I was a late starter for my post graduate training in Paediatrics. Following my undergraduate training in 1974, I went on to do a year of senior house surgency at Nagpur Medical college, worked in a mission hospital for six months and spent time in training in public health at the B.J.Medical College, Pune in 1976. After that I taught community medicine at Mahatma Gandhi Institute of Medical Sciences (MGMS), Sevagram. It was in 1978, I went on to do my training in Paediatrics.
I went through a state of confusion after my internship. I had invitations from the departments of Medicine, Surgery and Paediatrics for post-graduate training. The tradition in Nagpur Medical College at that time was, that professors invited those who scored well in the final examination to join a department for further training. If that invitation was not taken up, to get back to get into training would involve competing with subsequent batch of interns. In case they scored better in a particular subject, one has to wait, as post-graduate admission was based on the basis of marks obtained in the final examination in that particular subject.
I felt enthused by the specialty of community medicine, probably because of the wholistic approach to health care, which Professor Maya Natu, the head of the department of Community Medicine at that time conveyed in her theory and practical classes. I was specially attracted by the study of epidemiology of diseases and investigative epidemiology to find the source of outbreak of the air born or water born of faecal born infectious diseases which were more common then. I found the approach of ‘break the chain’ or contain the spread of infection as critical in epidemiology of communicable diseases. It was this which took me to B.J.Medical College to join for my post-graduate training in public health. It was a good time for Anna and myself, as we could be together after our marriage while Anna was required to do her sponsorship obligation at N.M.Wadia Hospital. However the two outstanding professors of the department of Community Medicine left on promotion and the department slipped in to a routine approach with lesser clinical interest or profile in epidemiology of diseases. I did not join to do MD after finishing my diploma examination in public health.
The 18 months of the training in Public health was far from what I expected. The other five trainees who ought to have joined for the course did not join that year, as they were not relieved form the government service for the training programme. I ended up as the only trainees. With Professors Deodhar and Sathe having left on promotion, the other faculty members did not rise to the occasion to formally take me through the regular schedule of the training programme. I was given guidance to read. I was able to associate with the infectious disease hospital and do some work for cancer registry. The then head of the department suggested to me to attach myself to any clinical work that I was interested in, as I was doing well in all the internal assessments and requirements of the course. I found the interactions with the faculty most useful. I picked up concepts in statistics, epidemiology, health administration, environmental an industrial health, etc.
That gave me an opportunity to work in the paediatrics department of N.M.Wadia hospital under Dr Karve, which was a learning experience. Anna and I found our time in Pune useful in several ways. Anna having been born and educated at Pune, this time in Pune gave me an opportunity to connect with Anna's biography of early years. Anna's parents were still in Pune, which gave me a contact with their history of forty years in Pune. Anna's mother being an Obstetrician, opened the door for me to conduct a research on Apgar score and clinical profile of newborns at birth. That was my first introduction to the examination of new born babies. I picked up some insights from the gross examination of placenta during this exercise.
I have many pleasant memories of that time in Pune. It was an introduction to self-directed learning. There were some personal benefits. I learned riding scooter, thanks to Mr George Jacob who helped me to use his scooter for this. Another friendship that lasts even now was with Mr Toji Mathew. We had some association with medical students in BJ Medical College and Armed Forces Medical College. To live in a city like Pune, which was cosmopolitan then and yet rich in Maratha culture was a learning experience. Anna and I remember this time in our lives as an endearing time in our lives after our marriage.
The final circumstance leading me to change from public health practice to Paediatrics came in an unusual way. While working in the Community Medicine department at MGIMS, under Dr Susila Nayyar, there was an outbreak of Measles infection and a large number of children were admitted in the hospital. Many children were in serious condition and needed care, for which I was deputed to the Paediatrics department to help the paediatricians. Following this, I continued in the Paediatrics department as Dr Nayyar felt that there was a need to promote community paediatrics in the hospital.
Dr Nayyar was a former health minister in the central cabinet, a personal physician of Mahatma Gandhi and the founder of the MGIMS. I was privileged to have had several sessions of conversations with her about the post-independent health care planning in India. Sir Joseph Bhore, who advocated providing primary health care through establishing Primary Health Centres in the country worked closely with Dr Nayyar. The conversation times with her were historical, hilarious and stimulating. It was not so common at that time for doctors to choose training in public health as other specialities were more impressive and brought more prospects to doctors. Dr Nayyar kept wondering how my choice for my post graduate training turned in the direction of public health.
That was another story, which enthused Dr Nayyar when I shared with her how much I was enthused by the approach of Dr Maya Natu to public health. Her approach was significantly different from what I was used to in the earlier years of my undergraduate training at Medical College, Nagour. Dr Natu presented public health as integration of preventive, promotive and curative health care, which made an enormous appeal to me. It was this exposure to public health with a new definition and perspective which made me to go to train in public health. Also, I knew that the department of Community Medicine at Christian Medical College, Vellore had a hospital attached to the department, through which it provided integrated health care to the rural community. That model was already recognised as the way of practicing community medicine in MGIMS under the leadership of Dr Nayyar.
When Dr Nayyar came to know that I chose training in public health due to a motivation to practice integrated health care, she was all the more persuasive for me to apply for training in Paediatrics in the hope that I might be interested to develop the specialty of Community Paediatrics. That is how I ended up applying for training in Paediatrics in 1978 to Medical College, Nagpur.
I do not think that Anna and I were ready to leave MGIMS at that time. Arpit, our older son was just a few months old then. We had a vibrant contact with medical students with some of them becoming our regular visitors. I having had my roots in Gandhian view and ethos of life had begun to like the proximity of Gandhi's Ashram, which was only a few minutes walk from our campus. Dr Nayyar had by then become a mentor to me. I imbibed the spirit of independence movement from conversations with her. Her first hand anecdotal narrations of of Mahatma Gandhi and Pandit Jawaharlal Nehru, the first Prime minister of India broadened my perspectives on the 'idea of India'. Although she was in her middle seventies, she had a bright mind and a communicating heart.
I had applied for paediatrics training during the previous two years, but did not receive the intimation of my selection. Having not taken up the position without sending even a letter of refusal twice, I was not ‘eligible’ to be considered, according to the opinion of the head of the department of paediatrics. But the dean of the MGIMS, who was a member of the selection panel, had known that I applied for paediatrics training on the advice of Dr Nayyar. He overruled the opinion of the professor Paediatrics as there was no such rule in existence. I still remember how the Dean sent me a message about my selection that evening and he asked to me go to Nagpur the next day to pay up the fees to claim my seat. I was glad that the Dean of MGIMS informed me on time, and I was able to go on the next day as the time for joining for the course was fixed for the next day before 4 p.m.
I thought that Dr Nayyar was more than pleased with this opportunity for me. She had this to say to me on the next day when I met her: ‘Whether I come back to MGIMS or not after my training, keep the focus on children to make a difference in their lives. Think of the most disadvantaged children, when you plan your career!’.
Looking back, I feel that was a ‘prophetic’ call, which were to follow me later in my involvement with children!
I have 3 more parts to this story, which would follow soon!
M.C.Mathew (text and photo)
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