OC SPOTLIGHT is a regular column on medical professionals in the ostomy community.
Dr. Harikesh G. Buch recognized the difficulties faced by homeless people in his home city of Mumbai early in his medical career. As a skilled colorectal surgeon, he devoted most of his career to caring for patients who were unable to pay for his services. Then something happened that changed the course of his life. He was diagnosed with rectal cancer at age 29 and underwent colostomy surgery, an operation that would serve as the focus of his volunteer work for many years to come.
Dr. Buch recalls that he was “devastated” after the cancer diagnosis, and though it didn’t take him long to become accustomed to living with a stoma, he had initial concerns about the using an ostomy pouching system. Will it leak? Does it smell? Could others see it? Those concerns extended to his career as well. Would he be able to continue as a medical professional with an ostomy? It was only after he met another surgeon in Mumbai who had a colostomy that he felt reassured. Dr. Buch could now be a role model for others, demonstrating to fellow ostomates in India that they could indeed live fulfilled, productive lives — a rather novel concept in his country because ostomy surgery often carries shame and creates rifts within families.
“Many relatives do not allow ostomate family members to enter the kitchen or visit temples,” Dr. Buch explained. “Marriages break over one spouse having a stoma. Some ostomates cannot get jobs. They are shunned in society due to a lack of education.” He also says these stigmas don’t just apply to India, but that they are universal beliefs in the developing world. “Globally, talking about ostomies is simply taboo. There is too much shame involved in the discussion.”
Through the implementation of educational programs, Dr. Buch is hoping to eliminate the negativity and unfair treatment displayed toward ostomates. It appears to be an uphill battle, but there has been significant progress in awareness over the last 30 years and he’s hoping acceptance will rise as well.
Along with educating society on how to respect people with an ostomy, Dr. Buch is passionate about teaching surgeons proper medical treatment for ostomates. Thanks to the support from his local Lions Club, he's able to travel to developing countries and all over the world to instruct healthcare professionals on surgical techniques and optimal ostomy care. “Without financial support from the Lions Clubs International Foundation, my training would not have been possible,” he said. Dr. Buch emphasizes in his training the importance of proper construction of a stoma and placement of the site.
“Many healthcare professionals often don’t realize the significance of location and stoma shape, size, and protrusion when it comes to giving patients quality of life again. In many developing countries, an improperly constructed stoma at the wrong site has led ostomates to depression and suicidal ideation.” — Dr. Harikesh G. Buch
Dr. Buch’s work with the Ostomy Association of India drew the attention of Malaysian IOA (International Ostomy Association) leader Dato John Cardosa, who encouraged him to take an active role globally. Eventually, Dr. Buch was elected to the office of Vice President of IOA’s Asian Region and was exposed to the problems faced by ostomates in many regions of the world. He explains how there simply aren’t enough surgeons, let alone certified Wound, Ostomy, and Continence Nurses. As a result, patients do not have access to skilled nursing care, counseling, or well-fitting ostomy supplies. He has also witnessed firsthand how many ostomates suffer because they cannot afford the exorbitantly expensive ostomy supplies.
"You cannot lead a normal life without a proper pouching system. Without them, life is miserable. Absolutely miserable," says Dr. Buch. “Ostomates in rural areas resort to using newspapers and towels, which leads to unhygienic conditions and emotional trauma.” Fortunately, due to high demand, local ostomy manufacturers have sprung up throughout India and China. Pouching systems of decent quality can now be produced at lower costs — a step forward in improving ostomy care and access to supplies.
Dr. Buch’s work to shatter stigmas and improve ostomy care in India well before the turn of the century and fortunately for ostomates of the world, it continues today. His commitment as an organizational leader and his service in many roles over the past two decades led the IOA committee to rename the “IOA Professional Service Award” to the “Dr. Harikesh Buch Professional Service Award” in 2014, and Dr. Katsushinda Shindo of Japan was the first recipient. We look forward to seeing more physicians follow in the footsteps of Dr. Harikesh G. Buch, and uphold the advocacy work needed for quality of life to ostomates worldwide.