Year : 2015 | Volume
: 1 | Issue : 1 | Page : 54--60
Dr. PK Mullaferoze motivational biography (3 October 1910-24 November 2008)
Dhruv Mehta, Nadir Bharucha, GS Chawra, Rakesh R Bhansali, Ella D'Souza, PC Shastri, GS Shashikala, Asha Dangarwalla, Fatema Jetpurwalla, AK Purohit
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Mehta D, Bharucha N, Chawra G S, Bhansali RR, D'Souza E, Shastri P C, Shashikala G S, Dangarwalla A, Jetpurwalla F, Purohit A K. Dr. PK Mullaferoze motivational biography (3 October 1910-24 November 2008).Indian J Cereb Palsy 2015;1:54-60
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Mehta D, Bharucha N, Chawra G S, Bhansali RR, D'Souza E, Shastri P C, Shashikala G S, Dangarwalla A, Jetpurwalla F, Purohit A K. Dr. PK Mullaferoze motivational biography (3 October 1910-24 November 2008). Indian J Cereb Palsy [serial online] 2015 [cited 2019 Aug 22 ];1:54-60
Available from: http://www.ijcpjournal.org/text.asp?2015/1/1/54/153580
It is an attempt to share the life and work of Dr. PK Mullaferoze to take a leaf out of her noble and far-reaching work and to create similar models which could address the total needs of children with cerebral palsy and their families.
Albert Einstein, paying tribute to Gandhiji's life and work said, "future generations would scarce believe that such a man like him walked on the face of the earth in flesh and blood." In a similar context, one can say "future medical fraternity would scarce believe a person like Dr. Perin Kavas Mullaferoze indeed lived and could with such passion, perseverance, and purpose kindle and create a team, an institution, a unique model for management of cerebral palsy at Mumbai in India and the first of its kind in South-East Asia".
Dr. Mullaferoze sowed the seeds of uncompromising care for habilitation and rehabilitation of children, by creating an institution. "The Cerebral Palsy Unit" in Children's Orthopedic Hospital (COH) where for more than 50 years, the children and families from Mumbai, different states of India, and abroad got guidance, support, and strength; were holistically managed by the team she had created to enhance their function and quality of life.
Dr. Mullaferoze was born on 3 October 1910, at 127, Cumballa Hill, Mumbai to Kavas and Tehmina Mullaferoze. The family was poor. Dr. Mullaferoze was a sickly child, had fever frequently and hence educated till 4 th std. at home in Gujarati. Then, she did her schooling from Queen's Mary's School, Byculla, Mumbai. She became Head Girl of the school. She then studied at Elphistone college, Mumbai, where she was an inter-college badminton champion too.
She passed M.B.B.S. in 1935 from Grant Medical College and J.J. Group of Hospitals, and worked as a house surgeon (the first woman house surgeon under Dr. SJ Mehta at JJ Hospital for 1 year. She then went to England and did L.R.C.P. and M.R.C.S. in 1937 and then F.R.C.S. (England) in 1940. Subsequently, she returned to India. She was offered post at the All India Institute of Medical Sciences and Lady Hardinge Hospital, but she declined the offer and joined the Cama Hospital as a house surgeon.
From 1943 to 1947, she offered her services for the Army. In May 1943, she joined the Indian Army Medical Corps as a surgical specialist with the rank of Major during the World War 2.
In March 1946, she was appointed Officer-In-Charge (OIC) Surgical Division with the rank of Lt. Colonel. She worked in Alipore, Asansol, Ranchi, Dacca, and Batavia (Indonesia), in extremely difficult circumstances, overcoming personal and health problems. At one point of time, in a span of 2 months, she performed 530 surgeries. The recommendation of the superior officer on "O.I.C. (Officer In charge) Surgical Division has skill and organizing ability of a higher order, sound diagnostician, skilful operator, unlimited capacity for hard work, excellent teacher. In administration of her division, she showed firmness and ability. I can confidently recommend her for a surgical appointment at a teaching hospital". She along with three doctors managed the 1500-bedded surgical division in Dacca (77 IGH). She worked in Alipore and Asansol for 1 year and in Ranchi and Dhaka for 3 months.
