Medical Dialogues interviewed Dr Kiran Aggarwal, President, Indian Academy of Pediatrics,Delhi and EB member Central IAP , on the issues plaguing the field of pediatrics in India and role of IAP in resolving them. Read further to know
MDT: Ma’am tell us about IAP and its key activities.
DR K.A: IAP is a national and a central body. We have our head office in Mumbai. We have 23000plus members. Our present national president is Dr SS Kamath from Kochi. Then we have state branches in all the states and we have some district branches. All the state branches are individually registered bodies but we follow the same pattern of the central body. There are around 1300 plus members in Delhi branch. This branch is quite old one we started in 1960 and got registered in 1996 It has very rich history ,as IAP Delhi we hosted World Congress in 1977 in Delhi an era of No Fax,No Email,No mobile so successfully. We have chapters dedicated to all the specialties; we have groups as well as some committees.
IAP has national conference once a year in any of the states, usually, in the month of January. This year it was in Delhi and was attended by around 7000-8000 delegates. Further, every state organizes its in own State Annual Conference every year.
MDT: With the growth of technology, it is believed that the role of a pediatrician has changed from a crisis manager to that of an immunizer. What is your opinion on this?
DR K.A: I don’t fully agree with that. As doctors, we have to save lives. And yet prevent people from getting the disease. Earlier, there used to be a number of infectious diseases and mortality used to be high but nowbecause of immunization, infectious diseases have fallen. Now, we as pediatricians are now shifting our focus on behavioral problems or community pediatrics too , which I believe earlier, were quite neglected.
MDT: Ma’am it is believed that Neonatology is the Achilles heel of Indian healthcare. No of deaths of children below the age of 6-months is quite high. What are your views on this?
DR K.A: I agree with you in a way.Yes, under-5 mortality in India has drastically gone down but our neonatal deaths are too high.However, neonatology now is getting separated as a super-specialty. For example, in Delhi, in Kalawati Saran Children Hospital and even MAMC, there is a separate neonatology department with a separate HOD. And HOD pediatrics has got nothing to do with the departmentneonatology. Having said that a general pediatrician is not refusing to attend to neonatology. Things are changing now. For example- earlier Gynecologists used to resuscitate the babies, then pediatrics developed and it became their job, and now the super-specialization of neonatology is developing which takes care of new born. But we as pediatricians still take care of newborns. This indeed is a part of our study and at most places, especially in rural areas pediatricians are in charge of new-born, which they do quite efficiently.
MDT: How does IAP help in taking neonatology awareness to tier-2,tier-3 cities and rural areas?
DR K.A: We have a big program, which was initially sponsored by Bill Gates Foundation called Neonatal Resuscitation Program (NRP). This program was initiated by Dr Naveen Thakkar, from Gujarat( past president of IAP and was in Polio irradication Programme too as IAP representative ). With time, we have managed to take this program all over India, to every state and district even to remotest areas empowering people to save newborns.
MDT:What role does IAP in bringing about uniform practices in the field of paediatrics?
DR K.A: A lot. Any disease erupts, epidemic or anything changes like say antibiotic resistance changes, our central IAP acts on it immediately. Experts meet and form the protocols, guidelines, which are immediately disseminated in the state branches, district branches and their central body members, executive members and through them its further circulated. We have webcasts,Webinars, CMEs where we have discussions and information dissemination is made.
MDT: Tell us about the role of IAP in raising the voice of pediatricians to the government.
DR K.A: This year the government/ Ministry of health has come out with a very nice program called BAL SWASTHYA KARYAKRAM. It was actually launched in 2013. And it has the provision of screening children from 0-18 years of age for four Ds- defects, deficiencies, diseases and developmental delays. In all other states lakhs of children have been screened and helped, but in Delhi probably due to political turmoil and lack of government in the last two years, it was not taken up. This year, we the Delhi Branch has written to Chief minister mentioning about this RBSK scheme This is a good program and we feel at loss as we wish to implement it soon and it would expedite important screening of children. for instance Neonatal Screening Programme for Congenital Hypothyroidism can give child absolutely normal life to grow and live if detected in neonatal period & treat started in time.
MDT:Any other issue that you are raising up with the government?
DR K.A: GOI had banned the primary packaging of liquid medicine in plastic bottle that is primarily given to children and geriatric population. You see, there is enough evidence that with temperature rise , there is some leeching of the lining of plastic and toxic substances are released. Anything packed, even water in such plastics are harmful. They are called hormone disrupters and interfere with the hormone actions in the human body. The government had given 6 months preparedness to pharmaceutical companies to come out with the alternate packaging of liquid medicines. The timing has expired March 2015, but improvement has not happened. IAP (Delhi branch) has written to the Chief minister so that at least changes can be expedited in Delhi, because that’s still continuing. We are at this moment fighting for that cause.
MDT: According to you, what are the lacunas today in the field of Pediatrics in India?
DR K.A: As pediatricians we come across a number of children with autism, learning disabilities, as well as ADHD. The present incidence of Autism 1 in 68. This sub-field of pediatrics in fact is quite in developmental phase. We still don’t have child developmental centers, even in the teaching hospitals and medical colleges. Unfortunately, most pediatricians are not trained to handle such cases. There are a very few pediatricians who know about these conditions and how to treat them. We are taking up these issues, but honestly there is a long way to go. For instance, in Delhi, only Maulana Azad medical college has child development center, with dedicated staff.We need such centers in all medical colleges, whether public or private. We need to train pediatricians in developmental pediatrics. We need to go aggressively on this issue , to train pediatricians on screening, diagnosis and treatment of these developmental disorders so that early intervention can take place.
MDT: Any advice for future pediatricians?
DR K.A: You know, I understand that we all are getting high tech these days and are doing things much more quickly than earlier. But future generation should keep in mind that they should not loose their clinical sense and compromise on the time given to the patient