Desicritics Category: Culture: Health

Health Care at Home

Ravi Kulkarni — Sun, 8 Mar 2009 03:30:23 EDT

In my previous blog I listed a litany of complaints about the health care system. In this blog, I will talk about some actions I have taken to ensure a healthy lifestyle.

By most standards, I am a health freak. It is not that I always do optimal things nor that I am in perfect health. But I have improved my health considerably in the last ten years or so and my blog is an effort to share my learning.

Over a period of time, I have been consulting doctors and getting lab reports. In order to improve something, one needs a baseline. One measure is to count the number of times a person falls sick. This is very subjective and sometimes deceptive too as major diseases can lurk under seemingly good health. The metrics in the lab reports provide a more objective basis. Based on these metrics I do my own research on possible lifestyle, diet and exercise changes that are needed to get better. I have realized measurable improvements of health over several years.

In my opinion, diet is the primary source of our health issues. After all we are what we eat. I avoid junk food, including all sodas, colas, synthetic additives and preservatives, synthetic sugar substitutes and so on. Where possible I have substituted whole grains for bleached floor, brown rice for white rice, olive oil for peanut oil and so on. I buy organic where I can. About 50% of my personal diet consists of only raw fruits, vegetables and nuts. For example today my lunch consisted of the following (all raw): sprouted moong (green gram), red and yellow bell peppers, Persian cucumbers, broccoli, apple slices, a mango, blue berries, raspberries, almonds and walnuts. I try to consume flaxseed in many different preparations.

Recently I purchased a Vita-mix whole food machine. It is an excellent device for making juices, soups, dips and assorted other things. I highly recommend this product to anyone interested in cooking and especially those who enjoy raw food.

Our teeth play a very important role in our health. It is not just the social consequences of bad breath or discolored teeth; they have a much more profound impact on our lives. Treatments like root canal can do more harm than good in some cases. I have followed a very simple regimen: I make sure to brush at least twice a day and floss after every meal for at least 2-3 minutes. Just flossing alone has made a tremendous difference in my dental health. Recently I also purchased a Panasonic mouth irrigator. This product is available for about $25 at amazon.com and worth its weight in gold.

As I am an IT professional besides being an internet junkie, it is almost certain that my eyesight is weak. However, I have always resisted wearing glasses and never got a pair. I think eyes are the best optical instruments ever designed and they are capable of working under extreme conditions. I have always relied on eye exercises and yoga to keep them in reasonably good condition. I definitely need reading glasses but don't yet wear any. I also do no wear sunglasses even in the sunny locale where I live. I think sunlight is good because we just don't get enough of it in our home and office bound existence.

I have mixed feelings about supplements. If one is deficient in certain vitamins or minerals, it may make sense to take a few supplements until that deficiency is overcome. But I am not sure about the effectiveness of multivitamins. Ideally we should get all our vitamins and minerals from our diet. It is almost impossible to determine the action and interaction of so many different nutrients which are present in foods an isolated in a pill form. Our ancestors did not take any supplements but at least some of them enjoyed perfect health. However, I must admit I have taken certain supplements over the years and they have certainly helped. In particular, Co-Q10 which helped eliminate PVC (premature ventricular contraction, a benign heart condition) and Niacin which helped reduce tri glycerides. I have discontinued use of both.

Our ancestors used to rely a lot on the natural and home remedies. As a result they probably lived a much healthier lives than we do, though our life spans have increased during the last century. Invention of antibiotics and vaccines have reduced deaths due to many infectious diseases. That the overuse of antibiotics is now being seen as a leading cause of super infections is the irony of progress. We are born with amazing healing capabilities. And yet we provide crutches and artificial props in the form of concoctions of harsh chemicals in the mistaken belief that intervention is better than letting the nature take its course. As a result we compromise the very body we want to keep strong and fit for a hundred years.

