A fine balance between a career and a calling!

Rohini designed this as the front cover

A while ago a news item  caught my eye!

“ Bhopal gas victims:  SC panel to discuss future of BMHRC today. TNN Mar 7, 2013. ‘The committee headed by Lt Gen (Retd) Dr D Raghunath, principal executive (Retd.) Sir Dorabji Tata Centre for Research in Tropical Diseases has been constituted by the apex court to look into the functioning of BMHRC and recommend to improve its efficiency as a super specialty medical centre.’”

It felt good to see my friend’s name as the head of a committee dealing with the fallout of a national tragedy. Raghu, is the first in our small community of Hebbar Iyengars to reach the top of his cadre and become the Director- General Armed Forces Medical Services- the senior most medical doctor in the Armed forces. (DGAFMS.) To the best of my information he is the only Kannadiga to have achieved this distinction.  An impressive record! 

When Tara asked me to go back to blogging I thought it was a good way to start with Raghu. When I spoke to him about my wish, he was not so keen at first but agreed later.
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You may wonder why I mention that he is an Iyengar and a Kannadiga? Very young when India became independent, we were given a new identity as Indians and felt proud. Our parents looked so happy and thrilled and the euphoria around us was palpable.  We learnt as we got older that while we succeeded in throwing the British out, many of us Indians had let unwanted prejudices to creep into our life. Raghu who grew up in Delhi, would have been branded a Madraasi. And he studied in Grant Medical College in Mumbai, again a different milieu with its own challenges.
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I met him first at my sister Srimathi and his uncle Narayan's wedding in 1952. While we were aware of each other’s   progress through the family grapevine we did not meet. Once when I stayed with his parents at Delhi, on my way to Roorkee, I remember seeing a picture of Raghu proudly explaining a science project to Pandit Nehru. To my comment that ‘he looks a scientist’, his father smiled and said 'he is good in all subjects'!  I had a nice time with his parents and cherish my morning walks in Lodhi Garden with his father.  (B.S.Dasarathy, who retired as Additional Director General of AIR)

I began by asking him about his picture with Pandit Nehru. He said it was taken at Modern School, Delhi to where he had switched to pursue biology. His father who was a gold medalist in physics had perhaps hoped that he would also study and excel in it. Nevertheless he facilitated Raghu’s inclination despite some monetary strain. He remembers his admission interviews very well. The Physics teacher had asked him, 'what is pi?’  He answered defining the constant (pi) rather than parrot its value! The definition that ‘Pi was a relationship between the circumference and the diameter of a circle and that 3.14 was a continuous decimal number’ thrilled the teacher, who said he had never heard this answer before. This well illustrates Raghu’s fundamental approach to any subject.

After a successful period in Modern School Raghu went on to pursue the Premedical Course in Delhi University, which he cleared with distinction and got a competitive seat in Grant Medical College, Bombay (Now called Mumbai).  It was his first move from home to a hostel in a different city and become part of a different culture. He graduated in 1959 and moved to Delhi in 1960 to do his house appointment in Safdarjung hospital.

Destiny brought us both to Pune, I moved there in Nov 1963 and Raghu was posted at Armed Forces Medical College (AFMC) for a course in 1964. Since then he has been a part of my life. We both were at the beginning of our careers and we met often. I remember accompanying him to the smelly animal house at AFMC where I helped him draw blood from rabbits! (I enjoyed this, my only contribution to science!) . We saw movies and discovered many eating places in Pune!  We did speak about events in our life which influenced us.

Going back to his early years, I asked him why he had joined the army when the world was open to him.  One would think as a doctor he would go abroad as many young doctors did. He says he is not sure even today! He too had plans of going to UK.  In fact, he interned in Safdarjung hospital, New Delhi, known for giving General Medical Council (UK) recognized house appointments in surgery and medicine successively. This would have facilitated his getting a Senior House Officers appointment in UK.  He enjoyed working with his two Unit bosses in the subject, (Medicine and Surgery) who were from the armed forces and impressed him with their professional caliber. 

Added to this was a favorable impression he had got of AFMC when he visited the newly built premises in 1957. This possibly influenced him to put in an application for an entry in to the Armed Forces Medical services, which he did. This surely was a change in his plan. Perhaps he was pulled towards it. Traditionally, as the elder of the siblings, it was expected that he would try and stay in India.  He felt that his parents were worried about his going abroad. He had accompanied his friend who went to apply at UPSC for Direct Permanent Commission on the last day of the deadline and on an impulse Raghu applied. The clerk, who saw that a few certificates were not attached, still accepted his application stating they could be submitted later if selected!

Raghu gave the entrance exam with an intent that he would join only if he was within the top one third. He did better!  He joined AMC in Feb 1961, at Lucknow. He remembers that it was his first ever first class coach train journey! 

Curiously his dilemma began from the day he joined the services. He felt odd in uniform and his reluctance persisted and was always looking for a valid reason to get out. It never happened!

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He was different

Raghu was not tempted to adopt the mores of the mainstream of the services. His colleagues advised him that sheer professional competence was not adequate and urged him to take up golf and bridge and be active socially. He rejected this well-intentioned advice and deliberately chose to spend time in the labs pursuing microbiology. He  treated with disdain the conventional wisdom that golf was necessary to climb up the ladder. As a brigadier he chose to ignore friendly warnings by some  that not playing golf would hurt his future! 

Time passed and he continued in AMC. He says he was not keen and never asked to see his confidential report made by his senior officer. It was permitted then that a junior could ask and read the report.  He was not tempted to cultivate seniors and create an impression for himself. A letter of resignation he had drafted and kept in his drawer, just in case he did not make the selection grade to a higher rank, never saw the light of the day! The excuse, a justifiable reason, he sought to leave the army never occurred.

Considering how India is embroiled in countless issues and conflicts of caste, religion and language. I feel it was fortunate that once he chose not go out of India, his instincts pulled him towards the Armed Services.  Serving ably and with integrity he rose to the very top of his cadre, proving that it is the best place to serve if you think you as an Indian and do what is best.

President of India pinning on the PVSM medal

I am not aware of any honor or recognition by other organizations he was associated with. His school, medical college or our small community of Hebbar Iyengars or for that matter state of Karnataka none seem to have taken any initiative to recognise and honor his achievements and contributions, his continued post retirement commitment to humanity through his specialty. I suspect that there is a need for self-advertisement or seeking recommendations by the powers that be.

 I do not think he bothers about these things. He is a true Karma yogi. We see he is active in many ways and travels a lot pursuing his interests. At home he has a very simple lifestyle, includes daily prayers to the almighty. 

Once I asked him; 'You say prayers, perform puja and so on! How do you reconcile this with your scientific inclinations?'  His answer was simple, 'Any scientist will admit that the world is very complex', and wondered 'whether we will ever understand this complex universe of ours!' As a clincher he added, 'Chanting prayers will keep Alzheimer at bay, Better you also start!'



 

It was a pleasure to write about my dear friend, who I admire. I enjoyed my talks with him to understand his work. My style is that of a rambler and I hope my brief introduction, followed by his tenure with AFMC (I have generously borrowed from an article he wrote for the college.) His sojurn in UK on study leave, his experiences away from AFMC and a bit about his personal life makes it enjoyable.

 

Reacting to a few comments. 
I had requested Jayashree, Bina, and also to my daughters Nandini and Rohini to preview my blog. The feed back from Bina was that 'Uncle there are a few things about my parents that I learnt from this blog'. I had the same reaction as I spoke to both Raghu and Vatsala trying to collect material. There were a few surprises for me as well. I will not divulge them, but I guarantee they will surprise you as well

While both Rohini and Nandini felt it could be made into 3 or 4 blogs, I chose to keep it is as a single blog. The reader can choose to read the way he wants . In fact, I found it difficult to make it small, rather I would have preferred it to be even larger than what it is now.

I have quoted from his article on AFMC extensively in the next chapter.   The full article is included in the blog as I feel it will interest many . 

His post retirement has been equally or more busy. But I thought it best to mention a few of his activities and concerns briefly at the end of this blog. I do hope that there will be more on these subjects in his own words when he finds the time!
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Raghu’s special affinity to AFMC. (Vatsala calls it his first love!)

The website on Armed Forces Medical College  acknowledges his contribution . "Department of Microbiology was created by bifurcation of Dept of Pathology in the year 1979 with the recognition of Microbiology as a subject distinct from Pathology. .. Amongst the other luminaries to occupy this chair were the pioneer microbiologists like Surg Capt PN Suri, and Lt Gen D Raghunath, who even today evokes a sense of admiration and respect among the microbiology fraternity."

