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  Presidential address
CORSIV -2004, Sivakasi,
24th September 2004

Dr. R.D.Prabhu
Ladies and gentlemen,

  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:

  1. to look after the interests of its members and the profession it represents; most of the associations do this any way.
  2. to ensure that its activities and programmes are in tune with the interests of the nation and fellow citizens.
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.
“Pr„jnasya moorkhasya cha k„rya-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.