I work on the bit between “this should work” and “why isn’t it working here?”
Doctor by training. Global surgery and health systems by occupation. Implementation by necessity.
Usually somewhere between a district hospital, a spreadsheet, and a WhatsApp group.
district surgical systems · national surgical planning · communities of practice · implementation · negotiation · trying to keep meetings shorter than the problem
The ideal pathway is excellent. Unfortunately, the patient is here.
Much of my work begins when the guideline, programme or policy meets a real health system — with its actual staff, actual budget, actual geography and the occasional machine that has chosen today to stop working.
The projects change. The awkward questions are surprisingly loyal.
Can the district hospital actually do it?
Not on paper. Not after three referrals. On a Tuesday night, with the team and equipment that are really there.
Who is the real expert here?
Sometimes the answer is the specialist. Sometimes it is the senior nurse who has quietly kept the ward alive for twenty years.
What happens after the PDF?
Policies, guidelines and national plans are useful. I am mostly interested in whether they survive first contact with implementation.
Can we make it simpler without making it stupid?
Frugal does not mean second-rate. It means stripping away what the context cannot sustain without stripping away safety.
With many people smarter than me. A useful arrangement.
Strengthening operative care in district hospitals
Training, implementation and evaluation with teams working where referral is not a plan so much as a road trip.
National surgical planning
Helping ask the deeply glamorous question: once a country has a surgical plan, who is doing what on Monday morning?
Communities of practice
Because sometimes the most useful clinical decision-support system is still “the people I WhatsApp at 2 AM.”
Understanding surgical systems
Registries, operating rooms, surgical volumes and the recurring discovery that a denominator can ruin a perfectly good story.
Notes from places where PowerPoint has limited jurisdiction.
The night-shift doctor is now dean, superintendent and switchboard
A district hospital lesson in how quickly job descriptions become aspirational after 8 PM.
The specialist was the senior nurse
A reminder that competence has never been particularly respectful of hierarchy.
When ideal is not practical, practical still has to be safe
Adaptation is not giving up on standards. It is figuring out which standards must survive the journey.
I publish some things. I am still trying to understand most things.
Research, field reflections, implementation notes and the occasional idea that survived peer review.
For the exhaustive publication list, ORCID is a much better filing cabinet than this homepage.
A doctor who wandered into systems work and stayed.
I work across global surgery, implementation, research and policy in India and with international collaborators.
I like difficult problems, practical people and meetings that end with someone knowing what happens next.
If the problem involves surgery, systems, implementation — or a meeting that needs rescuing — say hello.