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|NI FEATURE: CITADELS SCULPTING FUTURE - REVIEW ARTICLE
|Year : 2015 | Volume
| Issue : 2 | Page : 237-240
History of neurosurgery in Sher-I-Kashmir Institute of Medical Sciences
Abrar Ahad Wani, Altaf Umar Ramzan
Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
|Date of Web Publication||5-May-2015|
Dr. Abrar Ahad Wani
Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences. P.O. Box 27, Soura, Srinagar - 190 011, Jammu and Kashmir
Source of Support: None, Conflict of Interest: None
Sher-i-Kashmir Institute of Medical Sciences (SKIMS) is the only tertiary care institute in the state of Jammu and Kashmir. The department of neurosurgery was established nearly three decades ago and continues to be the leader in providing high quality neurosurgical services in the region. The article provides an insight into the genesis of the department and its sustained growth over these years. It also describes the plans for its future development.
Keywords: History, Kashmir, neurosurgery, medical education
|How to cite this article:|
Wani AA, Ramzan AU. History of neurosurgery in Sher-I-Kashmir Institute of Medical Sciences. Neurol India 2015;63:237-40
Health care services have an inequitable distribution in the world with the estimated neurosurgeon-to-population ratio varying from 1:81,000 in USA to 1:9 million in some regions of Africa.  As per the data available, the ratio is 1:700,000 in Jammu and Kashmir, the northern-most state of India. It has a population of approximately 14 million people. In this state, the Kashmir division had characteristically different requirements, as it is a land-locked region with only a single mountainous road providing access to rest of the country (along with facilities for air travel). The requirement for setting up a tertiary care medical center was immense. Realizing this need, the erstwhile chief minister of the state, Sheikh Mohammad Abdullah, formed a committee with visionary medical personnel of the All India Institute of Medical Sciences (AIIMS) New Delhi and Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, and the legendary physician of the state, Dr. Ali Mohammad Jan to conceptualize the process of establishing Sher-i-Kashmir Institute of Medical Sciences (SKIMS) in Srinagar. The dream was finally realized when the Institute was inaugurated in 1982 ([Figure 1], [Figure 2], [Figure 3], [Figure 4]). Since the day of its inception, the leading department of the center was the neurosurgery department which started its functioning in 1982. Prof Mohammad Afzal Wani, who had been trained in AIIMS, New Delhi, under the able guidance of Prof AK Banerjee and Prof PN Tandon, took charge. The department was established with the following aims: to develop and provide tertiary care to patients with neurological disorders needing surgical management; to develop an infrastructure for the management of neurosurgical trauma which had become a major health problem in the state of Jammu and Kashmir; to impart teaching/practical training to the undergraduate and postgraduate students undergoing surgical training and also to establish a teaching programme for the super-specialty of neurosurgery; and, to organize research on neurosurgical disorders prevalent in the community.
|Figure 1: The panel discussing the concept of SKIMS. In sitting row are Late Sheikh Mohammad Abdullah, Late Dr. Ali Jan and Dr Ajit Kumar Nagpal (the first director of SKIMS)|
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|Figure 3: Late Sheikh Mohammad Abdullah on one of his initial visits after the institute had started functioning|
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|Figure 4: In the background, the building of SKIMS under construction is seen; and, at the lower end of the image, the current main block is visualized|
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The department, right from its inception, had been well-equipped with operating microscopes, a C-arm image intensifier, equipment for neuro-monitoring, a stereotaxic system and a thermo-coagulation device for radiofrequency ablation. Dr. MA Wani used the best of his abilities and time to extend neurosurgical services to the people of the state. His devotion to this cause brought him and the department, immense fame. The growth of the department was very beneficial to the local population, who before the starting of neurosurgical services in the department, had to visit either AIIMS, New Delhi or PGIMER, Chandigarh even for a minor procedure like drainage of a subdural hematoma. The bed strength of the department rapidly increased to 50 and the facility for the optimum delivery of intensive care services was setup. The department, however, initially had to share the intensive care unit with other departments. The department started stereotaxy when Dr. MA Wani came back after doing a fellowship in stereotaxic procedures in Sweden. Within the next 3 years, Dr Wani had inducted three additional faculty members in the department, Dr. Roop Krishen Peshan, Dr. Makhan Lal Babu and Dr. Rakesh Saxena. By 1991, two more names got a place in the history of the department, Dr. Altaf Rehman Kirmani and Dr. Altaf Umar Ramzan, who had done their MCh from PGIMER Chandigarh.
The department was growing rapidly and smoothly when a political turmoil shook the basic fabric of the society of the region and SKIMS was no exception to it. Some of the faculty members migrated to centers outside the state and for a small period, the department was without a single faculty member. In those days, some doctors who could not join as faculty members, still offered their distinguished services for the welfare of patients. They rendered yeoman contribution to the maintenance of neurological and other health services of the state and the value of their contribution cannot be underestimated. Some of them included Dr. Masood Laherwal, Dr. Qawnain, Dr. Shadilal, Dr. Shafiq Alam, Dr. Javaid Zargar, Dr. Javaid Sheikh and Dr. Saleem Tak. The growth of the department came to a stand-still for many years as the entire government machinery was focused on managing the turmoil and there was complete cessation in the process of induction of new faculty members and in the purchase of new equipment.
