Dr R Ganapati ‘An Autobiographical Sketch’ (transcribed from an oral account) in S S Naik (ed) The Indian Leprologists Look Back. Bombay, 1990. pp. 57-61, posted online with revisions by E H Price, 31 August 2006.
1. Early Life:
[I was] born in 1930 in Tirunelveli town of the former Madras Presidency in a middle class family. I was brought up essentially in a semi-rural set up, my late father serving the government as a Civil Assistant Surgeon in various taluk headquarters’ hospitals in South India. I had my education, therefore, in small government schools, even after [our] migration to Madras on my father’s death in 1942. Graduation in science was completed in 1950 in Loyola College, Madras.
2. Medical Studies and Jobs:
[My] medical career in Madras Medical College in 1950-1955 was uneventful, as I was not one of those brilliant students known for showing exemplary skills in studies and in examinations. During [my] medical career my first exposure to leprosy was a dry prosaic lecture by a government doctor in the medical college. I had the opportunity to come into contact with Dr K Ramanujam, an upcoming leprologist who later became an acknowledged expert in clinical leprology. However a career in leprosy was never contemplated at that stage, though I was impressed by the plight of advanced leprosy patients who used to attend for their quota of dapsone tablets at the Primary Health Centre, Valathi in the hyperendemic district of South Arcot District, which I started [to see] on taking up my first salaried job. An aversion to practice of medicine in the conventionally prevailing commercial style and a vague inclination for making research contributions in some field related to public health led to attempts at [furthering my] career prospects in the field of nutrition, Tuberculosis etc.
3. Entry into Leprosy
A rather indeterminate career phase seemed to lead to something concrete in late 1963, when I chance[d upon] an application for a post of Assistant Medical Officer in Acworth Leprosy Hospital, Bombay. Later I took advantage of the opportunity to study the abundant clinical material available in the hospital at that period, taking up the post of Research Officer. Dr. N. Figueredo, Special Officer, though very deviant in many ways in the management of leprosy from the rest of the leprologists in the country, was at that time very helpful in imparting knowledge on some clinical facets of leprosy. Encouraged by the then Superintendent Dr. N. D. Katdare, and a team of devoted colleagues, I was able to make some significant observations on the clinical aspects of the disease. Opportunity for intensive field work and systematic field studies later became a reality by pioneering a movement which was possible by the establishment of “RRE Society” along with courageous colleagues like Mr. S. S. Naik and Dr. V. V. Dongre.
Later, contacts with a host of eminent persons in the field led to shattering the isolation which leprosy as a subject as well as leprosy patients were subjected to, particularly in Bombay.
[The] establishment of [a] research oriented field project in the form of Bombay Leprosy project led, in due course of time, to a fulfilment of [my] early ambitions to make contributions over a lifetime in a public health field, which were later appreciated as significant by the scientific community as well as [by] the Government.
4. Significant contributions:
After gaining extensive clinical, laboratory, and field expertise, I established a research oriented field project called [the] Bombay Leprosy Project (BLP) in the year 1976 which enabled me to carry out work which has given [me] the necessary expertise today not only for planning leprosy field programmes in a most rational manner but also has led to a better understanding of the transmission and causation of leprosy. The high scientific quality of multidrug therapy programme which is practised in the city and elsewhere today can largely be ascribed to the research by [the] BLP and [the] RRE Society into the intricacies of operational aspects of drug delivery systems and the exemplary training offered to various categories of personnel. I have to my credit more than 150 scientific papers on various aspects of leprosy.
My stature in the medical fraternity has enabled me to start leprosy treatment service of high quality in medical institutions, particularly teaching hospitals. For the first time, education in leprosy in medical colleges has received a tremendous fillip through the usage of audio visual aids in the form of videos.