An article Raghu wrote for AFMC answers many of my questions about his early days in the army. I quote a few highlights about his transition; from a medical graduate to an officer of AMC and the special place AFMC occupied in his long illustrious career with the AMC. (His full article is at the end of my blog. Interesting and a must read!)

“The 24^th JMO’s Course brought 23 of us to the college in May 1961.  ... We used to cycle to and from the mess. We could wake up later than during the military phase of the Course in Lucknow and were subjected to some intense professional training and skipping classes was forbidden. This resulted in interesting adaptations, like, sleeping with eyes open (!), simulating note taking etc. The occasional attempts to skip classes would get unstuck, as gaps in the seating arrangement were obvious.”  

"The Commandant interviewed us all (the Corps was then smaller!). And he congratulated me for standing first in the Course and was surprised when I chose Pathology .... He pointed to the immense potential of Public Health – a vision we have not realized yet!”

"AFMC was more compact and the laboratory based departments were far ahead of their contemporaries outside the defence services. The Blood Transfusion department was unique in the country, setting the pattern for specialization in Transfusion Medicine. Looking back, even discounting the nostalgia factor, I feel the College was at its professional peak then."

He was posted again to Pune in July 1964 for a course in Pathology in the college and it lasted for 48 weeks. (That is the time we met again!)  Major changes were taking place at the AFMC campus.  “This resulted in our being pushed out to a part of Golibar Maidan where tents were pitched on hurriedly constructed plinths. While a few of us had got used to life under canvas the majority thought it was a let-down. We stayed on till November under field conditions in the heart of Poona and even braved a monsoon!” 
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“... The standard of training became evident much later when in UK. The twelve month ordeal did end and we finally appeared in the grading exam and the University D.C.P. Those of us who survived the initial screening made it and were dispatched to our practical training phase.”

 It was a posting to Jammu , but the training got interrupted by the 1965 Indo-Pak war and an unusual sequence of events saw him in Siliguri by October. As a junior officer he was busy learning the ropes. Young, he had a lot of friends and was having a good time. The war with Pakistan had begun and while no officer was moved from Jammu, he got his move orders out of the blue, just ten days before the cease fire.

It was intriguing, ‘People thought I had pulled wires to get out. Even going out of Jammu was not easy’.  A series of helpful events enabled him to travel to Delhi, a kind officer let him take a ride on a train which was meant only for casualties, and then onwards to Shillong.  It was much later he found out that it was an error made by a tele-printer operator which had caused his move from Jammu to Shillong and on to a Siliguri unit. Though unhappy at that time, on hindsight it was a blessing. 

 “I volunteered (without hope) and was accepted for the (now defunct) Advance Virology Course. Thus July 1966 saw me back in Poona and in the Virology Section. The training under (late) Lt Col KNA Rao was in tune with the standards of AFMC. I spent the first week at the wash basin with lab attendant Joglekar. When I finally started growing cells in glass tubes I realised the wisdom of gruelling. Things have changed considerably since then; we now get ready-to-use plastic ware.”
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(I have nice memories of visiting Col. KNA Rao along with Raghu, usually for dinner. Heavenly for us starved of home cooked South Indian food!  I remember the prank Col. Rao’s son played on me. I suddenly felt cold around my neck and was too stunned even to jump when I saw the head of a snake right under my nose. I guess I just froze in fear, thus disappointing Sanjay. A doctor now!)

“Towards the end of the 1960s the country started thinking (nudged by the World Health Organisation) about controlling and finally eliminating small pox. Quick accurate diagnosis of the infection and vaccination of all contacts was the strategy adopted. (See more details in the full article at the end of the blog!) His work with this dreaded virus was important and proved useful when he was asked about his impressions on the efforts to eradicate small pox while in UK.

“The honour of being the only Capt on the faculty spurred me onto hard work. .. Being the youngest member of the team I was used at various places. However, this was the time I learnt my Bacteriology from seasoned technicians of World War II vintage. Sub Jayaram, Sub Ghosh Dastidar, Sub Prasad, Hav Sebastian belonged to a generation trained by British stalwarts who had come to India as a part of the War effort.”

“Acquiring the M.D. was a major objective for the first two years. Having registered in 1967 I became eligible to appear for the examination of Dec 1968-Jan 1969. ... ..The holiday was to be an interlude to charge the batteries before getting down to the business of reading for the MD. This was not to be. " 

"I met Vatsala again in June and thereafter events progressed rapidly to our marriage on 14^th July. Setting up house was not difficult those days. Guru Nanak Nagar had just come up and had vacant houses. Shankar Ramchandra was ever ready with furniture sets and life was simple. Teaching Pathology and Microbiology in the College and sharing the pleasures of setting up house combined to make the latter part of 1968 a memorable period, though the events pushed back my MD attempt to Aug 1969. Time progressed and I took the examination and passed despite having a combination of four (widely acclaimed) strict examiners (none from AFMC).”

(I remember going across to meet him one day while he was busy preparing for his MD. He seemed a bit worried as he had planned to study the whole night and felt he may go off to sleep. I stayed back, made him coffee at midnight and while he studied, I slept. The coffee which kept him awake did not affect my sleep!)

He passed MD in flying colors and was told by one of his professors that he stood first and would be awarded the gold medal. But he was not and his professor later confided that others in the committee wanted a student from the college be given the medal, as it was the first time, and they prevailed. While he was a bit disappointed, it taught him how the real world was different. This episode and his experience in UK wherein he acquired his FRC Path taught him many important life lessons.  
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“Apart from these personal and academic milestones, I learnt some good lessons in scientific work from my colleagues in the department. An important lesson in man management was also learnt when supervising difficult seniors while they took a test! ... This phase ended with my posting out in September 1971. It was a painful wrench and I left hoping to be back soon. Little did I realise that it would be a decade before I returned to the portals of the College.”

U.K. on Study leave

In 1972 while on a posting in Srinagar, he heard that he was selected for study leave and was happy. But his placement letter never came. He became pensive with each day’s delay. One day a friend asked him to go along with him and soon they entered the by-lanes of Srinagar. They stopped at an old house and met an old religious Kashmiri , a Hindu. Raghu was asked and gave the Year and the time of his birth. Then as he and his friend sat in silence, the old man began to speak. He narrated a few of Raghu’s past events which were accurate, including an accident in 1962. Then he went on to predict, that Raghu would go abroad next February and take an exam and pass. It was difficult for Raghu to believe this as he had no such plans! In addition, as if he knew Raghu did not enjoy being in uniform and was always hoping to get out, he predicted Raghu would continue in the army and would reach the absolute top as DGAFMS! 

Amazingly, as predicted, a letter for his placement came on Feb, 28, 1972. And he was on his way to UK with Vatsala, Jayashree and Bina. He received a lot advice from his friends and well-wishers. That UK was a difficult place to live and there would be prejudice. Life in UK was packed for Raghu as he was fully engaged in FRC Path studies and Exams. Vatsala was busy with kids. For her it was fun to live in a more organized culture and city.

His tenure being short, he realized that chances were slim to be involved in research to gain experience or get a fellowship. He met the RCP counselor at Bristol where he was posted to know what his chances were and it was not good! Unwilling to give up, he met the Royal College secretary and asked whether he could request a waiver for the primary exam considering his qualifications and experience and his short tenure.  Advised to apply and he applied, but a day later, than prescribed.

Luckily he was permitted to take the exam for the current year and it was a multiple choice paper. There was a negative mark of 0.25 for a wrong answer. He remembers that he answered all the 100 questions in Microbiology, 89 in Pathology, 90 in Hematology and 85 in Bio-chemistry. The results were expected in two weeks.
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The story of how he came to get the results is interesting and very British. He was told if he did not make it, he would be sent a thick envelope with prospectus etc., for the next year. In which case the postman would knock on the door to deliver it! If he had passed, a thin letter would be slid under the door. He explained this to Vatsala and if indeed a thin letter was received, to open it and call him. A thin letter it was and Vatsala conveyed the happy tidings!

His practical exam was at Guys Hospital, in a different location and he reached the lab 15 minutes late! He was allowed to take the exam but he had to complete the experiments within the specified closing time! No grace for the 15 minutes he had lost. He managed to complete the lab exams easily.

Next was viva, which he did well and with confidence. He recalls that he was asked how confident he was that India would be rid of Small Pox. He said he was not very confident that India would succeed. He adds he was happy to be proved wrong! India did become free from Small Pox in another two years’ time as Anderson had predicted it. (I guess it rankled him to make a wrong guess!)

