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From Jamia Masjid to SKIMS Director: Dr Parvaiz Koul's inspirational journey and legacy of excellence

'SKIMS is a brand and regardless of difficult circumstances, it has not only survived but excelled '
12:00 AM Mar 06, 2024 IST | MUKEET AKMALI
from jamia masjid to skims director  dr parvaiz koul s inspirational journey and legacy of excellence
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From a downtown boy in Jamia Masjid, Srinagar to the Director of SKIMS, Dr Parvaiz Koul's journey is as inspiring as it is intriguing. Raised in a close-knit mohalla with his parents instilling the value of hard work, Dr Koul has carried those lessons through an illustrious medical career. As he prepares to step down on March 8th, he leaves behind a legacy of excellence at SKIMS - pioneering respiratory research, advocating for merit-based processes, and proactively pursuing innovations to enhance healthcare services.

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In this candid interview with Greater Kashmir's Mukeet Akmali, Dr Koul reflects on his humble beginnings, the pivotal moments that shaped his path into medicine, and his resolute vision for SKIMS to evolve as a beacon of healthcare. His story underscores the power of perseverance, community strength, and an unwavering commitment to one's calling.

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MA: Can you share some insights into your upbringing and childhood experiences that influenced your decision to pursue a medical career?

Dr Koul: Growing up in downtown Jamia Masjid with my three brothers and a sister, life was modest, yet filled with love and warmth. My father, a dedicated government employee, tirelessly worked to provide us with an education during challenging times. Every achievement I've had in life is a testament to the hard work and blessings of my parents, though they passed away before witnessing much of our success.

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My childhood memories are intertwined with the vibrant atmosphere of our ancestral home. Even now, in my dreams, I find myself back in that cherished space, surrounded by the bustling energy of the neighbourhood. In those days, the entire Mohalla felt like one big family, with a strong sense of camaraderie among its residents. It was common for guests to be treated to dishes from neighbouring homes, and weddings were lively affairs where young mohalla boys eagerly participated in serving the guests of neighbours without feasting themselves.

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While I can't pinpoint exactly why I chose to pursue medicine, God might have answered the prayers of my late mother who had hoped that I become a doctor. Losing her at the tender age of seven was a profound loss, but her virtual presence continues to guide me, even in my chosen profession. My father has been my hero who was the epitome of sacrifice for our collective good. I can only pray for their peace in the other world.

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MA: What inspired you to choose the field of medicine as your vocation?

Dr Koul: Life often unfolds in unexpected ways. After completing my education up to 8th grade at SS Mission School in Srinagar, circumstances led me to transfer to Islamia High School in Rajouri Kadal, where I joined the same class as my elder brother. Despite excelling in academics, I made a spontaneous decision to switch to the non-medical stream in 9th grade.

A stroke of fate occurred one day when our drawing teacher was absent, and I found myself attending a physiology class with medical students. Intrigued by the subject matter, I felt a sudden inclination to pursue the medical field. Following my intuition, I promptly requested a change of stream, which proved to be a pivotal moment in my journey.

Interestingly, my elder brother made a similar switch to the non-medical stream and went on to have a successful career, retiring from service as a SE in the Public Works Department (PWD).

MA: Could you provide some details about your educational background, including the institutions you attended for your medical education?

Dr Koul: I did my MBBS from GMC Srinagar and completed my MD from SKIMS.  I Was fortunate to get a faculty position in SKIMS only and continued there till I am leaving SKIMS now after having had the unique fortune of working from a junior resident to the director. I was awarded an American College of Physicians fellowship in Pulmonary and Critical Care Medicine that I completed at NorthShore Long Island Jewish Hospital System, New York. I have been on the governing boards of several societies in Pulmonary and Sleep Medicine. I am currently a Governing body member of the Indian Chest Society, Indian Association for Bronchology and South East Association of Sleep Medicine. I also happen to be the Chief editor of the flagship journal, Lung India which is the official organ of the Indian Chest Society. I must attribute all my success to SKIMS.

MA: How did your academic journey shape your aspirations and career path in the medical field?

