Portal de Periódicos da CAPES

Mission 2034: Making Pediatric Surgery Greater – Presidential Address Delivered at the Golden Jubilee Conference of Indian Association of Pediatric Surgeons, Rishikesh, 2024

2025; Medknow; Volume: 30; Issue: 1 Linguagem: Inglês

10.4103/jiaps.jiaps_253_24

1998-3891

S. Ramesh Babu,

Sexual Differentiation and Disorders

Prof. S. Ramesh Babu, President IAPS (2023–2024) Distinguished Colleagues, Esteemed Senior Members, Vibrant Youth of the Indian Association of Pediatric Surgeons (IAPS), and Friends, It is with immense pride and great pleasure that I stand before you today, at this momentous Golden Jubilee Conference of our association, the Indian Association of Pediatric Surgeons (IAPS). The pediatric surgery section was started at the Silver Jubilee conference of the Association of Surgeons of India (ASI) in 1964.[1] The first IAPS conference was held at Bombay in 1967 when the first constitution was adopted. The mid-term conference of IAPS was conducted once in 2 years until 1984 when it became an annual event. The term was changed to "annual IAPS conference" in 1990, and today, we are celebrating the 50th Annual Conference. This occasion marks not just a milestone in the history of IAPS, but also a celebration of the collective efforts and unwavering commitment of our founder members who have contributed to the growth and success of pediatric surgery in India. ACKNOWLEDGING OUR PILLARS: SENIOR MEMBERS AND PAST OFFICE-BEARERS As we reflect on the past 50 years, we must first and foremost acknowledge the invaluable contributions of our senior members and past office-bearers.[2] They have been the pillars of this association, guiding us with their wisdom, experience, and dedication. Their role extends beyond the office, and we continue to seek their guidance and mentorship to navigate challenges and seize opportunities. I urge them to stay engaged and support IAPS in its goals. For lasting impact, any initiative must be sustained across leadership terms, fostering a culture of seamless transitions. At this crucial juncture of the golden jubilee IAPSCON, we would like to propose Mission 2034 of making pediatric surgery greater. We have unveiled a road map [Figure 1] where we have paved the way with several calculated steps. I thank our past president Dr. Dasmit Singh, incumbent president Dr. Sumitra Kumar Biswas along with enthusiastic EC members who were fully supportive of our novel initiatives. I would be elaborating on the deluge of initiatives we have taken this year to realize this vision of making pediatric surgery vibrant again [Table 1].Figure 1: Roadmap for Mission 2034 of making pediatric surgery greaterTable 1: Novel Initiatives by the Indian Association of Pediatric Surgeons during 2023–2024PEDIATRIC SURGERY POSITIONS IN MEDICAL COLLEGES Thanks to our predecessors, the National Medical Commission (NMC) has mandated that in medical colleges with 100 surgical beds, 10% will be allotted to pediatric surgery.[2-5] However, they have not specified who will cater to the needs of the children admitted in pediatric surgery beds. With medicolegal awareness, general surgeons are likely to face litigations if they are forced to operate on infants and newborns. Without pediatric surgical support, pediatric/neonatology training programs will also suffer.[6] To emphasize the need for pediatric surgeons in every district, we met the Minister of Health, Shri Mansukh Mandavia Ji. In addition, we made multiple representations via letters to NMC. Dr. Deepak Goel, Dr. Kaniska Das, and Dr. Yogesh Sarin have also made representations to NMC over the last year. We also met Niti Aayog Member, Dr. VK Paul, who appreciated our efforts to reduce infant mortality by spreading pediatric surgery to districts. Our goal is to make MCh/DrNB-qualified pediatric surgeon faculty position, a minimum standard requirement in all NMC-recognized medical colleges. We have written to NMC requesting the continuation of pediatric surgery rotation postings for MS PGs. I request HODs to pursue this matter locally so that the interest of MS PGs in pediatric surgery continues unabated. Several MCh Pediatric surgery postgraduate seats are unfilled. At present, 6-year courses are filled up regularly in apex institutes like AIIMS and they are running without glitches. We have represented to NMC for promoting 6-year MCh course in pediatric surgery in all state medical colleges so that the seats get filled in basic specialty counseling itself. Several young pediatric surgeons this year have started new pediatric surgery positions at districts and tier 2–3 cities. We