In Jammu and Kashmir, Dr. Mohammad Ashraf Ganaie stands as a beacon of knowledge and expertise in the field of endocrinology. Dr. Ganaie’s journey has been one marked by dedication and resilience. From his early days in medical college to his illustrious career at the All-India Institute of Medical Science (AIIMS) in New Delhi, his unwavering commitment towards his profession and patients has impacted the lives of many here.
In a candid and enlightening interview with Kashmir Observer’s Nazir Ganaie, Dr. Ashraf delves into the nitty-gritties of Kashmir’s challenges with ailments, shedding light on prevalent health issues in the region.
Q. Can you tell us about your initial days in medical college, and how your overall journey has turned out?
The journey overall has been great, considering the fact that my education in medical sciences went smoothly regardless of the environmental setbacks I had. When I entered the All-India Institute of Medical Science (AIIMS) for my doctorate degree, I got to know, much to my relief, that my training and prior education was no less in quality than any of my peers. A good number of students across a variety of courses even sought academic guidance from me from time to time — thanks to my reputation in the college.
That said, the academic scene for us was very good; education was great and satisfactory, while the competition was relatively lesser as it is today.
Q. Talking about the academic scene you just mentioned, how good do you think it is nowadays?
A lot of things have undergone significant advancement for sure; though due to a number of reasons, quality education isn’t in a great place right now. The presence of distractions, a lack of the number of teachers, or an overall lack of good teachers are some of the reasons.
Q. We’ve noticed that people tend to describe endocrinology as something related to diabetes; could you describe your field to our readers in simple terms?
Endocrinology would be described simply as the study of diseases related to the endocrine system and glands. Our body has a lot of endocrine glands inside it which secrete different hormones. This system consists of the Pituitary Gland near the brain, the Thyroid gland in the throat, reproductive glands, the Pancreas, Adrenals on the Kidneys, and a large number of smaller glands distributed throughout the body. Even fat can be considered something like an endocrine gland, since a lot of hormones are released from it. As a consequence of the number, a lot of diseases are prevalent that are related to the Endocrine system.
I agree with the fact that people think that an endocrinologist just treats diabetes; they even go as far as calling an endocrinologist a “sugar doctor”. This is primarily because of the lack of awareness, but a part is also played by the fact that a large set of endocrine diseases are hardly present in our society. A case of type one Diabetes can be treated by any trained physician; it’s only the group of people who suffer from secondary diabetes — where it is a part of a bigger disease — and people who have a problem specifically in the pancreas that need the attention of an endocrinologist.
Q. Since other than being a conventional doctor, you are also involved in a lot of research — like the tribal affairs you’ve worked on — did you come across anything valuable or revealing that concerns the scene of diabetes and endocrinology in Kashmir?
We indeed have done a lot of research, all the way back since I was in AIIMS; which, as you mentioned, consisted of projects related to tribal people at times.
Most of my experience is in the area of lifestyle or non-communicable diseases. Especially the problem of abnormal blood pressure, which is widespread in Kashmir. Some of the causes include Endocrine Hypertension, which usually occurs in younger people, and is difficult to control; such cases are some that we’ve seen being common in Kashmir. A lot of commonplace health practitioners prescribe steroids to patients at times, which can cause abnormality in blood pressure as a side effect. Another major cause is Hyperaldosteronism, a disease related to an excess of Aldosterone — a hormone secreted by the Adrenals — which has the ability to increase blood pressure. After being diagnosed, it’s treated by surgery, and the high blood pressure is controlled. The problem here lies in the lack of awareness, which causes a lot of people to miss out on diagnosis. After some time of surveying around, we found that a lot of people suffer from Hyperaldosteronism that aren’t diagnosed initially.
Q. A lot of people in Kashmir mention consuming blood pressure medication at some point; and sometimes it’s a case of self-medication. Can you educate our readers regarding blood pressure, hypertension, and medication?
Abnormal blood pressure is something that is very simple to diagnose; though unfortunately it’s very common in Kashmir, especially with tribal people. When compared to people from other states, it is very largely prevalent here. We’ve observed a common occurrence of brain hemorrhage or paralysis caused by hypertension. It even acts as a major cause of heart attacks.
People in Kashmir take hypertension very lightly, and a lot of myths about it are present. Problems like kidney failures and strokes are also caused by it, which renders a lot of people disabled, or results in death at times.
The major cause of abnormal blood pressure in Kashmir is that Kashmir is a hilly area and therefore has a higher altitude, acting as a factor to increased hemoglobin; and the common usage of high amounts of salt. Studies show that salt and hypertension have a hundred percent correlation.
