Every man's doctor

By Neeta Deshpande

Throughout his career in reconstructive surgery and rehabilitation for the leprosy-afflicted and in building community healthcare models, Dr Noshir Antia worked to take healthcare to the grassroots, realising that the fundamental cause of disease is poverty

A Life of Change, by Noshir H Antia,
Penguin India, 2009. Pages 189, Rs 299

A pioneer of plastic surgery in modern India who made signal contributions to public health concerns, Noshir Antia (1922-2007) led an inspiring life of innovation, courage, and persistence in the face of seemingly insurmountable odds. While paying tribute to this humanitarian doctor in an issue of Seminar, a colleague tells us about a plane ride that the young Noshir experienced in a town in southwestern India. On this flight, at a time when planes were accessible only to a select few, the young boy was “struck most by the underlying unity of the landscape”. His memory of the experience is imprinted with the school, temple, dhobi ghat, hospital and liquor shop, which “all had a place” in the “larger design”, if only one made an effort to see it. In the course of his remarkable life, while connecting the dots between poverty and disease, and proving that achieving good health, in his own words, is more a social than a medical or techno-managerial function, Antia was consistently alert to the “larger design” that struck him as a young boy.
                
Written in a simple and engaging style, Antia’s autobiography, A Life of Change, narrates the story of his eventful life spanning eight-and-a-half decades. Beginning with his childhood in the “overgrown village” of Hubli, the narrative spans the spectrum of his experiences and achievements, including pathbreaking work in reconstructive surgery on leprosy patients, the establishment of one of the earliest burns units in the country, and the research institutions -- the Foundation for Medical Research (FMR) and the Foundation for Research in Community Health (FRCH) -- that he built from scratch.

Unburdened by medical jargon from the perspective of the lay reader, but with enough detail to educate and enlighten those in the medical profession, Antia’s life story is a delight to read, leaving behind a lasting impression of how much one human being can achieve if he puts his mind to it.

Born in 1922, Antia grew up in small-town Hubli, living in an outhouse of the Portuguese Club with his parents. The young boy’s memories of the family maid Budhi, who “had only one sari a year” and “could not even afford footwear”, demonstrate a rare sensitivity. An incident when he was in the second standard speaks volumes about his intolerance of injustice. Noshir and his competitor got the same marks in an examination, but the other boy was given an extra mark in front of the whole class because he attended chapel, while Noshir didn’t. The little boy rebelled against this injustice, resolving not to return to that school. In the government school he was transferred to subsequently, most of his schoolmates were poor and Noshir would feel “a little guilty” when he would, at times, ask for a second buttered bun at the bakery opposite the school. “Caste, religion, or class” never came up in his dealings with his friends. Looking back, Antia believed that these early interactions with common people benefited and moulded him.

Medicine was Antia’s third choice for a career, the first being the forest service, followed by engineering. After a brief stint in the British army following his graduation, Antia left for the UK to specialise in surgery in 1947. England was very different then, writes Antia, as people were forced to live frugally in the aftermath of the Second World War. He considers himself “fortunate to have worked in England during this period because it showed (him) how much could be achieved with little money and facilities, and without compromising on quality”. The greatest influence on his life in England was that of the father of modern plastic surgery, Harold Gillies, an unorthodox genius from whom Antia learnt “not just technique, but also the attitude of a surgeon”.

After returning to India in 1955, he began work in the simple but effective Jehangir Nursing Home in Pune, on a salary of Rs 400 a month. Here, he “learnt to see patients as human beings with social, emotional, economic and other problems”. While cycling into the foothills surrounding Pune one evening, he encountered a “sea of faces with deformities” behind the barbed wire enclosing a government-run leprosy hospital, guarded by an armed policeman.

Soon, he embarked on a significant journey, using plastic surgery to transform the lives of the leprosy-afflicted. During operations, he had no one to assist him except the patients themselves, owing to an unreasonable fear of contracting the much-dreaded disease. Even the absence of electricity and running water did not pose a problem for Antia. Interestingly, during one of his procedures, the ancient folding table that served as his operating table broke, and the operation had to be completed on the floor!

The two decades that Antia spent building the plastic surgery department at JJ Hospital in Mumbai, which he joined towards the end of 1958, make for an absorbing read. Here, rehabilitation following surgery was given as much if not more importance than the correction of a deformity. Antia tells us about an encounter with two of his patients -- whose deformities he had corrected -- begging with a group. This led him to the understanding that surgery was only part of the process; rehabilitation of his patients then became his ultimate goal.

The Diwali of 1946 brought tragedy to Antia’s family, when his sister died of firecracker burns. Later in life, he established one of the earliest burns units in the country, at JJ Hospital. He also set up a burns unit at the Thane Civil Hospital, where he demonstrated that “simple and cheap treatment could also be highly effective”. Patients would wash themselves under a shower a number of times a day, and then remain ‘exposed’ without any cover or dressing. “The simple soap-and-water treatment… considerably reduces the need for skin grafting,” explains Antia, “since exposure and continued washing reduces infection and avoids repeated dressings which pull off the regenerating epithelium.”

A passionate urge to understand the scientific basis of medicine directed Antia to pursue immunological research work in the field of leprosy at the National Institute for Medical Research (NIMR) in the UK in 1968. Upon returning to India, he began researching nerve damage in leprosy at JJ Hospital. His research experience also enabled him to establish the Foundation for Medical Research (FMR) in Mumbai in 1975, which works with leprosy, drug-resistant tuberculosis and waterborne diseases, and has shown that excellent research can be achieved without spending exorbitant sums of money. This institution, along with the Foundation for Research in Community Health (FRCH) in Pune, also founded by Antia, have directed health policy and guided national programmes. Working in tandem, the sister institutions have done important work in public health “by asking the appropriate questions and not being afraid to move between the lab and the land”. FRCH provided research for the secretariat of the joint panel of the Indian Council of Social Science Research (ICSSR) and the Indian Council of Medical Research (ICMR) that produced the pathbreaking 1981 public health report ‘Health for All: An Alternative Strategy’.

Visits to villages in the north Alibaug taluka across Mumbai harbour imprinted on Antia’s mind that the fundamental cause of most disease is poverty. He responded by training people from within the community in preventive healthcare and providing simple oral medicines for them to prescribe, beginning a whole new chapter in his life in 1973. Most weekends, he would be at Mandwa village where he would train women from the surrounding villages to address minor as well as major health issues like malaria, tuberculosis, waterborne diseases, and family planning. Two decades later, in 1995, his goals expanded to a broader community health project at Parinche village near Pune. In 2002, a resource and training centre was established at Parinche, which hosted trainees from different parts of the country.

Whether detailing his involvement in the UPA government’s National Rural Health Mission (NRHM), his travels to various parts of the country and the world, or his views on democracy, panchayati raj, healthcare, science and development, Antia’s autobiography is a thought-provoking read. While the State has abrogated its responsibility towards basic healthcare for millions of its citizens, Antia’s committed efforts powerfully illuminate the path we must embrace towards health for all. In times when a majority of medical professionals prioritise profits over people, A Life of Change reminds us to return the focus of medicine to where it must remain anchored: the human element.

(Neeta Deshpande is a freelance writer based in Bangalore)

Infochange News & Features, June 2010