appreciate all of them as they have taken up the challenge of starting a new clinical service. They have saved huge travel costs for parents who otherwise would have to take these infants and newborns over several miles risking their lives. They have also helped in the development of special services like pediatric anesthesia/radiology etc., in the districts. Although several of them are still acting as a sole pediatric surgical faculty, I bet they will develop a full-fledged pediatric surgery department in the years to come and create more job opportunities. YOUNG MEMBERS OF THE INDIAN ASSOCIATION OF PEDIATRIC SURGEONS AND YUVACON We now have a strong association of 2200+ members and the latest 500 members are youth. This year a new initiative of YUVACON has been started. It is a virtual conference, "Of the Yuva By the Yuva, and For the Yuva." It was a runaway success with a huge number of participants. The leadership session towards the end of the virtual conference had several useful suggestions including the appointment of two Yuva representatives as co-opt members in the EC. This exposure will help to groom them towards future IAPS roles. I thank our vibrant social media team comprising young pediatric surgeons, Dr. Tanmay Motiwala, Dr. Abirami Krithiga, Dr. Vidya Bangalore, Dr. Ajay Kumar, etc. for their contributions. They have made us proud with hashtag #IndiaNeedsPediatricSurgeons in all social media forums during our pediatric surgery day. PEDIATRIC SURGERY DAY AND WEEK Pediatric Surgery Day in December was utilized for theme-based social media campaigns (more of public awareness) while Pediatric Surgery Week in June helped us to promote modern pediatric surgery within institutions (among students and colleagues). This year Pediatric Surgery Week has been revamped with a structured institutional plan to promote pediatric surgery. To kindle interest among MS General Surgery and MD Pediatric Residents, "IAPS Kindle" awards were started. From the IAPS office, a quiz program was designed for MS general surgery and MD pediatric postgraduates. While several departments decided to join online, some institutes conducted the quiz physically. Even an essay competition was conducted for undergraduate students, and three bright students were awarded prizes for their excellent essay on modern pediatric surgery. I hope the structured template we have started for Pediatric Surgery Week [Table 2] can be followed every year by IAPS.Table 2: Template for Pediatric Surgery Day and Pediatric Surgery Week of the Indian Association of Pediatric SurgeonsIAPS ZEE MOBILE APPLICATION: ONE INDIAN ASSOCIATION OF PEDIATRIC SURGEONS, ONE PLATFORM This year android and iOS applications have been launched for IAPS members to stay connected and informed of all IAPS activities [Figure 2]. The long-pending suggestions of past IAPS office-bearers such as congenital anomalies/tumor registry, member update, notifications, JIAPS announcements, election announcements, and districtwise member search have all been realized by this IAPS Zee app. Now, the entire database of members, calendars with dates of different conferences, etc., are available at the fingertips on the IAPS Zee mobile app. All push notifications are available at one point for IAPS Secretary General to make easy announcements. I request members to update their profile photo and address themselves and help us create a digital member database.Figure 2: IAPS Zee mobile application which provides unified platform for profile update, members search, news, guidelines, and registryVIRTUAL MEETINGS, WEBINARS, AND ONLINE INITIATIVES IAPS has been active in virtual teaching initiatives throughout the year. There is an ongoing debate on the safety and ethics of live operative workshops in conferences. While live workshops have been a regular feature of past conferences and were well appreciated by delegates,[7] of late there is a lot of apprehension about the same. IAPS was the first to be heard by NMC as a medical association on the need for live workshops. We stressed our position that live workshops are indeed an essential part of knowledge transfer and proposed a set of measures to make them safe. One of the alternatives to live workshops is to demonstrate the procedures online from an institute to a wide group of virtual audience. This ensures the anesthetic and postoperative safety of the patient and also ensures continuity of care by the primary surgeon. We have now started the initiative of "My VR, Your OR" and demonstrated a few times the feasibility of live streaming with just a capture card through zoom from their own operation