Content Credits: Mariyah Haji
Design Credits: Ishanvi Baranwal
Web Post Credits: Elvin Joshua Pinto
What attracted you to the world of innovation? What was your experience at the beginning of your journey?
My affinity and curiosity for problem solving has been with me since my childhood days. Later, when I took up science as my stream of education and vocation, l often encountered a dead end in my pursuit of knowing more about intricacies and intriguing phenomena that science could not explain. I was often advised by my seniors and mentors not to pursue the chain of thought beyond a point as it was unanimously considered futile to venture into territories marked as unknown and unexplained. It was at that point I realised the need to unlearn more than learn to open the doors to innovation. The repository of existing knowledge, I increasingly sensed, created boundaries and fences around my thinking prowess that dissuaded ne from thinking about a problem and its solution in offbeat ways.
Could you tell us a bit about your famous 50 rupees Aum Voicebox and its effect on society and patients?
Aum was essentially born out of an intraoperative challenge resolution but eventually translated into a medical device innovation. The proctoscope conventionally used for dissecting the anus was used by me for the pharynges in the Aum innovation. The ENT surgeon used a probe which I ound very useful for my OT needs. When I envisioned this solution wav back in 2013, the main trigger of motivation was a security guard known to me who had lost his voice and livelihood to throat cancer. Me and my partner Shashank, an industrial engineer who is also an silicone expert, were determined to find a solution that would be accessible, affable and affordable in the same breath, which will help throat cancer patients with surgically removed voice box (larynx) lead a life of dignity without losing their livelihoods.
Today, I find it extremely fulfilling that the AUM voice prosthesis has touched the lives of thousands of patients, who had not spoken for many years after losing their voice to cancer. What began as a pursuit for solving the problem aced by one individual is now being seen as a solution catering to th needs of throat cancer patients across 144 countries. It is one among the 100 global social innovations across the globe having earned accolades from the likes of Harvard Business Review, Forbes and BBC. It was one among the four healthcare innovations showcased at this year’s World Economic Forum in Davos. AUM bears testimony to the fact that innovations are best driven by human necessities and not market notions of what sells and what doesn’t.
It is advisable to focus on individual needs which if satisfied can fetch your innovation a mass scale that can potentially become a market. Noble intentions invariably find takers if executed with unconditional devotion to the larger cause. The approach of first studying the market and then finding some product based on economic and marketing perceptions is inherently flawed and certainly far from sustainable.
Tell us about a circumstance of unlikely collaboration or a moment of serendipity in your life as an innovator
All problem resolutions that attack the problem on lateral pathways pave the way for disruptive innovation which in the case of healthcare innovations eventually makes it possible to touch lives at the patient level. I recall the time when we were faced with an formidable challenge in our AUM journey. Although we had the prosthesis ready, we were not able to create an inserter for the voice prosthesis. We had been grappling with this problem for more than six months and were visibly disheartened.
It was during this phase that I visited a store with my family where my son was running helter-skelter brimming with earthy enthusiasm. Thanks to haphazard movements, a few boxes fell off the product shelves. As I rushed to put them back on the racks, my eyes fell on a box of tampons and I got an eureka moment that the inserter need not be a intricate medical device but something simple like a box, or better still, like a toy. I then went and met a toymaker in Channapatna called Kausar Pasha.
This was one of the most unlikely, non-domain, and serendipitous collaborations where Kausar was able to create a prototype for me within an hour’s time with wood and organic dyes. This was a game changer for our insertion technique that was inspired by the Occam’s razor principle, which says, when taced with an intricate problem, try to seek a simple solution. My effort also brought doctors and engineers together, otherwise a difficult proposition.
What pushed you toward a career in Medicine and then head and neck Oncology?
I am often asked this question for which I would like to cite what I tell my colleagues and students. Rather than ask oneself, “In which sphere am I likely to be successful?”, one should ask, “where does my passion lie?”
For me, it was a page in a book that truly fuelled my interest in the voice box, although my entry into medicine has been more the result of my mom’s wish and my good grades. I spent long hours with my anatomy professor and took deep interest in the dissection sessions. Prof. Humbarwadi was my first mentor and guide in med school. I spent hours with him on his pet preoccupation of dissecting the voice box, marvelling at its enigma and exceptionalism. It then seemed a wayward exploration, unaware that I was of the ‘grand plan’ that was to unfold in due course. I call it the premonition of destiny. Today, when I connect the dots, my ongoing work on voice prosthesis innovation is automatically put into perspective. You connect the dots when you turn back, not when you look forward.
