AIDS Pediatrician in Minneapolis
When Dr. Kiran Belani was four years old, she declared her ambition quite specifically. She said that she wanted to be not just a doctor, but a pediatrician. This typifies the confidence, certainty and sense of mission that she has shown ever since.
Dr Belani was born 1953 in Bangalore, capital of the southern Indian state of Karnataka, and the country's fifth largest city. At 16 she entered St. John's Medical College in Bangalore, and in 1976, at the age of 23, received her medical degree. She and her husband, Kumar, an anesthesiologist, moved to the United States. In 1978 Dr. Belani began a pediatrics residency at the University of Minnesota Hospital and Clinics. In 1982 she received a M.D. in Pediatrics from Bombay University.
Three years later, after a sojourn at the Children's Hospital of Philadelphia, she began an Infectious Disease Fellowship in Pediatrics back in Minnesota, where she cared for the state's first child to be diagnosed with HIV/AIDS. She stayed with that girl until she turned 21. In fact, until 1995, she cared for every HIV-infected child in Minnesota. In the years before antiretrovirals, her charges often succumbed to the virus. Then, about a decade ago, Dr. Belani could finally begin to share with HIV-positive young people the joys of their growing to adulthood.
Currently Dr. Belani serves on the board of directors and the medical advisory board of Camp Heartland, a camp for kids infected and affected by HIV in Willow River, Minn. (she received the camp's Heart and Hope Award in 2001); on the Antimicrobial Task Force of the Minnesota Medical Association; as a member of the Pediatric Judicious Use of Antibiotics Working Group of the Minnesota Department of Public Health; and as a division head of the Selection Committee for Pediatric Infectious Diseases at the University of Minnesota-Twin Cities. She has also helped to raise funds for HIV/AIDS patients in India through the Trickle Up Program, and helped to found Karnataka Comprehensive AIDS Research and Education Services (KCARES), whose members hail from both Minnesota and India.
Dr. Belani's sense of mission has certainly been passed to the next generation. Her children, Aarthi and Hrishikesh, whom she calls "wonderful citizens of this world," work respectively in human rights law and public health. It looks as though, for some time to come, we will have Belanis with us, encouraging us to stand up and fight.
How long have you been practicing?
|"Back then, prolonged HIV infection stunted the growth of children with HIV. Now that we have treatment, the kids with HIV are in the normal percentiles of growth."|
How many children are you seeing now?
Twenty-five children, We have a very small population of HIV-positive children here. They are from all over Minnesota. There are only two pediatric HIV specialists in the whole state. I was alone from 1985 to 1995. I was the only pediatric HIV specialist and this was this worst time for HIV.
Are you seeing any immigrants?
Our newer patients come from Mexico, Honduras, Ethiopia and West Africa.
Can you describe how your practice has changed since you first started?
There was nothing you could do years ago. Most children back then did not live past seven to 12 years old. And it was hard; these were children that you got attached to. It was really hard. All we could do was provide some supportive care and treat their opportunistic infections. We had many deaths, 10 to 12 in 1994. Now people are living longer, even the kids who are seriously ill. One child we've been seeing for 10 years has never had a CD4 count above 10. But the child is still functioning. So this would never happen back then.
Back then, prolonged HIV infection stunted the growth of children with HIV. Now that we have treatment, the kids with HIV are in the normal percentiles of growth.
Now that there are fewer children being infected, do you have time to do other things?
As an infectious disease physician, I have other patients (non-HIV positive). Yes, we have more time.
What's the best thing about your job?
Helping children achieve their potential.
What's the worst thing about your job?
Dealing with the social problems of HIV-infected families and children is difficult. Many of the problems are difficult to resolve and overcome. You have to remember that the parents of these HIV-infected children are infected too. So the parents often die while the children are dealing with their HIV. Sometimes the children go to relatives, but it's a lot of work to take care of HIV-positive kids.
We have a lot of HIV-positive children who were adopted. They had been given up at birth and then they were discovered to be HIV positive. We have three couples of gay men who have adopted infants who are HIV positive. They take such good care of their babies. There are a lot of good stories. We see amazing stories; we meet heroes all the time.
Did any weird things happen to you at the beginning of the epidemic?
In the early '90s, I had someone come after me. We started on AZT (Retrovir) for a child who was adopted and the parents said it was a poison and they called Peter Duesberg, the man who wrote a book claiming that AIDS isn't caused by HIV and they pulled the child from my care. I think my name is in the book.
What have been your greatest successes in your work? Greatest failures?
Greatest failures: Family problems of positive children. Families that don't have resources. Issues of poverty, substance abuse and they may have been formerly incarcerated and also mental health issues. Successes: Survival of kids to adulthood.
What is the biggest challenge you face as a clinician?
No control over insurance, access, issues of people who are marginalized by our society.
