I am a biologist hailing from a completely research-based academic background. My Bachelor’s degree in botany from the prestigious St Joseph’s College, Tiruchirappalli laid the foundation and created an interest in environmental studies and microbial ecology. However, at that juncture, a real passion for science and research had not yet blossomed in my heart.
My subsequent entry into the renowned and inspiring campus of the School of Biological Sciences, Madurai Kamaraj University, for my post-graduation created a deep-rooted dedication and passion for research. I am very confident and proud in reiterating that this transition towards a research mindset happened within a short time span of two to four weeks, through inspiration gained from observing the dedicated lifestyle of PhD scholars and motivation from my professors. Till date, I always cherish those initial days and share my recollections with my family, friends, and students.
Subsequently, for the past one and a half decades, I breathed in the research atmosphere at Madurai Kamaraj University, University of Cologne (Germany), Indian Institute of Technology (IIT) Madras, and University of Florida (USA). In all these places, I was surrounded by PhD scholars, post-doctoral fellows, masters students and professors. Stating that I breathed and lived research is not an exaggeration, as I spent around 18 hours per day in the lab and lab corridors.
Entry into a Hospital
After continuously working, breathing, sleeping, and living in academia, recently I joined as a Scientist in the KMCH Research Foundation affiliated with Kovai Medical Center & Hospital, Coimbatore (a NABH accredited multi-speciality private hospital) to establish my own independent research career. Here the environment is entirely different and I am surrounded by physicians, nurses, post-graduate medical students, and administrators.
Every day before entering the lab, I have to cross the sorrowful, worried, tearful faces of patients and their relatives. So, it is important that I have to be mentally strong to get back to my work after witnessing such distress. On the other hand, these moments had motivated me to do translational research along with basic science to relieve and counter their distress.
Hospitals and Research in India
The clinical set-up in India is entirely different from western countries. In the western world, research labs are largely linked with hospitals and it is quite common to see research faculty with an MD degree. But in India, the medical science and clinical research communities are rather separated and there exists little to no involvement of physicians in research.
As per my experience, the main contribution of Indian physicians to research is facilitating access to clinical samples and patient data. It is not that physicians in India do not have a passion for science; rather, except for a few, most of them lack sufficient awareness of science. But it is not wise to simply blame physicians for not getting involved in research. The total number of patients (emergency, inpatient, and outpatients) that Indian physicians have to take care of is very large and we cannot deny that their working time is dedicated almost completely to this noble lifesaving cause.
In fact, the number of physicians per citizen in India is still not comparable to developed nations. As per WHO data (2017) on health workforce, India ranks 136th in the world with less than one doctor per 1000 patients. It is unfortunate that medical institutes like All India Institute of Medical Sciences (AIIMSs) and medical universities have less or no connections with scientific institutes like the Indian Institute of Science (IISc), Indian Institutes of Science Education & Research (IISERs), Indian Institutes of Technology (IITs) and state and central universities. As I witnessed, even exceptional physicians with a real passion for science do not find time to read articles and perform research work. At this situation, it is the duty of the basic scientist to act as a bridge between scientific research and clinical practice in India.
Advantages of doing research in a hospital
The primary advantage of doing science in a hospital is the ease of access to clinical samples with complete patient data, which is a big challenge for researchers working in universities and research institutes. In addition, by direct interaction with the physicians, nurses, and patients as well as day-to-day observation, I understood some real problems associated with various diseases.
All over the world, there exists a strong barrier in taking the outputs from the lab-bench to the clinical bedside. This lapse can be rectified by combining basic research with the clinical environment. Hospitals often have huge manpower in the form of medical post-graduation students, nurses, and lab technicians and have good clinical biochemistry laboratories with sophisticated and automated instruments for clinical measurements. However, it is important that these resources are utilized sensibly for my research work in a way that does not hinder normal hospital activities.
Yet another advantage of doing science in a hospital is that there is no need to be completely dependent on government agencies for funding. Every pharmaceutical company has a mandate to provide funds for charity/basic research that is unrelated to their products (to avoid conflicts of interest). It is far easier for the physicians (as compared to basic scientists) to get funds from these resources. For instance, I was recently denied an international travel grant from a national funding agency and got only a partial travel grant from another national funding agency for participation in an international conference. At this juncture, the physician and president of our research foundation acted immediately and managed to get funds from a Pharma company to cover my international travel.
Challenges of doing science in a hospital
There are many challenges and barriers to executing science in a hospital environment. Pursuing a scientific career in a private hospital is not at all possible without the support of administration and physicians. In my case, I am fortunate to have both the chief administrator and a group of physicians with real passion for research. In other places, it is possible that administrators may view research activities with a money-based profit mindset, which will not work for science.
Another important mandate for working in hospital is that the researcher must have moral and social values. Interactions and interventions with the patients, physicians, or nurses should in no way affect their day-to-day work, which may, in turn, reflect on the morbidity and mortality of patients. So, it is very important to make sure that none of my research activities disturb their medical efforts and duties.
The space required for a physician for consultation is relatively small in comparison to a research laboratory. So, getting lab space is the most challenging aspect of working in a hospital and it completely depends on my performance as assessed by the generation of data, publications and procuring of grants.
The protocols in a hospital set-up can be really complicated, weird, and unusual for an academic researcher. Among them, the funniest, as well as one of the most deeply troubling aspects, is that the time of work is allotted in shifts, as applicable for physicians, nurses and other hospital staff. An academic researcher usually works around the clock, thinking, writing and executing experiments.
In addition, words like “shift time”, “punching”, “HR”, “manager”, “income tax”, etc. still sound strange to me. Another peculiar challenge is that I often get requests from relatives and friends to get appointments and medical advice from physicians in our hospital. While this can’t be ignored completely, it has to be dealt with judiciously based on whether the patients are critically ill.
On understanding the advantages of doing science in a hospital, the challenges and hurdles seem tiny. I am very hopeful that in due course, all of these hurdles will either be solved or I will become more used to prevailing protocols in hospitals. Altogether, I am slowly acclimatising to the hospital-based research atmosphere and genuinely believe that I can play a small but significant role in bridging the gap between the lab bench and clinical bed.
This is a companion discussion topic for the original entry at https://indiabioscience.org/columns/journey-of-a-yi/advantages-and-challenges-of-doing-science-in-a-hospital-in-india