Dr Koul: As I cruised in medicine, I noticed that you have to take a sidestream to grow in the field of your interest which I why I concentrated on Pulmonary and Sleep Medicine and Respiratory Infections. I was fortunate to have collaborations with some of the leading institutions in the world like the CDC, USA; WHO; Imperial College, London; University of Utah, Washington University, USA and many other institutions in the country.

I concentrated on researching the ailments in Kashmir. We have a high burden of respiratory disorders and I conducted most of my research in the area which has fortunately got international acclaim.

With nearly 500 plus publications, I am grateful to God for having received nearly 100,000 citations and having an H-index of 75. I must acknowledge the support of my juniors and seniors alike for having contributed to my research. While currently, others are very distant from my research statistics, I sincerely wish that one of my students overtakes me and relegates me to a distant back seat. That shall be a very proud moment for me. I have been the most cited researcher in Pulmonary Medicine globally for numerous months in the recent past. I am a part of the Institute of Health Metrics and Evaluation (IHME), University of Washington in respiratory epidemiology. I have been fortunate to be the only medical researcher from Kashmir to have found a mention in Stanford’s top 2% of researchers consistently since 2019, both in year-wise and career-wise ratings. People talk of a single paper in a journal like Lancet and I am grateful to Allah that I have 60 papers in the journal. I have published in big journals like Nature, Science, NEJM, JAMA, PLOS, BMC, etc. In short, God has been very very kind. However, I must emphasize it might carry my name but the contributions of my colleagues and the institution can just not be ignored.

MA: What were some of the pivotal moments in your early career, particularly your first job in the medical profession?

Dr Koul: Reflecting on my journey from a junior resident at SKIMS to where I am today has been nothing short of a roller coaster ride. Looking back, it's incredibly satisfying to see how far I've come. The recognition in my field, the affection from colleagues, the respect from juniors and students – these are all rewards that fill me with immense gratitude.

Having had the opportunity to debunk numerous myths surrounding diseases in Kashmiris has been particularly fulfilling. Being recognized as the number one cited researcher in my institution and ranking third in the country in chest diseases is an achievement I'm most satisfied with.

What more can one ask for? It's moments like these that make the journey worthwhile and inspire me to continue making meaningful contributions in my field.

I do not live in the Middle East region but am the Vice Chairman of the Middle East Eurasia and Africa Influenza Stakeholders (MENA ISN). Grateful to the Almighty.

MA: Can you highlight any significant challenges you faced during the initial stages of your career, and how did you overcome them?

Dr Koul: In medical school, I was always confused as to how others scored much higher than me. I was the first medical student in my family and there was no one to guide me. Finally, I got into the company of bright students like Drs. Sunil Munshi, Anil Mota, Saydain, etc and in their company I found a way to tweak my approach to learning. After that, the journey was much easier and awards and recognition were for the taking. Life was much harder as we did not have access to today’s internet and getting an article of relevance would at times mean going to Delhi to get a photocopy of the journal article.

MA: Throughout your career, you have been involved in numerous research projects and publications. Could you share some insights into your most notable research endeavours?

Dr: I have worked primarily in pulmonary disorders and respiratory infections. I developed an Influenza Lab in SKIMS with the support of CDC, USA and ICMR, Delhi. At a time when no viral lab existed in J&K, our lab tested thousands of patients in Kashmir, free of cost which would otherwise cost the exchequer crores of rupees besides the cost of setting up the lab. All those pieces of equipment worth millions have become the property of SKIMS when I recently allotted all the lab equipment and space to the Multidisciplinary Unit of SKIMS. From project savings, we were able to acquire 2 ambulances for SKIMS for which I must express my thanks to Mr Irfan, CEO of JamKash Vehicles for supporting us with some remaining amount. My work in influenza, vaccinations and respiratory disorders has received international acclaim and some of our works have been pioneering in the field, not only in the country but globally too. We even worked on MERS and other coronaviruses much before the pandemic of COVID-19 struck. Our works on respiratory epidemiology are cited widely. We worked on pulmonary hydatid disease describing some of the earliest appearances on imaging. Our work on renal tubular acidosis helped patients with recurrent muscle paralysis get treated with simple inexpensive therapy. We worked on a variety of locally relevant diseases to manage those better.

