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Year : 2018  |  Volume : 5  |  Issue : 3  |  Page : 137-138

Pilgrim's progress

Editor — IJVES, Director — JIVAS, Bengaluru, Karnataka, India

Date of Web Publication8-Aug-2018

Correspondence Address:
Kalkunte R Suresh
Editor — IJVES, Director — JIVAS, Bengaluru, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijves.ijves_55_18

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How to cite this article:
Suresh KR. Pilgrim's progress. Indian J Vasc Endovasc Surg 2018;5:137-8

How to cite this URL:
Suresh KR. Pilgrim's progress. Indian J Vasc Endovasc Surg [serial online] 2018 [cited 2022 Jul 4];5:137-8. Available from:

John Bunyan wrote the English religious epic “Pilgrims Progress” in 1678 tracing the Journey of “allegory protagonist” - a metaphorical hero by name Christian - from his hometown “City of Obliviousness” to reach “Celestial Abode.” His path was arduous with treacherous obstacles both in the forms of men and matter. Many parallels can be drawn with the progress of vascular “pilgrims” in India and perhaps in some parts of the world.

The narrator (author) tells the story of the Pilgrim, which was framed in his dream when wandering in the wilderness and entering a den to sleep:

Perchance we can metamorphose the “Pilgrims” name from Christian to Vascular (a person, not a specialty), we can perhaps see the progress made through the years. Over two decades back, Vascular in India was a Nomad Meandering in the wilderness like the Pilgrim in John Bunyan's classic “in rags and crying because of a burden on his back” — the massive vascular burden of this country — “Living in the City of Destruction” - patients undergoing unnecessary amputations and death. The pilgrim seeks a path to salvation from this burden. Vascular seeks the help of his neighbors— “Obstinate” and “Pliable” (the author found names descriptive of their characters)— to befriend them to unburden the load of “death and misery” of his tribesmen (read vascular patients). “Obstinate” (read cardiac related “tribes”) refuses Vascular and his tribesmen into his fold. “Pliable” (other surgical tribes) agrees to take them in but urges Vascular “to lead a practical existence within his fold but without identity. Refusing, Vascular builds his own shelter - Goodwill home” — akin to VSI. “Along with his tribesmen named Faithful, Skill, Honest, Worldly-wise man, Valiant-for-truth (members of VSI) the Pilgrim Vascular leaves his Goodwill home and travels along the Wall of Hope to Celestial Ground (read Medical Council of India [MCI]) to achieve their salvation (recognition of vascular specialty) with Shining Star (Madras Medical College [MMC]) throwing the light on to their path. However at the gates of Celestial Ground, they are stopped by a hybrid creature Apollyon, who with the help of ignorance, tries to swallow Vascular and douse the light of Shining Star. However Mr. Sagacity, the chieftain of Celestial Ground (read Chairman of MCI) stops these evil designs and delivers Salvation.” These are not mythical, but real events about vascular surgery in India — in 2002, the specialty of CTS (Apollyon) along with ignorance (some opinionated persons) tried to merge Vascular Surgery to create CTVS and probably close down the only existing vascular training center at MMC (Shining Star). The Vascular Tribe fought hard and MCI recognized Peripheral Vascular Surgery (Celestial abode!) as an independent super specialty, paving the path for numerous training centers!

Prior to the above “Pilgrimage,” there was only one center offering MCh in Vascular Surgery at MMC. The blessings from “celestial abode” and recognition of vascular surgery as an independent super specialty opened the horizons for starting training centers. In 2004, the National Board of Examinations (NBE) approved 18 months fellowship programs in a couple of centers and several “deemed” and health universities offered similar courses. Obviously, this was inadequate to provide training in all aspects in the huge, holistic field of vascular surgery. Hence, these were converted in 2007 to 3 years training programs for those who have already qualified in General Surgery - Diplomate of National Boards (DNB) by NBE and MCh by MCI. Now, there are 15 centers in India offering quality vascular training, with curriculum inclusive of “open” vascular procedures, endovascular interventions, venous disorders, vascular medicine, dialysis access procedures, diabetic foot and wound care including debridements and minor and major amputations. Training is aimed toward creating a “vascular specialist” than just a vascular surgeon. The intake of trainees is about 35 per year. The number of vascular surgeons in India has increased from hardly a dozen to about 15 years back to over 100 now and about 35 “new” graduates are added every year. Small numbers for a country of over a billion with75 million known diabetics! But, it indeed is “progress.”

How do we measure this progress? There are no ready-made “scales” to gauge the length, breadth and depth of progress. Perhaps, we can measure this by looking backward, not forwards. It should be measured by where we are now compared to where we used to be.[1] We have effectively increased numbers in our “tribe” by about eight times and most reared (trained) in the newly created “celestial abodes” (vascular training centers). Pilgrims have progressed and burgeoned!

The next obvious question — has the quality increased in tandem with the quantity? And what measures are employed and supports provided to progressively increase the quality? Of course, it is heartening to see each institution adopt rapidly changing methods of patient care into their teaching curriculum. More importantly, VSI has provided credible platforms for advancing the skills and knowledge of the trainees. Numerous young vascular surgeons have benefitted from “hands-on” overseas Fellowship programs mostly in UK, Ireland, and Austria.

Recently conducted “mid-term conference” in Bengaluru truly showcased the quality our young trainees have achieved, apart from a very large numbers (over a 100) of presentation. Yes, this augurs well for continuing “Progress” in both quantity and quality of presentations. Indeed, this provided the impetus for this Editorial.

These unique mid-term conferences envisaged about 10 years back, are entirely focused toward vascular trainees providing them the opportunity to present their original work and take part in a rather extensive quiz and other competitive presentations. This involves podium presentation for 5 Minutes on topics given to them ahead of time. The quiz competition to individuals and institutions truly tests the depth of their knowledge. The extempore presentation on topics picked only 15 Minutes before their presentation would challenge even some of the senior members. There are prizes for best individual presentation and a rolling trophy for the institution, which scores highest in all the arenas combined. The quality, apart from quantity, of presentations from these young vascular surgeons in training, has immensely improved over the years and continues to attain higher standards. Now, many of their presentations are accepted in reputed vascular conferences across the world.

Yes, the Pilgrims have arrived, but continue to March on. Unlike John Bunyon's single metaphorical hero, we have many protagonists who keep climbing, since their “celestial abode” is always at a greater level!

“Progress is the law of nature … The great fact to remember is that the trend of civilization itself is forever upwards… “ — Dr. Endicott Peabody,

As recalled by his famed student Franklin Delano Roosevelt

  References Top

Bruce K. How to Effectively Measure Progress. Blog; November, 2014. Available from: [Last accessed on 2018 Jul 20].  Back to cited text no. 1


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