Bone Marrow (Stem Cell) transplants are not only a niche speciality but also prohibitively expensive to a majority of the Indian population.

Dr Chepsy Philip, our next pathbreaker, Stem Cell Transplant Physician at The Believers Church Medical College Hospital, performs bone marrow transplants for diseases of the blood and marrow.

Dr Chepsy talks to Shyam Krishnamurthy from The Interview Portal about life altering experiences that led him to setting up his Clinical Hematology practice in his hometown (Thiruvalla) to make complex treatments available, accessible, and affordable to all.

For students, never be afraid to take up a challenge, they are meant to be daunting. Life doesn’t offer the same challenge to everyone. If it comes your way, it’s yours to take and tackle.

Chepsy, can you walk us through your background?

I grew up across multiple states in India. My parents have been hugely supportive and encouraging in each step I have taken. My father worked with the ONGC, and my mother efficiently managed all of us at home. There was a lot of shifting, with me and my sister moving across India with each of his transfers. My education and training were across 10 states! The change was a constant and it taught us to adapt and accommodate. This also exposed us to the variety and differences in cultures and people. It also shaped my interest and forged my confidence to explore new places and meet new people. As a physician, I am mindful of these differences and when I interact with new people each day, I am at ease but excited and greatly enjoy that…

What did you do for graduation/post-graduation?

My undergraduate course was MBBS training at Christian Medical College, Ludhiana. After graduation, I pursued a specialization in Internal Medicine for my post-graduation as MD. I then further specialized in Clinical Haematology and bone marrow (stem cell) transplants for my DM (Doctorate of Medicine) at CMC Vellore. I also further refined my skills in bone marrow transplantation as a visiting fellow at the Fred Hutch Cancer and Research centre in Seattle.

What made you choose such an offbeat, unconventional and rare career?

It was the service obligation on completion of my undergraduate MBBS training that set in motion a chain of events that have colluded into my choice and current position. Consequently, I now pursue clinical Hematology and bone marrow transplantation in my hometown in Thiruvalla.

Though it is usual to enter the rat race to pursue the next post-graduate degree after MBBS at the earliest, I believe my work experience immediately after my under-graduation was deeply influential. Being thrust as a real doctor all alone and being responsible to take decisions was acutely awakening and daunting. I ended up identifying my passion and my further pursuits got more refined along the way. 

As an undergraduate, I was greatly influenced by Dr. Mary John in pursuing internal medicine. The impact she had on patients and the fulfillment in her life made deep impressions on me. It was during these times that I researched the life and times of my institutes’ founder (CMC Ludhiana) Dame Edith Mary Brown. The magnitude of her work and the challenges she faced were very humbling. I was inspired to pursue challenges, and desired to create a social impact with my life. 

Later in my training when I was contemplating my career choice, it was Dr. Joseph John who swayed and inspired my interest in Clinical Hematology. But it is Dr. Vikram Mathews, my mentor, who changed the way I perceived myself and my work ethic. In his way, he helped me further uncover my passion and skills. His desire and energy to work, research and treat patients will be forever inspiring.

In 2017, after having finished my training and while working with my alma mater, I met with a near-fatal road accident. I was stranded helplessly in an unknown place. Thanks to complete strangers who were also using the highway, I was escorted to the safety of a hospital. I will forever be grateful to those unknown souls. It struck me while recovering, that life can take an unexpected turn at any time. There was so much more to give back to society. I then decided to return to my hometown with a dream to utilize my skills and gift and help establish a service that will be useful to many more. I am thankful to Dr. George Chandy for guiding and providing a platform to lay the start to socially relevant and useful Hematology and bone marrow transplant services in our region. 

How did you plan the steps to get into the career you wanted? Or how did you make a transition to a new career? Tell us about your career path

My initial choice of doing medicine/becoming a doctor was not purpose-driven. I was undecided when I had to choose subjects for my higher secondary and hence decided to pursue both mathematics and biology. I had a close group of friends, and we kept supporting and challenging each other to perform better. I always was inclined towards mathematics. Biology was not my strongest subject, but I was not bad at it either and I pursued options involving both mathematics and biology. It helped me be in a position where I could have more options when I had to choose. I had to make 2 choices; One choice was between engineering and medicine degrees, and the other was between government colleges and CMC. I chose the branch and institute which I considered would give me the best training. That is how I elected to pursue medicine at the Christian Medical College, Ludhiana. 

