At 154 among 195, #Health is just a word for India

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पाठ्यक्रम का दशक, परीक्षायें वृशक;

प्रेमाभिलाषी, रक्षक, मैं एक चिकित्सक ||

                                         -doc2poet

                  I am writing this post for the first ever chatter prompt: Health and this is going to be about the health system as a whole rather than just being about an individual. I hope its fine.

              The doctors  often  end up at the receiving end of public’s fury or govt’s  vote wooing  policies or media’s one sided stories but what’s their side of the story? It is still only some mysterious speculation. The truth is that our healthcare system is as ruthless and unforgiving for the doctors as it is for the patients. Politicians and bureaucrats take up all the breathing space in the system and doctors remain crammed up in the corners. It takes their heart and soul to become a doctor over nearly ten grilling years of otherwise enjoyable youth to come face to face to their dreams  But only a few of these dreams can survive in the real world.

From my archives

               The story starts with a young, energetic and ever hopeful medial aspirant who stumbles down the rabbit hole and wonders where he landed. Of the nearly 6 lakh aspirants entering the maze each year only a handful reach the treasure chest of super specialization (DM/Mch) only to realize that the treasure chest is empty and it has to be filled with even more hard work over the rest of their life. Nearly 10 years of study and nowhere to go.  Most of the few jobs offered in government sector are contractual only and does not allow private practice along with many other unnecessary limitations. Stringent rules for small clinics and huge capital and time required to get settled is not everyone’s cup of tea.  The private sector is rapidly going corporate ways with little scope for autonomy and more work per penny. The doctors are just trapped in a mess and only easy way out opens beyond the borders. It doesn’t mean doctors don’t earn enough but that there are very few options and leaving so much to chance after so much of hard work is demoralizing. Some leave for further studies, some for jobs and some just to get away but ultimately all are chasing their dreams only. It is ironical how India is promoting medical tourism and the doctors are leaving the country.

From my archives

              Doctors are being used as mere pawns for political gains. Poor planning and absurd interference in public health system by non medico administrators and illiterate politicians without consulting the experts is doing more harm than help. Already, nearly 75 per cent of India’s population is treated by quacks and such measures will only widen the rural-urban divide discriminating against rural folk, who are taken for second-grade citizens deserving medical care by a brigade of ‘qualified quacks’.

Media reports

1. Compulsory rural posting is just one such example. Yes it is a noble cause but the doctor has earned his right to make his own choice after all the time and hard work.
2. Promoting state- acknowledged quackery by adding more cadre of workers who are neither here nor there:
   • Shortened medical course at the graduate level to serve the rural areas.
   • Bridge courses for nurses and alternative medicine professionals.
   • Recognizing quacks and their practices.
   • Gujarat is even letting school kids to act as doctors under school health schemes
3. Negative media image for TRPs: Yes they go on a strike but not with the intention of killing someone but to fight for their own right to work in a safe and secure environment.
4. Replacing MCI with pro-private sector National medical commission.
5. Victimizing public health sector and sensationalizing private sector with freebees, i.e. poorly conceptualized mohalla clinics, polyclinics by Delhi government looting taxpayer’s money for short term political gains. (Public sector can be strengthened with a fraction of money being wasted)

        Doctors are also humans but their superhuman hard work should not be overlooked. There are good and bad people in each and every profession and things need not be generalized for everyone. Please take a moment and try to understand what a person goes through to become a doctor and you will know what he deserves…

What needs to be done?

           The two basic problems are: less doctors (The doctor-patient ratio in India is 1:1,700. The World Health Organization’s recommended criterion is 1:300.) And poor logistics (everybody knows). So,

1. The need is to start more medical colleges. The country has nearly 300 colleges, of which 190 are in Kerala, Tamil Nadu, Karnataka, Andhra Pradesh, Maharashtra and Gujarat. Uttar Pradesh, with a population of 19 crores, has only about 16 colleges. Bihar, with a population of nine crores, has eight. If the State governments open medical colleges in all the districts, we can have nearly 600 medical colleges, rolling out nearly 75,000 MBBS graduates a year.
2. Strengthening the infrastructure and facilities with incentives so that the doctors don’t shy away from rural areas.