My favorite home remedies are: turmeric, cinnamon, ginger and garlic for simple infections. Home made yogurt, buttermilk with asafoetida for many stomach ailments. There are a few commercial preparations that have become standard faire at our home. These are:

Inflameric as an anti inflammatory supplement
Oil of Oregano as a powerful natural antibiotic
Calendula Ointment (homeopathic) for cuts and bruises
Septilin for colds and flu

As a family, we have almost eliminated consumption of any prescription medicines. Neither of my kids, ten and six years old, have had to take antibiotics, ever.

We do consult doctors on a regular basis, but we tend to pay more attention to their diagnosis and much less to prescription. But once I have confirmed a diagnosis, subsequent course of action depends on my own research. Nobody knows my body, diet and lifestyle better than myself. Best course of action often depends more on these factors and less on a formulaic prescription. An average doctor does not have enough time or patience to take into account all these factors. My source of information:

Curezone - Lot of information, user contributed information, first hand reports etc.
WebMD - Information about diseases, medicines
FDA - US Food and Drug Administration
Allayurveda - Information about Ayurvedic medicines and principles
Yahoo groups - Individual ailment discussion groups

Our modern lifestyle almost ensures that we need to exercise on a regular basis in order to maintain good health. I try to get at least 45 minutes of 3-4 days a week, mostly on a treadmill. I probably need more flexibility and strength training, but I guess I will get there. While my lifestyle and diet do provide major benefits, exercise provides a further boost to it. My tri-glycerides have been high for the last several years. I have noticed that they come down measurably whenever I exercise regularly and go easy on simple carbohydrates and fat.

Yoga and meditation provide benefits to body, mind and spirit. I am still struggling to incorporate these into my daily routine. When I do that, my at-home health care should be complete.

Disclaimer: I am not a doctor and this article is not medical advice. Please do your own research and always consult a physician for your health concerns. If I am mentioning certain brands and products here, it is because I found them to be useful, not because I derive any benefits from this mention.

America's Healthcare Crisis, Part II - Physician, Heal Thy Profession

Ashoka Chakra — Sat, 7 Mar 2009 10:04:35 EST

Physician, heal thyself.

One bright sunny day two decades ago, I stood rather nervously in an examination room, taking an oral examination in order to graduate from medical school. The examiner stood a few feet from me and with a curtly nod summoned a patient. The patient shuffled in and the examiner observed his watch. After thirty seconds, he nodded again, and the patient shuffled out. The examiner turned towards me. “Your diagnosis, doctor?”

That was a different era, an era where physicians were scientists, trained observers and good listeners. It was an era when physicians spent time with patients. How times have changed.

In thirty seconds, I observed that the patient’s right shoulder drooped, he took shallow quick breaths, and that he was rather emaciated. Pulmonary insufficiency afflicting the right lung, secondary to either tuberculosis or cancer was my diagnosis and I passed. I was able to make that diagnosis because I had been taught the importance of taking a good history and performing a thorough physical examination. By the time of graduation, those skills had been mastered. Though the two can be time consuming, they are a lot more cost effective than modern tests. But more importantly, they establish a rapport between physician and patient that is priceless.

These days, physicians spend less than 5 minutes with a patient and move on after ordering myriad laboratory or radiology tests. The art of a differential diagnosis that required options to be carefully vetted has been lost to batteries of expensive tests. How many patients can attest to their physicians having spent time with them, and lent a sympathetic ear? Sadly, centuries old sacrosanct trust that existed between patients and physicians has been relegated to history books. A physician is not looked upon as a knowledgeable family friend but as a glorified laboratory technician out to make a bundle.

The mentality of conducting tests rather than dealing with patients directly contributes to the health care crisis. In my last op-ed, I had mentioned that it took a CAT scan to identify my neighbor’s neck mass, something that any physician worth his/her salt should have identified from across the room. If such tests are to replace the eye, is it any wonder that medical expenses have sky rocketed? A gastroenterologist I know brags that he does not even touch a patient any more. He sends them straight for radiological imaging or endoscopy. Since he spends less time per patient, he can see many more patients a day, enhancing his income considerably. Unfortunately patients fall for this, assuming that more tests are better. While directed tests to prove a diagnosis are very understandable, testing simply to replace the process of diagnosis process is very wasteful.