During my undergraduate training, I had many role models who shaped my personality rather than my strengths and interests. However, it was following my undergraduate training, during my service obligation at rural primary health care set up in Gujarat, that I found my calling and purpose. There I was entrusted with the responsibility of running a primary health center all alone which made me acutely aware of my strengths, weaknesses, and passion. I had overnight graduated to being a real doctor. Dealing first-hand with patients single handedly and being responsible for their outcomes was very daunting. Though I had many moments of self-doubt and frustration, that experience allowed me time to introspect and realize my inclinations to be with patients doing clinical medicine. I realized I enjoyed the analytics, deductions, and conversations with people much more than doing procedures or surgery. This had a major impact on my decision. I was armed with the resolve to get into internal medicine. I prepared myself for securing admission and was fortunate to be selected to pursue my dream. 

During our training, it so happened that no other contemporary was posted with us in each unit we went to. Though it made work very hectic with us being in the hospital at most times, it allowed us maximum exposure with patients. I strongly feel the benefit of that training in how I can form opinions and make decisions in my practice each day.

It was during my final year of internal medicine training that I had to interact with Dr. Joseph John who had just returned after his training in hematology. Seeing him set up a new service was very exciting, and it sparked my interest in hematology. 

Since I had realized my passion for internal medicine only by working on the ground, I decided to explore my love for hematology by working in hematology. I worked for a year to refine my interests to choose between cardiology or hematology, both of which excited me. I realized that I enjoyed doing hematology the most and committed to choosing it. I married Shilpa during this period and she again encouraged my efforts in choosing hematology. I then prepared and cleared my exams for further training. Again, when I had to make a choice between government college and CMC for training in Hematology, I chose to pursue training at the iconic CMC Vellore. 

At Vellore, Dr. Vikram Mathews was hugely influential in shaping my decisions. He provided guidance, motivation, emotional support, and became a role model in helping me set my goals and aspirations. His fire to settle for nothing but the best has rubbed on to me and serves as a daily reminder. My work with him resulted in the publishing of my thesis which is an important work in the treatment of acute myeloid leukemia in India. It won me an American Society of Hematology Abstract achievement award and was the basis of my selection for the International Development and Education Award by the American Society of Oncology. These awards were a boost to my career and confidence. These opportunities guided me to also explore other centers in the world. I directed my efforts and pursued a visiting fellowship in 2016 at the Fred Hutch Cancer and research Centre in Seattle to learn and observe from Dr. Rainer Storb who was in the team that performed the world’s first bone marrow transplant. It was such a magical moment to be with him and realize the efforts needed to be where he is. I continue to take his opinions.

Yes, Clinical Hematology is not a very well understood field. It is unique and different from Oncology. It is focused on cancers ( Lympoma, Myeloma, Leukemia) as well as non-malignant diseases of the blood and bone marrow. One might need a bone marrow transplant if the bone marrow stops working and does not produce enough healthy blood cells.

Since this speciality is limited to very few centers in our country  I was lucky to have had the exposure during my training to develop an inclination. I loved the journey where you are close to every patient who comes to you and was overawed by bone marrow transplantation where a single non-surgical procedure could offer a life-long cure by infusing healthy blood-forming stem cells into the body to replace damaged or diseased bone marrow.  In choosing a field  which was exciting, unique and also with a potential to make the most social impact-Hematology stood out for me.

Typically in the Indian system of modern medicine, your post-graduation is where you earn an MD/MS. This is where you can broadly choose between a surgical branch ( M.S) or a non-surgical /medical branch ( M.D) after your MBBS. This is an important choice since for the rest of your life this is likely to remain your career. This choice in my opinion is best guided by your interest rather than the ranks and the best place to realize it is by working on the ground. Further to your MD, you can choose to pursue deeper specializations into cardiology, nephrology, oncology, etc.  In my case, I chose to pursue DM in clinical hematology after the MD in Internal medicine, again after working in it before committing.. This is not a PhD- a difference being that DM is dominantly a clinical field where as the PhD work is pursued in laboratory-based research. 