He was soon taking his next exam, says he loved the questions and was a bit carried away. He answered the first question at length and in detail and suddenly it dawned on him that he did not have enough time to deal with the other questions. So he hurried through his answers for the rest. Later he met his guide who noticed his pensive mood asked him how it went. Raghu replied that he had not managed his time well. His guide consoled him ‘Let us hope that the examiner will take note on how well you have answered the first question’.

Fifteen days later a thin envelope was slid through his door. He was elated and also relieved when Vatsala read out that he had passed and was admitted as the Fellow of the Royal College of Pathology. It is only much later he discovered how his professor had taken care of his lack of time management. The professor had spoken to the examiner requesting him to the consider the quality of Raghu’s answer to the first question to evaluate his paper. 

(We see that the exams Raghu faced in UK differed in many ways from the ones we usually see in India. While it is fascinating how Raghu providentially managed to get away from his lapses of time management, applying late etc., I hope it does not encourage the youngsters who read this blog to test their luck.)

Back in AFMC

Out of his 36.5 years in the army, his total tenure at AFMC at different periods was 18.5 years. It is a record of sorts for an AMC officer. It gave him a lot of satisfaction to be part of AFMC and his special affinity to the college is no surprise.

He returned to AFMC, in the first week of April 1982 to a long tenure of over 7 years. This time it was the new Department of Microbiology he entered and took over in December 1984. The experience was different this time around.
 
Organising teaching programs and lecturing to three graduate batches and post-graduates was labour intensive. Added to this looked after the bacteriology and the Virology sections. He also tried to develop the concept of clinically oriented laboratory work that he had learnt during his study leave in the UK and had successfully tried out in Delhi. It was not so successful in Poona as despite common objectives the College and the Hospital could not really integrate. 

" The development of antibiotic technology, establishing a tissue typing facility, anaerobic culture methodology, improvement of mycology and mycobacteriology were some of the achievements during the period. As well as participation in National workshops, conferences and other academic activities. In addition a series of workshops on Antibiotic Susceptibility testing were undertaken and conducted well."

 "It was a totally satisfying period during which a lot was achieved and AFMC became legitimately recognised as a premier institution in the speciality of Microbiology. The department remained in the forefront of the thought process in the subject keeping pace with newer challenges as in the case of Human Immunodeficiency Virus (HIV) infection. AFMC started HIV surveillance along with the first lot of centres in the country."

   Unlike the previous tenure he was intimately involved with the Graduate Wing.  In addition to academic responsibilities, he was concerned with the day-to-day running of the graduate student matters.   He enjoyed the opportunity to interact with young minds and ' found it was far more satisfying than sterile interactions with some stuffy staff members'. Other responsibilities like Secretary, Medical Research Committee of AFMC and University affairs enabled him gain knowledge of every aspect of AFMC, which became an asset later on.

 "Overall this was the most satisfying part of my career and I am conscious that not many in the Service could be so fortunate". 

He moved on to an executive appointment in 1989 and missed AFMC and did not miss any opportunity to visit the College and renew his contacts with the personnel at all levels. And when his turn for promotion to the rank of Major General came around in 1992 he was assured that he would not be considered for an appointment to AFMC or anywhere in Pune as he had spent too long a period in the city!   It would have helped Bina to pursue her studies without interruption. It was not to be! He was informed that it would be Uddhampur and began working on the details.

One option was Vatsala to continue in Delhi so that Bina could stay at home and Raghu would be on his own. At this time he met a priest he was acquainted with who asked him about his promotion. When he heard of the plans the DGAFMS had, the priest just shook his head and said he would move south and not north as planned. And so it was

But he was back in AFMC and Pune (as Poona is called now) on 04 October 1992.
 ".... the College went through a bad time in May-June 1992 and a change of the Dean was contemplated. My (dis)qualification for posting to AFMC became an advantage. The DGAFMS summoned me and asked for my acquiescence for a posting to AFMC as the Dean. The prospect of returning to the portals of the College was tempting and I accepted the offer despite being warned by my well-wishers (sic) that I was stepping into a quagmire that would jeopardise further promotions."

His challenges in setting the college right were many and succeeded in winning the trust of the students and in convincing and getting full support from the Headquarters. (Fully chronicled is his article on AFMC) .

  

Raghu’s life away from AFMC.
While his tenure with AFMC was 18 years, he had another 18 plus years at various places and postings.  As we spoke about his tenure, and his ambivalent feelings about being in the service, I did wonder how he had managed to balance his scientific inclinations with that of an administrator in his senior postings right to the top of the Army Medical Corps. 

After his military training in Lucknow and professional training in AFMC Pune he was posted to Palampur in Himachal in 1962.  One would think early years as junior officer would be routine and normal. But a freak accident almost derailed his career with the army. During his training in the firing range, he picked up a detonator of a grenade which he was told was okay to take as souvenir.

He picked it up the next day and tossed it up when it exploded. The main charge had not blown off and had got detached along with the tailpin. He was lucky that he had worn a heavy jersey which was destroyed and the wallet in his left pocket had stopped splinters being lodged into his body. He was conscious and could do his own first aid. An ambulance took him to the hospital. (?). It was also the time casualties started arriving at the hospital due the Chinese war.

His palm was badly damaged; it was a miracle and the skill of the surgeon operating that only a large dark spot is seen on his palm as skin was grafted onto his palm. The spot is very sensitive and soft. His second operation was after four months on the day of Chinese invasion in 1962.  He was in Delhi for the operation and was then attached to the Delhi hospital till 1964. Just before all this happened an astrologer had predicted that his star would be affected by the “Asta Graha’s” (Coming together of eight planets) and had predicted an accident and had advised a puja be performed which his parents had done.

The period from 1964 till 1976 onwards saw his tenure alternating between AFMC Pune and other places, mainly Srinagar and the UK. An interesting and an eventful period well chronicled mostly in his own words.  

1976 onwards till 1982 was a period of consolidation in Delhi. He was in charge of the command Pathology lab where he was able to hone his skills in diagnostics and managing the clinical aspects of his work. 1982-89 as the head of department was able to use and demonstrate his skills in diagnostic microbiology in supporting the command hospital.

Working in the HQ he learnt to work with the system and was able to gradually make a mark in making the system more viable. He was the first professional to be given this responsibility of running a provision and stores functions. He was able to collect technical literature and find ways to establish the rating on quality of drugs procured.  1991 -92 he was head of Provision and Stores and steered it ably. He said the place was notorious as disciplinary actions were being taken at the time he moved into his responsibilities. Raghu was chosen as DGAFMS  looked for an officer with a clean image.

One would except at higher levels he would contend with Politicians who would try to take him under their wing or face hurdles when bringing in new ideas within the Army set up. But to my questions, he just smiled to indicate it  was part of his job to keep away from such situations and get around ignorance.

There is always the sad part of being in the army. I quote: (Link?)

“Capt Sharma’s words made the sufferer’s mother see reason and she said, ‘forget about what others are saying. Lieutenant-General D Raghunath — who was the then Director-General Medical Services (Army) — wrote to Ms Sharma’”.

“The courage and spirit of self-sacrifice displayed by Devashish is now a source of inspiration to young officers of the AMC. His name is spoken of with awe and a sense of pride... His name will be entered in the Roll of Honour in the AMC Centre, Lucknow”

Going back in time! Yes she is right, things happen when Vatsala travels

Raghu and I both got married the same year, he a little ahead of me. We had our homes close to each other in Guru Nanak Nagar in the first year of our married life and we often dined together. While I continued in Pune, he was in and out of Poona, posted on promotion.  Tara and Vatsala, cousins thrice removed, had common interests in music and both chose to become teachers. I still remember the vocal concert Vatsala gave the day after her wedding. Both she and Tara continue to be active in music. We both have two daughters each, we loved it in Pune, life was simple.

As we reminisced about those days, Vatsala spoke about her life as an army officer’s wife. She said she managed to fit in easily She grew up in Baroda and her father was a director in the Sarabhai group of companies. They had a social life within the cosmopolitan community of the company. And one of her relatives was in the army..

The story about her early days after the wedding is engrossing. she stayed in Delhi with her in-laws for a while. On an auspicious day she boarded the frontier mail to Bombay. The plan was for Raghu to meet her at the Dadar railway station. But due to floods in Tapti River the train was diverted to Kalyan. Raghu on his way from Pune by train got to know and disembarked at Kalyan to meet Vatsala and surprise her. 

