Shobana Kubendran loves human genes -- understanding them, how they work, even how they carry disorders. And she loves the ability to talk and advise families on the potential medical problems that children can inherit from their parents or other family members.
"I wanted to do something in genetics, although I hadn't decided what," says Kubendran, describing the time after she earned her medical degree and trained at the Trivandrum Medical College at the University of Kerala. She developed a curiosity about genetic counseling while working at the National Institute of Mental Health and Neuro Sciences in Bangalore.
"Our lab at NIMHANS was looking at genetic markers that were common in some members with schizophrenia or bipolar disorders and other family members that didn't have them," says Kubendran, 32. "The idea was to identify which regions of our genome could have genes that increased your chances of these disorders."
But despite questions families in India asked about diseases and disorders that go from parent to child, there was no formal degree training in genetic counselling. So Kubendran joined a two-year master's programme in genetic counseling at the University of South Carolina.
She describes the programme as a combination of genetics studies and psychosocial genetics counseling, suited for a variety of communities. Counselling training in the US starts with a broad education. "I wanted that depth of training, the only thing not available in India," she adds.
Today Kubendran works at the pediatric clinic at the University of Kansas School of Medicine, but focuses on a range of issues -- developmental delays in children, chances children will be born with birth defects like Down syndrome, and the risks of cancer in people with a family history of it. She also teaches pediatric care and genetic counseling to medical students, and residents.
In the process, Kubendran says, she realized the differences in the counseling process between India and the US: "The questions that were asked when I was working in India and the questions I get here are the same," she says.
"The approach to genetic counseling can be slightly different. India is a very traditional society with sometimes patriarchal families. There are some disorders in which the female is not affected but is the carrier and can have children boys specifically with neuromuscular conditions. When talking to the family about how it happened, you do not know how they will respond when they hear that the woman is the carrier. It can cause tension in the family, especially if it is traditional and where they can blame the woman."
Genetic counseling helps families adapt to these situations, she says.
She senses that Americans react a little differently when they hear similar news from the genetic counselor. Although she had spent a few years of her childhood in Washington, DC her father was in the Indian Foreign Service she was surprised to see how differently people in the US reacted to the issues, depending on their region of origin and their beliefs.
"There are conservatives and liberals in America and their reactions to genetic disorders can be starkly different," she says.
Now that genetic disorders testing is available in India -- including the latest cardiac testing -- doctors are getting more and more interested in how best to provide care, including counseling for patients and families. Kubendran has observed a substantial increase in doctors from India who are joining American schools for training.
"There is more awareness coming and that is driving the interest in these programmes," she says. There are short programmes -- two weeks long -- being offered in India. But she highly recommends the two-year master's program offered by a numbers of American universities.
She is grateful for her opportunities she has received in the US.
"This country offers a lot of opportunities and I was able to practice the things I like," she says. In March she heads to India for her marriage. Her fiancé, who she has known since medical college in India, is a resident at the University of Kansas School of Medicine. Eventually, she plans to return to India.
"This is such a burgeoning field," she says.
