By Dr Amitav Banerjee, MD*
We observe Teacher's Day on 05 September every year. In my journey from being a student and later a teacher which of course involves being a life-long student, I have come across many teachers who have never entered the portals of a educational institution, in addition to those to whom we pay our respects on Teachers Day.
I will start with my college days during which I encountered grass-root teachers who did not complete a formal education. But they were a great help during practical examinations in histopathology in Anatomy and in Pathology. Each department had a stock of fixed slides (they still do, some things never change), which are put under the microscope for students to identify. While during the practical sincere students struggled and strained peering into the microscope, there was one lab technician, I will call him Vrindhawan, who by just looking at the slides with their different patterns of staining or some cracks in the slide as markers, could identify what was the microscopic diagnosis.
Now we know that the much hyped Artificial Intelligence (AI) works just like Vrindhawan, without knowing what it is identifying. But by scanning thousands of images it recognizes the patterns and after it is trained on these images it could diagnose the histopathology or X-ray images without actually understanding what it is doing! Vrindhavan’s brain was doing same. But instead of images he was seeing the patterns outside the microscope.
I learned this skill from Vrindhavan. One day in practical class I was standing at the back while our brilliant teacher, I will call him Dr SD, had focused a slide under the microscope and was asking the students to have a look and identify the tissue. None of the students, including the class toppers could identify. I was a “slow learner” by today’s Medical Education Technology criteria so I did not volunteer. Dr SD, the astute teacher he was, and still is, saw my hesitancy. He called me by name and asked me to have a try. Before looking into the eyepiece, I had a fleeting glance at the pattern on the slide. Within a fraction of a second, I shouted, “It is a ganglion.” Dr SD almost hit the ceiling in surprise. Instantly he gave me a big hug in front of the class. Vrindhavan from the sidelines was watching with the pride of a “Guru” seeing his disciple do well. Then Dr SD uttered the words which still ring with me after half a decade, “Why don’t you study?” This phrase uttered with utmost sincerity was a turning point in my academic career. From a “slow learner” I became a dedicated learner exploring my strong points. His sincerity, stoked my “guilt” at “resorting to cheating” to identify the tissue. There was no ridicule in his response, only the warmth of a hug the best nonverbal communication.
Dr SD, must have seen many students and realized that one size does not fit all unlike modern day recommendations of “remedial measures” in form of extra classes for “slow learners.” This may be stigmatizing to some students. His unknowingly making me feel guilty made me determined that I should connect the dots in my education and live up to his estimation of my potential. Half a century later, I had the good fortune to meet Dr SD and his wife, both renowned teachers in Anatomy a couple of months ago, and take their blessings, when I was invited to deliver a guest talk on research methodology. The grand couple are both Professors of Eminence at this prestigious institute in Central India. During the talk I narrated how a warm hug from Dr SD turned a “slow learner” into a “sincere scholar.” Every saint has a past and every sinner has a future as Oscar Wilde said.
What about the teaching of Vrindhavan my first unconventional teacher? Well he taught me to look at the big picture beyond the microscope. This over the years became bigger and bigger when I became an epidemiologist in the Indian Armed Forces. While the microbiologist was looking at individual pathogens under the slide, or the clinician examining individual patients, I used to stroll around the area, looking at the bigger canvas which included the demography, geography, the altitude, the behaviour, the socioeconomic status, the eating and toilet habits, (some people still resort to open air defecation, which can make them vulnerable to mosquito bites), and occupation of people and then some as these factors playing out on the bigger canvas, have an important bearing on behaviour of outbreaks and epidemics.
My skills at looking at the bigger picture, an essential quality in epidemiology, alas decaying with computer simulations and mathematical models, was further refined by an unconventional, rather illiterate teacher, when I was posted as an epidemiologist in a highly malarious tribal region of Central India. We will call him Dayaram, a local tribal, who was illiterate and working as a labour for spraying anti-malaria insecticides. He being the senior-most labour, and on the verge of retirement, was called “mate.” He had worked for over 40 years as an antimalaria labour in the field in the densely forested tribal malaria ridden belt.
