Dr Neelam Mohan is a leading paediatric gastroenterologist and hepatologist in India, with more than 18 years of experience in the field. A pioneer in developing the field of liver transplantation, she is credited with highest number of paediatric liver transplants in the country.
Dr Mohan has set up India’s first ever department of paediatrics gastroenterology, hepatology and liver transplantation at Medanta Medicity, Gurgaon and runs the busiest centre in Asia for paediatric liver transplantation.
She is the country’s first doctor to start therapeutic endoscopic work in newborns and young infants. She has also established India’s first one-year fellowship in paediatric gastroenterology, hepatology and liver transplantation, certified by the Indian Academy of Paediatrics.
Honoured with several awards like ‘Fellowship of Indian Academic of Paediatrics’ (FIAP), ‘Vashisht Chikitsa Ratan Award’, and ‘Eminent Doctor of the Year’, Dr Mohan was recently awarded with Swastha Bharat Samman by Zee Health by Health Minister Ghulam Nabi Azad.
In an exclusive interview with India Medical Times, Dr Neelam Mohan spoke about her training days, the challenges she faced and her future plans.
What led you to a career in gastroenterology paediatrics?
I always wanted to do something different, something which did not already exist in the nation at that time. So, I realized that paediatrics had not taken a shape of super specialty in our country. Even doing just paediatrics was enough. Nobody thought beyond it that — can we go into paediatric gastroenterology, paediatric cardiology, and paediatric rheumatology? That awareness was lacking in the country at that time. So, I always wanted to do something that has not taken a right shape in the country and demands attention in terms of super specialty. As my training was in early 90’s, I wanted do to something which is unique and has scope of tremendous growth. Touchwood, I was very bright student during my MBBS and MD days and too fond of therapeutic procedure which give you some sort of satisfaction.
So, for some reason I decided not to go in the surgical field as I believed surgeons are good in their hands and physicians are good with brains. And since, I was always considered as someone with good brain, I didn’t choose the surgical field. But later I realized surgeons end up earning much more.
Three subjects fascinated me the most during my medial studies – Cardiology, Gastroenterology and Genetics, as genetic awareness was also at an infant stage in the country.
Neurology I did not like because I find it very depressing with hardly any results and I love to see results so I did not take it. And cardiology training was like looking to me still very difficult to culminate.
Finally, between Cardiology and Gastroenterology & Liver, liver fascinated me quite a lot, because liver is one organ, which is amazing. There was absolutely no awareness in 90’s, I decided that I want to do some endoscopic procedure, therapeutic procedure etc. So, this is the field in which you get the satisfaction of doing a procedure which a surgeon was not able to do and you were able to do. So, that’s how I kept my interest moving forward in GI.
Tell us something about your training days? The challenges you faced?
The training in gastroenterology did not exist in the country in 1990’s. There was only one place – AIIMS where there was at least some amount of GI training being done. But unfortunately, all those experts of the field have left that place now. I am talking of the time when Dr M K Bhan and Dr N K Arora were in AIIMS. These were the people who were doing some amount of research into GI and liver. I went into research and training with them and learnt quite a lot.
After working at AIIMS for one and a half years, I really felt hollow. As if I was not doing anything great. Everything revolved around two three subjects only. Gastroenterology in India meant just diarrhoea, beyond that we were not thinking. And in liver also we were doing just the very basic. So, I decided to go to England. Because of being a bright student with a good CV, I was selected.
I was trained for two years in England (1997-1999). At that time liver transplant was taking a really good shape in England. They were doing say 35-40 transplants at that time. By the grace of god, I am doing the same number of transplants now. But at that time, it used to be like nobody had ever heard about like a liver transplant here in India.
For two years, I did my training both in gastroenterology and liver disease. Because I knew I can’t go into super specialty only in liver, I wanted to do GI also and what I learnt were totally new.
I learnt about motility, manometry and chronic diarrhoea and bubble transplant. So that was a totally different field in which there was no exposure at that time in India and same was the case with liver.