Assistance provided to the Government of India in my capacity as the member of [the] National Leprosy Eradication Commission, the highest policy making statutory body, and to Maharashtra Government as a member of State Leprosy Council, as well as Consultancy to WHO for assessment of training centres in 1986-87 and for MDT Districts since 1988, has been helpful in focussing the attention of those vitally concerned in leprosy management to what I believe are priority areas.
More recently my specialisation has been one of integrated approach in the management of leprosy programme which has broken the barrier of stigma attached to the disease to a very significant extent and also has resulted in the reduction of management cost of the leprosy control programmes. Taking advantage of my membership in the governing bodies of several leading institutions engaged in rehabilitation of the handicapped in general, it has been possible to make these institutions accept leprosy patients along with other handicapped without hesitation.
I am currently engaged in operational research under urban and rural field conditions aimed at early identification of deformities, offering simple devices like splints, getting the patients operated by surgeons engaged in general hospitals and providing grip-aids for deformed hands in inoperable cases.
These are major steps towards ultimately in abolishing “vertical” approach to leprosy management and thereby eliminating stigma.
My visits to several countries have been instrumental in instituting collaborative research with leading institutions abroad which is likely to provide answers to many academic questions relating to leprosy.
I have been honoured with prestigious awards like Padma Shri (1983), JALMA Trust Fund Oration Award of the Indian Council of Medical Research (1986), Garware Medical Sciences Oration Award (1986), Yodh Memorial Gold Medal (1983) and Ambady Oration of the Indian Association of Dermatologists, Venereologists and Leprologists (1988). It is up to the circle of those interested in leprosy to utilize these honours for enhancing contributions toward our common goal.
5. Professional life as a Leprologist:
I believe that the role leprologists today should not be as isolated as has been the subject of leprosy. I realise that the tremendous responsibility of a leprologist in championing his cause effectively lies in exploiting his environment of general medical profession, medical students and paramedical auxiliaries, not excluding his family and friends and public towards a general understanding of the disease and thereby do[ing] justice to the leprosy sufferer. This realisation and tenacious pursuit of this goal has led me to lead a highly satisfying life as a leprologist, though this pursuit was by no means easy. However, I believe that my personality make up, which enables me to be somewhat insensitive to some common frustrations, might have been responsible for this degree of satisfaction. This personality make up coupled very well with a highly understanding circle of family members (of whom I must specially refer to my wife, brother and late mother) who were indulgent to my whimsicalities and idiosyncrasies as a “committed” leprologist. [My] sense of fulfilment, to some extent, in my career as a leprologist is also due to my thoroughly co-operative but critical band of friends (of whom I must make a particular mention of Mr. S. S. Naik, who has a special insight into leprosy management in its totality inspite of his pure laboratory background. I, however, feel that my professional role as a leprologist is still not complete.
6. Your participation of the changing patterns of leprosy-clinical, sociological, administrative and therapeutic aspects during your association with leprosy:
I have found the world of leprosy has been truly changing during my lifetime, the striking feature being the alteration in the clinical and to some extent epidemiological pattern of the disease. And this happened even during the days of patchy and unscientific distribution of DDS monotherapy. I have had the unique privilege of participating in studies relating to these changes, particularly during the period of more rational chemotherapeutic intervention through in multidrug therapy.
Administratively I have had the opportunity of attempting to introduce new techniques of management and training of personnel in an urban set-up, of course with varying degrees of success. I hold the belief that success in programme management would be more meaningful only if administrators realise the importance of making the staff under them understand the meaning of their work in [the] changing context of [the] leprosy world. I have had the unique opportunity, particularly in later years of my life, in experimenting on the almost revolutionary transformation in concepts of therapeutics in leprosy. Due to this transformation, many facets of which remain still to be understood, I believe that sociological approaches towards the disease also should keep pace with this unbelievable change with the same degree of optimism.
