Organ Specific Oncosurgeons (Cancer Surgeons)- A Changing Paradigm In Cancer Management: Dr. Shabnam Bashir

Senior Fellow Breast Surgeries Tata Memorial Centre, Doctor Shabnam Bashir Gaash is a professional of par excellence who has via her Caliber, hardwork, dynamism  shined in the  highly difficult and prestigious field of Surgery and made Kashmir Proud.

Dr.Shabnam Bashir
Dr.Shabnam Bashir

In an exclusive interview with The News Kashmir, Dr.Shabnam Bashir talks to Rameez Makhdoomi.

How was your academic life like? Why did you choose Doctor as profession?

To begin with, having suffered a lot of injustice in his professional life, my dad never wanted me to become a doctor. I too had started preparing for administrative exams but fate played its own trick.

I was in my 12th standard, and one of my friends ( who was very interested in palmistry!) asked to have a look at my hand. At that moment it sounded like fun so I let her prove her ‘skills’. Least did I know what was to follow: The ‘palmist’ came up with what changed my track & my entire life altogether.  With utter confidence she ‘declared’  that no matter what, I would never be able to attend a professional college in my life. And a true Arian that I am, I took that as a challenge & hit it headlong. I cleared my MBBS entrance exam in the 1st attempt (to my palmist’s surprise and to many people’s chagrin) and set my feet on the never ending journey of medicine!

From there started the tale of restless days and sleepless nights ( a story of every medical student). As months & years went by, I realised that life had directed me to where my soul would have always wanted to be. During my medical college days  I gradually developed more interest in clinical branches more so in surgery, till it actually became a passion for me for it used to give me greatest satisfaction to be able to get to a diagnosis quickly without much hit and trial, and to be able to get the patients relieved of their distress as quickly as possible. The greater the distress the bigger the satisfaction of relieving them. One of the reasons I developed a lot of interest in oncosurgeries (cancer-related surgeries) was the fact that these patients have to bear the worst possible distress.

A bit about your  journey towards achieving professional excellence ?

To cut short the long, the twisted, rough road of my academic journey could be summerized like this:

I moved out of the valley to get higher training, more experience and more professional exposure and  better opportunities of learning and getting finer skills from the best of surgeons in the best of medical centres around. Though surgery is an art and a very subjective skill yet having a strong foundation plays a great role in the long run.

I did my basic ‘accidents and emergency’ training & ACLS (advanced cardiac life support certificate) from the Apollo Hospital then DNB surgery (  post graduate specialisation in surgery) in Fortis under the guidance of a group of best open & laparoscopic surgeons of Delhi and NCR. I had a chance to work with very experienced cancer surgeons at the Batra Hospital, Jamia Hamdard, and Fortis. I did my MRCS (UK), also FACRSI.

 

Having chosen a ‘male dominated’ field of practice (i.e surgery) I had anticipated the hardships and road blocks ahead, but least did I know that it was going to be as tough as it proved to be. It was a Herculean task to be able to prove my worth & demonstrate my skills in a male dominated society and profession,  fighting all the indiscrimination and bias! Yet by the Grace of Almighty Alhamdulillah, I was able to move ahead & survive with dignity.

How did you develop interest towards field of Breast Surgery?

After having attended all those surgical conference throughout my surgical training,  I realised that there was a gradual shift from general MCh oncosurgery towards more ‘organ specific’ training and knowledge now. In a decade or so to come the scenario would be changed altogether. So I decided to focus on my areas of interest ( that in our jargon means the organs or surgeries/ treatments that we want to do ). Breast cancer being the number one killer of women in the reproductive age group, was topping my list followed by Colorectal cancers, as I believe that we have a huge lack of female surgeons – that too cancer surgeons – and more importantly women surgeons trained in specific areas like breast & colorectal part of the body. Both areas are very embarrassing for our women to expose to a male surgeon which is a prime reason for diagnosis and treatment getting delayed!

