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People’s doc, polio warrior

Thomas Abraham | Updated on April 06, 2018 Published on April 06, 2018

Dr Mathew Varghese, head of orthopaedics at Delhi’s St Stephen’s Hospital, is a hero to his patients and legions of admirers, including Bill Gates   -  RAMESH SHARMA

Booster dose: Rotary’s partnership was a game-changer in the government’s anti-polio drive   -  IMAGE COURTESY: ROTARY

Raman Bhatia

As India remains polio-free for seven years, a tribute to a surgeon who has for 28 years fought the good fight for his patients, including some of the poorest in the country

It is 10.15 on a February morning, and Dr Mathew Varghese appears looking fresh as a lark — there’s no sign of the work he has already wrapped up that morning: one knee replacement, and two surgeries on children with cerebral palsy. The head of the orthopaedics department at Delhi’s St Stephen’s Hospital is a hero to his patients and other admirers, including Microsoft founder Bill Gates. On his Facebook page, Gates describes Dr Varghese as “my inspiration and my real-life hero” for “fighting and (having) dedicated his life for polio eradication in India”.

I’m meeting him after a gap of about 10 years and he greets me with a warm hug and his trademark 1,000-watt smile. We sit down for a chat, joined by one of his most steadfast collaborators, Raman Bhatia, a past district governor of the Rotary Club Midtown (Delhi), who has been associated with Dr Varghese’s work since 2001.

In fact, legions of Rotarians from around the world visit the doctor regularly to see first-hand how his patients are benefited from his selfless work. As many as 42 Rotarians from the US and one from Australia were in town to meet him that day. Dr Varghese is about to make a Power Point presentation for us.

Bhatia first gives us an eloquent introduction to the surgeon’s work, describing it as life-changing for the largely poor people afflicted by the viral-infectious disease poliomyelitis.

Dr Varghese’s presentation starts off with a brief history of St Stephen’s Hospital. Delhi’s oldest medical centre had started out as a dispensary in 1876, and grew into a hospital in 1885. The polio ward was started by the famous surgeon Dr Balu Sankaran, who asked the then hospital director Dr Lucy Oommen to start a free ward for poor patients. Some beds had to be “reserved’ for polio patients, because road accident injury victims take precedence over these “elective surgery” patients, who generally require multiple surgeries and extended hospital stays. “We wanted to make sure no one was turned away because of lack of beds or theatre time,” explains Dr Varghese.

A time for fun and games

Dr Varghese joined St Stephen’s in 1990. The presentation brings out the painstaking efforts he has put in over the ensuing years. Currently, St Stephen’s Hospital is a regional centre for the national polio vaccination programme. On National Immunisation Day, it becomes active by 3 am.

One slide shows five children playing in a village — one on a swing, another climbing a tree, a third with a toy, and so on. “I love this slide. Childhood is all about fun and games. But polio paralysis takes away the fun and games out of childhood. Most of these children are beyond the protective maternal antibodies, and they get paralysed because they don’t get immunised,” the doctor says.

He had organised an anti-polio immunisation camp back when he was a medical student. But it was when Rotary partnered with the government in 1994 that things decidedly took a turn for the better. “Raman Bhatia was part of the advocacy efforts between the government and Rotary, besides WHO and Unicef, to convince the government to lead this programme... This was a major initiative, which changed things across the country.” For seven years now, there have been no reported cases of polio in India.

The doctor then moves to another slide, this one showing a village ice-cream vendor. Explaining the context for his American guests, he says, “For the survival of this ice-cream vendor, and his family, it is necessary to keep his ice-creams below zero degrees Celsius. But the government machinery could not maintain the polio vaccine at 4-8 degrees Celsius. So, in the 1990s (Journal of Paediatrics), 14 per cent of the children who were immunised were paralysed. Today, thanks to Rotary’s efforts, the cold-chain is maintained. The vaccine is colour-coded... if it gets denatured, the colour changes.” This ensures there is no chance of the vaccine failing, he adds.

Each of Dr Varghese’s slides drives home obvious truths.

