13 minute read
Surgeons Scope Magazine
by RCSI
Back to the Beginning
PROFESSOR DHANANJAYA SHARMA (FRCSI 2013) HAS BEEN, FOR ALMOST 50 YEARS, A PIONEERING AND INSPIRATIONAL TEACHER AND CHAMPION OF LOW-COST SURGICAL SOLUTIONS FOR THE DEVELOPING WORLD. HIS ENTHUSIASM AND EXPERTISE HAS BEEN INTERNATIONALLY RECOGNISED, BUT HE SHOWS NO SIGNS OF STOPPING ...
Professor Dhananjaya Sharma, MBBS, MS, PhD (Doctor of Philosophy), DSc (Doctor of Science), is Head of the Department of Surgery at Government Medical College and Allied Hospitals, which are affiliated to MP Medical Sciences University, Jabalpur, the largest teaching hospital in Central India. His work in innovating low-cost appropriate technology for healthcare in the developing world has been recognised with Ad Eundem Fellowships of all four Royal College of Surgeons of UK and Ireland, Honorary Fellowships of Royal College of Surgeons of ailand and Académie Nationale de Chirurgie France and visiting professorships/invited faculty at iconic Karolinska Hospital Stockholm and Oxford University.
I come from a family of doctors. My grandfather was dean of one of the oldest medical schools in India, and as a child I used to accompany my father, the doctor-in-charge of the Government’s Rural Public Health Programmes, on his official tours. My interest in public health stems from this time; I remember my mother saying to me that it was not possible to be a good doctor without first being a good person.
Studying came easy to me. I came first in the state in the higher secondary examination and did not struggle with exams in medical school. I did my internship in a small district hospital called Chhindwada – the workload was intense and there was very little in the way of modern equipment. Then I returned to the medical school where I’ve been teaching for the last 40 years for my postgraduate qualification in surgery. After three years of my masters degree in surgery, I went to work in a Christian mission hospital. at gave me a new perspective. The patients were very poor, and I felt that my purpose as a doctor should be to do whatever I could for them and people like them.
I came back to my alma mater in 1986 as a young, idealistic lecturer and assistant professor. And I’ve been here ever since. My first four years were all about mastering the technique and the skills. I wanted my technique to be perfect, because technique is freedom and enables you to focus on what you are doing, to nd the simplest and most effective way of doing things.
In 1988, I spent a couple of months as a visiting fellow at Vienna University where I was exposed to all the modern techniques of endoscopic surgery. When I came back I attended my first international meeting in Delhi in 1990, and listened to people from all over the world talking about their work. I was frustrated. I didn’t have the equipment or the instruments about which they spoke. How could I do research? One evening, I found Professor Michael Hobsley of University College London Medical School sitting by himself on a lawn chair. I summoned up the courage to approach him and introduced myself. I asked for his advice. ‘Everyone talks about such futuristic instruments and techniques,’ I said, ‘how can I do research with my limited resources?’ And he told me I could do everything with the basics I had. I spoke with him for just a few minutes but those few minutes changed my life.
We remained in touch and he encouraged me to register for my PhD. I went on to get my PhD and DSc, all the time focusing on research which was clinically relevant for my poor patients. Simultaneously, I became interested in translating my knowledge into frugal surgical solutions. Gradually, I started getting published, and I had the opportunity to be a visiting fellow at Kurume University Japan and at Sloan Kettering Memorial Kettering Cancer Center New York, USA.
I could see that I was going to become a professor and head of the department in the future and I wanted to be ready. One of my favourite quotations is by Benjamin Franklin: ‘By failing to prepare, you are preparing to fail’. So I was ready when I was appointed.
The first thing I did was to introduce a model of inclusive leadership. I told everyone that I would measure my own success by the number of successors I created. So everybody would have a say. When we were making a big decision, everyone sat together. And once we made that decision, everyone would stick
I also made sure that I kept my ego in check, and I made this a rule for my students and doctors too. The hospital is for the patients, the college is for the students. Surgeons are egotistical and arrogant and I didn’t want that in my department. I was fortunate to become friends with and be mentored by Professor Daniel Jaeck, Professor Emeritus at Strasbourg University, former President of the European Surgical Association, and he taught me to keep my ambition in check, to practice humility and to learn the difference between pride and arrogance.
As a young man I fell into the trap of becoming arrogant. But as I grew older and wiser, I realised that I came from a privileged background: my father was a doctor, my grandfather was a doctor, I was very good at studying, everything was on a silver platter for me. I realised that things were not as easy for people coming from very modest backgrounds. So I changed my arrogance to pride. If I think I’m good, that is pride. But if I think that only I am good, that is arrogance. As a teacher, it became my mission to help those students coming from very modest backgrounds. They’re my favourites. I make sure I give a lot of my time to them to guide them along.
The next thing I learned was the difference between knowledge and wisdom. It’s very easy to confuse the two. You can get knowledge from Google, but you cannot get wisdom from Google. How you apply the knowledge is wisdom, and knowledge is of no use unless it is used for the benefit of mankind.
In Hindi, we have a beautiful couplet, which translates as ‘The peacock dances in the forest, but nobody sees it’. I decided that I had to publish extensively to let people know what I was doing. I wasn’t going to be like a beautiful peacock dancing in a forest, with nobody noticing.
We have now published over a hundred papers on low-cost surgical solutions, which can be practised on a large scale, even in a district hospital. All solutions which I have published require zero funding and just use local resources. You don’t really need a lot of money. You just need enough to survive. All solutions are shared on the Center for Global Surgical Innovations and low-cost solutions website www.surgicalinnovations.in.