MA: How do you believe your research contributions have impacted the field of medicine and healthcare?

Dr Koul: I believe that our works have made an impact in understanding the canvas of diseases in Kashmir. We demonstrated a high prevalence of COPD in Kashmir. We showed that cystic fibrosis (believed to be non-existent in Kashmir) does actually exist and now many researchers are working on it. Our works demonstrated that internationally recognized works can come from any place in the world. We recommended a change in the vaccination schedule for influenza vaccination for India (WHO used to recommend the Northern Hemispherical Vaccine for India as it is geographically located in the Northern Hemisphere). We demonstrated that these recommendations were not borne by evidence and were relevant only in Kashmir whereas most of the country required a Southern Hemispherical Vaccine. The World Health Organization finally adopted this and the vaccination recommendations for India were changed. Just this month SKIMS published a paper questioning WHO’s influenza vaccine composition, on February 21. Just 2 days later, WHO adopted the same and more recently on February 29, the leading medical journal, NEJM published a perspective endorsing our stand. Isn’t it immensely satisfying to introduce a concept that is adopted by the WHO? Yes, our work did have an impact locally and globally.

However, the concept that I cherish the most arose from a casual talk that I had with Prof. Kaiser Kaul, ex-principal and HOD of paediatrics, GMC Srinagar. I had gone to him for samples for our influenza surveillance.

While discussing a patient of heart failure and acidosis, he cursorily mentioned to me that they had been encountering many cases of this malady that resulted in rapid deterioration and deaths, with no identifiable etiology. I remember telling him that there was a malady reported in Japan called ‘Shoshin Beri Beri” with similar features that is caused by thiamine deficiency. Since thiamine administration was rather innocuous, I suggested that he could try it in some of these patients. Later I was informed that this simple measure resulted in total recovery of these patients. The casual conversation led to the recovery of hundreds of such patients in all institutions in the valley and subsequently got published in many journals. This particular research will never carry my name but I have derived the greatest satisfaction of my life from that 5-minute discussion with Prof. Kaiser. All credit to those who worked subsequently on it. God chose me to speak about it at an opportune time so that save hundreds of young lives were saved. Many youngsters are working now on it and I always render my support for them. Notable in this regard is Dr. Javed Iqbal of the Neonatology Department of SKIMS. I wish them well. I am told that following the reports from Kashmir, similar reports have emerged from other rice-eating regions of the country and they have also started treating these patients with remarkable success. To look back and note that a cursory talk could result in such a big change in the management of a life-threatening disorder across the country seems like a miracle rooted in a divine intervention.

MA: As the Director of SKIMS, what are your primary responsibilities and objectives in leading the institution?

Dr Koul: The director of SKIMS is the driver of a ship with wide individual facets. Besides being the apex tertiary care institute of the state, SKIMS has a huge role in rolling out trained manpower that man multiple institutions of the state, country and many institutes across the globe. SKIMS is a deemed University as well that confers degrees and diplomas in graduate, postgraduate and postdoctoral courses in medical, paramedical and nursing streams. The director of SKIMS is a conduit between the Chairman Governing body (the governor, LG or the Chief Minister, whatever the case) and reports to him through the Chief Secretary. It is a unique arrangement specifically carved out for SKIMS by wise forefathers to obviate any procedural wrangles in the management of SKIMS. The main tasks of the director are to facilitate recruitment at various levels, prioritize procurements and works and have them carried out in the finest possible manner. The director of the institute is a Secretary in the health and medical education department with the domain of his working restricted to SKIMS and SKIMS medical college. The domains are the overall functioning of SKIMS, recruitment, procurement and liaising with the authorities. The functioning of SKIMS involves 3 main domains of patient care, academics and clinical research. The director facilitates all of these. But i believe that the government should augment funding to SKIMS.

MA: What initiatives have you undertaken to enhance the quality of healthcare services and research facilities at SKIMS?

