Dr O P Kalra is Principal of the University College of Medical Sciences (UCMS), New Delhi. Dr Kalra finished his MBBS from Jawaharlal Nehru Medical College, Aligarh and MD and DM (Nephrology) from the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh. He joined UCMS as an assistant professor in 1988.
In an exclusive interview with India Medical Times, Dr Kalra shares his experience as the Principal of UCMS, a post that he has been holding for seven years, and the achievements that kept him motivated to face all the challenges successfully.
How medicine came by as a profession?
This decision came quite naturally to me when I was studying in school. My English teacher asked us to write an essay on what you would like to choose for your future profession. I thought for a while, and decided to write that I want to become a doctor in future. Why it came to my mind, because I always consider it as a very noble profession. You can do so much for your patients, for your students.
I think these two things are very important in life. The relationship of a doctor with the patient and the relationship of a teacher with the student. And particularly, when you are a medical teacher you are able to have both of these things. As a teacher you can be with the students and as a doctor you can be with your patients. My father supported a lot in my decisions. He always motivated me to appear in competitive exam and then get into the medical profession. I went to appear at few centres, and got selected in Aligarh Muslim University for MBBS. I always relish that I was the student of that university. Five and a half years over there and then I did my postgraduation from PGI, Chandigarh. I joined medicine there for my postgraduation and then I did my nephrology training there only.
When did you decide to become a nephrologist?
When I was doing my postgraduation from PGIMER, Chandigarh, I liked the subject of Nephrology very much because there is so much you can do in nephrology, particularly with patients with threatening problems like end stage kidney failure or for those whom we can say that we have written them off. At that time transplant had just started in few centres in India and PGIMER, Chandigarh was one of the first centres in the country to start kidney transplantation. Patient who has less chances of survival, when given a kidney transplant eventually get back to the normal life. So, that is one thing that is very gratifying about the kidney diseases. Secondly, the sudden onset of kidney failure, which is a very life threatening disease, requires haemodialysis support for a very short time and then they are able to get back to their normal lives. So, this is what interested me a lot and that gives you a lot of satisfaction of being a doctor and treating such patients.
How has Nephrology grown as a specialty over the time?
There are a lot of advancements which have taken place. Firstly, in our country particularly, the specialty has grown quite a lot. In Delhi, 30 years back there were just two or three centres which were doing haemodialysis. Now, there are more than 80-85 centres in Delhi alone which are doing haemodialysis and peritoneal dialysis (PD). Also, many centres are now doing kidney transplantation. The quality of haemodialysis machines have improved quite a lot and most important is the quality of water, which is being used.
Earlier, doctors were not so much conscious about ensuring the high quality water, which is used for doing haemodialysis. But nowadays every haemodialysis unit is using reverse osmosis treated water and the water has to be purified as per the American Standards, which is must. This has been able to ensure a good quality dialysis.
But the most important thing still has been that dialysis has been out of reach for most of the people who are in the lower socio-economic status. In this direction, we at GTB Hospital have done a lot of work. First, being in a government hospital we are able to provide quality dialysis to the poorest of the poor patients. And secondly, I have been involved with the Delhi government for the last three years particularly for the development of haemodialysis centres in Delhi. We have developed this under public private partnership, where we have been able to reduce the cost of haemodialysis by nearly 40% and at the same time ensuring quality haemodialysis at these centres.
Under this arrangement, Delhi government is providing haemodialysis through a private party in the Delhi government hospitals. Delhi government is providing the private parties the space and the building and the private party is providing the haemodialysis machines, the material, manpower and the doctor’s support also. So this way, Delhi government is able to save a lot of budget because it doesn’t have to invest on its own and quality dialysis is ensured to the patients with severe renal failure at nearly half the price. Those who are very poor, who are below the poverty line, or hold Antyodaya Anna Yojana (AAY), or have an income of less than Rs 3 lakh, the Delhi government on the recommendations of the doctors is providing completely free dialysis.
India has been able to extend its experience in Nephrology to other countries too. I was in Nepal at B P Koirala Institute of Health Sciences, Dharan, from 1997 to 1999. The institute has been established with the support of the Indian government. Doctors from India go there on deputation basis and the institute has now come up very nicely. The dialysis facilities in the country had been very poor and the haemodialysis services were mainly centred in Kathmandu. In Dharan, for the first time, we developed haemodialysis unit outside Kathmandu.
What are the current researches in nephrology especially that are an area of focus at UCMS?
In UCMS, we have established a very good dialysis centre. Over here, we have been doing lot of research also, especially in the area of diabetes and diabetes resulting in kidney diseases. For the last 15-20 years, non-communicable diseases are on the rise in the developing countries like ours. Diabetes, kidney diseases, strokes, heart diseases are increasing so much so that nearly 60-65% patients now are dying due to non-communicable diseases. So, there is a lot of need for research because when a patient develops complications, then the cost of treatment is exorbitant. Therefore, we need to find out methods by which we can prevent the development of these complications. For example: diabetes can lead to heart attacks, kidney disease and strokes. But once a complication develops the cost of treatment is very high. So therefore, if we are able to control diabetes, high blood pressure properly at several folds lower cost, then we can prevent to a large extent development of these complications. But we can’t totally prevent it. The reason is that some of these things are also determined genetically. For example, whether a patient of diabetes will develop kidney disease or not. To some extent diabetes is well controlled if the blood pressure is well controlled, then there are less chances that this person will develop kidney diseases.