At Seattle, I recognized that the clinicians were referred to as MD, and they would pursue a PhD to advance their research skills. In India that is what the DM degree is meant to do.  Both are highly respected degrees but one being more clinical based and the other more research oriented. 

I was blessed to have advanced my skills both at Vellore and at Seattle.  While both centers are doing phenomenal work, there was a clear difference in the work pattern and resources. While there was protected time for research in Seattle; here in India, the clinical work was so overwhelming that research almost always took a back seat. Still, it is so much satisfying to see the contribution to society and science despite these challenges at many centers in India. I think the challenge in resources adds to the satisfaction of achievement while working here.

Typically cures are researched in the labs(bench), then evaluated in animal models, then through trial volunteers and finally into routine clinical practice( bedside) where a person afflicted with disease can be benefited. This might take years and still have very few options for cure. That is where hematology is different and exciting from other branches in medicine. The translation from bench to bedside has been the fastest in this field. This is not to take away anything from other specialties; each of which is integral and vital for a cure.  It is my opinion that there is a sharp contrast to many other fields where treatment has been stagnant. Revolutionary treatments like targeted drugs for cancer, bone marrow & stem cell transplantation, and now CAR T cell therapy are just to name some of the excitements. 

I was due to become a full professor with a patterned schedule in life, when I met with the near-fatal accident and I decided to move on, change course and start from scratch again elsewhere. It was and is still daunting to set up a new hematology and bone marrow transplant service. Adding to it was the challenge of setting it up in my hometown, a third-tier city during the COVID pandemic. It is important to have good mentors and I bounced my thoughts off both Dr. Vikram Mathews and Dr. Rainer Storb. They were supportive and I began to explore options. It was Dr. George Chandy who then gave me the necessary confidence and was hugely pivotal in helping me make a decision and set up the new service here in Thiruvalla. Slowly but gradually, we started our clinical service and are now offering bone marrow transplantation here in Thiruvalla. It has been hugely rewarding and motivating to offer such treatment to patients in my hometown and the central Travancore region. It is a prayer and desire that we continue to be of service to all those in need.

How did you get your first break?

Without a doubt, it was my rural posting, following undergraduate training, which gave me a chance to introspect and explore my strengths and weaknesses and set me on the course and role I am in today.

What were some of the challenges you faced? How did you address them?

Planning: I did not intend to run the primary setup alone, but an unforeseen change presented itself. I was initially reluctant to take up the challenge, but I had to improvise and rise. Introspection led me to analyze my strengths and weaknesses. I made a plan to handle outpatients till I and my team were ready to manage inpatients. I reached out to a senior colleague at a nearby place for guidance and would take his help in deciding. From a purely outpatient service, we upskilled ourselves into an inpatient facility by year

Skills and knowledge gap: This was not something I had a quick solution to. I had only completed my undergraduate training and I had to acknowledge the limitations. I catered to the outpatient clinic to the best of my skills and learned to refer those who needed inpatient care, in the best interests of the patient, to another clinic nearby. I also followed up on their progress in that hospital to maintain continuity in their care which built confidence in both the patient and myself.

Retrospectively I realize I could have done things differently, but I greatly value those two years for the opportunity to introspect and realign myself to be more focused and driven. Each patient who improved and thanked me gave me the confidence I needed and instilled a sense of purpose in being a doctor. The joy of healing another person and conversations with them convinced me in choosing my further path. That experience made me aware of the need to plan and have the required skills to execute a plan to success.

Can you tell us about your current tenure as Clinical Hematologist?

I currently work at the Believers Church Medical College Hospital in Thiruvalla tasked with the responsibility of setting up an advanced center for hematology and bone marrow transplant. This is a third-tier city in Kerala and my hometown. Adding to the challenge of the location, have been the circumstances of setting up this niche service during COVID. But it has been a joy from day one of my return. 

