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The President's inaugural address during ISACON 2017 on November 26, 2017, at Kolkata

2018; Medknow; Volume: 62; Issue: 1 Linguagem: Inglês

10.4103/ija.ija_785_17

0976-2817

BB Mishra,

Global Health and Surgery

Good evening to you all. I start with a great Oriya poem 'Kehi rahinahi Kehi rahibe nahiti; Bhaba ranga bhumi tale Sarbe nija nija abhinaya sari; Bahudube kala bele' Which means 'nothing is permanent in this world, all have to leave...... after completing their task and role; with the passage of time.' At the outset, I thank all my fellow colleagues, governing council members, my mentors and my seniors for the unconditional support. I thank the almighty for the profuse blessings – to accomplish my tasks – to complete my tenure in my journey of Presidentship of Indian Society of Anaesthesiologist (ISA) 2016–17 from Ludhiana to Kolkata. The theme of 65th ISACON is enigma to reality. It's strange but I somehow correlate my personal attributes a lot to the theme of the conference this year. I'm sure a lot of people find it very difficult to understand me and find me mysterious in many ways. Let me help you look a little deeper into my personal thoughts, my tenure as the President and me as a person in general. Since I can remember, I've always been a driven and highly ambitious person. Every human has a list of things they set out to achieve in their lifetime in short, their 'wish list'. I feel very privileged to be saying that, I achieved the number one thing on my wish list – to serve as the President of ISA. In my tenure as the President, I've come to know of many truths. As a President, I can say it was quite an eventful year. It gave me the opportunity to travel across the length and breadth of this country. It gave me the opportunity to represent ISA at South Asian Association for Regional Cooperation Association of Anaesthesiologists congress at Colombo, Sri Lanka. Though there was an invitation from the Chinese Society of Anaesthesiologists (CSA), I decided not to attend the CSA conference because of Doclam issue as my nation is above my society. I had personal as well as professional ups and downs. I was diagnosed with adenocarcinoma left lung, Stage IV, sometime back but even that couldn't shake my passion for serving this society. This isn't the time to get into the details of it, but I wanted to mention this to tell you that, I'm a man who turns every weakness to my strength. Like a famous quote goes, 'when life throws you a curveball, you hit it out of the park'. I thank all the coordinators of zonal PG Assemblies for making it possible to hold all the six zonal PG assemblies this year, which was the concept started for preparing the final-year PG and DNB students to appear their exams. Out of 150 countries, India was selected for the project 'Safe Country; Safe Anesthesia' by World Federation of Societies of Anaesthesiologists (WFSA). The project is implemented in the state of Telangana. I thank WFSA for selecting India and Government of Telangana for agreeing for the project to be conducted in Telangana. Under this project, four young anaesthesiologists from Telangana were nominated by ISA to attend ASA congress at Houston, USA, and their registration, to and fro flight charges and hotel accommodation were borne by WFSA. The number of Inland scholarships has been increased to 10 this year. The selection test will be conducted tomorrow in hall A from 7 AM to 8.30 AM. ISA will bear an expenditure of Rs. 35,000 per candidate for nominating them to the centre of their choice for observership for a duration of 1 week. I thank Neon Pharma for the financial support for Inland scholarship program. The concept of formulating the ISA resuscitation guidelines which was overdue could take a concrete shape. Yes; societies' conscious resuscitation guidelines thought was made by Prof. PF Kotur and his team, with lot of inputs by Prof. Manimala Rao in 2010 and 2011. But ISA was forced to opt out from that project. Today, I thank the coordinator Dr. SSC Chakra Rao and the team of Prof. Rakesh Garg of AIIMS, New Delhi, Prof. Syed Moied of AMU, Aligarh and Dr. Mukul Kapoor of Delhi for preparing the algorithms and the manuals. I thank all the participants who attended the training of trainer program on 24th and 25th November; we can conduct workshops of cardiopulmonary resuscitation (CPR) based on ISA resuscitation guidelines in different corners of this country. The headquarters for this has been started at Kakinada with a financial support of Rs. 7.7 lakhs from Rangarai Medical College Alumni of North America in procuring the mannequins. We are the first society in the world to formulate the compression-only life support guidelines. Ours is a country with 1.3 billion population; every day, a number of resuscitations are happening across the length and breadth of this country; for any resuscitation in the hospital, always the anaesthesiologist is called and the only thing we have to do is to capture the data. For this, we have made a web site with a dedicated server. One can upload the data and retrieve their data for publication in any journal. ISA will use these data for modification of the guidelines in future. In 1 year, if not a lakh, we can have some thousand data. I propose to form a research wing of ISA for CPR and a board for coordinating with other countries and International Liaison Committee on Resuscitation. For the first time, we have started the mentor and mentee program. It is the first of its kind to be started by any anaesthesia society in this world. Out of 20 mentors selected by ISA; 15 mentors attended the training program for mentors. This program is on Harvard School module and first of its kind in the world. This year, the WFSA theme is 'safe anesthesia is essential for safe surgery'. For safe anaesthesia, there is a need for practice of safety and quality excellence by the anaesthesiologists. Safety in anaesthesia