Cachar Cancer Hospital - Dr. Ravi Kannan

My guest is Dr. Ravi Kannan. In this episode of the Oath & Staff Podcast, he talks about the core values of Cachar Cancer Hospital, the poor patients he serves, and why his colleagues are his greatest rewards.

Link mentioned in this episode:
Cachar Cancer Hospital: https://cacharcancerhospital.org/ 

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Transcript

Intro

SPEAKER_00 0:00

Hello and welcome. You're listening to Oath and Staff, a podcast about human stories from people of medicine. I'm A. David Singh, your host, former neurosurgeon, and author of Magical Rome Universe. When I am on this podcast or writing fiction, I explore the same themes: service-mindedness, overcoming challenges in a complex world, and how our choices shape who we become. In today's show, I'm talking to Dr. Ravi Kanan, a renowned surgical oncologist. His story begins 20 years ago when Dr. Kanan was working at the prestigious cancer center at Chennai, South India. However, the universe had different plans and guided him across the country to Silchar in the northeastern state of Assam, where Dr. Kanan built a people-centric model of compassionate cancer care. During the last 19 years, he has served as the director of Karcher Cancer Hospital and Research Center, which provides medical and social care to millions. He is also the recipient of Ramon Marksasai Award, often called Achia's Nobel Prize, as well as the Padam Shri. The Padmanshri, as you might know, is a high civilian award given to Indians who have made distinguished contributions in the arts, literature, science, medicine, and social service. Today I am truly excited to talk to Dr. Ravi Kanan on the Oath and Staff podcast, where you will hear about his remarkable journey as a medical doctor, the core value he practices in the service of humanity, and how the Kaucher Cancer Center provides hope and healing for marginalized and underserved communities in Northeast India. Welcome, Dr. Kanan. Welcome to Ooth and Staff.

SPEAKER_01 2:12

Thank you. Thank you for inviting me this evening.

Origin story - Cachar Cancer Hospital

SPEAKER_00 2:16

It's my pleasure. Dr. Kanan, I was thrilled to hear your TEDx talk at Assam University titled You Don't Need to Be Powerful to Bring a Change, in which you had spoken about the origin story of your hospital. Would you please tell our viewers and listeners about the beginnings of the Khacha Cancer Hospital and how the title of your TEDx talk ties in with the origin story?

