Role model: Parivakkam ArunakumariBMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4877 (Published 28 November 2018) Cite this as: BMJ 2018;363:k4877
Parivakkam Arunakumari originally set up the paediatric and adolescent gynaecology service at Basildon Hospital because she felt that the care of young girls with gynaecological problems could be much improved.
“They were being seen by clinicians who were not necessarily trained to appreciate the delicate and sensitive nature of these intimate examinations,” she says. “There were many unnecessary investigations and over medicalisation.”
Part of the problem was that paediatricians are not trained in gynaecological assessments and gynaecologists aren’t used to examining children. Paediatric and adolescent gynaecology sits at the intersection of the two specialties. “Girls and adolescents have a completely different set of needs to adults,” Arunakumari says. “For many patients, it’s their first encounter with gynaecology services and it is imperative that we get it right.”
Girls are now entering puberty much earlier, some as young 8 or 9, which can cause huge emotional problems, Arunakumari says. “Usually you don’t expect gynaecological problems before puberty but now this is becoming more common, partly because of the rise in obesity.”
At Basildon Hospital, Arunakumari set up regular paediatric and adolescent gynaecology clinics to deal with problems such as vaginal bleeding before puberty, vaginal discharge, vulval itching, vulval pain, and congenital abnormalities. She also established a surgical service at Basildon and Norwich which meant that patients who would previously have had to travel for minor procedures could have them done closer to home.
Congenital abnormalities have a huge psychological impact on girls, Arunakumari says, so she set up a peer support group allowing them to talk to someone else who has experienced what they are going through.
Arunakumari also streamlined the termination of pregnancy service which previously was patchy and fragmented. “Women seeking abortions constantly feel like they are being judged when they come into the hospital,” she says. “I wanted to provide a situation where they do not feel blamed. It is not our remit to judge them, we are there to provide a service.”
She has also been involved in developing the forthcoming NICE guidelines on intrapartum care for high risk women and has been the lead reviewer on a number of guidelines for the Royal College of Obstetrics and Gynaecology.
Despite all of this high level work Arunakumari is most definitely a people person. “Staff in difficulty—including medical students, junior doctors, and secretaries—often seek me out to help them,” she says, “This is an enormous privilege. I am grateful for the ability to offer my time and effort generously.”
When Arunakumari was 14 years old her mother died of heart disease, something which inspired her to go into medicine. “Her death was premature and could have been prevented if there had been a doctor nearby,” she says. She did her initial medical training in Chennai, India, and came to the UK aged 28.
“The medical culture in Chennai and in the UK is very different,” she says. “In Chennai there was a very paternalistic approach whereas in the UK there is much more shared decision making involving the patient. The UK also has more of a team approach where every member feels valued.”
Arunakumar stresses the importance of not just being a good doctor but also being a good person, and says values and attitudes are as important as knowledge and skills. She tries to abide by Mahatma Gandhi’s maxim, “You must be the change you wish to see in the world.”
Nominated by Sujatha Kalburgi
“Despite having a busy portfolio career, Dr Arunakumar is a strong people person; excellent at establishing rapport with patients and staff alike.
“Her sharp clinical acumen, strong knowledge base, infectious zeal for clinical work, and unquenchable enthusiasm for quality improvement programmes are truly inspiring.
“She effortlessly unifies disparate team members and implements change—both material and cultural—smoothly.”
Sujatha Kalburgi is an SAS doctor in obstetrics and gynaecology, Basildon Hospital.
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