What skills are needed for the job? How did you acquire the skills?

I am still learning each day. You need a clear vision and direction when given such responsibilities. I spent close to three months drawing up how I wanted to go about handling this responsibility before committing to this position to set up a new service in my hometown. You need to have the confidence and trust of people around you when you are setting up something new. People will take cues from your passion. My days as part of the student’s council and later running a primary health center independently helped me find a way to drive and encourage my colleagues and team. Most Importantly, I realize that none of my challenges compare to what my patients are tackling each day. Many of them are dealing with life-threatening situations. Their cheer and perseverance always motivate me to keep trying harder.

What’s a typical day like? 

I begin the day by going over emails and plans for the day in the morning before I get to work. I begin work by focusing on the inpatients in my service going over their problems and plans. Following this, it is time for my outpatient clinic. This usually stretches till the evening. In between, I also juggle time between the outpatient and the day-care, doing procedures and patient counselling. After seeing the patients, I round off my day by going over my patients’ course with my colleagues and following through with the plans and their outcomes through that day. Then it is time to spend precious moments with my family. I remain available and accessible to those in need over the phone throughout the day.

What is it you love about this job? 

It is always exciting to work in a field such as hematology because there are new patients, advances, and challenges each day. It is challenging and fulfilling at the same time. I don’t know what to exactly pinpoint.

How does your work benefit society? 

Hematology and Bone Marrow Transplantation is an important but niche area of specialization in medicine and oncology. The expertise is limited to major cities and many are unable to access and afford such treatments. The work that we do enables people in this Central Travancore region at Thiruvalla to explore such niche services closer to home in a more economical way. We have been able to provide an exclusive service which has typically been out of reach to many, by making it more affordable and accessible to people in this region. We also recognize that there is still much more to be done. A case in point; we recently were able to support a complex surgery and followed it up with a bone marrow transplant in a child whose father is a daily wage worker. In a year, we have been able to treat more than 3000 patients and do 15 bone marrow transplants including in adults and children. We are surely bringing a higher standard of care in treatments closer home. This is a first for our region and it drives us to keep doing more.

Tell us an example of a specific memorable work you did that is very close to you!

The journey with each patient is a motivating and memorable experience. But if I have to choose, it will be Grace’s experience. The goodwill and genuinity of people who supported her amaze me. She was only 3 when she was diagnosed with a failure of her bone marrow which required her to be dependent on blood transfusions for life. Hailing from extremely humble surroundings she needed a bone marrow transplant to survive. There was no way the family could have arranged the finances. Typically, most families would walk away, resigned to their fate. Her parents just didn’t give up. Finance or the magnitude of the treatment didn’t deter them. They asked around. They went around. With the help of their community and the local parish, they raised the needed amount in record time. They were able to raise the finances with crowdfunding and we were honored to support her treatment and recovery. Today she leads a normal life like any normal child of her age. She is such a joy…The power of humanity is amazing! It is up to us to chase it.

Your advice to students based on your experience?

Never be afraid to take up a challenge, they are meant to be daunting. Life doesn’t offer the same challenge to everyone. If it comes your way, it’s yours to take and tackle. There is always a way around every challenge. Keep yourself open to learning from each experience. Be quick to forgive and move on…Being alive each day is a great blessing. You shouldn’t spoil the opportunity by being trapped in your fears, failures, and frustrations…Share your skills and shape a better life for those in need.

Future Plans?

The niche specialty of clinical Hematology and bone marrow transplants are prohibitive to a major section in our country, in terms of costs and expertise. The country needs more than 100000 (One lakh) transplants a year, but the entire nation combined is able to perform a minuscule number of around 2000-3000. In time I hope we will be able to scale up as a regional centre that will treat a large number of patients which will significantly help us reduce costs, thus making it more affordable to those in need. This should help us scale up research and also deliver recent advances in the field for our patients in the region. We also hope to grow into a training centre that will enable more students to return to their hometowns to set up more transplant units to meet our country’s growing needs. I dream that no patient in India with cancer or other diseases of the blood should be denied treatment for lack of availability, accessibility, or affordability.