SPEAKER_01 2:46

In the late part of the last century in the 1980s and 90s, the only cancer center in the northeast was in Goahati. That is about 350 kilometers from Silchar, where I am. And those days, even today, it's a it's a challenge sometimes to get to Guhati. But those days, many of the bridges were not there, the roads were not like what they are today, and so it used to be very difficult for people to travel to Guhathi. And the cancer was a common problem in the region for a variety of reasons, and almost every family will have somebody or the other with a cancer. And then you also know cancer treatment takes a very long time to be completed, and results are often uncertain. And so for people to travel to Gohati or to Kolkata and stay for four months, six months was a tall order, and many of them would give a treatment, they would come home to die. And so local lay citizens of the region, you know, decided that this was not okay and took matters into their hands. Teachers, lawyers, tradesmen, farmers, engineers, they joined hand, a very small number of doctors, they joined hand and formed the Cancer Society, Qatar Cancer Hospital Society. And then they went about, you know, door to door seeking support. They held street corner shows. You know, ordinary rickshapulas gave them a day's wages as a donation. They went, sought support from different political leaders, and the local MP at that time was an influential minister in the central government. And so he got them land, and in 1996 they actually opened a hospital. And you know, the the hospital was work initially uh sustained by by uh local surgeons, Dr. K. P. Chakavarati, he's around today also, he's 94 years old. He was an ophthalmologist and a joint director of health in the government. He had just retired, and in 1992, the members of the society requested him to join. And so when the hospital opened, he opened a textbook on oncology for the first time, self-trained himself to deliver chemotherapy. So people would go to Kolkata or Guhathi and come with prescriptions for chemotherapy. So he would deliver the chemotherapy and send. That's how the hospital started to function. In sometime around 2000, the then director of the hospital, Dr. Chinma Chaudhvi, visited a number of cancer centers to see how a cancer hospital has to be organized. I used to be working at the Cancer Institute in Chennai and he spent several months with us there. The Cancer Institute had a had a policy that nobody should be denied treatment for want of resources. We would treat everybody whether they could pay or not. And Dr. Chowdhury was very, very shaken up by this philosophy. So when he came back, he would frequently call me and send patients to Chennai all the way from Silja for treatment. It so happened that in 2006, sometime in October or November, I quit the institute suddenly. Some small problem, and I was young, I just walked off. And Dr. Chaudhri called me just a month later for some patient. I said, I'm no longer there, but you send your patient, I'm sure he will be taken care of. Oh, you should come here at that time. All we knew of Assam were bombs and floods. So Sita, my wife, said, No baby are going there. No, any place on earth but Assam. Then these people, the society members would call frequently every weekend, they would call. Those days there were those PCO booths, you know, for long distance call. Sometime in April I told Sita, let's go and see the place once. So Sita, my daughter, and I came on a visit and we spent a week here. I spent time in the hospital and Sita went around this community. The society members took her around. We went visiting schools, and school principals were so supportive. Come, your daughter will get admission. She was in class four. She was in a school that did not have examinations. Every year she would go and she would go on to the next class. You know, what did you do today? A pie, played. And so when we came here, I said she doesn't know Hindi, she doesn't know Bangla, she doesn't know Akamya. Don't worry, doctor. Children are very smart, they will learn. The local KV principal, I am a Kendri with Dyanaya product. The local Kendri with the principal was Hari Singh. Hari was my batch KV passed out. I passed out from KV Tambraam. He passed out from KV Kapurtala. And so in two minutes we had our common educational ancestry, you know. So, Ravi, your daughter will get admission because of one, two, three, four. He rattled out several reasons. She had to take an entrance exam. That's a different story. But then before we could go back, Sita said, uh, there is a lot of need here. This is what we should be doing. And so when we went back, she resigned from work. She used to be the regional officer at USEP in 109. She resigned from work. She initiated conversation in both our homes. Both sets of parents were dead against the, especially our mothers were dead against the idea. My colleagues, they were very, very concerned for me. You know, that this may be uh professional uh suicide. But they were very supportive, you know. I have great colleagues all over the place.

SPEAKER_00 9:06

Thank you for sharing that very personal story about uh you and your family. And I was equally impressed by how the local community of Silchir got together and started this hospital to serve cancer patients.

SPEAKER_01 9:22

Very inspiring.

SPEAKER_00 9:24

Very, very inspiring indeed.

Core values

SPEAKER_00 9:26

So let's talk about the hospital. Uh would you tell us about the mission statement and core values of the Kachar Cancer Hospital? And what is the target population that your hospital serves?

SPEAKER_01 9:41

See, our our target is people at the bottom of the socioeconomic pyramid. If somebody with money comes, we will treat. But our target is people who are marginalized, who are at the bottom of the economic uh ladder, who don't have resources to go elsewhere, who don't have social support structure. That is the target of the hospital. So our mission statement is that you know we want to prevent every cancer that can be prevented, that nobody should be denied treatment for want of resources, that nobody should die in misery and pain because of cancer, and most importantly, no family should be impoverished because of treatment-induced expenditure. And core values is something that all of us sat down and wrote together. We had several brainstorming sessions. We took a whiteboard and wrote down all these values. We said compassion is our most important core value. What does it mean to be compassionate? What we will do, what we will not do. And then we said our next core value is we will be pro-poor. We want to now change it into pro-people, but it is pro-poor. And then we said we want to be evidence-based, we want to be scientific. We said frugal innovation is very important. We are in an underserved community, we are, you know, starved for resources. But just because we are poor doesn't mean we have to deliver poor quality care. We have to be innovative to be able to deliver good quality care. And then we said we will value teamwork. We are a great team. Today we are about 500 of her, and each of my colleagues is a hero in his or her own right. Every one of them is a hero for me.

