For his "significant contribution to older people’s healthcare in Wales,” Dr Firdaus Adenwalla was conferred the British Geriatrics Society’s (BGS) prestigious Marjory Warren Lifetime Achievement Award for 2024. "Adenwalla is a great example of someone wholly committed to improving care for his older patients. Over many decades, he has innovated and developed services close to home, pioneering the Hospital at Home (H@H) model,” remarked BGS president Prof Adam Gordon. Named in honor of the founder of modern geriatric medicine, Dr Marjory Warren, "the Award is presented annually to someone who has made an outstanding contribution to the healthcare of older people,” noted a post dated August 29, 2024 on the Society’s website bgs.org.uk.
As acknowledged Adenwalla, "I feel humbled that my colleagues find me deserving of this recognition. Over the years I have had the privilege of working with inspirational and committed healthcare professionals… This Award acknowledges their dedication and recognizes the importance of H@H services across the UK.”
In his email responses to Parsiana, Adenwalla explained, "In the UK there has traditionally been a divide between care in hospital and care in the community with lots of barriers leading to poor communication and mistakes happening at this interface. H@H services have helped greatly in breaking down these barriers and improving communication and care… It is important to understand that this service is not about preventing someone going to hospital if they needed that level of care. It is about providing an alternative option in the right circumstances. H@H services are also very useful in expediting a discharge from hospital,” he continued.
Since the National Health Service provides free medical care to all UK citizens, the cost of H@H vs traditional hospital care is a major concern for the government. Although there are no conclusive results, studies have indicated that the costs appear to be on par. "What has been unequivocally shown is that H@H is safe, effective and patients and their families much prefer being looked after at home,” stated the 60-year-old geriatric specialist.
He further explained that H@H and palliative care "are different services but similar in that both look after people in a very difficult and vulnerable stage in their lives. The two services often work together to provide the best possible care for the patient. Their aims are different. The aim with H@H is to get patients better and back to their original level of functioning. This is not always possible as most of our patients being old are frail and have multiple problems… Since Covid, this way of working has become very popular and numerous services have mushroomed across the country.”
Top and above, far l: Dr Firdaus Adenwalla with his support team in Wales
From l: Sarosh and Dr Jyothi Adenwalla, William Hunt, Dr Sherna and Dr Firdaus Adenwalla
Referring to his first few assignments in geriatric medicine in the UK, Adenwalla noted, "I did feel very comfortable in this specialty as I found I could easily develop a rapport with my patients. There is no doubt that the values I was taught by my parents (late father Dr Hirji, a surgeon who specialized in treating craniofacial anomalies in children, more so the disadvantaged, and mother Gulnar who now lives in Coonoor) of honesty, kindness, empathy and humility helped cement my patients’ trust in me.”
Initially there was "a lot of negativity around H@H. The reason my team and I persevered was the immense job satisfaction it gave us.” The H@H proponents realized that prolonged hospital stay for older patients often leads to "a downward spiral in their health and wellbeing. They are at risk of getting all sorts of complications. They become deconditioned, weaker, often depressed and lose whatever chance they had of returning home. In contrast, when we are looking after an older person in their own home we not only see them getting better quicker but also see their whole life coming together again.”
According to Firdaus, ailing Parsi seniors would benefit from "comprehensive geriatric assessment” based on which right care in the form of medicine, nursing, physiotherapy, occupational therapy and support for mental health can be provided at the right time at the right place. "India already has and can further develop the infrastructure to support H@H” since it has the advantage of close family ties as also medical centers other than hospitals where investigations are undertaken. Capitalizing on technological advances in medicine, H@H services now use point of care blood tests and ultrasound scans at a patient’s home availing of features integrated in ipads and mobile phones.
Born in Trichur, in Kerala, Firdaus recalled he was brought up in the Jubilee Mission Hospital campus and from a young age "would go with my father on ward rounds and into the operating theater. I was able to witness firsthand the way he interacted with his patients. The fact that he was not fluent in the local language did not seem to be a barrier. The tone of his voice and the touch of his hand seemed enough to earn the absolute trust of his patients. I realized how vital a role trust played in the doctor-patient relationship.” An alumnus of Lawrence School in Tamil Nadu and St Thomas’s College in Trichur, Firdaus pursued his medical studies at Kasturba Medical College in Mangalore. Before proceeding to the UK in 1995, he underwent a year’s training with noted physician Dr Farokh Udwadia, a close friend of his father, at the Breach Candy Hospital in Bombay.
Nearly two decades ago when working in Neath Port Talbot Hospital at Swansea Bay University Health Board, Adenwalla’s efforts were crucial in establishing its Acute Clinical Team. Moving beyond traditional domiciliary care the Team’s aim was to provide H@H services for frail adults, a service that was one of the first of its kind in the UK. Currently he is on the committee of the UK H@H Society that advises healthcare workers and managers on setting up such services. He is additionally working as a consultant geriatrician in the recently commissioned "Safe at Home Service” at Cardiff and Vale University Health Board, Wales where he provides senior clinical cover, supporting and training general and advanced clinical practitioners and nurses.
Firdaus’s expertise in geriatrics is shared by his wife Dr Jyothi who has a special interest in Parkinson’s disease. Their daughter Dr Sherna who is specializing in nephrology is married to William Hunt who is training to be an anesthetist. Son Sarosh is doing his PhD in mathematics at the Liverpool University. Firdaus’s older sister Homai Kumaravelu and her husband Kumar who live in Coimbatore have set up the Meher Eira Trust for underprivileged children. His younger sister Meher Verghese teaches creative art and design at a school in Al Ain, Abu Dhabi. Believing that "religion can be a force for good but unfortunately we often see its ugly side,” Firdaus stated that at home they celebrate all festivals and special days from Onam to Navroz.