A good plan, but it was Raghu who was in for a surprise and a lot of tension. There was a power shut down at Kalyan station and the train had been moved to a siding. Vatsala knew nothing of all this as she slept blissfully. An anxious Raghu got on to the train, it was dark as he went up and down thrice and kept shouting out her name. Vatsala who was in deep sleep was suddenly woken up and wondered who it was shouting out her name and shouted back asking ‘who is it?’  It  was a very surprised Vatsala  who saw a greatly relieved Raghu walking towards her!

They did not say how this dramatic meeting was enacted, but added that it was commendable that the only coach attendant on the train had waited till she, the last of the passengers, disembarked. At Dadar, Narsimhan, her brother-in-law, who was waiting to receive her, was surprised when he was paged, and amazed when he saw both Vatsala and Raghu, who had taken a local train, approach. Vatsala said she was not afraid but still wonders how the situation had developed into such a climax! She claims that things are never simple when she travels.

Still new to army life, she learnt much later that officers in AFMC worked half-day on Wednesdays and Saturdays! It was when a colleague dropped in one Wednesday afternoon . Raghu says it never occurred to him to tell her or change his routine. Since his bachelor days he was wholly preoccupied with Lab work and kept late hours. This continued even after his marriage!  Good for him that she had  an ‘Adjust Maadi’ nature!

There is another story about his preoccupation with the lab. He was to receive a medal by the DGAFMS for standing first in the SMO course. Raghu forgot to tell her about this important event as he left for work that morning. Later he requested a colleague to pick her up and get her to attend the event. 

The travel saga continues. The Kashmir posting in 1971 began with some hiccups as Raghu discovered that it was not advisable to take the family along. They broke journey at Delhi and Raghu proceeded alone to Srinagar as Vatsala continued to stay at Delhi till cease fire. I remember they had come home for lunch before taking the train to Delhi and onwards to Srinagar. Suddenly realizing it was late, they rushed and Vatsala grabbed Nandini instead of Jayashree as she got into the car and we realized it soon after the car began to move. There could have been greater drama of chasing them but Raghu stopped as we frantically waved to him and we made the switch.

Raghu came to Delhi in Jan to escort Vatsala to Srinagar by air. Their flight did not land in Srinagar due to snow. The plane was diverted to Amristar where they could get off or go back to Delhi, which they did. On hindsight she felt that they could have stayed at Amritsar and seen the golden temple.  However the weather improved and they landed in Srinagar the next day. Yes she is right, things happen when Vatsala travels (Worth a separate blog!)

They landed in Srinagar and as luck would have it, Raghu had night duty on the same night. Vatsala and Jaishree were all alone on their first night. Raghu showed her how to keep the Bhukari  burning (coal stove which is now replaced by a room heater!), but while she did try to stoke the burning coal it went cold and she could not get it going! They spent the whole night in bitter cold. Raghu said that their orderly who could have helped was just outside the house. But I agreed with Vatsala ‘I did not know who to call, they all looked alike in their long coats!’ A few days later, the snow fell thrilling them. But they were not aware that they needed to clear the snow when fresh. Come morning the snow had hardened to ice and they were marooned for a week as it was not possible to drive the car or even walk.

As she recalled the three and a half years in Kashmir, she remembered that in winter all oils froze except mustard oil. There was no cooking gas during winter due to supply issues, but they had Prabhakar kerosene stove, which consumed a lot of kerosene. We oldies remember the stove. She said the Fridge was of no use with an outside temp 6 deg and in any case  the power supply failed often.

It is good to eat walnuts in winter and she remembers that she had stored them in a bowl and the quantity went decreasing rapidly and finally walnuts disappeared.  They had no clue what happened. They got to know why when the Bukhari was dismantled after winter. The half-eaten walnuts were in the pipe which went out on the roof from the stove. A rat or probably a squirrel had taken it away and stored it in the pipes.They were reminded of their special status when Srinagar became ‘out of bounds’ for the army family whenever there was any trouble in the city.

An interesting anecdote on how impressions are created! Raghu would walk up to Lab which was close by, so he hardly drove and it was Vatsala who used the car regularly.  So when they sold the car in Srinagar, the buyer offered to drive for the formalities and acted surprised when Vatsala said Raghu would drive and take care. He thought Raghu did not know how to drive.

She enjoyed the Army social life. While the protocols were new to her, she was used to social life in Baroda. Summer was just lovely. And they would have many visitors during summer.  I asked her how Jayashree did in Kashmir who was just over three at the time. Vatsala said Jai was very bold and once took a ride to a friend’s place while it was snowing in a van which was delivering goods. Another time a few friends and her parents took a bus and she just hopped on went along with them.

Raghu added that he was busy as a pathologist. Specimen kept coming, the results would be placed on his table and he would see the slides before signing.

Over to children
Raghu and I met often while in Pune, it was also the time our children got to know each other. Jayashree and Nandini were born in the same year Jayashree  was a little older. Rohini and Bina came four years later, with Rohini a bit older. We kept in touch even as I moved out of Pune.

 I asked Jayashree and  Indira (Bina is her pet name!) to add . Bina has this to say:

“He has been able to pursue a lot of activities well after retirement which is really creditable. In spite of being so successful in the medical field, he never pressurized my sister and me to pursue the same after passing out of school. We were always taught to be grounded and humble especially in the later years when we were seen as the ‘General’s daughters’!! Personally I feel very fortunate to have seen my growing years in the Army in the warm environment of AFMC , which has helped me learn a lot of values in life.”

 “I remember the time when Jayashree  got admission to Junior College in Garware College, Pune which was quite far from where we stayed. Daddy would insist that she go by bus to College but that would take a long time due to erratic bus services at that time. So, to counter that, Jayashree one fine day, just decided to cycle the distance of about 10 km up and down daily. Daddy was quite wonderstruck at her perseverance to cycle it rather than take the bus. So, the dedication and discipline that has been seen in Daddy has definitely found its way to one of his daughters! “

“Not many would know about the love that Daddy has for dogs. We did have a pet, a lovely Golden Retriever called Cleopatra who was really fond of Daddy and went on to live for 14 years.” ( I remember Cleo. As l love dogs, I used to give her a gentle massage on her head and stroke her neck the way dogs love to be petted.  Cleo got used to it and whenever I was at Raghu’s Cleo come to me and nudge my palm with her nose to remind me to give her a massage!...Nidhi)

“ There is an interesting anecdote which I’ve heard Mummy mention of how Daddy, Dr. Sanjay Rao, Mummy and my grandmother were travelling in a car from Pune to Bangalore with a snake called Jonathan kept in a box on the overhead luggage rack. Jonathan was being taken as a laboratory specimen for some tests. Mummy and my grandmother were obviously kept in the dark about this extra passenger! They got to know about it only when Jonathan decided to disappear!! For the remainder of the journey, both of them were paranoid that at some moment it would definitely creep up on them.”

“Another amusing incident happened when we were leaving from Bangalore after my uncle’s wedding in 1984. The train had stopped close to my grandparents place for the signal and was waiting to proceed. Just then, Mummy realized that she had forgotten to take some of the wedding fruits and sweets that had been given to her by my grandmother. So, Daddy just ran over to my grandparents place to pick it up with all of us sitting in the train! You can too  well imagine how hassled Mummy was that he should be able to come in time before the train resumes its journey. Equally shocked were my grandparents at seeing Daddy at the door to pick up the forgotten stuff while the rest of his family was anxious in the train!!”

“He was deeply involved with the setting up of Sir Dorabji Centre for Research in Tropical Medicine in the Indian Institute of Science Campus Bangalore, and is still active with ICMR New Delhi and Institute for Tribal Medicine Jabalpur and a few colleges on setting up research facilities!” 

The pleasures of  a grandfather

      MY IMPRESSIONS OF AFMC

By 
                           D RAGHUNATH

  

   I first heard of the Armed Forces Medical College in 1957 when I was in Pune (then Poona) on a visit to my mother’s cousin Lt Col NG Govindaraj who was at that time the Registrar of MH Poona. A couple of officers on the AFMC staff dropped in on an evening during my stay. They described the college set-up and I later went across to see the new building which was nearly complete. To say the least I was impressed. The institution was on a seemingly unattainable plane and a far cry from my college, Grant Medical College, Bombay. It is probable that the encounter prompted me to consider entry in to the Armed Forces Medical Services.