theater. Our tech savvy younger generation should take it up and I also urge our IAPS subspecialty sections to use this virtual opportunity to increase their outreach to students. A virtual women conference was conducted online to celebrate women's day. We encourage IAPS Womencon and IAPS YUVACON as regular virtual events under the auspices of IAPS. COLLABORATION WITH OTHER MEDICAL ASSOCIATIONS Thanks to the efforts of Dr. Bajpai, a collaboration has been made with the National Neonatology Forum (NNF) for the first time. The first NNF-IAPS webinar was on newborn jaundice, biliary atresia, and liver transplantation. We wish this collaboration to continue in the years to come. IAPS and IAP president met on the sidelines of medical education conference held at Chennai and discussed the possibility of joint webinars and joint social media campaigns and created joint guidelines in areas of common diseases. I sincerely hope these collaborations continue. We have also initiated a MOU with the Indian Society of Pediatric Nephrology to conduct joint virtual meetings with SPU-IAPS. It is essential to collaborate with other sister associations such as the Federation of Obstetric and Gynecological Societies of India and ASI also. LEGAL AND POLICY ADVOCACY IAPS has been proactive in all legal and policy-making initiatives throughout this term. A legal cell has been formed to offer legal advice to IAPS members; Dr. Pradeep Arora, Dr. Abraham Mammen, Dr. Anil Dubey, and Dr. Alpana Prasad are part of it. Disorders of sexual differentiation (DSD) are back in limelight in courts since activists started questioning the need for any intervention.[4] IAPS apex DSD multidisciplinary committee (AMDC) was formed as early as in November 2023 in line with DSD JIAPS guidelines.[8] AMDC has a mix of pediatric surgeons, pediatric endocrinologists, and child psychologists, and two AMDC meetings have been conducted so far. IAPS has been proactive in setting up a virtual meeting with the Solicitor General Ms. Aishwarya Bhati, and on her insistence, we were invited by the Government of India to brainstorm DSD issues and come up with recommendations. We met twice, once physically at AIIMS and once virtually with department of health to formulate central government DSD guidelines. IAPS has published the results of survey on the decisional satisfaction of grown-up children/adults and their parents.[9] By and large, parents and grown-up DSD patients were very happy with the current treatment being offered in India, and the incidence of gender dysphoria is low in our DSD population. Children's "right to live" and "right to health" are fundamental rights, and IAPS will not give up on the rights of children with DSD to seek necessary medical intervention. INSURANCE FOR CONGENITAL ANOMALIES We are currently facing two issues on the surgical treatment of congenital anomalies: (1) Ayushman Bharat packages for pediatric surgery are meager and not uniform and (2) private insurance companies are not covering congenital internal and external anomalies.[10] Several past presidents and office-bearers have expressed anguish regarding the same and have taken multiple steps.[3-5] We met the finance minister of state Dr. Bhagwat Karad at Delhi and requested for uniformity of Ayushman Bharat packages. We thank Dr. Totla, and AIIMS director Dr. M. Srinivas for guiding us in this regard [Figure 3]. IAPS members Dr. Meera Luthra and Dr. Kant Shah later had a meeting with Dr. V. K. Paul at the planning commission and we thank them for their involvement.Figure 3: Meeting of office-bearers of the Indian Association of Pediatric Surgeons with IRDAI officials and Finance minister of State, Dr. KaradFor safeguarding the rights of middle-class parents on private insurance for their children, we met IRDAI officials and represented that congenital anomalies indeed are accidents of nature and should be covered by private insurance companies.