Dr Koul: Many. I think the director facilitates working and raising the issues with authorities. We received funding from the Government. During my tenure, we have tried to further improve upon the good work done by my predecessors and eliminate anything that in wisdom was detrimental to the functioning of SKIMS. Anything that was outside of the frame of the rules and was within my authority has been summarily taken care of. A lot of high equipment was procured which included Digital cath lab, Virtual bronchoscopy, air decontamination unit, OCT, surgical instruments, ERCP scopes, cranial and spinal surgical instruments, hemodialysis machines, anaesthesia work stations, ventilators, automatic pathology processors, IHC etc. New equipment for the Cancer Center is on the anvil which requires a nod from the Commissioner Secretary of Finance as we already have money in place from the centrally sponsored scheme. Fire fighting system, Plantations, Upgrading of canteen, Hostel facilities, Road map for new hostel buildings, etc. We started a full-fledged Pulmonary ICU. For a long time, CABG was not happening in SKIMS. We have now been doing 2-3 cases every week since April 2023.

In the patient care front, we introduced digital payments, online services like patient appointments, online report retrieval, payment gateway for fee deposition by patients and students, RAS assessment, etc.

Academic courses like DM in Pulmonary Medicine, MCh in Endocrine surgery, Fellowships in Spine surgery, Colorectal surgery, and DNB in Emergency Medicine

I changed the coordinators of various additional assignments that had been awarded rather arbitrarily without following a proper process and replaced them by selections made entirely on merit cum seniority.

Recruitment of about 30 faculty members, promotion of many faculty members, recruitment of staff at the Class 4 level (under academic arrangement) and regular selection of resident staff have been accomplished at the recruitment front, thanks to the support of the government. Retrieval of land from encroachers which includes 400 plus Kanals from the Aanchar area and 8 kanals from BSNL (the lease had expired in October 2022)was possible through the support of the government, specifically Dr Arun Kumar Mehta. Efforts to reclaim land near faculty quarters and address illegal occupation further emphasize institutional integrity and effective governance

I ensured a flip to academics and research. Formal development of centrally sponsored MRU which will be the driver of clinical research in SKIMS for a long time to follow and annuls the need of a separate department with a similar focus.

As a rapid responder to disaster preparedness and management, SKIMS has demonstrated proactive management and strategic planning. Following the Amarnath Yatra cloud burst disaster in 2022, swift action was taken to ensure 24-hour helicopter landing support through the upgrade of the helipad, exemplifying a commitment to emergency preparedness. We were able to salvage all who were evacuated to SKIMS. We are conscious that SKIMS serves as the ultimate tertiary care support for disasters of all kinds and SKIMS has been consistently and successfully doing so. The trust that people and authorities bestow in SKIMS keeps the place going in its constant endeavour for excellence.

MA: In your opinion, what are some areas where SKIMS can further excel and contribute to the healthcare landscape of the region?

Dr Koul: SKIMS is a brand and regardless of difficult circumstances, it has not only survived but excelled in most spheres of its functioning. It has already attained a significant name for itself in excellence in patient care, academics and research. However, there always shall be a scope for higher growth and excellence. Newer specialities, state-of-the-art equipment, and infrastructural and human resource development are areas where there is a constant requirement for improvement. Keeping into consideration, the ever-increasing demands of the hospital, we have to have an easier means of procurement and recruitment that was so thoughtfully planned by the leaders of yesteryears. While we have managed some commitments under CSR from JK Bank, Powergrid corporation, etc which would be supportive of the governmental funds, some mechanism of supporting high-end equipment has to be carved out. Advanced equipment, augmentation of beds, and development of stand-alone facilities for neurocare, cardiac care, pediatric care, emergency etc are required and need to be introduced. Intensive care beds have to be amplified. Newer courses, technical courses for paramedics, and nursing staff, newer diagnostics in radiology, pathology, microbiology and immunology, specialized clinics, diversification and focused specialization, are some of the areas that require enhancement. I see SKIMS as a continued seat of excellence for patient care, academics and locally relevant clinical research. It has taken years of hardwork to reach to this level of functioning and the trajectory onward is only ‘up’, regardless of the challenges. I must commend the SKIMS faculty for getting extramural projects that augment the capacity in terms of manpower as well as equipment, in addition to contributing to the literature.

