Reason

As I walked down the endpoint hill drenched in sweat, I see a sparrow bringing down a wriggling worm to its death in fury putting to torture as a part of the prey predator completing the cycle of hunger. The worm gave away in no time and left it’s flesh and blood for the sparrow to feed upon. The sparrow now flies away as it notices me nearer abandoning its hard earned food for it’s own life and spirit. I looked at the civilization from the hill. As these mere living forms fed, mated and struggled to survive; man made bows and arrows to tame the world, made BMWs and Benzs from class C to E and made the world the world a very big place to live in and then made telecommunications to make it smaller again. Cut trees and started the Global Warming campaign to save earth for its children tomorrow. Every bad act results in an inconspicuous vicious cycle that inevitably results in something bad unless intervened upon.

I frequently lose my thoughts to understand the meaning and purpose of things imagining a beautiful destination, a beautiful answer but mindlessly wandering through the streets without knowing directions. The time spent on such an adventure in all our lives have innumerate examples each of us constantly ending up somewhere that we want to believe is our destiny or reach there and then accept it as our destiny or nowhere NOWhere questioning destiny and still wandering hoping to find light at the end of the tunnel.

Through all of mankind’s survival, the thought to reason I feel has been the most significant change that altered the very essence of survival and progress we made across our existence. There is something in the evolution of the human brain that we have developed to understand, logically reason and prioritize a particular fact or statement. Tagging a reason to any interpretation of the many from the most complicated human brain validates it over its counterparts. Eason is all we look out for. Why? Reason again!

We find those reasons in different things, every one of us in different objects, persons in love and other abstract emotions and in passion. Irrespective of a possibility that this all could be a meaningless existence we constantly endure pain, suffering and seek the ‘Pavlonian’ pleasure consciously or subconsciously in search of the purpose in our lives for reasons many.

How does it happen that all life you believe in something or someone and suddenly it all crashes into abyss like an ambitious wave shattered as it dives into its own waters only to be embraced gently as it returns again. Is it that a person acts superior to make up for his inferiority complex or is it just that he is superior. Does somebody say something to mean it or acts like to mean it or because it sounds best in a given situation or may be for no reason at all only to be interpreted, analyzed and talked about by people who are themselves so lost and confused.

To me, we are desperate to find patterns cramming up our Anatomy, Physiology and Medicine ultimately trading it in an attempt to fulfill another man’s need in an existence wanting to mean something to somebody in life or after death perhaps only to return again.

On a very broad perspective we see that life isn’t in its whole in our hands despite our best efforts and most serious thoughts from, to whom we were born to whom we meet and to where and when we meet our awaiting death. The best I understand we can do is to accept things as they are and to make the best out of life in being a good friend to a friend, a good son to a father and a father to your son, a husband to a wife and a master of yourself all as an ‘expression of HappYness’ to make tomorrow, a ‘better’ tomorrow.

 

Autonomic dysfunction!

14/01/2012, Manipal.

Yesterday’s night was one of the most dreadful nightmares of my life. 3 weeks ago when the grand finale was finally about to commence I wished for just a few things. One, I should not fall sick or meet with accidents, both in and out of hell. Two; Nobody I know (or don’t know too, if possible) should fall sick (and need me). Three; Let me be a machine and just pass this phase.

2 days ago as I was walking up and down the corridor trying to master the science of Carpentry in the given day, I suddenly felt a strong surge from the inside. This surge was no enthusiasm or the spirits or the usual episodes of exacerbated palpitations that have been in last 3 months and in not less than 2 minutes, I was staring into the washbasin, vomiting out everything I ate since morning. I never vomited even the times I got drunk and wondered if it was food poisoning or the force-fed excessive knowledge to the brain in the last few months.

I continued to roam around the house to keep myself just enough distracted with a book in my hand but ran to the basin every 20 minutes. I ate nothing so I guess I had to vomit ‘just water’. The nightmare of unknown origin [MUO] healed magically by that mid-night. Love from the housemate and the neighbors fastened the cure. The next day, after a satisfying theory exam I came home and convinced myself to take a short nap to freshen up and start preparation for the 5 specialty Surgery paper-2 subjects for the next day morning. The aim of revision was to basically turn the pages without reading much but the latest I got a look at those pages was 2 weeks before, since I began with Surgery paper 1 and Medicine followed since. As great God would have it, my landlord aunty happened to take her first dose of Tramadol for her usual backache and suddenly felt dizzy and I had to respond. They were very sorry for the disturbance but I wouldn’t pass it either, at least not after they fed me with easy digestible Idlis before I left for exam today as I was on an empty stomach since yesterday morning.  It was not only a social responsibility but also the word that 2 to-be-docs live upstairs and none of them around when the need arose; at the least to call it an emergency and to respond to the moment. I thought of it more of a moral responsibility that presents itself with greater complications than answering on the blank papers and scoring marks. That night, running through the incessant names of surgeons and their surgeries and distances from the anal verge, I found myself at the verge. I was lost and then like always began to worry about nothing. I finished, closed and then the next day filled the 16page booklet served to me. The paper was easy, so simple that our immediate seniors who had to face the brunt of the previous year paper and sat to write the exam again with us were seen literally jumping with joy and hitting their chests and fists against each other as the bell rang and I only thought to myself that I survived this- a nightmare.

