|PEOPLE WE ADMIRE
|Year : 2022 | Volume
| Issue : 1 | Page : 111-114
The cancer care messiah of Northeast India: Dr Ravi Kannan
Rajkumar Kottayasamy Seenivasagam1, Puneet Dhar2
1 Department of Surgical Oncology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
2 Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
|Date of Submission||15-Apr-2022|
|Date of Decision||16-Apr-2022|
|Date of Acceptance||16-Apr-2022|
|Date of Web Publication||28-Apr-2022|
Dr. Puneet Dhar
Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Seenivasagam RK, Dhar P. The cancer care messiah of Northeast India: Dr Ravi Kannan. J Med Evid 2022;3:111-4
Medicine was universally perceived to be a noble calling and at least a bit of the passion to help others is still present in practically everyone who becomes a doctor, despite the drastically changing public perceptions of commerce being the major driver! Yet very few can follow that passion and take it from mere thought to action. The journey is fraught with the drive to excel professionally, satisfy academic goals, have a personal life at par with one's peers, be surrounded with the latest (technically or technologically) gadgets and occasionally be enticed by the lure of lucre. Thus, many medics find these forces punctuate their lives to varying degrees and the path from idealism diverges much against their inner feelings at the beginning. However, we are lucky to occasionally come across some exemplary role models who have managed to bring succour to their initial thirst with enthusiasm and success. Our Journal of Medical Evidence (JME) highlights many who continue to inspire with such sparks igniting young minds and reminding us of our real paths. We interviewed Dr Ravi Kannan, one such inspiring beacon who choreographed his dream into reality.
Dr Ravi Kannan is a surgical oncologist and the Director of the Cachar Cancer Hospital and Research Centre in Silchar, Assam. He did his MBBS from Kilpauk Medical College, Chennai; his MS (General Surgery) from the Maulana Azad Medical College, Delhi and his MCh (Surgical Oncology) from the Cancer Institute, Adyar. After his training, he worked in the Surgical Oncology Department at Adyar.
He first visited the Cachar Cancer Centre in 2006 at the request of a colleague where he saw the difficulties faced by the patients of Barak Valley in receiving cancer treatment. Moved by the plight of the people, he soon left his practice in the Adyar Cancer Institute, Chennai, and moved to Assam with his family in 2007 to provide basic healthcare facilities to the people of the Barak Valley and Silchar.
He was awarded the Padma Shri in 2020 for his contributions to healthcare in the North East of India. The citation for the award hailed him as 'a medical messiah for cancer patients in the remote Barak Valley' and 'Silchar's Saviour'. Over the past 15 years, he and his team have treated over 70,000 cancer patients free of cost and also provided for their accommodation, food and employment. He has transformed the small rural cancer centre into a full-fledged hospital and research centre and has launched innovative measures for last-mile healthcare including domestic visits and satellite clinics.
An editorial team from the JME interviewed him during the recently conducted midterm conference of the Indian Association of Surgical Oncology (MIDCON IASO 2022) at Shillong, Meghalaya, for which he was the organising chairman.
| Journal of Medical Evidence: Tell us About Your Early Days and Your Motivations to Become a Doctor|| |
Dr Ravi Kannan
My father was in the Air Force. This meant we, his children, needed to move places often and had to change schools. This was both good and bad. Good because we saw many places and many people but bad because I did not have roots anywhere. Hence, most of my lasting friendships were from the older age groups.
I chose medicine because of my mother. She was from Kumbakonam, which was, in those days, a small village. She had wanted to become a doctor, but she could not due to economic conditions. She was inspired by the family physicians around her, especially Dr Natarajan and Dr N. K Subramaniyam. She would see them visiting patients at their homes to treat them. Since she could not become a doctor, she wanted her son to become one. Hence, when I finished class 12, I had no other thought other than to join medicine.
Initially, I wanted to become anything but a surgeon. At that time, my father was posted in Ambala. I completed my internship and went to Ambala to study for the entrance exams. On a visit to Srinagar, we went for dinner to a friend of my father whose wife was a surgeon in the Air Force. However, she was caught up in the hospital and came back when we were about to leave. Hence, we went back in to talk to her. She made coffee for me and asked me what I wanted to do. After I explained to her my choices, she told me the reason why she was stuck in the hospital that day. She had some road traffic accident patients, one with a chest injury, one with a head injury and one with an abdominal injury. She started explaining to me why and how she managed the chest injury patient first and then the head injury and followed by the abdominal injury. I was mesmerised with the way she explained this to me. Then, on returning, when I had to fill out the PG entrance application form – on all six choices I wrote General Surgery!
| Journal of Medical Evidence: And then you Chose Surgical Oncology Inspired by…?|| |
Dr Ravi Kannan
I cleared the entrance and joined general surgery at the Maulana Azad Medical College, New Delhi. I was the only outsider there and so I got the unit which nobody wanted. However, that was a blessing in disguise and I got into a unit which had Dr Sharada and Dr Kakkar. They were very keen that we should know theory first. A sound theoretician makes a sound surgeon. It was a true general surgical unit, which had cases from scalp to toe. Hence, we had an enormous exposure, a lot of it being in oncology. In my second year, I decided that I wanted to do surgical oncology.
