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Journal of Indian Association of Pediatric Surgeons
     Journal of Indian Association of Pediatric Surgeons
Official journal of the Indian Association of Pediatric Surgeons         
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PRESIDENTIAL ADDRESS
Year : 2020  |  Volume : 25  |  Issue : 2  |  Page : 68-70
 

Presidential address


President, IAPS 2018–2019; Department of Pediatric Surgery, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India

Date of Submission29-Dec-2019
Date of Acceptance01-Jan-2020
Date of Web Publication28-Jan-2020

Correspondence Address:
Dr. Ramesh Santhanakrishnan
Department of Pediatric Surgery, Indira Gandhi Institute of Child Health, South Hospital Complex, Bengaluru - 560 085, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaps.JIAPS_227_19

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How to cite this article:
Santhanakrishnan R. Presidential address. J Indian Assoc Pediatr Surg 2020;25:68-70

How to cite this URL:
Santhanakrishnan R. Presidential address. J Indian Assoc Pediatr Surg [serial online] 2020 [cited 2020 Aug 11];25:68-70. Available from: http://www.jiaps.com/text.asp?2020/25/2/68/276939




Dear Dignitaries on the stage, seniors, colleagues, and young friends,

I am indeed humbled to stand in front of you as the President of our beloved association.

My innings in the Indian Association of Pediatric Surgeons (IAPS) started during my M. Ch. training days have stretched well over the last 25 years and have been an extremely fruitful one.

I started as a wide-eyed wonderstruck young trainee and have been a regular participant of all the academic events of the association and attended all but three national conferences of ours since then. As my contribution grew, my responsibilities grew as well. I became an EC member, had a very successful tenure as the Hon. Secretary, and finally rose to this chair last year.

I am truly blessed to have such a wonderful mix of elders, colleagues, and young friends constantly supporting me and guiding me as needed and always blessed me. A sincere note of gratitude to each and every one of you.

This 1 year stint as the President has been an eventful one with lots of seen and unseen activities, but a very satisfying one. As I lay down my office tomorrow, I have total satisfaction that I have discharged my responsibilities, to the best of my capability with absolute neutrality and in accordance with our constitution.

Trust me, I have given it all of me to the betterment of our association.

The achievements of this team of Executive Committee are very many and will be listed in detail by the secretary – most notably, we have kicked in e-elections for the first time. At this stage, I would like to congratulate and thank Dr. Prakash Agarwal for his untiring efforts throughout the year. The Executive Committee as well the Election Committee has done a great job, and a lot of other members have chipped in whenever the need arose. What else can a President ask for?

At this juncture, Pediatric Surgery is at cross-roads. There is shrinking demand for our branch despite a burgeoning pediatric population in our country. It is sheer irony that many teaching departments are nearly empty. Plenty of reasons are put forth for this:



  • Pediatric Surgery is not considered “lucrative enough” for the current younger generation
  • The branch entails lots of hard work and demanding, which the current-day youngsters are not ready for
  • There are not enough job opportunities after training
  • There is wide variability in the fee structure, salary, and bond requirements in various centers across the country. All of them are valid observations, no doubt.


But, if we dig deep, there is a lot of unpalatable truth too.

  • I believe that many of the residents are not adequately trained. How many of our trainees are comfortable starting their practice soon after their M. Ch./D.N.B. in Pediatric Surgery?
  • Lack of skills – both the diagnostic and operative skills – is indeed a serious cause of concern. How do we expect to fight, survive, and thrive in the harsh world of reality, which is “result-oriented”?
  • There is a lack of uniformity in the curriculum and training methods among the various institutes with each center believing what they do is the best. How many of us have taken honest feedback from our own trainees to ensure that the training can be enhanced to suit their needs?
  • There are several instances of residents being exploited as they are treated as “bonded” laborers
  • This list can go on too…, but what is the point?


Are there solutions to the vexing problem? Yes, there are:

  • If we, as teachers, can shift the focus from “us” to “them,” a lot more empathy will emerge and we will be able to understand their concerns better
  • Our focus should shift toward ensuring that our residents get a good gainful employment
  • We need to streamline the curriculum with uniformity across the centers despite all the hurdles
  • We should make a conscious shift in the focus of our training from “knowledge” to “skill” and have an objective evaluation of our training. This will ensure that they are adequately equipped to face the world's vicissitudes
  • Starting 6-year M. Ch program in Pediatric Surgery under the MCI will definitely alleviate the issue as there will be more takers if half of the seats are given for NEET-based entrance along with MD and MS. This will provide the residents with more time to learn not just the knowledge but also the much-needed skills in a focused manner. This will also avoid the interested students wasting their time in General Surgery
  • Meaningful research in India is few and far between. This makes us follow the western protocols by default. If only we could have more clinical research from our country, it will benefit the entire developing world as the issues here are far different from the western world.
  • The lack of original research has hurt us very deeply, and we are forced to follow the protocols and guidelines laid down by the westerners. With the patient numbers that we have, we can become world leaders if we can just apply our minds to regularly conduct research suited to our needs. We, as the association, should constantly egg our members to take up research to address the local needs of our populace.
  • It is indeed gratifying to note that there is now an IAPS Textbook of Pediatric Surgery – authored by Dr. Rajeev Redkar. This is sure to highlight the “Indian Approach,” which is sorely missed in the western books
  • The insurance cover and coverage of regular pediatric surgical conditions are very erratic and absurd at times. We certainly have to make a concerted effort in this direction to ensure most of the pediatric surgical conditions will be operated by us and with a good financial package
  • The “Glamour” factor is definitely missing in our branch, and we generally “under-sell” ourselves. Somehow, we seem to take the financial burden of the parents on ourselves


