Interview with Dr. Janaki Vishwanath MD [Paed], Fellowship in Neonatology, Sydney, Australia
Dr. Janaki Vishwanath is a beloved teacher and superb neonatologist, and a wonderful human being, currently heading the Dept of Pediatrics and Neonatology at Rangadore Memorial Hospital. Shekindly accepted our invitation to share some snippets from her life and times.
Dr. Janaki, thank you so much for your time. Tell us something of your early childhood. What made you choose the career of medicine ?
It was when I was in the 6th std, my father sat me down and spoke to me. My late father, who served in the higher Management at Kirloskar Electric was a strict disciplinarian, a Gandhian and spoke impeccable English. He said “Apply your mind to study hard, a doctor’s profession is service- oriented,noble and the only one in which you can help a lot of people in need. And we cannot afford to pay capitation!” Myimpressionable pre-teen mind registered only the bit about serving people and studying hard and I was hooked!Of course, then career choices were restricted to two streams, medicine or engineering! After the tenth standard exam, all serious medicine hopefuls made a beeline to the National college to do their PUC, the college then with the best training ground for science students. I did too, my father’s next words stressing me all the more ‘You MUST get into the BMC only! I shall not send my daughter away to a hostel for five years!’ I succeeded! Guess it was aptitude, focus and a father’s passion for his daughter that worked.
Dr. Janaki, can you recall your UG days at the BMC ? What were your influences ?
Students are very influenced by their teachers and I can recall a few right away. Dr DG Benakappa, doyen in Paediatrics was the reason I chose pediatrics as my PG course. Remember the exact day! In my third-year clinical posting in his ward, we gathered around him, as he explained about the four-year-old thin boy squatting on the bed, calling him ‘Krishna’ on account of his blue tinted dark skin. While sad with the diagnosis, I was thrilled to witness a master clinician at work at physically diagnosing a Fallot’s tetralogy and vowed to follow in his footsteps if I could.
If I am disciplined and stick to practicing it with my team, it’s all thanks to late Prof Hande, his assistants Drs Anwar and Nagabhushan. My best friend and I rode the bus to Bowring Hospital each morning from Hanumanthnagar to attend the Medicine Unit. One morning we landed at 8-15am instead of 8-00 am, and we were made to stand outside the ward for an hour, as the grand rounds were being conducted inside. The humiliation was a disguised lesson for life. We learnt discipline, clinical skills and basics from that wonderful team in internal medicine. And that punctuality I now demand from my Fellows!
Late Dr Srikanta, Prof in surgery, showed me that camaraderie among the team is so rewarding. He took the unit every weekend to the local eatery to feast on mosuruvade. He was a staunch advocate of the girl child, unusual for that era, and I was inspired and impressed.
We had eminent physicians, Dr Das and Dr B M Jayaram, two elegant and polished clinicians [they actually wore bow ties] and Dr Dhruvanarayan tutoring us in physiology in BMC. Unforgettable teachers all, we were lucky to have them.
Dr. Janaki, your PG days in BMC were your significant years in many ways.
Yes, they were. I was to meet and know three important teachers -Dr DGB, Dr Shivananda[Meshtru}and Dr D Vishwanath.The triad! We were quizzed by Prof DGB with questions that Nelson did not offer answers to. Rescuing us, Dr Shivananda pushed us to read the latestjournals, PCNA or IJP [red journal] and IP!DR DGB was always so update in the subject, he impressed upon me the need to constantly renew myself with the latest in the field. Meshtru would call us to see cases at odd hours 4-30 to 6pm, then DV would take clinics from 6 to 8:30 pm! We PGs learnt all our clinical pediatrics from them, examining patients then reading up theory.
Dr Malathi Yashwanth set a new standard in patient care. Sunday rounds were no different than weekdays in the thorough attention to detail and workup of the child. Madam would patiently listen to and answer all the mothers’ queries, and make sure all us had examined each system! I learnt about commitment in child care and sincereattention to minutiae from her.
While on duty with Dr HMV Kumar -a funny incident comes to mind. PGs were let loose on the patients first and then the senior on duty would come and give his opinion on management. We students were gathered around a post-dated newborn with typical features of loose skin, wrinkles etc. The senior walks in, spots the baby from afar and starts shouting at the attendant, saying why have you brought the child in this state so late, he is in severe dehydration etc. The father looking confused says ‘sir, it was born four hours ago” and the abashed senior shook his hand instead. How we laughed! We learnt a lesson here too. Take a history first!!
Dr. Janaki, you met your future husband in VVCH !