Jonas Salk was the person who invented the rst successful polio vaccine and gave away its rights for $1. What he said about teaching was: ‘Be good ancestors’. My biological DNA goes to my family, but my trainees carry my surgical DNA. So I have to be a good ancestor. My mentees come to me with many limitations, and it is for me to help with their imperfections and improve them, to give them confidence. I love teaching. Many of my students have gone on to become professors all over the world, but many return a er training and rejoin the department. e Government asked me to take on the roles of Dean and Vice Chancellor but I declined, because I want to be a teacher not an administrator. I didn’t want to be a boss; I wanted to be a leader.
“We have now published over a hundred papers on low-cost surgical solutions, which can be practised on a large scale, even in a district hospital.
As an academic leader, it is my duty to nd these low-cost surgical solutions. How do I go about it? I need global wisdom, learning from everyone, but using local resources. I combine the two, and call it ‘Glocal solutions’. My mentor in Strasbourg, Professor Jean-Marie Lehn, Nobel Laureate in Chemistry 1987, talks about creating science. ‘Think outside the box,’ he says. ‘Don’t just read and follow science, create your own science.’ I made it a rule in the department: If you have a problem, you don’t have some machine or instrument, don’t complain, don’t come and cry on my shoulder. Come with a solution. I train my students that every diffculty is an opportunity.
You can do research on what is interesting or what is important. When I was young, I wanted to do a heart transplant in the morning, go back home, have a nice lunch, come back and nd a vaccine for cancer. at was my dream. So that would have been interesting. But I had to deal with diseases of poverty, perforations and obstructions, with no ventilators, and no intensive care unit. So I had to do research on what is important for me and my patients. I couldn’t keep on dreaming, thinking, ‘One day, I’ll have that …’ and waste my life getting frustrated. So, we made a rule. Modify, simplify, and apply. Don’t wait for expensive things that may never come. Whatever is available, you modify it, you simplify it, and you apply it. And we started getting successful results. at is what I teach and preach and practise. e simplest solution is the best, so try to nd it. And more often than not, it is the most economical one.
The next rule was: Don’t waste your time. Don’t discuss people, don’t discuss events, discuss ideas instead. I ask my trainees, ‘What do you talk about when you are having a cup of tea or coffee? Movie stars? Sports stars?
“Unless I bring value to my patients and my students, I’m not doing my job. I have to do more for people who are less privileged than me because leadership is about serving, not ruling.”
Why? You are scientists. Your job is to think science and discuss ideas.’ As Marie Curie said, ‘Be less curious about people and be more curious about ideas’. I tell my trainees to keep an open mind and, as Linus Pauling, [Nobel Laureate Chemistry, 1954, and Nobel Laureate Peace, 1962] said, ‘If you want to have good ideas, have plenty of them. Recognise which are the good ones, and throw the bad ones away.' I tell my trainees that if they want mentors and sponsors they have to stand out in the crowd. How do they do that? By being prepared and doing their best every single day.
I love teaching. Teaching is synonymous with learning. The only thing which increases when you distribute is your knowledge. I feel very privileged to have had the opportunity to teach all over the world and to be recognised with so many awards and fellowships. Simultaneously, I have had the privilege of teaching in developing countries such as Thailand, Bangladesh, Maldives, Bhutan, Pakistan, Mexico, Afghanistan, Myanmar and Nepal.
Our department is a General Surgery department. We have many specialties, – paediatric surgery, gastrointestinal surgery, kidney surgery, plastic surgery, and breast surgery, but we work together. There are no silos, so there is a lot of cross-fertilisation of ideas. Ninety per cent of the surgeons have been trained by me. It’s like a family. So we sit together, and there’s a very healthy rivalry. If someone publishes two papers in a week, he has the bragging rights. That is our innovation ecosystem. Young fertile minds are the best for Finding solutions. My job is to protect them from all those things which can go wrong in a government hospital – if their salary is late or they have problems at the bank. I am the father figure, I keep them protected and provide a healthy ecosystem so they can do their best. Of course we have had our share of failures, but we learn from them, and we move on.
I still put in 18 hours every day. I will retire from my official position next year, but I will continue to teach and write and travel. I don’t want to sit at home. Zoom has made it so easy – I can teach anywhere. I am ready to take up more challenging work, and will continue to work on developing frugal surgical solutions and teaching people from very modest backgrounds. Unless I bring value to my patients and my students, I’m not doing my job. I have to do more for people who are less privileged than me because leadership is about serving, not ruling.
I have been married to my childhood sweetheart, Neeta, for almost 40 years now, after a long courtship. She is a clinical psychologist and a counsellor and is now retired. Every day I tell her that she is the most beautiful girl I have ever seen. Yes, I am a diehard romantic. My son and his family live in Seattle, so that is where we spend all our holidays. My grandson is my hearthrob. Doting grandfather is an understatement. I’m absolutely crazy about him. In Hindi, the word for grandfather is Baba, and when he says ‘Baba’ my heart skips a beat.
There was never anything else for me but being a doctor. I’d do the same thing all over again. When I was young, I refused a couple of lucrative offers to work in the Middle East and in Europe. I was very clear in my mind that I have to look after my patients here. It is my responsibility to do good for those who are less privileged than me. I had to provide leadership by serving my people and my students. And that I have done. I hope the people who take over from me will continue the same work. ■