SPEAKER_00 11:46

Dr.

Hospital structure and daily operations

SPEAKER_00 11:47

Kanan, would you please give us a brief overview of the structure of the hospital, the staff, departments, and the main activities that take place every day.

SPEAKER_01 11:59

See, when we started, we were a small team of about 23 people. And we didn't have the resources to do a master plan and implement it. So we grew organically. Today there is a need, we put in place a structure to solve that problem, institutional it, and move on. And then there are problems with firefight, and all these years that is practically what has happened. We have now 500 people, and and we have all the standard uh divisions for taking care of cancer patients. You know, we have a very strong preventive oncology division, very, very large community presence. We're in several communities in the districts around that. We have a you know good pathology, radiology, uh, molecular oncology, good diagnostic services. And then we have uh treatment, medical, surgical, radiation, palliative case, and then we have a good research unit. We are uh we are uh teaching uh service, we have courses in nursing oncology, surgical oncology, palliative medical, and these are increasing. And then and then there's a research facility which uh takes care of both basic research, epidemiological research. We now have a um research administration, you know, clinical research secretariat, and then support services, you know, dental surgery, blood bank. You know, we have I think the most important part of the organization is our outreach into the community. Some 140, 150 beds in the hospital. But then a lot of people are not able to come to the hospital. There was a time in the initial year when we realized that most patients, nearly 60% of patients, did not even come for a second hospital visit. They would come and then they would go and not come back. And even those who started investigations, less than a quarter of them completed treatment. And so we put in place a number of measures, you know, we reduced the costs of care, we fast-forwarded investigations, treatment, because they're all daily wage earners. For them, a day lost in the hospital is a day's wage is gone. And so the family starved at home. So we said, no matter what happens, anybody who comes to the hospital will be seen the very same day. We never tell them that there are no appointments, go and come back another day. Because what will happen? They will go back home or they will stay in a public space in the railway station or bus stand and come back the next day. We said core investigation should be done. That same day the blood biochemistry X-ray ECG happens. Next day morning, he has his endoscopy or biopsy. Following that, he has the imaging and he comes back the next afternoon. All our pathology reporting, I have amazing pathologists as colleagues, all our uh pathology reporting happens on frozen section. And so by the time they come to us in the afternoon, the diagnosis, the staging, and the treatment plan is ready. And then they will go back home and plan what is to be done and come back. It also gives us time to look for support for their care. And so we put in place a number of measures. Some of the one of the most important things, you know, is see, because of a project with the FIDAC, we started testing two satellite centers because FIDAC, you know, wanted to test a telemedicine software and they wanted to test it in the Law Fish, and uh they worked with the local NIT that chose us as a clinical partner. And so we put up a satellite center in two of the districts around us, in Karimgan and in Haila Kandi. We now have uh six, seven, eight satellite clinics around us, and we run these centers so that patients don't have to come to the hospital for everything. A lot of work happens in the satellite center. Similarly, we also have a very aggressive home care program. Home care was originally started for people with incurabilities who are dying of the cancer and are not coming back to the hospital for palliative care. But their services have now increased and we go to homes of populations. In villages, what happens? The community will typically come and see what's happening. And so they're a captive audience. So after the home care program is done, they will go, they will get hold of onlookers and talk to them about health, about cancer, early injection. And through this awareness, you know, patients come up and say they have a lump in the breast or they have a difficulty in swallowing, and we identify cancers among these people. And so, and then the home care program also started visiting homes of people who are not coming back to the hospital to try and understand what we can do to help them. And then the third thing that we do is through the community oncology program, you know, we have a very large community program. We have several districts around us where we work with the government, with the NHM, with the Asha. India has a system of accredited social health activists called Asha. Asha means hope. And they are community leaders who are basically mobilizers for health programs. And so we work with them to promote awareness for early detection for palliative care, a variety of activities. And what we learned is in order to treat poor patients, not only do we have to provide low cost, good quality, quick treatment, but 24 by 7 we have to demonstrate that when we say we are pro-poor, we are really poor poor. The way we talk, the way the hospital facade, the way we dress, somebody stops us on the corridor, we have to stop immediately, attend to their problem. If I am not able to attend to it, I must take him or her to somebody who can solve the problem. If I were to, you know, brush them off and tell them to come to the clinic or some other place, they will withdraw into their shells and they will disappear. One rude word, they don't have the the the courage to stand up to, you know, anything that is difficult to marry. And so every activity of ours has to reflect this pro-poor time. Even today, despite all these measures, 30% of patients don't come back for treatment. And so that is a very big problem, bother for us. The other thing that we are looking at is, you know, when we treat poor people, we realize that even though in Assam education for kids is free, their kids will drop out of school because there's nobody to earn the daily bread. Kids have to go out to work. And then a large number of them don't go back to school ever. It means another generation is ruined. And so we are actually bothered about two of these problems. You know, one is how do they prevent loss of education? And we're exploring a variety of ways to see how we can get these kids to complete schooling and look at higher education. The other thing is they're all small jobs, you know, daily wages. And so when they go through cancer treatment, many of them don't go back to productive livelihood. The loss of livelihood. So by treating cancer for a breadwinner, it's actually created a problem for the family, another mouth to be fed. And so we're now trying to see how we can ensure livelihoods for these families. Again, we are trying to do a number of things.

