Families looking for a board-certified pediatric rheumatologist in India—which has a population of more than 1 billion—are unlikely to find one.
“The official count is zero,” Dr. Thomas J.A. Lehman said in an interview. “They don't have any training programs for pediatric rheumatologists in India. They have a few physicians who practice pediatric rheumatology, but there is no formal training program. When you talk to physicians in India, they tell you 'we're doing pediatric rheumatology, but we all started out as pediatricians. Somebody sent us an interesting rheumatology case and we're trying to learn pediatric rheumatology as we go along.'”
In October 2009, Dr. Lehman, chief of the division of pediatric rheumatology at the Hospital for Special Surgery in New York, spent 1 week as a volunteer guest lecturer at the annual meeting of the Indian Pediatric Rheumatology Association in Nagpur, India, which is in the country's centrally located state of Maharashtra. Also volunteering to teach at this meeting were fellow pediatric rheumatologists Dr. Charles H. Spencer from Columbus, Ohio, Dr. Angelo Ravelli from Genoa, Italy, and Dr. Tadej Avcin from Ljubljana, Slovenia. Almost 200 pediatricians and a handful of adult rheumatologists assembled at a hotel conference center, eager to learn about the state of pediatric rheumatology in a country coping with spotty infrastructure and poverty.
Dr. Nandini Babhulkar of the department of pediatrics at the Indira Gandhi Medical College and Mayo General Hospital, Nagpur, organized the conference. In his interview, Dr. Lehman extended his congratulations for her excellent job in bringing pediatricians and pediatric rheumatologists from the United States and Europe together with physicians from India to advance the care of children with rheumatic diseases.
The attendees were “mostly in their 30s and 40s, physicians working to be the pediatric rheumatologists of this generation for their country,” Dr. Lehman said.
Physicians in India see many cases of juvenile idiopathic arthritis, but lupus and scleroderma are especially common. “That's probably due to genetics,” said Dr. Lehman, who is one of about 280 board-certified pediatric rheumatologists in the United States. “Different populations have different backgrounds.”
Topics he talked about during the meeting included recognizing and understanding common rheumatic diseases of childhood, working with physicians in other specialties in the care of patients, “and reinforcing how to take care of people when they don't have access to the newest drugs. They have nonsteroidal anti-inflammatory drugs, methotrexate, and steroids. The biologicals are available in India, but many patients can't afford them.”
“In a country with few pediatric rheumatologists, the best long-term results will come from steps that minimize the need for doctor visits and long-term medication,” he said.
“At present, too much emphasis is being placed on expensive medications that suppress chronic inflammation and too little on finding the cure. Drugs that suppress inflammation need to be continued indefinitely with repeated doctor visits and monitoring. We don't have the ability to cure any of the rheumatic diseases yet, but that's where our emphasis must be.”
During a discussion at the meeting about the risk of tuberculosis complicating immunosuppressive therapy, he learned that most physicians in India “often assume that the patient needs to be treated for TB, because TB is so rampant there.”
In spite of such obstacles, Dr. Lehman said that he returned home from the meeting inspired. “There are many children in India with rheumatic disease.”
“They're short on drugs and they're short on financing for the more expensive drugs. But this was a group of interested and enthusiastic physicians who are working hard on getting pediatric rheumatology established in that country. I'll be going back in the future to do more teaching. They need it, and I'm glad to help out.”
Dr. Lehman said his expenses were paid by the division of pediatric rheumatology at the Hospital for Special Surgery in New York.
A group of interested and enthusiastic physicians are working hard to get pediatric rheumatology established in India, said Dr. Thomas J.A. Lehman.
Source Courtesy Dr. Thomas J.A. Lehman