AWARENESS TO ACTION- THE SPECTRE OF ANTIBIOTIC RESISTANCE...

    Antibiotic resistance awareness week…..phew a mouthful. At first look one is likely to see it as another packaging exercise on the part of some healthcare marketing team. Look a little deeper and you come face to face with a looming public health catastrophe. Terms now coming into common healthcare usage-XDR (extreme drug resistant) diseases, pan resistance, and the apocalyptic sounding ‘post antibiotic world’, all signal a dark future for infectious diseases. Make no mistake, it is menace that that has no silver bullet remedy- it’s only a multi-dimensional approach of clinicians, public health bodies, policy makers and an aware public which will keep it in check, yes keeping it in check will be a triumph. In the meantime, lets us explore what is being said and the initiatives across the world. Here the media has taken the lead on many occasions and for a broad description of the situation, lets zoom out for an overall view, and start with a recent piece by Lhendup Bhutia , first written for the OPEN magazine..     Click to read http://www.huffingtonpost.in/open-magazine/how-india-became-the-anti_b_8440100.html Here is an infographic, another take on the problem…..   Click to view http://indiatoday.intoday.in/story_image.jsp?img=/images/stories/2013March/misuse-abusive_enlarge_030913060221.jpg&caption=   For those who’d rather listen to experts speak, look no further than this TED talk by Drug resistance economist (scary, right! They have a field devoted to the study) Ramanan Laxminarayan..     Click to watch https://www.ted.com/talks/ramanan_laxminarayan_the_coming_crisis_in_antibiotics?language=en   When the nation is considered the epicentre of the disaster, while the government and policymakers were downplaying its importance and trying to contain the news by discrediting the scientists, the reality breaking out in different parts of the country was hard to ignore. This lead to a set of suggestions called the Chennai Declaration in 2013…..     Click to read more http://www.indianjcancer.com/article.asp?issn=0019-509X%3byear=2013%3bvolume=50%3bissue=1%3bspage=71%3bepage=73%3baulast=Ghafur   This was further refined in to a roadmap ….published in 2014 Click to read the Road Map 2014 http://www.ijmm.org/article.asp?issn=0255-0857%3byear=2014%3bvolume=32%3bissue=3%3bspage=221%3bepage=228%3baulast=Team Here are some guidelines for the patients and public from the American Board of Internal Medicine (ABIM) called simply Choosing Wisely      Click to read, Choose wisely full article...

Beyond Borders

  Collateral Damage!The term has been so ubiquitously and loosely used that it has lost all meaning except one- almost always the party at the receiving end is helpless and hapless. And never has it been brought in to greater focus than recently with the October 3rd bombing of the hospital at Kunduz in Afghanistan, manned by the Medecins sans Frontieres (MSF). Thirty people lost their lives and numerous lay injured. Explanations will be given and blame may be proportioned but humanity is yet again the casualty. Disaster relief work is the kind of frontier medicine which takes special people with a calling to do; they bring their skill sets, ingenuity and heart to a task most difficult. MSF has been tackling health problems in some of the most difficult parts of the world over the last 40 years. This Nobel winning humanitarian organisation has consistently gone with their team of healthcare workers and logisticians into parts of the world where natural and manmade crises have ravaged the helpless. Biafra, East Timor, Sri Lanka, Kosovo, Rwanda, Afghanistan- there has been no strife torn part of the world which the MSF has not sent their team to. Egalitarian in nature, the team leads are often nurses or logistics people- who so ever are best equipped to lead. Extremely resourceful, the logistics team at short notice is able to set up spare yet fully functional medical facilities from scratch, so the health care professionals can get to work as soon as they land up. As part of an MSF mission in 1999 when the Eastern coast of India was hit by a super cyclone, we were in the island villages off the coast of Orissa working with people marginalised in every sense- the Bangladeshi families inhabiting...

Financial Planning for Doctors & how it’s different...

The medical profession is held in awe and respect across the globe. It is a noble profession as doctors try to heal sickness, diseases, treat physical and mental trauma. Acquiring doctor’s degree is result of years of hard work in academics, many years of training and spending huge sums of money. Usually a Bachelor’s degree in medicine takes about 5 years. But in today’s world that might not be enough to have a successful career and many opt for a Master’s degree like an M.D. which usually takes another 3 years. And then specialisations in various fields. Some might want to do specialized courses which again take time and are expensive. Some might pursue studies abroad which means higherinvestment. Doctors also need to keep updating their skills and educating themselves. So compared to other professions, a doctor invests a lot in his career and starts earning properly a little late in life. Doctor’s economic cycle He might start earning properly after the age of 28-30 years which is late compared to other professions. A doctor can either begin his career by assisting another doctor or working in a hospital. This means he begins on a regular salary late and hence his social life and events also gets delayed. A late marriage, a late kid and long erratic working hours do influence his financial life. He does not have much time to concentrate on planning his finances. Earnings peak between 40-50 years. Doctors have the advantage of continuing their practice for as long as possible. But this depends a lot on their reputation and health. Business does go slow for some doctors or starts cooling down once they finish some years in the business. Younger doctor get more popular, they are more in tune with...