Among all the negativity, a smile and a simple thank you is all that we seek:

धड़कानों  की  धुन  पर  गुनगुनाती,  फिर  कोई  ज़िंदगी,

 ख़ुशियों  में  डूबे  कोई  दिल, जो  था  कभी  ग़मज़दा ;

रूखे  से  लब,  थिरकते  फिर  ख़ुशी  से  मिलकर ,

जब रोम–रोम  हो   स्वस्थ  और   मर्ज़  ले  विदा ;

 भावुक  मन,  नम  आँखें , करती  हों  जैसे  इलतज़ा,

और  मुस्काती –काँपती  आवाज़,  करती  शुक्रिया  अदा ;

है भाव  विभोर  ये  तन  और  मन,

जैसे आ मिला हो स्वयँ ख़ुदा, ये  रूह  जैसे  आबिदा…

                                                            -doc2poet

This post for the first ever chatter prompt: Health.

https://www.theblogchatter.com/chatter-prompts-health/

I would love to hear what you have to say on this topic. See ya:-)

#Infertility is #NotATaboo

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  ‘Infertility’ the word itself tells the story…it speaks of negativity in volumes. It’s like saying “not-a-mother” or worse “can’t-be-a-mother”. It is a taboo at least in India and will continue to be until we come up with a positive word for this condition. Although this is not the only thing that needs to change but it will surely give a positive makeover; much like the scheduled caste did for dalits and differently-abled for physically challenged.

What is actually infertility? 

• It refers to the inability of an individual (male or female) to contribute to conception, or to a female who cannot carry a pregnancy to full term. For practical purposes, if you have not conceived after trying for one year then you need to consult a doctor for complete work up. On the brighter side, WHO gives you 2 years time before calling the name but in practice, people trying for more than 10 years have also conceived.

You are not alone.

• The World Health Organization (WHO) estimates that the prevalence of infertility in India is around 12.6 percent and considering our population it is a huge number.

The root cause of all the problems is that women don’t make decisions when it comes to family planning.

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• An Incident (somewhere in 2008):

   I was an intern in family planning clinic at a tertiary care govt. hospital in the capital city. A young female, well dressed and apparently from a well to do background came to the clinic for an abortion; but surprisingly she was all alone. I could see the courage she had to gather to come to us on her face; teary eyes, trembling feet and shaky voice. Legally, she could get the baby aborted without husband’s consent but even then she would need someone to accompany her following the procedure (which was free). BUT we had a policy to go for M.T.P. only if the mother opts for contraception, temporary (like copper-T) or permanent (Ligation) (Because if you don’t want this baby, either you should wait or put a full stop) and for that husband’s consent is MUST. In this case the husband or the family clearly didn’t know. Then it struck me; this young lady wanted to space the babies but the husband or the in-laws didn’t want her to. Even her own family or friends were not there with her. She basically didn’t have a say in it. And over the years I realized that this is not uncommon. 

In India, brides are made for only one purpose (besides the chores of course).

• A baby delivered in the first year of marriage is seen as a positive sign in Indian household and it is fairly common but it cannot be a good thing if the average age of marriage is 22.2 for women.

Pregnancy within 1 year of marriage; A norm and why it is a problem?

• It may be a good thing for some but problem for others because if you have not conceived by the first anniversary, you would have hit the eligibility mark for infertility by definition. Peer pressure works in family planning too because you are already late if everybody else is getting pregnant. This is the stage when a family affair becomes a big issue for the the whole community.