I have always believed that the body finds wonderful means to cope up with anything presented to it. During our classes and clinics, I was amazed to see how an infant adopts a squat to tolerate a cyanotic spell, how a man with a varicocele walked into the OPD wearing 2 undergarments to alleviate the dragging pain (though the increased temperature due to the double wear might exacerbate a lil’ bit). Stress too precipitates something of a similar response making our body go nuts and finding ways to ‘let go’, both through voluntary (movies and addictions) means and involuntary (autonomic dysfunction) means.

A friend of mine said over stress manifests in him as allergy/ hypersensitivity reaction. Another friend said he and his roommate had to be on Proton pump inhibitors for their gastritis. Mine usually being insomnia and a lil’ worry, this time was accompanied by a few episodes of nausea, vomiting, diarrhea, not to forget palpitations, pale stools (steatorrhoea) and high colored urine that resolved spontaneously with the last exam giving me no chance to see which one of my differentials were correct! 

WHAT’S YOURS?

   

Night mares and hares

Owing to my yet to heal broken shoulder and the recent radiculopathy, I sat at home and just like any other exam season I began to question everything in life. Where was I headed and what I was doing.

It’s about 2 into the dark. I ran out into the balcony hearing a ‘scream of death’. It was the second of the 3 kittens that Tony, the landlord’s dog downstairs has killed in the past few days. I stood there in strange agony wondering if it died the same way as it’s sibling; the same foul play along the narrow edges of the roof?! The last one among Kitty kitty’s (the name of the cat that adopted us) litter tremblingly leaned over the edge and looked as the dog bit the body of it’s dead brother again and again. Do they ever learn from their mistakes like we do, I thought in curiosity.

Maybe, the key to our evolution is that we learn from the mistakes of our ancestors not only through history but also very quickly than other genes and species that need greater Pavlovian conditioning.

As Kitty kitty jumped on the roof to return home with a fresh dead rat, I wondered if she realized that all of her litter is reduced to one. Not surprisingly she did more than I thought she would, she purred in agony all night long searching for the missing kitten, the same purr that the black cat owing to its unlucky color gives away in the neighborhood. Only now did I know what the sound meant. A dose of Alprazolam or Diazepam in the night’s milk could be of some help to her, I thought. The last kitten with blue eyes was fear struck with the death of it’s 2 brothers and didn’t let her mother leave to go hunting for food and played with it’s tail all day. The next day everything seemed fine again and Kitty kitty got herself pregnant again! The black cat helped. 9 weeks later, not in my house Kitty!

p.s 9 weeks is the gestational period for cats.

p.s.s Cats eat rats and eat them with delight but why do dogs have to bite cats when they don’t eat them?!

p.s.s. Do they experience love as the same way as we do?

Insomnia- I

After sitting hours straight and have accumulated enough toxic gases, my head erupted in a yawn and I was glad that sleep was coming because if the human brain truly had any limit or capacity, I think mine just exceeded the limits. When the altered consciousness says that it can’t take it anymore, sleep is a wonderful thing. It makes everything go away and gifts you a new silent start tomorrow.

I turned the lights off and holding my 14week potbelly like a pregnant women with lardosis and wondering what I would be dreaming today, I reached my bed 4.5 feet away with great difficulty. May be one of those Richie Rich dreams where I get to be the king and have to play a 3D virtual ‘Game of scratch’ to save my queen and the kingdom or oh ooh, one of those where the world is about to an end only to survive at the climax of the dream where the whole of mankind spent all of it’s money, resources or finished off with it’s ‘bucket list’ that many of us had nothing to live for after the unexpected survival! Death as a whole, when it comes it all, at once, doesn’t seem like a bad idea at all now. In one of those dreams which I still vividly remember, I was at Marine drive when the skies began to crack open and spill down avalanches and I ran to save myself all across the globe, from the Pyramids to the Red sea and the Alps of Europe all at once. Ooh! I think I even spotted a few dinosaurs! 