Super-specialisation means not only ‘mastering a skill / craft /organ system surgery’…but also to keep oneself updated with latest trials, studies, latest   management protocols, guidelines for treatment and innovations in that area. And it is beyond human capacity (unless one is a self -proclaimed genius!) to be able to ‘master’ all organs  and keep abreast of all the minutest details of that particular organ. For doing justice to one’s profession the need of the time is deciding upon an area or organ of interest and trying to master that particular area so that one is able to do  justice to the patient and one, s own conscience.

Secondly let me tell you, as a surgeon though it gives me equal satisfaction to be able to relieve the misery of my patients in any corner of the country or world …for Allah (swt) says in Quran that “if you kill one innocent person it is equivalent to having killed the whole humanity and if you save one life, it is like having saved the whole human kind”…that is irrespective of caste, creed, religion, sex, ethnicity, or financial background or place of origin.  I know charity should begin at home and that we all owe the most to the soil we belong to so InshaaAllah would be soon amongst my own people.

Why you selected Tata Memorial Hospital ?

Having defined my areas of interest, I finally moved to what is considered the ‘apex institute for cancers’ in the country and one of the  few top cancer centres in the world ( the Tata Memorial Cancer Centre,  Mumbai) for my super-specialisation in breast cancer management & surgeries which, Alhamdulillah,  I have finished now. Hence I would be ( inshaaAllah) targeting my second area of interest i.e the colon and rectum.

One more thing that majority of people might not be aware of is that majority of cancer patients coming to Tata Institute are from other states and are not even able to arrange for their food or stay in Mumbai. You’ll find them ‘residing’ on the pavement alongside the hospital building…with bedsheet as their flooring and polythene sheets as their ceilings! Be it scorching heat & humidity or the ruthless monsoons of Bombay, for months together men, women, children and all huddled together  lying on the pavement, all to themselves.

Being served free breakfast and lunch  by a generous five star hotel (Taj Sats) though obviously being able to serve a simple meal only( as the  numbers they are catering to is humongous). This scene in the early mornings, when we enter the hospital premises, is enough to tear our souls apart and we usually try to avoid an eye contact with any of them as each pair of the eyes is full of despair, agony, uncertainty, expectations and what keeps them going is the Hope. Believe me, it is not easy to be able to handle such amount of pain, distress, stress and responsibility!

What was the main reason of you not serving in your native place Kashmir?

One of the important reasons why I had been forced to move out of my native place long back was that, despite my Curriculum Vitae being unparallel for the post that I had applied for, at one of our ‘big premier institutes’ in Srinagar, I was declined appointment because I refused to bribe the concerned authorities (believe me it was the routine there!) And additionally I was neither a relative of any political figure nor a blue-eyed candidate for that matter!

Where from this dedication comes despite such tough job?

‘Dedication’ means following anything religiously with utmost honesty and passion. It is not easy, trust me; at times it takes hell out of  us!! It means seeing & following something with your eyes open or close in Your thoughts, words & deeds .At dawn, at dusk and in the hustle bustle of the  day or silence of the night! It needs a little amount of craziness within.

Why has there been increase in number of cancer cases in our part of the world especially Kashmir?

The reason behind the fast increasing number of cancer patients is both the rising  incidence  as well as better detection rates due to advanced technologies and better awareness. The number of cancer patients that we are dealing with in the institute that I am working at currently  in various departments is around 1000 every single day.

There has been a drastic change in the lifestyle of people, more sedentary habits ( exercise releases a lot of antioxidants in the body), change in food habits .More of junk, canned, freeze dried foods rather than fresh stuff and hence exposure to a lot  preservatives and toxins ( carcinogens) leading to various cancers. Our youngsters are getting badly influenced by the aggressively marketed concepts of modernisation and liberalization & carefree attitudes and social media influenced ‘ cool ways’ of living and hence we come across a lot of them getting addicted to smoking and even alcohol ( was surprised to see so many Muslims even from conservative societies like ours indulging in hard drinks and all). The other factors include technologies like microwave. Studies say that when the food is heated in the microwavable wares (except glass wares) some chemicals get released from the cookware, one of them being Diaoxin, which is a known carcinogen  related to many cancers especially breast cancers. Even the plastic water bottles if left in cars through the day will get heated in sun and release same substance and same happens if they are  kept in freezers ( not the fridge door).

