Year : 2012 | Volume
: 8 | Issue : 4 | Page : 658--660
Interview with Dr. Ramesh Bilimagga
Atreya, 34, !A Cross, Silver Oak Street, J. P. Nagar, 7th phase, Bangalore, India
P S Sridhar
Atreya, 34, !A Cross, Silver Oak Street, J. P. Nagar, 7th phase, Bangalore
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Sridhar P S. Interview with Dr. Ramesh Bilimagga.J Can Res Ther 2012;8:658-660
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Sridhar P S. Interview with Dr. Ramesh Bilimagga. J Can Res Ther [serial online] 2012 [cited 2022 May 21 ];8:658-660
Available from: https://www.cancerjournal.net/text.asp?2012/8/4/658/106596
Dr Ramesh Bilimagga, has been unanimously elected as the new president of the Association of Radiation Oncologists of India (AROI). He is known to be tireless, dynamic, and possibly among the most industrious personalities in contemporary radiation oncology. Apart from being the director of HealthCare Global- Bangalore Institute of Oncology, he also happens to be actively engaged in the social cause-he is an active Rotarian and a member of various social organizations. Dr Ramesh S Bilimagga (BSR) who is beloved by his patients, colleagues and students alike, was recently interviewed on behalf of the Journal of Cancer Research and Therapeutics by Dr Sridhar PS (SPS). The transcript of this interview is provided here.
SPS: Congratulations on being unanimously elected as president. The community of radiation oncologists considers you as an indisputable doyen. How did you choose to be a radiation oncologist decades ago, when radiation oncology was regarded as a minor offshoot of diagnostic radiology? Did you foresee a good future for radiation oncology?
BSR: Thanks for your kind words dear Sridhar! Answering your question as to how I entered this field of radiation oncology, I must say, it was by chance, not choice. It was the year 1975, at that point of time, when I was looking for a job, the public commission of the government of Karnataka announced posts as 'registrar cum lecturer in radiology'. I applied, I was waitlisted for six months, and then in December 1975, received my regular posting as a lecturer in Kidwai Memorial Institute of Oncology, Bengaluru. It was an entry by chance- serendipity! Having worked for 35 years, there has never been any regret. Radiology as a branch forked into 'diagnositic radiology, radiation therapy, and nuclear medicine', all three branches which have a very good standing now.
SPS: With about three decades of experience in this field, you have probably witnessed the best and the worst that one could expect in the field of radiation oncology not just in India, but throughout the world. How does Radiation Oncology as a discipline in India, fare in comparison to the European and North American centers?
BSR: Firstly, radiation oncology has been evolving all over the world across the decades, including in India. There has not been a 'worst time' ever, at least the way I perceive things. I do concede that in the earlier days, we would see too many radiation reactions with low cure rates. That actually had made people place low priority in choosing to enter the field of radiation oncology. Then, with the advent of computers, there was a drastic improvement in treatment techniques. Every day we see a new invention or an idea. From deep X-rays, to cobalt and then to linac, then to conformal, IMRT, tomotherapy, cyberknife... it has not stopped. The quest for targeted and individualized therapy has been driving improvements and innovations. As far as comparison of India to the rest of the world, I must say that the future is bright for radiation oncology both in India and elsewhere.
SPS: Agreeably, we have evolved. We all know you as a big-time brachytherapy exponent. In the earlier days, you were one of the very few people in this country to have used pre-loaded radium sources. Did you at that time, ever have thoughts of disappointment? Did you then ever think prospectively about what we have today- with regards to equipments, technology and outcomes?
BSR: Yes Sridhar, I was one of the persons who did use radium. Those days, we used the original rubber ovoids, tandem, with no anesthesia, and have treated despite difficulty in positioning the equipment, and despite an inability to verify source positions. Why just brachytherapy, even with external beam RT, we would manually calculate doses. Then we had a need for simplification of formulae, and I recall having ourselves formulated new methods for quicker dose calculations. Then there was an introduction of computers, and things have never been the same since then. The introduction of computers has given a very big and unpredicted boost to radiation oncology, easily more than to any other field.
SPS: Three and a half decades in radiation oncology, and three decades in the Association of Radiation Oncologists of India (AROI). You may have seen trends come and go. Any plans, as the new president, for reforms and changes in AROI?
BSR: My introduction to the AROI dates back to 1980, while in post-graduation. Over time, the association grew from strength to strength. We could hardly see 30 people then in the association, and now, at each conference we see not less than 800-1000 members! Another thing worth remarking about is our scientific indexed journal, the JCRT (Journal of Cancer Research and Therapeutics). It is now on par with any international journal, well-cited, high on quality and read throughout the world. Then, ICRO (Indian College of Radiation Oncology) has been ensuring regular teaching programs throughout India, providing a good chance for students to interact with faculty very closely.
Our association offers many fellowships, works towards academic upliftment, and every new president across the years has been adding additional value. Now that we have more and more people in our organization, we must focus on finding ways to involve each of them in the association. Hence, a few new wings have been planned.
First, we have plenty of young radiation oncologists who are enthusiastic, energetic, with fresh thinking processes, they are hungry for knowledge and innovation. So, to provide a forum for them, we are inaugurating the 'youth radiation oncologists' wing, in Kerala in February 2013.
