|An Australian in India-II|
Why did you want to study Medicine?My family was not well off. I wanted to ensure that I was better off. I wanted material comforts for my children and my family, which unfortunately I did not have. My father was from a poor family. He had to leave the town because there was no work. He had to take whatever jobs he could get at that time. It was a struggle all the time. I did not want to struggle like that. Getting into medicine was a way out. Of course, It meant getting better grades and working hard.
In your family there were no doctors, so why did you want to particularly take up medicine?
I used to admire those few general practitioners who attended on me and my family when I was young. They had strength, kindness and were down to earth. They looked different. They had rich, fruity, deep voices. Like them, I wanted to drive a nice car and carry a big black bag.
Why did you join Psychiatry?
Upto 1970, people thought that those who were not good in anything else took up psychiatry. It is really true in my case. I was not good at anything. I could not do surgery. I was not good with my hands.
I went for psychiatry as I was always interested in English literature, history, drama, philosophy and psychiatry was the only field where these interests could be partly accommodated. Psychiatry in Australia is full of failed writers, musicians, dramatists, actors and artists. Psychological theories, psychoanalytical theories and existential philosophy are all relevant to psychiatry.
Why did you leave Adelaide?
I left the country as I could not stay in Adelaide. It was inward looking and parochial. It was important to move out and meet challenges elsewhere. I was not content having a triple fronted house with a double garage, 2.2 children, an unhappy wife and staying smug under the wings of a consultant.
For the past twenty-five years what have you been trying to achieve in Psychiatry?
I am trying to get it right. I am trying to get a broad understanding of the nature of psychiatric problems rather than look at them from a narrow point of view and understand psychiatric problems from the biological, social and historical perspective. For me, fundamentally, the nature of psychological misery is the same worldwide.
I am trying to understand what schizophrenia is all about. I am trying to develop medical education programmes for the graduates and the post-graduates. I am trying to develop a mental health service that is effective and innovative. Generally speaking, the service needs to be more accessible and responsive to the general practice. Service personnel need to adopt more evidence based practices, which means that the treatment given is based on the sound evidence of its effectiveness. They need to ensure that they provide care in a manner that is humane and compassionate.
How are you making it possible?
We are trying to do it in Newcastle by evolving responsibilities so that everyone knows the policies. We are trying it through vision and focus on improving streams of mental health services with the leadership of several clinical education and training to those who are responsible for delivering services. I am also trying to do it by providing leadership and by setting an example by my own behaviour.
What are the difficulties you are facing in implementing a responsive and innovative service?
We are facing normal inertia and resistance to change what exists in all long established systems. To get over it, we are communicating and consulting with all our staff and other interested parties. We are trying to provide supportive and positive environment in which the staff can achieve these changes. We are educating and training the staff by having consultation and communication with the GPs and patient groups. We are aiming at better mental health outcome for the patients and a congenial clinical environment in which to teach and do research.
In Newcastle, you seem to be working with several psychiatrists from India, any comments on that?
We had shortage of staff in Newcastle and we had to recruit people from many parts of the world like UK, Yugoslavia, Fiji, New Zealand and also from India. On the whole I can say Indian psychiatrists in Newcastle are outstanding. They have very good clinical skills and they have been trained extremely well in India.
What is your impression about the service delivery by the NGO and the government run mental health facilities in Chennai and Bangalore, which you visited?
I have been very impressed by the work, the quality of clinical assessment and the treatment provided. I found the staff of the Schizophrenia Care and Research Foundation (SCARF) in Chennai, to be very committed and dedicated. It is a very effective organisation to provide care, advocacy, treatment and research for the people affected with schizophrenia.
On the other hand, I found NIMHANS (National Institute of Mental Health) at Bangalore to be a very impressive organisation. I was impressed by everyone there. Their quality of work is very high. The people are all of very high caliber. Their public work and the published work and consultancies they do with WHO etc. show how well they are regarded. Both in the Institute of Mental Health in Chennai and NIMHANS, I was impressed by the fact that they do qualitative work with such few resources compared to what we have in Australia.
What are your plans to establish linkages between India and Australia in future?
I would like to explore the possibility of sending registrars to India for three to six months to expose them to quite a different treatment environment and problems of health care delivery in countries like India.
I would like to have exchange of trainees and medical students and develop bonds that should benefit both sides. I would like to set up an elective programme of four weeks to three months at NIMHANS and St. John’s Hospital in Bangalore and at SCARF INDIA and the Madras Medical College in Chennai. I would also like to start collaborative research between Australia and India, with SCARF and other groups. Lastly, I would like to come to India for a few months and not for a few days as there is so much to learn, share and take back.