But it’s been a while I dreamt in sleep. Actually, I have to admit that I began to have trouble sleeping. It’s not the barking of the dogs or the cats that find way inside the house that disturb me anymore but my own pounding heart. It beat so hard and gave me a constant company like pain during my post-operation that I worried if I would have to lay in bed all night awake until the first rays of the morning would forcibly make me throw the blanket off. I doubted even if any sleeping pill would be an antagonist to this disease. A few years ago, I enjoyed a 7-hour sleep even before my 1^st year university exams and there was never a problem before either. Oh good great sweet killer education, I ask thou, what have you done to me?

Health Care Of Rural India- An essay

It makes me wonder how eligible I am with the mere knowledge for a 10 mark question from the chapters of Community Medicine, having visited an ENT surgeon for a small furuncle and the Dermatologist for acne under insurance coverage this morning to speak of the poverty my country is struck with, complex issues which affects the lives of millions, whom I might never encounter in my whole life and yet have an impact on mine.

While adopting the Constitution on January 26, 1950, we, the people of India, dedicated ourselves to the creation of a new social order based on equality, freedom, justice and the dignity of the individual and, to the end, decided to eliminate poverty, ignorance and ill-health.

They say India has a national health policy but doesn’t have a national health service. The first part of the statement, I understand through a look at my 800 odd paged Park’s textbook of Preventive and Social medicine. The latter part, anybody would agree when they take a stroll down Dharvi, one of the worst hit slums of the alpha world city- Mumbai or a far flung off village in Bihar where people still die off Diarrhea.

As may be easily anticipated, the overall picture of the current health care is a mixture of light and shade, of some outstanding achievements whose effect is unfortunately more than offset by grave failures.

India stands at 134th position in the UN Human Development Index. When it comes to healthcare or for that matter anything, there are two Indias: One India that provides high-quality medical care to middle-class Indians and medical tourists, and the other in which the majority of the population lives—a country whose residents have limited or no access to quality care. Nearly 74% of the rural population doesn’t enjoy all the benefits of modern curative and preventive health services. Also, 73.6% of the doctors are concentrated in the urban areas and a mere 26.4% in the rural areas where a near 75% of the population lives. Not only does the wide variation exist between the rural and the urban but also the geographical distribution of hospitals vary according to local socioeconomic conditions all across the country with a wide gap between Uttar Pradesh and Kerala.

‘Health by the people, placing people’s health in people’s hands.’

Primary Health care is considered one of the greatest milestones in the history of health care in India, the very basic roots of survival for millions. The building of PHCs- the 1^st level of contact, constitute the fundamental requirement of a sound referral system and the realization of ‘Health For All’. 

One driver of growth in the healthcare sector is India’s booming population, currently 1.1 billion and increasing at a 2% annual rate. India will surpass China by 2030 and by 2050, the population is projected to reach 1.6 billion.

Figures from Rural Health Statistics reveal some startling trends. Sub-Centers, Primary Health Centers and Community Health Centers — the bedrock of rural health delivery — have grown in absolute numbers since Independence: From 725 in 1951 to 57,353 in 1981 to 1,71,687 as of March 2007. They remain the backbone of rural health-care in the absence of private sector presence.

‘Rural health care in India faces a crisis unmatched by any other sector of the economy’. - Arvind Panagariya, The Economic Times.

 Besides tremendous progress, not all Health statistics are healthy for rural India. Considering the limited facilities available in a sub-centre, 50% of the sanctioned posts of Specialists at CHCs remaining vacant, run-down infrastructure, poor supply of drugs and equipment, illegal selling of the public welfare supplies and soaring rates of chronic employee absenteeism, commission practices that exist between the rural unqualified doctors and the doctors from the health institutions in the nearest cities or the district heads; quality health-care remains a mirage for much of rural India. There is no healthy Comparison of this with the hospital (public and private) beds available in the urban areas, which are greatly uneven. While the rural poor are underserved, at least they can access the limited number of government-support medical facilities that are available to them. The urban poor fare even worse in terms of primary health care and they cannot afford to visit the private facilities that thrive in India’s cities. 

The launch of National Rural Health Mission [NRHM] 2005-2012 is a giant in the creation of a national service whose need was conceived almost 30 years before; aims to provide effective healthcare to India’s rural population, with a focus on 18 states that have low public health indicators and inadequate infrastructure. Through the mission, the government is working to increase the capabilities of primary medical facilities in rural areas through Accredited Social Health Activists (ASHA) and Link Workers and ease the burden on tertiary care centers in the cities, by providing equipment and training. It integrates multiple vertical programmes and also embraces the Indian system of medicine [AYUSH].