But we have seen that even if the diabetes is well controlled, the blood pressure is well controlled, still many of these patients go on to develop kidney diseases or even blindness. So, we have been working on the genetic factors as to determine what are the hereditary factors or genetic factors which can regulate the development of kidney disease. We could find that there are certain genes, which can increase the susceptibility of an individual with diabetes to develop kidney disease. Or are there certain diseases which can have a protective role against the development of kidney disease? This is one area which has been our main focus of research.
What are the unsolved challenges in Nephrology?
A problem which is growing in our country is that we are getting lot of cases of kidney disease of unknown etiology. It means that the exact cause of disease is not known yet. Lot of cases are coming up, particularly in Andhra Pradesh with kidney disease of unknown etiology.
There is a registry which is called Chronic Kidney Disease (CKD) Registry of India which was earlier being maintained in Gujarat but now it’s at AIIMS. In that we maintain a data of the various patients with chronic diseases and the various causes associated with them. And the most important cause in our country is diabetes, followed by kidney disease of unknown etiology.
Out of various factors we are investigating, one of the factors is that there may be certain pesticides or organochlorine pesticides which may be responsible for cases of unknown etiology.
Nowadays the use of organochlorine pesticide is increasing for various agricultural activities. If we use these food products, our total intake of pesticides is going to be on the rise and these pesticides from farms and fields flow into the rivers and thus ultimately used for drinking purpose. In the case of improper purification of water, our total intake of pesticides in the body goes up. High pesticide levels have been shown to have a very bad effect on the kidneys, on the nerves, on the fertility rates, on the brain functions, cognition etc and also on blood pressure. We are working in this area also.
We are also working in the area of effects of certain heavy metals, which have a bearing on the development of kidney diseases. And then there may be certain industrial toxins, pollutants that go into rivers. This way heavy metals, industrial waste, pollutants have a very bad effect on various organs including kidney.
We are also trying to establish certain cardiovascular risk factors in patients of kidney disease because kidney disease patients are at a very high risk of dying due to heart disease because of accelerated rate of atherosclerosis in them. We are looking at some of these factors that have such a heightened risk of dying due to heart diseases.
We have been able to identify certain nucleotides, which are associated with higher risk of developing diabetic kidney disease. We presented our work at the conferences of the Indian Association of Nephrology, the Association of Physicians of India, the Indian Academy of Clinical Medicine. We have also published our results in prestigious journals.
How are you managing the funding part for all this research?
We have applied to various funding agencies to give us funds. We have a project sanctioned from the Department of Biotechnology; they gave us funds of nearly Rs 35 lakh to do research on diabetes. Another colleague of mine, who is associated with me, has been sanctioned Rs 50 lakh by the Department of Science and Technology to do research work on the study of various pesticides in kidney disease of unknown etiology. Our research scholars and postgraduate students are also doing active research in various areas.
In the beginning you said, you consider Medicines as a noble profession. Do you think the scenario has changed over the time? Can we still call it a noble profession?
The scenario has changed a lot actually in the last couple of decades, particularly because medical field has become more materialistic like every other field. Now when people are getting into any particular profession they are actually looking at what materialistic gains they are going to get out of it. So therefore, the corporate hospitals, which have come up, are also looking mainly at what materialistic gains they can have. But they are also able to provide quality services to the population. And secondly, the risk of litigation into the medical field has increased. So when we are treating a patient, we are always at risk that the patient may drag us into litigation. Thirdly, violence against doctors has increased. Even in China, the violence has increased tremendously in the hospitals. So the corporatization of the healthcare services, the violence in the hospitals, the cases of medical negligence and litigation are increasing.
Earlier, the doctor-patient relationship and the teacher-student relationship were considered to be very sacred. Now that respect is going out. The respect is dwindling. I don’t think I will blame only students for this; teachers are equally to be blamed here. Teachers also have to realize where the lacuna is and how to bridge that gap.
Did you always aspire to be a Principal of a college some day?
I just wanted to do good service for the medical profession and never planned that I will be a Principal of a medical college someday. When this opportunity came, I was in two minds whether to go for it or not. My wife told me that you must go and take this challenge. It required a lot of support from her, as the role demands a lot of time, responsibilities and commitments. She has been very supportive as it requires long working hours and then you have to coordinate with various agencies – Delhi Government, Delhi University, UGC, Ministry of Health, Ministry of HRD, Medical Council of India. Since then, it has been seven years now and role has been very challenging.
What strides has UCMS made during your tenure?
