ARE YOU A ‘TAP TURNER OFF’ ?

Forty year ago, as a young postgraduate student of Public Health at the London School of Hygiene and Tropical Medicine in 1973, I listened to a guest lecture on ‘ The future directions in Research’. The speaker, Prof. Denis Burkitt  (of Burkitt Lymphoma fame) had just become head of the Medical Research Council in UK, after some path breaking research on ‘Fibre in the diet’. The core of his lecture was an important question he posed to all us youngsters, as we began our new vocations.  Are you a Floor Mopper or a Tap turner off – he asked. I was 25 and a young graduate from St. John’s Medical College, challenged to a new vocation in community oriented medicine, after an inspiring and life changing internship experience in an East Pakistan refugee camp near Kolkatta. This experience  had completely  alienated me from the  cadaveric oriented  medical education and the dehumanizing,  organ centered, hospital based clinical  training I had received  till then. Something was missing! Health was supposed  to be well being and  not just  illness and disease management. The refugee camp experience  had shown me how much a marginalized community  could do when its participation was sought by enthusiastic health professionals. I also discovered how little my medical education had taught me about building health or working with people and communities. I was both confused and disillusioned and began searching for a new meaning to health. Dr. Burkitt, asked us all to imagine a room with a wash basin. On entering this room, we were told we would find that water is pouring out of an open tap, the outlets in the sink are blocked, the sink is overflowing and there is a mess on the floor. He then asked us what would be  our first response to tackle  this challenging  situation? Would you turn the tap off and unblock the sink before cleaning up the mess or would you take up a floor mop and  be satisfied mopping the floor. Naturally we all opted for becoming first a ‘tap turner off’. This seemed common sense!  He then provocatively noted that the medical and nursing professions have long become  used to  floor mopping,  using drugs and technology to tackle the overflow of illnesses and disabilities in the community. They were enthralled by the ‘cherry or chocolate flavoured floor mops’ manufactured by the industry.  This had led to the establishment of a dominant  paradigm of the bio-medical, techno-managerial, model of hospital medicine with little  interest among health professionals to support health promotion and health policy.  Initially I was quite disturbed by this question as many of you may be today. Brought up on the white coat and stethoscope mentality  and pavlovian prescribing reflexology of orthodox medicine, the challenge that we may just be  floor mopping when we could attempt to   turn off the tap of disease was thought provoking.  Our knowledge of medicine and health has grown over the last few decades and we were beginning to understand better the  preventable causes of illnesses and disease. Could we use this emerging knowledge to evolve new strategies for health and healthy living? This was Burkitt’s challenge! Over the next few decades, this question continued to provoke me, though over the years I also became less disturbed and grew a bit wiser. I realized that we were beginning to increasingly appreciate, measure and diagnose the deeper, social, economic, political, cultural, and ecological determinants of health. Newer health agenda and health empowering strategies were been developed to varying levels of competence and complexity. New disciplines were emerging, new systems, new paradigms, new innovative ideas. Dr. Burkitt’s searching question thus became a lifelong stimulus for me.  Along the way  two other  ‘Gurus’  added to a new evolving understanding.  In the 1980’s Prof. Banerji of Jawaharlal Nehru University (JNU), Delhi  inspired many of us to understand “ health service development as a socio- cultural...

Tracking Expenses

Keeping track of expenses? I mean who does that? This reply came from one of my doctor client who’s about to start with the financial planning exercise. I am sure many readers of this article are of the same view as almost all professionals are only concerned about the income part in their cash flow and do not pay heed to the expenses they do. They feel that they earn to spend. Which is true in one way but you also have to understand that it is your spending that designs your financial future. Being unaware of expenses can be attributed to one of the following:  Many professionals, especially practicing doctors, receive fees in cash and their inflows vary month to month. I think there are very few doctors who are able to exactly account for all the details of their income.  The discipline required for recording accounts and creating financial statements is missing. Though many doctors have full time accountant to do this work, but still they have no clue of their profitability in a month or a month when their expenses have surpassed their income. With good inflows of cash, they were told by their accountants to make the expenses in cash otherwise they will have to show the income and file income tax returns that will be taxed. So the unaccounted income turns into unaccounted expenditure. Many doctors have not demarcated personal expenses with business expenses. So whatsoever expenses came in front of them they pay it from pocket. I understand that profession earns for personal expenses, but one also has to know what personal expenses are getting paid from professional income. The financial planning for personal finance and business finance are two separate subjects. I completely agree that income is...