I am coming to that! I was destined to wed Dr DV and continue to spend glorious years with him as my husband, guide, mentor,and support and caring father to my two children ever sincethen. He is my go-to person in every need, my sounding board!
Dr Kishore Baindur, our classmate adds:
‘DV as I see him- humble, dedicated and humane. Teaching is his passion,and he knew his basics like the back of his hand. He was always ready to share his knowledge with each one of us. Boon to us students was his availability to help at any emergency at any time. Stage-shy, he remained a workaholic. He was integral to the success of national Pedicon 1980.
My addition(SB) -
I recall DV painstakingly demonstrating a venous cut down on a moribund dehydrated infant in the chaotic GE ward, to save his life. Intra osseous procedure was only learnt post MD. He took clinics for exam-going-student’s after-hours. Once, such an intensive coaching for a select gathering took place in my family apartment that had not been tenanted for months. I remember serving everyone tap water believing it to be fresh. Imagine my chagrin, when weeks later I discovered that what I served was tank water stagnant for months! No damage done, luckily, especially as we were exam-going in a few weeks!
Dr. Janaki, do go on.
Do you remember the elegant Dr Rajam Ramamurthy, an award-winning neonatologist,and alumnus of BMC,who spoke to us on newborn resuscitation using her prizewinning mannequin? I was entranced. This was in our third year MD and I decided that this is what I wished to pursue.
As PGs posted in the Sick Newborn Wards, we had the horrific task of certifying daily deaths, at least two or three per day! Hypothermia? Sepsis? God alone knows. I vowed to make a difference somehow, sometime in my lifetime!
Dr. Janaki your MD was done in 1985. Where did you begin your pediatric career ?
I joined the Ambedkar Medical college ‘86 and in 7 years I was Associate professor. Always focused with dreams of neonatology, I applied in India. I was not offered any post apart from Observer-ship in PGI or AIIMS, there being no DM at that time.
I wanted formal training, and with immense support from family, in ‘94, I was accepted and went to the Nepean University Hospital in Sydney, Australia. It was a wonderful experience. We trained UGs and nurses. I spent 18 useful months on hands-on training and learnt enough to be confident to set up an NICU on my own.
I was at the fork in the road again. I was unwilling to stay back and work for a country, where I remained a cog in awell-oiled machine and where I would certainly not be missed. On the other hand, my work backhome could make a huge impact to my own country’s new-borns, a difference to our babies’survival [certifying three deaths at end of each day in the SNW was intolerable statistics]. I saw that my UG /PG education was govt funded and we had paid peanuts at that time from our pockets, I needed to give back! My decision was made. I came home.
Their loss has been our gain! Please go on.
It was not easy. I started with Bangalore Childrens Hospital in RR Nagar and worked with Dr Hariram for 3.5 years. At that time, NICU care at tertiary level was only available in Manipal, St Johns and MSRMCH. We were a valuable addition to the city’s NICU need, but the hospital was twelve kms away from my home and there were too many days when I or Dr Hariram stayed behind overnight, to care for the ventilated new-born. We had no Fellows. Registrars were hard to get. When we did get them, many went on to Australia with my reference and succeeded there. So, without a team, it was tough to run the unit.
I moved. And decided that training a team was dire. That was when I took up intensive training of nurses and Fellows at the KR Hospital in Hanumanth Nagar, Fellowship from the RGUHS, later from the NNF And the IAP. Care improved tremendously. Dr Ranjan K Pejaver was my colleague. I was at KR Hospital for 14 years, with lots of good work and innumerable success stories.
Rangadore Memorial Hospital, Shankarpuram has been set up by you in 2014 full time, and is running as an excellent tertiary referral NICU as well as a centre for training of fellows in the RGUHS, NNF and IAP with students enrolled from all over the country.
At RMH, our range of patient clientele varies from City Market vegetable vendors to those in higher echelons in tech companies. When a patient can’t pay, we charge a little, 30% maybe [free treatment is not valued] and make up the deficit with donations. Win-win for all. Our NICU caters to in-borns that are products of high-risk pregnancies that RMH is known to accept with its highly trained Obs-Gyn team as well referrals from the city and outside. Our fellows come from various backgrounds. Some of them quit well paid jobs to come learn with us and it’s my responsibility to ensure that they learn from even the experienced nursing staff as well. I have a gem of a nurse who has been with me fifteen years and I tell my fellows don’t be ashamed of owning to being helped. The challenge is building the dream team. NICU is TEAM work. Each one teaches many, passing on what he or she has learnt.
