'I did not take up research for any award.'
'What is more important is the medicine that I have developed.'
'This helps the patient recover and the family is happy that their relative has survived and they go back to their lives.'
Tribals and rural folk flock to the Bawaskar Hospital and Research Centre at Mahad in the Raigad district of Maharashtra, for treatment of scorpion or snake bites. The hospital stocks models of various types of snakes -- vipers, kraits, cobras and more -- so patients can identify the reptile or arachnid that bit them and anti-venom is accordingly administered.
Dr Himmatrao Saluba Bawaskar, who runs this hospital, is known for his meticulous and methodical management of bites by scorpions and snakes, especially of Mahad's vicious red scorpion, Mesobuthus tamulus. Indeed his work is now well-known throughout India, and recently China.
Dr Bawaskar hails from tiny Dehed in Jalna. Of a poor village background, he put himself through school in Buldhana, working on farms, in brick kilns, restaurants, temples and shops. He earned his medical degree from the Government Medical College, Nagpur, and later further qualifications from Pune.
He worked for many years in Birwadi in Maharashtra's Konkan region in the Western Ghats, where he saw tragic fatalities, especially in children, because of scorpion stings. Experimenting with various kinds of treatment, he found success in reducing deaths to a bare 4 per cent or less. Dr Bawaskar published his research, over the years, in various prestigious medical journals, including 70 papers in The Lancet -- the 201-year-old British health weekly -- and proudly put wee Mahad on the medical map.
An earnest, upright man, only concerned about the welfare of his patients, his motto has been to live simple and stay simple.
Dr Himmatrao Bawaskar describes to Rediff.com Senior Contributor Neeta Kolhatkar, how he saved his first patient, an eight-year-old boy who had been bitten by a scorpion. The boy lived. But Dr Bawaskar could not be at his father's cremation, that was happening the same day in his village.
You opted to set up a hospital in Mahad. All your life you have worked in rural areas, which most medical practitioners run away from. When you first learned that so many people in India die of scorpion bites, did it shock you?
Of course, it was shocking.
I graduated with an MBBS in 1975. At that time, nowhere in our medical textbooks or journals was there a mention that a scorpion sting can cause death and how to treat them. Why there was not even any mention of it, forget the treatment. Our professors taught us how to save the lives of people, but there is just no previous study telling us how to prevent deaths due to scorpion bites.
It was later when I went to work at the primary health centre at Birwadi, in Konkan, that villagers pointed out to me that people died from scorpion bites. I couldn't believe it initially, till I joined the PHC.
The compounder working at this PHC told me how his son, who was studying in the 10th, died of a scorpion bite, just a few days prior to my joining.
Why would any parent lie to me? I prodded him to give me all the details of his son's condition. He narrated: The boy had vomited, had hypertension, profuse sweating, felt exhausted, puked blood, fell down due to lack of strength, garbled speech, froth at the mouth, and then died.
This was the boy's clinical autopsy. I realised the problem and called upon my professors.
Were your seniors or professors in a position to help you? How did you work with this lack of information?
No, none of them could.
How could they have helped me? They had no prior experience or knowledge. And there was no recorded case (with details on) treating a scorpion bite.
I came there (Birwadi) to work. At that time, my parents told me they wanted to see my name in books or journals and not to have a bungalow or car. Their wish could have been only fulfilled through research. Garaj he sanshodhanachi janani ahe (Need is the mother of research).
After I joined the PHC, there would be at least one death on a daily basis from a scorpion bite. I got scared. One day, a six-month-old baby was bitten by a scorpion. The mother took the child to a nurse and within minutes she died.
It was heart-wrenching. I swore then I would do everything within my means to find a solution for this problem. Another problem, at that time, was nobody was keen to admit a patient bitten by a scorpion.
I have seen scenes where parents and families would prepare for a child's cremation after learning s/he was bitten by a scorpion.
At that time, 40 per cent deaths were due to scorpion bites.
Wasn't there enough research on this subject in the public domain?
There evidently wasn't any research. And the government has not supported research in the medical field to overcome scorpion bites. No government (in power) wants a scientist and they do not support research because it entails a lot of funds and expenditure. This lack of support is primarily due to the fact there is no immediate outcome.
Research is a long-term pursuit. It may take 10 to 20 years. But, of course, it will provide permanent treatment and medicine. But no government wants to support it.
Now, on the other hand, look at Israel, Brazil, the USA, and the UK -- they allocate a lot of funds and provide infrastructure for research. They encourage researchers and scientists to pursue long-term studies and so they are on top.
