Prof C. N. Purandare is a Consultant, Obstetrician and Gynaecologist, Purandare Hospital Mumbai India, Mumbai Police, Hon. Consultant, Saifee Hospital & BSES Hospital, Mumbai. He is also a Visiting consultant at St. Elizabeth Hospital Mumbai. He has held many prestigious positions like President FIGO (2015– 2018), President, FOGSI (2009), President Indian College of OB GYN (2009) and Emeritus Dean Indian College of Obstetricians and Gynaecologist. He is Editor Emeritus, Journal OB GYN of India (JOGI), FOGSI. He was the Project Director, FOGSI-FIGO-B& MGF-MNH Project, and Ex. Hon. Prof. OB GYN, Grant Medical College & J J Hospital, Mumbai. Professor Emeritus O&G Research institute Ministry of Health Russian Federation.
Editorial note:
I am extremely pleased to present this guest editorial
by Professor C. N. Purandare, a beloved teacher,
who has been the guiding force not only to me but
to so many of his students and colleagues. He is one
of the illustrious past editors of this journal. When I
requested him to write an editorial on what it takes to
be the FIGO president and a successful obstetrician
and a gynaecologist, he was more than happy to share
his thoughts. He has penned down his memorable journey
of more than four decades. I am sure it will be of
immense interest to readers. Here I present pearls of
wisdom from an obstetrician and gynaecologist with
a 45 years of experience and command!
-Professor Suvarna Khadilkar, Editor in chief.
“You can’t do anything about the length of your
life, but you can do something about its width and
breadth”-Evan Esar
A Doctor’s life is a fascinating journey of several ups and
downs, of feelings, making a difference in the lives of those
who have placed their precious lives in your hands, because
your hands are the ones that give hope, heal and spread happiness.
It’s invigorating, more so in the life as an obstetrician
and gynaecologist, as one deals with the two lives of
the baby and mother. I joined the profession by choice, as
I come from a family which has a background where we
talked and walked obstetrics all the time, shared motivating
stories about the profession thus it constantly kept encouraging
me to be a part of the same fraternity.
Gynaecology and Obstetrics (OBGYN) are the two sides
of the same coin, while former is considered a science,
the latter an art. One can carry on work as a gynaecologist
where the formula of one plus one is equal to two works;
however, the same cannot be true for work as an obstetrician,
given that there are many real-time variables to keep up
with. Decision making in Gynaecology can wait for a week,
while the surgeon consults his peers, books and can expedite
the procedure; however, in Obstetrics, one needs to take split
second decisions and must have the required expertise to act
on immediately. One cannot tell the patient in labour that we
can wait and do normal delivery or do a forceps or vacuum
or caesarian by thinking about it or consulting evidence and
come back to do it tomorrow. It is a 24 × 7 job with no exceptions;
action has to be taken right then and there!
At a tender age of fourteen, I was in awe of my grandfather
Dr. N. A. Purandare, who influenced my decision to do
medicine and then OBGYN.
I started my career as an obstetrician; training, practicing,
teaching and knowing that it’s a long journey and knew that
it was going to be tedious journey. The unique experiences
and life’s lessons moulded me to be a better doctor, individual
and human being as this profession needs compassion,
understanding and empathy.
Maternal and perinatal mortality can never be zero, and
we have to deal with situations of both happiness and sadness.
Pregnancy and its outcome are considered by the
mother and the family as a happy event to be celebrated, but
at the same time a loss of life for a family can be devastating,
and an obstetrician has to be in the forefront to explain the
loss which is a herculean task in itself.
Little do the patients and their relatives realize that pregnancy
is not a simple natural process with always a happy
ending (although we always strive for the same), things
can go wrong within minutes. All this gives an obstetrician
tremendous mental stress. Anything more than 200–300
per year deliveries for an obstetrician is a physical, mental
and emotional nightmare. In India, 37,000 obstetricians
need each single one to deliver or supervise average 800
deliveries.
Gone are the days when women had numerous pregnancies.
Today with small families everyone is expecting a
healthy baby who would be a future Einstein in adult life.
Any disability which can occur congenitally or during the
process of labour is not acceptable leave aside death.
Faith in doctors has eroded due to the day-to-day life
experiences patients have had and one feels that everyone
around them is set to cheat and make money as making
money is the entire population’s ultimate goal. Honesty,
integrity and ethics have taken a back seat in the social structure
world over.
World over some lawyers advertise how they can extract
money from the doctors and institutions at a percentage
sharing with patients putting pressure on doctors to practise
defensive Obstetrics. Whichever way you may deliver,
vaginally, instrumental delivery or Caesarian, the doctor is
sued resulting in majority of newly qualified doctors shying
away from being an obstetrician. The Art of Obstetrics is not
dying but nearly dead!
On the one side, society is screaming that there are too
many Caesarian sections, but at the same time Obstetric
practice has changed from delivering a young 25 year old
or less women to a high risk 35 years plus women, many of
them with medical problems and IVF pregnancies.