SPEAKER_00 19:54

So you're providing both uh medical care and social care to the community through the hospital.

SPEAKER_01 20:01

So you know what? I really think that you cannot provide health care as a tunnel because healthcare, education, livelihood, environment, so many of these factors are so intimately one is linked to the other. If you look at if you look at providing education, ignoring the health aspect, you've lost the game. If you provide health care and ignore the loss of livelihood, the loss of education, you've lost the plot. We have to look at it wholesomely. We may be able to do everything on our own, or we may find partners who will work with us to do this.

unknown 20:41

Dr.

SPEAKER_00 20:41

Kanan, thank you very much for sharing those deep, deep insights about the work, the remarkable work that you and your colleagues are doing at Kachar Cancer Hospital. So I was wondering uh how do you divide your time between uh surgical care of patients and running the hospital?

SPEAKER_01 21:03

Clinical care takes we see them all the time, the patient in front of me, or the wardround that has to be done, or surgery that has to be performed. I have very good colleagues in accounts, in administration, in information technology, in resource mobile, and so they more than make up for my ineptitude, you know.

SPEAKER_00 21:26

I am sure that's not the case. No, that is the

Initial challenges

SPEAKER_00 21:30

truth. So let's go back in time. When you moved to Kachar Cancer Hospital 19 years ago, what were the initial challenges you faced in your role as director of a cancer hospital? And how did you resolve those challenges?

SPEAKER_01 21:45

When I look back in hindsight, you know, the biggest challenge for us probably was the fact that we didn't know anything about administration. We didn't know anything about economic, all we knew was. Taking care of sick people and operating and working with colleagues to make sure we deliver multidisciplinary care. That's just about what we knew. And so we learned everything on the job. I didn't know how to manage nurses and training personnel, and you won't believe we were only six nurses when we started. None of them was formally qualified. Okay, and very quickly we started having A and M's and G and M's, and when we were 30 or 35 nurse, there was a government uh uh call for nursing uh positions, and suddenly, you know, 25 of them disappeared. Overnight, 25 of them resigned, and suddenly from 35, we were down to 9 or 10. And then we sat down, my nursing supervisor who was there, then also we sat and took a decision that at all times 50% of our nurses must be the traditional nurses that we had dai who were trained on the job. And so today, for statutory reasons, we are now 240 nurses, but even now 120 of my nurses are qualified, it meets all the statutory requirements, and half my nurses are still the old Dai trained nurses, but they are brilliant, you know, they're like sponges. They just didn't have the opportunity to learn and grow. They are paid better than any DAI nurse in the community. They have respect, they see value for what is happening, and they hold the backbone of the institution together. And then things worked out. I have great, tremendous people as colleagues, you know, at all levels. Right from cleaning staff to technicians to nurses to doctors to administrators. Amazing set of people who have joined us.

