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VOLUME MARCH 2020 THE GREY MATTER QUARTERLY NEWSLETTER FOR MEDICAL STUDENTS BASED IN M.I.M.E.R. MEDICAL COLLEGE Something in the air Tuberculosis: The Math A total of 1.5 million people died from TB in 2018 (including 251 000 people with HIV). MDR-TB remains a public health Worldwide, TB is one of the crisis and a health security Ending the TB 10 leading causes of death threat. WHO estimates that there epidemic by 2030 is from a single infectious were 484 000 new cases with among the health agent. Above HIV/AIDS. resistance to rifampicin – targets of the Sustainable Development Goals. In 2018, the 30 high TB Globally, TB incidence is falling at about 2% per year. This needs burden countries accounted to accelerate to a 4–5% annual for 87% of new TB cases. decline to reach the 2020 Eight countries account for milestones of the End TB Strategy. two thirds of the total, with India leading the count. It creeps up on people everywhere, while they travel in local trains, walk in crowded markets and do so much as breathe the air that an infected person has coughed in. Aside from all of these appalling numbers and grim statistics, this disease is both physically and mentally crippling. We call for pre and post test counselling along with regular follow ups to be included as part of the National Health Programme on Tuberculosis to help patients get through a gruelling treatment period. Through this edition we hope to encourage medical students across the country to diffuse what Dr. Zarir Udwadia says is India’s ticking time bomb. 1 2 Dr. Zarir Udwadia on T UES G IEW ERV TTHHEE PPEERRFFEECCTT PPAATTHHOOGGEENN INT In conversation with Riya Barar & Damini Narkhede, III/II M.B.B.S. I started publishing articles in journals when I was doing my MBBS. Having the kind of bent towards research that I've always had and having the opportunity of working in a hospital like Hinduja that encourages those interests, I consider myself very lucky. Most private hospitals don't encourage such activities, but I think it would be really boring to be seeing patients from morning to evening. It's these other interests of mine that keep me going. Q. Tell us about your particular interest in Tuberculosis. A. For me Tuberculosis was almost fortuitous. At the University of Edinburgh there used to be a really famous professor by the name of Sir John Crofton. He had conducted all the initial research on drug resistance in Dr Zarir Udwadia is a preeminent pulmonologist and tubercle bacilli. He had retired by the time I got there, but researcher. He has contributed extensively to the everyone around would speak about this man in hushed work on drug resistant TB and was the first doctor to tones. I think at every stage of my life a little serendipity has document totally drug resistant TB in India and among always played a role. This was one of those. Here I was, at the first few to do so worldwide. this great hospital where this great man had worked. They He is known recognized widely for his famous TEDTalk would show us the laboratories he used, where he did all his amongst other things. drug sensitivity testing to develop the current regimen for tuberculosis treatment we now use. Though I didn't see many Q. What are some of the reasons you chose medicine tuberculosis patients in my 4-5 years of training in the UK, an as your profession? interest developed. A. I don't think there's anything else I could've done. So it Q. Is there a case you will always remember? was either, become a doctor or go bust, and I didn't want the latter. Medicine was the conversation at home since I A. Zubain Irani, a young haemophilic who was one of the first come from a family of doctors. I would often wait in the few patients I saw after coming back from the UK. We have hospital while my father was seeing patients, so I think it reports showing that he was resistant to Rifampicin, Isoniazid was in my blood perhaps. Medicine is a nice way of doing and some of the other first line drugs making him one of the well for yourself while doing well for others. first patients with MDR TB. We didn't know how to deal with him, no one did at that time. I wrote to experts across the Q. Why did you choose to specialize in Respiratory globe, in those days there was no email, so I used snailmail. I medicine? got in touch with a world expert on Tuberculosis, Dr. Peter Davis. He gave me advice, sent some drugs and experimental A. It was an interest from my undergraduate days. I finally vaccines. Zubain had extensive cavitatory lesions and kept chose it after a process of elimination. I was dreadful with having major bouts of haemoptysis which were made worse my hands, so surgery was not an option and perhaps I by his haemophilia. We tried everything for 3 years and he wasn't cerebral enough to do neurology. Since cardiology eventually succumbed to his disease and died. I contributed seemed too high-tech for me, I finally chose Respiratory a chapter in Dr. Peter Davis' textbook and wrote on MDR medicine. Tuberculosis. I think Zubain must be the person who gets the credit for inspiring me to work against tuberculosis more Q. What would be your advice to young future doctors? aggressively. He taught me so much and I'll never forget him. A. It's so important to stress that you need a combination of being very busy clinically, while also developing other academic interests. That's a bug one should catch from an early stage. 3 Q. Can you tell us a little about your passion for A lot of these articles are non-pulmonary but, you’ve got to research? develop an interest in other parts of medicine as well. I believe that's what makes a really good doctor. A. I always had an inclination towards research and publishing articles. Initially, the thrill for publications was Q. What advice would you give your younger self if you strong, but that's long gone now. I don't just observe and could go back in time? treat. I write, research and publish as well. Every Thursday I dedicate 2 hours to a journal club with all my residents and A. To have a little more fun along the way! fellow colleagues. It's a pet project and a passion of mine. I really enjoy pursuing it in addition to being a clinician. I Q. What are the changes you’ve noticed in healthcare deliver lectures all over the world now, mostly about over the last 25 years? tuberculosis. Another disease I specialize in is, interstitial lung disease. It's a very nice feeling when you're asked to A. Sadly, It has gotten extremely commercialized. Sometimes deliver talks in some of the best institutes in the world. I get I get cases in the ICU where I’m only expected to monitor the to talk about what I love while I travel the world. Now I'm a patient’s lungs, while other doctors monitor the other failing little picky with the locations, however. I only go if it's a nice organs. You aren’t completely responsible for a single place like Rome or Vienna. patient anymore. When my residents tell me that a particular case isn’t Respiratory, I always tell them that to be a Chest Q. You've spent a lot of time training abroad. What is physician, you’ve to be a good physician first. Medicine has one thing or practice you saw there that you would like also become more corrupt. It doesn’t just depend on the to see in our country as well? system but, individuals as well. A doctor must stick to his principles. One day you’ll reach a stage like mine when if I A. I spent four years training abroad. Their students are ask the patient who sent him to me, he says I googled you. prepared very well from the beginning. They teach you how When I see doctors announce proudly that they don’t take to talk, how to speak at conferences, inculcate interests in cuts, it makes me sad that we’ve to say these things out loud research, how to write a paper, an abstract and so on. We instead of it being the norm. have all patients here, but often we don't know to talk to them, how to deal with them in the right manner. These are Q. What do you think about the lack of treatment things which could be stressed on in the earlier stages of a monitoring when it comes to TB patients in private student's life. I worked at the Brompton Hospital, which is a setups? centre of excellence in Respiratory Medicine. It was great to use tools like CT Scans, which were not widely known at the A. The lack of monitoring is what has caused resistance. We time. However, I believe after having the kind of clinical once called 104 private practioners of Dharavi, Asia’s most experience this country offers and then inculcating some densely packed and biggest slum. We gave them a sheet of other skills would be the perfect blend for a physician. paper and asked them a single simple question.

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