'I told them India was like a giant jumbo jet. It would take off slowly and be unstoppable'

This doctor couple put their faith in India. And in return India has put faith in them.

On December 5, 1988, a cold winter evening, an Air India plane touched down at Mumbai airport, and a young bearded doctor disembarked with his luggage that included a fat load of books.

Mumbai-educated, with degrees from the Seth G S Medical College and the KEM Hospital, he had left India's shores four years earlier to gain postgraduate training at the Johns Hopkins University School of Medicine in Baltimore.

His wife, who had also graduated from the same medical colleges in Mumbai and who was training further at the Yale University School of Medicine, followed him back to India a few months later landing in Mumbai, also on an Air India jet, because they "always took the national airline," in July 1989.

The couple's return journey to a pre-liberalisation, Rajiv Gandhi-run, hopeful India could not have been without a wee bit of trepidation for what the future held for both of them. In those days -- nor even now -- very few doctors considered returning to India after gaining a higher education in their respective medical fields abroad. 'Reverse brain drain' among physicians was fairly uncommon.

Yet for this doctor couple, interestingly, there had been zero doubts. No trepidation. Or nervousness either.

India was very much their country and home and they could not dream of practicing medicine in their chosen specialities anywhere else. It was part patriotic regard for a homeland and part believing there could not be any other destiny for either of them except India.

"We were thrilled and very emotional about returning to India; felt a lot of excitement too. We were fully commited to working in India. Both of us left with the idea of coming back in two years, but stayed on for four. We were thrilled and very emotional about returning to India."

"During the four years we were in the US, we made six trips home. Every vacation we headed home and saw very little of the US during our time there! I was offered a visa that would make me eligible for a green card, but declined as neither of us considered the possibility of staying there."

Settling back down in India and adjusting to the Indian tareeka (way) of doing things, in the initial days, was sometimes not easy, given that their qualifications and training did not always match the facilities available, but they soldiered through, always keeping their focus and dwelling on the bright side of life.

This doctor duo put their deepest faith in India.

And in return India put well-justified faith in them.

Today, both of them are at the top of their individual fields in our country and are pillars of the medical fraternity, taking new strides daily in medicine and medical research.

Indeed, idealistic doctor couple Dr Firuza R Parikh and Dr Rajesh M Parikh, with their hard work, dedication, modesty, perpetual positive thinking, showcase the best of what India has to offer and are examples to doctors who follow in their footsteps, including their elder son Dr Swapneil Parikh and his wife Dr Meenal Khandeparkar.

Dr Firuza courageously began India's first IVF facility within a private institution in 1989, and there is a burgeoning army of children out there, in many a middle class home, who owe their existence to her.

Her IVF science and technique has seen her bring Southeast Asia's first micromanipulation baby* into the world in 1994 and foster the first laser-hatching pregnancy** in 1999 and recently start up cumulus-aided embryo transfer*** for the first time anywhere.

An internationally-recognised fertility specialist, she is presently the director of assisted reproduction and genetics at the Jaslok Hospital and Research Centre, Mumbai, and visiting professor at the department of obstetrics and gynecology at the University of California at Los Angeles.

Accolades, medals, milestone acknowledgements and awards keep tumbling into Dr Firuza's lap every year for her exceptional lifework in assisted reproduction and genetics and she has received over 30 awards.

In addition to extensive coverage in the India media, her research and skills have been profiled in umpteen international newspapers and magazine as well -- The Boston Globe, The Washington Post, Time, Newsweek, The New York Times, among many others.

As a member of several national committees -- like the Experts Group for Formulating the National Guidelines for Accreditation, Supervision and Regulation of ART Clinics in India, Monitoring Committee of Network Project: Developing Cells and Tissue Engineering -- Dr Firuza advises the Indian government

Dr Rajesh, who was for decades one of the country's most well-known practising psychiatrists, is now the director of medical research and an honorary neuropsychiatrist at the Jaslok Hospital and Research Centre, Mumbai. He is also adjunct professor of psychiatry at the University of Iowa, Carver College of Medicine and a former WHO global expert on depression.

He has worked on some 50 reseach projects and has delivered well over a hundred international talks on mainly neuropsychiatry and mood disorders -- for instance for 10 years consecutively in joint Jaslok-Harvard symposia at the APA annual conferences he spoke on the cross-cultural aspects of mood disorders.

