Expert Breakfast Report for Aug 2nd 2023: Dr. Prasath Jayakaran, Dept of Physiotherapy.

Another outstanding Expert Breakfast session, with Dr. Jayakaran giving us a taste of life in India, being very honest about his own aspirations and stressing the importance of accepting proffered opportunities, even if they do not match your own ideas very closely, all in a very amiable, open fashion.

The King’s Story

“There was a wealthy King who decided to give a big banquet to all the smaller Kings and Princes around the world. When they were assembled, he said to them, “I’ve got a big kingdom, and I’ll give a part of that kingdom to you, and I’ll give the Princess, my daughter, to you. But there is a challenge. He took them to a long swimming pool, about 300 metres in length. “Whoever jumps into this pool and swims to the far side will get half my Kingdom, and my daughter as well.” And those present said, “Well, why not?” And the King said,”Oh, I forgot to tell you there are crocodiles and alligators in the pool, and perhaps a few sharks you might find on the way. Then everyone backed off and said, “No, I’m alright where I am.” So the King said, “OK, I’ll up the game. Whatever you want, I’ll give.” And still no-one was willing to do it. . . . . Then suddenly, everyone heard a splash of water and saw someone swimming in the pool. They all started cheering, then they saw he was slowing down, but he reached the end and got out. Then the King said, “OK, come on then son - good job! What do you want?”

“I want to know who is the person who pushed me into the pool!”

So began Prasath’s talk, - along with his comment that this story had some bearing on what he was going to say.

Dr. Jayakaran’s Story

He has been in New Zealand for 15 years, and his first 20-odd years were spent in India, where he was born. There he undertook his first degree, and Masters in Physiotherapy, coming to New Zealand to undertake a Ph.D. When he began Physiotherapy studies 23 years ago, it was not a profession that was very well recognised, and Prasath was not very keen on it himself. His original aim was to do Medicine, and after gaining very good grades in his last year at school, he made two unsuccessful attempts to gain entry to Medical School. Particularly in those days, Medical School entry was extremely competitive.

Two Pushes into Pools!

His parents were paying the entire cost of his studies, and it was his Father who pushed him to undertake Physiotherapy studies, really against his will. After the 4 year course and 6 month internship, “I was not interested at all, thinking ‘What am I going to do after this?’” He found a job, but was still largely disinterested. The his girl-friend (now his wife) urged him to undertake a Master’s degree, against his inclinations. She obtained the entry papers, filled them in and asked him to sign them. “All I did was sign the papers!” Once again, entry was by examination, consisting of multiple choice questions, “which usually throws me off. . . . So don’t ask me why I am testing you all!” . . . .

Against his expectations, especially after failing Medical School entry twice, he passed. It was while undertaking his Masters degree that he began to recognise the true value of Physiotherapy.

Amputations and a Ph.D.

CMC Hospital — Image by: John Cross

He then worked in a few different places in India, one being the Christian Medical College (CMC) Hospital, a mission-led Teaching Hospital in Vellore, where there was another challenge. He did his Masters in Sports Physiotherapy, and this hospital had no positions in that area - but they did offer him work in a different area, to which he agreed, partly because it was in his home town. There he started to develop an interest in a number of things “further to what I had learnt . . . . . . . . That was my ‘eye-opener’ place, where I started to work with people with amputations, when they have lost part of their leg or arm in motor accidents, as well as diabetes and leprosy, which are highly prevalent. I used to see 30 or 40 people a week with amputations, and that stimulated my interest to study more in that area. That is when I started exploring a Ph.D. “ This was on the subject, particularly in people with amputations, of balance - how people learnt to walk after amputations with their new prosthesis.” After finishing his Ph.D., Prasath undertook a post-Doc Fellowship in the UK.

Where He Now is, and How to Reach Your Place

At this time, he returned to New Zealand, continuing his research into balance, as well as teaching balance, along with clinical practice as a Physio, working with people with balance issues, particularly Parkinson’s disease.

Prasath at Work in Otago — Image by: John Cross

Prasath explained he wanted to make 3 points:

1. We all need a little bit of a push at some point. “It could be friends, or family, or whatever you call it.” It may be an annoyance, but in hindsight, one can see how the need for that existed. That little push that takes you where you wouldn’t have been, or wouldn’t have thought about.”

2. “Oftentimes our first choice may not be the best for us. What
I mean by that, I wanted to do Medicine, Medicine, Medicine, - that’s what was in my head, but the World is big and wide, and there is a lot more that we can do.”

3. Take opportunities when they present themselves. “Where I am now, I did not search for opportunity, but when it came, I said ‘OK’”. Another little push, this time that you give yourself . . .

Question Time - Working with People - Why Choose NZ - Differences Between Vascular disease amputees and Trauma amputees

Asked about what he likes most about working in Physiotherapy, Prasath talked about working with people.”Even when I travel around, I am not keen on seeing places, but more so on meeting people.

Essentially, the next question was asking if he felt fulfilled even though he had not been able to do Medicine. “It’s a completely different field. Of course Medicine has it’s place. In the end, I think it is all about working with people, whether it’s Medicine, or Physio, or any other field. That’s a desire which has been fulfilled.”

The next question asked why he had come to New Zealand, specifically to undertake a Ph.D. “I was looking for specific guidance on how to improve balance for walking in amputees. Using the library resource, I could not find any literature support or research support, particularly with regard to amputations due to diabetes and that kind of disease, as opposed to amputation following physical trauma. It was this that lead me to think that there was material for a Ph.D. in this area. Obviously, they are different. Then I started approaching a few Universities in the UK, Australia and New Zealand, and not many were keen to supervise that particular area of research.” However, Dr. Gill Johnson at Otago (now retired) was keen, and so he came here.