   The 24^th JMO’s Course brought 23 of us to the college in May 1961. By that time AFMC had settled in its permanent quarters and the main building had been spruced up. We stayed in the ancient two storeyed building that is now the Graduate Wing Pathology & Microbiology departments. We used to cycle to and from the mess at 1, Cross Road. We could wake up later than during the military phase of the Course in Lucknow and were subjected to some intense professional training. The atmosphere was akin to our wont, though, skipping classes was forbidden. This resulted in interesting adaptations, like, sleeping with eyes open(!), simulating note taking etc. The occasional attempts to skip classes would get unstuck, as gaps in the seating arrangement were obvious. Some instructors were interesting. Lt Col George Bird was a fearsome personality(looked like a bird of prey) who drummed in the essentials of Transfusion Medicine through sheer force of words. There were others who compared favourably with our teachers in the Medical Colleges.

   Poona was a moderately sized town then and during our stay from the end of May to the third week of August had balmy weather. The great Poona flood also happened during our stay (the event was forecast by black-tongued Ramki). We used to haunt the Main Street, which had shade giving trees on either side, and discovered some interesting joints no longer there. Time passed on we came round to exam time. There was not much tension, but, the necessity to do well was impressed since the results could take us into specializations. We, as a batch, fared well in all the major subjects, except Medicine. The new Professor of Medicine had high standards and low markings! This resulted in no specialist in Medicine emerging from the Course. The Commandant interviewed us all (the Corps was smaller than now then!). Gen CC Kapila congratulated me for standing first in the Course and was surprised when I chose Pathology (which included my choice subject – Bacteriology, as present Microbiology was called then) for my specialization despite having the choice of “all the specialties except Medicine” reflecting the prevalent mood of writing the requiem of infectious diseases “now that antibiotics have come” . He pointed to the immense potential of Public Health – a vision we have not realized yet!

   In the pre-Graduate Wing days AFMC was a more compact establishment and the laboratory based departments were far ahead of their contemporaries outside the defence services. The Blood Transfusion Department was unique in the country, setting the pattern for specialization in Transfusion Medicine. The College staff was carefully chosen and usually stayed on for long tenures. Looking back, even discounting the nostalgia factor, I feel the College was at its professional peak then. August end saw us scattering all over the country to our respective Fd Ambulances enriched by the nearly three months contact with AFMC.

   The recommendation at the end of the JMO’s Course resulted in nearly half the batch being detailed for the Advanced Specialty Courses. I came for training in Pathology. The course started in the first week of July 1964 and lasted for 48 weeks in the College. When we reached Poona a day before the start we were struck by the major changes that had taken place in the intervening 3 years. The College was bustling and a number of young graduate students were visible. Our old quarters had metamorphosed into teaching departments. The room I had occupied earlier had become a part of the Pathology Department (GW). This resulted in our being pushed out to a part of Golibar Maidan where tents were pitched on hurriedly constructed plinths. While a few of us had got used to life under canvas the majority thought it was a let-down. We stayed on till November under field conditions in the heart of Poona and even braved a monsoon!

   The hectic pace of training, however, did not leave time for self-pity. Life used to start with a bicycle ride at 8.00 am and we used to see the tent only by 8.00 pm. Simultaneous pathology, bacteriology (as microbiology was called then) and biochemistry sent us into a tail spin. In the afternoons we were busy doing the practicals and also demonstrating to the graduate students. At the same time a large load of slides ranging from the ‘normal’ extending on to the most obtuse neoplasms were foisted on us daily. Our batch was the largest in the history of the department (the record is still unbroken!). Catering to 16 service and two civilian students must have strained the departmental resources to the utmost. This forced us to evolve some sharp practices like cajoling some media plates and storing them in secret refrigerators (including the bar!). Nevertheless, the high pressure training stood us in good stead and we did acquire skills in laboratory medicine. The standard of training became evident much later when I competed in the UK.

   The twelve month ordeal did end and we finally appeared in the grading exam and the University D.C.P. Those of us who survived the initial screening made it and were despatched to our practical training phase.

   The large number of trainees in our Advanced Pathology Course could not be accommodated in Command Pathology Laboratories. I was sent to Jammu. The training under (late) Lt Col HN Seth got interrupted by the 1965 Indo-Pak war and a strange sequence of events saw me in Siliguri by October. I was settling down to a full tenure with an ABTU when I volunteered (without hope) and was accepted for the (now defunct) Advance Virology Course. Thus July 1966 saw me back in Poona and in the Virology Section. The training under (late) Lt Col KNA Rao was in tune with the standards of AFMC. I spent the first week at the wash basin with lab attendant Joglekar. When I finally started growing cells in glass tubes I realised the wisdom of gruelling. Things have changed considerably since then, we now get ready-to-use plastic ware but the ordeal strengthened our basics considerably. AFMC was busy preparing to launch its first batch of internees and had taken graduate teaching in its stride. The staff was devoting a considerable portion of its time to undergraduates and I felt post-graduate teaching had slipped. However, the standards were still high. During this period we were put up in new rooms built on Sholapur Road. In fact, I was the first person to move in and took room No. 1/1.

   A curious incident occurred in October 1966. One of the monkeys in the animal house escaped from its cage and took to the trees. It so happened that it had been injected with a heavy dose of rabies virus (fixed strain) a couple of months ago but had suffered no ill effects. Attempts to trap the animal failed and it spent two days outside. On the third day after its escape in the afternoon there was a frantic summon from the Commandant’s office. The escaped monkey was calmly in the front corridor and the rumours had it that it was issuing orders! (The animal was captured and taken back to the animal house where it was sacrificed). The high point of the Virology course was a field trip to Sagar district of Mysore State (now Karnataka) to study the epidemiology of Kyasanur Forest Disease. The trip was exciting and gave us (we were two trainees) a good grounding in fieldwork.

   Towards the end of the 1960s the country started thinking (nudged by the World Health Organization) about controlling and finally eliminating small pox. Quick accurate diagnosis of the infection and vaccination of all contacts was the strategy adopted. Consequently during the Advanced Virology Course as well as subsequently when I was in the Bacteriology and Virology Sections I would get calls from the Cantonment General Hospital to resolve the confusion between florid chicken pox and variola. This required the conveyance of the vesicular fluid to the Virology laboratory in capillary tubes. I used to carry sterile tube in my shirt pocket and bring the fluid immediately after collection to inoculate embryonated eggs as well as examine the fluid under the electron microscope. The manner in which we did this then will send shivers down the spines of the present day microbiologists! Rigorous vaccination with vaccinia kept us hale and hearty. In fact, no one could cross into the business part of the Section unless his vaccination status was checked. If there was any doubt vaccination would be administered with the bifid Hagedorn needle. Positive variola isolations were stored in the deep freeze. When the entire stock of variola virus was destroyed in 1977 the Section felt bereaved! 

   The end of the Adv. Virology Course coincided with the start of the 36^th Senior Medical Officers’ Course (SMO) from Jan – Mar 1967. The stay in AFMC continued and we had another spell of lectures and clinics culminating in an examination. The post-examination celebrations had taken their toll and I do not remember the last day of the SMO course, having been in a drug induced haze the whole day. I am told that I attended the Commandant’s interview and was congratulated on standing first in the Course and securing the DGAFMS medal. During the military phase of the course, I was posted to AFMC on the staff of the Pathology department and, thus, returned to the College as a part of the faculty.

   The honour of being the only Capt on the faculty spurred me onto hard work. The virology background took me to the section where I learnt the speciality further and worked under my mentor Lt Col Achyuta Rao and later Surg Cdr/Capt AV Ramana Rao. Being the youngest member of the team I was used at various places. However, this was the time I learnt my Bacteriology from seasoned technicians of World War II vintage. Sub. Jayaram, Sub. Ghosh Dastidar, Sub. Prasad, Hav. Sebastian belonged to a generation trained by British stalwarts who had come to India as a part of the War effort. In fact, the hoary traditions of the CMP Lab (Central Military Pathology Laboratory) which was the forerunner of the Pathology department persisted till the products of the institution held sway. When the last of them moved out in the early 1980s they carried away with them a professional tradition. Those of us who have shared their thoughts and succeeded these veterans have probably not lived up to their expectations.