In 1947, for her medical services during the world war, she was awarded a Military- "Order of the British Empire."
In 1947, she returned to Cama Hospital. In May 1948, she was appointed Hon. Asst. Surgeon, JJ group of Hospitals. In January 1950, she was appointed as Hon. Asst. Orthopedic Surgeon at JJ Hospital, when the orthopedic department had been started with Dr. Parmar as the Head. She became Hon. Orthopedic Surgeon in November 1952 when Dr. Parmar retired.
She joined the COH as Hon. Orthopedic Surgeon along with Dr. KT Dholakia, working under Dr. MS Keni. She was later appointed Hon. Officer-In-Charge in 1953. She became the Medical Director and the Chief Orthopedic Surgeon of COH in 1956.
She took great pains and worked relentlessly to upgrade the hospital and provide the best facilities for the patients. Initially, she dedicated all her expertise as an orthopedic surgeon in the treatment and prevention of poliomyelitis and congenital deformities. From 1956, the number of children with cerebral palsy at COH showed a phenomenal increase and Dr. Mullaferoze felt a proper, well-coordinated setup of professionals was the need of the hour.
To learn more about cerebral palsy, she traveled far and wide, saw the work of Bobath and Eirene Collis (UK), Prof. Guy Tardieu (France), Mi laniComparetti (Italy), Dr. E. Kong and Dr. U. Aebi (Switzerland), and Dr. H. Narabayashi (Japan).
In 1962, she visited the centers of excellence working for cerebral palsy in the USA for 2 months along Ella D'Souza (physiotherapist), in an exchange of persons program sponsored by the Department of Health, Education and Welfare, Washington DC. Institute of Rehabilitation, New York and State Rehabilitation Hospital, West Haverstraw (Residential) were visited. The empha sis on team approach, interactions meetings, and case discussions which were held regularly to evaluate and plan the treatment program of each child impressed Dr. Mullaferoze. She liked this approach where each staff member's contribution and evaluation was duly considered.
In 1963, at COH, the pilot project of cerebral palsy unit got started. On 1 January 1969, a first fully staffed Cerebral Palsy, the first of its kind in India and South-East Asia, took roots because of the vision of Dr. Mullaferoze. In a short time, it became a model institution where cerebral palsy children from India and other parts of Asia got the best care from a dedicated team under Dr. Mullaferoze's guidance. Even families from far and wide, including abroad came for their child's treatment.
In COH, there were pediatricians, ophthalmologists, ENT doctors, orthopedic surgeons, neurologists, psychiatrists, psychologists, visiting physiotherapists, occupational therapists, speech therapists (with special acoustic rooms and audiometry), medical social workers, special educators, orthotists, prosthetists, and visiting dermatologists. There were places for hydrotherapy, limb plastering, surgery and dental departments. There was a special day for taking clinical photographs, which was initiated by her.
She was one amongst the first six doctors who were instrumental in starting Bombay Orthopedic Society.
She was very strict and her focus was on growth and development of the child and well-being of the family. The problems of children with disability touched the core of her heart. The rich and the poor got her equal attention and care.
She started counseling sessions and re-assessment sessions for monitoring the child's progress with her whole team of therapists psychologists, social workers, special educators.
She emphasized detailed documentation, and wanted her staff to be precise and thorough in their documentation and the files to be neatly written. She started Brace Clinics case conferences, and aimed for high standards.
She wanted those working for children and for the institution to give their best. She used to challenge her therapists, inquiring, probing, and taking them to greater heights of excellence. She wanted them to visit different institutes to broaden their horizon.
She instilled a sense of hope, promise, and compromising care. She gave insights that were simple, practical, and meaningful for families.
She innovated splints surgical techniques, and adopted phenol technique to reduce spasticity. Those who saw her operating had found found her to be extremely methodical and quite tender while handling tissues.
She wanted aids and appliances to be maintained in the neatest condition; in fact, there was a special shoe-shine day for those who were admitted in the wards.
She used to personally taste the food that to be served to the children in the wards. She would readily admit a child in the wards when they had to come for therapy from too long a distance.