The irony: 

• Excessive physical or emotional stress results in amenorrhea (absent periods) which may add to infertility. Also, the neglected females who are already facing malnutrition and excessive weight loss are at a greater risk of falling prey to infertility and pregnancy related complications. So, it can turn into a vicious cycle going on for a very long time if not forever.

The paradox of age.

• For a woman, infertility can manifest as either the inability to become pregnant or to maintain and carry a pregnancy to a live birth and both extremes of the fertile age group are bad for that but the younger end is often ignored by the society. However, it is not a coincidence that the WHO has included age as low as 15 years in the operational definition of infertility when the legal age of marriage is 18.
• Many women are waiting until their 30s and 40s to have children and this leads to age becoming a growing cause of fertility problems. Aging not only decreases a woman’s chances of having a baby but also increases her chances of miscarriage and of having a child with a genetic abnormality.

Common causes of Infertility in Indian women:

• Infections of the female genital tract are generally considered to be the leading preventable cause of infertility worldwide, especially in developing countries.
• Sexually transmitted infections (STIs) may constitute as high as 85 percent of these infections. A condom is a simple and effective way to keep all/most of them at bay.
• Another common infection which is often difficult to diagnose is the tuberculosis of genital tract. With the kind of exposure and prevalence of TB in our country, it can happen to anyone. Although it is not fatal but most of the damage occurs silently which only delays the treatment. The good thing is that it is easily treatable.

Breaking the Ice: Males can be infertile too.

• It is a pity that we need a social media campaign to convey that males play equal role in fertility and infertility alike. In fact, in 40 to 50 per cent cases, the male is the affected partner.
• It’s because of the social set up that women are blamed for a childless marriage, but men are equally in need of treatment.
• Actually, they are the ones who make the baby a girl or a boy which is another big taboo being imposed on females (but obviously they can’t choose).
• And they are the ones who can prevent all the STIs by using condoms.

Who else can be blamed? Urban lifestyle of course.

• The changing lifestyle is certainly to be blamed for both the male and the female infertility. Smoking, alcohol consumption and delayed marriage are among the main culprits.

Problem bigger than infertility itself: ‘The Quacks’.

• These are the unqualified imposers who take advantage of the superstitions, myths and the popular beliefs surrounding the ultimate taboo of infertility.
• They not only rob people of their money but also of their valuable time which only delays the treatment. Each quack visit is an opportunity lost.

Infertility is preventable; yes you read that right.

• Only an estimated 3 to 5 per cent of who are infertile, are due to unknown or unpreventable conditions. Rest all are preventable or at least treatable.

Facing infertility: What to do?

• Consult a qualified practitioner as soon as possible. He/she may be a gynecologist, an IVF specialist or anyone approachable.
• When in doubt, visit a Govt hospital. There are special weekly infertility clinics in all/most secondary and tertiary level hospitals.
• Some hospitals even have an IVF center which provides free consultation and services; like the state of the art IVF center at Lok Nayak Hospital, Delhi.

The right approach to infertility:

• Both the partners should be worked up together to reinforce the fact that the female is not the only one that can be affected.
• Counselling sessions should be staged to chalk out a plan, allay anxiety, bust myths and cater to any all the questions which the couple would like to get answered.

The way out: Not always expensive but a long walk anyway.

• The good part is that 80 per cent of the infertility problems can be corrected through simple medications and advanced and expensive treatment methodologies like the IVF or egg donation are required in only 20 per cent of the cases which usually have some underlying complications.

Be patient and don’t lose hope.

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• Some tests have to be done on specific days of the menstrual cycle, so the complete work up may take up to 2 to 3 cycles/months or more depending upon the problem.The work up is in itself a long step-wise process to rule out abnormalities one by one.

• Some tests are expensive and a few very painful and the results may take time.

• Even after all these efforts, all the investigations may come out to be normal, it happens but they are still necessary to rule out certain conditions.

• A majority of such patients with unknown underlying cause still respond to simple medications.