Can Ethics be taught ?...

Is there a way to teach or motivate people to behave in a manner that is morally right? This captivating topic has been the subject of intense speculation and study and has thrown up some riveting points of view. The question is whether ethical behavior is ‘caught’ or ‘taught’. A few weeks ago, there was a front page article on a pilot project aimed at teaching ethical behavior in every Kendriya Vidyalaya School across India. ‘Integrity Clubs’ will conduct activities that explore ethical values like integrity, compassion,  honesty, tolerance, love, responsibility and respect. Student members will be called ‘Young Champions of Ethics’ (YCEs) and will spread, through skits, games and debates, the evil effects of corruption, terrorism and unethical practices. In our country that is plagued by an administration rife with malpractice and corruption, this is truly a commendable effort emerging from the Department of Education that will make strides in changing the way our future generations think and behave. Finally we are speaking up and facing the truth about our situation. We must strongly condemn unethical practices and the Government today makes this possible through RTI Acts and other such recourse. Can we accept that individually we are ethical but the ‘system’ is corrupt? Placing the blame firmly where it belongs, with our selves, is the first step to setting right the system. The time for impotent hand wringing is over and each of us is mandated to take steps, however tiny, to bring back ethics into our work and lives.   Which brings us back to the question- can ethical behavior be taught? Certainly, ethics can be taught about, but does this mean that we can ensure that people will begin to behave ethically? Gordon Marino, professor of philosophy at Saint Olaf...

ALTER-NATIVE SYSTEMS of HEALTH CARE...

ALTERNATIVE: – Across America, thru’ Oxford, and Web to Websters  (I mean the Dic-s) define as a single choice other than something  (nowadays the meaning extends even to several).  Alternative Medicine on the other hand is defined by OED as something other than ‘traditional’ medicine. Gosh!  That’s interesting.  So far,  systems like Ayurveda, Siddha, Unani and so on ( including around 360 at an Alternative Medicine Conference) were being referred to as “Traditional” – Indigenous, Tribal, Native and so on, as opposed to the “Modern” or “Cosmopolitan” system.  Sort of confusing isn’t it – as to which is traditional and which is the alternative?  Is it not an oxymoron to label currently practiced medicine as a modern tradition? Just a moment – looks like they got it right.  At least in India, that is Bharat, more than 70% opt for non-allopathic systems as first choice, especially in rural and semi-urban areas (where more than 75% of India i.e. Bharat lives) for reasons of availability, accessibility, affordability and appropriateness.  That clears the air a bit on which is the ‘alternative’. This Indian goes to the modern hospital as a last resort and is even prepared for death as a possibility.  Is it modern medicine’s reputation, the common man’s fears, the inadequacies of the current systems of health-care delivery, or the incongruence of its personnel?  Maybe all of the above, considering a common enough practitioner’s experience, where the 80 year old proudly proclaims THE reason for his health being – “never been to any doctor nor taken any ‘English medicine’ in my life”. Wise choice and good alternative, considering the recent BMJ’s concerns about the over-medicated human – you need to be healthy to claim such things. Alternative also, pre-supposes an ideal and anything else as...

Neo-app: helping babies Jun22

Neo-app: helping babies...

In our first article of the series, we review an app that is taking its baby steps in the field of standard treatment protocols and is bound to be a success The google play store which houses the app WHO-CC AIIMS describes the app as: AIIMS WHO CC STP with the help of neonatologists from SEARO region have come out with STP’s for management of sick newborn at small hospitals with limited resources (newborn stabilisation units and first referral units). These are based on current evidence based practices advocated by WHO HQ (Managing newborn problems: a guide for doctors, nurses, and midwives, World Health Organization 2003) and experts’ opinion till date (26th January 2013). (to come in a separate dialog box if possible) With a file size of just 278 kb, even the slowest of internet connections ensures that it turns out to be a fast download. Furthermore, a doctor doesn’t need to have the fastest or the latest processor to run this app on a smart device The display program is very interactive. The home page consists of situations which would require rapid assessment and immediate management of emergencies. Apnea, shock, bleeding, seizures, hypoglycemia and hypothermia are the listed options. Selecting any one of them opens up a popout box which gives on an average about 4-5points of management briefly with another option for selecting “follow STP” This is where the app really lives up to what it has been created for.  They have not tried to give a generalized protocol. They have actually given various situation and circumstances which would enable the practitioner to choose accordingly. Lets take respiratory distress for example. The popout box apart from giving a list of symptoms and parameters to check also gives the option to select...