The level of ignorance surrounding polio is appalling, he says. Therefore, when a child gets paralysis, the parents give a host of medicines to try and reverse the paralysis.

“But polio paralysis is irreversible,” the doctor points out. “The irony is that the paralysis is preventable; but if the paralysis happens, the deformity is preventable... the disability is also preventable. And, yet, we as a society fail these children.”

Booster dose: Rotary’s partnership was a game-changer in the government’s anti-polio drive   -  IMAGE COURTESY: ROTARY

 

 

 

Healing — physical and spiritual

“Can you make my boy walk without crutches?” a father had asked him. “In India, crutches have a stigma associated with them,” the doctor explains. The child’s hip was bent at 90 degrees, knee at 120 degrees, and both couldn’t be straightened. His foot too was in a bad state. After multiple surgeries his legs were straightened. He then walked without a limp but with calipers.

“So, they were very grateful. They had made a vow to visit a hill temple if the boy came off crutches. So they climbed, but had to leave the braces behind and the father supported the boy. Later they trudged down for about 10 minutes... this boy realised he didn’t need his father’s support. He could walk without the brace. (There was a gasp all around.) What was the wish? To walk without crutches. What was the wish granted? To walk without crutches and braces... Spiritual healing, while I am only doing physical healing,” Dr Varghese pauses in his telling. There’s a bit of a stunned silence, and then everyone breaks into applause.

More clips, more cases explained. Various types of post-paralysis deformities rectified and children and youth from around the country put on their feet. And where standard therapies are not enough, Dr Varghese and his team take to innovation.

“This girl (another slide), her knees are bent. Couldn’t straighten it under anaesthesia. The technique we have in the textbook even today is the ‘Serial Wedge Corrections’.” The treatment requires weekly visits to the hospital, but that meant loss of a day’s wages for the parents. The doctor decided to instead go in for “our own St Stephen’s Hospital method, where we fit in this contraption, and tell them to turn it at home, a millimetre a day. She is now standing upright (shows the clip). Look at the smile on her face.”

Not just surgeries

Dr Varghese explains that polio also causes shortening of the legs. Madhubala, aged 18, had six inches shortening in her legs. Dr Varghese told her mother it would take a year to 18 months to set right. The Ilizarov apparatus was fitted to lengthen the legs.

The story doesn’t end there.

“Soon she is married. The boy too had polio and they have two lovely daughters.” When a road accident left the husband with a fracture and the surgery was messed up, first at a local hospital and then a private one, leading to puss formation six months down the line, Madhubala finally ordered her husband to “Go to MY doctor”. He was back on his feet soon enough, but had lost his job by then. “Raman Bhatia has been helping many of my patients find jobs. One of them runs a motor-parts shop in Panipat. I got him a job there. So, you see, merely getting them physically corrected is not enough... Many of them need to be helped to find jobs.”

Lessons learnt

Along the way, Dr Varghese learnt many more valuable “lessons”.

“I was a young man full of knowledge, no wisdom. So, I see this child crawling and I scold his mother. The mother said the child cried for a whole day when they tried to make him wear the braces. Lesson learnt: Merely fitting the brace was not enough — the child needs to be trained to wear it. So, we have gait training, to walk with the brace.”

In another instance, he recalls upbraiding a mother for not making her child wear the calipers. “This is a 25-year-old slide. The mother said the hospital had told her they could not have a new brace for two years. Lesson for me — the child should get a brace when he needs one... if it has to be repaired, we do that.”

Time for another slide. Titoo couldn’t stand straight because his legs were bent backwards. He couldn’t wear a brace and was operated on to get him to stand upright with braces. “One day, I receive a call from his father. It was the day the Consumer Protection Act was passed in Delhi. Titoo’s father said over the phone, ‘Doctor sahab, you made a big mistake.’ I was worried that there was some complication in the surgery and said ‘sorry’. ‘Today, Titoo’s teacher summoned me for his pranks,’ the proud dad said. I heaved a sigh of relief... ‘His normal childhood is back with him. Thank you for that’.” (A hearty round of applause and smiles all around.)