• Even when the cause has been identified, the conception may still take time. The treatment is scheduled on the basis of menstrual cycles, so 1 treatment option per month, which amounts to only 12 trials in a complete year.

• With the kind of technology available today, infertility is bound to lose if you have the guts to keep fighting. Time is an important factor in this battle, even more important than money.

My best wishes to all the struggling couples. You may visit  http://infertilitydost.com/ for more information, inspiring stories, support groups and more or just contact me.

This blog is to #SpreadAwareness about Infertility through Infertility Dost, India’s first website that facilitates couples to brave infertility with support and knowledge. You can find other links on Write Tribe.

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It is an  article from my archives, wrote it long back for an awareness campaign but I still find it relevant and hope it can show the right path to the lost souls. You may read the original article at http://nerdyindian.blogspot.in/2016/10/a-step-towards-making.html .

#CleanAirBeautifulHomes with Royale Atmos

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Air pollution; As I recall we learn about it as part of our primary education. If you remember those water cycle, solar system and types of pollution days. Air pollution isn’t new to us but does it happen indoors too. Didn’t know!

Pollution has been a hot topic over the news lately with a number of Indian cities making it to the WHO list of most polluted cities of the world. Surprisingly, Delhi isn’t the most polluted any more, according to the World Health Organisation’s (WHO) urban air quality database released in 2016. In all, four Indian cities are among the world’s ten most polluted cities, 10 out of top 20 are also in India.

If you are already feeling lucky that your city is not on the list or because you mostly stay indoors in your home or office, you need to align some facts here.  The common notion is that burning bio-fuels for cooking is the most important cause of indoor pollution in developing countries like India. But using LPG cannot save us from this evil because urban locales have their own problems. Studies have confirmed that an average urban household may be more polluted that the outside.

So what are these indoor air pollutants?

Remnants of harmful gases, aerosols, chemicals, dust etc all contribute to air pollution inside our homes.

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Volatile organic compounds originate mainly from solvents and chemicals. The main indoor sources are perfumes, hair sprays, furniture polish, glues, air fresheners, wood preservatives, and many other products used in the house.

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Tobacco smoke generates a wide range of harmful chemicals known to cause cancer and it is hazardous for active as well as passive smokers. If you smoke indoors, your kids maybe at risk too.

Mosquito repellents; in the times of dengue and

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chikungunya I am yet to see a household which does not uses any mosquito repellent, be it coils, mats, liquid vaporizers or anything else. They add to the pollution too while protecting you from bites.

Biological pollutants include pollen from plants, mite, hair from pets, fungi, parasites, and some bacteria.

Formaldehyde is a gas that comes mainly from carpets, particle boards, and insulation foam.

Toxic gases like carbon monoxide circulating inside our vehicles air conditioning system. Yes, your car is polluted too.

Dust, moisture and pets are among the usual suspects too.

Why should we be scared?

Simply because they are bad and if you are allergic to something in particular then they may be even worse.

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The main health effect is the irritation of the eye, nose and throat. In more severe cases there may be headaches, nausea and loss of coordination. In the long term, some of the pollutants are suspected to damage to the liver and other parts of the body. Many of them are allergens and can cause asthma, hay fever, and other allergic diseases.

Why do they stay indoors?

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Well, simply because they don’t have a way out. Poor ventilation in cramped up buildings, and increasing use of synthetic products in construction and furnishings are the main culprits. Most localities lack basic infrastructure and cross ventilation is rarely seen because the homes are open on one side only.

These are the times when air purifiers are preferred over open gardens or porches. We need to change before our air does.

What can we do?

=> There’s no single right answer (because each one of us react differently to these pollutants and the conditions differ too). But some general guidelines may help us to find our own right answer.

=> Switch to natural or at least use limited number of synthetic products. Use them judiciously balancing safety and toxicity.

=> Let your home breathe to clear these pollutants out. De-clutter you home and open windows more often but don’t let the mosquitoes in.

