The Doctors Guleria of AIIMS

From Kangra to AIIMS in New Delhi, Dr JS Guleria and son Dr Randeep Guleria, both Padma Shri awardees, have come a long way. The father, now 93, was Dean, AIIMS, where he started teaching the first batch of students in 1958. He retired in 1987, having set up OPD clinics in cardiology & medicine. The son, 61, is the incumbent AIIMS Director and member of the National Task Force on Covid-19. In an interview to Aditi Tandon, the Gulerias talk about Covid, AIIMS, their beginnings in Himachal and brushes with three PMs

The Centre has unlocked virtually everything even as Covid-19 cases are rising. Is that a concern?

Randeep Guleria: We haven’t reached a situation where we can say the disease has plateaued but at the same time, it’s important to restart the economy. People must understand that we are still in the thick of the pandemic and their responsibility in terms of wearing masks, maintaining physical distance and washing hands is more today than it was during the lockdown when restrictions made adherence to precautions easy. There’s a Covid fatigue in people and that’s a concern.

Will the virus get more virulent in winter?

RG: The combination of air pollution and other viral infections like influenza as well as Covid-19 will increase hospitalisation and the burden on health system in winter.

Should we expect a Covid peak in the upcoming festive season?

RG: That’s a concern. People tend to crowd during festivals and cases may rise. For the country as a whole, it will take some time to say we have peaked and cases are coming down, but I hope we can weather the storm as far as the festive season goes.

What is the burden of asymptomatic cases in India?

RG: Nearly 40 to 60 per cent patients may be asymptomatic or mildly symptomatic. So there are a large number of people who can spread the virus but don’t take precautions assuming they are Covid-free. That’s why infections continue to spread. Everyone must wear masks to break the chain of transmission.

When can we expect the vaccine?

RG: By early next year, but the challenge is how we market it once we have it; how do we produce enough doses, syringes, vials, how do we train people and ensure an efficient cold chain so the vaccine reaches the priority populations. The government is working on this.

What level of vaccine efficacy are you expecting?

RG: Any efficacy over 50 to 60 per cent will be acceptable as that will give us some decrease in case numbers. We can vaccinate high-risk groups and reduce cases enough for normal activities to restart.

Is the virus in India mutating?

RG: Current news is that the virus hasn’t changed significantly for a vaccine not to be effective. Unlike influenza virus, this virus continues to be relative stable. That’s very good news for vaccine development.

Dr JS Guleria, you have practised medicine for nearly 70 years now. Why do you think India’s Covid mortality is so low?

JS Guleria: India has inherent immunity and the previous BCG vaccine could have played a role.

Despite the strictest lockdown, why are India’s cases the second highest in the world?

RG: Certain things happened during the lockdown which were not expected. Migrants started going home and many people didn’t follow the lockdown strictly and moved around. The lockdown served us more in preparing healthcare facilities better. We also reached a stage where we were trying to restart the economy and lifted the lockdown when we did not have a downward trend. That’s why we have been emphasising that although the lockdown has been lifted, our responsibility in terms of Covid-appropriate behaviour continues.

What are your abiding memories of Himachal?

JSG: The memory of my school in Kangra’s Indora, which was the only boarding school at the time. It was up to Class X and was located in a jungle. Our bathroom used to be 3 km away; our breakfast was two chapattis made of wheat and chana; lunch was Ganga Jamuni daal. It was a very rigid life, but I guess that is the reason why I am 93 today.

You studied medicine at Amritsar. What brought you to AIIMS-Delhi?

JSG: I actually wanted to be an agriculturist but was rejected in the interview for admission to Punjab Agricultural College, Lyallpur. Then I decided to study medicine and joined DAV College, Lahore. After Partition, I returned to Kangra and then pursued MD at Amritsar Medical College. Just when I got selected for Punjab Civil Medical Services, a pensionable job, I learnt of an opening in AIIMS, New Delhi, which had just been set up then. I paid three-month salary to Amritsar Medical College to be relieved of PCMS to join AIIMS. Even though everyone advised me against leaving a pensionable job (AIIMS job was not pensionable at the time), I took the plunge because I wanted to teach. I was selected. When I joined AIIMS, there was no building or hospital. We built the institution brick by brick. I remember when we opened the cardiology lab at AIIMS, we swept the floors ourselves.

