An Interview With Dr. Shahjada Selim, Assistant Professor, Department of Endocrinology, BSMMU

Dr. Shahjada Selim, Assistant Professor, Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, is a bestselling author, one of the few prolific medical researchers in Bangladesh, renowned endocrinologist and a passionate clinician.

By profession, he is a specialist in Diabetes, thyroid disorders, obesity, infertility, sexual disorders, growth disorders, hormonal disorders, osteoporosis, metabolic disorders, electrolyte disorders, lipid disorders, hirsutism, gynecomastia, male and female hypogonadism, erectile dysfunction, PCOS, sleep disorders etc.

Mr. Selim takes great interest in medical research, health practices in our private and organizational life, and creating health awareness in order to build a healthy generation.

Dr. Selim spoke to Future Startup’s Ruhul Kader about problems in our healthcare system, lack of research and scientific exploration in the field of health and medicine, the rapid growth of diabetes and obesity, health practices for busy people and entrepreneurs and why organizations should help their employees maintain a healthy lifestyle.

What follows is a lightly edited transcript of the interview which has been prepared by Rahatil Ashekan. 

Future Startup: Briefly tell us about yourself.

Dr. Shahjada Selim: I am an endocrinologist, or more simply, a hormone specialist, hormone-related issues including Diabetes, Thyroid disorders, infertility, sexual disorders, menstrual difficulties, etc. I teach (Assistant Professor, Department of Endocrinology) at the Bangabandhu Sheikh Mujib Medical University (BSMMU). 

I am also specialized in osteoporosis (a medical condition when bones become brittle and fragile) which has become prevalent in the recent years.

Although we call it endocrinology, the work we do is actually called endocrine metabolism in a broader sense. We also deal with obesity, yet another common problem prevalent throughout the world. These areas and pertinent disorders and medical conditions make up our area of work.

FS: How did you come to be a doctor? Was it a childhood passion?

Dr. Selim: I had never seriously thought about becoming a doctor during my childhood. Instead, I was immensely passionate about astronomy. Even these days, I like to learn about stars whenever I get time. It gives me pleasure.

But, I am a whole-hearted clinician now. I love my work. Medical research particularly interests me the most. I love to work on new things and explore new ideas.

FS: Bangladesh has made very little progress in science and medicine in the past years. It is hard to come across that many groundbreaking works and innovations in this area. We publish an annual list of extraordinary young people called ‘Under 35’ but we could not find anyone for our list last year from science and medicine. What do you think, what are the problems?

Dr. Selim: Medical education takes relatively longer time than other disciplines. It is hard for doctors to accomplish breakthroughs within the age of 35 due to their lengthy academic years. So, if you are looking for young people with great accomplishments in this field, you better broaden the age limit.

I would suggest you to find among the age group of 45. Before becoming an endocrinologist I conducted researches on visceral leishmaniasis (commonly known as "Kala-ah-jar" or Black Fever) myself when I was working at the Art of Medicine.

Another much-neglected area in Bangladesh is the sex-related issues. There is an illogical taboo attached to everything that concerns sex in this country. That is very harmful because it creates difficult problems for the long run that you could have solved easily otherwise. People who have real sexual problems even hesitate over whether or not they should see a doctor.

There has been very little progress in that respect. I happen to be one of the few people who have been doing research on this. There is only one publication about diabetes and erectile dysfunction in the country, and it is prepared by me.

Let's come to the point of lack of research and innovation. Put simply, it is hard to conduct research for us. There a number of reasons, of course. Take, for example, our discipline-endocrinology. The total number of members of the endocrinology society are only 122 which, not to mention, is horribly low compared to the 7,200,000 diabetic patients (8.4% of entire population) in the country.

Moreover, among 122 members, some are settling in abroad and some are associated with other disciplines. That leaves us with only 93 dedicated clinicians. That's why I tell my students that if everyone suffering from diabetes or thyroid disorder decides to consult endocrinologists, we will die from a sudden influx of patients. We are horribly ill-resourced. And we get very little time to spend in research and other serious works.

The second problem is that our service structure doesn't require research works from doctors for starting practice. If there were an institutionalized requirement of research works, then we might see a different scenario.

I have conducted and published 28 research papers, which makes me eligible for a professorship at the university. But if the university had instructed me to submit my own research papers before assuming professorship, I would have been more inspired and incentivized. We do have the requirement at BSMMU. But there is room for improvement.

In fact, our academic sphere, as a whole, is not that much research-oriented. But it is hard to make progress without research. Take any field you want, and you can't do much without effective research works.

Relevant data is also a critical problem in Bangladesh. Due to the low rate of research, we do not have sufficient data on our population. As a result, we have to do analysis with the data taken from foreign books and other sources. That is a great drawback.

FS: We understand that there is no easy fix to this problem, but we need effort and proper initiatives to get over this predicament. So, what do you think can be a solution?

Dr. Selim: There is a certain level of positive willingness for research and innovation from the very top level of our government and leadership of the country but somehow it seldom follows through down the road.

There is, of course, lack of patronization and transparency to some extent. Institutionally, there is not enough structure and requirement and motivation. So, all these things need to be addressed gradually in order to make progress.

However, things are slowly changing. There are a few achievements as well. There was recently a study called GATS (Global Adult Tobacco Study) in 2007 which was conducted in 15 countries at the same time. Surprisingly, we were the first ones to complete it successfully and one of the bests.

There are other notable examples as well but those are not enough and we need more.

FS: Diabetes is one of the fastest growing diseases now. According to some sources, currently, 8.4% of our population is suffering from Diabetes which will be 12% by 2030. This is a very alarming prediction, but we don’t see enough effort to prevent this.

