By Reba Paul
I waited among very patient patients outside Dr. A. Marthanda Pillai’s consulting room. The recent recipient of the Padma Shri award, who lives in Trivadrum and heads the team at Ananthapuri Hospitals and Research Institute, had a packed waiting room. I wondered what it would be like to meet a Padma Shri recipient- would I need to be extra polite and respectful? Surely a man who was respected for the huge amount of medical service given freely to thousands poor patients, wouldn’t be too hard to talk to. Inside the doctor’s room, behind a large table sat a bespectacled man in his early seventies, wearing an army style bristle- brush moustache. Just as I started wondering whether I should be nervous, a polite smile appeared. Clad in a simple brown shirt, sleeves rolled up to the elbows – Dr.Pillai looked like the kind of doctor who was ready to get into action at the shortest notice. Exactly how I would want my neurosurgeon to be if I needed one
Dr Marthanda Pillai (Former Head Neurology Department. Govt. Medical College-Thiruvananthapuram, Presently Chairman & Managing Director, Ananthapuri Hospitals & Research Institute, Thiruvananthapuram) graduated from Medical College Trivandrum and then went on to CMC Vellore to specialize in Neurology, after which he practiced there until 1978. He joined the Medical College service in the department of Neurosurgery after this, following which he worked at Kottayam for some time. Later on he went to England for a few years of further specialization and training, and returned to Medical College. Dr. Pillai was awarded the Padma Shri award in 2011 in recognition of his work in the field of neurosurgery and his service in performing brain and spinal operations for poor patients free of cost. When Dr. Pillai served in the government Health Service he oversaw the improvement of the neurosurgical services, taking it to one of the best at the national level.
H.C: “Going to CMC – was that a part of your initial plan?
“CMC was the foremost centre in the field of neurosurgery at that time and had the first center established under Dr.Jacob Chandy. Being there has greatly impacted who I am as a doctor and my career. It was more a place of worship than a hospital – there was that kind of a reverent attitude… and everyone was committed, service minded. Their day started at 7 o’clock, and went on till 11 or 12 at night, depending upon the workload. Absolute dedication and service – that’s what I saw there. My Professor was Prof.Mathai, who was a role model – his attitude and concern towards the patient, his work culture, punctuality, and meticulousness- were all inspiring to me. Seeing and being with senior doctors who were like this has really influenced my attitude towards this profession.
H.C: Has studying abroad played a part in shaping your career?
“Yes. That too has influenced my thought process, work culture etc. It was more or less similar to what I was seeing at CMC Vellore – their commitment to the patient. For instance, if a doctor is the MO of the Casualty, they just don’t pack up and leave after duty hours. After duty hours, they come back to the ward to check on the patient and see if their diagnosis in the causality was the right one, and would also follow up on the patient until discharged. Another thing would be - an approach of critical thinking about the patients as well as the medical approach taken – that was always there.
H.C: Would you say that this kind of an approach is lacking in our practice of medicine here, in Kerala?Could be, but there are various reasons for that – one is that we are not tuned to that sort of a situation. When we look at modern medicine, most of the diseases, particularly neurological diseases as we know them now, were all described by doctors in the West. They are the ones who documented and began studying it in the current manner and form. We are more bookish – if something is put down on paper, we do not look any further than that. They are not like that – their thought goes beyond what is in the book. They don’t accept the status quo – there is a scientific curiosity to know more about things. That is why they constantly try to find out newer medicines, or define new scientific processes.
But they have much lesser patients than a doctor here has – so there is more time to pursue research and experiment. Also, over here, this profession is a way of making a living. This is our only means of security. In the UK, they do not have to worry about social security. On another angle, they also do not have the concept of amassing wealth for their future generations like we do here. All of these social factors count in how our attitude is formed. Things are different here – there is competition, it’s a mad race for existence and survival. So for many of the people, the time you spend on the real profession becomes much lesser.
H.C: So it was very important that you could have this experience?