7. Narrate any interesting or important incident connected with leprosy:
Such an incident happened on 10 November 1989 at the General Body Meeting of the Indian Association of Leprologists, as I was chairing the session as the Association President. Conceding to what I thought was the desire of the majority of IAL members present at the Conference to retain the office of IAL in Bombay for two more years, I was driven to the necessity of contesting the election, along with my other important office bearers. While fully realizing that JALMA Agra was relatively unsuitable at that juncture to have the office shifted to, I faced the difficult and embarrassing task of utilising my casting vote as the President in favour of [a] shift to Agra, during the ballot-tie, without any consideration of personalities involved in the contest. I did full justice to my conscience as the President of JAL in casting my vote in favour of shifting the office, though I and my team-mates, along with several members, sincerely desired at that moment for another term of office in Bombay. It was also distressing and amusing to see that most of the members who desired so did not care to attend the meeting.
8. Your thoughts on the future of the field of leprosy in India over the next 25 years.
I think that the next 25 years hold bright prospects in the control of leprosy by way of containing the transmission rate and altering the clinical pattern of the disease further, though eradication of deformity which must be our real goal will not be achieved in this period. Far greater and concerted and co-ordinated, action on the part of several persons and organizations who profess to show interest in leprosy may be necessary to reach this goal. I foresee a more sustained interest of the medical profession in matters relating to leprosy in future.
9. Your remembrance about famous people who have inspired, and influenced you and your career in leprosy.
I remember that the visit of Dr. Cochrane to Bombay in 1964 and his examination of patients and histopathological slides made a tremendous impact on me. His demonstration of a dermal nerve affected early in the disease in a biopsy stimulated my interest which was later sustained through contacts with Dr. C. G. S. Iyer, Dr. K. V. Desikan and Dr. Mrs. S. S. Pandya. Dr. Figueredo’s dogmatic teaching and leprophobia which he created among the staff trainees and public did influence my later career. Dr. N. D. Katdare’s encouragement to RRE Society and to me as a member of the staff of Acworth Leprosy Hospital in my scientific pursuits was a very significant factor in my later contributions. I have learnt from Dr. V. Ramanujam and Dr. G. Ramu several aspects of leprosy through personal contact as well as through reading their contributions. Mr. William Gershon and Mr. Hermann Kober also realized the need for urban leprosy projects and later some of the Committee members of Bombay Leprosy Project have played their rules in providing a scope for my field work. At present I seem to he influenced by the concepts provided by some bacteriologists who seem to give a new turn to our approach to chemotherapy in leprosy. Given opportunities, I hope to field-test some of these concepts.
10a) Some thoughts on Leprosy:
As regards control of leprosy everyone that matters has experienced the futility of the so called “SET” approach practised during 30 years of unsupervised monotherapy being replaced by a new era of rational fixed duration chemotherapy with multiple drugs. At least now I hope that the need to redesignate the slogan as “TES” will be appreciated, with “T” representing not only chemotherapy but total patient care with special reference to attention to deformity which can be followed under simple field condition[s].
Inspite of tremendous advances made in the academic sphere, leprosy is still in isolation. The protagonists of the cause of leprosy eradication themselves seem to fall a prey unwittingly to this phenomenon. While paying lip sympathy to the concept of integration, they seem to be in the dark on how to conduct and implement the process of integration. The near impossible task of demystifying the sensitive subject of leprosy could be carried out only by leprologists and leprosy managers through systematic contacts with those not fully professionally engaged in leprosy work. Still, the non-leprosy sector is kept uninformed about the disease. While huge funds are directed to maintain “Vertical” leprosy programmes, it is hardly realised that if [the] non-leprosy sector is involved, it will not only lead to elimination of stigma but also reduce the cost of leprosy management in the long run. This does not mean that I advocate abolishing all “Vertical” structures; I just would remind that such ivory towers have additional responsibilities besides patient care.
11. Interests in Subjects unrelated to Leprosy:
Administrative and political events relating to public health in general; sports with special reference to cricket and tennis; travel and music seem to interest me.
The script received in September, 1989.
Also see http://www.bombayleprosy.org/about.html