    • Have you ever seen an Orthopedic Surgeon offering the old-fashioned rods and screws and plates just because the patients cannot afford? They convince the patients about the necessity for the latest implants in the field and that the costs are worth it
    • Have we seen the Cardiologists or Gastroenterologists employ cheaper stents or equipment keeping in mind the patients' affordability? They simply offer the best available equipment and charge for them
    • All the Ophthalmologists do have slit-lamps in their clinics and place the latest IOLs for cataracts without wincing a bit.


    • Why then are pediatric surgeons bending over backward to please the patients and cutting costs? It is just the mindset, and we need to change that if we have to create the “glamour” factor for our branch
    • How many of our colleagues are keeping abreast of the latest technology and embrace willingly the changes in the concepts and technology? If not, we are slowly being left out. We certainly need to stretch ourselves to raise the bar for ourselves and make an earnest effort to keep abreast with the changing technology
    • There has been increasing legal interference in our field, and the rights activists are very vociferous. The recent Madurai High Court judgment banning surgeries on intersex conditions is a good case in point. With the increasing tussle between legal and medical fraternity, let us not lose sight of the fact our opinions and moral stands do not matter in the court of law. We will have to somehow reach out to the legal circles and ensure a fair judgment of the medical profession, however difficult it may seem. Let us remember that the law of the land is equal to all and naively expecting them to understand our point without any effort from our side is just futile.
    • The need of the hour is a sensible approach to a sensitive subject and a multi-pronged approach and to keep the legal option only as a standby
    • I have always wanted to create an IAPS academic repository which will be a single platform providing all the information with regard to training and educational opportunities across the world. Even though I have not succeeded in it so far, I am sure we will be getting it soon. This will surely go a long way to help our youngsters to equip themselves better
    • The other area that I see a particular need is “Transition Care.” There are so many children who have fought against nature and share the successes and failures with us. We stay with them through their thick and thin and become so emotionally attached with these chronic patients (such as those with exstrophy bladder, neurogenic bladder, and cloacal malformations)


    • Their care does not end with them growing into adulthood, and we hand them over to the care of our adult counterparts. We get so emotional to find out who can handle them better, and we realize that the adult urologists or gynecologists are neither willing nor equipped to handle the challenges
    • If we can evolve a good “Transition Care” system, it will not only provide good care for our patients but also open up fresh opportunities for our colleagues. If some of us can dedicate ourselves to “transition care/adolescent surgeons,” there would be a potential to usher in a new subspecialty altogether. It is certainly a need of the hour


  • There is definitely an invasion of our branch b other specialties such as Urology, General Surgery, and Neurosurgery. This is inevitable with an increasing saturation in their own branches that they are bound to look for fresh frontiers


    • No rule or legislation can handhold and protect any specialty. The only insurance against invasion from other specialties is skill enhancement. Unless we do that, we will slowly perish. There are of course a lot of efforts taken in this regard, but they need to be strengthened further


  • The framing of Standard Treatment Guidelines (STG) is a welcome move by the IAPS. The treatment modules and STG will do a long way in ensuring quality service rendered in a uniform manner across the country. I am very happy that this executive committee has taken several initiatives to frame several STGs, and this will be an ongoing exercise to be continued by the subsequent office bearers


In conclusion, I would like to state that Pediatric Surgery is a branch that is constantly evolving, challenging, and regularly raising the bar. Let us all take pride in being Pediatric Surgeons.

We, Pediatric Surgeons, I believe, are the cream of surgical specialists and are bound to seek newer heights, face fresh challenges with vigor and definitely win all the time.

IAPS will continue its unwavering commitment to empowering our members in all possible ways to ensure the motto of our association is adhered to.

The preamble of our constitution states:

We, the Pediatric Surgeons of India do hereby unite to form an association titled “Indian Association of Pediatric Surgeons” with a view to propound, to practice, to promote and to propagate the speciality of Pediatric Surgery to render high quality surgical care, to foster fraternity and familial feelings amongst the members, to pursue professional practice with ethics and empathy and to stay away from a milieu muddled with mundane materialism.

Can anything be stated better?

Jan Hind, Jai IAPS.

Thank You, Ladies and Gentlemen, for a patient hearing.






 

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