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In 1955 while cycling past a Government leprosy colony in Pune, Antia saw leprosy patients with several deformities isolated behind a barbed wire fence, treated almost like criminals. He did not understand why they were subjected to such indignity for no fault of theirs. Antia resolved to help the victims of this dreaded disease.

Dr. Noshir H. Antia
Simplifying the Complicated

Michael Jackson radically transformed his facial features and skin pigmentation. Dolly Parton started the trend of breast implants. Dev Anand regularly undergoes facelifts. All celebrities desperately want to look younger than their age and manage to do so thanks to the wonders of plastic surgery.

Plastic surgeons are the only people to benefit from this craze, permanently and without any side effects, with their pockets always full. However, there is a doctor who performs plastic surgery for a noble cause, to help patients who suffer from leprosy, a contagious disease affecting the skin and the nerves, resulting in mutilations and deformities. That doctor is Noshir H. Antia, FRCS (Eng), FACS (Hon). In a career spanning over five decades, his major areas of interest have been plastic and reconstructive surgery, biomedical research and community health, including, surprisingly, panchayat raj and rural development.

After graduating from Grant Medical College and the J.J. Group of Hospitals, Mumbai, Dr. Antia went to the U.K. from 1947 to 1955 for post-graduate studies in general surgery. Opportunity knocked when he started working with Sir Harold Gillie, founder of modern plastic surgery, and young Antia became interested in the subject. Antia could well have carried on with his practice in the U.K., like most Indians who go abroad for studies and do not return to share their knowledge with their motherland. But Antia was cast in a different mould: “My roots were in India. I had spent the first 15 years of my life in Hubli. This got me in contact with the problems of common people. The desire was to use my newly acquired knowledge to solve some of these problems.?/font>

In 1955 while cycling past a Government leprosy colony in Pune, Antia saw leprosy patients with several deformities isolated behind a barbed wire fence, treated almost like criminals. He did not understand why they were subjected to such indignity for no fault of theirs. Antia resolved to help the victims of this dreaded disease. His interest lay mainly in the correction of deformities of the face, which had not been undertaken ever before. This was his chance to become a pioneer in the field of leprosy. Recalls Antia: “Since leprosy patients had hitherto not been admitted to non-missionary hospitals, and as no one was willing to assist me for fear of this disease, I had to go by myself to the Kondhwa Leprosy Hospital on the outskirts of Pune. I carried my own instruments and drapes and operated on a rickety wooden table with other patients as the only assistants. One holding a torch, one boiling instruments in a hundi and one wearing a gown and gloves for surgical assistance! Within nine months I was able to demonstrate that all deformities of the face caused by this disease could be corrected by utilising and modifying the basic principles of plastic surgery. All this had to be undertaken under local anaesthesia. The results were good, even though the table broke during the first operation and hence the rest of the operations had to be completed on the floor!?Antia was later invited to present this “original?work as a Hunterian Professor at the Royal College of Surgeons, England.

An uphill task
After that, there was no looking back. He received an offer to start a plastic surgery unit in his own alma mater, Grant Medical College and the J. J. Group of Hospitals, from Dr. Shantilal Mehta, the Dean. For the first time ever, Antia admitted leprosy patients for corrective surgery to a non-missionary hospital, the J. J. Hospital, despite warnings by colleagues that this would drive other patients away. But, ultimately, Antia proved that these were only myths propagated by fear to break out of the beaten path. Besides, he was not averse to challenges: “I was given eight beds distributed in several wards of the hospital with little else ?It was an uphill task without any assistants or facilities. Few knew what plastic surgery was and I had to demonstrate this through results.?/font>

N. H. Antia training a trainer how to examine leprosy patients.

He was also principal collaborator in leprosy with the late Dr. Darab K. Dastur on a U.S. Government-funded project on “Nerve Lesions in Leprosy? Antia explains: “Since most of the deformities of leprosy are the result of damage to the peripheral nerves, this inevitably led me to the study of nerves during surgery together with Dr. Darab Dastur, a pathologist. I eventually spent two years in a laboratory in London to learn immunology, as a full-time student, at the peak of my surgical career, considered by most as professional suicide!?Immunology, according to the Oxford dictionary, is “the scientific study of resistance to infection? Antia firmly believes that the cure and control of communicable diseases lies mainly “in the field of national and international politics in order to alleviate poverty, the underlying cause, and not in medicine, surgery or research? The late Sohrab Godrej, Chairman, Godrej Group of Companies, always lamented that diseases such as tuberculosis, malaria, cholera and other water-borne diseases, which were eradicated at great cost, have returned with a vengeance. The underlying cause, again, is poverty. The answer, according to Antia, “lies in political action by the people themselves?

Low-cost health care
The study of immunology led Antia to join the Foundation for Medical Research (FMR), which was established in 1975 as a laboratory for the study of major medical problems in our country. Beginning with research into specific problems in leprosy, it has progressed to the study of tuberculosis as well as water-borne diseases. “Research only provides clues for control by getting a deeper understanding of the disease, not for its actual use,?Antia cautions. The present Trustees of FMR offered a building and seed funding. Having established its credentials, the major part of the funding now comes from national and international research grants. Recognition as a National Research Institution allows 125 per cent tax exemption to donors!

