I was ridiculed when attempting something different: Laparoscopy pioneer Tehemton Udwadia (IANS Interview)

By Vishnu Makhijani

New Delhi, Jan 8 (IANS) His mentor taught that success is not a destination, but the journey. "And with such mentors," says Dr. Tehemton Erach Udwadia, the pioneer of laparoscopy or minimal invasive surgery in India, "my journey with all its stumbles, all the ridicule I faced when trying to do something different, has been an exciting, joyous roller coaster ride where Ive screamed when going down and laughed when going up."

His journey over nearly 70 years "has been a rollercoaster ride with ups and downs, stumbles and falls, getting up brushing the abrasions and moving forward. I have been blessed with remarkable good fortune in all the people I have come in contact and worked with over the decades, my mentors, my peers, colleagues, residents, nurses and patients," Udwadia, a recipient of the Padma Shri, the Padma Bhushan and the OBE, who has penned this heart-warming journey in "More Than Just Surgery -- Lessons Beyond The O.T." (Penguin), told IANS in an interview.

Through the journey, he has learnt that the best professional performance and personal joy "is try and be yourself, do what you feel is right, and not be part of the herd which like sheep is marching to the beat of a distant drum, or follow the dictates of evidence-based medicine or of professors in five-star hospitals. All patients do not go to five-star hospitals and the strength of surgery is to treat all patients."

"A short-term spent in research trained my mind to think of new avenues of treating old diseases which gave meaning, joy and passion to my work," he said, adding: "Coming from a middle-class family and seeing my father's devotion to poor patients rubbed onto me and became a part of my thought process."

Initially, every surgeon thought that laparoscopy was an exercise in futility, but several physicians started referring their gastrointestinal cases to him. The residents were delighted because they were getting into a totally new field of surgery which possibly had great future significance.

In his book, "Laparoscopic Surgery", published in 1991, Udwadia wrote that the procedure "may well be the springboard for new endeavours in minimal invasive and minimal access surgeries (MAS) in areas not even dreamt of today". Today, "far from being a fanciful prediction, time has proved it is a gross understatement. Today, all abdominal surgery can be done laparoscopically," he says.

At the same time, he writes in the book that MAS is just the beginning: "Surgery will get smaller and safer but the smaller will become incomprehensibly bizarre. Mini-robots, the size of an atom, could engineer intra-corporeal changes in nanos to carry out intra-corporeal manoeuvres like target delivery for drugs to eliminate disease cells like cancer." When does he see this happening and more importantly, will this filter down the line?

"As I have said in the book, the future could be wilder than the craziest of science fiction stories. Mini-robots operating on nanos is being worked on but this work is in its basic infancy and will take a lot more effort and research to come to the clinical stage (if it ever does). This futuristic surgery would be confined to just the few centres indulging in this effort and would take years to gain some spread," Udwadia said during the interview.

"Such surgery would only be confined to these few centres and would certainly at no stage trickle down to the total population. This is similar to the liver transplant which is confined to super specialty hospitals and is so complex that it can ever be a part of rural surgery. However, the writing is on the wall that as John Hunter said more than two centuries back that 'surgery will become both knifeless and bloodless', with interventional surgery, molecular biology, genetics and similar advances, all nibbling away at surgery as it is done today," he added.

Q: About a decade-and-a-half ago, when India was the flavour of the month and there were a plethora of international organisations falling over backward to sponsor seminars in the country, a prominent Union minister had proclaimed that 60 per cent of the population lacked access to basic healthcare. What, to your mind, is the situation today and what more can schemes like Ayushman Bharat do to improve the situation?

A: "I'm not too good at statistics, but feel the situation is more or less the same as the percentage who do not have basic healthcare. Health has never been a priority of any government from the time of independence, till for the first time, this government, three years back, uplifted health with a massive financial input starting the Ayushman Bharat scheme. If properly implemented with the planning and vigour of our other infrastructure schemes, this scheme would be a game changer in India's healthcare."

"The objective of this scheme must be to move beyond paying for individual poor patients, move to create an infrastructure that takes health to the doorstep with widespread mini-hospitals, well equipped with trained, dedicated, happy manpower. This infrastructure will remain forever a sustainable base to perpetuate healthcare where it is most needed -- in rural India. What we need to do is improve statistics, not flaunt them," Udwadia added.

Another area of concern he lamented, "is the vast divide, which is increasing between the doctor and the patient which has created a rift in doctor-patient relationship. If we are to come back to the old times of trust and acceptance, the doctor has to ensure he treats the patient as his close friend or relative, and the patient has to realise that the surgeon is human and practicing an art which has innumerable variables and inconsistencies, and is merely a human trying to help the patient."

Q: In this context, how does he see the 'new normal' if there ever will be in a post-Covid world?

A: "In the process of evolution, the Homo-Sapiens has encountered and overcome several threats to its very existence. Covid is one such episode in the history of mankind which I'm sure will be overcome in its own time and there will be a post-Covid world. Covid, apart from its traumatic impact has also been a source of information to the human race. We have to learn that no country is an island by itself and when it comes to threats of this magnitude, we all have to stand together and be together."

"Hopefully it has taught mankind, which was growing more and more self-centred, greedy for more and more materialistic comfort and environment to learn the difference between wealth and materialistic acquisition to simple success and happiness. Hopefully the fast-eroding structure of family, togetherness, community and care for the underprivileged which has rapidly been eroded in the pre-Covid era will again find a place in our lives for the simple joy of life and happiness," Udwadia added.

Q: How does he see his personal road ahead?

A: "At 87 and with health issues, I look back with gratitude for having a fulfilling career and a good innings. The road ahead will have very limited professional activity (one clinic a week as I have just now), more golf, and much more time with my wife Khorshed and the children and my grandchildren. Sadly, travel which over the years was a great joy of my wife and I is restricted due to Covid, but if Covid leaves us, to travel," Udwadia concluded.

(Vishnu Makhijani can be reached at [email protected])