Then, more than 40% of our members are women, who in addition to being professionals also fulfill the roles of a mother, a daughter and homemaker. They have their own problems and issues which cannot be solved in a generalized manner. To help them discuss their interests, we are inaugurating a forum for them, through the 'women's wing.
Third, we have a number of colleges offering post-graduation degrees and DNBs, we have a large number of students, who too need their own forum. So, we at AROI are providing a platform through the 'student' wing.
Fourth, we often have to interact with various statutory and governmental bodies. For example, the recent issue of taxes being increased on brachytherapy sources. We need to voice our concerns to the concerned authorities in the government, and we need a platform with a good number of people with the influence and skill to accomplish the same. So, we need a new 'public relations' wing.
Also, a lot of interaction is going to continue with ASTRO, ESTRO and other international organizations. So, an international coordination committee is also needed, to reach out to counterparts in America, Europe and Asia.
SPS: So plans are in place to tackle and deal with bureaucratic issues...
BSR: Yes, for an example, we wanted representation of our association with the AERB Sarkar committee, and they have been very nice to let us make it a routine to meet once each year, to voice our concerns to the AERB Board. Also, 2-3 of our members have been inducted into the AERB, thus helping interactions with AERB.
With regards to the interactions with MCI, we have a good number of our own members working as Board members. We are taking their help, for example in getting the name of our degree changed from 'radiotherapy' to 'clinical oncology', which has been a long-pending demand of our association. We are taking it seriously and are quite sure that it will be achieved.
SPS: What are your concerns over the management of cancer care in this current age of economic uncertainty? Of special concern is that our discipline is technology hungry and expensive.
BSR: A good question actually, and very valid particularly for a developing country like ours. We lack hospitals, and when we have hospitals, equipment are lacking. A good thing is that the government has been taking keen interest, with the central government allocating a good amount of funding to fight cancer. Not only for equipment but also for funding and reimbursing treatment. Lot of money unfortunately gets returned unused. Thus the slogan for this year is-"use the money given". To see that funds will be utilized and not returned, our association will formulate plans to allow concerned people to communicate effectively and in seeing that funds will be optimally utilized.
SPS: The revolution of modern radiotherapy in India can be rightfully attributed to the handful of intrepid entrepreneurs in the corporate sector. However, the progress of RT in the government sector, to say the least is lackluster. Do you plan to influence and persuade the government (central and of the states) to upgrade and increase the capabilities of government cancer centers?
BSR: We have luminaries in our association who have experience in the rural, urban and semi-urban sectors. We are preparing a document-"vision document of radiation oncology in India" to aim for a period over ten years. It will map out the needs of the rural, the semi-urban and the urban areas, and how these needs can be met. That will give us ideas, both for the players in the private sector, government and NGOs, as to how to proceed on the right track.
SPS: What advice do you have to offer to the young radiation oncologist?
BSR: "The days are such, that the moment you have the interest, the world is open for you". The kind of improvements in the field that are happening in India and abroad, our radiation oncologists have a great future ahead of them... The young should dedicate themselves to their work and patient care.
SPS: Given the volatile state of the world today, with routine conflicts being very common, there is a threat of nuclear terrorism which is looming larger than ever before. In the event of a nuclear terrorism incident, or even a civil nuclear disaster, the community of radiation oncologists will be expected to have the expertise to deal with the situation. Does the AROI have protocols to handle such scenarios?
BSR: Honestly, no plans or protocols are in place to deal with such situations. Acts of nuclear terrorism may not only cause large number of instant deaths, but can also inflict a large number of casualties who may need special care. Widespread radiation contamination will be a difficult situation to deal with unless systematic plans and countermeasures are in place. Now that you have highlighted the issue, it is going to be a priority for the Association to evolve plans and strategies to deal with the worst case scenarios!
SPS: Please forgive me for a rather personal question. We all are aware of your kind act of donating a kidney to your close friend Dr Kilara. We also know that you have adopted a girl child. About 'being simple, and to be what you want to be, and to do what you want to do', we have read about in books, but we presume it to be difficult in actual practice. But Sir, how were you able to do the things that you did! I often am at a loss of words to describe that!
BSR: I must say, it was never a decision of my own, but a family decision. We generally discuss about the routines of life. When I found out that my close friend was in need of something that I could spare, something which God had given to me, I discussed the same with my wife. Now I am glad that I could be of some use to my friend!
Then the entire idea of adopting the girl child, I attribute it to my wife. She has indeed been a joy to our family, and such deeds are from where true joy comes!
SPS: You have been a Rotarian, an active member of the society at large, and have been perfectly balancing your professional and personal life. Regarding the time factor, everything you do is 'on the dot'. How do you manage the same?!
BSR: It is a question of 'time-tabling' your day-how much time to spend in each event, each activity and in work, and with family. Be present in that particular segment of time, in what you are doing! Whether at home, or in hospital, your mind should be where you are!
I believe that a doctor should not only be concerned with hospital and patient care alone. That would totally imbalance his/her life and productivity will come down. Therefore, a lateral expansion of the entire horizon should be present. We are not meant only to treat patients, but to improve humanity as a whole. That is the reason why I am closely associated with the Rotary Club, the IMA and also many voluntary organizations.
Be it participating in cricket, or in golf, it gives me an indication that I am enjoying life. That's the point!
SPS: Immense thanks for your time, and for this interview. On behalf of the readers of the JCRT, I again congratulate you, and also wish you the best in all your endeavors, for the Association and on the personal front. Thanks sir!