If that's not enough, Dr Rajesh, a savant of sorts, who only recently got a cellphone :), also paints; does professional photography; is a quiz buff, who any day may floor audiences on KBC; is fluent in six languages and speaks and lectures in French; is learning Sanskrit and Greek; writes books and papers; and, at not even a moment's notice, will drop all his dizzylingly multifarious pursuits to squeeze out ample time to help someone in need of advice, a hospital bed, a medical recommendation, assistance in treatment, or a rare drug and was the go-to person for myriad types of support through the worst days of COVID-19.

During the COVID-19 pandemic, he re-invented himself, seeing a record number of patients online and was deeply immersed in understanding SARS-CoV-2, which lead to two books -- The Coronavirus, What You Need To Know About The Global Pandemic and The Vaccine Book for COVID-19.

Dr Firuza and Dr Rajesh met in their first month of medical school in Mumbai: "She liked a poem I had published in the college newspaper and walked up to me and introduced herself." They complement each other in their approach to medicine and each is the other's best fan.

As senior physicians, Dr Firuza and Dr Rajesh have over the last 32 years plus, with 64 years experience between them -- and that's not counting from when they joined medical school in Mumbai in July of 1974 -- watched the way medicine has evolved in India. They have witnessed the slow but sure modernisation of our hospitals and health services and the promising and steady rise in standards of Indian medical care.

The doctors sat down together with Vaihayasi Pande Daniel/Rediff.com to look at the way Indian medicine has developed on various fronts:

How much better is access to medical care for Indian patients?

Dr Firuza R Parikh: As in the rest of the world, in India there have been immense strides in access to medical care for patients due to the accelerated progress of online medicine. This has been partially triggered by the pandemic.

Yet ironically the pandemic has also highlighted the disparities in access for patients based on their socioeconomic status and where they live.

Dr Rajesh M Parikh: When Firuza and I returned to India in 1989 from Yale and Johns Hopkins hospitals many of our colleagues in India and the US were dumbfounded. We were told later that some even made bets on how quickly we would get frustrated and return to greener pastures.

To an extent they may have been right. It was not easy. I returned to a full-time academic job at a municipal medical college and hospital in Mumbai and from day one faced several challenges.

Yet within a year we were at the Jaslok Hospital and found work that met the highest international standards. While access to quality medical care is a challenge everywhere, we can be proud of the high quality of care available in India.

What about the availability and quality of equipment and tests?

FRP: In my field of IVF, we have the most advanced level of care in the world, particularly at JaslokFertilTree. Within a year of inception, we were getting patients from 60 different countries of the world and from every state of India. Recently, we had our 20,000th baby. Today, high-quality infertility care is available in every state of India.

RMP: Unlike IVF, neuropsychiatry is still in its developmental stages in India, but we are optimistic that, with greater awareness and acceptability of mental disorders and their treatments, in a few years we will be on par with countries that are more advanced in their level of care and its accessibility.

Would you say that with the passage of time is the famed bedside manner becoming a thing of the past and is patient-doctor communication worsening because younger doctors don't understand the value of a physical examination and hearing a patient's symptoms attentively?

RMP: Each generation of doctors has bemoaned the deterioration of the bedside manner and communication in the subsequent generation! It goes back almost to the beginnings of the formal practice of medicine.

While those of us who have been in medical practice for decades may have a thing or two to teach young doctors in bedside skills and communication, we too have a lot to learn from them, particularly in how seamlessly they harness technology to enhance their skills.

Change is constant and we should try to embrace it rather than resist it.

How welcome is it see the increasing awareness of the patient? Is that is a pro or a con depending on the income levels of patients?

FRP: We have seen an exponential increase in the level of knowledge that patients have about their illnesses and the treatment options.

While sometimes this can have some disadvantage in that with the plethora of information on the Internet, it is not easy to select reliable sources and patients can be misled. But, overall it is a positive development.

An informed patient is always a pleasure to treat and communication moves much faster.

RMP: I entirely agree with Firuza. It is as though we are witnessing a second Guttenburg revolution. The first was triggered by moveable type printing and now we have the Internet!