Health in the time of Hartal Mar14

Health in the time of Hartal

It is that time of the month in Kerala again……….the good old hartal. A political party calls for one, calculated to disrupt life and activity in the worst way possible. The populace or at least the majority gear up for the holiday with a calm acceptance and in some cases anticipation. The small business, unsuspecting visitors to the state and events scheduled for the day take a beating. Beverages, legal and otherwise, show brisk sales. All in a day’s play for us in Kerala. Healthcare, of course has to run a different course. That is expected to function as if there is no disruption. It can’t shut shop and sit at home. Asthma, appendicitis, ureteric calculi and labour don’t know there is a hartal on. And so, function we must. Now, on to the hospital. The pace is visibly slower, the OPDs are sparse but the ER is bustling. The ambulance drivers are doing overtime, ferrying more doctors than patients. Who wants to drive in their own vehicle and risk a broken windshield or punctured tyres? Not that ambulance offers complete immunity- there have been instances of stone pelting and injuries to doctors and other personnel in ambulances too. In a memorable instance the same miscreants landed up in the hospital ER to be treated by the same doctors they had stoned a brief while before. As if showing up for work is not tough enough, one has to manage other disruptions. The children who otherwise would be in school are now at home with no caretaker. The house help who otherwise would be at your home, is now at her home as there is no transportation- there is as yet no provision to provide ambulance service as transportation for house maids. Ah…just the mundane concerns of the average population. Back in the hospital, there are disruptions of other kinds. Carefully laid out workflow like so many assembled pieces of jigsaw, are in disarray. Like…the planned list in the OR can’t start on time, will have multiple impediments in the form of unavailable staff or relatives and lack of support services. The emergency transfusion of a rare blood type may get stalled with disastrous implications. The planned discharge does not happen leading to inconvenience of the patient and for the one waiting for the bed to be vacant. On the flip side, this is the day everyone in the vicinity of the hospital wants a check-up- after all they are jobless for the day and the hospital is within walking distance. And the list goes on.. At best of times, healthcare is a finely arranged balance of many unpredictable moments and components. Disruption has far reaching consequences, seen and unseen, for the care provider and the patient. And when the disruption is manmade, it’s just a case of cutting off your nose to spite your face. While there is always a mention of ‘Essential services will not be disrupted’, the reality is inevitably otherwise. Essential service for the common man is also provided by common men and women- they too have lives and concerns as the rest. When society and media expects more of healthcare providers, they must be willing to support them to deliver the best. Are you listening, fellow common man?...

INTIMATIONS OF MORTALITY Mar07

INTIMATIONS OF MORTALITY...

What can be as morbid as a discussion on mortality? While artists and writers may find it romantic, doctors for the large part don’t like any serious discourse on death. Right ? Well, not quite. Counterintuitive as it may seem, when advances in health and care have seen longevity at an all time high and going higher yet, we have started seeing more and more concerns about mortality and end of life issues. From bestsellers’ Mitch Albom’s Tuesdays with Morrie and Randy Pausch’s The Last lecture, we’ve learnt to confront the inevitable with grace and dignity. With all this, can our fraternity be far behind. Over the last few years, we have had some deeply insightful writing. Atul Gawande’s recent book- Being Mortal is a wonderful recent example- an important book on a topic becoming increasingly relevant. Here are a few others; letters, poems, videos that examine different facets of mortality. Peter Saul- Let’s talk about dying Australian intensive care specialist uses the TED platform to raise important questions on the decisions surrounding end of life. Vivek Hande- RIP, Dear warrior… Indian gastroenterologist pens this ode to a cherished patient. Oliver Sacks- My own Life Neurologist and writer Oliver Sacks confronts the news of inevitable.. Danielle Ofri- Patients need poetry and…so do doctors This one is a double bonanza- New York physician and writer Danielle Ofri writes on Poetry and doctors while introducing Rafael Campo and his poem. The multiple links in this article are a treat in themselves.. Pauline Chen – Final Exam: A Surgeon’s Reflections on Mortality Liver transplant surgeon and author/ columnist Pauline Chen in conversation….on writing, inspirations, mortality and more… As you see, thoughts on mortality are not all morbid. Every once in a while, it can give us a...