Presidential Speech IAPSCON 2023

ABSTRACT

Respected Chief Guest, guests from overseas, esteemed colleagues, dear students, and friends, I am deeply honoured to address you at this prestigious gathering at the Indian Association of Paediatric Surgeons (IAPS) Conference. I take this opportunity to remind all members that our responsibility extends far beyond our operating theatres. The Incidence of congenital anomalies in India is still 18.2/1000 live births with a high mortality of about 6.78/1000 live births, with a vast majority of these children with congenital anomalies being born into poor families, resulting in a large proportion of children being left untreated or incompletely treated. To address these problems, the IAPS makes the following suggestions: (1) Urgent instructions from the government to insurance providers to launch affordable and easily accessible insurance policies that address the needs of newborns, infants, and children. (2) To ensure the appointment of at least one pediatric surgeon for every pediatric intensive care unit/neonatal intensive care unit being set up in district hospitals. (3) To make pediatric surgery an essential subject in the undergraduate curriculum at MBBS level and ensure that medical colleges and district hospitals have at least one full-time pediatric surgeon on their faculty. (4) To ensure that newborns and children (up to the age of 18 years) have access to a pediatric surgeon or specialist who is well trained in surgery on children, much like medical problems in this age group are treated by pediatricians, surgical problems should be entrusted to pediatric surgeons. Someday, a pediatric surgeon for every child’s operation may become a reality. Hope that day is not too far away.

Respected Chief Guest, guests from overseas, esteemed colleagues, dear students and friends,

I am deeply honored to address you at this prestigious gathering as the Indian Association of Paediatric Surgeons (IAPS) Conference serves as a testament to our collective dedication to the field of pediatric surgery and underlines our unwavering commitment to the well-being of the youngest members of our society.

I take this opportunity to remind all members that our responsibility extends far beyond our operating theatres - it encompasses the holistic care, well-being, and futures of our young patients requiring not only exceptional medical expertise but also empathy, patience, and a profound sense of responsibility, We must be vocal champions for the rights and well-being of children, advocating for accessible and equitable healthcare for all.

Our healthcare systems have evolved phenomenally, and it is crucial that we stay at the forefront of innovation. As we gather at the IAPS conference to exchange our experiences, share knowledge, and discuss the latest developments, we have an opportunity to harness the collective wisdom of our community and drive progress in pediatric surgery. At present, the Indian Paediatric Surgical community has grown to a healthy number of 1900+ in the country with several hundreds more in training. Each has to become a brand ambassador for our specialty.

Born in 1879, pediatric surgery got recognized as the surgical care of birth defects requiring novel techniques, which also required specialized hospitals able to handle children. By the 1940s, surgical repair of birth defects which were previously considered untreatable started becoming successful. By late 1970s, the infant mortality from major congenital malformations reduced to under 5%. The figures have only been improving thereafter.

Such is the importance of surgery on children that a Global Initiative for Children’s Surgery was launched in 2016 and a model was developed to Advance the Surgical Care of Children. This identified four pillars: development of infrastructure, service delivery, training, and research, and relevant guidelines were created for each vertical. This shortlisted the personnel, equipment, facilities, procedures, training protocols, research, and quality improvement components at all levels of care.

However, at the governmental level, due to limited visibility, the care of children with surgical diseases has still remained an underappreciated and underfunded area in health care, and this is despite congenital anomalies making up 9% of the surgical burden of disease worldwide. Two-thirds of this burden may be preventable with timely surgical intervention of these anomalies. It is also estimated that one-third of all childhood deaths occur due to a surgical condition even though the presentation may have resembled a Paediatric Medical Condition.

To top it all, The UN Millenium Development Goals has envisaged the goal of controlling preventable deaths of newborns and children under 5 years by 2030. Now, this can be only done with a large investment in children’s surgery. World Health Assembly resolution WHA68.15 finally recognized the importance of strengthening emergency and essential surgical care in children as an essential component of universal health care.

Moreover, after 1990s, there is a significant decline in infectious diseases, paralleled by an increase in diseases amenable to surgical care and Congenital anomalies increased from the seventh most common cause of death in children under 5 to the fifth most common cause. This increase in the incidence of congenital anomalies and decrease in the incidence of infectious diseases, places congenital malformations ahead of HIV, tuberculosis and malaria as a cause of under 5 mortality. Hence, a larger contribution is going to be required from pediatric surgeons, thus we need to invest a lot more resources into this specialty.

With 40% of India’s population consisting of children, <8% of children in lower-middle-income countries have access to expert surgical care, while almost 1–2 lakh patients in our country require surgery annually. Such is the robust demand for the services of a pediatric surgeon. This is a huge deficiency identified by GAP Analysis.

