based service. Private healthcare is being handled as a business rather than a calling.

As for public healthcare, this needs ramping up in terms of infrastructure, quality of service and improvement in patient-provider ratio. The budgetary allocations for health must be doubled. Healthcare must shift focus from the present hospital-based care to community care. Home care, preventive treatment and wellness should take precedence.

There needs to be equity among healthcare service providers, too. The gap in salary and benefits between members of a healthcare team is very large. As members of a team, the role of each provider is important, be it doctor, nurse or technician. Hence there must be a sense of fairness and equity in compensation.

More than 4 billion is the requirement to set up a medical college that adheres to current regulatory norms. Besides becoming a dampener in establishing such institutions, this large financial outlay also leads to the vicious cycle of medical students being charged exorbitant academic fees. These students, in turn, find ways to expeditiously make good the cost once they join the medical profession, frequently by unfair means.

India’s health system must shift focus from hospital-based care to community care, says Dr Somaraju

How has the partnership between CIHS and the Tata Trusts progressed in the trauma and learning centre project at the Government Medical College in Thiruvananthapuram?

We are in the process of establishing the ‘apex trauma and emergency learning centre’ at the Government Medical College in Thiruvananthapuram with the support of the Trusts and in partnership with the Kerala government. This simulation-based centre will train about 9,000 doctors, nurses and other healthcare providers on emergency and trauma care over the next two years.

Along with this, we have also planned to train people in the general population — students, auto and taxi drivers, police personnel and other first responders — on cardiopulmonary resuscitation and first aid during emergencies. It is an onerous responsibility and we hope that this wonderful initiative will serve to improve patient care and reduce trauma-related mortality in Kerala.

You have spoken a lot about the stress of modern-day work and life and its consequent effect on the everyday health of people. As somebody who surely experiences plenty of this, how do you cope, personally and professionally?

Stress gets reduced when one truly believes in what one is doing. For me, other matters become relatively trivial in the pursuit of caring for people. The ‘cowboy model of medicine’, wherein a single doctor was expected to cure a patient, has become outdated. In the present age of collaborative medicine, medical professionals have to work in teams.

Working in teams has huge advantages. In addition to better outcomes, it also enables the sharing of workload and allows for a better work- life balance, thereby reducing stress. The aspect of work-life balance becomes even more important as women join the profession of medicine in ever-larger numbers.

As a part of a large group of cardiologists, I have found great positives in working together over the last 30 years. But to make a difference it is vital that one finds a good organisation and the right platform.

“As members of a team, the role of each provider is important, be it doctor, nurse or technician. Hence there must be a sense of fairness and equity in compensation.”