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EDITORIAL
Year : 2023  |  Volume : 28  |  Issue : 1  |  Page : 1-4
 

Presidential address at 48th Annual conference of the indian association of pediatric surgeons (iapscon 2022) Goa october 14-16, 2022


President, Indian Association of Pediatric Surgeons, Department of Pediatric Surgery, Lady Hardinge Medical College, New Delhi, India

Date of Submission02-Nov-2022
Date of Acceptance24-Nov-2022
Date of Web Publication10-Jan-2023

Correspondence Address:
Yogesh Kumar Sarin
LL-106, Tower 1, Commonwealth Games Village, New Delhi - 110 092
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaps.jiaps_159_22

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How to cite this article:
Sarin YK. Presidential address at 48th Annual conference of the indian association of pediatric surgeons (iapscon 2022) Goa october 14-16, 2022. J Indian Assoc Pediatr Surg 2023;28:1-4

How to cite this URL:
Sarin YK. Presidential address at 48th Annual conference of the indian association of pediatric surgeons (iapscon 2022) Goa october 14-16, 2022. J Indian Assoc Pediatr Surg [serial online] 2023 [cited 2023 Feb 1];28:1-4. Available from: https://www.jiaps.com/text.asp?2023/28/1/1/367383









Respected Chief guest Dr. Bhagwat Karad, Minister of State Ministry of Finance, incoming President Indian Association of Pediatric Surgeons, Dr. Dasmit Singh, Secretary IAPS, Dr. Sanjay Rao, elected members of executive council, chairpersons and secretaries of different sections and chapters and groups of IAPS, faculty and delegates from India and abroad, teachers, colleagues, and my dear friends, it gives me a great pleasure to stand before you today to deliver the presidential address.

I admit while I was preparing this address, I did go through the presidential addresses of my predecessors published in our association's journal JIAPS; these addresses are source of lot of wisdom and make one introspect where we as an association stand today. I may share that the longest and the shortest presidential addresses delivered in the recent past were by Dr. Rasik Shah and Prof. SN Kureel, respectively. After thorough research, I decided to touch upon the grievance of our brethren, especially the younger ones and possible solutions for them.

At the outset, let me remind the ethics involved in our superspecialty. More than three decades ago, Dr. KT Kelly, Professor of Moral Theology remarked, “I would think that a good indication of the moral calibre of a society is the amount of attention and care it gives to its sick, especially those who have nothing to contribute directly to society, the aged, the mentally ill, the severely handicapped and the very young. As long as man's dignity is not based simply on his usefulness to society, this must hold true.” unquote.

So, we mainly treat children with congenital abnormalities born in low-socioeconomic families. Naturally, there is not enough money in this profession. Is that the reason why pediatric surgery is not considered “lucrative enough” for the current younger generation? Or is it that this superspecailty entails lots of hard work and is demanding, which the current-day youngsters are not ready to take up or cope with? Or there are not enough job opportunities after training?

Before embarking on examining the reasons for discontent, we should understand Maslow's hierarchy of needs [Figure 1]. I am sure many of us here are aware of it.
Figure 1: Maslow's hierarchy of needs

Click here to view


This five-stage model can be divided into deficiency needs and growth needs. The first four levels, physiological, i.e., roti kapda, makaan, safety, love/belonging, and esteem are often referred to as deficiency needs (D-needs), and the top level is known as growth or being needs (B-needs). Deficiency needs arise due to deprivation and are said to motivate people when they are unmet. Maslow in 1943 initially stated that individuals must satisfy lower-level deficit needs before progressing on to meet higher-level growth needs. However, he later clarified that satisfaction of a need is not an “all-or-none” phenomenon, admitting that his earlier statements may have given “the false impression that a need must be satisfied 100% before the next need emerges.” When a deficit need has been “more or less” satisfied it will go away, and our activities become habitually directed toward meeting the next set of needs that we have yet to satisfy. These then become our salient needs. However, growth needs continue to be felt and may even become stronger once they have been engaged. Growth needs do not stem from a lack of something, but rather from a desire to grow as a person. Once these growth needs have been reasonably satisfied, one may be able to reach the highest level called self-actualization, achieving his or her full potential. Every person is capable and has the desire to move up the hierarchy toward a level of self-actualization.