An article based on our research published in The Outlook magazine mentions the frequency of occurrence of hypertension in Gujjars and Bakarwals; highlighting that fifty percent of them suffer from hypertension, and thirty-three percent have pre-hypertension symptoms. Since no facilities are available with such people, which would have included doctors, or just people who could check blood pressure, these people take blood pressure medication usually just once a week, when they have a headache or something. This causes fluctuation in their blood pressure, which is said to be more damaging than steady hypertension.
Q. Is there a common symptom or sign that can help us recognize hypertension?
There is almost no primary or major symptom of high blood pressure, it can only be surely diagnosed when one checks it with proper instruments. Though people commonly feel exhaustion or body aches when it happens, which they can’t properly explain to the doctors, resulting in misdiagnosis. Headaches or a problem with vision are not just common symptoms, rather signs of a hypertensive emergency.
Q. Talking about Diabetic people, how can they live with their disease while maintaining their health?
They should first of all avoid getting hypertension at any cost; and it’s easy, they just have to lessen the amount of salt intake. A study highlights that if a person with diabetes has their body damaged to a certain point, a person with blood pressures receives five times as much damage, and a person with both diabetes and blood pressure gets their body damaged up to nineteen times the amount.
They should also comply with their doctor. Non-compliance, or not taking medication regularly is a disastrous problem that is present in Kashmiri people.
Q. People in Kashmir have this habit of taking medication for years on end, all the while not reducing salt intake, which hinders their process of getting better. What would you suggest in this matter? Is it required that their medication be changed?
Periodic and regular follow-up is must in such diseases. We can’t just keep taking medication continuously without any changes, since a lot of them have side-effects, and some drugs don’t have the desired effect at times, because of factors and targets of the medicine varying from patient to patient. These factors include age, sex, whether a person is diabetic or not, and pregnancy.
People, due to misconceptions, have erratic medication taking habits, which is detrimental to their health.
Diabetic patients also have this habit of increasing salt intake against their decrease of sugar consumption, which is also a problem. When we look at the resources provided by American Diabetes Association and International Diabetes Federation online, it’s evident through research that a patient can easily consume 15-20g of free sugar without any disturbance, but if the patient increases 5-10g of table salt intake, the blood pressure will shoot up.
Q. We’ve heard about your achievements and great work in AIIMS and in treating influential people such as politicians. Could you tell us something about them?
AIIMS New Delhi is an institute that is central and different, it is on a level that is in direct competition to the rest of the world; the programs they hold are a lot of the times in collaboration with prestigious universities like Oxford or Harvard. So, it gives a person this sort of a platform to shine, which it did to me too, and I worked very hard when it did. The institute encourages people under it to grow, and appreciates innovations and any new ideas. I took a step in my time there to try and create this research ecosystem, which got me a letter from the health ministry saying they’d be pleased to allow me to do so. AIIMS Delhi as an institute and the people there encourage you and mentor you into excellence.
Q. Could you educate us regarding diet regulation and maintenance that keeps a person, or maybe a diabetic person or such healthy?
An initiative of diet control to promote a healthy well-being is surely a productive pursuit. We’ve seen, more so in earlier times, that an average Kashmiri man would work hard in the field and come home to a fibrous meal of rice and vegetables twice a day, which would yield a calorie count equal to what he needed for working in the field. This would keep the person healthy, and prevent a lot of lifestyle-borne diseases. Problems started arising as people started slowly adding to this diet, like regular consumption of fatty meat cooked in a lot of oil, high-calorie snacks like potato chips and biscuits, and regular use of cream and butter, all the while not engaging in any kind of outdoor activity. This has made diseases like fatty liver very common. Such a lifestyle has to be brought under control in any way, for a healthy lifestyle. A person should always keep track of the number of calories being consumed. Processed food items should also be avoided, as they contain a lot of contaminants that disrupt the endocrine system.
A lot of areas have specific diseases, these are determined by altitude, geography and diet. Iodine deficiency for example is common in hilly areas, due to a low Iodine percentage in the soil, contrary to coastal areas, where Iodine is high in almost everything. Kashmiris also have a deficiency of thiamine or vitamin B1 at times which causes a lot of diseases. Many such things which include endocrine diseases are prevalent because of the mentioned factors.
- *Excerpted from “Beyond The Headlines | Dr. Mohammad Ashraf Ganaie in Conversation with Nazir Ganaie” (Kashmir Observer/Youtube). Compiled/transcribed by Saqlain Beg
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