The bone marrow transplantation (BMT) scenario in India has always been a challenging one. Haploidentical BMT is essentially transplantation from an HLA-half matched family donor. Complete HLA-matching has always remained a prerequisite for a successful BMT. However, there is only a 20-30 percent chance of finding such a donor in the family. The likelihood of finding a complete HLA match amongst random unrelated donors is less than one in a million. Having a very conserved gene pool, one can easily find a matched donor from the unrelated donor registries in the western population. However, such registries in India are rarely maintained and are still at their nascent stages. It's one of the most challenging forms of BMT. Today, Dr. Sarita Rani Jaiswal belongs to the bracket of one of the few individuals in India who holds extensive knowledge and expertise in such novel types of hematopoietic stem cell transplantation (HSCT). She is one of the pioneers to have played a major role in establishing India's first haploidentical HSCT program initiated under the leadership of Dr. Suparno Chakrabarti ­ with the establishment of a BMT Unit back in 2013 at DHRC, also known as Dharamshila Narayana Superspeciality Hospital and Research Centre.

Under the mentorship of Dr. Suparno, Dr. Sarita has done nearly 200 such transplants with excellent results over the last 11 years. Their research in this field has been subject to over 40 publications in esteemed journals in this field from across the world. As a result of her extensive research and innovation, Dr. Sarita has presented their work in the world forum in competitively selected oral sessions for seven consecutive years, both in the US and Europe. This is possibly a unique achievement for any doctor from this field.

In a recently held interaction with the WE India Magazine, Dr. Sarita Rani Jaiswal, Program Director, Blood and Marrow Transplantation, Dharamshila Narayana Superspeciality Hospital, shared some highly specialized expertise she possesses, her contributions in this particular niche domain of healthcare, and much more.

Take us through your early professional journey. What motivated you to venture into such a niche domain within the healthcare industry?

My decision to become a doctor and pursue a long-winded career was not looked upon very favorably by my close or extended family. I was married off very early, but my in-laws and my husband never stood in the way of my studies, even if it meant I had to be in another city for the first few years of my marriage. While me pursuing an ambitious career was an exception at that time in my family, I realized down the years that my refusal to submit to the patriarchy became an inspiration for a lot of girls from my extended family and beyond in the later years.

I was fortunate enough to join Dr. Suparno Chakrabarti, who is credited with the pioneering work in this field of BMT when he initiated a haploidentical BMT program in 2010.  I really wanted to understand this discipline in depth from someone of that calibre. Doing fellowships from Italy and Fred Hutchison Cancer Research center, US had further shaped my understanding of the basic science and its translation behind this procedure.

What facets of your personality have helped you become a leading healthcare expert in your respective field today? In your opinion, what are some critical characteristics one requires to become a competent doctor?

I became a doctor to make a difference. Not just to have a career or earn a living. Through many ups and downs, my exploration of this goal led me to find my niche when I joined the BMT program led by Dr. Suparno in 2011. The discipline was new to me. It was exciting and challenging. It was Dr. Suparno's continuous quest for perfection and his singular goal of doing the best for the patient that made me explore a lot of talents in me, which I never thought existed. I was always hard-working and devoted to my work. But this was the first time I felt that no obstacle is too big to overcome. It required discovering my inner pride and self-confidence, which has set me apart in a male-dominated discipline.

“Being a BMT physician is a very different ballgame where one has to devote full time to patients care if one has to make a difference”

In the obtuse world of healthcare, which is driven by medicolegal conundrums, practicing a discipline where life hangs by the balance for months together, is exasperating, to say the least. Despite having the options to shift to less intense and challenging disciplines, I have taken up the challenge to not only save the lives of not so fortunate patients but also investing myself in research to improve the outcome of such transplants. For me, the critical factors in my success are H1P4- one `H' (honesty) and 4 "P" s stand for Passion, perseverance, perfection, and patience.

Tell us about your expertise in terms of BMT and haematology. What are some of the major work areas in the said field?

We are doing Haploidentical BMT for both malignant and non-malignant blood disorders. I have made significant contributions in establishing many novel approaches to hematopoietic stem cell transplantation. These have changed the perception of innovation and research emanating from India in the eyes of the western world. As a result of our innovative approaches involving natural killer cells and regulatory T cells, we can claim the best outcomes in haploiden-tical BMT in leukemia (ranging from 70-90 percent).

Now, we have reached a juncture where we can say that for malignant diseases and diseases like aplastic anemia, our results from haploidentical BMT are comparable to the best centers in the world, if not better. In non-malignant diseases like thalassemia and sickle cell anemia, we are actively developing a safe and effective protocol for haploidentical BMT. The initial results are encouraging. If our trials bear out the early promise, this might make a cure possible for the large majority of thalassemia and sickle cell anemia as well.

As a leader in healthcare, how do you keep yourself aligned with the periodic evolutions occurring in the industry?

'Half matched or Haploidentical BMT' is probably the most difficult and advanced discipline in medicine to practice. Simultaneously 'Hematology and BMT' is one part of science where one has to be continuously updated, as newer developments are emerging every week if not every day.

Good leaders are a crucial part of an effective transplant program. This is not just writing the medicines; we have to manage every component associated with BMT like `unit internal environment,' `nursing and housekeeping education.'  By communicating with the sufferers and the family, and learning from our previous experience, and having the vision to improve the results by thinking out of the box, one can mold him or herself into a valuable and respectable healthcare leader at the same time.

Given your time-consuming and demanding profession as a leading doctor, how do you manage to strike a balance between your work and home life? What are some activities or hobbies that you enjoy in your spare time?

Being a BMT physician is a very different ball game where one has to devote full time to patients care if one has to make a difference. We spend many sleep-less nights when a patient is sick. I had to prioritize my professional life above the family/home life. My children have been deeply understanding, and my husband has been extremely supportive once he realized the demands of my profession as a BMT physician. I have spent years abroad for training when he has managed the home front.

I would like to mention a great sense of fulfillment I had when my 10-year-old had told me that I need to go to the hospital because my patients need me more, despite himself being sick and bedridden. The fact that my profession and its demands beyond it being a livelihood was appreciated by my young family is probably one of the greatest rewards in my life.

Dr. Sarita Rani Jaiswal, Program Director, Dharamshila Narayana Super speciality Hospital And Research Centre

Dr. Sarita belongs to the bracket of one of the few individuals in India who holds extensive knowledge and expertise in such novel types of hematopoietic stem cell transplantation (HSCT).