In the 1800s, U V Swaminatha Iyer (known affectionately as Tamil Thaataa) painstakingly rebuilt Tamil scholarship, restoring lost texts and revitalising the language for future generations.
Is it any surprise that Professor Balasubramaniam Venkatesh, one of Australia’s pre-eminent intensive care medicine specialists who has shaped the discipline’s scholarship internationally, is a descendant of Tamil Thaataa?
Surely his forefather would approve of his recent appointment to the Member of the Order of Australia?
“The scale of his achievements was phenomenal,” Professor Bala Venkatesh AM muses. “I’m sure he’d be proud of this if he was alive though.”
As a child, he remembers being brought to the feet of his antecedent’s statue in Chennai to learn about Tamil literature. But he always had an eye for science, loving biology when he was in school.
“I’m the first doctor in my family, as far as we can trace back. My grandfather, who was based in Tirunelveli, built a free maternity hospital for the poor based on charitable donations. That was a big influence in our family,” he recalls.
Training generations of ICU professionals
After completing his MBBS at the Christian Medical College, Vellore, Professor Venkatesh studied a research degree at the University of Birmingham, where he felt compelled to specialise in intensive care medicine.
“The attraction of intensive care is you see conditions related to all the specialties,” Professor Venkatesh says.
“The other thing is it’s very procedural, you are very hands-on. You have to put patients on life support and put big central cannulae into the arteries and veins. All that makes it challenging, but at the same time, very attractive.”
When Professor Venkatesh arrived in Australia in 1995, intensive care medicine was a discipline still in its infancy, with only one accredited course. Over 25 years, he helped establish the College of Intensive Care Medicine’s training program, a course which every ICU practitioner working in Australia has undergone.
“It’s pleasing to see people who’ve gone through it succeed, become specialists and come back as examiners on the course,” Professor Venkatesh says.
It was a training model so successful he was invited to implement it in India, where he remains an Honorary Professor at the College of Critical Care Medicine, and at St John’s Medical College Research Institute, Bangalore.
Serving as an examination chair, Vice President, and then President of the College of Intensive Care Medicine from 2014 to 2016, he helped set the rigorous framework which has made Australia a leading critical care provider.
“Intensive care in Australia has the world’s best outcomes; we have a 90 to 95 percent survival rate which is fantastic. A small proportion do not survive, but at least they get the best care whilst in the intensive care unit,” he says.
During his tenure, Professor Bala Venkatesh AM not only advanced the field’s academic rigour, but its workplace culture, leading an international taskforce to improve gender equity and eliminate discrimination.
A confronting, pressurised environment, ICU specialists see people in the worst of health, from burns victims to car crash survivors.
“When you start, it is confronting, especially when you see people who don’t survive the illness despite your best efforts, and when you see young people die,” Professor Venkatesh says of working in ICU.
Despite the demanding nature of the job, Professor Venkatesh stresses the importance of collaboration.
“You’ve got to remember you are part of a team and respect your colleagues. Patients are always first and foremost. The team is equally important,” he advises budding doctors.
“If there’s a smart junior doctor in your team, do not see them as a threat to your leadership. If you in fact nurture that person, then it’s great for the patients, your team, your department and your own career, because if the department grows, everybody grows.”
Fighting septic shock deaths
From 2013 to 2017, Professor Bala Venkatesh AM helmed ADRENAL, the world’s largest septic shock clinical trial across Australia, New Zealand, Denmark, Saudi Arabia and the UK. It found administering steroids greatly improved septic shock patient’s recovery, findings which were published in the prestigious New England Journal of Medicine in 2018.
A life-threatening reaction to an infection, septic shock is caused by an overactive immune system causing blood pressure to plummet, which leads to organ failure and death within hours if not treated.
“The trial was important for a variety of reasons, because till then this had been a 50-year controversy – people weren’t sure whether steroids improved it or not, and clearly the ADRENAL trial established the conclusions very clearly,” Professor Venkatesh recalls.
Since this trial, Professor Venkatesh has worked to increase our understanding of the condition, currently chair of Queensland Health Statewide Sepsis Steering Committee.
“People understand the word pneumonia, but people don’t understand sepsis. It’s interesting because when people die from a pneumonia, they’re dying because the pneumonia progresses to a whole lot of body reactions which cause sepsis,” he explains.
“The word sepsis is not commonly mentioned; the hospital discharge summaries, the death certificates don’t mention the word sepsis, they often say pneumonia. I think we as physicians and clinicians have to increasingly use the term to raise the awareness.”
As a Professor in Intensive Care Medicine at the University of Queensland and The George Institute for Global Health, Professor Bala Venkatesh AM has helped developed a nationwide sepsis standard to help clinicians recognise the condition.
“Sepsis is one of the most common reasons for admission and death in the intensive care unit. The deaths from sepsis exceed those of the national road toll and all the common cancers combined in Australia, but it’s a little-known fact,” he reveals.
“Sepsis is an area which really needs a lot of research, and that’s why we are now doing a major program of work.”
Committed to sharing health outcomes across the pond, he was instrumental in The George Institute’s Indian COVID-19 research program and is currently investigating the efficacy of precision medicine in treating septic shock with paediatric patients in Delhi.
“What I tell people now is we have to think global. We are very privileged to live in this country, but we have the ability to influence global health,” he says.
“I tell people to go and work in other jurisdictions – there’s a lot to be learned.”
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