She would encourage therapists to make children as independent and functional as possible and would just facilitate a little to do their activities of daily living themselves.
She would share insights as to how she attended a conference internationally which was totally organized by persons with cerebral palsy.
She would go out of her way and help those who were poor, the children who needed nutritional supplements, or the families that needed conveyance help, but only to those who were really motivated and showed involvement in the treatment of their children.
She would take feedback from the social workers of the families. She would counsel and speak to their families who were regular and involved in the care of the child. She used to ask them to work whole-heartedly with dedication or leave if they worked half-heartedly.
She would write compassionate letters to employers/work places which are situated far away from Mumbai from where the father-mother had come for treatment for their child, and suggest for longer leave or if the child needed long-term care, even transfer of job.
She wanted her staff to link up with doctors of other hospitals if they were referred for an opinion there.
She also encouraged the teachers (special educators) to start a school for remedial education - the first of its kind school for children with learning disabilities, a school on the hospital campus. Many children attended therapy and school simultaneously. Because of the trust the school created, even many final exams of children studying in other schools, but admitted at COH for treatment were Conducted at the hospital.
She could speak fluently in five languages, i.e. English, Gujarati, Marathi, Hindi, and Konkani.
For therapists and She conducted regular courses held seminars, and wrote several papers on cerebral palsy which she read at national and international conferences. She would be heartened if some cerebral palsy Services were started started in a small town/city and would enthusiastically ask how these centers were running. She felt that there should be centers of excellence for cerebral palsy in most cities and towns, and they should have satellite/peripheral centers and should reach out to rural areas.
She motivated parents to come together and form support groups, and to write their accounts to motivate others.
Children who grew up always came to thank her and meet her over the years. When your touch lives at such a level, it is bound to leave with a sense of satisfaction.
Dr. PK Mullaferoze's vision, sincerity, dedication, tenacity, and zeal to serve and ameliorate the problems of children with cerebral palsy and other disabilities are indeed beyond measure, and words.
She lived simply, was a very private person, unmarried, and kept a low profile. She was an avid reader of books on fiction, history, and biographes, abhorred the television, and was a lover of animals.
She was a champion of nobility of the medical profession - blessed are those who were treated by her and those who trained under her. Her passion and intensity transformed the lives of patients, families, and medical people who trained with her.
She was elected Fellow of the British Orthopedic Association in 1963. She was the only Indian member of the World Commission for Cerebral Palsy. She was selected as a special member of the International Cerebral Palsy Society (ICPS) and attended the first Congress of ICPS held at Arhem, the Netherlands in 1971.
She retired in 1985, but continued to work in advisory capacity till 1995 when she gave up due to health reasons. After a brief period of illness, she passed away at Bombay Hospital, where her immediate family of Dr's Bharucha had got her admitted. She passed away on 24 November 2008.
The Indian Academy of Cerebral Palsy (IACP) has indeed given a fitting tribute to Dr. Mullaferoze by observing her birthday (3 October - the week) as National Cerebral Palsy Day/Week, and she was made the Founder President of IACP to which she reluctantly agreed apprehending the commercialization of the medical service. Our collective responsibility lies in creating holistic models like the one Dr. Mullaferoze created, so that at one place, most of the needs of children with cerebral palsy are addressed and met, and the wellness of families and caregivers gets enriched. It was such a rare coincidence that the first national Cerebral Palsy Day observed by the IACP was Dr. PK Mullaferoze's centenary year 2010.
May we carry on the work that she lived for all her life, the flame of cerebral palsy care that she lit; We should, with similar passion and intensity, nurture it and see that it keeps illuminating brightly, so that it can touch the lives of children and families and then pass it on to the next generation.
Insights of Dr. PK Mullaferoze
Always at the back of my mind was there, how much good I can do.
To do good is my Religion.
Make therapy for children fun and functional.
Be simple, try and do things with your hands, and improvise.
Work with passion, pay attention to the smallest details so that the whole picture will have order.
Listen to the silliest complaint of the patient, a good medical history is half the battle won, and also the family's heart.
Make your children meet the challenges of daily living, do not handle them like glass, take care but teach them how to fall and rise.