Training nurses and registrars and retaining them is the biggest success anyone can hope for. Nurses trained with us get fabulous offers from overseas and staff attrition always looms. No regrets there, as their future matters too. In RMH we started the formal fellowship NNF exam for nurses and we have 3 award winning nurses.
It was in 2018, I dreamt of Breast Milk Banking [BMB]. Then Covid hit with a funds crunch with which our hospital was badly hit. What was needed was 30-40 lakhs and I dared not ask the management. Our hospital works with a few entrepreneurs and corporate houses whose CSR permits funds to be released for a just cause. And this happened to be a dream come true! I wanted it so badly, it did turn into a reality, thanks to a generous donor. When I told him, he said, ’that’s all?’ We now have an established BMB that has not only fed our own 750 preemies, we do give it to other hospital NICUs too on request, and at nominal cost. I am grateful to our generous mothers for the donor milk, they have been loving saviours.
Dr Janaki,you were deservedly awarded’Best teacher’ by the NNF a few years ago. Can you tell us what are the attributesof a passionate teacher? What makes an ideal student? How do you handle Fellows and DNB students differently? Finally, you are reputed to be exacting ?
I believe wide experience of a senior teacher should be shared with the students as much as textbook knowledge is. When a baby’s case study is atypical, not going according to the standard text, I teach from my experience to help them think out of the box to solve the case,and not offer lengthy lectures. Anything that stimulates independent and responsible thought processes, makes them keen to learn, and I give them projects with Q &A, in my teaching. Students learn so much by the example the teacher sets,and so we walk the talk! Modeling compassion and caring, I can set the tone for better clinicians, and so great care for futuregenerations.
Ideal students? Doctors who are keen to learn and have an aptitude, who are innately good human beings with good communication skills, make ideal students. Punctuality is a must. Come on time, not worrying about when you will be let off.
DNB/MD students, I focus on teaching them clinical diagnoses and management whereas Fellows are drilled on counselling, communication, documentation and management of the unit.
Equipment handling, nurses’ training, overall care of unit is the Fellows field of learning. [Laughing]
So I have a dubious reputation of being very tough? I know I am finicky about certain things where I will not compromise, as in, if it involves patients’ safety and care. For example,in our unit, the Fellows check the crash cart every single day, one of many on the checklist. Protocols are dinned in their heads and they are expected to teach nursing staff regularly as they learn new things. Many Fellows trained with us, have implemented the same in their units countrywide and expressed gratitude for the strictness we had enforced. I set an example for excellence in patient care and demand the same from them. If that is being strict, so be it! My students and I share a wonderful camaraderie. They know I care deeply.
My principle of ever admonishing them in private and praising them in public has held good since I began teaching years ago. I value students who work with integrity and application and extend a lot of help in their facing the exam with confidence.
Dr Janaki, can you share some of your counselling tips ?
I find talking to the extended family esp. the parents-in-law and father very helpful in resolving crises that may crop up. Inter-familial blame-games get defused. Nutritional and psychological support of mother is ensured, with the family rallying around. Counselling is draining but following protocols and bringing to the conversation sense, empathy and a listening ear mitigate any setbacks.
Dr Janaki, finally, what do you attribute your success to?
My Parents! They have been my pillars of support all along as I balanced kids and a demanding career.
My husband DV! He and I took turns at bringing up our children, being with them, tutoring them in values and academics, while sharing our sense of joy and fulfilment in our own vocation. My kids wanted me home between 6-9 pm that I tried to honour. So much so, I must tell you this touching anecdote. I overheard a conversation between my son and his friend.“Hey Sriram, how did you celebrate Ugadi?” and my son went “when my mom and dad are BOTH at home, that means Ugadi!”. We could talk forever about quantity vs quality of time in raising kids, but kids know better.
The children are opposite poles. My daughter Shruti, a pure scientist and a petite person physically, is tall in stature with many PHD students benefitting with her impeccable guidance and work ethics, at the National Institute of Biological Sciences, a premier institution. I have two grandsons that are my pure joy.
My son Sriram is in the USA in a tech company and is as happy on the sports field as at his desk, right from his boyhood.
Dr Janaki it has been a pleasure to talk with you and see your life and vision. Where do you see yourself in the future?
It’s been along journey with no regrets at all [unless you remember the thought, I had had at the medicine crossroad, of taking up vocal music as a career!] I have achieved much and more than I deserve. Even today I meet NICU grads that have made it to success and happiness who come back and let me give them a hug. I will concentrate on phasing out the letting go over the next few years of course. I love my work and will retire when I need to, with no looking back!
Thank you, Dr Janaki, our readers are sure to find solace and inspiration from your life well-lived, and we wish you good health, great peace and lots of happiness.