To an outsider the money issues relating to doctors is disturbing, like the fact that doctors want referral fees. Or how young, fresh-out-of-medical-school doctors are gravitating to only more lucrative specialties and that might lead to an eventual decline/dwindling in the number of GPs and to certain specialties will fall short of enough manpower.

FRP: Yes. Not all is well in the state of our medical affairs. But we do have checks and balances in place even though they are not always effective.

Society has become commercial in general. Look at the enormous legal fees, for example. I cannot think of a single doctor who will deny treatment to an ill person on account of fees. There are not many professions where this would be true.

There have been more and more incidents relating to the safety of doctors. They sometimes get attacked or beaten up by patient relatives.

RMP: This is becoming an issue in our country.

Part of it, may be attributed to what you alluded to earlier about communication skills. Across the world expectations from medical workers are getting higher. Dissatisfaction with what is perceived is resulting in increased litigation in the West and violence against doctors in our country.

Yet, time and again the doctors have put the safety and the health of society above their own welfare. The recent pandemic is one such example.

How does the older generation of doctors compare with the younger crop coming in terms of skills and more? Younger doctors, especially, seem to put a lot of store in ratings and it is very important in their scheme of things.

FRP: We live in a world where increasingly the line between reality and virtual reality is blurred. It is a world where ratings matter as much for medical care as for food.

I personally see nothing wrong with doctors striving to improve their ratings. It also serves as a mirror to them about how their services are perceived. Rajesh, for example, has over 450 5 star ratings. Something that is extremely rare in our profession.

RMP: And, of course, as always Firuza is ahead of me. She has nearly 800 high ratings. So, it would be unfair of either of us to complain about ratings!

How has the pandemic tested the system, both positively and negatively?

RMP: Our phenomenal vaccination drive is a testament to how our system rose to the occasion. Unfortunately, we did not do as well with testing and early response to the pandemic especially so in the plight of our migrant workers.

What is the overall status of medical research in India?

FRP: Of course, much needs to be done in the quality of our medical research, but we are amongst the leading countries in terms of research output. Rajesh has brought about sweeping changes at Jaslok in his role as director of medical research by starting with the basics such as standard operating procedures.

RMP: Dare I disagree? I do plead guilty as charged!

How has the IVF field evolved? What have been the challenges and the setbacks?

FRP: Our biggest accomplishment: Being on par with and occasionally ahead of the best in the world. Our largetst challenge: accessibility and affordability. At JaslokFertilTree we are working on these issues.

How much better is the awareness about mental health and has that led to a higher percentage of doctors entering the field?

RMP: Yes and no. More doctors are entering the field. Then again, there are more psychiatrists of Indian origin in the US than in India.

The pandemic has triggered sweeping changes in the acceptability of mental disorders and their treatments. Social media too has played a major role.

There has been a rise in the number of cosmetic specialist doctors who concentrate on how the body looks.

FRP: A sign of our times! Personally, I see nothing wrong with that. They are very skilled and work just as hard as other medical practitioners.

How about the progress of improvements in medical care in rural India?

RMP: A long way to go, but we are getting there. It is a complex issue and certainly merits a lot of attention. The solution spans multiple disciplines beyond medicine such as politics, economics and sociology.

Why did you both decide to come back to India after completing your training in the US?

RMP: I recently came across an old news clipping. In 1974 when we were in our first year of medical school, I was interviewed by the Evening News from The Times of India group. They asked my plans. I said I would do my MBBS and MD in psychiatry in India and go to the US to super-specialise and return to India. That's exactly how it panned out.

When we decided to return our friends in the US and in India thought we were making a big mistake and would regret it. At that time pre-liberalisation hardly any doctor returned.

I told them India was like a giant jumbo jet. It would take off slowly and be unstoppable. Everyone thought it was a joke. I guess we are having the last laugh. So many of our contemporaries want to return now.

I think patriotism, a love of our culture, families, faith in India and fear of bringing up children and growing old in an alien culture might have all factored in our decision.

An aside: My mother worked for the Family Planning Association of India when I was five. Within a year she grew disillusioned with the programme and switched to becoming a pioneer in the crèche movement.

I grew up hearing her say, 'They are getting it wrong. India is not 700 million mouths to feed, but 1.4 billion hands to work! Our population will be our asset some day'. She also was anti-Malthusian. So I grew up in a home where both parents believed strongly in India.