Lifestyle and Cancer prevention

SPEAKER_00 23:55

That's a very inspiring story, Dr. Kanan. Thank you for sharing that. When we when we were talking about getting you on the show, I took the opportunity to do some research. In one of your videos, you had mentioned that cancer is a lifestyle disease. Would you please tell our viewers and listeners about the different kinds of cancers that can be prevented by making healthy lifestyle choices?

SPEAKER_01 24:24

If you look at India, you know, broadly speaking, 60-70% of cancers are caused by lifetime, head and neck cancer, uh esophageal cancers, gather cancers, breast cancer, nerva cancer, all in some some manner or the other caused by lifestyle. You know, tobacco. Tobacco is a very big problem even today, especially chewing tobacco, very big problem in the country. Though the last survey showed smoking has reduced, except for three or four states. Chewing tobacco is not counted. We don't have any idea what's happening. And then alcohol. Alcohol is a very major problem in many states in the country. And then the dietary choices and dietary preferences, how we make the food. Now there's a lot of processed food coming into the market. Physical activity, and across the board, physical activity has come down. When we were kids, you know, we were always on the streets cycling, swimming, playing. It seems to have disappeared. Kids are on their phones and their computers, and it is a change in lifestyle. Well, while they are eating a lot of processed food, they are exercising far less. Tobacco, alcohol accounts for a whole lot of head and neck cancers, esopageal cancers, sanctuatic cancer, uh, urinary tract cancers, gastric cancer, diet implicated, colorectal cancer, breast cancer. So many, so many cancers are uh because of our lifestyle. Now, for a second, keep cancers out. If you look at heart disease, which is the commonest cause of death in the country today, both strokes and cardiac diseases, what aggravate diabetes or hypertension, peripheral masculine disease, COPD. So many non-communicable diseases have the same set of causative agents. So when I talk of cancer prevention, when I don't use tobacco, when I don't drink, when I eat healthy, exercise regularly, take care of infections and inflammations, I prevent a lot of cancer, but I also prevent heart disease. I prevent stroke, diabetes, hypertension, COPD, peripheral. So many diseases are prevented. In other words, we're actually promoting health in the community. And this is something that does not have to go out from the doctor or the nurse. This is something all of us can do, talk about in our own spheres of influence in our communities.

SPEAKER_00 27:10

Thank you for that. That's a public service announcement, and I'm happy to share it widely across both video and audio podcast channels.

An Institution at Crossroads

SPEAKER_00 27:20

Another video which I saw of yours was uh the your presentation at the IDES Kader Orachul at my Abma Matters CMC Valor. In your Erudai talk, you had stated that your hospital is an institution at crossroads. Dr. Kanan, would you please tell us about the key issues that are being considered and discussed by you and your colleagues at this crossroad?