Dr. Selim: To add to your estimations, some other studies suggest that the number of total diabetic patients in Bangladesh is 7.2 million which is projected to be 14 million within 2040. Add to that, over 52% people are undiagnosed, meaning they are not even aware of their diabetes.

You can see how huge is the gap between the number of diabetic patients and doctors, as I mentioned earlier. Moreover, diabetes demands extra care on the part of the doctors. It's not like a viral fever when doctor's only duty to prescribe some medicine and that's it.

Doctors who treat diabetes need to take more responsibility and teach the patients what to do, when and which medicine to take. But, this is not possible in current structure because there's a severe shortage of physicians and facilities compared to the number of patients. We need to change the structure so that doctors are able to properly treat every patient.

Moreover, most of the diabetes-related initiatives are privately taken with very limited government support. While we have specialized government facilities for almost all major diseases, diabetes receives very little to no attention. I think the government should pay more attention to this problem; otherwise, it is going to be a serious health threat for us as a nation.

FS: Why do you think this disease is growing so rapidly? How can we prevent it?

Dr. Selim: We are currently among the countries that are considered to be most vulnerable to diabetes. That is not to say that the prevalence rate of diabetes in our country is very high. Saudi Arabia has a 25.4% prevalence rate and Beirut 34.75%. Till date, we are only at 8.4%.

Surprisingly, the prevalence rate is dropping every year in those other countries, whereas, it is on the rise in Bangladesh. Along with lifestyle reasons, we generally have some genetic flaws. Our physical structure makes us prone to diabetes even if we get a little fat. This is called lean-Indian-complexity.

There are two main reasons as to why we generally get diabetes. First is our food pattern which is highly carbohydrate-dependent. We know that diabetes is a carbohydrate metabolic disorder. So, that puts us in a very risky position.

We should adopt a more protein and vegetable-based eating habit which will reduce the risks. This is albeit a long-term measure but it will bear fruit if we can put it to work as soon as possible. Second reason is our soaring economy, which is making us more and more sedentary every day. We are more likely to get diabetes due to lack of physical labor.

All these reasons along with the environmental pollution make our region more prone to diabetes. We cannot eliminate all the root causes overnight, but we can certainly try to do easy things to prevent diabetes, such as- changing our food pattern, walking at least for half an hour every day.

We also need to design an effective system to provide proper medical services to diabetic patients. Diabetes is a complex disease. It varies considerably from one person to another. So, we have to treat every patient according to their individual needs. That is very important. Furthermore, the government should allocate more budget for this sector which is very nominal at this point.

FS: Obesity is yet another problem that is on the rise, as you were emphasizing. There is a growing rate of obesity among the young people.

Dr. Selim: Obesity is going to be a serious problem if we fail to address it properly. I think part of the reason behind this growth is the structure of our educational institutions. Young people do very little to no physical exercise at school/college/university. This lack of physical activity makes them more likely to develop diabetes. 

We first need to academically encourage school and college-going young people to actively participate in tasks that require physical labor. Secondly, either the authority in institutions or the government should arrange annual sports ceremony for the students and encourage regular physical work. Thirdly, the concerned authority must raise awareness about a healthy diabetes risk-free food habit for the students.

FS: We, at Future Startup, work with entrepreneurs, CEOs, executives and the likes and their job, most often, is sedentary in nature and they get very little time to exercise. How would you advise these people to prioritize health in their lifestyle?

Dr. Selim: I believe it is all about mindset. You just need to take your health seriously and act upon it. First, they need to take into consideration the risk of physical inactivity. It does not matter whether you are an entrepreneur, CEO, top employer or a mid-level manager, lack of physical activity will finally push you to the edge of diabetes and other health problems. Not only that, it will make you less effective.

There is a huge difference between the work of a healthy person and that of one who is not. It is proven that physical activity helps us to be more productive and help our brain to sharpen.

So, people who are in business must take time out to do some sort of physical work, such as- walking. If the nature of your work is sedentary, then walk after dinner at night. If you can't make time to take a walk outside at all, try using a treadmill which I suggest to many of my patients.

FS: How important it is to maintain a healthy diet?

Dr. Selim: As I have mentioned it earlier, our food pattern poses a great health risk. Sweet, for example, is quite harmful to not only diabetic patients but to normal people as well because it increases your body-weight. We often distribute sweet for a good occasion but I think we should change theses cultural narratives and instead of sweets, we should give fruits.

Another popular food item which I consider to be totally unhealthy is "Biryani." We need to gradually discourage people about not to take this type of food. In fact, when WHO told me to write a slogan for a campaign, I wrote: "Add fruits to your favorite food, not sweets."

So, it is important that we maintain a healthy diet. Vegetable, fruits should get priority and we should actively avoid foods that are not good for our health.

FS: Do you think there is a connection between employee health and a company's overall productivity?

Dr. Selim: Of course. A healthy employee would contribute way more to the growth of a company than his/her somewhat not that healthy peer. So, companies must look after their employees' betterment and encourage workers to maintain a healthy lifestyle.

Successful companies around the world offer lucrative health program for their people not because they are generous towards their people but because it is a worthwhile investment.

When you invest in the health of your employees, the return is way too high. Take a simple example, if people maintain a healthy lifestyle they would not get sick often and would not need sick leaves. This single metric can make a difference between two organizations.

FS: Do you have any specific health advice for our readers, like maintaining a general routine or something like that?

Dr. Selim: Eat healthy. We have to look out for risky food items, such as- potatoes, sweets, and salt. We also need to replace our daily three-course to a five-course meal which will reduce the risk of obesity.

Everyone should walk every day. But, if you really can't manage to do so, then walk at least one day a week for a long time. Also, you have to look after your children. We don't want our future to suffer from obesity and diabetes future generation, do we?

Interview by Ruhul Kader, Transcription by Rahatil Ashekan, Images by Dr. Shahjada Selim

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