MA: How do you envision SKIMS evolving in the coming years to meet the healthcare needs of the community more effectively?

Dr Koul:  As I said, the most important role of SKIMS is churning out manpower that man's health facilities. Apart from advanced patient care, and identifying particular areas of development, SKIMS is foraying into research projects that will help understand the disease milieu of the UT better and that will serve as the basis for policy planning. The data generated from research from SKIMS remains the basis for shaping future healthcare in Kashmir. Some pressing issues need consideration and address by the authorities.

I strongly believe that faculty should superannuate at 65 years rather than 62 years to save academic programs from getting derecognized due to a severe shortage that is hitting academic programs. Ironically, the same person is allowed to join other institutions for upto 70 years while we lose out on these seasoned professors who could drive our academic programs. Our academic programs are in danger if our manpower is not beefed up and raising the age of superannuation would be really helpful. Additionally, engineering wing of SKIMS should be considered to be restored back as it has hampered the efficiency of our systems. I also believe that the recruitment of faculty should be considered through Apical selection committees as was in vogue, the composition of Apical selection committee is way superior to the PSC where we have only one technical expert compared to a host of credible technical experts in the Apical Selection Committee. The perception of SKIMS being a bed of irregularities has to go because in my time, not a single recruitment has been made without merit. Some wrongs might have happened in the past but you cannot view a current scene through an old prism.  I have raised all these issues with the authorities and I am sure they will be dealt with compassionately on merits.

MA: What advice would you offer to aspiring healthcare professionals and researchers who are embarking on a similar career path?

Dr Koul: Medicine is a difficult profession. However, if you have decided to pursue it, do it diligently. Your profession will take a heavy toll on you, your family and your social contacts. You have a price to pay for being in the profession. At the end of the day, a tear of happiness from a satisfied patient is worth millions in the bank. You need to be updated in medicine because it is not long before you realize that what you know and have been taught is not only obsolete but can be harmful to the patient. So there is no escape from staying updated. Youngsters must foray into clinical research, get into collaborations and publish regularly. Aim for relegating a Parvaiz Koul or an AH Zargar to a distant back seat. Trust me, our youngsters are so good that it is easily doable with just a little effort.

MA : What personal philosophy or guiding principles have helped shape your approach to leadership and innovation in the medical field?

Dr Koul: I have experienced the hard face of ill health and I consider it an opportunity from Allah to contribute to cleaning SKIMS. I did it without any vengeance. I cleared papers of all, even those who kept my files in cold storage for months. It took me seconds to clear their files. Whatever was in my authority has been done. Whatever was beyond me has been requested for approval. I have put across SKIMS's point of view for contentious decisions and requested a review of those decisions. I know that nothing is cast in stone and there is always a possibility of course correction. Favouritism has been done away with. People today in SKIMS do not get positions due to proximity to corridors of power, but solely on merit. I invited a lot of critique on it but that is what I believe in and fortunately, there are many like-minded people in the institute who supported me in this. My philosophy has been simple, “Merit should prevail”. We made hundreds of appointments and written examinations. None was contested or scrapped. All legal cases that I inherited were strictly instructed to be fought on merits and not just because we have taken an unjustified stand. For faculty interviews, the best testament to the fairness was that some person accused us of nepotism and interestingly the complainant was the one who had been selected. There cannot be a better barometer of transparency. Procurements have been done solely on GeM or open tendering. I have largely cleaned SKIMS and I am sure that anything left shall be addressed by my successors and the relevant authorities. I am thankful to the authorities and colleagues for their support. SKIMS has faced challenges in the past too but rose again largely unscathed.

In short, I can never thank SKIMS enough for my personal growth and that is the sentiment of many of my colleagues. SKIMS has served the people of the state and will hopefully continue doing so retaining the apical position in the healthcare scene of Kashmir. I can only wish it well and a smooth ride out of its challenges. Long live SKIMS.

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