It is said that the last 10-cm journey through the birth
canal is one of the most difficult journeys that a human being
ever undertakes in their life. It is this journey that an obstetrician
facilitates with all the experience and skill.
A time will come when no one, patients or doctors alike
would like to take a chance of a normal delivery and like we
see in private sector of Brazil nearly 90% will be Caesarian
deliveries and the remaining being accidental vaginally
deliveries because no one was around.
Our years of training are mentally, physically strenuous. I
remember getting up at 5 a.m. to do the ward round with 90
patients, many of them on the floor between beds and also
under the bed what had to be seen in 2 h before the registrar
came for his round.
Further twice a week it was an overnight duty delivering
a dozen patients between two house officers.
I vividly remember few interesting and funny episodes
of those golden days; the entire unit residents waiting in the
evening of our emergency Sunday for the freshly cooked
meal being brought from my home which was shared.
A patient undergoing a surgical termination of pregnancy
was reluctant to get an IUCD fitted for contraception and
when probed she said she would be careful as this accident
happened because it was her husband’s birthday.
A patient was asked to bring a stool sample for check-up
the next week and landed up with a whole week’s stools
packed in a Dalda container.
I had some extraordinary colleagues and seniors making
the journey during training worthwhile in the end. I cannot but not mention Dr. E. J. Sequiera, Dr. Sharad Nanavati,
Dr. S. S. Thakur from Nair hospital, Dr. G. B. Belvi from
Bhagwati hospital Borivali and Dr. Fergus Meehan from
Galway Ireland under whom I trained. Each one of them
moulded me and taught me different facets in life and the
profession. Dr. Sequiera taught me to fight battles with
your own generation and not take them to the next, Dr.
Thakur as my PG teacher, to put the best foot forward and
aim to be the best, Dr. G. B. Belvi gave me experience and
confidence as a surgeon and Dr. Fergus Meehan, confidence
to be on par with everyone and anyone. These facets
eventually helped me to be what I achieved in the end.
The 4 years I spent in Ireland were the turning point
in my life, from a shy and scared of senior’s kind of an
individual; I blossomed into a confident, articulate obstetrician
ready to face the world. Galway taught me to treat
my juniors as colleagues and friends, the fruits of which I
see and enjoy even today.
Today’s obstetrician and gynaecologist has become a
multitasking multispecialist with high stress levels. One
who has to bear the stress of routine day-to-day work,
monetary, setting up of practice, medico legal, family
needs, peers, seniors and head of the departments who
in this day and age treat their colleagues and juniors like
slaves or subordinates to be harassed and trampled over.
I remember that in the past, one angry look of Dr. K.
K. Deshmukh at JJ Hospital without a spoken word used
to be enough for residents not to repeat the same mistake
again. You cannot demand respect, but you have to earn it
and she really did.
Going forward, I urge my colleagues to utilize their
spare time to read books, play games, experience simple
things in life, do whatever you want, whenever you want
and let go of your inhibitions, cool you off by looking for
affection from family and friends, eat well as the next meal
time can’t be guaranteed, catch your forty winks when
you get a chance, shower affection or appreciation to your
juniors when they deserve it and love your family members
as they are the shining stars in your life.
My tenure of 20 years in JJ Hospital as the Honorary
Professor of Obstetrics and Gynaecology was extremely
satisfying as I taught thousands of undergraduate students
and hundreds of postgraduate students. They all became
my true friends and supporters for life, and I am indebted
to them.
My progress professionally in organizations like Mumbai
Obstetric and Gynaecological Society, The Federation of
Obstetrics and Gynaecological Societies of India in various
capacities for 20 years and ultimately the highest honour
to represent India as President of FIGO have been very
humbling, I have no hesitation in dedicating this to all my
seniors, peers, students who gave me the support, love and
affection and continue to do so.
Government decision to remove honorary teachers and
keeping full time ones sadly brought the great institutions
like Grant Medical College to mediocrity.
Teachers who were fortunate to work in both private as
well as public sectors acquired iconic stature. These honorary
teachers would impart high level training to students and
budding gynaecologists. During my tenure as a honorary in
Grant Medical College, we onetime boasted of many such
iconic personalities in different departments of the college,
like Dr. Farouk Udwadia, Dr. Tehmton Udwadia, Dr. B. K.
Goyal, Dr. B. S. Singhal, Dr. Vasant Patwardhan, Dr. Usha
Saraiya, Dr. Tulpule, Dr. O. P. Kapoor, Dr. Altaf Patel, Dr.
Jairam, Dr. Vasant Jaykar to name a few on the panel. I am
happy to note that MCI has realized the damage done and is
in the process of reversing the decision.
I always told my students being successful is more important
than standing first in a class. In life you can’t win all
battles, winning and being successful are different entities.
When you progress in life, you will have enemies and their
jealousy will not let you prosper. Politics is in every field
therefore focus and fight only those battles which matter and
not all which will sap your time and energy.
As Sir Winston Churchill said “You have enemies? Good.
That means you have stood up for something in your life”.
“Get happiness out of your work or you may never know
what happiness is”. “Elbert Hubbard”.
Live life that matters