SPEAKER_01 27:49

Yeah. So there are many changes happening in society around us. And um so you if you if you take my own colleagues, when we started off several years ago, many of us were very young. Many of my colleagues were not married. They've got married, they made babies, their kids have to go to school, they would like to construct a house, they would like all perfectly uh reasonable requirements. That all of it costs money. We serve a very poor community and they don't have the capacity to give us the kind of money that my colleagues sometimes need. And so it's a it's a perennial debate in the hospital, you know, that just because we treat poor patients should we remain poor. That's not that's not uh a fair expectation. And so, you know, there is there is this argument, you know, that we must waste charges. So these are difficult arguments to settle. You don't want to hurt patients, but you also don't want to do injustice to your own colleagues. And how do we make both ends meet? When we start, we are all very passionate. We are all uh motivated by a cause. And then as as we grow, as you know, we our families expand, our social needs increase, there is some divergence. You know, I say we must all see all patients that come to the hospital every day. Now they want to go home, they have their own kids, they have their family, and so there is some dichotomy, you know, they don't want to stay on longer, and so it conflicts with our core value of compassion. Patients have come spent a lot of money and come here, they cannot afford to stay overnight, they will lose another day's wages. There's no right or wrong answer, but these are issues that we must settle in the long term. I used to think that, you know, people who join us today are people who have not seen the struggle that we have gone through in the past. I used to think that youngsters who join today are probably the reason why our core values weaken. But the truth is, it is the leadership of the organization that actually contributes to the to a very large extent for weakening in core values. You know, when I when I when I overlook, you know, inappropriate behavior by somebody in the organization who I consider crucial, then I'm sending out a message that these core values are negotiable. And then what is happening is we we were the only hospital in the region, and soon there will be other hospitals coming up. The idea of poverty itself will change with time. And so when there are other hospitals coming up, some of these hospitals have glitzy paintings and tiles and fountains and all the rasmatas, then people say we would like to be like that. But that is at variance with what our core population, target population is. It is important for for differences to happen, and it is very important for differences to be spoken about. And then, see, we we served a very poor population, and then what has happened? The government insurance has come in, and so there is some money at the bottom of the pyramid. There are for-profit organizations which would like to share some of the money at the bottom of the pyramid, and so for a variety of reasons, patients will go to other organizations, and then they will lose all their resources, and then they will come back to us without anything in hand, and so then there will be an argument, you know. Oh, this patient has gone elsewhere, he has spent all his money, why should we take care of him now? So, yes, in one sense, that argument is correct, but on the other hand, it is not it is not about the money that the patient has, it is about the need the patient has. So the community itself is at crossroads because the whole idea is changing. This morning we had a staff meeting in the hospital. We had a long conversation about how we continue to stay true to our core value of taking care of poor patients. But if we have to take care of poor patients, we have to make sure that a critical mark of poor patients continue to come here. If they are all going away, how do we stay relevant to the needs of the community with changing times? And now with technology, with AI coming in, you know, everything is going to change, you know. And so, how do we empower ourselves to deal with all these changes?

Building trust in Local Community

SPEAKER_00 32:47

An organization that serves people like a hospital is uh dependent on its relationships with the community around it. As the head of your hospital, what initiatives did you develop to build and retain the trust of the local community at Silcher?

