Sharan Khela, Crohn's Disease Patient Advocate

Struggling with Crohn’s Disease

Sharan Khela had no prior knowledge of IBD or Crohn’s when she received a Crohn’s disease diagnosis in 2002. Coming from a Punjabi, Sikh family, her diagnosis came as a relief mixed with confusion and uncertainty for both her and her family. Very little was offered in terms of education and no efforts were made to involve an interpreter for her parents to accommodate the language barrier.

Sharan’s Pediatric team started her on enteral nutrition but failing this the next step was a course of Prednisolone, a steroid medication to combat the symptoms of her Crohn’s. Since steroids are meant as a temporary treatment option, Sharan was then recommended to have surgery a year after being diagnosed in 2003. Her Gastroenterologist (GI) felt that this would be the best option long term and although biologics were mentioned at the time, Sharan’s doctor felt that approval would be difficult for a moderate case. After her surgery, she remained on medication for several years and this allowed for her to continue with school as normal. However, things took a turn when it came to transitioning her care from pediatric to adult care.

Sharan started to flare soon after transitioning to adult care and her new GI only ever offered a course of Prednisolone as a treatment option. Although meant to be a temporary treatment, she continued to be on a high dose of steroids for almost 5 years.

“I felt like my quality of care had gone downhill with transitioning to adult care and my new GI wasn’t taking my condition seriously or even trying to escalate treatment. As a result, I started to neglect my health, becoming reckless with my diet and medication because it wasn’t helping me anyway,” Sharan recalls.

Already having attempted to complete her final year of university for the second time due to her Crohn’s, Sharan knew if she could not complete the year on her second attempt then she would have to drop out. She refused to let her condition undo 5 years of hard work and pushed herself to graduate and get her Crohn’s under control. Sharan advocated to be transferred to a new Gastroenterologist to see if they would be able to help her achieve remission, allowing her to then focus on completing her degree. Shocked to hear she had been on steroids for so long as a teenager, Sharan’s new doctor pushed for a biologic treatment to be considered. After several rejections, the treatment was finally approved and showed immediate results, allowing Sharan to graduate with her class.

Ileostomy Surgery & Reversal

In 2014, Sharan underwent an emergency subtotal-colectomy to form an ileostomy. “I felt completely alone in my condition at the time,” Sharan remembers. “I had never met anyone with a stoma before or even heard of them. Although my GI had mentioned the possibility of needing an ostomy at some point, it seemed like a distant issue and not a health concern that would affect me in my twenties.” During this time, Sharan came across a Crohn’s & Colitis UK Facebook forum which gave her the opportunity to connect with other patients like herself. Sharan’s daily struggles regarding her ostomy were discussed and validated by other ostomy patients on the forum.

Almost three years after her initial surgery, Sharan had her ostomy reversed, a decision she came to regret soon after. Although she had become accustomed to having an ostomy, Sharan still struggled with the stigma of having one, and felt pressure to go ahead with the reversal so she could go back to being ‘normal’ again.

“I chose to go through with the reversal even though I was reluctant because of the cultural emphasis placed on being a fit and healthy prospect for marriage in South Asian families as well as the general stigmas attached to having an ostomy.”

Advocacy Work & IBDesis

Shortly after her reversal surgery, Sharan decided to become more involved with patient advocacy work to help her through a period of mild depression. Taking inspiration from the original Facebook forum she had joined previously, she started volunteering with Crohn’s and Colitis UK as a local network volunteer in 2018. As a volunteer, Sharan worked closely with patients going through similar experiences to herself.

“It was liberating to speak with other patients who understood what I had gone through,” Sharan explains. “As I became more involved in this type of advocacy work, I realized there was a need for support, specifically within the South Asian community.”

Alongside other patient advocates like Tina Aswani Omprakash and Madhura Balasubramaniam, Sharan founded the private Facebook group, IBDesis, a dedicated space for South Asian individuals living with IBD to share their experiences, struggles, and to support each other. The group focuses on addressing the stigmas and misconceptions that are so commonplace in South Asian culture. “There’s a lot of judgement even in other Asian support groups surrounding IBD, with many people advocating against western medicine and urging patients who are struggling to deal with their issues through natural methods only,” Sharan notes. “Because of this, there is hesitancy and fear ingrained within the community, so we stay out of clinical research. However, this reluctance to participate ultimately hurts South Asian patients in the long run.”

Sharan recalls a conversation 20 years ago with her GP at the time who admitted after her diagnosis that the delay in referring onto a specialist was due to his belief that IBD was not a condition South Asians dealt with. With stigma so prevalent in the South Asian culture surrounding chronic conditions like Crohn’s, Sharan found that the biggest hurdle to navigate in the creation of IBDesis was creating a space where members felt safe enough to open up about their experiences, as many of them had never been represented before and shared isolating experiences similar to Sharan’s.

Since its initial launch, IBDesis has expanded to other social media platforms and joined together with South Asian IBD Alliance (SAIA). The group hosts community members from across the globe, relying on virtual meetings for now, but Sharan hopes to eventually expand to in-person conferences and events.

As an advocate, Sharan believes in the importance of highlighting the positives of clinical research and being open to appropriate treatment methods.

“There are new medications available today that didn’t exist when I was a child. We need to take advantage of these new resources to help the South Asian IBD community,” Sharan says.

With more conversation now surrounding IBD than ever before, Sharan is hopeful the stigma will decrease for South Asian IBD patients. For women in nearly all cultures but especially for southern Asian women, there are major milestones and expectations surrounding marriage and motherhood. The IBDesis community serves as proof that people living with IBD and Crohn’s Disease can have successful open, honest, and personal communication about their condition with their spouses, raise children, and live full lives despite their illness.

“Going at a pace that is right for you in terms of your treatment and learning to self-advocate is the most important thing for a patient to remember,” Sharan says. “Not everyone is ready to be an advocate and that’s okay. It’s a very personal decision. The role of those who do become advocates is to help all members of their community feel seen and recognized, no matter what decisions they make about their personal health.”

Looking ahead, Sharan hopes to encourage more advocates for chronic conditions from all parts of South Asia to share their stories. “We want to remove as much of the lingering uncertainty and fear as we can for patients. This will improve the diagnosis and treatment journey for those with IBD who come after us.”

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