The last seven years have been very satisfying for me. When I took over, the number of postgraduate students was just 49 and the undergraduate students was 100. So, one of the main things that has happened to this college is that we have been successful in capacity building. Our MBBS intake has increased to 150 students. During this period, we went through eight successful inspections by the Medical Council of India. Similarly, postgraduate intake has increased to nearly three times. We have now around 150 postgraduate students, making up a total of 450 postgraduate students, which is actually a 200% increase in PG seats.
Now, the research output from our college and the number of papers, which are published in national and international journals, is actually very high. We publish more than 400 articles in various scientific journals every year. We encourage our students and teachers to attend national and international conferences. We have also been organizing national and international conferences here. We have been able to extend our research funding from external funding agencies from Rs 1 crore to nearly Rs 12 crore. We are getting funds from the Indian Council of Medical Research (ICMR), the Department of Biotechnology, the Department of Science and Technology, the UGC (University Grants Commission) and so many other funding agencies. Our faculty has put in a lot of efforts doing research and many of them have got patents too.
Every year in the ranking done by India Today in survey of medical colleges of India we stand at a high position. This year our factual ranking was one, and three years back we had an overall ranking of three. But generally, we have been ranking among the top ten colleges in the country. So, I think that is a very big achievement by our faculty, by our non-teaching stuff, by our students and our alumni. Everybody has been really working very hard so that this college is able to bring out a good name.
One more thing I would like to highlight is that our college is located strategically in such a location that it caters to a huge population. We are catering to nearly the entire Trans Yamuna Area, also to some extent the rest of Delhi and the western Uttar Pradesh (UP).
We are catering to a total of about 6-7 million population; we have 1500 beds and we have a daily outpatient strength of nearly 5,000 patients. Since majority of the patients whom we treat belong to the lower socio-economic strata they are not able to go anywhere else but come here for the treatment. So, we are able to deliver our services to the lowest rung of society.
Our MBBS students, postgraduate students go to various healthcare centres, both urban and rural. This time on the Independence Day, they organized health education camp in the Leprosy Mission Hospital.
Our college is a constituent college of the University of Delhi and we are proud to be a part of it as the University of Delhi is also the number one university in the country. We are able to ensure very good conditions for our teachers and students. Our college is well known among medical colleges.
Which achievements in your career are you most proud of?
My major achievements have been whatever I have achieved through this college. My college has given me everything. I will say my major achievements have been my students. Very often we get students from US, UK too; some of our students are now in very high position in various medical colleges in the country. So, when they come and say they have studied from this college or from you, I think that is our main asset; we have really not built empires, our students are our assets.
What have been some of the major challenges while imparting responsibility of a Principal?
Working and coordinating with several agencies is a great challenge. Whether you want to increase your postgraduate and undergraduate intake or increase certain facilities you have to go through a great deal of work. So, this is actually a very tedious task. You have to do a close liaising with the Delhi government, the Ministry of Health, the Ministry of HRD, the Medical Council of India etc. It’s a really very sensitive task when you have to take care of nearly 900 MBBS students, nearly 450 postgraduate students, para-medical students at both graduate and postgraduate level and a nursing school also. So in total 1500 students are studying here at a time.
We also have nearly 200-250 teachers, nearly 500 paramedics from the college side. So, you have to be always alert and sensitive to their needs because you cannot afford to be complacent or take anything for granted.
In the scenario of corporatization of hospitals, how can we make the healthcare affordable?
We can make the healthcare affordable by encouraging indigenisation of healthcare technology; that is very important. Increasing research, particularly to make our research relevant to the local needs, is key to affordable healthcare.
When total healthcare budget of the country is just 1.25% of the GDP, research scenario is obviously not going to get any impetus. In Europe, the total share of the healthcare budget is 7-8% of the GDP; in the US, it is 17%. So therefore, our budget is very miniscule and almost 75% of healthcare expenditure comes out of the pocket of the patients themselves. Almost 70% of the people who are living in the lower socio-economic bracket cannot afford the costly services. We have to increase the budget to increase facilities for all.
In this regard, soon we are going to have a two-day event at the King George’s Medical University, Lucknow, where we are going to discuss how we can make healthcare affordable.
What are your interests outside medicine?
I like listening Indian Classical Music and I can sing a little bit when a song is playing. I am also very fond of Sufi music, I listen to that quite a lot. I used to play badminton and table tennis, I don’t get much time to play now. But I enjoy being with my family, though my children are not here now. My son is a doctor studying in Philadelphia; my daughter is studying radiation oncology at Christian Medical College, Ludhiana.
What will be your advice for the young generation of doctors?
The most important message to students is that whatever they do, they must do it with their full heart and soul into it. They must do it with passion; if you are doing it under pressure of somebody then you can do it only for a very short period of time. So, practice with lot of devotion, dedication and hard work and with passion. If you have passion then passion will drive you; if you don’t have passion then outside forces cannot drive you for a very long time. It is a noble profession and we should believe in that. We should always try to maintain the sanctity of doctor-student relationship and teacher-student relationship. I think that is supreme.
by Vidhi Rathee
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