I will start with my college days during which I encountered grass-root teachers who did not complete a formal education. But they were a great help during practical examinations in histopathology in Anatomy and in Pathology. Each department had a stock of fixed slides (they still do, some things never change), which are put under the microscope for students to identify. While during the practical sincere students struggled and strained peering into the microscope, there was one lab technician, I will call him Vrindhawan, who by just looking at the slides with their different patterns of staining or some cracks in the slide as markers, could identify what was the microscopic diagnosis.
Now we know that the much hyped Artificial Intelligence (AI) works just like Vrindhawan, without knowing what it is identifying. But by scanning thousands of images it recognizes the patterns and after it is trained on these images it could diagnose the histopathology or X-ray images without actually understanding what it is doing! Vrindhavan’s brain was doing same. But instead of images he was seeing the patterns outside the microscope.
I learned this skill from Vrindhavan. One day in practical class I was standing at the back while our brilliant teacher, I will call him Dr SD, had focused a slide under the microscope and was asking the students to have a look and identify the tissue. None of the students, including the class toppers could identify. I was a “slow learner” by today’s Medical Education Technology criteria so I did not volunteer. Dr SD, the astute teacher he was, and still is, saw my hesitancy. He called me by name and asked me to have a try. Before looking into the eyepiece, I had a fleeting glance at the pattern on the slide. Within a fraction of a second, I shouted, “It is a ganglion.” Dr SD almost hit the ceiling in surprise. Instantly he gave me a big hug in front of the class. Vrindhavan from the sidelines was watching with the pride of a “Guru” seeing his disciple do well. Then Dr SD uttered the words which still ring with me after half a decade, “Why don’t you study?” This phrase uttered with utmost sincerity was a turning point in my academic career. From a “slow learner” I became a dedicated learner exploring my strong points. His sincerity, stoked my “guilt” at “resorting to cheating” to identify the tissue. There was no ridicule in his response, only the warmth of a hug the best nonverbal communication.
Dr SD, must have seen many students and realized that one size does not fit all unlike modern day recommendations of “remedial measures” in form of extra classes for “slow learners.” This may be stigmatizing to some students. His unknowingly making me feel guilty made me determined that I should connect the dots in my education and live up to his estimation of my potential. Half a century later, I had the good fortune to meet Dr SD and his wife, both renowned teachers in Anatomy a couple of months ago, and take their blessings, when I was invited to deliver a guest talk on research methodology. The grand couple are both Professors of Eminence at this prestigious institute in Central India. During the talk I narrated how a warm hug from Dr SD turned a “slow learner” into a “sincere scholar.” Every saint has a past and every sinner has a future as Oscar Wilde said.
What about the teaching of Vrindhavan my first unconventional teacher? Well he taught me to look at the big picture beyond the microscope. This over the years became bigger and bigger when I became an epidemiologist in the Indian Armed Forces. While the microbiologist was looking at individual pathogens under the slide, or the clinician examining individual patients, I used to stroll around the area, looking at the bigger canvas which included the demography, geography, the altitude, the behaviour, the socioeconomic status, the eating and toilet habits, (some people still resort to open air defecation, which can make them vulnerable to mosquito bites), and occupation of people and then some as these factors playing out on the bigger canvas, have an important bearing on behaviour of outbreaks and epidemics.
My skills at looking at the bigger picture, an essential quality in epidemiology, alas decaying with computer simulations and mathematical models, was further refined by an unconventional, rather illiterate teacher, when I was posted as an epidemiologist in a highly malarious tribal region of Central India. We will call him Dayaram, a local tribal, who was illiterate and working as a labour for spraying anti-malaria insecticides. He being the senior-most labour, and on the verge of retirement, was called “mate.” He had worked for over 40 years as an antimalaria labour in the field in the densely forested tribal malaria ridden belt.
Our education and qualification should not close our eyes and ears to unconventional teachers due to arrogance which creeps with learning
From a distance and seeing the topography he could identify mosquitoes which transmit malaria. He told us there were two types of mosquitoes, one which rests in the outdoor in the forests and the other which are found in the villages near human habitation and may rest indoors. I took his inputs seriously and started cultivating and identifying the mosquitoes He was right. The mosquitoes in the forests comprised of Anopheline fluviatilis, a very efficient outdoor resting vector in the surrounding teak forests. And from the nearby villages we identified Anopheline culifacies, a not so efficient vector as it prefers animal blood.