Most of pediatric surgeons probably cannot afford to buy Ferraris or Jaguars or may not afford an annual Luxury line Regent Seven Seas cruise costing 0.3 million dollars a person, but they definitely can afford to have upper-middle-class lifestyles; the majority of us could send our children to study abroad. So let's focus on self-actualization, on our ability to treat and operate the sick neonates, children, and adolescents and save and accentuate their lives, rather than being engulfed in perpetual negativity.

For that, we need to have opportunities to the right knowledge, skills, experience, and attitudes. It is moral responsibility of all teachers, whether in teaching institutions or in corporate sector to train the students well, and let them hone their skills so that they are confident to go out and excel in the competitive world. Of course, the system, primarily the State and Central governments need to create jobs where young pediatric surgeons could practice and self-actualize. This can be achieved by:

  1. Starting Department of Pediatric Surgery in every Medical College
  2. Creating jobs for qualified pediatric surgeons in every district hospital
  3. Introducing pediatric surgery as part of the curriculum of “pediatric care” in MBBS
  4. A bill to be passed in parliament or a National Medical Commission notification to be circulated that elective surgeries of all children and adolescents aged < 18 years could be performed only by qualified pediatric surgeons.


Just opportunities are not sufficient. Discontent and depression associated with it are not connected with opportunities and earning potential. Multimillionaires and celebrities are known to suffer from and die of depression. Psychologists agree that depression stems more from isolation than from losses. Adequate and appropriate communication with family members, friends, and professional colleagues is highly essential for happiness. Let me elaborate as to how we can win over professional discontent by communication. Communication may be of personal life or professional life, the later may again be either intradisciplinary or interdisciplinary.

Pediatric surgery is a highly demanding specialty. A columnist of the Times of India recently suggested that it could be the reason as to why medical graduates hesitate to take up this specialty as their career. Veracity of this can be attested by similar poor enthusiasm of students in other demanding specialties such as cardiothoracic surgery. Obviously, a complex reconstruction of exstrophy bladder or esophageal atresia with tracheoesophageal fistula requires several hours of toiling. More than the hard work, we are also easily disappointed by adverse events in our workplaces. The grief of losing a child or having an incurable crippling complication is unbearable. It not only shakes one's confidence, professional pride, and sense of worthiness but also breeds depression. This professional burnout is now a universal phenomenon among doctors, especially after the COVID-19 pandemic. When the Western world has already started examining the mitigations, we are not even aware of it and many of us are not willing to acknowledge its presence in Indian settings. Consultants especially those in private practice work long hours and are deprived of proper sleep and diet. Consequent worsening of physical health contributes to mental health compromise. Therefore, we should strictly follow timetables of our life. Work–life balance is highly important. In his classical treatise entitled “on the making of a surgeon” Prof Ian Aird said, “A surgeon who misses a party for the sake of earning few pounds by attending a sick patient should not have become a surgeon on the first instance.” Institutions often provide adequate relief to senior consultants. But those in private practice often miss their family occasions. This can be overcome to some extent by establishing group practices. When work and stress are shared, the mind enjoys any income.

Good understanding among members of the same fraternity removes work-related stress. Intra-specialty communication is as essential as interpersonal communication of family and friends. We often meet at annual conferences. But that is not sufficient. We should communicate with our professional brethren all throughout the year. Today's technology greatly facilitates this difficult task. I am happy to know that pediatric surgeons are using social platforms (WhatsApp, Facebook, and Telegram) not only to interact about academics, and patent care but also about sports and fitness, travelogues, medicolegal issues, finance, art, music, pets, and even laughter.

Interdisciplinary interaction is highly beneficial both for us and for our little patients. A child falls sick without knowing if it is a medical or surgical disease. Specialty partitions we have are artificial and are created for our own convenience. Transcending the boundaries will theoretically benefit our patients, but that is impractical. As a compromise, establishing interdisciplinary communications and cooperation will achieve the same goal. How many of us attend annual meetings of the Indian Academy of Pediatrics and vice versa? Strangely both associations are concerned with the well-being of children. Understanding and cooperation among various specialties concerned with children can be improved by forming a federation of pediatric medical associations. I have put across this idea of having a “Federation of Pediatric Associations of India” in the October 2022 issue of the IAPS newsletter. Together, the federation of many professional bodies working for children will be more robust in pressurizing the government to get the necessary legislation passed in the best interest of children. The advantage would also be taken to do collaborative research and public reach out. Cooperation between the bodies will ensure better implementation and success of projects proposed by member associations for the welfare of children. I shall be more than happy to mediate this mission.

