Medical ethics

How a child suffering from Kala Azar in rural Bangladesh went on to become a renowned oncologist

Dr Fazlur Rahman, who has authored a book on his journey, speaks to 'Scroll.in' about the importance of empathy in medical sciences.

In this book, The Temple Road: A Doctor’s Journey, Dr Fazlur Rahman talks of his life story – from a boy born to in rural East Bengal (now Bangladesh) to a leading oncologist in the US.

Growing up as a childhood in a small village in Pora Bari, he experienced at first hand the vulnerability of a person suffering from a potentially fatal disease. As a child, Rahman had Kala Azar, a parasitic illness spread by sand flies that causes a greyish discolouration to the skin, bouts of fever and enlargement of the spleen, among other symptoms, whihc almost killed him.

But he managed to beat it, going on to study in the Dhaka Medical College, the biggest medical college in Bangladesh and later win a scholarship to St John’s Hospital in New York. After becoming a US citizen, he wrote essays on medical ethics and other social issues related to medicine.

In an interview to Scroll.in Dr Rahman talks about how his childhood shaped not just his personality but also his practice and the need for doctors to be empathetic.

How your childhood in Bangladesh has shaped the way you practice? You fell sick when you were child, lot of premature deaths, no medical facilities. How something like that impacts the way you work as a doctor
In the book you have read, my mother died when I was only seven. A child remembers some things more than the others. She had a brother who was very dear to her. He died also of malaria. She said someday you will be a doctor, Fazlur. Then she also died suddenly, that thing is stuck in my mind. If she had lived for a long time, perhaps I would have forgotten that.

After she died, and when I was recovering from the grief and sadness, I developed Kala Azar. it is a parasitic illness. It almost killed me. When you become a doctor, you get a sense – I have been through that. When I see a person who is a patient, I have some understanding about their difficulties.

I am not saying I am any better or worse than any other doctor. But because of my upbringing and because of life experiences, I have developed some sensibilities [that help me understand these patients]. Can I practice [it] every single day every single hour? I am sure sometimes I fail. But I try to understand the patient and their suffering – show empathy.

You write about your training in Dhaka Medical College where your teachers, emphasised the importance of speaking to the patient and taking their history. This practice, one could say, has taken a setback. Now doctors stress more on getting tests done.
We have to accept change. Technology is an important part of medicine. But my concern is that simply having MRI or CAT scan or PET scan alone [is not enough]. You still have to talk to the patient. You cannot replace bed-side understanding of the profession. I am not the only one, many other doctors talk about this, here in India too.

We are getting more impersonal because of technology. It is not the fault of technology. It is simply because we rely on it too much. In the past we did history and physical [examination] because we did not have as much technology. Now, if someone complains of chest discomfort, it is easy to order a CAT scan rather than checking a person thoroughly. It is expensive too. We have to use technology, but with restraint and when we need it. Not indiscriminately. Simply because it’s available, you should not use it very quickly. Bedside medicine is still important despite technology. That is my point.

What is the importance of compassion in medicine? Do we need to take another look at how students are trained in medicine?
I teach humanities and medical ethics in the Angelo State University, Texas. I start with empathy and compassion. My own feeling after practicing all these years is that you cannot study empathy.

We have too much emphasis on science (in medical schools). We need science to be a doctor. But you also have to understand empathy, compassion, and human rights. If you get a patient with lung cancer, he is not just a lung cancer patient. The same patient may have other problems. He has a family and children who are suffering too. As a doctor, we have responsibility to understand the patient and show sympathy. We need technology, but we are becoming a little more impersonal. When patients feel like they don’t care, they get upset and angry.

In India, there are often reports of resident doctors getting beaten up, many times by relatives of patients. Could this be because of lack of communication?
We do not have that (in the US). We do not know that. That’s part of the communication problem. We have a tendency to not give bad news. If a patient has lung cancer, we need to tell his relatives – sir, your father has lung cancer, he may not get better. He may not get cured.” If you do not explain anything, they will feel – what have you done?

Medicine has become business and you mentioned that you were uncomfortable taking fees.
Yes, I didn’t know about business side of it. But I do feel that when medical students are trained, they need to know about business side.They don’t have to be a MBA, but they need to understand that when they order a CAT scan, it costs thousands of rupees. When you drain the patient’s resources without explaining to them what the purpose is, and then the patient dies, the relatives do not feel good about it. Residents need to think twice before ordering a CAT scan.

