‘Australia, India have a shared history of innovation.’

Dr. Sonu Bhaskar has been recently awarded the Australia Global Talent Award for his contributions to medicine and efforts to identify the cause of stroke, which is Australia's leading cause of death. Dr. Bhaskar is a physician-scientist, board director, neurologist, and a researcher with a strong focus on global health, neurology, and health systems. He is the founding director of NSW brain clot bank - the world’s first initiative which is conducting research on treatment and prevention of stroke. He spoke to Akasha Usmani.

Akasha Usmani (AU): Can you tell us a bit about yourself?

Sonu Bhaskar (SB): Oh, thank you Akasha. I am a physician scientist and academic neurologist, I lead national and international initiatives in Global Health and Neurology and I am the founding director at the NSW Brain Clot Bank and Global Health Neurology and apathy international collaborative initiative to tackle pressing challenges in Global Health and Neurology and I also wear other hats including, I sit on the board of several non-profit organizations in Australia and overseas, most importantly the Rotary Club Sydney and I also chair International task force on several pressing global health issues including Covid-19, which is quite important as you know because of the on-going challenges that we see and witness Covid.

AU: Can you tell us about the journey which led to your winning of the Australia Global Talent Award?

SB: I think this is, this recognition, I am first of all very grateful for this recognition by the advance boards and also the Australian government that supports the board and the entire committee , the international committee that actually leaded on this, this recognition is for my contributions to stroke in particular with more generally in medicine for leading, it was first initiative in acute stroke that is about setting up the brain clot bank in Sydney, the curiosity and the efforts to discover the unknown causes of stroke.

Now for those of you who are not from the discipline of medicine or doesn’t come from this, stroke is a leading cause of death and disability in Australia it’s the third leading cause of death in Australia and globally, In India as well it’s the leading cause of death and disability so stroke is a major burden to our community, to the world, In India as well as Australia.

Since 2015, we now have a new treatment it’s called endovascular thrombectomy, which is a mechanical procedure by which we can pull the clot out of the brain so acute ischemic stroke is a particular type subtype of stroke, majority of the strokes are ischemic strokes, it is because of the blockage of an artery in the brain, now this blockage when it happens then the blood supply to the brain is limited and brain needs oxygen to survive so when there is a limited supply of oxygen then the brain tissues, they all starts dying and the treatment that we offer now is called endovascular thrombectomy by which you can pull the clot out and once the clot is cleared the blood supply to the brain is restored and there is dramatic recovery in patients, it's a life changing, game changing treatment that is possible.

Since 2015 with this avenue of re-treatment options, there is also new opportunity that have arisen that is to look at the clots that have now retrieved from these patients, now we know that there are banks in cancer and so forth, we can excise cancer tissue, cancer tumours and then we are able to look at the cancer tumours so that has informed our understanding of cancer but this was not available for stroke before, since it’s a new opportunity, now in 2017 before I set up this initiative in Sydney in Australia, I spent two and a half years from 2017 to 2019, working and understanding how these clots gets informed, understanding of stroke ideology, where they are coming from because about 30-40 per cent of stroke patients are patients what we called cryptogenic stroke, these are stroke without defined cause or mechanism so we don't know where the clots came from.

Now because of these ambiguity in their origin there is an ambiguity in the treatment and that is a huge cause of concern for clinicians and for patients alike. Now with this opportunity to look at the clots, my fundamental curiosity was that can we use these clots to understand the mechanism of a stroke in those patients where we don’t know what cause the stroke to begin with and that was the origin of how the initiative started, I presented my initial findings, a few years of work at the European Academy of Neurology at Oslo and it was very well recognised, that year I received two European Academy of Neurology Investigator Awards and when I returned from Oslo, I decided that it's time that you know, this is an important issue, now we need to kind off need to roll it out and make this available to hospitals and centres around the world.

I truly believe that medicine and science is to share, is to share the joys of what we do with those who cannot, and I think in that spirit of sharing, that's when it started and we were very fortunate in Australia that there are opportunities available to harness the capabilities, to look at the advanced causes using sophisticated technology and needs.

So after that founding the brain clot bank, we continued to look at these important issues and we have extensively worked in understanding the causes of stroke and then recently we have also that innovation that started here now, we have started a satellite bank, brain clot bank in UK in Liverpool so that's the, the initiative started in Australia now, I really like to see this going global and making a difference around the world and I think it has captured the imagination around the world because of its novelty and impact that it achieved in such a short time.

But more so the award is also recognition of my contributions to medicine in general, during Covid-19, I led an international task force, a consortium of more than 100-50 physicians and health care workers from 25 and more countries including India and we produced evidence based guidelines that could provide critical and informed decision making at a time when you know Covid had engulfed the world and there was so much ambiguity of what is the best treatment options and I am very humble that the work we did at that time and we continue to do made enormous difference in people’s life and not just in one part of the world but around the world and it was covered extensively across and several international news outlets but also it was published in peer-reviewed medical journal which is important to advance medicine.

Beyond medicine and stroke, I have, as I said I am very involved in community because I truly believe that as a doctor, as a clinician, as a scientist we have a role to play in advocacy to speak up for the marginalized communities of the world and in my role as a board director across several non-profit organizations I keep at very core of my heart that the voices of marginalized communities are represented.

I come from a very humble beginning myself and through my journey in life and today I have made it a point that the voices of the marginalized community, the underrepresented communities in the world do have a voice and I continue and I will continue to be an advocate for those communities in Australia but around the world and I believe that the science and medicine is a great tool for sharing for being an advocate, through use of digital health, technology and telemedicine we can provide these resources across to the remote pockets in the world, including villages in India.

