Government Medical College, Nagpur, India
Baylor College of Medicine, Houston, TX, USA
National Institute of Immunology, New Delhi, India
University of Texas Health Science Center at San Antonio, TX, USA
Baylor College of Medicine, Houston, TX, USA
Society for Education, Action and Research in Community Health (SEARCH), Gadchiroli, Maharashtra, India
I graduated from the Indira Gandhi Government Medical College Nagpur and completed my residency in internal medicines from the Government Medical College, Nagpur. The hospital where I received my post-graduate training in medicine was one of the largest hospitals in central India and catered to the health needs of economically less fortunate. This training helped me develop my clinical skills but I realized that in addition to clinical skills, I needed to develop research skills to tackle challenges related to health. I had a dilemma- should I pursue a career in basic science or public health research?
The attraction to understand the building blocks of the body was overwhelming and I decided to pursue a career in basic science research. I was particularly fascinated by the two cognate systems in the body, the immune system and the nervous system. I was trained in immunology research at the Department of Immunology at the Sanjay Gandhi Post Graduate Institute of Medical Science, Lucknow and at the National Institute of Immunology, Delhi. I then received a post-doctoral fellowship at the University of Texas Health Science Center at San Antonio, USA and joined the laboratory of Dr. Sunil Ahuja, a physician scientist and a leading investigator in the field of genetic epidemiology of HIV infection and chemokine biology. My transition to neuro-immunology took place in this lab. I worked on the less well understood, non-chemotactic functions of chemokines in the brain. My studies showed a role for chemokines in memory-like behaviors, inflammation in a model of Parkinson’s disease in mice and astrocyte survival. Subsequently, I was trained in clinical neurology at the Baylor College of Medicine in Houston, USA. During my residency, I had an opportunity to conduct research on healthcare delivery among veterans with dementia. I realized that due to the inadequacies in healthcare delivery systems patients do not receive optimal care despite the availability of resources.
In year 2007 a trip to see the work of SEARCH, a non-governmental organization working in rural and tribal parts of Gadchiroli district in India, completely transformed my career and brought me to the field of public health, a path that I considered earlier. In this visit I had an opportunity to see the challenges of delivering healthcare in rural and tribal regions of India. However, I could also see that using innovative methods these challenges could be overcome. By training semi-literate village health workers, SEARCH was able to overcome barriers to the healthcare delivery for infants and had significantly brought down infant mortality in its work area, much lower than the national infant mortality rate of India. This and other pioneering public health research conducted by Drs Abhay and Rani Bang at SEARCH had lead to change in health policies related to maternal and child health as well as women’s health at National and International levels. During this visit I also learnt that chronic non-communicable diseases were emerging as a health priority in rural India and there was a need to conduct research to tackle this problem. I had the same dilemma that I had before - should I continue research in basic sciences or conduct research on public health issues? This time I chose to work in an area where there is a pressing need for research and where my work would benefit those who need it the most. After a short stint as a faculty in the Department of Neurology at Baylor College of Medicine, I returned back to India and joined SEARCH.
Since 2011, I am working with SEARCH in rural and tribal areas of Gadchiroli district of Maharashtra, India. I was assigned the responsibility of developing a center of excellence to conduct studies to understand the problem of chronic non-communicable diseases in rural and tribal areas and develop healthcare delivery solutions for these problems. I also started providing medical care to the rural and tribal patients in the rural hospital of SEARCH. This experience has helped me gain unique insights into the problems of healthcare delivery in rural and tribal areas.
Studies conducted by my team over last four years have shown that stroke is emerging as an important public health problem in rural India. In order to tackle this challenge we have set up a Rural Stroke Research and Action Lab at SEARCH which conducts research on various aspects of stroke in rural areas. We found that in rural Gadchiroli, one in seven deaths is due to stroke. Most likely, similar situation exists in other parts of rural India. Furthermore, stroke affects younger and productive age groups of the society in India and other developing countries. As healthcare for managing stroke and its risk factors is not easily available in rural areas, stroke becomes a disease of poverty and perpetuates poverty. Fortunately, stroke is also a preventable disease. Controlling risk factors for stroke, most importantly high blood pressure, lead to reduced stroke mortality in developed countries. However, no field studies have been conducted in rural areas of India or other developing countries to identify an intervention which would reduce stroke mortality. The fellowship awarded to me by the Wellcome Trust and the Department of Biotechnology will help me address this important question and also conduct research on the burden of stroke in a rural area of India. The studies conducted under this fellowship will provide important evidence-based inputs for the Government of India’s non-communicable diseases programme.