improved dramatically after 2000, partly due to the introduction of monitoring standards. The required standards of monitoring were formalised by ISA in monitoring during anaesthesia and recovery. Moreover, safe anaesthesia requires the presence of a qualified anaesthesia provider who has access to the appropriate drugs, equipment and facilities and is able to work with a trained assistant. Unfortunately, these standards are not available to many of our colleagues in this country and around the world. Quality excellence in anesthesia What is excellence in anaesthesiology? How do we measure it? What can we do to understand, assess and improve this essential aspect of our practice? Recent trends in training and assessment in anaesthesiology have focused on the acquisition and demonstration of competencies. Although competence is a necessary prerequisite for excellence, it is not in itself sufficient. In setting our sights on competence, we may miss the opportunity to aim higher. Nevertheless, there is still something to be gained from subdividing practice and examining the individual parts. This can lead to higher standards and improvements in professional skill, but the isolated part must be set within the total professional task of the anaesthesiologist for these improvements to be realised. We owe to our patients, our colleagues and ourselves to strive for excellence in all that we do. Safe, high-quality patient care, good working relationships and our own professional pride and fulfilment are all at stake. Nevertheless, for all its importance, attempts to explore the many facets of excellence in anaesthesiology have been made only recently. Anaesthesiologist is the leader in many occasions as a healthcare provider. Hence, the anaesthesiologist is expected to lead the team on many occasions, be it trauma management, disaster management or the services in the emergency room. With respect to teamwork, leadership and coordination within and between teams are important human factors. What exactly constitutes good teamwork varies to some degree with regard to team and task characteristics (e.g., task complexity, time pressure and standardisation). However, research indicates that there are core competencies constituting good teamwork. For example, the 'big five' model suggests that teamwork requires five competencies: Team leadership Mutual performance monitoring Backup behaviour Adaptability and Team orientation. These five competencies require the support of coordinating mechanisms such as shared mental models, closed-looped communication and mutual trust. A more recent approach suggests that the growing number of more dynamic, ad hoc teams and multiple team memberships requires 'teaming', that is the ability to quickly set the stage for working well in any team. Core teaming processes are speaking up, collaboration, experimentation and reflection. Particularly, the importance of speaking up as a central teamwork competence is being more and more acknowledged. Today, there is an enormous increase in the number of violence against healthcare providers. Stringent laws or a penalty is the need of the hour to stop these incidences being repeated. Patients' demand is growing in leaps and bounds. They want to actively participate in the therapeutic decisions and want all decisions to be informed and intelligent. Lack of understanding of anaesthesia being an essential part of secondary health-care services is now not merely limited to the operating room. Administrators forget anaesthesiologist services are also required in the emergency room, Intensive Care Units, catheterisation laboratory, magnetic resonance imaging suite, pain clinics, resuscitative rooms, electroconvulsive therapy. Thus, I reckon that we need to look into certain important aspects besides medical skills; doctors must learn sociology, psychology and man managerial skills such as effective communication, and doctors have to have a patient ear. Hence, the most important four things we should look into are communication, documentation, communication of documentation and documentation of communication. The ISA welfare scheme, the Family Benevolent Fund (FBF), requires members' participation. It is the only way we can help our own colleague's family. At present, we are able to disburse rupees 5 lakhs; with increase in the number of membership to 4000, we will be able to disburse ten lakhs to the family. I request the ISA members who are not the members of FBF to become the member of FBF. Anaesthesiology is the practice of medicine dedicated to the total care of the patient before, during and after surgery. Hence, I want every anaesthesiologist to develop the attitude of leadership. Small and steady steps can be quite big and spectacular. They move you to a bigger place. And as I get older, I've realised that the only thing that speeds up is time. But as much as its true that time is a thief, time also leaves something in exchange. With time comes experience – and however uncertain you may be about the rest of the world, at least about your own work you will be sure. On this note, I have something small yet important to share with the next and the other future Presidents of ISA sitting in this auditorium. One of the greatest gifts you can give yourself, right here, right now, in this single, solitary, monumental moment in your life is to decide, without apology, to commit to the journey and not to the outcome. I thank Prof. Bibhu Kalyani Das and her team for the excellent academic feast. I congratulate Dr. Arabinda Ray, Dr. Subhendu Sarkar and Dr. Sumanta Dasgupta and their team for the excellent arrangements of 65th annual conference of ISA. I wish all success for the conference. Let me wind up with a quote of Patrick Lencioni: 'Remember, teamwork begins by building trust. And the only way to do that is to overcome our need for invulnerability'. – Together, we can make a change – to improve patient care and access to safe anaesthesia. Long live ISA.