The new millennium ushered in a new era that restarted development in the institute and the department. The bed strength of the institute was increased to 650. The department of radiology got a 1.5 tesla magnetic resonance imaging (MRI) and a multi-slice computed tomographic (CT) scanner leading to a quantum jump in the diagnostic abilities of the department. Confucius stated, "Our greatest glory is not in never falling but in rising after every fall." This was reflected in the departmental reorganization after years of turmoil.
In 2001, Dr. Abdul Rashid Bhat joined as a new faculty member after getting training from Banaras Hindu University, Varanasi. He is very innovative and started some new spinal procedures here. In 2008, the department got a further boost when three more faculty members were inducted, Dr. Abrar Ahad Wani, Dr. Sarabjit Singh Chhiber and Dr. Nayil Khursheed Malik who added further input into the establishment of new procedures from their training in their parent institutes, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS) Lucknow, PGIMER, Chandigarh, and National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, respectively. Prof ML Babu became the head of the department in 2010 and maintained the pace of steady growth in the department. In 2013, Prof AU Ramzan took over the leadership of the department and was very keen to modernize the department. In his tenure, a state-of-the-art microscope, new drill systems, an ultrasonic suction aspirator and modernization of the theatre set-up was possible. We were able to establish a separate neurosurgical intensive care unit which is an eight-bedded unit with the latest set of ventilators and other related equipments. With induction of Dr. Sajad Hussain Arif who did his MCh in SKIMS itself, there are now 7 faculty members in the department [Figure 5] and [Figure 6].
|Figure 5: Left to Right: Dr. Mohammad Afzal Wani, Dr. Makhanlal Babu and Dr. Altaf Umar Ramzan|
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|Figure 6: "Alone we can do so little and together we can do so much." The current faculty of SKIMS (sitting row from left to right) Prof. AR Bhat, Prof. AU Ramzan, Prof. AR Kirmani; (standing row from left to right) Dr. Nayil Khursheed, Dr. Abrar Wani, Dr. Sarabjit Singh, Dr. Sajad Arif|
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| » Patient Related Services|| |
The status of clinical services offered may be assessed by the following data obtained from the annual report of SKIMS. 
Trend of clinical workload (2014)
At the present moment, the department is running daily referral clinics. There are three operating rooms (ORs), of which two ORs are dedicated towards conducting elective surgeries and one OR is used only for emergency procedures. They are well-equipped with modern state-of-the-art, technical equipment/instruments necessary for the management of complex neurosurgical, spinal and peripheral nerve surgical problems [Figure 7]. The department is providing round-the-clock emergency cover to all types of trauma victims which include road side accident victims and victims of blast and gunshot wounds. The department has sub-specialties like skull base surgery, neurovascular surgery, endoscopic surgery, neuro-oncology and pediatric neurosurgery. The department is supported by the faculty members of the Departments of Neuroradiology, Neuropathology, Neuroanesthesiology and Critical Care.
| » Academics|| |
The department has been very active on the academic front. The surgical postgraduates/residents and senior residents rotate through neurosurgery for getting experience in this field. Bedside clinics, journal clubs, seminars and conferences are organized from time to time to upgrade the academic knowledge of staff members. Inter-departmental scientific meetings are regularly being held. The department is actively involved in academic interaction with various departments in the Institute as well as with sister departments outside the state.
The department started the MCh training programme in 2005.The degree has been recognized by the Medical Council of India. The first batch of MCh students passed out in 2008. The degrees are awarded at the annual convocation event [Figure 8]. Till date, 14 neurosurgeons have successfully completed their MCh training. The annual intake of MCh students for training is 2 per annum and this is going to be increased to 4 per annum very soon.
|Figure 8: Annual convocation of SKIMS with the ex-president of India, Hon'ble Srimati Pratibha Devi Singh Patil, the governor, Mr. Srinivas Kumar Sinha (on the left side) and the union health minister, Mr Gulam Nabi Azad (on the right side) presiding as honored guests|
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The department is actively involved in the telemedicine interactive teaching programs with other major centers of India. These meetings are held in the department of telemedicine which is located on first floor of the laboratory wing. The telemedicine facility has given an additional impetus to the department in managing neurosurgical problems with the highest professional standards expected from a postgraduate training institute.
| » Recent Developments|| |
Dr AU Ramzan has continued his modernization drive and is keen to develop an endovascular laboratory. Two faculty members, Dr. Abrar Ahad Wani and Dr. Nayil Khursheed Malik have been deputed to GB Pant hospital to undergo training in this subspeciality. They have started the endovascular diagnostic procedures in the department. In the next six months, a three-dimensional digital subtraction angiography set up is being established in the department that will enable coiling of aneurysms and embolization of vascular lesions. An epilepsy program is also being initiated. In order to successfully implement this project, Dr. Sarabjit Singh Chhiber has been doing an epilepsy surgery fellowship in AIIMS, New Delhi.
| » References|| |
Black PM, Giannakopoulos G, McCormack TM, Nair S, McCabe MF. Development of neurosurgery beyond the North Atlantic countries: Africa, Asia, Australia and New Zealand, Central and South America, and Eastern Europe. In: Greenblatt SH, editor. A History of Neurosurgery. Park Ridge: AANS; 1997. p 543-60.
SKIMS Annual report; 2014. p. 154-8.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]