SPEAKER_01 33:08

The truth is we didn't do anything consciously. We did it, you know, without knowing that that is what we were doing. People would come and ask us to come and address meetings with the community, we would happily go. We have a very large community participation. And then we had an administrative officer who was a retired school teacher. The society posted him as our administrative officer when I joined in 2007. That man was probably the single Mr. Kalyan Sakavarki. He is the single most important reason for the hospital's growth in the last so many years. The man had a knack of interacting with people of all shades, from different opposing political parties to different uh community groups, different religious groups, different, you know, academic industry. He had a he had a knack of managing everybody on very good terms. He would frequently go out into the community and then say, Doctor, come, you have to go and speak at this meeting. Doctor comes. Whatever he said, we would follow. And that is one very major reason why we have a very large, um, very good uh equation with the community. And now we hear retired and we have younger colleagues taking over. And one of the things that we are trying to teach our younger colleagues is to build that community partnership. Another example, how how we serve the community, you know. See, blood banking used to be a it used to be a uh problematic thing. Patients would uh often uh bring paid donors, blood would be donated, and then blood banks would sell blood at a cost. So when we started the blood bank, we took two of the major policy deficiency. Number one, we will not ask for replacement donors. Entire blood should be voluntary because even I my wife needs a cesarean section, if I have if I need blood, I need blood immediately. At that time, if you ask me to go and get blood, what will I do? I will find the first fellow who will who will give blood if I pay him some money. I will ask him to come and donate blood. If my father has a fracture femur and I need blood for him, if you at that moment of crisis, if you ask me for replay, I think it's a very cruel practice. And so we said all our blood donations must be voluntary. The second thing we said is we will not give whole blood. So we started a policy where we will only give components. At that time, this was not such a prevalent practice in the region. And so we were able to reduce the cost of whatever we were spending for the blood to a third because we had plasma, we had RBCs, we had playflate. And so we were able to reduce our cost and pass on the benefit to people who needed blood. But then it needed uh community donors to come forward to donate. And so Ghana went about uh evangelizing blood donations, and now we have multiple camps every week, and we are never short of blood for patients. The community helps us do this. So we during COVID, you know, we didn't have access to all these N95 masks and all that, and then we had several medical bodies advising that multilayer cloth masks are good. We sent out an appeal, you know, that we need cloth to make masks, and we got bales and bales and bales of cloth from different vendors in the community, and so we made masks for our staff, for our patients, for community members, for everybody. There were floods, horrendous floods two, three years ago. The whole area was underwater, and then ours was the only kitchen running in this village area. And so at one point of time, 900 or thousand people. We had people who came and gave rice and dal and and so we would put all of it, bake kitschy, and we supplied the whole campus. So the community comes forward to support us for a variety of activities, and it is it is symbiotic. We support the community, and the community supports us back in return. As I think it's a very good feeling at the end of the day.

Biggest Rewards

SPEAKER_00 37:43

During the last uh 19 years as director of Kachar Cancer Hospital and Research Center, what would you consider are your biggest rewards?

SPEAKER_01 37:54

My biggest rewards are my colleagues, you know. I didn't bring any of them to the hospital. They all one by one by one, they all came and joined us and added value to the system. They grew and they helped the system grow. The second biggest reward, I think, are the friends that we have built, friendships that we have built across the country and elsewhere. We have a very large number of people, medical, non-medical, who support us in so many ways, big and small ways. And you know, they may be donors, they may be CSR partners, they are medical colleagues of mine. And I think I keep telling everybody, you know, it is more important to be friend raisers than fundraisers. And the the friendship that we have formed with, we have posed with different people across the country is a is a very big reward for me, I think. And then, of course, our own patients, you know. Some of them will become well and they will come back and invite you for births and the weddings. And also patients who don't survive, their family members will come back to more patients. I came to the ward to finish round before going home, and I found this man lying very sick. He is a young 30-year, 30-odd year. He had a metastatic lung cancer, he came with the pericardial effusion. So we did a pericardiosynthesis, he became well, he became better, and we sent him home on some oral drugs. A few days later, again one evening I come and I find him there, low volume, pulse, very sick again, re-accumulation, cardiac tamper. So we took him to the theater and we did a small pericardial window and created the uh pericardioperitoneal uh communication. He became well. His only question, he had a newborn son at that time. And in the Bangla community, at six months, they have a ceremony where they feed rice to the baby for the first time. So he wanted to be alive for that ceremony. And and and so somehow he lived, not because of me, but he lived and we were invited for that ceremony. Two months later, he died. His wife, who used to be there, at some point I lost connection. About four, five, six months ago, I get a call. She's now somewhere in uh Delhi or somewhere. He's gotten married again. Her son is now a big boy, and she called to tell me that the son is now joined engineering. Just just out of the blue. And so these moments uh make you feel that you know, even if you have failed to save somebody's life. She spoke about that, her husband, and about the Anna Prashana. And so these moments affirm the value of what you're doing. Those are those are my rewards.

SPEAKER_00 41:25

That's a very touching story. Thank you for sharing it, uh Dr. Kanan. I had the opportunity to interview another cancer surgeon who is my batchmate from CMC Valor. Her name is Dr. Shalini Mishrao. And uh I believe she's known to you.

SPEAKER_01 41:44

Yeah. She supports us good in our uh pediatric oncology work.

unknown 41:51

Right.