So with that I came back to India in 1999 and nobody wanted to recruit me because I only wanted to work in gastroenterology and hepatology. Doctors cribbed and used to ask me — you won’t give injections, won’t do night duties and won’t do deliveries, then what will you do?
I was outright in my replies that I wanted to increase awareness related to gastroenterology and liver. Fortunately, I got a break in Ganga Ram Hospital where for 10 years I worked upon many good things and also set up a unit which came up as the best unit in the field of gastroenterology and hepatology. We were pioneers in liver transplant at Ganga Ram at that time.
There, we started up a lot of work in reflux disease and gastroenterology and endoscopy. I was the first in the country to start endoscopic procedure in 2.5-kilo babies. Nobody had ever thought about doing endoscopy in them. I started not only diagnostic but therapeutic endoscopy. So we did a lot of first, first and first there and that kept my confidence moving forward.
What do you find most interesting in paediatric gastroenterology?
GIP is a field in which we treat right from a running nose, cough or asthma to complicated ones. We treat everything. But if I am able to save somebody’s life – the kick that it gives shoots my adrenaline up. A Ferrari ride won’t give me that adrenaline surge which saving someone’s life does. Of course, I believe doctors are just ‘Mohras’, it’s he — the almighty Lord — who does it. I feel if he has chosen me as the blessed one to save people, I have the onus of being very responsible and try my best to save the life of a patient.
The amount of blessing that I get from parents of children is overwhelming. Most of them write to me, most of them call me the second mother of the child, so if I feel if I am able to become the mother of so many children, the purpose of my life is solved.
It’s a team effort in Medanta, where we have shaped it up so beautifully and everything is going in such a way that highest number of successful transplants are going here in India and we are head to head with America if not more than them and with the grace of god, results are even better in their comparison. If they are giving 90 per cent, our success rate is 95 per cent.
Are there any particular individuals or events that played an important role in shaping your career?
My husband and my children have been my consistent motivators and supporters. I feel as if they are always standing beside me and giving me a pat for good job. They have been always there for me.
Professionally, I would like to mention the names of four doctors who have guided me and supported me. My first mentor was Dr S C Arya. He was a paediatrician in Ganga Ram Hospital. He had that confidence in me that I should do something different and he introduced me to Dr M K Bhan, who is now working with the government. Both posed a lot of faith and trust in my capability. I used to work at AIIMS from 7 am to 9 pm and never took a penny back home. All I used to get, I gave it to poor people who came there for treatment. I feel I used to get too emotional with my patients.
But I wanted to spread my wings from A-Z, and I wanted to get to the zenith, which not everybody was able to do. So, Dr Bhan was the one who wrote some excellent words for me and sent me to England.
My third mentor was Dr S K Sama. When I came back from England, not many people were happy to keep me because they thought I would not be able to succeed, as the field that I chose didn’t exist in India. But, Dr Sama had that vision for me that I will grow much more than just a paediatrician.
Dr Trehan (Dr Naresh Trehan), of course, has influenced me a lot. Under him I have mushroomed a lot.
How challenging has been the journey?
Well, to be honest it has been a very tough one to reach where I am today. There were many hurdles. I felt demotivated and down quite a lot of times during the course of my journey.
My mother was an extremely positive person and I am lucky to have my mother’s genes. I have inherited that positivity and optimism for life. She taught me even if there is one-fourth water in a glass, never think its three-fourth empty, only look at the one-fourth quantity. I have always been an extremely positive person so I remained focused and consistent towards my goal.
Yes, my stars have not been very lucky. Sometimes, I felt that to achieve the same thing, I had to work a lot lot harder to achieve as compared to what, I feel, my colleagues did. So, if one is extremely positive and passionate, no one can stop you from reaching success. And if you have the knowledge – success Jhakh Maar Ke Aayegi. I truly believe in it.
If you have the knowledge, if you have the consistency and the focus, you shall definitely achieve your goal. May be some people may get it in first attempt, some in second and some people may require a lot of time. And now that I have achieved it, I may be allowed to say that my story in Ganga Ram Hospital for 11 years was not an easy one.