   Acquiring the M.D. was a major objective for the first two years. Having registered in 1967 I became eligible to appear for the examination of Dec 1968-Jan 1969. The thesis on Murine Typhus that took me to the grimiest parts of Poona Cantonment was complete and till May 1968 the preparations were “on course”. However, I erred in not taking the result of my annual leave that year. I drove down to Bangalore in the last week of May in my new car hoping to have a good holiday after finally getting my thesis cleared by (then) Col BDP Rao (no mean achievement!). The holiday was to be an interlude to charge the batteries before getting down to the business of reading for the MD. This was not to be. I met Vatsala again in June and thereafter events progressed rapidly to our marriage on 14^th July. Setting up house was not difficult those days. Guru Nanak Nagar had just come up and had vacant houses. Shankar Ramchandra was ever ready with furniture sets and life was simple. Teaching Pathology and Microbiology in the College and sharing the pleasures of setting up house conbined to make the latter part of 1968 a memorable period, though the events pushed back my MD attempt to Aug 1969. Time progressed and I took the examination and passed despite having a combination of four (widely acclaimed) strict examiners (none from AFMC).

   Apart from these personal and academic milestones, I learnt some good lessons in scientific work from my colleagues in the department. An important lesson in man management was also learnt during this period. It so happened that I was detailed to invigilate a SMO examination. The examinees were all senior to me in age and service Iit was a residual course). Some took advantage of this and used unfair means. This generated a representation to the Commandant who hauled me up. However, he put me on the job with an injunction to conduct the examination as “a member of the faculty should” and not as a junior officer. The attitude of Gen NDP Karani has remained in my recollections as exemplifying the spirit of AFMC. I may add that when I encountered the trainees once again I mentioned to them of the trouble that they had caused. In response they assured me that they will adhere to the straight path (and they did!) this time around and erase the blemish they had caused. This is where the ‘uniform’ speaks out. The subsequent years were spent in actively practicing my profession. This phase ended with my posting out in September 1971. It was a painful wrench and I left hoping to be back soon. Little did I realise that it would be a decade before I returned to the portals of the College.

   I returned to AFMC, in the first week of April 1982to a long tenure of over 7 years. This time I entered the new Department of Microbiology that had split off from the (joint) Department of Pathology in 1978. I was the second senior most member of the faculty till I took over in December 1984. The experience was, thus, different from the earlier one. Organising teaching programmes and lecturing to three graduate batches of medical student (apart from other courses conducted by the College) and post-graduates was labour intensive. Added to this I looked after the bacteriology sections, at times, the entire floor of the department and, of course, the Virology section. This was also the period when I tried to develop the concept of clinically oriented laboratory work that I had learnt during my study leave in the UK and successfully tried out in Delhi. It was not so successful in Poona as despite common objectives the College and the Hospital could not really integrate.

   The department overcame its initial disadvantage of being a splinter group and established itself amongst the older departments of the College. I must confess that establishing a viable relationship with the Pathology department was the most difficult. The development of antibiotic technology, establishing a tissue typing facility, anaerobic culture methodology, improvement of mycology and mycobacteriology were some of the achievements during the period. The young department had been noticed by peers elsewhere with active faculty participation in National workshops, conferences and other academic activities. In addition a series of workshops on Antibiotic Susceptibility testing were undertaken and conducted well. It was a totally satisfying period during which a lot was achieved and AFMC became legitimately recognised as a premier institution in the speciality of Microbiology. The department remained in the forefront of the thought process in the subject keeping pace with newer challenges as in the case of Human Immunodeficiency Virus (HIV) infection. AFMC started HIV surveillance along with the first lot of centres in the country. The substantial tenure kept personal problems in the background and enabled me to devote myself to the profession to such an extent that exit in 1989 to an executive appointment was a jolt and I felt that the break from the College was final.

   Unlike the previous tenure these years I was intimately involved with the Graduate Wing (GW). Academic responsibilities were certainly there, in addition, I was concerned with the day-to-day running of the graduate student matters. Some of the jobs were, supervision of the admission process, overseeing the hostel administration as the Chief Warden and helping organise extracurricular activities. Though distracting from Microbiology and keeping me busy,  the opportunity to interact with young minds was far more satisfying than sterile interactions with some stuffy staff members. In fact the working days were so long that it was usual to return home between 7.30 and 8.00 pm. Half days were not there, so much so that Vatsala (my wife) did not know that there were two of them in the week. She became aware of the half day on Wednesdays only much later in my third AFMC tenure! I am sure the need to think ahead of the active young minds kept me going.  

   This long period saw 8 Commandants and a large number of colleagues coming and going. Apart from the GW other responsibilities  like Secretary, Medical Research Committee of AFMC and other quasi-professional matters, including University affairs increased my commitment to the institution to the extent that there was hardly any aspect of AFMC that I had no personal knowledge about. It was irksome at times, however, became an asset later on. Overall this was the most satisfying part of my career and I am conscious that not many in the Service could be so fortunate.

   After such an intense involvement in the College it was inevitable that I maintain a ‘watching brief’ on AFMC and constantly endeavour to further its cause whenever I could. I did not miss any opportunity to visit the College and renew my contacts with the personnel at all levels.

   I spent my entire period as a Brigadier in executive appointments and when my turn for promotion to the rank of Major General came around in 1992 I was assured that I would not be considered for an appointment to AFMC or anywhere in Pune as I had spent too long a period in the city! However, the College went through a bad time in May-June 1992 and a change of the Dean was contemplated. My (dis)qualification for posting to AFMC became an advantage. The DGAFMS summoned me and asked for my acquiescence for a posting to AFMC as the Dean. The prospect of returning to the portals of the College was tempting and I accepted the offer despite being warned by my well-wishers (sic) that I was stepping into a quagmire that would jeopardize further promotions. Thus, I found myself back in AFMC and Pune (as Poona is called now) on 04 October 1992.

   The alienation of the students for the powers-that-be   was palpable. In my association with the graduate students I had never seen such a degree of animosity. The task was, therefore, cut out. It was a long haul requiring a gentle but firm handling. Gradually the atmosphere cleared mostly due to the good qualities of the students. They forgave us a lot! A major factor that appeared to have influenced the earlier unsavoury events was a decline in the teaching standards. Good teaching was dependent on personal qualities, the DGAFMS and the three DGsMS cooperated. There is, however, a lesson here. It is in the selection of faculty. A few poorly motivated staff members can start a process of decline. It is worthwhile remembering that institutions take a lot of sweat and time to build but little effort to destroy.

   The unfortunate events of 1992 did, however, have some salutary effects. The College did get a review. Some the results are already visible, but thew progress is slow. I hope it does not need another upheaval for the progress to culminate.

   It was a memorable moment when the order appointing me as the Commandant arrived by fax. I formally took over the same afternoon  as in any case I had been officiating for nearly three months, The only person senior to me in the Wanowrie area – my wife pipped me. It was also the last personal event seen by my mother. The Dean’s tenure telescoped into the Commandant’s and due to a delay in the appointment of a new incumbent I operated both the desks. As I sat on the chair, in October 1994, a flood of memories of the previous incumbents passed through my mind. I felt small before the predecessors some of whom were illustrious national figures. While I had personally known a few of them, I knew the others by reputation. Mentally I sought their good wishes and prayed for courage and strength to discharge my responsibilities up to their standards. To strive for the benefit of the College was the goal I set myself. I also reflected on the good fortune that had enabled me to spend some time in every rank from Lieutenant to Lt General (except Brigadier) in the College either as a trainee or on the faculty.

   There was a lot I wanted to do but did not manage as I moved on after just 9 months. In fact, the urge to contribute something prompted me to draft a letter seeking to stay on in the College instead of going on to the Delhi appointment (DGMS Army). The need to move on in a hierarchical set-up deterred me from converting the draft to a formal application.

   The role of Commandant AFMC was different from the ones I had played earlier. The need to maintain a smooth relationship with the other forces at play became evident. The delicate relation between the Command Hospital (SC) and AFMC exercised me quite a lot. It is unfortunate that the relationship between AFMC and its principal hospital is hostage to the inter-personal equations of the protagonists. This is an aspect that needs to be addressed effectively for the College to attain its full potential. During the prolonged stays at the College I had perceived  this delicate balance being disturbed by  colliding egos of the heads of the two institutions . However, once I was in the vortex I experienced the cross currents. I strove to maintain an even balance during my tenure in the interest of the common good. I hope that a retrospective assess ment of my time will that my actions were in tune with this conviction.

   Eighteen and a half years in the College at all levels have been enjoyable. I have been fortunate to have been able to savour the joys and pinpricks all through and given a chance I would not hesitate to go over the same ground again or many times more. In all these years I have realised that we have built a remarkable institution, probably the best in the country. But the greater realisation has been the firm conviction that AFMC has an immense potential, The College itself and its associated entities are the finest collection of establishments, which can advance the cause of Medicine in the country. Already we produce good doctors, competent Nursing officers and capable technicians for the Armed Forces. We need to do more and above all owe it to the Services and the country to keep striving continuously. We can reach for the skies (only if we want to).