SPEAKER_01 41:51

You don't you don't have a see this is the idea of this is what I meant, you know, friends. You know, we don't have a pediatric oncologist. We don't, but we get kids with leukemias and well's tumors and osteosarcomas. And so we constantly need round-the-clock advice. And so few of our pediatric oncology colleagues across the country have created a group, and every Saturday they would do a tumor board to advise us on what how we should manage. Shalneg is one of that group, you know.

SPEAKER_00 42:25

So when I was talking to Shalnig, who was kind enough to come on the podcast, and uh the same question, what's your biggest reward? She uh gave the same story as you that the children that she treats as cancer patients, they become well, they join professions like medicine and engineering, go on to have families, and then they bring their children to meet her. So that was a very touching story, and I'm hearing the same story from

Vision for the Hospital's Future

SPEAKER_00 42:54

you. Dr. Kanan, I was wondering what is your vision for the Kachar Cancer Hospital after you hand over the reins? And how will you ensure that the core values that you practice are maintained by the next generation of leadership?

SPEAKER_01 43:11

So I think the challenges that every generation will vary, and we cannot be prescriptive for future challenges. Future generations will find their own challenges, make their own choices, but the value systems, the basic core values cannot change. And so we are now in a we have several programs in the organization where we talk to our colleagues, we get people from outside to come and talk to our next generation of leadership. Our vision is, you know, that the hospital must be firmly rooted in the community. So long as we are true to that vision, I think we will be fine. Now, the government of Shripura gave us 15 acres of land. Somebody gave us land in the middle of Karim, about two acres of land. We're trying to see if we can get something going there. So whoever takes over will have to make sure that our engagement with the community becomes deeper and more meaningful. The the the the the challenge of continuing core values, continuing to keep the mission of the hospital of being inclusive will fall upon his or her shoulder. And I think the biggest challenge will be for the new leadership to look at technological progress that will happen in information technology, in biotechnology, because many things will change over the next 10, 12, 15 years. And the leadership has to be adept at adopting and adapting, changing technology so that you know we are not left behind. And so this is what I think is needed for the next leader.

SPEAKER_00 45:06

From

For Medical Students and Young Doctors

SPEAKER_00 45:07

your vast experience as a surgeon and director of your hospital, what is the one key inspirational message that you would like to share with medical students and young doctors around the world who are just starting their careers? Please give us one pearl of wisdom.

SPEAKER_01 45:28

We're all born unequal. For whatever democracy, whatever we say, we are born unequal. Some of us are born into wealth, some of us are born into families that are very high academic achievers, some of us are born with a lot of skill set, and some of us are born with nothing. We are born to, you know, rikshapulas and fishermen, and you know, and none of us chose to be born where we were born. Some of us had opportunities by virtue of the fact that we were born in a family that could give us those opportunities. And some of us were born in places where, you know, there's nothing. This was done by God or whoever deliberately. He gave some of us more of wealth and education and skills and opportunities and talent, and gave others less because he trusted that those of us who have all this, what little we need for ourselves, and use the rest for people who don't have. And I I I totally agree, you know, that I was born into privilege. I could go to school, I could go to college, I could become a surgeon, I could become a cancer surgeon, I could come and sit on a podcast and talk to you like this, all because of where I was born. And so whatever I can do to use my skills for the benefit of people who don't have any of these things, I think it is a it is a responsibility that I have. And that I think applies to all, all physicians.

SPEAKER_00 47:18

Dr. Kanan, it was so wonderful talking to you. I had a great time getting to know you and the remarkable work that you're doing in the service of humankind. Many thanks for coming on the Oath and Staff Podcast.

SPEAKER_01 47:32

Thank you. Thank you very much. The privilege is all mine. Thank you, thank you, David.

SPEAKER_00 47:38

And that's all for today, folks. I hope you enjoyed this episode with Dr. Ravi Kanan and also found it inspirational. Thank you for tuning in and subscribe for more.