Prelude Of The Missing Link

Encephalitis Ward

In past two decades, India has experienced the massive transformation of private healthcare system as clinicians became service providers, erasing out the concept of family physician or general physician and diaspora of super-specialisation with introduction of several other ‘-ist’ suffix to categorise super speciality, doctor-patient relationship transformed to seller-consumer relationship  etc. etc. Private healthcare system in India transformed to one of the largest service industry of the world. On contrary, the public healthcare facilities are yet not sufficient to cater the mass, and hence the public health issues still remain as burden of the Indian society. Both the situations have been evolved around one person – the Doctor, who is the sole link of the entire fruition, be it good or bad. And there is a missing link also.

As evidenced in history, India is not very keen to archive its treasures, probably due to having enormous natural resources, including skilled human resources. One of such prominent example in Indian medical history is Sushruta Samhita – the origin of surgery in India (and probably in the world) and we lost the original manuscript. While western world is keener to document their works, we are absolutely reluctant to do so. On one hand, Indian doctors are keen to maintain medical records in technical words for the purpose of research, presentations etc., but not interested to have proper visual (or audiovisual) documentation of their specialized works. And that’s the missing link – CLINICAL or MEDICAL PHOTOGRAPHY, the concept that does not exist in cognition of the Indian healthcare system.

While the prevailing practice of evidence-based (laboratory & radiological) diagnosis including ‘invisible light’ medical imaging is already dominating the Indian healthcare sector, on contrary the other type of imaging process has been neglected that has a strong role in establishing evidence of diagnosis, treatment and outcome. As I experienced, like many others, doctors also think that taking an image through mobile camera or point-and-shoot digicam (thanks to the digital age) or just hiring any photographer (mostly free and in obligation) can serve the purpose, but that’s not the right approach towards documentation. Do people prefer to go a coiffeur rather than a surgeon for surgery? Or which one surgeon chooses to make the incision inside operating room – a shaving blade or a sterile scalpel? I have seen medical images in its worst form in several CMEs and medical conferences during presentations; too dark, too light, dark shadows, lack of sharpness, color variations, important detail buried, messy, unspecified scale, serial photographs that don’t match – these pictures are worth somewhat less than the legendary ‘thousand words’. Why is it that the clinical photographs we see are so often a disappointment? One simple reason: they took in most neglected manner, often very casually, as the creator did not pay respect to h/er own work or did not bother to archive the work for the future generation.

I am not concerned or talking about photographic tricks, such as are seen in some advertising for anything from hair tonics to fairness cream. Playing with angles of view, make-up and clothing, perspective tricks, soft focus and lighting can exaggerate the benefits of treatments on offer. Even more dishonestly, images can be manipulated at the processing stage and this is both easier to do and harder to detect in digital images. There is no place in clinical recording or publication for using such photographic manipulation to misrepresent outcomes, and in some cases it would be illegal. We should be careful to ensure that we can demonstrate the attribution of our images. The linear scale, perspective, depth of field, proper exposure, understanding the light (both available & artificial), background and surrounds are all imperative part of a clinical photograph, which need training and practice to sharpen the skill just like medicine and surgery. And that’s also equally applicable for taking audios and making audiovisuals.

Doctors acquire different intellect through training & practice, which is not common in other people in the society. There are thousands of evidences where doctors wrote immortal poems and proses, painted with amazing skills, played for the nation, the talent that hidden inside these intellectuals and overshadowed by their formal education. If doctors may become bureaucrats, then what’s wrong to become a clinical photographer? They know the best about what to document and why. What they don’t know – “HOW” to document. Though I know without institutional intervention (private or public), the penetration to the Indian psyche is next to impossible, simultaneously I also know somebody needs to take the first step. So I am…

From operating room to public health issues, from clinical photography to health photojournalism, if wide spectrum of overall health needs to be documented, then only doctors can do that; but only after the proper dissemination of knowledge of both medicine and photography. Medicine is the combination of art and science, and that’s applicable to photography also. With due respect to journalists, photojournalists & photographers of other genre, “Documenting Health” must be specialized – strictly and it’s not everybody’s cup of tea. After all, battlefields and operating rooms are the similar kind of theatre and only the specialists can visually narrate the factual story, without distracting the soldiers or surgeons.

With a dream to watch the new dawn of “Documenting Health” in Indian healthcare in coming future, this is my first post and I promise to share my experiences, knowledge, learning, and obstacles as a medical photographer in the coming days.

Coming up next – “Daguerreotype To Digital: The History Of Medical Photography”