The hospital operates on many patients when they are skeletally mature. A young man who approached Dr Varghese for a surgery to get him off his braces was asked to come back a week later. “If the wards are full, I tell those living in Delhi to come back the next week. But this young man stamped his foot and said, ‘No, doctor sahab, you have not recognised me.’ He was Titoo the naughty boy, come back to me after 10 years...”

A round of the wards

After the presentation, we went on a round of the polio wards — some are long-stay patients, some have undergone multiple surgeries. I enquire about various aspects of their ailment, treatment, home, education and work.

Dr Varghese shares a very pertinent observation. “I have seen that education for those who come from villages and small towns is limited to the local school/college. No one takes these polio-affected children to a big city to continue their education. Therefore, most of them have low education levels.”

So, have the number of surgeries dwindled over the years, I ask. Yes, Dr Varghese says, for two reasons. One, there are no new cases. However, the older cases take much longer to treat. From 600 a year in the past, he gets 120-150 cases these days.

The second reason is that there is little interest in polio patients in most other hospitals. Those skilled in this surgery are mostly retired. “The younger ones are not doing it. The surgery itself may be easy, but the decision-making is complex. If you ask any corporate hospital, they wouldn’t know how to prescribe a brace for a child,” Dr Varghese says.

As we say our goodbyes, one Rotarian from the US hugs Dr Varghese and blesses him. Another Rotarian, a physician, is all choked up when he shakes hands with this nondescript-looking “hero”.

As I head for the parking lot, Dr Varghese gets a call from the Operation Theatre — a patient is ready for surgery. The time is around 2 pm. While the rest of us had water, coffee and biscuits during the presentation, Dr Varghese had not had even a sip of water in all this time. And now he is off to the OT. No food or water there either!

A doctor who lives for his patients, indeed.

A foot soldier’s ringside view

Raman Bhatia’s tryst with polio eradication and rehab of the polio-afflicted started in 1987-88 as the district co-chair of the Polio Plus Committee. He helped raise funds and organise polio corrective surgery (PCS) camps in tribal areas of Gujarat and Madhya Pradesh. Bhatia shares his experiences and insights with BLink

Raman Bhatia

On Rotary and the effort to make India polio-free

The Rotary Foundation of Rotary International helped conduct more than 83 free-of-cost PCSs and rehabilitation camps, benefiting nearly 6,531 children in India. Complex cases are referred to the larger city hospitals, including St Stephen’s Hospital, which are supported by RC Delhi Midtown and through Matching Grants (now renamed as Global Grants) from The Rotary Foundation.

Over the years, Rotarians not just from India but other countries too, have volunteered in the PCS camps as doctors and support staff.

Dr Mathew Varghese and his work

Our association with Dr Varghese started in 2001. This is the only hospital in India with a designated polio ward. Dr Varghese is one of the finest surgeons in the country, and his devotion to rehabilitating polio patients is well-known. Fifty per cent of the treatment cost is met by Rotary, the rest by the hospital. Till now, we have worked with about 9,000 cases. Post-surgery, the care, the compassion that the patients get here, that is what heals them.

Religion-based opposition topolio drops…

We had a huge challenge from that quarter, but we overcame it. We got all the religious leaders from different sects together and held meetings in Lucknow, Delhi and Mumbai. Sometimes we took along a reputed doctor from the community and explained that he gave the drops to his own children. We even ordered polio drops from Indonesia, the world’s largest Muslim-populated country. We went to great lengths to convince everyone.

In Deoband, we got a fatwa issued. The main priest’s grandson had polio... he realised this disease is avoidable with the help of a few drops.

Now that India is polio-free, should we relax or remain vigilant?

Polio drops are given every year on two Sundays in January and February. This year, it was in February and March. There have been no polio cases reported in India in the last seven years, but we have to continue immunising our small children, because in neighbouring Pakistan and Afghanistan, polio is still prevalent.

Published on April 06, 2018
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