We welcome your comments at letters@scroll.in.
Sponsored Content  BY 

How technology is changing the way Indians work

An extensive survey reveals the forces that are shaping our new workforce 

Shreya Srivastav, 28, a sales professional, logs in from a cafe. After catching up on email, she connects with her colleagues to discuss, exchange notes and crunch numbers coming in from across India and the world. Shreya who works out of the café most of the time, is employed with an MNC and is a ‘remote worker’. At her company headquarters, there are many who defy the stereotype of a big company workforce - the marketing professional who by necessity is a ‘meeting-hopper’ on the office campus or those who have no fixed desks and are often found hobnobbing with their colleagues in the corridors for work. There are also the typical deskbound knowledge workers.

These represent a new breed of professionals in India. Gone are the days when an employee was bound to a desk and the timings of the workplace – the new set of professionals thrive on flexibility which leads to better creativity and productivity as well as work-life balance. There is one common thread to all of them – technology, tailored to their work styles, which delivers on speed and ease of interactions. Several influential industry studies and economists have predicted that digital technologies have been as impactful as the Industrial Revolution in shaping the way people work. India is at the forefront of this change because of the lack of legacy barriers, a fast-growing economy and young workers. Five factors are enabling the birth of this new workforce:

Smart is the way forward

According to the Future Workforce Study conducted by Dell, three in five working Indians surveyed said that they were likely to quit their job if their work technology did not meet their standards. Everyone knows the frustration caused by slow or broken technology – in fact 41% of the working Indians surveyed identified this as the biggest waste of time at work. A ‘Smart workplace’ translates into fast, efficient and anytime-anywhere access to data, applications and other resources. Technology adoption is thus a major factor in an employee’s choice of place of work.

Openness to new technologies

While young professionals want their companies to get the basics right, they are also open to new technologies like Augmented Reality, Virtual Reality and Artificial Intelligence. The Dell study clearly reflects this trend — 93% of Indians surveyed are willing to use Augmented/Virtual Reality at work and 90% say Artificial Intelligence would make their jobs easier. The use of these technologies is no longer just a novelty project at firms. For example, ThysenKrupp, the elevator manufacturer uses VR to help its maintenance technician visualize an elevator repair job before he reaches the site. In India, startups such as vPhrase and Fluid AI are evolving AI solutions in the field of data processing and predictive analysis.

Desire for flexibility 

A majority of Indians surveyed rate freedom to bring their own devices (laptops, tablets, smartphones etc.) to work very highly. This should not be surprising, personal devices are usually highly customized to an individual’s requirements and help increase their productivity. For example, some may prefer a high-performance system while others may prioritize portability over anything else. Half the working Indians surveyed also feel that the flexibility of work location enhances productivity and enables better work-life balance. Work-life balance is fast emerging as one of the top drivers of workplace happiness for employees and initiatives aimed at it are finding their way to the priority list of business leaders.

Maintaining close collaboration 

While flexible working is here to stay, there is great value in collaborating in person in the office. When people work face to face, they can pick up verbal and body language cues, respond to each other better and build connections. Thus, companies are trying to implement technology that boosts seamless collaboration, even when teams are working remotely. Work place collaboration tools like Slack and Trello help employees keep in touch and manage projects from different locations. The usage of Skype has also become common. Companies like Dell are also working on hi-tech tools such as devices which boost connectivity in the most remote locations and responsive videos screens which make people across geographies feel like they are interacting face to face.

Rise of Data Security 

All these trends involve a massive amount of data being stored and exchanged online. With this comes the inevitable anxiety around data security. Apart from more data being online, security threats have also evolved to become sophisticated cyber-attacks which traditional security systems cannot handle. The Dell study shows that about 74% of those surveyed ranked data security measures as their number one priority. This level of concern about data security has made the new Indian workforce very willing to consider new solutions such as biometric authentication and advanced encryption in work systems.

Technology is at the core of change, whether in the context of an enterprise as a whole, the workforce or the individual employee. Dell, in their study of working professionals, identified five distinct personas — the Remote Workers, the On-The-Go Workers, the Desk-centric Workers, the Corridor Warriors and the Specialized Workers.

Dell has developed a range of laptops in the Dell Latitude series to suit each of these personas and match their requirements in terms of ease, speed and power. To know more about the ‘types of professionals’ and how the Dell Latitude laptops serve each, see here.

This article was produced by the Scroll marketing team on behalf of Dell and not by the Scroll editorial team.