But I grooved faster than the other people. At the end of the day, I feel very extremely satisfied with what God has given because I let the growth keep happening. Sometimes, though, I am not very satisfied when it comes to myself, but that is in a positive way. I feel the day when I will be satisfied with myself my growth will stop. This dissatisfaction is only at a personal level.
For example, for the last two-three years I am working on the idea of a children’s hospital. It may or may not come true. But at least, I am striving to do something better. I keep working like a spider, consistent and focused, building a web of knowledge and learning around me.
I am supposed to be very good in teaching too. I make science simple like maths. And that’s why students are very fond of me because I feel I teach them the concepts in a simplified manner.
When my juniors tell me that the aura I give them is so positive that they get amazed where I get so much energy to work right from 8 am to 9 pm. I tell them that energy comes from within. I believe traditional methods of healing work wonders to give you peace, consistency.
What brought you to Medanta Medicity?
There comes a stage in life when you want to do more and you feel space for growth is lacking. The purpose of moving from Ganga Ram to Medanta was because I felt at Medanta my growth is going to be horizontal, as vertically I had already achieved quite a lot.
So, I was looking for horizontal growth where I can have a tree. I wanted to spread my knowledge into sub-divisions in six subjects. There should be knowledge and practice of motility, endoscopy, ERCP (endoscopic retrograde cholangiopancreatography), capsule endoscopy etc. Now, you name it and we have it. We keep on training our team here and concisely work to have the best department, which can open up all new dimensions in the treatment of liver. Medical is not one time knowledge, we keep on updating ourselves and improve.
For example, we have just sent our technicians for training to England and America. Right now, they are in Milwaukee (US) for three weeks to get the training.
What do you expect to grow further in Medanta?
In India we have around 40 per cent of the population as less than 18 years, but, what a shame, how many Children’s Hospitals are existing in India?
Now, I am expecting Dr Trehan to give us complete freedom for a dedicated Children’s Hospital where the administration should not be looking at income. The hospital should just be able to sustain itself and profit should not be the prime motive. So, my next dream is to open a children’s hospital where everyone works sincerely for an all round development of children, whether it’s child development, social work, autism etc. Each super specialty divisions should be there for them.
I hope we should be able to get a good children’s hospital, where we should be working in a Robin Hood manner catering specially to the poor.
What was the most difficult case in your career?
I believe that there is something called positive energy system because I have seen miracles happening. When the same amount of effort we put on four children, and three survive and one doesn’t, it gives me vibes there is something beyond just medical science. There were two-three miracles, which I can’t forget. Out of which, I would like to mention one.
In one unforgettable case, a child named Blessy had liver problem and another rare thing called hepatopulmonary syndrome. So, there was a shunting in the lungs and besides she also had some heart problem. Given the three problems of liver, lungs and heart, chances of her survival were minimal. Her mother had faith that I am the one who can save her. That was one of the most complicated cases of my life.
After ten days of the liver transplant, she developed hepatic artery thrombosis. I remember it was 31st December 2012; I was not sure whether we could save her. We performed almost a ten-hour surgery and created a graft which connected a new artery to the liver. We worked very hard and with god’s blessings we could save her. She is seven months and healthy now.
So, the point is even with multiple rare conditions we could save her, sometime even with 70 per cent survival chances we couldn’t save another. There is someone above everything that plays its cards.
You have an interest in social work and have also started some free clinics and camps. How do you manage between your core profession and voluntary activities?
Social work is really one area that I am keen towards. This year I have stepped up my efforts further. I go in the morning to different schools, colleges and students’ union where I want them to know, the awareness, about hepatitis B and C as it is much more dangerous than HIV. People need to be aware of it. We run free paediatric gastroenterology and hepatology clinics and free clinic for the thalassaemics.
Our Cherry Hill Educational Society aims to provide free basic education to a certain section of people.