Simplify things, the most illiterate and rural person should understand what you are saying and want to carry out.
Do not use too much gadgetry; a clean bed, a clean bed sheet, healing hands and a committed heart is what is needed.
Do not make money for the institution by dragging on therapy, call families till a point where you attain optimal functionality.
Treat children in the context of their cultural situations, work with things of the earth, the mud-grass, sand, water.
Be informed, read, travel and see different centers, broaden your horizon, but then leave the book and read the child.
Work in harmony as a team to give best to child with cerebral palsy and the families.
Be meticulous, be intense, do not be mediocre and do things half way, get involved totally or not at all.
Parents should not lose heart, lament at the lack of services in their cities. Create a team after learning from experts here. I too am a battle scarred soldier, let us confront the system and create a better future.
Hospitals should be accessible, never high rise, spacious for walking-non slippery, wheel-chairs/trolleys can easily move and there should be ramps.
Hospitals are the mandir, masjids why our politicians do not want to work deeply for the sick and needy.
I believe (though you may confirm with Dr. Chawara) she had applied at JJ Hospital for the post of Orthopedic Surgeon, but was not called for the interview! She went anyway. At the end of the interview, she walks in and asks the interviewers why she was not called. She was told that being a lady she would not have been able to handle car loads of patients that were expected at the hospital emergency. She promptly replied, "I am used to treat train loads of patients." She got the jobShe had an imposing personality and people were awed by her presence. Some were scared, some were honoured, some were unsure of her reaction, but everyone wanted her attention. She instilled an army like discipline in COH where the ward boys had to salute with their arm horizontal and not half-heartedlyA child with Koch's spine was admitted one afternoon when I was a resident. The next morning she asked me if the first dose of Inj. Streptomycin had been administered. I had not been able to and got slapped for it. I thought of an excuse and said I would put in an indent for it immediately. That's when she told me she had kept a sum of Rs. 5000/- from her personal money for any delay in management. The medicines were to be bought with that money at any time of the day or night and she would be reimbursed whenever convenient. The Matron was also blasted for not informing of this arrangement. That was the kind of dedication she had to her patientsShe would bully everyone in the department, but was actually hoping to improve their performance and change their way of thinking and approach to a patient. She was very conservative in her views regarding treatment options, and took a long time to accept surgery as a frequent option in the treatment of cerebral palsyHer association with Dr. Mrs Gulbanu Premji helped bring up the institution, as the doctors and management were friends and got things done, not stalled at every stepShe tasted the food given to the inpatients everyday (non-veg. and veg.) and would have an entire batch thrown away if she thought it was not fit for consumption. The matron would always ask resident doctors if they wanted more food, as she was instructed to see that they do not go hungryDr. Mullaferoze was of international repute. When Dr. WJ Peacock conducted workshop for the second time in NIMS Hyderabad, in 1989, he made it sure that he would meet Dr. Mullaferoz (first time). He indeed met her in Mumbai while returning to USA and was highly impressed with herShe was quite skeptical regarding various surgeries being developed for CP. She used to say these surgeries just enjoy honeymoon period, afterwards keep dragging because nothing else is available. So was her doubt about SPR, and therefore invited me to discuss about it. She participated in the discussion during CME and perhaps understood the fact that reduction in harmful spasticity might help to improve the child's disabilityI was highly impressed with her lifelong dedicated services to children with cerebral palsy. Therefore, I wanted her to be the founder member of the IACP. I, with the help of Dr. Fatema Jetpurwala, could convince her. She did sign, but wanted to withdraw looking to her doubt about the commercial aspect of various associations. Again in her home we tried to convince, but she remained skeptical. I am sure today her soul will feel happy to see the growth and advancing services of the Academy.