India, on the other hand, gives secondary status to researchers and they are neglected.
Have you seen a change in this attitude towards research? Or has it been the case with every government India has had?
No, no. Since the birth of this nation, no government has encouraged research. A nation that lacks in research is a 'vanjoto desh (unproductive country)'. This lack of support for research also derails development.
Look at America. See how that country leads on many fronts due to research. It is the most developed nation and we will always be underdeveloped.
Everyone calls our nation: Young India. But in my opinion, we should have a 'healthy India' instead of a young India.
What did you feel when you won a Padma Shri in 2022. Were you expecting it?
It is not about expecting any award, because I did not take up research for want of any award. Our mission is to continue doing the good work that I had started and this may bring some recognition as I got with (the Padma Shri).
What is more important is the medicine that I have developed. This helps the patient recover and the family is happy that their relative has survived and they go back to their lives.
What bigger award one can hope for? This is the best reward.
After you completed your MBBS and went to rural Konkan, how did you overcome this biggest hurdle of being able to do research?
It wasn't easy, especially in an environment where there was no knowledge or trust in medicine.
First, I began to hospitalise every patient brought in for a scorpion bite. I began to record their heartbeat, pulse, blood pressure, respiration.
Does the patient have cyanosis (bluing of the lips, nails, skin)?
How exhausted was he? When did cough begin? How serious was the cough?
When did blood pressure begin to drop? After the blood pressure began to dip, when did respiratory problems begin?
Then I deciphered that these patients were dying due to heart failure. I would then give them the treatment that we were taught for treating patients with a heart attack. But even after being given treatment for heart attack, they would show no signs of improvement. This was refractory heart failure (end-stage heart failure even after medication is administered).
You felt at that point you had to study further?
Yes, I needed to develop more research. I then decided to pursue higher studies and went to the BJ Medical College, in Pune, to study for an MD in medicine. In the 1980s refractory heart failure was a hot topic of study. At that time we were told to give sodium nitropusside as a drug for treating refractory heart patients.
After completing my MD (1981) I took a posting back to Konkan, because that was where my work was needed. In 1983, I got my first case. An eight-year-old child was brought in after being bitten by a scorpion. He showed all the symptoms of severe scorpion envenomation -- difficulty in breathing, nausea, vomiting, accelerated heart rate, muscle twitching, and drooling.
His chances of survival were already low, And then the child's condition deteriorated even further when he developed pulmonary oedema (excess fluid in the lungs). It was then -- for the first time -- I gave sodium nitroprusside.
Even today, most leading hospitals do not administer sodium nitroprusside as treatment, because the blood pressure dips suddenly after it is administered. Now, the BP in cases of scorpion bites is already low, and we have learned in our books not to give this medicine in cases where BP is already low.
But I still went ahead and administered it because there was a lot of pressure on this child's heart. In such cases, sodium nitropusside helps. Within four hours the boy's BP increased, his breathlessness decreased and he recovered!
After 24 hours I told his father that his boy has been saved. This was my first case of curing a patient of a scorpion bite.
What did you feel after saving this child's life?
Feelings were mixed, because that was the day I received a telegram informing me that my father had died and that his cremation was that day.
I have alway lived (according to) the teachings of my parents and I did not attend his funeral, because this child did not have another doctor. Also, this boy was the only child of his parents.
They reiterated their faith in me and said that whatever was to happen was in their destiny and they asked me to go ahead with my treatment (of sodium nitroprusside). I couldn't leave that boy and his treatment halfway.
I vowed to give him back a fully-recovered son with my treatment, which I could do. That meant I could not attend my father's funeral.
Now research should be easier in these more modern times, with the development of more information, technology and science?
No. In fact, this kind of research is absolutely not possible today, due to (the power of the) consumer courts and the Consumer Protection Act (CPA).
It has impacted medical research in India.
I honestly tell you: I couldn't have conducted my research and experiments in today's times within the framework of the CPA. I would have been scared of paying lakhs of rupees in compensation.
That is how scared scientists are, because they have been snatched of their right to experiment. We have to take permission from the ethical committee (Central Ethics Committee on Human Research or CECHR) and it is a long due process.
Look how far the developed countries have come after these processes were put in place in their country. Their researchers have been provided with advanced facilities. We are not even halfway there yet.
But isn't the CPA beneficial to our citizens, especially the poor who are often used in experiments and suffer severe consequences? Now doctors and scientists must comply with certain processes to complete their experiments?