Yes. It is very important to have this exposure. Especially after you pass a certain stage in your profession, it is always good to look at the approach of professionals in other places. For example in Vellore, which is considered one of the best teaching centers, we used to have postings in other medical institutions – in Madras or Bangalore or Karnataka… you would visit four other centers. The purpose was to understand that one situation or problem could be approached in different ways – you would see different people approaching similar situations with different perspectives. We lack this element in our teaching programs here. In my case, you can say that I got the opportunity by chance.
H.C: So would you say these are certain things that should change in the way our system works now?
You know, one very good thing about how the system works in the West is that right from the undergraduate level, there is a teacher to gauge the aptitude and skills of the student, and effort is taken to develop these skills. And ultimately the student will choose a profession for which he has more skills. It is not so over here – most of the time the parents decide that the child should go for MBBS. And there are many students who stop their course midway, especially in the private professional course sector. That is because without considering the child’s aptitude, the ambition of the parent is directly planted onto the child.
Of course the system is changing, but you can’t keep taking a lot of time to do this…even after so many years of realizing this is a problem, we are still ‘thinking’ about how and where to bring about change. We should be taking a little more of an active approach. I think the human resources department is focusing on this now.
H.C: Why is the human brain such a challenging topic to you?
Looking at it as an organ in your body – no other organ can match it , in terms of its physiological function. It constitutes only about 2% of your body mass, but almost 15% of the blood pumped out of the heart reaches the brain for its proper functioning. About 20-25% of the oxygen that we breathe is supplied to the brain. So you can understand how active the brain is. If we look at the functions- unlike other tissues like skin or the lining of our stomach etc. which looks like rows of bricks one on top of the other, the brain cells are very different. The actual cell body of a brain cell will be in one place but its process may be in a portion of the brain that is distant from it. One cell may have about 50,000 connections with another cell or its processes. So the brain is a group of cells that has such an intricate network – around 2 billion cells are in the brain. This cannot be duplicated by any computer – 2 billion cells with 50,000 interconnections!This has its own advantages and disadvantages. Once the brain is damaged, it is almost impossible to reestablish all of these 50,000 connection between cells. That’s why recovery is more difficult in cases of injury to the brain as compared to other organs. But the brain is adequately protected, unlike any other organ – it’s the only one with a hard bone covering. Now, even this has its advantages and disadvantages – a tumor growing in the brain has no place to expand whereas a tumor in any other organ has space to expand. So in the brain even a slight increase in volume produces quite a lot of ill health or is life threatening. Also in the case of infection – all other places in the body have their own defense mechanisms to fight against infections; the brain has much lesser capacity for this.
H.C: Is aging a part of the brain function?
Technically speaking, the reason that a person ages and dies, is due to the gradual decrease in brain function. In the first two years of your life, your brain grows by 200%. This is sustained for many years – up to 30-35 years. After this, even in people who are in the best of health, the brain slowly starts degenerating. When your brain starts failing, then every other organ slowly starts failing. This degeneration depends on how much of your brain you use. In all of us the capacity utility of the brain is hardly 2-20%. There are areas of the brain that are literally dispensable, simply because we are not using the whole brain. When you use a part of your body, there is a corresponding blood flow to a certain part of the brain. So leading an active life, using your brain and its thinking and processing capacities, engaging your mind - these are all things that will help keep the brain active and healthy.
H.C: What’s your opinion of the quality of the medical profession in India now? Are we moving in the right direction?
We cannot make a flat statement about that. The younger generation is more intelligent – that is evolution. So that process is going on, they are much more intelligent, versatile, and resilient. But the existing social order, the circumstances that exist, the lack of ideal people to look up to… these are all things that need to be addressed if the profession is to evolve in a good manner. When children are in their teens, having a role model is essential. We do not have good role models for our children to be inspired by. All we have is a distorted perception of life that is acquired through TV or other popular media. Many of them find their own way through trial and error. If there is anything wrong with the younger generation, the social order or the system is to blame. So if we correct the system, things will be better.
H.C: Are there ways in which the medical establishment can function in a much better way, so that the people are benefited more?