The new course (Bachelors of rural health care) for 3 year and six months that demands for a five-year service in a rural area is a potential solution as primary health care is the need of the hour but are we compromising rural health care just in the desperate attempt in making more doctors to bridge the gap is an intriguing question. The extension of regular MBBS study period for rural service raised a huge out cry from the students. Though it was a shrewd idea of the politicians to fill their vote banks by promising the rural population, doctors at their doorsteps; the consequences of such a bill would have changed the entire face of rural health.

Solutions including the National Rural Employment Guarantee Act (NREGA), Janani Suraksha Yojana(JSY),  fundamental reform of the long established Public Distribution System (PDS), a new Food Security bill under consideration by parliament which proposes to issue coupons direct to BPL families, Vandemataram Scheme, RCH programme and programs to encourage sustainable farming practices are being implemented for the overall development.

Indian health services have carved out meaningful programmes of health services, research and demonstration. Mobile based primary health care systems, Automated Medical records, and development of innovative roles for allied health professionals, Telecommunications and Telemedicine—the remote diagnosis, monitoring and treatment of patients via videoconferencing or the Internet. It’s only through solutions such as these that a rural population approaching 700 million can be benefitted with proper healthcare facilities. 

The misdistribution of biomedical services and the lack of penetration of public health services create a dilemma for Indian patients. They encounter a bewildering array of medical services, ranging from qualified traditional medical practitioners to untrained, self-taught purveyors of medicines and cures. This frequently accounts for this type of patient use, which may be described as “forced pluralism,” and for provider practice that is “unethical and dangerous”. This by-now entrenched pattern of inappropriate medical practice and patient abuse, calls for a review of policy, a plan for regulation, and action against the unqualified. The Government is undertaking strategies in order to harness the available local resources by incorporating the existing self -made rural health professionals to the mainstream of health care.

Private sector spending dwarfs the total healthcare being financed by the public sector. In 2003, fee-charging private companies accounted for 82% of India’s $30.5 billion expenditure on healthcare. Most of the population is forced to seek health care from the private sector and pay out of pocket at the time of illness. Eighty percent of our healthy care is met through individual household expenditure, one of the highest internationally. Studies show that an average of 24 percent of Indians are impoverished because of medical expenses.

In such circumstances there are two alternatives, either that government increases it’s spending on healthcare and to improve the quality of care in its institutions and thereby protects the poor from catastrophic health expenditure, or the poor resort to some mechanism that protects them when they fall sick. While the former option seems to be materializing in various forms in our country the only solution to provide health care facilities to the poorer sections of the society could be the community health insurance through which the basic health care needs can be taken care of.

Only 11% of the population has any form of health insurance coverage. The Employees State Insurance Act (1948), Janarogya Yojana (1996-97), Yashaswini Insurance scheme (2002)- a micro insurance initiative, in the state of Karnataka by a public–private partnership for the farmers who previously had no access to insurance. Recently launched government-sponsored health insurance schemes, such as Arogya Sree scheme (Andhra Pradesh) and Rashtriya Swasthya Bima Yojana (RSBY), target poor Indians, offering cashless cover while allowing beneficiaries to choose among empanelled public and private providers.

More state governments should pursue such initiatives so that most or all of the population can afford to purchase at least a minimum level of coverage. Also the problems such as reimbursement, a process that can take up to six months,

 should be efficiently tackled . The widespread availability of health insurance would help to drive demand for services and provide additional revenue to improve the quality of care.

‘There is a great difference between medical facilities available in Western countries and that in India. But there is a common thread — Indian medical professionals.’

The usual cycle of migration of health care professionals from villages to cities, cities to metropolitan and from the metropolises to the US and abroad where they believe are better amenities, better job satisfaction, better professional brethren, better adaptability, better experience and most importantly ‘Better Quality of Life”. Reports are that close to 38 per cent of practicing doctors and dentists in the US are of Indian origin. Ironically the migrating doctors do not hesitate to work in the rural areas of the developed nations, as the pay for doctors who prefer to work in their rural areas is more while it is just the opposite in India.

The term ‘health’ is not found in the US constitution but yet they have always taken extreme measures to provide their citizens with the 3 sentinel services- Defense, Education and Health care. In 2008, U.S. health care spending was about $7,681 per resident and accounted for 16.2% of the nation’s Gross Domestic Product (GDP); this is among the highest of all industrialized countries.