[11] We wrote multiple letters to IRDAI and we had a second virtual meeting with Dr. VK Paul of Niti Ayog. We stressed that children with congenital anomalies should not go untreated due to lack of insurance cover. I sincerely hope future office-bearers will convince other private companies and the Insurance Regulatory and Development Authority of India (IRDAI) to ensure uniform insurance cover for both congenital internal and external anomalies. SECTIONS AND STATE CHAPTERS OF THE INDIAN ASSOCIATION OF PEDIATRIC SURGEONS We have started awarding the best performing subspecialty sections and state chapters, and this year, SPU section and TN state chapters have been awarded for their best performances. As recommended by past presidents, we have streamlined and regularized the activities of many sections this year. Because of our proactive approach, APSO has now completed auditing accounts and RIPSS has completed formal registration with registrar of societies. Thoracic chapter funds have been restored to IAPS account with the help of Dr. Bibekanand Jindal. We have appointed Dr. Manoj Joshi as a convener to register the thoracic chapter, revive it with existing members, and appoint new office-bearers. This year, Jammu and Kashmir state chapter of IAPS has been started and I wish them all success in their future endeavors. The voter list has been thoroughly revised, incorporating all sections membership details this year. I thank our Secretary General and Section Secretaries for this humongous exercise of matching IAPS membership with section membership. For the first time, One IAPS one election has been conducted for PESI, SPU, APSO, and RIPPS. The election exercise through e-voting process was seamlessly led by President Elect, Prof. Dr. Sumitra Biswas and we should continue this "one IAPS-one election" online voting system. We have started issuing certificates of election and certificates of EC completion, as in future evidence of having served in IAPS EC is likely to be mandatory. We request the IAPS members to ensure that they do not create a vacancy of senior positions in sections (like chairman, chairman elect, or secretary) while they contest for elections. We need to introduce the necessary changes in the constitution so that one member holds only one senior position at one point and completes his/her term before becoming eligible to apply for another senior position. With the growth of specialty sections, there are now too many workshops and conferences scheduled within a year. While local institutional events can continue, it is crucial to maintain a 6-week gap between IAPS and section events. We should adopt a uniform calendar so that good delegate attendance can be ensured for IAPSCON and section meetings. We also encourage state chapter conferences to be clubbed with national events wherever possible to minimize travel expenses. During summer, virtual meetings, webinars, case discussions, mock examinations, and collaborations (IAPS-NNF and IAPS-ISPN) can be organized. A liaison between section secretaries and the IAPS Secretary General is needed to ensure a 1-week gap between virtual events. AWARDS REGULARIZATION OF THE INDIAN ASSOCIATION OF PEDIATRIC SURGEONS As suggested by our past presidents, a lot of reforms have been introduced in awards' selection process. A MOU has been signed for Padmashri RK Gandhi Gold medal (With an endowment of INR 10 Lakhs, Contributed by Dr. R K Gandhi family), and the same model of MOU is being applied for all other awards also. I should offer due credits to our past president Dr. Dasmit Singh and past Secretary General Dr. Sanjay Rao for starting this process. The award committee has been expanded to a five-member committee, and the process has become transparent with a credit-based, equitable and representative awarding pattern. We have also proposed that all IAPS awards should undergo a uniform process of advertisement/nomination, followed by merit-based selection without ex-ante recommendation or postfacto approval by any person beyond the awards committee. We have proposed a new award called IAPS Clinical Leadership Award to recognize and honor outstanding pediatric surgeons. Achievers who have demonstrated exemplary leadership in three age groups: 30–40, 40–50, and 50–60 years would be awarded, respectively, at IAPSCON. PUBLICATIONS AND RESEARCH The third edition of IAPS standard treatment guidelines (STG) has been updated and released. We have included many new chapters, and I would like to thank the new contributors. We need to revise IAPS STG every 2 years, and it must be mandated in the constitution. Similarly, IAPS textbook must be revised once in 4 years. We have initiated talks with publishers about the second edition of IAPS textbook and we hope to complete this process within a year with the help of one and all. IAPS has been very active in research activities this year. Two articles have been published in JIAPS by IAPS EC: (1) Guidelines for antenatal counseling based on systematic review[12] and (2) Survey of DSD parents and children on their management decisions.