Hepatitis is one area that I hold a lot of interest in. I was the group leader for Guidelines on Management of Hepatitis C presented at the World Congress, August 2008, in Brazil and a representative from Asia and Commonwealth Countries for the Working Group in Liver Disease in Children at the World Congress held in 2012 in Taiwan.
We experts chose to lead hepatitis B and C because almost 300 million people are suffering from hepatitis B and 190 million from C. Seventy per cent of these sufferers get hepatitis in their childhood. We paediatric people realized this and started working towards setting real goals. I started giving lectures in schools as I felt a lot of awareness was needed, especially among girls because if she understands the importance of health, the future would be healthy.
What could be the possible reasons that we still haven’t been able to bring hepatitis under control?
Because hepatitis B and C is asymptomatic. The only thing we have been requesting the government is to make hepatitis B vaccination universal and that we have been harping on for the last ten years. Though, we have the vaccination programmes spread in almost all states, we lack in making it universal.
We can draw some lessons from Taiwan experience. In 1989, they made it (hepatitis B vaccination) universal and after so many years the incidence of hepatitis is less than one per cent now. We have to stop further growth of it and tab the percentage here by vaccinating one and all. Make vaccinations free and universal.
Tell us a bit about the focus of your current practice and research areas you are focusing on?
There are two main researches I have been working upon. One — how stem cells can be an answer for some metabolic liver disease. The next move I want to make is in stem cell transplant. But it is at a stage of infancy because we are not getting support and funds from the government. We are trying to approach them to materialise it.
Second – in epidemiological studies where we are trying to look into hepatitis B and C awareness. I do free clinics for thalassemia patients and have formed a children’s society, which unfortunately is not able to get much funds and I am the only one contributing to it. So, if I am able to get funds for the society in a transparent way, maybe I can do a lot for children.
There is a view that we blindly adopt western practices of research and diagnosis and there is a compelling need to find local solutions for local problems in India. Your comments.
Yes, that’s true. This is also something that Dr Trehan keeps on emphasizing too. He says why just we need to blindly follow the western practices. I think it will take us another decade or more where we will reach at a level, where we are doing some newer discoveries into drugs.
It is good that we have at least started laying foundation stone, but even to look into epidemiological research we need to keep in mind what are the local problems, what is the simple way towards approaching these diseases.
If you ask me if liver transplant should be done by every government hospital, the answer would be no because the same amount of money that they will put in setting up the facility can be used to save thousands of people who are suffering from less complicated diseases and use resources for vaccination.
What I am trying to say is research should not be only in the hands of the government sector but in amalgamation with the private sector because the private sector is catering to almost 80 per cent of the population.
What are your future plans?
Being a Piscean, I am a bit of a dreamer. Something in me says that ten years down the line I will reach a stage where I will be into some amount of policy making. But because I do not want to get into hardcore administration right now, I do not want to go on to opening a hospital. I am very fond of clinical science and do not want to leave my clinical work because that is my strong footing. I do not want to be a purely administrative person but yet I would love to spend 25 per cent of my time into administration, 25 per cent of my time into the policy making (given an opportunity), and 50 per cent of my time to clinical work because I feel that is my strength.
What advice would you give to young medical professionals and your colleagues?
In today’s era, it is more difficult for a woman to succeed. Of course, women are progressing, but I feel that the amount of the hurdles that I went through was sometimes related to me being a woman. I believe to be called as brains with beauty and not beauty with brains. Believe in women empowerment and education and the health of nation will improve. Women can rise even a step further than men. All we need is to be organized. Just being balanced is the key.
The message is don’t ever get disheartened, when you have the focus and passion you will definitely get what you want. It is only a matter of time. Some may get it early, some may late but do not loose your dedication. Success does not take a straight easy way, hurdles would be there but tread the way you are onto and you will enjoy the journey and success. Be honest and give your hundred per cent in what you are doing and come out with flying colours. This message is not only for my fellow medical professionals and students but for everyone who has chosen to dream big.
by Vidhi Rathee