The National Health Account shows that India’s total expenditure on health amounts to 5.10% of the gross domestic product (GDP), while its per capita total expenditure on health is $80 compared to an average of over $220 spent by many other developing countries. Consider the contrast with the Bhore Committee recommendation of 15% committed to health from the revenue expenditure budget, against the WHO, which recommended 5% of GDP for health.  In this very year India spent 300 bn to hold the most expensive Common Wealth Games ever.

Does the elixir of dynamic economic growth distract us from acknowledging that the superpower status will be denied to us until our country can bestow social justice to its own citizens?

"Taking real time data and immediately feeding it back into the product, tapping local entrepreneurial talent, doing incredible marketing and education based on aspirations and not avoidance will make health care as ubiquitous as Coca- cola", said Melinda Gates in her TED talk. Only through real education can the masses be made to realize the ‘felt needs’ and they shall be more receptive to hear when their stomachs are full enough. It is through research into cheaper modalities of health care delivery like ORS, a revolution can happen.

I look forward for that day, when we can pride ourselves on our determination, enough wealth, organizational skills, intellectual and technological capacities to develop an ideal health care model such as the NHS and provide health care to every citizen in need.

Change appears to be the hallmark of this generation. This is fortunate, for change is the hope of the future. But let’s remember, true prosperity starts in the countryside.

P.s. This essay on the 'Health Care Of Rural India' has been a product of a hot furnace in my head for a 

National essay writing competition- DR. VISHWAS PATIL MEMORIAL ESSAY COMPETITION supposedly conducted by APCM, Dhule during my preparation time for the third year university examinations which included Community Medicine.

Like, all things are not appreciated in life, I never got a reply despite calls to Dr.Singh or my mails to their society.  Well, let there be a reader for this hard-made piece at the least!

                                                                                                                        -Raviteja Innamuri

My love!

I remember the first time I saw her. The evening was hot and the inners wet. The Sun poured down sweat that precipitated on the cooler mortals. She stood in the corner of the dark room along with her other friends. She was different. She smelled different. I couldn’t help noticing her. At first from the corner of my eyes and then, inevitably staring at her. The mirror glare from the rider passing by disturbed her grace. She noticed me and broke my stare, threw my head down and filled me with guilt to the brim. I had no reason, why? I stared at the Taj Mahal much longer and nobody said a thing!

I was at the same place the next day. Maybe, it was just coincidence.  She was there too. None of us said a thing. I was there the next evening and perhaps the next one too until all it took was a simple handle- shake.

I don’t really remember much after that. The ride was always pretty smooth with her. I could never get bored. The feeling was always like the wind sweeping through my hair making curls and sweet subtle music as it sensitively touched my eardrum as it left softly brushing my pinna. She took me to new places, introduced me to new fellas. There was always something to do, something new. She rarely complained and though there were a few misunderstandings; the mechanic was not far away. 

She always farted silently. She was always very polite and waited patiently for me. She always took hours long to clean up but always looked prettier than the last time I saw her. She intimidated the other girls. Oh boy! You could tell! She could never bear thirst. You had to get her the drinks else she wouldn’t budge.

She needs to be treated more delicate than a flower. I feared every second if I would bruise her if I hit, any harder. But she could endure any pain, race any distance and a great opportunist. She never backed down. For her, stamina is nothing more than one extra foot when your heart is ‘one hundred percent exhausted’ and your mind says ‘no more’. Man! She is a winner. 

In the many years I have known her I could never tell how special she is to me, until now. You are a miracle. Happy anniversary Laura! You are the most wonderful thing anybody could ever own!

p.s. Laura is a bike.

What make great quotations GREAT!

I have always wondered what made good quotations great. Is it really who said them or are they great because the ones who heard them have interpreted them greatly. Many times in life, we hear people say profound things just in the passing; things that are capable of igniting minds and changing lives.

As a tribute to my wonderful friends, here are some of my best catch!

"Cases are not stupid; only case sheets are."
- Priyanka Shuklae. 13/05/2011.

"We all just pretend."
-Krithika Singh  on her latest night out.

"You are distracting yourself."
- Roopa Patel on things distracting me.

"The vaguest of symptoms precipitate the sophisticated of investigations."
- Me; on the patient's investigation report for 'giddiness'.

"Teach me something."
-Miss Ann in her intermittent awakening phases of her sleep- wake cycles at clinical postings.

"There is an old dictum of mine. If you know, write. If you don't; write more."
-Anonymous; who had taken 8 additional s for the OBG exam.

"Off the eyes is off the mind."
- Re-quoted by Mr. Roy.