The pattern of malaria in this tribal belt intrigued us. We were losing many soldiers for some years in the region in spite of energetic conventional anti-malaria measures like fogging, indoor sprays, mosquito repellent like odomos to be applied during night patrolling and so on. While we could bring down the incidence of malaria inside the military station among families and children, and troops who did not do night duty in the forests, all our measures made no dent on those doing patrolling at night in the dense forest. These troops who were security guards had their barracks also in the periphery of the military station.
Dayaram came to my rescue. He hesitantly tried to convey his hunch on the mystery. No one else took the illiterate mate seriously. He told me to visit the barracks of these patrolling troops and inspect their toilets. I did so. Most of the toilets were blocked and had no water supply. I asked the security guards why they did not complain?
But to someone who is aware that in large parts of rural India (the study was carried out almost two decades earlier), until recently, people were more comfortable going to the open fields to answer the call of nature, the link made sense. The soldiers, the majority of them hailing from rural India, were going to the forest fields at dawn and dusk -- perfectly coinciding with the biting habits of the outdoor mosquito vector in the region, Anopheline fluviatilis. The penny dropped. Immediately, the soldiers were advised to use odomos on their exposed parts while going to relieve themselves in the fields (as it did not seem feasible to change old habits soon). This simple “bottoms up measure,” drastically brought down the malaria incidence among these soldiers!
The detailed research paper based on this work was awarded the Director General Armed Forces Best Research Paper Award! Alas, I could not include Dayaram as a coauthor to this research paper, as he could not sign his name and the editor would not agree to a thumb impression in place of his signature!! The work was also presented during the prestigious Mapuskar Oration Award some years ago.
The message on this Teachers Day is that everyone is a teacher, we learn from everyone, perhaps more from people with their ear to the ground. Our education and qualification should not close our eyes and ears to unconventional teachers due to arrogance which creeps with learning. This is more essential when presently the art of medicine is being suppressed and the science is getting fragmented.
Someone summed up the message elegantly, “Every person I've ever met has probably taught me something. They probably weren't doing it consciously, I probably didn't recognize that I was learning something, I probably don’t even remember what I learned from most of the people I've met. But every human interaction is a learning opportunity.”
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The detailed research paper based on this work was awarded the Director General Armed Forces Best Research Paper Award! Alas, I could not include Dayaram as a coauthor to this research paper, as he could not sign his name and the editor would not agree to a thumb impression in place of his signature!! The work was also presented during the prestigious Mapuskar Oration Award some years ago.
The message on this Teachers Day is that everyone is a teacher, we learn from everyone, perhaps more from people with their ear to the ground. Our education and qualification should not close our eyes and ears to unconventional teachers due to arrogance which creeps with learning. This is more essential when presently the art of medicine is being suppressed and the science is getting fragmented.
Someone summed up the message elegantly, “Every person I've ever met has probably taught me something. They probably weren't doing it consciously, I probably didn't recognize that I was learning something, I probably don’t even remember what I learned from most of the people I've met. But every human interaction is a learning opportunity.”
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*Renowned epidemiologist, currently Professor Emeritus at DY Patil Medical College, Pune, India. Having served as an epidemiologist in the armed forces for over two decades, he recently ranked in Stanford University’s list of the world’s top 2% scientists in the year 2023. He has penned the book, "Covid-19 Pandemic: A Third Eye", and has delivered keynote addresses in national and international forums
Beautiful write up. Thoroughly enjoyed.
ReplyDeleteSalute to Vrindawan and Dayaram and many more of our unsung heroes who contribute so much to the practice of medicine and yet are hardly ever acknowledged!
Our most important unsung teachers who teach us regularly to see and learn from pattern recognition, be it their own external or internal medicine events are our patients who are also the primary beneficiaries of our medical education.
Here's a video that shares more about "patients as teachers" in medical education: https://youtu.be/xvE5b8Xk3vM?feature=shared