My journey began in North India, which is where I went to medical school. I came to the UK in 1992 and continued my training here. I then went to the USA and worked as a hepatologist at The Johns Hopkins Hospital, which remains one of the top academic medical centres in the world.
I came back to the UK in March 2007, which is when I joined BSMS, so I’ve been here for 11 years now. I didn't seek out Brighton as a place to come as such, and sometimes life has a funny way of working out – I ended up here and it turned out to be a brilliant decision.
I am a clinical academic. I spend half my time doing clinical work and half my time doing academic work. I am based at the Medical Teaching Building at BSMS, but I also spend a lot of time at the University Hospitals Sussex NHS Foundation Trust and at the King's College Hospital NHS Foundation Trust in London. Usually, I spend Mondays and Fridays at University Hospitals Sussex NHS Foundation Trust and I go to King’s once a month. Wednesdays and Thursdays are supposed to be academic, but a lot of the patients I see are really sick so it’s not always that easy to define.
When I first came to BSMS, hepatology wasn't a sub specialty, it was part of gastroenterology. I had to build our research and reputation from the ground up. Now we are recognised as a national hepatitis C centre, we are a level 2 training centre for hepatology and we have an established academic programme. It is great that our work here is now recognised nationally and internationally.
My father inspired me to get in to medicine. He is a doctor and is still working part time as a doctor in Delhi, India, at the age of 86! He encouraged me to be a dermatologist, but my passion was always hepatology. I knew that's where I wanted to be. I did also consider journalism as a career and at one stage I was really torn between this and medicine. Growing up in India in the 80s, there weren’t many female journalists at all and there were huge security risks associated with this line of work too. I also realised that there wasn't a clearly defined career path, so even if I got into journalism, I couldn't see how my career would progress. Medicine on the other hand was far more defined in terms of a clear career path.
My proudest moment so far was spending a year at Johns Hopkins. It is regarded as the best hospital in the world, so to work as a hepatologist was an unbelievable experience and one that I found incredibly rewarding. In fact, when I first came to BSMS, Prof Kevin Davies didn't put my name on my office door for six months because he thought I’d be tempted to go back!
Joining BSMS was an incredibly exciting time, albeit scary too. Everything was very established at Johns Hopkins, whereas hepatology didn't exist as a speciality at BSMS. It took me six years to get my first grant. We weren’t on the map at that time, so it was the biggest challenge I’ve faced so far. I can remember clearly what my first grant was – it looked at active case finding for hepatitis C in the community. I had no idea what it meant to submit a National Institute of Health Research (NIHR) bid back then, so when I look back at my previous NIHR submission now I cringe! I was once told that the key to a successful grant was collaboration, and I obviously didn't have many links when I started here, so this was a really challenging period. I now have two successful NIHR grants, one each as a Chief Investigator and Co-Investigator.
So much has changed 11 years on, but my research continues to be centered around eliminating hepatitis C. We have wonderful new drugs available to us, but almost all with hepatitis C in England are vulnerable and disenfranchised individuals do not engage with hospitals. That is why about 50% remain undiagnosed. My research focusses on developing novel integrated community models for care in a bid to engage these hard to reach people (people who inject drugs, homeless etc). We are currently providing community hepatitis clinics at drug and alcohol services and homeless hostels. Unless we engage these individuals it will be difficult to eliminate hepatitis C.
The model we have developed has been really successful and we aim to submit a large grant to try and replicate what we are doing in Brighton on a national basis. This is a long-term plan so we’ll know in July if we have got to the next stage and we’ll find out next year if we have been successful. All of the national centres have effectively run out of patients to treat. Everyone who needed treating has been treated so now we have to do active case finding to engage with those hard to reach groups. Other centres and teams are now coming to us to learn how they can engage with these groups too, which is testament to the work we have done at BSMS. My research team is made up of two research fellows (Dr Lucia Macken and Dr Ahmed Hashim), one academic clinical fellow (Dr Dev Katarey), one academic F2 and one nurse (Ms Margaret O’Sullivan), so I have five people I am currently supervising. I meet them every two weeks and it’s really rewarding for me to work with such talented people.
If we can eliminate hepatitis C, it will be the first infectious condition to be eliminated without a vaccine. The last infectious condition to be eliminated was smallpox, but this was done with a vaccine. The NHS wants England to be the first country to eliminate this in the next five-seven years. At the beginning of my career, the cure rate for hepatitis C was 20%, and it now sits at 95%. I can’t think of anything else that's moved at this pace and it’s been so exciting to be a part of this movement.
If I was to give my younger self any advice, it would be to follow my dreams and go where life takes you. I think sometimes you have to fail to succeed and failure should only ever serve to motivate you and not define you. The first three grants I applied for were all turned down. When I eventfully got the grant, and began my community screening project, I thought I could screen in the community and then pass these patients on to the hospital. But zero patients were treated as <10% attended so we completely failed in this project. But it was this failure that made me rethink how we could engage with these patients and it was this failure that got us to where we are now – on the brink of eliminating an infectious condition.