|PEOPLE WE ADMIRE
|Year : 2023 | Volume
| Issue : 1 | Page : 99-102
Dr. Soumya Swaminathan: A pride scientist of India
Abhishek Sadasivan1, Ajeet Singh Bhadoria1, Samiran Nundy2
1 Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
2 President, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
|Date of Submission||04-Feb-2023|
|Date of Decision||15-Feb-2023|
|Date of Acceptance||25-Feb-2023|
|Date of Web Publication||26-Apr-2023|
Dr. Ajeet Singh Bhadoria
Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sadasivan A, Bhadoria AS, Nundy S. Dr. Soumya Swaminathan: A pride scientist of India. J Med Evid 2023;4:99-102
| Editor in Chief: Could You Please tell us Something About Your Early Life – Birthplace, Parents and Schooling: How Influential were Your Illustrious Mother and Father?|| |
My childhood was very happy. I grew up at the Pusa Institute, the Indian Agricultural Research Institute in an environment that I think was ideal for children. We could play freely. We had lots of friends, we ran around the whole campus. There were no issues of any security or fear.
We could go where we wanted and also we had exposure to students and faculty members all the time because our house was always full of scientists as well as students and my parents were very nurturing of the students. So apart from the professional discussions, they would have with my father and my mother would take care of all of their other needs and very often help in solving their personal problems. We had a lot of foreign students in the institute as well. I remember that over Christmas, my mother would make sure that there was a Christmas party, especially for those students from Africa and others who could not go back and would have missed having Christmas at home.
Hence, we celebrated all festivals and enjoyed each one of them. I used to go to the laboratory with my father or his students. And so we, from an early age, knew what experiments were about. What PhD theses were about? However, at the same time, we also knew about my mother's work, which was more on pre-school education, particularly for underprivileged children. Both my parents' work was very deeply rooted in equity and also in addressing the needs of the communities that we were living in. As a child, I travelled with my mother to construction sites, where she and others set up Mobile Crèches to address the needs of pre-school children of migrant labourers.
When we travelled, we had a very good cultural exposure to people from different states. We would come to Tamil Nadu for our summer holidays, to spend time with my grandparents, in Kumbakonam, Thanjavur district. We also went to the other parts of the country especially to wildlife reserves and wherever we went my parents made sure that we understood and were exposed to the way that the local people lived, their culture, their language, their local food and other habits. And I think that helped us to grow up as people who could understand and relate and not be judgemental about different cultures and different viewpoints. We are three sisters and we were never made to think about ourselves as girls, but only as individuals. Hence, we never ever had the feeling that they were certain professions or things that we could not aspire to whether it was mountaineering that one of my sisters was interested in, or environmental activism that another sister was interested in or whether it was my changing aspirations from wanting to be a veterinary doctor to then wanting to be a geneticist to then finally going into medicine. We were encouraged to follow whatever our heart was telling us to do.
| Editor in Chief: Why Did You Decide to Become a Doctor?|| |
I don't know; a matter of chance I think because as I said, when I finished school, I wanted to be a pure scientist. Perhaps, I was inspired by my father, I wanted to work on human genetics. It was also because I had done a project during my science talent scholarship that involved a hereditary chromosomal defect. I worked in Calcutta on this project with Professor Archana Sharma and met a child with Turner syndrome. That had fascinated me and I wanted to pursue the field of genetics. Then I entered Premed, in Hindu college and my entire class was preparing for the medical entrance examination. And so I was the only odd one out who seemed to want to continue with BSc Zoology. Everybody else was going to coaching classes and planning what entrance examinations they were going to take. This was, of course, pre NEET and you had to take individual entrance examinations. Hence, I was reluctant, but ended up speaking to a few people who were in their 3rd or 4th year of medical school. And then, was encouraged to go ahead and write the entrance examination, because, one could still pursue the human genetics speciality after MBBS.
So I wrote only the Armed Forces Medical College (AFMC) entrance examination, and I was fairly confident that I would not get in and, that would resolve the dilemma for me. Hence, I purposely chose to write only one entrance examination, was shortlisted, went for the interview and got admission. I then heard from many people that it was one of the best medical colleges and so I ended up joining the AFMC. Hence, the pathway was not, for me a straightforward one. It was not that I had always wanted to be a doctor or anything like that, but I did have a commitment to science from a young age.
| Editor in Chief: What Were the Highlights of Your Armed Forces Medical College Education?|| |
The first thing I would say is that the education we got was superb, and part of the reason, I think was discipline that the college had and so there was no question of not having a class or not attending a class or anything like that. We had very good teachers both in the pre-clinical and on the clinical side. I think we got adequate exposure to clinical cases because we had both civilians and army personnel being treated in the hospital. We also developed well-rounded personalities because it was a college where extracurricular activities were encouraged.