You simply need to keep creating the dots as you move forward. At some point, it all begins to make sense. When I was ready to leave med school, I aspired to become a neuro physician, not a surgeon. However, I almost instinctively chose ENT – Head Neck Surgery for my post-graduation, without any known trigger whatsoever to explain the choice. In the library, my eyes invariably fixated on a chapter on throat cancer every time I opened my book, almost as if this chapter held a series of decisive conversations with me, not the other way round.
I made Head and Neck cancer surgery my choice for specialization, and even ‘decided’ on the institution to pursue it: the Tata Memorial Hospital in Bombay (although I had an assured seat in a Bangalore institution). All of this happened without any rational explanation to ‘justify’ my choice. Looking back, I can now say some elusive force was guiding me towards the voice box which in turn brought me closer to head and neck oncology. More often than not, your gut feel, if sensed in the right way, takes your heart and soul on the path destined for you.
What changes do you project for the medical world in the coming future? What advice would you give to medical students to prepare for the same?
I believe the next ten years are going to be very crucial for medicine. We are moving towards a hand to mouth syndrome where technology will become our best friend to enable and expedite human healing but this should not come at the cost of the precious human touch. Going forward, we would need to ensure an emphatic design for medical education. I see the lack of two Cs and the proliferation of one C as the greatest threats facing medical education and practice: lack of communication, lack of concern, and proliferation of commercialisation.
Further, trust in any relationship including doctor-patient relationship is amiss today. The onus in on the Gen Z and Gen alpha students and would be practitioners to diffuse the threats and restore trust back into the system to make healing an organic process. The pandemic was the biggest wake up alarm sent out to us that it is society’s collective responsibility to focus on wellness and wellbeing to create a healthy disease-free society, and not merely build more hospitals to treat existing and evolving diseases. The medical student of tomorrow must strive to become a clinical scientist through holistic learning and proactive search and innovation, beyond the confines of conventional medic education that stresses on clinical and administrative excellence.
Medical care is only a part of the holistic term health care, and it comes into play only when there is a deviation from health. A healthy society thrives on as less ailments and hospitals as possible. High time we broke the conformal barriers that disallow health care innovations to serve the larger cause of humanity.
What does a day in your life look like?
My day begins with sunrise and ends well after sunset, and it is well spent in the company of my colleagues and patients. My OT and OPD are my temples, churches, mosques and synagogues where I see God in my patients and they see God in me. Making my patient feel at home and help bring a smile to his or her makes my day and gives me the energy and motivation to begin the next day on a fresh note of hope and enthusiasm.
Could you tell us about a case that was pivotal in your life as a surgeon?
There are several cases but I always remember my carotid body tumour surgeries where I was able to contribute to the betterment of the prevailing benchmark. To cite a case in point is a carotid body tumor surgery where a casual discussion paved the way for disruptive innovation. For any surgery, I adopt procedure founded on innate logic rather than textbook learning. I have not delved deep into the reasons for my preference given the ease of my dissection by virtue of what comes naturally to me. In this particular case, the cardiothoracic surgeon asked me why I prefer to dissect the internal carotid artery first, when the textbooks clearly recommend dissecting the external carotid artery first, given that it is where the feeder vessel comes from. It is also easier to dissect and less prone to adverse consequences.
My rejoinder was that it is more logical to attend to the internal carotid artery first as it has no branches extending to the neck, and it is better to deal with its complexity of life-threatening possibilities (like torrential bleeding or patient’s death from stroke) while the surgeon is fresh than when fatiqued after having dealt with the external carotid artery first. More importantly, a cardiovascular surgeon is needed while attacking the internal carotid artery which is main blood vessel connecting the heart to the brain, and being a scarce resource, his or her wait times and work times need to be optimally decided. Based on this experience, I wrote an article titled: The
“INT-EX Technique”: Internal to External Approach in Carotid Body Tumour Surgery in an indexed, peer-reviewed journal and is globally accepted as a standard procedure.
You juggle multiple professional identities from oncologist and surgeon to innovator and researcher, to innumerable advisory and leadership positions. How do you balance it all with your personal life?
Surgery is a highly intricate endeavour, and much of the thought and action happen on the spur but it is important for a surgeon to embrace collaborations, which merit a cross talk between methods and practices of disparate disciplines and cultivating the art and science of looking for solutions in the unlikeliest of avenues, domains and spheres. That explains my escapades into diverse domains. Yet the ecret sauce of juggling multiple identities is to collaborate with teams and folks better than you which helps one achieve an incremental participatory growth built on shared visions.