Interview with Prof Terence Ryan

Prof. Terence Ryan, emeritus professor in dermatology at Oxford medical school, UK is not new to Kasaragod in Kerala, India. It all began with his interest in learning about other systems of medicine apart from allopathy. This inquisitiveness brought him to Kerala and eventually to the Institute of Applied Dermatology (IAD) at Kasaragod. With years his involvement with the IAD has witnessed his active mentoring in the projects of IAD which has gifted the organization with immense knowledge with his vast professional experience and Chairing several International Committees.
Prof. Ryan was recently in town to attend the 4th National Seminar jointly held by IAD and International Skin Care Nursing Group (ISNG). In a tete- e- tete with Sushma K S, Ryan spoke about the new phase of activities in IAD on developing curriculum for Skin care nursing in India.

•          Could you tell us something about your journey as a medical practitioner?
I went to school during the Great War and with 16 different schools it was difficult getting into Universities. But I luckily got through the difficult exams at Oxford and my journey ahead was quite easy.
I had a particular interest in dermatology from the beginning and I had three careers. One would be in pure dermatology that’s skin diseases, the other in blood supply of skin and finally in lymphatic drainage i.e. drainage system of the skin. I made a career in those ending up as President of World Societies on both those research projects.
My department in Oxford had a lot of interest in tropical diseases particularly leprosy. I gradually became more and more interested in public health and particularly during the time of my retirement which was 12 years ago I began to take up chairs or positions of seniority in number of public health dermatology organizations including the International Committee of Dermatology, President of the International Society of Dermatology and Chairman of the International Foundation of Dermatology. That is the only three international organizations in Skin Care and I might have been head of all the three at different times.
•          How are you associated with IAD?

Partly because I have always been interested in other systems of medicine other than just the kind we practice in England. And I have been also interested in Lymphatic disorders. So, the combinations of those two lead me to go to an Ayurvedic meeting in Kerala and Dr Narahari was there.  I saw that our ideas had a commonality. I believed that the Ayurvedic system medicine mixed with the Western or the Bio- medical way of managing Lymphoedema should be a good combination. So, we began to work on it.

•          How has been your experience so far working with IAD?

It has been very successful. We have got an international reputation, several publications clearly made a difference in the way we wanted that doesn’t have to be expensive, involving patients in their own decision making and management. All the things I intended should happen have happened because Dr Narahari is a very good organizer and he has a good vision of what should happen.

•          IAD is turning to a new leaf, a new beginning i.e. skin care nursing. How you foresee the future of skin care nursing in India?

Well, the same as it is in U.K. In the U.K I had nurses in my department looking after the same conditions 20 years ago but mostly wounds ad burns rather than skin diseases. And then when Steven Ersser was my Chief Nurse at my department we decided to develop a British Skin Care Nursing Group and that was the time when I was the President of the British Association for Dermatologists.
I was able to give them a position in a meeting. Now we have more nurses who are expert on the skin than the dermatologists of U.K. We have about 1,200 nurses who are really expert on the skin as opposed to about 500 dermatologists. When that was proving to be successful, we decided to create an International Skin Care Nursing Group with Steven Ersser as the Head of it and myself as adviser and we developed  it in various parts of the world. Two weeks ago we were developing it in Nepal. I think that is successful there and they will definitely take it forward.
This being a larger country, India has been leading the initiative with Dr Vineet Kaur who is in Varanasi. She was in my department as a dermatologist with Steven Ersser 14 years ago developing some of the first publications on British Nursing in the field of skin care. She has been trying to launch a greater interest in skin care nursing in this county. She was in Nepal and she succeeded there. Now, Steve is here, we hope to persuade Indian Nursing a role in Skin care officially with dermatology as advantage to patients.

•          India has so many vast and diverse cultures and even approaching a medical treatment is sort of culture for us. So will it be taken as an advantage or a disadvantage for this particular project you are planning to launch?

My objective is to provide skin care for all. I am currently the Chairman of task force for skin care for all, run by the International Society for Dermatology. In order to achieve skin care for all one needs to be aware that it’s provided not just by the dermatologist but by nurses and other health professionals and other systems of health particularly.
For instance, in India- Ayurveda, in China- Chinese system of medicine, western system or bio medicine is not the only system of medicine.

And when it comes to treating the skin, one of the problems in a country like India is that although you may have something like 6000 dermatologist that by no means is enough for a 1 billion population. Those dermatologists are way often very busy with numerous patients. The things they prescribe like ointments and pills or advise about the skin, the advice they give may take 3-4 minutes that is all the time they have got and as they go out the patient needs to find somebody to explain to him how to put this ointment on. Do I take this pills everyday? How o I take them?

There are many questions that a patient has to ask and if you don’t answer those questions you are wasting everybody’s money. The belief that perhaps somebody in an outpatient clinic who is there with the time not to describe, not to do invasive surgery but simply to be there to advise the patients on the questions they have about the treatment they have been prescribed. And that’s what we think the nurses should do. And she does it successfully elsewhere. But India has been slow to use nurses in that way.


•          Now we have seen media creating avenues for any kind of advocacy. Be it social or corporate sector (through Corporate Social Responsibility). In this case, it is a health care issue which is not well taken by government. What is the role of media to advocate concept of skin care nursing in India?

The media could be extremely useful in drawing some publicity to both the need and also the capacity of the dermatologist working with the nurses to do the job.
I think the need is very clear. Many patients want skin care but don’t know how to do it even though they see dermatologists. They are frightened of the dermatologists or uncomfortable and they need somebody else. And that somebody else could be the nurse. Media needs to draw attention to the fact that awful waste of money is occurring as a result of insufficient explanations to the patient on what they should do.
There are two levels of information the media needs to give. One is to the patient, the other to those in government management, government or the Nursing Council. Many other organizations need to have their eyes open about a very significant absence in this country of goodness in caring for the skin.