Exactly. In a country where there is a paucity of adequate equipment, where there still aren't modern machines to measure BP, they suddenly want us to jump into the league of advanced nations. They have all the required machines, knowledge, equipment at their fingertips.
We are still 'minors', not even the age of 18 and they want us to behave like them.
Here if I give a slip to a poor patient to get a CT scan, it will take them eight days to get an appointment. Then, in such a dire situation, how are we expected to complete research and think of modern, new types of treatment?
In today's times, with the CPA and an ethical committee in place, do you think you could have pursued your research on scorpion bites?
Oh absolutely not! I am damn sure the ethical committee would have rejected it.
What research are they doing on coronavirus in India? They had been giving Remdesivir, which too was told to them by the American doctors. Most of the research has been done in the USA and the UK. What research has been done in treating the virus here?
Are you saying these new laws are ailing Indian research?
Yes, it is a curse of Indian democracy.
If today I get scorpion-bite patients and if we are to follow their procedures, then instead of attending to the patient, I would be preoccupied with the fear of legal consequences.
People in the cities, who have been actively raising these issues of CPA and strict ethical committees, are disconnected from the reality that exists in villages and rural areas.
Today the number of people dying due to scorpion bites has come down to less than 1 per cent. The success of my research is how doctors at the PHCs can now treat these patients.
Democracy has killed research and science.
How can you say that democracy killed research and science? The US and the UK are democratic countries and they have implemented strict guidelines and are doing well.
Firstly, there are many restrictions on the resources in our country as compared to these advanced democratic nations. They need to upgrade our resources and infrastructure.
Along with that, they should upgrade the ethical committee, to begin with. They can make changes in the CPA. It is a good Act, I am not against it. I understand their aim is to bring us in the league of foreign advanced countries. But in areas like where I work, Mahad, we have parched resources.
If I have to pursue research, I have to develop a protocol and it takes at least two months. It takes another three months to pass the protocol. It is mandatory -- as part of a process -- to get statistics for any research study and then it goes to the ethical committee. If it is a private study, then you have to pay nearly ₹70,000. If your study is backed by a government body, then it takes more time.
If I get a serious patient (suffering) a scorpion or snake bite, I will be bogged down by the procedures set down by the ethical committee, instead of treating the patient.
There are nuances to this that have been completely overlooked. We don't have the infrastructure for conducting research at the grassroots level and we can't find sufficient numbers to show statistics in order to prove conclusively (the need for a kind of) treatment.
This journey wasn't easy for you, even on a personal front. Was it tough coming from an underprivileged background?
Yes, because, you see, problems were bound to arise. I am the son of poor, illiterate, parents. My parents did not have the means and nor was there an environment encouraging higher studies. At that time, in our village, we did not even have proper roads, nor electricity.
After this, I was forced to leap into a much better-developed world where students around me were from privileged backgrounds. They had the means for higher studies and more conducive environments (for learning).
It is not easy being a first-generation learner. It caused me a lot of problems as there was a lot of pressure on me. I could not enjoy an ideal happy childhood and adolescence. I had to work doubly hard and felt burn-out at an early age.
I had to attend to cattle, the farm, work in a hotel, sell newspapers at a bus stand, sell diaries and work to raise money.
Life then was only full of struggles. The work I should have done in my twenties, I did in my adolescence.
My growth was like a bonsai plant. Then I got depressed and took psychiatric treatment for which I lost a year, though I went on to complete my MBBS.
Your research has been accepted in the British Medical Journal. That must have made your parents proud? Was this is a bigger achievement than getting a Padma Shri?
Of course, they were happy.
Imagine, even if our name is published in a newspaper, we read it often, as it gives us immense pride and happiness. In an international journal, it is even more satisfying.
The BMJ rejects 99 per cent of research papers and accepts only one percent which they find relevant. The feeling is not something I can explain in words after I was told they have accepted my research.
The treatment I have recommended is recorded by the BMJ and it is now reaching the doorstep of people living in villages everywhere.
Was your study accepted the first time you submitted it?
Well, initially the editor rejected it.
I then wrote saying I sat throughout with the patient (an eight-year-old boy) and recorded all his symptoms and the effects after administering the medicines. After 24 hours the child survived and I was by the side of this boy.
Then my study got retrospective approval. And I am glad, because today cases of snake and scorpion bites can be treated by any fresher doctor even at a PHC. That is the achievement of my research.
Feature Presentation: Rajesh Alva/Rediff.com