Antia is also committed to research-based community health, especially in rural India, and has successfully demonstrated alternative models of low-cost, easily accessible health care, through the Foundation for Research in Community Health (FRCH), the sister institution of FMR.

Godrej has played a significant role in the FMR and FRCH. Says Antia: “Both Naval and Sohrab Godrej had considerable interest in the social problems of the underprivileged and we worked together at the FMR as well as the FRCH since its inception. Our objective was to employ a combination of medical, laboratory and field studies to understand and, if possible, alleviate the problems of the disadvantaged, especially of women and children in rural areas.?/b>

The Mandwa Project of the FRCH was designed to understand the social and cultural problems underlying diseases of the rural community: “The local women of 30 villages demonstrated to us that if we could trade our knowledge of medicine with their holistic wisdom based on the local reality, these women could achieve in five years the results which the Government hoped to achieve for diseases like leprosy, tuberculosis, water-borne diseases and even Family Planning 25 years later.?Assured of Naval and Sohrab Godrej’s financial support, Antia launched the project with a young doctor from the J.J. Hospital and a young graduate from the Tata Institute of Social Sciences ?which eventually was to have repercussions on the Government’s health policy. Seeking to establish links with the rural community, which would serve as a channel for transferring knowledge at the grassroots and enable them to maintain better health in their own surroundings, the project ultimately trained a woman from each of the 20 to 30 poverty-stricken villages. Recalls Antia: “Naval Godrej would often sit with me even on hot afternoons under the tree discussing this venture, whose results surprised both of us.?/font>

N. H. Antia testing sensation in a leprosy patient.

But as most good things don’t last long in India, this project, too, was short-lived. The local leaders, male chauvinists to the core, saw this as a threat to their power. Besides, they were unsuccessful in putting pressure on the late Naval Godrej to provide jobs to their kith and kin at Pirojshanagar. When their absurd demands were rejected, there was violence and finally a shutdown. “Naval and I were adamant,?recalls Antia, “but he was very disappointed. He was interested in people, looking after them. We worked for 10 years, spent nearly 20 lakh rupees, but no one knew about it ? that’s the difference.?The project was wound up in 1983. But Mandwa proved to be an important learning experience, the greatest achievement being in the field of health education, where a village woman, once convinced, could transmit the knowledge and technology to the rest of the community in a manner which no external media could ever hope to achieve.

Pilot projects
Other pilot projects followed in Uran and Malshiras villages, which emboldened the famous Parinche project. Parinche is a valley in Purandhar Taluka, Pune, with a population of 20,000. Parinche reveals even better results. As Antia proudly puts it: “It shows how women can undertake 70 per cent of all health and medical care as well as other functions like Grameen Bank, water, sanitation, growing medicinal herbs and even telemedicine. They now train similar women health workers in other districts of Maharashtra and also from other states like Orissa, Jharkhand, MP and Gujarat.?This project is supported by the Tata Trusts, European Union and other institutions such as HIVOS (International Humanistic Organisation of the Netherlands) and MacArthur Foundations.

N. H. Antia and S. P. Godrej in a discussion with village health workers at Parinche, Purandhar Taluka.

Deteriorating health scenario
Antia has been associated with the well-known social activist Anna Hazare for the past 20 years when Hazare started work at Ralegan and Antia at Mandwa. The FRCH has recently undertaken a study of the economic and social development of Ralegan for the Ministry of Rural Development, Delhi. It also hopes to establish a rural hospital and training centre at Ralegan.

Antia deplores the steadily deteriorating health scenario in our country. This is because emphasis is laid on vertical programmes by the World Health Organisation and the World Bank, thus destroying the integrated approach of the Indian Council for Medical Research and the Indian Council for Social Scientific Research report “Health for All? an alternative strategy formulated in 1981. According to Antia: “Inputs into the existing system can result in increase of our external debt and consequent distortion of our health scene.?/font>

The other major factors that are destroying indigenous health practices and systems of medicine that have sustained our people over the millennia are overinvestigating and overprescribing. Antia explains: “The medical profession has now been coopted by the market economy and is dominated by the pharmaceutical and medical instrumentation industry in an area where consumer resistance is at its lowest. Hence five-star hospitals now dangerously overinvestigate, overmedicate and oversurgicalise the rich, pauperise the middle class when they fall ill and divert 20 per cent of the meagre resources of the poor from food to medicines and that too mostly of the wrong type!?/font>

The answer lies in making people aware that they are being taken for an expensive and dangerous ride and in opposing the pernicious policies and practices of the World Bank and other international agencies under the garb of philanthropic aid. Antia adds: “The answer also lies in questioning our own politicians, bureaucracy and medical profession that promotes this perverse policy for reasons of their own.?/font>

Antia’s achievements have been widely recognised and acclaimed. He has received several awards, but the award dearest to his heart “is the love and affection that is provided by the patients, colleagues and those whom we have trained, including village women?

Dr. Noshir Antia has shown the world how most problems can be solved if there is the necessary desire and will. The theme of his work has always been “simplifying the complicated? It has been lonely work, but for him it is not only satisfying but singularly rewarding.

Rashna Ardesher