It is hard to believe that Subratada (Dr Subrata Goswami) is no more amongst us. When a life passes, I always think about the loss and feeling of emptiness of the family and friends. I often think about the impact of societal loss and as a doctor the impact of the person in patient care and the patient care systems as well. In the next few paragraphs I’m trying to reflect on his endeavour to improve the pain management for the patients of West Bengal and creating an awareness in the wider health system and how he took it forward.
I was privileged to meet him in Medical College in 1987. Like many others I have reached out for patient care and family related help and advice many times over the last few decades, and I have known him personally too. He helped anybody who needed care in whatever way he could (clinically, financially, mental support, connecting people, organisational help, education, training and always with compassion). I had many discussions with him post 1990s about healthcare system needs, socio-political change and how it is affecting the people who cannot pay for healthcare. As his societal belief of fairness and equal right flourished, he engaged more in helping poor farmers and industrial factory workers and chasing his dream of improving healthcare. I was not surprised that his thoughts and vision were different from average doctors who work in a hospital or in private care in traditional speciality.
He noticed that there was a lack of awareness and service in both public and private healthcare on how pain affects the human body and mind. He was seeing the effect in factory workers (in ESI Hospitals) and farmers who can’t afford expensive private hospital treatment. As an Anaesthesiologist he was keen to understand how other countries are managing this. He reached out to me in 2008-2009 to know about pain management practices in UK and Europe. We had had long discussions; it was clear to me by 2010 he has a clear vision. He had a vision to establish a pain Institute within public sector to look after pain. I am aware he had similar discussion with senior doctors in Canada and USA too. He had a clear idea to establish a curriculum to train doctors and allied health professionals about the management of pain with appropriate educational accreditation. He had an intense academic interest on how this could be evidence based, it could be in the standards as it delivers in Europe about curriculum, clinical outcome assessment and with excellence. The work started by training himself up. He visited many Institutes (Public and Private), collaborated with same minded doctors, observed practices, peer-reviewed practices and compared clinical outcome.
He formed a group to peer review each other’s practice who were working in anaesthesia and offering pain management. He convinced colleagues who are interested to take this forward as well. Subratada had insight about limitation of his training hence he got himself trained in Europe and passed the European fellowship exam (FIPP) for pain management along with a colleague. This was a really hard task – coming from India in Europe, where exam system is different. In Europe, knowledge, skills, communication skills with patients, compassion, empathy and depth of philosophy of patient care gets assessed both in living subjects and cadavers. It wasn’t a surprise that he passed the fellowship (FIPP) examination and acquired appropriate accreditation.
By the time he was giving lectures in medical seminars, delivering workshops raising awareness about the need of service for the patients and improving knowledge and skills of fellow doctors about pain management, he completed his PhD, which is a hard task when one is doing a service, looking after family, and giving free service in some rural clinics. His hard works, academic depth, knowledge of need of a system-wide change were impeccable. He got himself in the forefront of the change the system of care of management of pain as a new speciality in Kolkata.
Indian Society for Study of Pain was only established in late 1980s and didn’t have a huge impact in common patients’ awareness and services in West Bengal. To run a new speciality, one needs government or institutional support. For established sub-specialities (Cardiac, Neuro, Surgery, Rehabilitation) there is a pathway and departments which support the service. For a new speciality it is a huge uphill task. He was clear—he wanted this to start in public sector in a collaborative work with private sector clinicians. It showed his breadth of vision and inclusivity.
To establish and run an effective institution, one needs to have an excellent understanding of systems, staff, people , their values and cultural belief and the change needed. I was impressed by the breadth and depth of knowledge about quality assessment of exam system from somebody who didn’t have a university role. He always talked about the relation between clinical outcome, knowledge, skills and quality of exams and assessment. The work started working within the ESI hospital in the top floor. The challenge of red tape of bureaucracy, communication, knowing the right people at the top, influencing the hospital administration putting in the right bid to create a pain Institute cannot be underestimated.
With his tireless perseverance he reached there in 2013 to open the ESI Institute of pain management after getting funding for instruments and getting people trained in a new speciality. This was a new era for pain medicine which has not been the standardised format of medicine, like cardiology or respiratory or specialist surgical areas. It is hard to convince the medical fraternity that this is a speciality in its own right and needs expertise from a team of Clinicians and allied health professionals including physiotherapists, occupational therapist and pharmacist and theatre workers in larger scale (like Stroke service).
I visited his institution in 2015 and 2016 and 2018 was amazed by the advanced set up for teaching and training with multiple seminar rooms with audio-visual and hands on training area. As we were walking towards the treatment room he talked about the need for wider lifts and corridors for patient’s comfort. His heart was right in the middle of patient care need and patient experience, and he had a great sense of humour too. He was showing how the porters navigate the wheelchairs in between beds which was no different than driving a taxi in busy roads in Kolkata. He gave priority to patient comfort and staff training as he clearly recognised to create a workforce with appropriate knowledge and skills is the key for any clinical practice. We had many exchanges on the curriculum on the fellowships, how standards in UK training are maintained, the use of electronic patient record, how quality assessments are done, and staff being looked after. While writing this and going through those emails reminded me, he was the Organising secretary to make it a success of the first World Symposium on pain in Kolkata in 2013.
I introduced him to some of the UK systems of quality assessment which I gathered as a MRCP Examiner which he really appreciated. And the fellowship programme started. With the colleagues help in Anaesthesia in Kolkata he was able to not only establish the pain management as a fellowship training and service but also raise awareness in the state and nationally as a separate speciality which was unheard in Kolkata before 2010 in public sector.
The rest of this is a story, he had recognition, even with financial challenge institute was able to recruit trainees. Patients were pouring in, invitation to talk in clinical conferences kept arriving, and he worked 24/7. He presented his work in national and international conferences where he eloquently explained that the science, skills and technology and patient engagement can change the quality of life of a patient with pain. He was focused on organisational management process and skills off work force development and how the standards of training assessment quality patient care were maintained. I admired his integrity and compassion all the time.
It was challenging for him – navigating through the mindset of traditional medical faculties, private care, public health system hospitals and institutions to start and maintain a new service with individual effort. He was aware of that and created a very efficient team, he had the advance communication ability to be able to communicate to a labourer or farmer, and at the same time, getting into an office at the ministerial level to be able to put papers and business cases through to convince them why this is needed for the people in Kolkata and West Bengal. Having a declared different political and socialistic viewpoint and trying to get help from ministers of different values and different politics is very hard, but what drove him is his conviction and will to improve patient care which took precedence over any other things. His agility and humility were exemplary.
The striking thing about him was the ability to have patient focus of an individual, clinical outcome and compassion and empathy with the patient at the same time being clearly aware of organisational development and succession planning. Even when he was physically struggling with his Motor Neurone Disease, he carried on working going to his Institute doing his clinic in a wheelchair. We talked about Stephen Hawking (though the disease was different), need for MND research, how charity money in UK to research etc. How conviction and perseverance could take things further—there couldn’t be a better example in the history of pain management in India and possibly outside India, as well.
I often think about the quote ‘’the most beautiful people are those who can love and help without expecting any return’’. And the only return he expected was not for him, but for his patient care, their outcomes, their comfort, their happiness, and their improvement.
The light of the life of Dr Subrata Goswami may have passed on, but illumination of his work , love, and compassion remains in the mind and hearts of friends, families, colleagues, and patients. I hope we can all take a moment to think about his values and feelings which drove him to create a new institution, a positive change, and awareness of how pain-free life could be the shining light of the life.