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June 19, 1999


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Baby doc uses paladai to help newborns in Philadelphia

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Apoorva Mandavilli in Philadelphia

At a time when the globalization of the Indian economy has let in a flood of Western commodities, a pediatrician in Philadelphia is quietly helping American babies benefit from the wisdom and simplicity of a traditional Indian device.

When babies have trouble breast-feeding in the United States, doctors and mothers have used tubes, fingers, spoons, droppers and bottles with artificial nipples to assist them, with varying degrees of success.

Now, Vinod Kumar Bhutani, a pediatrician at Pennsylvania Hospital, is offering a radically simple solution that has caught the attention of the medical establishment and newspapers. By using the South Indian feeding cup paladai, he is helping at least 300 mothers give their own milk to their babies. "This a kind of low technology transfer," explains Dr Bhutani.

Technology transfer and global medical projects are a natural for Dr Bhutani, 49, a world citizen. Because his father was a diplomat, he had a childhood that spanned several continents: he was born in Washington DC and raised in the United States, Ethiopia, Hong Kong and Bangladesh. But after living in Central City, Philadelphia, for thirty-odd years, Philadelphia is home, he says.

"It's hard to think of India as home. I've visited every year since I was a boy but the US is home and India is home-home," much like kids have a dad and a dad-dad or grandfather, he adds laughing.

Dr Bhutani's "home-home" was a place he visited every year as a child, and as a young man, he decided that he would practice medicine in India. Accordingly, he enrolled in the Armed Forces Medical College in Poona.

"When I was in AFMC, I was a stateless orphan because I had not grown up in India," he explains. His statelessness also meant that he could not join the army, and he interned at the only hospital that offered him an internship, Safdarjung Hospital in New Delhi. "The hospital was one of the busiest and poorest, and all the sickest people landed up over there," he recalls.

As he worked through his pediatrics internship, he "made a very emotional connection with the children I saw there. Babies communicate in such a special way and I communicated with them."

In the years since then, he has become a specialized care-giver and is now a neo-natologist, a doctor who specializes in the care of newly born, even premature babies.

Communicating with an infant is a "very different bond than speaking to a child or an adult," he says. Babies that young "don't speak but they communicate at a whole different level. You just have to be tuned in to them, that's all."

While still at Safdarjung, the young and idealistic Bhutani was unprepared for the three-month physicians' strike that was the first of its kind in India. At the end of the three months, he found himself in a hunger strike in front of the health minister's home.

"Finding myself in that situation was very weird," he recalls. The experience prompted him to question his beliefs and expectations from medicine. At the same time, physicians were also being given the clear message that as with an oversupply of potatoes, the vast numbers of physicians in India were of little value.

"To think of any professionals, forget physicians, being compared to a sack of potatoes and to be informed that that there was no future, was the ultimate disillusionment," he recalls.

Out of that disillusionment, he approached the American embassy to apply for a green card, only to find that he was still considered a US citizen.

Although it was strange to contemplate leaving India after preparing to practice medicine there, he left for America "in search for ideals and a place to practice those ideals."

To practice medicine in a worthwhile fashion in India, Dr Bhutani explains, "it was very important to have mentors who believed in you." Although there were seniors, some of whom he is still in touch with, who had faith in his ability, "they had very little power to change your environment for you," he says.

His experience with medicine in India compels him to return every year and work with medical schools and pediatricians and exchange information.

In turn, physicians and nurses also have an opportunity to come to the US and become acquainted with techniques in new born-care.

Dr Bhutani is particularly interested in training nurses for pediatric care. He points out that nurses in India still wear caps, are much more like handmaidens than professionals, and are only allowed to do certain things. "If you want to improve healthcare in India, the only way (is) to improve the care provided by nurses," he says. "I have a strong belief that we have to improve the status and esteem that our nursing colleagues have."

But changing that status quo may encounter resistance from people who figure higher in the Indian medical hierarchy, says Dr Bhutani.

He recounts a specific incident in an Indian hospital "which shall remain nameless" where Ann Schwoebel, a nurse who often accompanies him in India, encouraged an Indian nurse to listen to an infant's heart with a stethoscope. Physicians in that hospital were outraged at the breach of traditional roles and threatened to go on strike, he recalls.

"The issue related to the status of individuals. A lot has to do with the gender dynamics and what society perceives (nurses') role to be," he says. For Dr Bhutani, the issue has since become "a crusade," and he continues to visit India and work toward his goal each year.

At home in Philadelphia, he has a "beautiful wife and a beautiful daughter." His wife of 17-odd years, Shalini, is an advisor for International Students at the University of Pennsylvania. Their nine-year-old daughter Ranee is poised to enter the fourth grade and was just elected by teachers and peers to receive her first award.

Dr Bhutani's pride in her is obvious as he explains that the award recognizes a student who is "a good leader, looks after others, is kind, and is a staunch friend." Does his daughter take after him? He laughs and says, "I think after her mother. But I hope a little bit after me."

His father, a widower, lives with his son and has "a charming girlfriend that he has been dating for five years." He has two younger brothers; one a respiratory therapist who also lives in Philadelphia and works in the same hospital, and another who is an investment banker in New York City.

Dr Bhutani has traveled all over the world and has many favorite regions including Tuscany. But he harbors a special fondness for south India -- particularly Madurai, Bangalore and Kancheepuram -- and the cities of Rajasthan. He also enjoys the cuisine from various parts of the world, and on weekends, finds it relaxing and creative to cook an exotic feast.

When he has the time, Dr Bhutani likes to take long walks in the country, and watch movies, particularly films by old masters of the craft like Orwell, Hitchcock ("oh, don't even get me started on Hitchcock") and Guru Dutt ("he's fantastic").

Of the newer breed of film-makers, he is very impressed with the work of Sai Paranjpe, who he thinks "is just incredible as a director."

Although he lived in India for only a small period, he is actively involved in the South Asian community in Philadelphia. He is the president of the Philadelphia chapter of the Association of Indians in America.

Dr Bhutani and his wife are also involved in 'Sawera' and 'Sewaa', a domestic violence group for South Asian women; his wife is one of the founders of the organization.

"I look at India as a whole country, maybe because I don't belong to any state," Dr Bhutani says. "Most (Indians) in Philadelphia are very parochial and culture-based. There is only a very small group of people who think India is India as a whole." It is that "small, ragtag group" of people who do community service in Philadelphia, he adds.

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