After I finished my MS, I had a scaphoid fracture and was resting. I was aware of the Tata Memorial and Adyar Cancer Hospitals. Hence, I wrote a letter to Dr Shanta expressing my interest in surgical oncology without really expecting a reply, but I got a prompt call for an interview. Dr Krishnamurty interviewed me exhaustively for 1½ h for the junior-most position they had. At the end of the interview, he said that he will be happy to take me, but you go back home and talk to your father and then let us know. Hence, I joined as a registrar. He used to say that the job of a surgeon ranges from doing an oesophagogastrectomy to giving a bedpan to a patient.
This saying has stayed with me throughout my lifetime. After that, I cleared the entrance and joined MCh at Adyar. All that I know, I have learnt from the Adyar Cancer Institute and my teachers there. I have had amazing mentors throughout my life.
| Journal of Medical Evidence: Tell us the Story behind Your Move to Assam Leaving behind Your Job in a City like Chennai. What was Your Family's Reaction?|| |
Dr Ravi Kannan
After finishing MCh surgical oncology, I worked at the Cancer Institute, Adyar, for 15 years. During that time, the former Director of the Cachar Cancer Centre used to refer patients to Adyar. In December 2006, he invited me to visit Assam and join his hospital. My wife Sita and I were sceptical at first because the only things we knew about Assam were bomb blasts and floods. In April 2007, we went to visit Assam. My daughter was in class 4 at that time. I spent time at the hospital which had an inspiring story. It was formed by laypeople, because the incidence of cancer was high in that area and there were no cancer facilities.
My wife went around the community and we started looking around the schools for my daughter. The people were very welcoming and we got admission for my daughter in the local Kendriya Vidyalaya whose principal was my batchmate in school. My wife was instrumental in convincing me to move to Silchar as she understood the needs of the local people. She left her job in Chennai and convinced both our parents. Without the support from my family, I could not have moved to Silchar and done whatever I have done till date.
| Journal of Medical Evidence: What was the Situation of Cancer Care and the Challenges you faced in the Initial Days in the North East when you Moved There?|| |
Dr Ravi Kannan
When I moved to Silchar things were very basic here. We had a 20-bedded hospital with minimal staff and no qualified nurses. I also did not have any administrative experience. Dr Mutthu, a resident doctor who came to assist me for few months from Chennai, taught me the basic tenets of administration. From there, every step has been a learning experience. We did not have any game plan and the truth is we learnt along the way.
In the initial days, we did not have adequate human resources, we did not have any infrastructure and we did not have an autoclave or a generator. Moreover, we had days when we had to operate with lanterns. We initially saw outpatients in the morning and did surgeries in the afternoon. However, we changed the schedule to operate in the morning and modified our OTs to have big windows to operate during sunlight.
| Journal of Medical Evidence: Tell us About Your Journey in Cancer Care at the Cachar Cancer Centre over the Last 15 Years|| |
Dr Ravi Kannan
One by one, we started solving the problems, but new problems started coming up. My friend Dr Harit Charturvedi from Delhi got me an autoclave. My friends have helped me a lot and never ever refused anything that I asked. Initially, we thought that giving free treatment will make patients come to the hospital, but 30% of patients did not complete treatment, so we started giving food and accommodation. We found out that these were daily wage labourers who lost their income during cancer treatment. Hence, we gave them ad hoc employment. We then started calling up patients who missed appointments and put up satellite clinics along with Centre for Development of Advanced Computing (CDAC) and a home care programme for palliative care.
We made a plan of Rs. 500 fees for lifetime consultation. Terrain and transport was a problem. Hence, now we are looking at putting up satellite hospitals with 6–8 beds and 10–12 staff each which will cater to a community within 30–40 km radius where consultations, day-care chemotherapies, palliative care and follow-ups can be done. Slowly, we are looking to expand this into 30-bedded hospitals which will have telecobalt machines and can provide the entire gamut of cancer treatment. This is being planned with the help of the local community and different non-governmental organisations. We keep changing our priorities according to the needs and challenges.
