It is said that medicine is a noble profession. True enough, India-born Dr Atul Malhotra and Dr Arunaz Kumar have tapped deep into the moral, social and personally satisfying advantages of being doctors. Their approach to medical care goes beyond duty hours as they help educate people in rural India on childbirth and childcare through their charitable program ONE-Sim.
The couple migrated to Australia in 2005 after completing their MBBS and MD from University of Delhi. Atul is a consultant neonatologist at Monash Newborn and research scientist at The Ritchie Centre, Hudson Institute of Medical Research. He also holds a senior lecturer appointment in the Department of Paediatrics, Monash University and is the current recipient of a RACP Foundation Research Fellowship.
Arunaz is a senior obstetrician and gynaecologist, who has trained across numerous hospitals in Melbourne before receiving her fellowship of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (FRANZCOG) certification in 2009. She also holds a Graduate Certificate in Health Professional Education (GCHPE) from Monash University and completed her PhD in “Interprofessional education using simulation in Obstetrics and Gynaecology” from Monash University.
If their credentials are impressive, their philanthropy is equally inspiring backed by zeal and the potential to “give back to our country of origin in our own small way”.
Despite their busy professional lives, the couple founded ONE-Sim, a special program that runs maternal and neonatal educational simulation programs in rural communities in India. “We are bringing obstetric and neonatal emergencies into a single platform and tackling both maternal and child health issues at birth,” explains Atul.
The idea for ONE-Sim came to Atul during his research work in India when he felt there was a need for basic level education. He found health professionals had extensive theoretical knowledge but no practical hands-on training. About five years ago, Atul also received a special grant from the Bill Gates Foundation to implement some of his innovative research projects. “I thought there could be no better place than India to implement it,” he says, adding, “The Gates Foundation funds simple projects which can make a change to outcomes.” He was working on improving childbirth outcomes based on poor condition at birth but when he started working with the communities he realised he needed to focus not just on babies but also the mothers. And with Arunaz’s PhD on obstetrics and gynaecology simulation-based education in Australia, it was an idea whose time had come. That’s how ONE-Sim was born.
So while Arunaz trains professionals with complex child-birth issues, Atul teaches managing babies born during distressed births and providing them with critical care in the first few hours of their birth.
Since the past three years, ONE-Sim has trained more than 1000 health-workers, doctors, nurses and midwives in the states of Uttar Pradesh, Punjab and Haryana. Their work takes them to India twice a year. And they are on an expansion mode hoping to touch Rajasthan and parts of South India such as Karnataka next year. But even if they are not travelling to India, Atul and Arunaz train other people going to India to run projects with their programs.
How ONE-Sim runs sounds simple to a novice. But, obviously, it is the result of great expertise and experience. Atul and Arunaz have formulated a workshop that is applicable to all health workers and customised according to the requirements of the place. “We provide the framework depending on whether it is a high risk set up, a primary hospital level or a secondary level. You address the needs of what the place requires. It is called ‘Train the Trainer’ workshop where those who learn further impart the training to their own staff. In a day we may have three workshops, sometimes it depends on how far one health centre is from another or how much time it takes depending on the number of staff.”
Thus, every staff member gets a hands-on experience. “It’s not didactic teaching; we have simulation models for training on complicated childbirth or newborn care. Each member gets that physical interaction thereby developing that sensory perception of handling child births,” says Arunaz. So high-fidelity mannequins are used to facilitate the simulations for the participants. “These are low maintenance mannequins with no electronics involved, they pack up in a suitcase and we can carry them around from one site to another,” she adds.
What is really important is that the workshop and training prepare workers for any emergencies. “The special value is, we teach things that are not likely to occur often but when they occur they are equipped to manage within the critical time with efficiency and by learning how to use the resources available to them,” explains Atul, who as a neonatologist works in the intensive care units looking after complex babies born very premature.
Atul and Arunaz work with local collaborators who understand the complexities of the area. The collaborators generally advertise their arrival and invite all staff involved in childbirth – be it nurses, midwives, doctors and anyone who looks after child birth – for training. This year, the duo is training students of medicine and nursing. “We thought instead of waiting for them to graduate, we will train them beforehand so that knowledge is passed on.”
According to Arunaz, postpartum haemorrhage is the leading causes of direct maternal death. “Mothers bleed quite suddenly and if their haemoglobin is already low, a normal blood loss of 500 ml can convert into litres very quickly. We need quick management. We have process in place in Australia but other places may not have the protocol and wherewithal to manage such situations. So there is the need to go through the important steps of how they can act within their set up.”
Having been involved in a lot of research activities in Australia, Atul observes that the problems Australian babies have is different to what Indian babies have and the tools used are different in both countries. “In India, it is more about getting the simple things right, we don’t worry about too complex or too premature babies there because we don’t have the resources, so I think we need to work to the strengths and the resources the place has.” Arunaz, who runs her own private practice as an obstetrician, says it is a community-based specific need for which they need to tailor those requirements towards that community.
Today, Atul and Arunaz’s charitable project is benefiting not just communities in India but also countries such as Malawi and the Pacific Islands. A lot of their colleagues who have heard of their special workshop have taken it to these countries. Just last month alone, 300 health workers were trained with their models in Malawi, Africa.
Such philanthropic work requires funds too. Besides the Gates Foundation, Atul says he has been lucky to be supported by his college, the Royal Australasian College of Physicians, some grants from the university, and support from local doctor groups and organisations such as the Overseas Medical Graduate Association. “We’ve had a significant amount, so every time someone gives us, say, 5000 dollars it helps us to buy another model. Every little bit of support helps.”
Atul and Arunaz met when they were studying at the same medical college in India. Theirs is a partnership with complementary strengths. With ONE-Sim, they are committed to making a continuum of care to India, the world and society at large.
“The best way to give back is through your strengths,” reflects Atul. “A lot of people contribute to healthcare by giving to charities and supporting other people; if we have the resources and time to do things ourselves I think there is no greater satisfaction than that. That’s what drives us.”
Going back to India is no longer for holidays but to run their workshops. “That ways it helps us keep in touch with our country and it’s a bit of a new way to see the country and make a difference. We have been embraced by the communities in such a loving manner – something I would never have had if I was not doing this work. I think that opens up new opportunities for people to engage with the country they belong to, it’s like going back to your roots.”
In Australia too, the couple is engaged with childhood advocacy groups. For all their work, Atul and Arunaz have been nominated for the Pride of Australia medal. “We haven’t won it, we have just been nominated,” laughs Atul.
Whether they win the coveted medal or not, they want to liaise and engage with more and more workforce. “See, if we can save one baby or one mother’s life by spending four days in India every six months – that is worth it,” sums up Arunaz.
By Indira Laisram