 It is now an equal honour to be on the side-lines and watch the progress of a unique institution which unlike many others. I am sure that my successors will do ever better. 

GOD SPEED AFMC!!

Postscript

   The above is a copy of a write-up done in 1998 for inclusion in the Souvenir for the AMC Reunion. It is largely a reproduction of the mouldy copy I retrieved when going through old papers. A paragraph on the small pox work has been added in italics since that work engaged me for duration of my stay in AFMC from 1967 to 1971. 

   Many years have now rolled by and the Armed Forces Medical College has been continually improving. Ever since an annual rating of Medical Colleges have been published in the Press it has featured amongst the top five, in fact often in the first two. The alumni of the College have embellished the Armed Forces Medical Services and brought it up to the best medical care giver of the country. The alumni in uniform have participated in the Wars fought by the country and have been in the forefront of the natural disasters that have struck our countrymen. Not all the products of AFMC have worn the uniform but, nevertheless, they have shone among their peers and brought credit to the College. I have visited the College a number of times after laying down office and each time been impressed by the changes. It is heartening to see the vision of the early 1990s unravelling and exceeding expectations.

Bangalore

September 2016

Post retirement, his continued committment and concerns about health of us Indians.

Raghu’s life after retirement took on different dimensions. As Bina said he continued to be busy as ever. I dare say he became even more active. One would imagine, at least immediately after he retired would continue in Delhi, but he chose Bangalore. He almost joined a private hospital but did not!

His activity also includes the pleasure of being with students and colleges and creating the right attitudes for the younger generation.

 The Bhopal Tragedy
It was the news about this national tragedy which prompted me to write the blog. I did query him about it. He said there is a website on Bhopal tragedy. It was the largest industrial accident in the world at that time and till now! The response by the American company would have been different if it had happened on their land. They would have been required to handle it as per their country laws. He thought victims were short changed, did not get due compensation. (Example; Deep water gas tragedy!) GOI  failed to fix culpability, settled out of court.

Nevertheless a hospital was established to take care of the gas victims. It grew beyond the original limit and was run like a private hospital. SC wanted the management be taken over from ministry of health by ICMR and AE department. 

AE did not want the responsibility and ICMR ran it and at present it is out of ICMR. The committee was dismantled. Raghu is not in touch with the latest situation.

 Is the focus still on gas victims since 1993 still there?  SC wanted the dependents also be taken care by the hospital. Long term the people are not affected. Publications on Bhopal tragedy, the extensive research, vindicated Raghu’s thoughts on the tragedy.

He said he was offered the position of DG of the Bhopal hospital in 1999. At the same time the TATA offer was made. He opted for Bangalore. ( A bit of arm twisting was attempted as the person who offered the Bhopal post said he could make TATA withdraw their offer)

As I searched the internet his name came up on many different sites on the internet. We see he is involved in many critical areas; public health and epidemics. Our preparedness to counter bio-terrorism is a serious issue. We see his constant endeavor to bring in the best from the world to us in India. And the role the private medical industry he hopes will play.

His concerns

The fundamental structuring of medical care in the country is such that more than 70% of it falls in the private sector, which is not “committed to community health services” but is confined to “care of individual patients”, says Lt Gen (retd) D. Raghunath, principal executive of Sir Dorabji Tata Centre for Tropical Diseases in Bangalore, and lead author of the NDMA guidelines.

 “Public health has been moribund for some time and moving that is a challenge.”

His worry, for instance, is that if a patient turns up at a private hospital with fever and vesicles on his face, it’s important that it is diagnosed properly to rule out small pox. “Will a private clinic come forward to report it?” he wonders. That’s a challenge NDMA is battling with.

A view of the many threats we may face

 The articles below tell us that there are serious threats for us which need to be addressed not by armed forces across the border, but through science, research and technology. We forget this till it becomes too late! It is reassuring that there are people like Lt. Gen. Raghunath  who keep working in the background and keep reminding us about them.

n other professionals are on LinkedI

Have they mastered bio-warfare too? By Our Science Correspondent THIRUVANATHAPURAM, OCT. 16. With the anthrax attacks in the United States being described as ``acts of terrorism'', worrying questions arise about the sort of biological warfare capabilities which terrorist groups may have developed. ….The anthrax bacterium is quite easy to grow and was, therefore, one of the first to be cultivated in the laboratory, according to Lt. Gen. D. Raghunath. Although anthrax is primarily a disease of hoofed animals, humans can also get infected by the spores. The cultivation of anthrax and making fine particles containing the spores would, however, require special clean rooms and safe handling facilities, observes Lt. Gen. Raghunath.

The microbes strike back  (Perhaps the most serious of them all!)

N. Gopal Raj

DANGEROUS COME BACK: Bacteria are fighting back. Are we at the end of the penicillin story?

There was a happy period in the last century when it appeared that humanity was at long last gaining the upper hand in its age-old struggle against disease-causing microbes. So much so that a U.S. Surgeon General is often credited with saying in the 1960s, “The time has come to close the book on infectious diseases.”

But bacteria have fought back, finding ways to become resistant to various antibiotics. The sense of triumph has increasingly been replaced by alarm over whether the bad old days of untreatable infections might be around the corner.

The problem of antibiotic resistance has been there from the start. Shortly after penicillin was discovered and even before it had entered clinical use, bacteria resistant to it were found.

In his Nobel Lecture in December 1945, Alexander Fleming, the discoverer of penicillin, was remarkably prescient. “It is not difficult to make microbes resistant to penicillin in the laboratory by exposing them to concentrations not sufficient to kill them, and the same thing has occasionally happened in the body.

“The time may come when penicillin can be bought by anyone in the shops. Then there is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant.”

Use of an antibiotic creates an evolutionary pressure that leads to resistant forms proliferating. Under-dosage can hasten the process. But for several decades as resistant bacteria became more prevalent, they were held in check with newer antibiotics.

In India, as elsewhere in the world, these antibiotics have had a huge impact on infectious diseases, remarked  Lt. Gen. D. Raghunath (retired), who was Director General of the Armed Forces Medical Services and now heads the Sir Dorabji Tata Centre for Research in Tropical Diseases in Bangalore. Prior to the antibiotic era, “you just couldn't get rid of these organisms at all and hospital wards used to be filled with people with chronic infections” of various kinds, he said. Pneumonia was often deadly even to those in the prime of life. It was not uncommon for a cut or prick to lead to sepsis that killed a person in a matter of days. Surgery has become safer as a result of the ability to control any subsequent infection.

The steady discovery of novel antibiotics from 1940 to 1980 has not been sustained, he observed in a paper in the Journal of Biosciences. The 1990s saw only one new class of antibiotics being approved while all other introductions were variants of existing classes.

With few new antibiotics under development, the problem of resistance has become all the more acute. But the battle between microbes that produce antibiotics and those that resist them has been going on long before humans arrived. Penicillin was isolated from a mould that Fleming found which killed bacteria. The biological pathways that produce antibiotics have evolved over millions of years. In a similar fashion, other bacteria have found ways to avoid being wiped out by such toxins.

Bacteria can take in genetic material from one another as well as from viruses that infect them. Through such genetic transfers, they are able to draw on the existing repertoire of resistance mechanisms. This is an important route by which germs become less susceptible to the antibiotics that humans throw at them.

In addition, mutations, which occur randomly, can also produce genes that aid resistance. Research recently published shows that sub-lethal doses of antibiotics can enhance the mutation rate.

Thus, genes for antibiotic resistance already exist or can be readily generated. When widespread use (or misuse) of antibiotics takes place, bacteria with such genes gain an edge over susceptible strains and become more prevalent.

Even when synthetic antimicrobials were introduced, which would not have been encountered naturally, bacteria were able to evolve resistance to them in course of time.

Over the years, a number of disease-causing bacteria have become resistant to several antibiotics. There is a growing global problem too of “superbugs” – germs that are resistant to so many drugs that treating such infections becomes difficult.

MRSA

One such “bug” is known as methicillin-resistant Staphylococcus aureus (MRSA). A bacterium often found on the skin and inside the nose, the drug-resistant form of it can produce dangerous infections of the skin, soft tissue, bones, the bloodstream, heart valves and lungs.

Methicillin resistance was first reported in England in 1961 and appeared in the U.S. a few years later. Various strains of MRSA are now found across the world.

“The evolution of MRSA exemplifies the genetic adaptation of an organism into a first-class multidrug-resistant pathogen,” remarked Cesar A. Arias and Barbara E. Murray in a commentary published in the New England Journal of Medicine last year. Worse, it had turned into an important cause of infections acquired outside hospitals.