The evolution of the health delivery in our state is quite ideal –and over time, things are definitely improving. When a need comes, an adequate change comes. Availability of an efficient medical service at an affordable cost – is not available in many states of even other advanced countries. Even in a place like the USA, almost 40% of people who need medical care may not be in a position to receive it. Here, we have a combination of public and private sectors and other national institutes to ensure that everyone who needs medical attention gets it. So we can say that our system is a better system by any standard. We have to remember however, that quality improvement always comes when there is a demand for it and when you are vigilant. In Kerala we have a population who is health conscious and are also very demanding that they want the best. This kind of a watchdog role is being taken by the public so there is a constant automatic improvement happening in the system.
Almost all areas of our state are receiving good health care through the private or government sector – even remote areas. Of course there is commercialization, and corruption does exist to an extent. But the positive aspect is that we are improving, we are giving better health care, at an affordable cost. So generally, the direction that it is going in is alright.
H.C: What is your opinion of the condition of the auxiliary services that we have right now?A lot of improvements are actually happening in these areas. Earlier, the ambulance was used only to transport a dead body. It was just a vehicle with a driver. It’s not like that anymore. We have well equipped ambulances, with well qualified professionals. But this should be cost effective. The number of ambulances should be increased on the basis of utility. If you have 100 ambulances, which are not being utilized, then that is a waste of resources. The number of trained people also should be increased in accordance with the need. This can go a long way in givingtimely help to patients. For example, if a patient has a heart attack, an ambulance goes to pick him up, the accompanying healthcare professional should be able to thrombolize the patient– which is same thing to be done for a stroke. This will shorten the time taken for the patient to get adequate attention, and can improve his chances of survival and recovery. For a stroke, if you can thrombolize within four hours, it can go a long way to dissolve the clot and prevent further complications.
H.C: What is your take on many patients going in for alternative treatments following a stroke and other such neurological conditions to facilitate and aid recovery?
The scope of an alternate system is limited. If you have a genuine disease, modern medicine is the one thing that can give you maximum relief; I have no doubt about that. People with psychological and psychosomatic disorders – for example, a patient complaining of back pain and repeated scans do not show anything wrong – such patients might get solace from alternate systems. For any real diagnosed disease, modern medicine is the only science that can give good relief. Ayurveda, in particular is effective for chronic illnesses, like stomach upsets or dermatological conditions. And the massages and other things are a substitute for physiotherapy. But even this needs a word of caution – a patient who suffers from neck pain should not go for Ayurvedic treatment without proper investigation – or it could do more harm. Especially in cases of disc prolapsed or bone disease; if proper diagnosis is not done initially, in many cases, massage can make things worse.
H.C: So what would be your advice for a stroke patient – many are conflicted about what to do next.
For a stroke, you have to always go back to the reasons that caused it and continue to treat it. Diabetes, cholesterol and lifestyle habits- all these are contributing factors. And a patient who gets a stroke is likely to get many more strokes over time. So lifestyle and dietary changes, exercise - these are the things to be strictly followed. And adding physiotherapy for recovery is scientific- if these things are followed, there is nothing more to be gained from any other alternate system. I don’t mean to belittle any other systems, but the scope of what they can do is the same as what the patient can achieve with these changes. There are, however, a large number of patients that do go for alternatives like naturopathy etc. Most of these are related to psychological symptoms. The main things to remember is that rather than emphasizing on the curative aspect, we should be focusing on prevention of disease. Curative aspects are always taking great strides forward, but these are all expensive, so we should be looking to prevent disease….
and many are lifestyle related.
If you had not become a doctor, what profession would you choose to be in?
(chuckles)I would have been an engineer. You see, in neurosurgery, instrumentation and the mechanical aspect is very much there – the surgery is very dependent on tools and other equipment. This is something very interesting to me- the mechanical aspect of the brain.
H.C: What was your response to the prestigious award that you received recently?
Of course, there is a satisfaction that what you are doing is being recognized…but basically it gives you much more responsibility. Because once you get this kind of recognition you have to live up to it and keep improving your performance.
H.C: Finally, what would be your advice to someone of the younger generation who wishes to be an effective doctor?First thing is, if you have an aptitude for it, go for this profession. This is a field that requires a high level of social commitment. You have to practice medicine with religiosity. It’s just like a prayer in a place of worship, and if you do that, then the rest of the things will follow automatically.