A few Papers/ presentations by Dr. Mullaferoze
Diagnosis of Cerebral Palsy, E.P. Bharucha, P.K. Mullaferoze at 1 st Asian Pediatric Congress- Delhi 1961Cerebral Palsy, at the Pan-Pacific Rehabilitation Conference, Tokyo; April 1965Surgery in Lower Limbs in cerebral palsy, P.K. Mullaferoze, P.H. Vora; 1969R.J. Katrak Oration -Western India Regional Conference at Bombay; December 1974Needs of the child and team approach towards the management with special reference to India, read at the International Cerebral Palsy Society Conference, New Delhi; Nov. 1977.Summary of some of the papers cited above
3. Surgery in Lower Limbs in cerebral palsy, P.K. Mullaferoze, P.H. Vora; 1969.
"Surgery in lower limbs in cerebral palsy" by Dr. Mullaferoze Medical Director and Chief Orthopedic Surgeon and Dr. P. H. Vora, Asst. Orth. Surgeon. Paper is the research project of CP unit, demonstration and research centre. It is the report of 230 operations on 93 children of age 3-14 with spastic CP in the period 1953 to 1969. They were analyzed and their results evaluated; follow-up ranged from 1 to 17 years. An attempt is made to give aims and indications for surgery in these patients. Short descriptions are given of the more commonly performed operations with their rationale. Over the years how selection of the operative procedures changed and which deformity to tackle first in a patient with multiple deformities are discussed. Very good results were obtained in 12 (very good means walks independently and confidently without aids), good results in 51 (good means walks independently with crutches), fair results in 21 (fair means walks, but needs orthosis and aids), and poor results were obtained in 9 (meaning slight or no improvement). There was satisfactory improvement in those who were mentally challenged if adequate pre- and post-op training was given, supervision was done, and parents took interest. If the patient becomes ambulatory, it solves many problems as wheelchair living is not compatible in the Indian scenario. Periodic check-ups and counseling are needed in the language the parents can understand.
4. R.J. Katrak Oration -Western India Regional Conference at Bombay; December 1974.
In the Dr. Katrak Oration, Dr. PK Mullaferoze reported about the work done from 1953 to 1973 when 6500 children with cerebral palsy were seen. Of these, 139 underwent surgery, majority in the lower limbs. Pre-op PT/OT/speech therapy was performed for 3-6 months.
Hip surgeries done 75: 17 unilateral and 29 bilateral; at knee 94 surgeries: 12 unilateral and 41 bilateral; at ankle 173 surgeries: 61 unilateral and 56 bilateral. Thus, a total of 342 surgeries were done: 90 unilateral and 126 bilateral.
Team approach was emphasized. Doctors from different disciplines (even dental surgeons) therapists, nurses, social workers, special educators, and vocational guidance persons should be on the team. Home visits of social workers were encouraged, and repeated counseling done. We are not giving treatment, but training. Therapists who are trained in the treatment of cerebral palsy are absolutely necessary. Surgery should enhance overall function; person should improve as a whole, not just that part which was tackled. Comprehensive assessment by the team is needed before surgery.
5. Needs of the child and team approach towards the management with special reference to India, read at the International Cerebral Palsy Society Conference, New Delhi; Nov. 1977.
Dr. PK Mullaferoze stressed on team approach, partnering with parents, working with enthusiasm and coordination. Counseling is needed from time to time in their language. We have to spread awareness of cerebral palsy, approach early, and demand early treatment for the child.
Education should be vocationally oriented and not purely academic. Education should be in mother tongue.
People have to migrate from villages and small towns to cities for jobs, which would not be possible for persons with cerebral palsy. So, emphasis should be on vocation as much as academics. We have to create interest in the medical profession and make them realize that no one specialist can care for all the needs of the child with cerebral palsy and that team work is necessary.
We have to provide better facilities for prevention, and major cities should have centers working for cerebral palsy so that families do not have to travel long distances and spend so much money. Efforts should be made to organize a team and evaluate cerebral palsy and guide parents. General hospitals have a team; interest in the subject is needed. An orthopedic surgeon or pediatrician can take the initiative and form a team. We start from zero, but a beginning has to be made.
This article is an compilation of articles and thoughts of:
Dr. Dhruv Mehta, Dr. Nadir Bharucha, Dr. G. S. Chawra, Dr. Rakesh R. Bhansali, Mrs. Ella D'Souza, Dr. P. C. Shastri, Dr. G.S. Shashikala, Ms. Asha Dangarwalla, Dr. Fatema Jetpurwalla, Dr. AK Purohit