Even though we treat poor patients, we ensure that the standard of care is maintained. We have now started doing microvascular and minimally invasive surgeries. However, we do not use costly drugs like monoclonal antibodies and do not insist on palliative chemotherapy if it does not impact either the patient's life or quality of life. The Indian Cancer Society has started supporting us with the costlier medicines for patients for whom they are indicated.
Since 2017–2018, the government insurance schemes have helped a lot for the treatment of patients. However, we are facing problems since they can be used only for treatment and not for diagnosis. Since people defaulted during the initial diagnosis period, we started supporting them for this. We as doctors should remember Dr Francis P Buddy's quote from 1925, 'the secret of the care of the patient is in caring for the patient'. Hence, unless you start feeling bad for the patient, you as a doctor will not progress.
| Journal of Medical Evidence: What are Your Thoughts on Cancer Care in India? How is it Different from Other Countries?|| |
Dr Ravi Kannan
I think cancer care is improving and growing dramatically over the past 10 years. We are seeing a lot of change. At one end, in bigger cities, anything is possible. At the other end, there are still huge challenges for patients in smaller towns and rural areas. The government programmes should aim to introduce and maintain the most appropriate standard of care rather than to be reliant on high-end technologies such as robotics, costly monoclonals and proton therapy. It should ensure that a certain standard of care is available across the country and also concentrate on health promotion and cancer prevention. Prevention is more important than treatment.
| Journal of Medical Evidence: Share with us Your Vision for the Future of Cancer Care in India|| |
Dr Ravi Kannan
The government should invest its money in prevention, pre-diagnostics, standard of care, palliative care and rehabilitation. We should ensure that every place has access to basic imaging facilities such as magnetic resonance imaging and computed tomography scans, regular proven treatments, chemotherapies and surgical techniques. The private sector cannot replace the government. They should work in tandem with the government. Only the government has the depth and the resources to bring about the much-needed change. This does not mean that you and I as private citizens do not have the responsibility.
Health promotion is a national responsibility. For example, smoking, lack of exercise and alcohol are some of the things that if taken care of properly can prevent 70% of the cancers. This will help in the prevention of other diseases such as diabetes, hypertension and heart diseases caused by the same set of factors. We as doctors should be champions in promoting health.
In this aspect, there is no standard template and we should incorporate the best practices from around the world. We should adapt scientifically proven things from our own past. We should be proud of our past; at the same time, we should adapt good things from around the world.
| Journal of Medical Evidence: What are Your Thoughts on the Future of Surgical Oncology as a Speciality?|| |
Dr Ravi Kannan
Surgical oncology as a speciality is a good concept. However, as with all specialities, I think we are taking it a little too far. Sub-speciality training such as head-and-neck oncology and gynaecology without basic surgical oncology training and principles is incomplete. Soon this will become like general surgery, where gastrointestinal surgery, urology, etc., have eroded basic general surgical training. I think the training should be general surgery, then surgical oncology and then sub-speciality training.
Without basic surgical oncology training, such sub-speciality training will be incomplete, for example, a gynaecologist who does not know to do bowel resections or repairs or a head-and-neck oncosurgeon who does not know how to do a gastric pull-up. Such sub-specialisation is not ideal for the Indian scenario when we are deficient in basic surgical and oncology specialities. What we need is a well-rounded and trained surgical oncologist with a focus in a special area.
| Journal of Medical Evidence: Finally, What is Your Advice to Young Medical Aspirants and Budding Doctors?|| |
Dr Ravi Kannan
I strongly believe that everybody wants to serve the sick. Our focus must be on patient care. Our primary goal should be the patient's interest and all other goals are peripheral to this. Hence, long as we do not lose sight of that and if we work in a manner in which we put the patient above everybody else, we will do well. When our interest does not conflict the patient's interest, I think we will not have so many litigations and violence against doctors.
We as doctors should learn communication and soft skills so that we will be able to comfort the patients. I would like to remind you of a story that I read in Cecil's Textbook of Medicine in which a physician in America chose to attend one of his patient's funerals over giving a presidential address to a scientific society. He felt that at that moment, it was more important for him to be with patient's family than deliver the address. He is a role model for all physicians.
Thank you Dr Ravi Kannan for that thought-provoking interview. Clearly, the Padma and other awards are richly deserved even though never sought! We sincerely wish you the best and more for your venture and hope you continue to motivate others to serve the underserved.
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Conflicts of interest
There are no conflicts of interest.