Hospitals in the wealthy countries have been reeling from an explosion of MRSA, noted another report. It is estimated that in the U.S. alone, such infections cost billions of dollars to treat and claim thousands of lives each year.

In India

Published papers show that MRSA is a problem in Indian hospitals too. Recent work done at the Sir Dorabji Tata Centre indicates that community transmission of MRSA is occurring in this country as well.

Staphylococcus aureus is classified as a Gram positive bacterium. (This classification is based on whether the bacteria can be stained with a particular technique.) The same process of escalating antibiotic resistance has been occurring in Gram negative bacteria too.

Various Gram negative bacteria acquired genes for what are termed “extended spectrum beta-lactamases”, enzymes that can break up a wide range of antibiotics.

As a result, strains of bacteria such as Klebsiella pneumoniae, which can produce a variety of serious infections in hospitals, and Escherichia coli, a common cause of urinary tract infections, became resistant to many antibiotics. Antibiotics known as carbapenems, which had been held in reserve, were therefore needed to treat such infections.

But then bacteria found ways to evade the action of carbapenems too. One way to do so was by acquiring genes for enzymes called carbapenemases that target those antibiotics as well.

Klebsiella pneumoniae carbapenemases were reported in the U.S. and subsequently worldwide, observed Patrice Nordmann, head of a unit studying emerging antibiotic resistance at Hopital de Bicetre in France, and his colleagues in a paper published last year. “Their current spread worldwide makes them a potential threat to currently available antibiotic based treatments.”

NDM-1

Another carbapenemase that offers a similar sort of antibiotic resistance is New Delhi metallo-beta-lactamase 1 (NDM-1), which was the subject of a recent paper by Karthikeyan K. Kumarasamy and others in the Lancet Infectious Diseases.

It was not possible to say whether the gene for NDM-1 originated in India or was introduced from somewhere else, Dr. Nordmann said in a telephone interview. But the main reservoir for dissemination of this gene worldwide was clearly  Bangladesh, India and Pakistan. His own unit had 10 samples of bacteria with the NDM-1 gene that had come from people in Australia, France, Kenya and Oman.

The common factor was that these people had either been hospitalised in the sub-continent or, as in the case of a French girl, spent time in the region.

In the case of the Klebsiella pneumoniae carbapenemases, Greece, Israel and the eastern U.S., were the three principal reservoirs.

But drug-resistant Klebsiella pneumoniae was a problem mostly in hospitals, he remarked. “My most important concern would that it [the NDM-1 gene] is located to a large extent in E. coli [ Escherichia coli].” E. coli was a source of community-acquired infections such as those of the urinary tract. With India's large population and poor sanitation, such a drug-resistant bacterium could spread through food and water.

“Treatment of infections caused by pathogens producing carbapenemases, including NDM-1, poses a serious challenge as these infections are resistant to all commonly used antibiotics,” observed B.V.S. Krishna of the Department of Clinical Microbiology at the Royal Infirmary of Edinburgh, U.K., in a letter published recently in the Indian Journal of Medical Microbiology.

The negatives

The lack of antibiotic policies and guidelines to help doctors make rational choices about antibiotic treatment was a major driver of the emergence and spread of multidrug resistance in India, he pointed out. This was augmented by the unethical and irresponsible marketing practices of the pharmaceutical industry as well as the silence and apathy of the regulating authorities. Poor microbiology services in most parts of the country added to the problem.

V.M. Katoch, Director-General of the Indian Council of Medical Research, recently announced that a unit would be established to issue guidelines on antibiotic use and keep track of hospital-acquired infections.

But without new antibiotics, the outlook appears grim. As Dr. Arias and Dr. Murray remarked in their article, “We have come almost full circle and arrived at a point as frightening as the pre-antibiotic era: for patients infected with multidrug-resistant bacteria, there is no magic bullet.”

Without new antibiotics, the outlook looks grim.

A few LINKS

INDIAN ASSOCIATION OF PATHOLOGISTS & MICROBIOLOGISTS

... The highlights of these symposia include lectures by Lt Gen D Raghunath ..

National Disaster Management Authority Government of India

 National Disaster Management Guidelines—Management of Biological Disaster ... I would like to place on record the significant contribution made by Lt Gen (Dr.) D. Raghunath, ..

http://www.icmr.nic.in/annual/2010-11/nirt/committees.pdf

COMMITTEES SCIENTIFIC ADVISORY COMMITTEE

Lt. Gen. D. Raghunath Director General, ICMR (Retd.) Principal Executive (Retd.) #247, II Main Road, Jayanagar Pune – 411 040 Bangalore – 560 070illi

The microbes strike back - OPINION - The Hindu www.thehindu.com/todays-paper/tp-opinion/the.../article585132.ece  Aug 21, 2010 - D. Raghunath (retired), who was Director General of the Armed ... Published papers show that MRSA is a problem in Indian hospitals too.

[PDF]Preface - Indian Council of Medical Research icmr.nic.in/annual/2006-07/jabalpur/preface.pdf  ..provided by Lt. Gen. D. Raghunath, SAC Chairperson,  ….who is always a source of inspiration

[PDF]Preface - Indian Council of Medical Research www.icmr.nic.in/annual/2007-08/jabalpur/preface.pdf … the constant support and guidance provided by Lt. Gen D. Raghunath.

[PDF]Information & Publications - Indian Council of Medical Research icmr.nic.in/annual/2004-05/rmrc_bhub/info_publ.pdf ..May 18, 2004 -                                  Lt. Gen. D. Raghunath.

Tropical Course 2010 - Christian Medical College www.cmch-vellore.edu/TC2010/Faculty%20-%20CV.html...Lt.Gen.D.Raghunath PVSM, AVSM (retd.)

[PDF]Introduction - Department of Health Research www.dhr.gov.in/annual_report/2011-12/icmr_introduction.pdf  ..Lt. Gen. (Retd.)Dr. D. Raghunath, … Following books/documents published by the ICMR were also released

Microbiology - Welcome to Armed Forces Medical College www.afmc.nic.in/Departments/Micro/homepage.html ...Amongst the other luminaries to occupy this chair …Lt Gen D Raghunath,

 [PDF]National Vaccine Policy - National Health Portal www.nhp.gov.in/sites/default/.../NATIONAL_VACCINE_POLICY.pdf.... Working paper  produced by Vaccine Security Workshop ... Lt. Gen. (Retd.) D.Raghunath, (Path) Former DGAFMS

[PDF]2007-08 - nirth www.nirth.res.in/publications/annual_report/annual_report_2007-08.pdf..the constant support and guidance provided by Lt. Gen D. Raghunath, SAC.

Downloadable News Bulletin May-August2007 - indian association of ...www.iapm.org.in/iapmmayaug07.pdf   Viral infections: Moderator Lt Gen. D. Raghunath,. Bangalore.

[PDF]Downloadable News Bulletin October-December2010 www.iapm.org.in/iapmoctdec10.pdf Oct 20, 2010 - Apcon 2010   ” Work Finish Publish”. .... The General Body accepted the election  of  D. Raghunath, Principal Executive, Sir Dorabji Tata Center for Research.

 [PDF]Carbapenem-resistant enterobacteriaceae: a reality check - World ...National antibiotic resistance…Lt Gen D Raghunath. 

[PDF]Minutes of meeting of 8-9 August 2015, NIRTH, Jabalpur.www.nirth.res.in/thrf/minutes_meeting_thrf/thirteenth_meeting_minutes.pdfMar 4, 2012 -   Lt. Gen. D. Raghunath… Advisor,

The Telegraph - Calcutta (Kolkata) | 7days | Galloping germs, docile ...www.telegraphindia.com/1110515/jsp/7days/story_13983687.jsp  May 15, 2011 - “It's a vicious cycle,” says     Lt Gen. (Retd) D. Raghunath

 [PDF]Bulletin January 2012 - National AIDS Research Institute

www.nari-icmr.res.in/pdf/bulletin/jan-2012.pdf  Lt Gen Dr. D Raghunath was the chief guest for the function.

[PDF]Sir Dorabji Tata Centre for Research in Tropical Diseases www.nihfw.org/doc/kr_cti.pdf       Contact: Lt. Gen D. Raghunath..  ...

Annual Report - Bhopal Memorial Hospital & Research Centre www.bmhrc.org/PDF/BMHRC_Final1.pdf  ..    chaired by Lt Gen D. Raghunath