We were all encouraged to play sports, to take part in dramatics and quizzes. Hence, I was a part of the dramatics club, I was a part of the Debating club, I was also at some point playing basketball, even though I was not very good at sports and we participated in intercollege cultural festivals. Hence, I think that built the other aspects of our personality and leadership qualities and we also developed very strong bonds with each other because it was a residential college. The one odd thing about the course was the ratio of girls to boys, which continues today. Out of 120 students, we had 100 boys and 20 girls. The girls have a huge advantage in that college because they got a lot of attention and privileges. I think it was a wonderful undergraduate education to have.
| Editor in Chief: Please Elaborate on Your Further Training in AIIMS Delhi, the USA and UK|| |
I did MD Paediatrics at AIIMS, New Delhi under Dr. OP Ghai, he was the head of the department at that time and had excellent faculty. I think I got excellent clinical training. The only thing that I would say was missing, was rigorous training in research methods and even though I did an MD thesis and we all did theses, I would not say that trained me to do high quality research in any way. Then, after a year and a half of senior residency, I wanted to do a super specialisation in paediatric pulmonology. So I ended up going to the Children's Hospital of Los Angeles. It had a double programme in neonatology and paediatric pulmonology, even though I was interested on the pulmonology side, I also had to do neonatology. We had a faculty that were not only good clinicians, but they all pursued specialised areas of research. I chose to work with Prof. Tom Keens, who was really an excellent pulmonary physiologist and the work that I did with him, the 2 years of fellowship, actually was what grounded me in research and clinical research methods. We had a choice, we could have done animal research as well, but I opted for research in the pulmonary physiology laboratory and worked on control of breathing essentially and came up with some very high impact publications, but the main thing, it taught me was really how to design a research study, how to ask the right questions and the whole process of conducting the research, data analysis, the writing as well as the presentation at a conference. And I remember the way he mentored us, as junior fellows, we would be first asked to present at a regional conference, then we would go to a national then and then an international conference. So within the 2 years actually I had progressed through that and I was really passionate about the field. I thought that there was a lot to be done in India. Through serendipity, I ended up meeting someone from the ICMR's tuberculosis (TB) research centre in Chennai, which is when my husband and I decided we would return. So, I got very excited actually and visited them.
And I said yes because, everyone here, understood and talked research. A lot of clinical trials, but there was also a pulmonary physiology lab, as well as microbiology, biochemistry and immunology laboratories. The pulmonary physiology laboratory was run at that time by Dr. VK Vijayan and he actually said to me, I'm looking for someone to do paediatric work, because I am an adult pulmonologist. So that's how I entered the TB research centre, now called National Institute for Research in TB.
I started with pure pulmonology work, but very quickly switched to TB, because, once I had a permanent faculty position there, then you know, was expected to mainly spend most of my time on TB research. But again, I tried to make it crosscutting, integrating immunology with clinical work. Later, I got an opportunity to build the HIV-TB programme. At that time, Prof. NK Ganguly was the DG of ICMR, who said, look no one in India is focussing on HIV and TB and you should be the one doing this. There was a National Institute of AIDS research that had been set up in Pune, but he said they are looking at a lot of other things and it is the TB institute that should be focussing on some of these questions. So, I was given a free hand to set up that programme clinical, but also on the laboratory side and the social and behavioural aspects. So I actually, built socio-behavioural sciences in the institute, as the ICMR did not have a focus on that, built the laboratory sciences and made sure that we had all our assays accredited.
Then did a number of clinical trials which were I think quite useful. Got to work very closely with the national control programme, which gave me a lot of insights into the interface between research policy and also, taught me how researchers actually sometimes do things in order, but are not thinking about the policymaker, we are just thinking about impact on patient outcomes, which is important.
But later in my career, I recognised that if you really want to have a large-scale impact, you also have to include policymakers into this dialogue, find out what are the questions that are bothering them and what they are looking for.
| Editor in Chief: Why Did You Decide to Return to India?|| |
There was never any doubt for both my husband and I. We were very clear that we were going abroad for some training, acquiring some skills and that we wanted to come back and work in India. I never once was ever tempted to settle in the US or UK.
| Editor in Chief: What Do You Regard as the Main Achievements of Your Career in Chennai, the ICMR and WHO?|| |
I helped build the TB-HIV research programme in India which then, took off, at a time when there was a lot of stigma. And, I think it needed a group of us, to be seen visibly to be working with these people. In my own institute, there was stigma, not everyone was willing to work with these patients. I actually had to go around asking doctors and nurses, if they were willing to work with me on HIV. There was a huge amount of fear, pre-Antiretroviral therapy (ART), you know, it was a death sentence. It also taught me, the importance of what beyond the biomedical aspects a patient needs from a doctor, or a medical team because invariably all our patients died at that point, even though some improved and then deteriorated, some went through very prolonged periods because we were providing very good supportive care.
So, in the end, they were all facing death. It was a very depressing time. And I remember being asked by the patients, why they could not get the treatments that other patients were getting abroad, because antiretroviral treatment had become available in the late 90s and so it brought a lot of ethical questions that we could not answer.
I was also looking after a lot of orphans at that time when very few paediatricians looked after HIV + patients. There were NGOs that would basically take care of these orphans, take care of a lot of their medical needs. It exposed some of the dark side of the medical profession also.