I was recently speaking at Ministry of Panchayati Raj at Government of India’s workshop on how do we build a capacity for rural healthcare in India and I spoke about how the technologies and advancement in medicine has a great potential to unclog some of the systematic barriers, that was existing for such a long time in countries, in developing countries and other developing nations more so in developed nations as well, there is a lot of urban and rural divide and through the use of these technologies and advancement in medicine we can do tremendous good to bring the best of medicine to those in the communities which do not have that access. I hope that puts a picture of what we are doing.

AU: Yes, that's amazing. So, what made you come to Australia?

SB: Yeah, thank you. I came to Australia 10 years ago and I came through one of the neurologist who was at Hunter college that time in New Castle and I came to New Castle and that time it was a great opportunity to work at the frontier in stroke, in medicine in general and I took that opportunity and initially I came for few years but those few years became longer years and today it's been 10 years in Australia.

The first four and a half years in New Castle and then I moved to Sydney and today the entire journey has been explained to you before, that's how, you know Australia is a great country, it's a multicultural country which I believe is as asset in the country, the people from no matter what's your background or where you come from, if you believe in what we have and the talent you have and the background you come from, we can all make a difference and I think that the opportunities that are available in Australia, and I truly believe that's true about india as well, these two countries have a shared history of innovation and of resilience and I think that the two countries have so much to offer to this world.

AU: Yes, definitely. What change do you think your discovery will bring in the field of medicine?

SB: Medicine as you know it’s a slow process always, it takes time before things change, when I started it took a long time before it got attraction and I think that for right reason because medicine develops over time and from the bench to bedside translation, it even takes longer but I am very grateful that I think the work we are doing are making an impact but we must continue to move forward and as I said my ideal goal is to make it global where we can share what we know with the world community and see how we can impact and the communities around the world and I think India and Australia are at a great vantage point to be a leader, in leading innovations in the Asian, specifically in the Asian subcontinent but indeed globally.

AU: Thank you so much for the answer. Can you also talk a little about your NSW brain clot bank? How did that happen? It's the world’s first which is a huge thing so...

SB: Oh, thank you, the brain clot bank initiative that started, its world’s first initiative in this area as I have said to you and the reason is before 2015, we didn't, you know, the stand of care and stroke practice changed before that we didn't have that, although there was opportunity but it was not routine so unlike cancer where you do the surgery and take the cancer tissue out we weren't even doing that for decades now so the cancer platforms were well developed but stroke, this field has a dramatically changed in last few years, specifically last decade and advancements in medicine has probably precipitated in this new innovation.

Brain clot bank is an initiative where we look at harmonizing how we can investigate these clots, understand by using sophisticated microscopy techniques but then co-relating that information with clinical and other biological information and see how that correlation can inform our diagnosis and prognosis in these patients.

Now this is important as I have said to you before that in that 30-40 per cent stroke patients, acute ischemic stroke patients where we don't know the cause or mechanism of stroke, this could be, this can potentially be of great benefit and i think that this novel initiative does have a potential but moving forward we are setting up a digital infrastructure which is that no matter which place in the world somebody comes from they can process or collect these clots locally at their centers but then pool their data on a digital repository so that data sharing can happen, infrastructure can be built around the world.

Of course it takes time while we set this infrastructure but once this all is optimize we would be able to roll it out globally but of course I must admit that Covid-19 has been a big challenge and for some time our resources were mobilized towards much more pressing issues which is Covid and during that time as I explained to you, that international task force that we set up for health care workers prepared this action and advocacy. In India, it was a huge burden on healthcare workers during the Covid and evidence based medicine was even more important at these time when there is very limited information about what works and what does not work so I believe that these efforts should combine together and evidence based decision making in medicine as well as the frontier in terms of biological and discovery and bench to bedside translations is the future of our medicine is informed and our ways to treat diseases or diagnose them.

AU: Yes, what effect will your work have on the improvement between the Australia - India community?

SB: Thank you, there are multiple ways this can have an impact. The first is that the stroke is, you know, it's a condition that have fixed Indians- Australians alike, it's a leading cause of death and disability in India and is a leading cause of death in Australia so it doesn't differentiate between Indians and Australians or Indo-Australians, it affects us all so any advancement in this field will have an impact on this area, it’s an important area for sure and any advancement that comes out of our work will make an impact not just in the discovery pipeline, the diagnostic, prognostics but also on the policy pipeline and on policy framework so that's important. I recently gave a talk at the Panchayati Raj for the government of India and it was on the tele-medicine for the rural capacity building rural healthcare and I think there is so much of synergy of expertise that we can offer in between these two countries, there are some great innovation and pipeline in Australia that can be shared with India as well as there is great human resource capital in India which can be you know shared with Australia and vice versa, there is so much of synergy between these two countries and the work they are doing will have an impact in Australia, will have an impact in India and I think this journey is our shared journey. As somebody who has my beginnings in India, I had a very deep sense of gratitude to these two countries - India and Australia and I will continue to champion more stronger science and innovation for the betterment of these two countries - Australia and India in particular, but indeed for around the world.

AU: Do you have any message for the people who will be reading the article?

SB: My message to people is - no matter where you come from, no matter what your background, no matter where you start - you all can be a changemaker for the future. Believe in yourself. Be your authentic self because that is something no one will take it away from you and your curiosity to learn and discover and to achieve has no barriers it is limitless, our capacity and endeavour to know the unknown and to strive to discover something new should continue irrespective of our backgrounds and that is the true spirit of resilience and how we as humans can make a significance difference to our communities and also around the world.

AU: Thank you, thank you so much for taking your time out and agreeing to do this interview with us.

SB: My pleasure, absolutely.