=> Use products that conform to strict international environmental and safety standards like the green assured Royale Atmos from Asian Paints.

How can Royale Atmos help?

Royale Atmos is a first of its kind paint that not only looks beautiful, but also cleans the air making it purer than before by  reducing harmful air pollutants like formaldehyde. Its Activated Carbon technology reduces harmful pollutants from the air. Additionally, Royale Atmos also absorbs and reduces select foul smells to make the air fresher. It is the first Asian Paints product to have a fragrance, instead of the normal chemical smell of paints. Thus, it also acts like an air freshener by releasing a mild fragrance weeks after painting. And it does so while it protects your walls against the toughest household and water based stains.

For more information visit here: https://www.asianpaints.com/atmos.

Diabetes: #VOW #BNLF

Hey guys,

BNLF by indiblogger is coming up and I can’t wait for November for my first ever BNLF event. There’s so much to do and I loved this get published initiative by storymirror.

So, here’s what I’ve been thinking to write about. I have a connection with the diabetes and its complications. I have seen up close what it can do to your loved ones. I can’t express the helplessness when it strikes and being a doctor made it even harder for me to witness it from the window. If you have been following my poetry you may have sensed it too. I know how difficult it is even when you understand whats and whys and when you don’t…I can’t even imagine. I have been wanting to write a layman’s guide to diabetes and hypertension for everyone so that they can understand what they are dealing with. I have already written a Hindi version but an English version is long overdue.

I said it ” A know it all guide to diabetes and hypertension for everyone” in English. I hope to help as many people as I can with this initiative. Sooner or later it is going to hit the shelves and transform lives for greater good.

See you at BNLF dehradun.

Perspective: Are you sure there’s a Coin?

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I wonder “why this kolaveri di?” (Tamil expression for why this killing rage) Why there is chaos everywhere, why so much negativity and why do we ponder around freedom of expression when most of us fail to imbibe, understand and accept things as they are.

Being a medico I have lived with multiple choice questions for a long time (longer that I actually loved to) and they teach us just one thing…there’s only one right answer and the rest are all wrong. Most people live by this rule in their lives too. But PGI Chandigarh (Medical college that conducts own MCQ based entrance test) refuses to bow down to this monotony and they offer more than one right answer to each question. That’s it. EUREKA!!! Although such question are even tougher to answer but this is where the ray of hope is hiding. The simple truth that there can be more than one right answers for a given situation. But here also we fall prey to “भला उसकी धुलाई मेरी धुलाई से सफेद कैसे?” I mean the fight continues to decide who is more right…Pity.

 

 

 

So where does perspective fall in here. It simply means two people can see the same thin differently from where they are standing and more importantly they both may be right. There are some other expressions for this too like, walking in their shoes to understand their views and the other one which urges you to look at the other side of the coin too.

मेरे सही होने से, तेरा ग़लत होना ही सही,
ये धरती अम्बर  सब तेरे, मेरा मन  का कोना ही सही ||

-doc2poet

THE OTHER SIDE OF THE COIN: If you are a mathematics nerd, you would have appreciated that besides the flip side there’s a rim of the coin too. The small thickness which may be a minority in itself but still a side of the coin. Bye the way, I don’t know who said that there can only be a coin. This concept is easier to understand if you consider a ball in place of a coin. See, now there is no flip side but a possibility of innumerable sides. An endless combination of perspectives to the same given situation.

Being right is not everything,

Wrong is not always a bee sting,

My right may be your left,

If we stand together,

Both are right and no one is left,

We see the flip sides of a coin,

Forget to see the rim,

Dive deep into the possibilities,

Fail to traverse the brim,

If we consider each and all,

Doubts will clear and thou shall see,

The coin is actually a ball,

If we can accord this truth,

Peace will be in near sight,

Acknowledge this simple fact,

That we both can be right,

We both can be right…

***

-doc2poet

May God bless us all…