What do you think is the biggest problem children and adolescents with HIV face today?
Discrimination, hopelessness, poverty, social issues.
Can you describe what kind of discrimination your patients have faced? What sort of social issues?
Discrimination in school by peers and sometimes by teachers and principals.
What do you think is the biggest problem adults with HIV face today?
Long term medication compliance, risks of medication.
|"We have three couples of gay men who have adopted infants who are HIV positive. They take such good care of their babies."|
For the most part, what do you think is the biggest risk factor for HIV?
Sexual transmission. Intravenous drug use in other countries, in Russia, etc.
What single change would you like to see in HIV care?
Easy access to meds, easy protocols for combination of meds. We will get this.
What do you provide in terms of education or counsel for a patient who is just diagnosed?
Lots of tender loving care on the first visit and hope and optimism.
What do you provide in terms of education or counsel for a patient who is about to begin treatment?
Lectures on compliance and stories of patients who passed away before drugs were unavailable. How much luckier you are today in the U.S. to be diagnosed than before 1996!
If you were infected with HIV today, at what T-cell count would you begin treatment?
I would begin as soon as diagnosed.
What's the key to a great healthcare provider/patient relationship?
Honesty. Compassion or empathy.
How do you feel about patients who take a proactive role in their own treatment? Do you have many patients who are proactive?
Not too many. We have some wonderful parents who take an active role and this shows in the outcomes (undetectable viral load).
Who was your all-time favorite patient and why?
A Mexican girl who acquired HIV from a blood transfusion in Los Angeles at birth. She is now 20 years old and is waiting for a kidney transplant. Her attitude is positive and she takes things in stride. Her life has been one near death experience after another.
What is the most important, memorable or useful thing you have learned from your patients?
Perseverance and their hope for recovery despite all odds. And their faith in my expertise or healing, which is sometimes difficult for me to live up to.
How do you maintain a positive outlook and avoid burning out?
I avoid burning out by looking at patients like the Mexican girl and how they cope with SO MUCH!
If you weren't a clinician what would you be?
I have always wanted to a "real" doctor since age six. I also played doctor. In India there was a lot of illnesses and I was never afraid of this, I was always curious and wanted to help doctors.
Who would you dedicate this award to if you could?
I would dedicate this award to Steve Gilbertson, who succumbed to this virus in 1993. He was 21 years old at that time. His dad is the one who nominated me. Steve was a hemophiliac who got HIV. He was such a beautiful person. He had hepatitis C and HIV and hemophilia and he still maintained his niceness till the end. He never blamed anyone. His family was also very supportive. I cared for him from the time he was 16. He still went to school and tried to have a normal life. He would take his meds to school.
Where did you grow up?
I am an immigrant. I grew up in Bangalore, India.
What did you want to be when you were a kid?
A pediatrician (since age four).
What kind of work do your parents do?
They own their own company, a chemical business.
When did you decide on medical school?
I went to med school at age 16 and was a doctor by age 23 (1976).
|"You have to remember that the parents of these HIV-infected children are infected too. So the parents often die while the children are dealing with their HIV."|
What made you decide to go into HIV care?
I was an infectious disease fellow in 1985, serendipity or happenstance.
Who were the most influential people in your life, both professionally and personally?
My mother. Dr. Paul Quie has been very influential in my professional life and my husband, Kumar, who is also a physician.
What do you do in your spare time?
I don't have any free time!
Can you talk about your family?
My husband is also a physician. Both of my children are wonderful and an inspiration for my work with disadvantaged and ill children. One is studying human rights law -- she is 25 years old. The other is 22 years old and in school for public health.
Where do you live? What kind of community is it?
Minneapolis, Minn. Great place. Beautiful in the summer and progressive in health care.
If you had anyplace to live besides where you live now, where would you live?
What's the best vacation you ever had?
Many, mostly in Europe -- in Italy, Switzerland and Norway.
What's the biggest adventure you ever had?
Life! Moving to U.S. at age 25 from India and having my first child at age 26.
What's currently on your bedside table for reading?
I think Paul Farmer's biography is one of them.
What kind of music do you like to listen to?
Popular music, rock & roll, jazz. The Beatles.
Anything else you think it's important that people reading this interview know about you?
I want the people around the world infected with HIV to have similar opportunities with antiretroviral drugs that our children here in the U.S. have had. Many of them have undetectable viral loads and are attending school like normal children. I would like all discrimination against children and HIV to be GONE.
I would like to see the near elimination of pediatric HIV in other countries, India, African nations, to happen as quickly as it has happened in United States. In six years, from 1994-2000, we have seen a tremendous success in the decline of pediatric HIV in the United States.
I would want to return in my next life again as an infectious disease physician. It is a rewarding career.
How long have you been in medicine?
I have been involved in the medical field since age 16. Almost 36 years.