In addition to that lots of animal fat with decreased fiber intake is one of the most important modifiable causes of colon (large intestine) cancers in our valley. Other substances like nitrosamines from our tea, high salt intake, smoked fish, high incidences of H Pylori infections and, of course, genetics play a role in gastric cancers in our state. Some cosmetics also have been found to contain certain carcinogens.

And then last but not the least the menace of radiations from mobile phones, laptops, communication towers etc etc..so on.

A lot of awareness generation is required and screening programmes need to be designed to fight the menace. And additionally some laws and rules have to be aggressively implemented to prevent the masses from general sources of exposure to potential carcinogens from radiation towers, pesticides ( GMOs), unapproved or undeclared preservatives etc

Are Doctors Soft Targets in our part of the world?

Doctors have always been a soft target of society and especially the media (though for being from media I dont expect you to agree on that – aleast not publicly.) Whether it comes to issues of deserving respect, getting their deserved positions, being dealt with honestly, their desire for better working condition, hope of gratitude & thankfulness from their patients, to be able to have atleast one single day all for themselves, to get some peace of mind and happiness and to be able to run away from the huge amount of stress that they face in their day to day working atleast once a while or dreaming to be able to provide better living conditions to their families and better education to their kids (like all other human beings). Sometimes it seems they are being governed by a different set of rules and measure measured by different yardsticks than the rest of the society. And you will bear me out that it is not fair or just.

People forget that we are from amongst them only.  They forget who a doctor is – the one who chooses their health over his own, who prefers relieving them of their distress & miseries  over his own family ( most of the times we are not able to be with our own families when they need us the most), giving precedence to their peaceful sleep in the wards over his own sleep, their treatments, procedures and surgeries over his food (most of the times not getting his timely basic meals even ) . Doctor is the one who misses out his family ceremonies to be able to make his patients have a speedy recovery for their family functions and giving all the time, attention and energies (even the share that belongs to  his ownself and his family) to his patients and their families. They forget to realise that we give our prime years and decades into this field to be able to deliver substance healthcare.Our counterparts in other fields take far lesser years and efforts to settle down professionally and get tremendous social and financial outputs comparative to the years invested and are not a target of criticism every now and then with or without reason.

Additionally, on one hand they expect us to be their ‘Messiahs’  and  on the other hand drag us to consumer courts!! If the society behaves like a consumer buying healthcare,  the doctor would inevitably be forced to behave as a seller of the same. To define a doctor’s role more clearly, the society first needs to be clear as to what they want from him.

Though I am at no point of time denying the fact that there have been and will be elements in our fraternity  who have astrayed and done mistakes, negligence or even  crimes but then they have to be measured on the same scale as other humans. After all doctors too are a specimen from the society at large!

Your take on Ban on Private Practice  in Kashmir?

Banning private practice is no solution .We need to remember forbidden fruits are always sweeter. It needs a more practical approach from both sides…better remunerations, providing better for diagnostic & therapeutic technologies…and safe, comfortable & respectful working atmosphere from government and other concerned authorities and honesty, compassion and dedication from doctors. And of course some sense of gratitude and respect from the society for the person who has been chosen by the Almighty as His representative hand to allay suffering, ameliorate pain and provide cure. Do consider the fact that the ‘white coat’ might be concealing a soul deeply wounded by indifference of the society to his sufferings and agonies. The best encouragement for any soul to keep doing good is ‘appreciation’ of that good.

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A doctor is – the one who chooses their health over his own, who prefers relieving them of their distress & miseries  over his own family ( most of the times we are not able to be with our own families when they need us the most), giving precedence to their peaceful sleep in the wards over his own sleep, their treatments, procedures and surgeries over his food (most of the times not getting his timely basic meals even.

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