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Interview: Dr T S Kanaka, Asia’s First Female Neurosurgeon

Dr Thanjavur Santhanakrishnan Kanaka, born on March 31, 1932, is widely recognised as Asia’s First Female Neurosurgeon. She completed her MBBS in 1954 and MS (General Surgery) in 1963 both from the Madras Medical College. Later she completed her MCh in Neurosurgery in 1968, PhD in 1972 and Diploma in Higher Education in 1983. Even at the age of 84, she has a sharp ear and a keen eye despite her glasses and hearing aids. Her passion to learn and acquire knowledge is still alive.

Dr Thanjavur Santhanakrishnan Kanaka
Dr Thanjavur Santhanakrishnan Kanaka

Currently, Dr Kanaka, under her parents’ name, runs a trust and a healthcare wellness cum research centre near her house at Chromepet in Chennai. Her father Mr Santhanakrishnan was Deputy Director of Public Instruction and Principal of Madras Teacher’s College and her mother Mrs Padmavathy was a ‘perfect homemaker’ guiding the family.

In an exclusive interview with India Medical Times, Dr T S Kanaka spoke about her decision to devote her life to medical profession, her interests in spirituality, her experience in stereotactic surgery and as a woman in a male dominated surgical field and her post retirement routine.

You were born and brought up in Madras, so what does Thanjavur in your name indicate?

Actually, I belong to Thanjavur i.e., my father, my grandfather and all my ancestors are from Thanjavur. My father is T P Santhanakrishnan where T stood for Tanjore. In our initials we could include our ancestral place and our father’s name. Some people even include their mother’s name in their initials. My father was a government servant subject to transfers and promotions. He was a teacher to start with but finally retired as the Deputy Director of Public Instruction. I was born when he was placed here in Madras.

A photo of Dr T S Kanaka’s parents Mr Santhanakrishnan and Mrs Padmavathy in her office
A photo of Dr T S Kanaka’s parents Mrs Padmavathy and Mr Santhanakrishnan in her office

Please tell us about your family.

I was born along with four sisters and three brothers of which only one sister is alive, apart from me. All of them were highly educated. Given that we belonged to 40s and 50s, it’s a huge thing. My youngest sibling was Amarnath who died at a very young age. He, being the last one, was the dearest to the family. So, I have named this house after him. I didn’t want to get married because I wanted to involve myself completely into my profession. My mother understood my situation and accepted it. But my father, like any other father, wanted to get me married. But you see, back then the crucial decisions of the family belonged to the woman of the family. They appeared as subordinates but always the woman’s words went in the house. These days we are talking about female equality, but back then there was female superiority (she laughed) though it’s all changed now.

I was reading about your interest to pursue spiritual studies, but you still went ahead to continue medicine. What was that made you interested in spiritual studies? Were you looking for some answers? Did medicine help you get those answers?

No, no; it wasn’t like that. It’s not spiritual studies as such. I was more interested in spirituality because of certain circumstances. The early death of my younger brother affected me a lot (her eyes filled up). I was very young back then; I had to look after him for two years and eight months. We were fighting a losing battle. That was when we thought, ‘What’s the purpose of this life?’ He was sound until nine years of age when he suddenly vomited blood. In those days, medicine was not as advanced, only chronic alcoholics with liver failure would vomit blood. We were so worried when such a young boy had this ailment. I had already joined my MS back then; I used to stay 24/7 with my brother and took care of him. We tried two complicated surgeries for him. Both were successful, but the second surgery he did not survive, we lost him. And that made me question the materialistic life and its purpose. So, that was when I chose not to marry and dedicate my life to serve patients.

You were in the team that conducted stereotactic procedures in its initial stages of introduction in India. Can you tell us about them then and how much it has advanced now?

Stereotactic procedures were taken up initially in only three centres in the world – Tokyo (Japan), Frankfurt (Germany) and Madras (India). In India, it was only in Madras. In stereotactic surgery, what we do is make a small lesion in the particular area which is either concerned with the particular function or it is on the network of the function where we block the stimulus in the form of electrical impulses reaching that area. Initially, it was started only for Parkinson’s disease. The tremors of the Parkinson’s disease were not amenable effectively by drugs though the rigidity responded to drugs. But a stereotactic surgery creating a lesion in the ventrolateral nucleus of the thalamus almost made the tremors stop.

Dr V Balasubramaniam was the main person responsible for these procedures here. He was a person with wonderful brains. He used to think of lots of methods and techniques in stereotactic surgeries, which other countries did not do. They did it only for Parkinsonism, except for Dr Hassler in Frankfurt and Dr Hirotaro Narabayashi in Tokyo who used it for many conditions. The advantage of stereotactic surgery is that you make only a small lesion because those days brain surgery meant mortality but this was not associated with high mortality. Dr Narabayashi used it for many conditions of which cerebral palsy and behavioural disorders were important.

Because Japan was more developed than India, in regard to science, they were able to record the activity using oscilloscopes and do stimulations and ascertain their accuracy of surgery. They were also able to observe that when they did a surgery in the amygdaloid area for behavioural disorders, the convulsions also stopped which was an additional bonus. For certain type of behavioural disorders, like the wandering disorder, lesion in the amygdaloid nucleus was not enough, there had to be another lesion made in the reticular system of the thalamus — the internal medullary lamina.