 What’s so special about AIIMS that the government is replicating the model across states? Can AIIMS-like institutes ever equal AIIMS-Delhi?

JSG: No. Calling new medical colleges as AIIMS-like institutes is the biggest disservice to AIIMS-Delhi. Other institutes can never come up like AIIMS-Delhi. You cannot put in that kind of money, manpower, sweat and blood, you can’t open up those many specialties. New institutes should have been called something else. AIIMS-Delhi is one of a kind that has fulfilled its mandate of patient care, teaching and research against all odds.

Dr Randeep studied medicine at IGMC-Shimla and PGI-Chandigarh. What brought him to AIIMS?

JSG: Between 1984 and 1992, Dr Randeep was in the PGI and was an Assistant Professor there. I asked him to come to Delhi. My advice to him was to stay closer to the national capital. And of course he wanted to be in Delhi because we, his parents, were there.

You attended to Pt Nehru in his last days? What do you remember?

JSG: Pt Nehru was in Bhubaneswar in May 1964 when he suffered a paralysis of the left side. Three AIIMS doctors were flown urgently. I was a Junior Assistant Professor then. My duty was to look after Pt Nehru and stay with him. Since he could not walk on his own, I would shoulder him around. This routine lasted till Pt Nehru died. I particularly remember an occasion when Lord Mountbatten came to visit Pt Nehru, who had gone off to sleep. He waited for Pt Nehru till he woke up.

You were also the first doctor to attend to former PM Indira Gandhi when she was brought to AIIMS on October 31, 1984?

JSG: Yes, she was accompanied by RK Dhawan, ML Fotedar and Sonia Gandhi. She was brought dead but the then Health Minister B Shankaranand asked us not to declare her dead till Rajiv Gandhi arrived. He was out of the city. Both Pt Nehru and Mrs Gandhi respected doctors a lot.

Dr Randeep, what are your memories as a personal physician to late PM Vajpayee?

RG: Vajpayeeji had a lot of respect for doctors and would often invite me over for breakfast. His sense of humour was great.

What are your memories of Kangra?

RG: I have been going to Himachal regularly both to my grandparents‘ place, to our village Manjra and to Dharamshala. Dharamsala I remember a lot because I grew up there, we used to go there regularly, my grandmother used to be there and my mother used to go regularly. We used to go to Mc Leodganj for picnics regularly. Now it has become such a crowded place, a tourist spot with so much traffic jam. For a large number of years there was no electricity in our village and lamps were used. We would sleep on the roof and watch the fireflies. It was a sight.

Has healthcare in Himachal improved since you left?

RG: Himachal is among the few northern states to do well on healthcare improvement. Today ambulance services from Himachal go all the way up to PGI. I was a member of the Himachal Health Commission and we have seen the transformation. We had IGMC-Shimla, but now we have a government medical college in Tanda. AIIMS is coming up in Bilaspur. Many private medical colleges have also come up.

How do you both see each other as professionals?

RG: My father is an astute clinician. People say he has a sixth sense and can diagnose what no one else can. Even in Covid times, he continues to see patients on the sly and I have a tough time trying to stop him from being exposed.

JSG: Dr Randeep is an excellent clinician, teacher and human being. As AIIMS Director, you have to see many VIPs, but he has never refused a poor patient. While he became AIIMS Director, I missed the post. I was shortlisted and told by the then Health Minister that I was being appointed Director, but later my junior was appointed. I became Dean and continued to work for AIIMS. In 1958 when I joined, there was no building in AIIMS. We were given a ward each for medical and surgery in Safdarjung Hospital where we would teach. I admitted the first patient in AIIMS on December 31, 1959 by the name of Mr Khema after the nursing hostel was converted into a hospital. We set up the OPD clinics for cardiology, medicine and chest at AIIMS and instituted the DM degree.

During your times, medicine was more of a mission, but now it is considered a profession.

JSG: Yes, we were driven by a vision to build AIIMS. In my times, it took 14 years to get a car from government quota. Today, allurements have led to unethical situations.

Tele-consultation is a norm in Covid times. Can technology replace patient-doctor interface?

JSG: Never. I must see my patients. Human-to-human contact is irreplaceable.

RG: Medicine is all about being able to look at and understand the patient. Tele-consultation can supplement healthcare in Covid times, but can never totally replace the patient-doctor interaction. Medicine is both a science and art, and the art of medicine is linked to seeing the patient.