Prasath was then asked what the difference was between the balance problems of diabetic amputees compared to trauma amputees. “A normal adult does not actually think about their walking, it is automatic to them. But there was a learning process. When an infant first starts to stand up, they fall . . stand up, and fall. The brain is amazingly plastic, and learns to set some rules so we don’t have to think about this all the time. When a person starts to use a prosthesis, they have to think and relearn how to walk. For that relearning, sensory feedback is needed from where the prosthesis is in contact with the limb. Because people with diabetic and vascular disease have less sensory perception, it is harder for them. . . . . Also, traumatic amputation is more common in the 40’s and 50’s, whereas those others are in older people. Since the plasticity of the brain decreases with age, these things together potentially make it harder.”

Phantom Pain and VR, Keeping Your Options Open

Asked about phantom pain, Prasath first differentiated between phantom limb sensation and phantom limb pain, explaining that the first is where, after a limb has been removed, people feel that it is still there. Phantom pain is when pain is felt in the part of the limb that is not there. Phantom limb sensation is common shortly after an amputation, because the sensory pathways from the limb to the brain are still largely intact.

Phantom limb pain can be treated with mirror therapy, where a mirror is placed in such a way that the intact limb can be seen in the mirror, tricking the brain into thinking there are two healthy limbs. Over time, with repeated exposure, the pain often diminishes. “Not one particular strategy works for everybody. There are various things that can be tried. One of the ones these days is virtual reality, which is more immersive than mirror reflection.

Another is something like TENS (transcutaneous electrical nerve stimulation) or another procedure applied to the end of the stump.

Another question was directed at the problem of keeping your options open yet being required to put Physiotherapy as your single preference. This appears to have arisen because some people who were selected to do the Physio course changed to something else. This left spaces on the course which could be filled by those who had indicated Physio as a first choice, but had failed to get a place in the initial round.

Why Physiotherapy? and more on Mrs. Jayakaran

The next question. was: “Do you know why your family chose Physio?” Prasath explained that in India, even now, there is great pressure to choose a professional course, either in Health or Engineering. (Although Computer Science has now been added to the desirable group). Even within those disciplines, there is a hierarchy. For example, Civil Engineering would be low on the list of desirables. “I wanted to be a Health Professional, mainly because I prefer working with people. So when we looked at the Health Professional courses on offer . . . the two courses I preferred were Pharmacy and Physio.” His Father was not supportive of the Pharmacy idea. Also, Physio was just coming in as a Bachelor course, around 1992, “and I started in ’97, so it was very fresh at that point, which might have been the reason . . To know any more you’ll have to ask him!”

Asked about his wife Leema, and what she was now doing, Prasath told us that Leema also trained as a Physio, but is not registered here. We went to the same class, which is unusual in India as well.” (Most commonly, marriages are arranged even now, so I assume that the word ‘unusual’ in the previous sentence refers to theirs not being an arranged one in that sense. - Ed.) “Our first child was 6 months old when we came to New Zealand.” Since they have had more children since then, Leema has never had the time to consider registration, but now is teaching Anatomy in Health Science courses.” (One of the members present commented that ‘She’s very good!” to which others agreed, whereupon Prasath jokingly commented “I’ll not tell her!”).

Outside Work, and Meeting a New Patient

He was then asked what he prefers to do outside of work. “Well, I’ve shared my professional journey, my personal journey is - after moving here - obviously connecting with people. It’s a new place, a new culture, everything. A new language - although I learnt English, my very first interaction was with a bank officer when I went to open a bank account, and I couldn’t understand a word of what she was saying! She could see I was not understanding, and slowed right down, which made it even more difficult for me to understand! It was very tricky at that time. I was connecting with people who shared a similar background. Another part of my personal journey is my faith journey, and worshipping with others . .. that keeps me outside of work.”

Dr. Jayakaran was then asked to talk about what ran through his head when a new patient presented. “The first thing is ‘This person has come to me asking for help . . .Every question I ask, and everything I want to do with them is about: How can I help?.”

It is first necessary to gain their confidence so they will share with you things they might not share with others. Every question and interaction is aimed at finding out what the source of their problem really is, and to provide the needed solution, if possible.

Separating Work and Work-Life Balance

Initially, Prasath found this difficult.”It was difficult to ‘switch off’. . . . . Switching off in Academic positions is very important. I used to be monitoring my e-mails in the evenings and weekends . . . .It’s a very important question, work-life balance. Switching off is very important for all of us. It could be anything, but, as I said, my ‘switch off’ is my family and my faith journey.” He still scans his emails in case there is something that requires an immediate response, but only a couple of times each weekend, and it has to be an urgent matter. “So if you send me any emails at the weekend . . (the remainder of his comment was drowned in laughter).

Physiotherapy Qualifications, and The Best of Times

In response to a question about the various Physiotherapy qualifications and what they could be used for, Dr. Jayakaran outlined the situation in New Zealand. “There is a Bachelor’s here, then Master’s and Ph.D. There are two levels of Bachelor degree, one is the ordinary degree - which allows a person to practice as a Physiotherapist, whereas the 4 year Honours degree opens the way for higher courses of study, namely Masters and Ph.D., when Teaching and Research become options. Then there are two kinds of Masters degree, one being a clinical degree giving the individual a speciality such as Sports Medicine, Orthopaedic rehabilitation, etc., as well as being able to refer cases to ACC. The other is a research Masters for people who have not done an Hons. B.Physio, and enables them to continue to a Ph.D.  Those with research degrees (Honours and Masters) can still choose to be clinicians, so it gives a wide range of options.

Prasath, in answer to the final question, found it difficult to pick out the period of his professional life that had been most meaningful for him, and plumped for his two and a half years at the CMC Hospital as being a time which altered the course of that professional life.

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Posted: Tuesday August 8, 2023