Dr Balasubramaniam went to Tokyo to meet and observe these techniques and started doing them in India and spread his knowledge to all of his team. I used to do surgeries in the dentate nucleus of the cerebellum. When I presented a paper at the 5th International Congress of Neurological Surgery, 1973 in Tokyo (the only lady to be present there), the inventor of the apparatus himself came and asked me how are you able to do it as deep as dentate nucleus. But stereotactic surgery did not bring money. It was not accepted in the USA, though the UK accepted it. The USA equated it to frontal lobectomy. But frontal lobectomy puts the patient in a vegetative state; stereotactic surgery did not do that. Anyways, it’s not very well developed now mainly because it didn’t give much income to the doctors. It’s like meningioma could be removed as a laddu and you get money as laddu but this was not like that. Not many doctors were interested in it.

A view of Dr T S Kanaka’s office in Chennai
A view of Dr T S Kanaka’s office in Chennai

Why did you want to become a neurosurgeon?

I was doing my MBBS when my brother-in-law (my sister’s husband) developed seizures. He was taken for treatment to Dr B Ramamurthi, one of the initial neurosurgeons in India. Neurosurgery in India was established only in three places initially — Chennai, Vellore and Bombay. So, as an enthusiastic medical student, I used to ask him lots and lots of questions. He told me, finish your MBBS and come, I’ll teach you neurosurgery. That was something that motivates and pulls us into the field.

How was your experience as a woman in a male dominated surgical field?

Even getting into MS General Surgery was difficult as a woman. But my research works during the UG (under-graduate) days and my college dean’s support all helped me get the seat. Even as a UG student, I was interested in research. In our third year, we came to know that gonococci were not cultured yet. So, my friend and I decided to culture it. We worked with multiple departments and were given a separate lab by our dean and we finally cultured it! So, these helped me get into the department but the department chief always conspired against me. He never gave me the knife; he made sure that I wasn’t given any emergency cases during admission days. Back then, no body, not even a gold medallist, would pass surgery in a single attempt. My friend Dr Kanakaraj would sit behind me during theory exams and would comment that I could write ‘refer my answer sheet three years ago’ for certain questions because theory questions would always be repeated but getting through clinics was difficult. Out of all these politics, I came out as a successful surgeon.

Please tell us about your record in blood donations.

All our family members used to donate blood once in four months or so. There were no voluntary donors back then, it was so difficult to get blood. People, who were below the poverty line, used to sell their blood for money. I wanted to start donating early, but the person in charge used to say, ‘wait for your time’. We were that interested in blood donations.

What’s your opinion about head transplantation?

I’ve not read much about that. But from what you say, I would say that may be it is technically possible. But it is impossible for humans to replace the brain that God gave us.

Bionic Eye is being tested to improve ARMD (age-related macular degeneration) and Retinitis Pigmentosa. It has a lot of electrical connections which ultimately end up in the visual cortex. How feasible do you think this would be? Will it be as successful as the cochlear implants? Like we helped the deaf hear, can we make the blind see?

See, these vision and hearing are all highly specialized functions. For general functions like sensory and motor areas, it is quite recoverable because it has lots of supplementary areas. But these specialized functions do not have much supplementary areas, so it’s not possible to bring back the function to near normal but we could try.

What’s your word of advice to medical students?

The world is highly competitive these days. Even the number of medical colleges has increased. So, you’ve to equip yourself to face the world. You need to do original research, present papers, know how to write papers because these are what are important. Don’t depend on your teachers for everything, do things on your own. Even a single tap on your phone gives you a lot of access to information; information is the key these days.

What’s your opinion on modern healthcare?

It is far from those days. The technology and techniques have improved so much that these days the morbidity after a surgery is far less when compared to those days.

After your retirement, at this age, what’s your routine now?

I was waiting for this question. ‘Now’ is important because past is past. When I retired, with my retirement amount I wanted to build an old age home. I went for help to HelpAge India, they somehow knew about me. The person said, “You were literally living in your office at the hospital for 40 years now; you cannot run a home. Think of something else.” I kept thinking throughout my train journey back home and that was what served as my Bodhi tree. I established a ‘wellness centre’. I have a clinic where I listen to the problems of the elderly. They have simple problems like memory defects, insomnia, drowsiness, giddiness, fatigue, tremors, unsteady gait, falls, pain, urinary incontinence etc, which seem very unnoticeable problems to the youngsters in their family and the young doctors. They need someone they could talk to about their problems. I’m doing that. Now that I’m in their age I can understand their problems.

Would you like to say something to our readers?

Yes, I’m in the mission to ensure the wellness of the present and future senior citizens. The young India is not young anymore; as the longevity is increasing, the elderly problems and their quality of life have to be looked into. I’m doing surveys to identify such elderly people who are suffering from mild ailments and try to offer them my services. Since I have always been giving free service and am incapable of raising funds, I request volunteers to participate in this mission and feel the pleasure of giving. I also request the funding agencies to come forward and help. We welcome all who are willing to participate in this research to come forward and reach us at my email tskanak@gmail.com or call me on my phone number 044-22230935.

Note: A person working with Dr T S Kanaka in her wellness centre said that she’s active even at this age and is so concerned about the welfare of the world that she performs ‘Agnihotram’ with the purest form of ghee available in the market. We do not know if her Agnihotram will save the world, but her ideals will surely make a difference.

by Usha Nandini

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