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Naresh Gunaratnam, MD ’91

Naresh Gunaratnam, MD is a gastroenterologist and research director at Huron Gastro in Ypsilanti, Michigan. He is also the president of Grace Girls’ Home in Sri Lanka. He is a guest speaker at the 2016 Medical School Reunion Weekend and is celebrating his 25th reunion from the UVA School of Medicine.

Why did you choose the UVA School of Medicine?

It was a random thing. I was in college and had this hallway conversation with a guy who interviewed at UVA and he said it was the greatest school ever and that I should look into it. Frankly, I’m from Upstate New York and didn’t really know much about UVA so I just said OK. But I checked it out last minute and thought maybe it would be a nice place to go. I interviewed at UVA and was impressed with the school and the beauty of the institution. It was a nice spring day in Charlottesville, compared to weather in New York at the time. Two weeks later, I got a letter and I was sure I didn’t get in. I thought, “Great. My first rejection.” I didn’t open the letter at first, and I was sitting in my biochemistry class and my heart was beating really fast. Halfway through class, I couldn’t stand not opening it any longer so I did and the first word was, “Congratulations.” I interviewed at other places but that first memory and first experience didn’t seem to compare and I chose UVA.

What led to your specific area of concentration?

One of my uncles is a gastroenterologist. When I was 17, I went on rounds with him and watched him do procedures. At 17, being able to see inside the whole body with an endoscope and do that without cutting somebody open was the greatest thing ever. I was intrigued and I knew it was what I wanted to do. My uncle is very close to me – he’s been like a second father to me and a role model because I lost father at 19. I wanted to be like him: a great physician and phenomenal person.

What was your experience like at the UVA School of Medicine?

Honestly the first two years were really tough. I was one of the few out-of-state students. Most of my classmates had come from within Virginia or UVA undergrad. I am a really social person and I like to connect with people. Having to reconnect with people was difficult. Of course, I was also inundated with so much work during my first year that it was challenging. It took a year or so to establish friendships, but forming those relationships eventually made it more fun.

What advice would you have for today’s medical students just starting their careers at UVA?

When I was in med school, there was a lot memorization and information that you were forced to learn. As a practicing physician, I have found it be irrelevant. Communication is what’s so important – learning to work in groups and talking to each other is what you will remember for the rest of your life. Back then, you studied alone and regurgitated it on the test. Working together, collaborating and teaching each other – that type of learning is going to stick with you and you’ll form friendships that will last your whole life. Two of my best friends now are people I met in my second year. My best memories of med school are from those relationships.

What is keeping you most excited about the field of medicine today?

It is constantly evolving – the thing that is most intriguing to me is the use of technology and using tools like electronic health records. Medicine is all about controlling knowledge – the amount of knowledge out there is insane. In my own field there are like seven different journals – 30-50 articles are published per month and to stay on top of that is unrealistic. With tools and smart learning strategies, a doctor becomes more of a counselor than a keeper of the knowledge. Instead, the knowledge is accessed by a smart computer. A patient will tell the computer, “I have fever and chills and hurts in my right lower quadrant.” The computer will search papers and in one second it would tell you the top three diagnoses. You will then see a doctor and he will review and confirm the diagnosis because only someone who has seen these symptoms and seen patients can truly diagnose.

This will be far more helpful for patients and physicians. Right now, 80 percent of my time is spent gathering data. In the future, it will be 20 percent data and 80 percent counseling patients. Collaborating with patients about the nature of their illnesses is where my value added is. Patients will walk out of doctors’ offices more satisfied. It is a waste of my time to run around and gather information, entering different passwords and so on. Inside of 10 years, we will be inside a different paradigm. Right now, that transition phase is very frustrating to most physicians. It’s not intuitive and is a huge hindrance to providing good care.

You are the president of Grace Girls’ Home, an all-girl orphanage in Sri Lanka. How did you get involved in this effort and how has it changed you as a physician?

I’m originally from and was born in Sri Lanka. Civil war began there in 1983 and went until 2009. I had family there during that time. It was one of the bloodiest wars ever, and 100,000 people were killed.

A lot of children lost parents during the war and Sri Lanka doesn’t have a social service system so you had all these children in the streets. In 2002 a friend of mine named Eric Parkinson contacted me and said, “Let’s see what we can do.” We started by setting up a girls’ orphanage because girls were at higher risk for abuse and being exploited. We decided to create a home for 20 girls to keep them safe. When we started, we raised $25,000 and built this home for 20 girls but we soon realized there were thousands of children needing help. We acquired a resort that had shut down – it had seven acres of beach front property and within six months the home had the capacity to help 100 girls. I started becoming involved overseeing their medical care. In 2003 I took a trip and started doing basic things like height and weight measurements. I would see a14-year-old girl who looked like she was 6. We would give them vaccinations, multivitamins and protein.

In 2004, we added an elder care facility. Elders stay with their children in that culture and so sometimes with the war they had no place to stay and were wandering the streets. They would come into the hospital with pneumonia and didn’t have a home so the hospital would give them a mat and feed them. They were called “mat patients.” We met with the hospital’s CMO and offered help. Our facility took care of 60 elders.

We also began offering vocational training for girls and started a daycare with 60 kids ages 3-5. We hired two teachers and fed the kids breakfast and lunch. They came from refugee camps and the daycare allowed parents to go to work.

By 2004, we had a pretty sophisticated operation and were taking care of 350 people. Then in 2007, the financial crisis hit. We were self-funded and it was very hard to raise money. In 2008, I made the difficult decision to scale down some of our programs like our daycare and orphanage. But how do you kick a girl out of an orphanage? We would find family members like an uncle and found homes that we felt were reliable.

In 2009, the war ended. These girls were on the front lines and saw and heard bombs. They lived through degrading experiences with soldiers plus the 2004 tsunami. Our place was right in front of the water. We were very, very fortunate.

As for how it changed me as a physician, the past 10 years I have been very inspired. I do a lot of high tech interventional endoscopies and use very expensive equipment and do sophisticated procedures that may help one person. I have to step back and ask myself where am I most useful. Frankly the WHO and World Bank say the fastest way to get rid of poverty is to educate girls. It’s so true – when you give them the capacity to go to school, you change the paradigm of that village or town from dependency to autonomy. It has been fun for me to see two of these girls go to college. In Sri Lanka, that is really difficult. We have had six girls graduate from a U.S. – sponsored dental training program to be dental hygienists. They have graduated, are living independently and are calling their own shots. They make their own money, and no one is telling them what to do. That gives me a lot of self-fulfillment. If we focus differently, health is not just absence of disease but the wellness of the whole emotional, spiritual and physical being.

It’s also made me broaden my definition of health – I need to take care of the whole person. For example, for the guy with bleeding ulcers who is an alcoholic, I need to address the root cause and that will affect the other 15 problems this guy has that we spend millions to treat. Care needs to be more holistic.

Take obesity. We are not trained in obesity. It is fine that I can treat the symptoms. I can treat a patient’s reflux but his biggest problem is that he’s morbidly obese and that is what I need to focus on. Until we address the root cause, he is going to keep having the same problem and new ones like cirrhosis. Let’s go back to the root cause, the one that’s difficult to fix. I’m not the first guy to tell him to lose weight. But I can help him on that journey and that is fun for me. It’s very easy for me to say, “Here’s a pill – your reflux will get a little better.”  My role is trying to fix that root cause. My philosophy has changed. Five years ago, I’d say, “Here’s your pill for your reflux and have a nice day.” Today I say, “I’m not giving you a pill. Let’s fix your primary problem.”