Keeping these goals in mind, the IAPS has taken on the mantle of bringing forth these facts across all stakeholders. One such endeavor is to celebrate Paediatric Surgery Day on December 29 every year, which is the day the association was founded in 1965.

The theme for Paediatric Surgery Day in December 2022 was “Your paediatric surgeon – The safest option for your child’s surgery.” This was celebrated with a massive print media and social media blitz created by our team of young members. The traction gained nationwide was extremely successful in centralizing the focus on pediatric surgery and the pediatric surgeon. The idea is to generate some candid glory for this crucial branch, which it so genuinely deserves.

Similarly, the Paediatric Surgery Week was celebrated in June 5–11, 2023, with the theme promoted being incontinence of urine and stools. Many nationwide campaigns were run successfully and presentations and videos, designed professionally, are still being run in many hospital lobbies even today.

Such activities will automatically spawn the cause of pediatric surgery among both parents, medical students, and governing bodies to ensure that the best possible treatment is made available to children.

The state chapters and the subchapters also progressively came into existence, each organizing an annual conference under the aegis of the IAPS. Such an academic meet is a great forum where teachers and students from medical colleges and private practitioners from urban and rural destinations interact and share their mutual experiences.

Our association has come a long way since its founding fathers toiled really hard and gave it a separate identity from ASI. We are now proud to have 50 training centers established, training about 150 pediatric surgeons every year, but lots more needs to be done.

One area being focused on is securing better popularity and a luring appeal to our surgical residents to take up pediatric surgery as a choice superspecialty. As such, there is enough evidence that pediatric surgery is a recession-proof branch as well as provides a great opportunity for service to society, so the potential just needs to be harnessed appropriately.

We soon expect equitable resource utilization by our health department by making the services of pediatric surgeons available in all medical colleges and hospitals of the country.

In the draft proposal of our National Medical Commission regarding minimal standard requirements for new medical colleges, we were successful in getting included a clause wherein any institution with 100 intake capacity of MBBS students per year, which is mandated to have a neonatal intensive care unit (NICU) and a pediatric unit, a pediatric surgeon must also be appointed. The draft had further proposed 4 units of general surgery of which we have stipulated that 1 unit should be made into a pediatric surgery unit. This would not only benefit the children of the local communities but also generate employment for pediatric surgeons addressing their long-pressed demands.

Getting the insurance companies to recognize congenital anomalies as an essential group for reimbursement of medical expenses has been a challenge and a start has been made with some companies providing limited services, but a lot more work needs to be done to make insurance available to each and every child.

We have made periodic representations to the health and finance ministry in this regard with limited success.

While the Insurance Regulatory and Development Authority of India has issued summary guidelines to the insurance companies for insurance of children’s surgeries, it has not found universal success amongst the insurance companies. We seek the personal intervention of Honorable Minister Dr Bhagwat Karad to ensure this is looked into in the best interest of children who are the future workforce of our nation.

The best part of pediatric surgery is the fact that in most cases, once operated, the children become normal, productive citizens of the country with great motivation to do good for other citizens and that is often an unseen benefit of pediatric surgical patients.

The incidence of congenital anomalies in India is still 18.2/1000 live births with a high mortality of about 6.78/1000 live births, with a vast majority of these children with congenital anomalies being born into poor families, resulting in a large proportion of children being left untreated or incompletely treated.

To address these problems, the IAPS makes the following suggestions:

1. Urgent instructions from the government to insurance providers to launch affordable and easily accessible insurance policies that address the needs of newborns, infants, and children

2. To ensure the appointment of at least one pediatric surgeon for every pediatric intensive care unit/NICU being set up in district hospitals

3. To make pediatric surgery an essential subject in the undergraduate curriculum at MBBS level and ensure that medical colleges and district hospitals have at least one full-time pediatric surgeon on their faculty

4. To ensure that newborns and children (up to the age of 18 years) have access to a pediatric surgeon or specialist who is well-trained in surgery on children, much like medical problems in this age group are treated by pediatricians, surgical problems should be entrusted to pediatric surgeons.

We are confident that the implementation of the above suggestions will help to improve funding and make access to pediatric surgical care easier.

Someday, a pediatric surgeon for every child’s operation may become a reality. Hope that day is not too far away.

Before I conclude, I would like to express my deep gratitude to the organizing team for a wonderfully organized workshop and conference and a special thank you to all the faculty and each delegate for making this conference a huge success.

Thank you all.

Long Live IAPS.

Jai Hind.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.