Some colleagues, despite the fact that, we has all signed the Hippocratic oath, really did not want to take care of these people as they thought anyway they were going to die. Some even asked me why I was spending all my time on these patients. So, I learnt a lot about medicine, and I think I realised how important the social sciences were and also how we needed to solve their other socio-economic problems. There was no point, just curing them of the disease they were suffering from, because their quality of life was pretty bad. So, we had to work with a lot of NGOs, we worked with marginalised communities with gay men, hijaras, who were criminalised at that time. So in Chennai, my major achievements, I would say was really building interdisciplinary and multidisciplinary programmes within TB and putting on a much bigger emphasis on the need for the social sciences.
In the ICMR, I had a very short term, what I tried to do was bringing in more diversity into some of the committees and also try to develop mentorship programmes and inspire young scientists, not just in the ICMR but also in other medical colleges as well and try to develop programmes for medical graduates to pursue a career in research.
At the WHO, I would say that building the science division from scratch is something I am proud of. Most of that time was spent in the pandemic of course but what we were able to do in terms of coordination of research, in developing and helping to set the standards for vaccines and drugs, framing treatment guidelines in a timely manner, advocating for equitable access and running the Covax initiative. So during the pandemic, I think that the science division played a very important role in guiding the whole response to the pandemic. But even if the pandemic had not been there, I think I had set the foundation for the work of the science division and as the first chief scientist, I felt really privileged to be able to do that.
| Editor in Chief: What Do You Regard as Indian Medicine's Greatest Successes?|| |
I think that, if you look back, over time, we have had a lot of advances and understanding of our own problems and diseases that was done by medical doctors working in India. There are many people that that we can name, who did very solid research, a lot of it done in the 1950s, 1960s and 1970s without all the hi-tech technology that we have today. Which set the stage, not only for understanding the pathogenesis but obviously then for treatment and I think our emphasis on affordable care. This is, of course, something the private sector has contributed by having a massive generics industry that we have been able to provide access to huge number of people. But compared to many other countries, now that I have had an opportunity being in WHO, India has done relatively well.
| Editor in Chief: What Are Its Failures? How Should We Correct These? How Can We Improve Indian Medical Research? Why is Tuberculosis Still a Public Health Issue in India?|| |
Starting with the failures, I think we have to invest in primary healthcare, we have not done enough of that, and public health. So, every state needs to have a public health cadre and we really need to build up a primary healthcare workforce, not only doctors but also a number of other skilled workforce and linking it with the community. I think the second one is around addressing the determinants of disease, on the risk factors, this is where I think there are gaps, diet and water sanitation, which is being addressed to some extent, but things like air pollution, the environment we live in, these I think need to get more attention if we are to really address chronic disease. Third, I think we are not doing enough translational and implementation research, we are not using the data that we collect or to inform our policies and our programmes makers.
And yes, there is a missed opportunity and I think what we have to do is to really with much more emphasis on research in our medical schools, which I do not think is happening. It did not happen when I was in medical school. I do not think things have changed that much.
We really have to bring in opportunities for research for medical students and some of them will become passionate about it and this is what students in other countries are doing.
| Editor in Chief: What is the Future Regarding COVID Globally and in India?|| |
I think COVID might go through some ups and downs for some time because the virus is still able to mutate and become more transmissible and able to overcome pre-existing immunity. However, what we see now in countries that have well-vaccinated populations is that this is not translating into severe disease or deaths. And so that's the goal. I mean, we still have quite high deaths globally, but that's because we still have a lot of unvaccinated people, particularly the elderly, in many countries. So as far as India is concerned we are in a much better position. But again, I would say that we have to look at our own data, we have look at our own cohorts, we have to look at the waning of immunity, whether there is going to be a need for yearly boosters and so in which age groups, etc., and we must do that using our own population-based data using the CoWIN app. In terms of TB, I think. 50% of TB in India's attributed to underlying undernutrition and so I think we cannot take away the fact that TB is a disease that is rooted in poverty and its association with undernutrition. We have to address that but we also have to deploy new tools. We have to be leading in research.
We need to really invest in better vaccines as well as in better point of care diagnostics.
| Editor in Chief: What are Your Future Goals? What Do You Enjoy Most Apart From Your work? What Advice Would You Give to Young Doctors?|| |
My goals would be to really look at the health systems from a holistic point of view and trying to work on the risk factors and see how we can reduce them. A lot of it is related to climate change or other environmental risks, including our food systems – it is a complex area but that is the area that I'm interested in. On advice to doctors, I would say that. You know, you have to be well informed, you have to be scientifically literate. You cannot be a very good doctor and not be scientifically literate.
So one really has to make an effort to develop those skills to have a critical thinking mind to be able to read papers, analyse and know a little bit about statistics. A lot of things are available online now, so one can educate oneself. And keep good documentation of everything you do, because research can be done in any setting.
You do not have to be in a fancy laboratory to do research. Even a doctor in a remote rural area, can contribute by keeping good records and then being able to use your analytical mind to ask the right questions and change the data. In fact, that is what we need today.
We need more research coming out of diverse environments particularly from, our rural areas.
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Conflicts of interest
There are no conflicts of interest.