Our communication should not be curtailed by the geographic boundaries of India. Children of South Asian Association for Regional Cooperation (SAARC) countries face more or less similar challenges. Communicating with our brethren in Pakistan, Nepal, Myanmar, Bangladesh, Malaysia, and Sri Lanka will be mutually beneficial. International reach broadens our minds and helps us to come out of the entangling D-needs of the Maslow pyramid. It is time to revive the Federation of Associations of Pediatric Surgeons of SAARC countries for regional cooperation. I understand some of our members had recently visited Dhaka and Bangladesh for a pediatric urology event. I visited Dhaka Shishu Hospital at least thrice during 2017–18 and had an observer faculty coming from there visiting my department in 2019. I feel proud to share that we have trained two MCh Pediatric Surgery trainees from Nepal recently.

Another important area of interdisciplinary, communication is adolescent pediatric surgery. Anorectal malformations, exstrophies, vaginal atresias, Hirschsprung's disease and so many other anomalies that we treat will have lifelong implications. Tasks which were not a problem during childhood turn out to be a nightmare when these children grow up into adults. For example, the sexual satisfaction of exstrophy patients, fertility of subjects of undescended testis, and growth retardation of cancer survivors can be devastating to the concerned individual. Unfortunately, pediatric age by definition is only up to the end of teen ages. Beyond 18 years, the care of these individuals is abruptly withdrawn from our side and they are shunted to a complete stranger in adult specialties. A smooth transition is possible if we have proper communication with adult specialists. A section of adolescent pediatric surgery under the auspice of IAPS has been created with approval of the general body last year and we are working on it. Bringing adolescents into our fold not only improves the quality of life of our patients but also nurtures a sense of satisfaction in us.

Communication with public is paramount for ultimate happiness. By this, I do not mean interviews and counseling done in clinical settings. Rather I mean communication with communities. The unspoken language of public communication is social service. “Paropakaram Hidham sareeram” is a well-known doctrine enshrined in our Vedas. Money and happiness paradoxically increase when we tend to give them away. It is true that most of our patients are from low-socioeconomic class who cannot afford to pay the hefty professional fee. Using the Vedic principle, we can metamorphose our grievance into advantages. By lending free service to these ailing children, we can find a purpose of our life – typically the B-need of the Maslow pyramid. We can do charity operations at individual levels. At the same time, an institutional backup will enhance the outreach programs and offer necessary legal protection. With this aim during my tenure as secretary of IAPS, the community-oriented pediatric surgeons (COPS) section was started in 2006. We even conducted several charity operative camps at desolate places such as Port Blair, etc., For some unknown reasons, COPS was abandoned few years ago. Younger generation members who feel unhappy about this specialty may find their relevance by reactivating COPS. COPS can liaison with schools to teach the children about trauma prevention and first aid. COPS could coordinate with the Indian Child Abuse Neglect and Child Labor section of the Indian Academy of Pediatrics and help with surgical problems of street children, institutionalized children, and those who have suffered sexual abuse.

Our aim is to reach the unreached stars. For this, we first need to communicate with those stars. I am sure that good communication will open up the doors of professional happiness and bliss. A happy pediatric surgeon is vital for enhanced services and improved outcomes of surgical operations. In these pursuits, it is not only us but our little patients are also immensely benefitted. I quote a 2000-year-old wisdom from sacred Thirukkural which says:

“He who can communicate fearlessly and tirelessly

Will win over battles endlessly”

Let me conclude my presidential address by quoting three human virtues which all of us should strive to imbibe-perseverance, acceptance, and gratitude.

I express my sincere thanks to Dr. Sudhakar Jadhav, and the other members of the organizing committee, especially Dr. Jui Mandke and Dr. Kant Shah for their hard work and dedication.

I must thank all of you for patience hearing. Long live IAPS.




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