[9] We are glad that a multiauthor book has been completed on minimal access pediatric surgery by our senior IAPS members. A book on thoracoscopic repair of esophageal atresia has been published by Dr. Ravi Kanojia. A color atlas on bladder exstrophy has been released by Dr. S. N. Kureel. A book on multidisciplinary treatment on DSD has been completed by Dr. Simmi Ratan. Three multicenter studies on long-term outcomes have been initiated by IAPS office and are ongoing: (1) bladder exstrophy, (2) esophageal replacement, and (3) DSD. We need to pursue this and ensure that some useful knowledge emerges out of these multicenter studies. EDUCATIONAL AND TRAINING INITIATIVES BY THE INDIAN ASSOCIATION OF PEDIATRIC SURGEONS AND JIAPS Our editor in chief Dr. Rasik Shah has kickstarted a useful initiative JIAPS Abhigyan - a journal review session dedicated to high-impact publication in our flagship journal JIAPS. Such initiatives should continue in future as these will help our IAPS members in producing high-quality articles for JIAPS. IAPS in association with JIAPS is planning to start a certificate course "Scholarium" to teach nuances of research methods, statistics, meta-analysis, and paperwriting. "IAPS Vishwa-mitra" series of lectures by overseas NRI pediatric surgeons was regularly conducted and was well received by one and all. To commemorate golden jubilee of IAPSCON this year, we have started a virtual "IAPS Abhimanyu award paper session" for general surgery, pediatric, and neonatology residents. This initiative will popularize pediatric surgery among these allied specialties, and I hope this session continues in the years to come. SHORT-TERM TRAVEL FELLOWSHIPS OF THE INDIAN ASSOCIATION OF PEDIATRIC SURGEONS: NATIONAL AND OVERSEAS There are several senior IAPS members who have developed a niche area of expertise over the years, and IAPS has explored opportunities for young pediatric surgeons to go and train with them. IAPS has taken up this task of matching a mentor and mentee at both national and overseas levels. We have initiated the process of inviting young pediatric surgeons to apply for national and overseas short-term observer training. This is usually self-funded; however, IAPS will also try to work out cash awards and a certificate of short-term travel fellowship/observership for the first few mentees who complete the program. Several overseas pediatric surgery/pediatric urology NRI consultants have confirmed to IAPS office that they are willing to take candidates as observers abroad. So far, seven candidates have been matched to go abroad for this overseas observer program. We have started talks on collaboration with the British Association of Pediatric Surgeons and have also started exploring the chance of a "funded one-year fellowship" opportunity at Europe and Canada. Dr. Pramod Reddy has come forward for a funded pediatric urology training opportunity. I only hope our young candidates make use of the golden opportunity of overseas pediatric surgical exposure which we have fructified to celebrate Golden Jubilee IAPSCON. EMBRACING THE FUTURE: THE NEED FOR POSITIVITY AND ADAPTABILITY In this rapidly evolving world, the field of pediatric surgery is brimming with opportunities. Modern pediatric surgery is not just a dream; it is a constantly evolving discipline that offers immense scope for growth and innovation. However, to fully harness these opportunities, we must remain positive, adaptable, and forward-thinking. As we celebrate 50 glorious years of IAPSCON, let us honor our past, embrace our present, and confidently stride into the future. I want to thank the Golden Jubilee IAPSCON organizers for a wonderful show. "Coming together is a beginning. Keeping together is progress. Working together is success," said Henry Ford. Several IAPS members have supported the IAPS office at different levels for the benefit of our IAPS family this year. I see a lot of enthusiasm and hope in the Zee generation leaders and the last day of IAPSCON witnessed this generational shift where the young pediatric surgeons took over the whole show. With their unwavering commitment, I am sure we will achieve Mission 2034 of making pediatric surgery greater. Finally, I would like to extend my heartfelt thanks and appreciation to IAPS Secretary General Dr. Vikesh Agrawal for his unwavering commitment, exceptional enthusiasm, teambuilding skills, and sincere involvement in executing all our initiatives. During my tenure, a remarkable transformation occurred as all IAPS members, the executive, and top leadership collaborated seamlessly to envision, plan, execute, and analyze our goals continuously. I feel very satisfied to handover the legacy of the IAPS to the man of wisdom, Prof Dr. Sumitra Biswas, our next President, and I am sure that he will take IAPS to newer heights. Long live IAPS! Jai Hind!!