Physicians argue that the legal atmosphere or patient pressure forces them to perform myriad tests. While both arguments are true to some degree, physicians must ask themselves who ultimately dictates standard of care.

The standard of care is not limited to diagnosis. Therapy is perhaps a more important component – after all, the increase in life expectancy over the past five decades is due largely to life saving drugs developed by the pharmaceutical industry. However, despite our appreciation for the pharmaceutical / biotechnology companies and their products, we should also keep in mind that they are responsible for the largest increase in health care costs. In this area, physicians can do a lot to curtail runaway prices. An example would be prescribing generic drugs instead of brand name ones. It is wrongly assumed that generic drugs are somehow inferior to brand name drugs. Generics have to prove their safety and equivalence to branded drugs before the FDA approves them and there is no reason to prescribe expensive brand names while cheaper alternatives are available.

My last comment is to exhort physicians to take back the practice of medicine. To take it back to an era where physicians were respected and the profession was an honored one. To take it back from bureaucrats, lawyers, and insurance company executives whose short term vision is dangerous to patients and the field of medicine. In short, physician, heal thy profession.

Disabled Children Wait up to Two Years for Wheelchairs

Dr Bhaskar Dasgupta — Sat, 7 Mar 2009 00:22:04 EST

You know I keep on moaning about the fact that the ways of meeting children’s needs here in this country are strange? We are doing something for our long term sick children’s education by providing them by computers but i suppose you can say that that’s sort of optional.

But how about children who are unable to walk and need a wheelchair? If we have a fully funded NHS, surely they should be getting a wheelchair immediately? Well, no, unfortunately no. Read this and weep. I quote:

The NHS was told today to stop relying on charities to fill funding gaps after figures revealed many trusts would not pay the full cost of electric wheelchairs for disabled children.

Why on earth is this situation allowed to happen? Why aren't they given a wheelchair immediately? This is mental child abuse. And then not only people have to pay their taxes, but also give charity? Talk about being inefficient.

Statistics from 54% of NHS trusts in England and Scotland revealed that disabled children in England are forced to wait five months on average for a wheelchair.

5 months. Can you imagine? If you aren't disabled, think about this, you are forced to wait for 5 months for shoes. You dont have shoes. You cannot just go and buy them but are waiting to get them. Not for 1 day, not 2 days nor wait till the weekend so that you can purchase it, but for 5 months, 20 weeks, 140 days. 140 days without any shoes. Can you imagine what that will do to your feet? Now think about the poor disabled child. 5 months without a wheelchair.

The worst performing primary care trust (PCT), East Lancashire, in the north-west of England, had an average wait of two years for an electric wheelchair.

5 months was average across the country, but this area had an average wait of TWO years. And if you think that manual wheelchairs are possible, remember we are talking about children who are unable to control their muscles, so they cannot literally move about without assistance. Electric wheelchairs allow them to do so. And this is average 2 years, means 50% of the children in that area would have spent much more than 2 years waiting for an electric wheelchair.

The survey showed 58% of children in England had to wait at least three months for an electric wheelchair and 14% waited more than six months.

It gets worse. We are indeed a 3rd world country if this is how we treat our children in need. And then apparently we have sunk tons of money into the NHS.

Overall, 50% of the PCTs that responded said they did not fund the full cost of a powered wheelchair for a disabled child. Westminster PCT made an average contribution of only £700 towards the cost of a child's powered wheelchair, it said. Almost all PCTs contacted by the charity said the cost of a wheelchair was around £2,000 but in fact the true cost of a basic electric wheelchair would be around £3,000.

Holy crap. And rest of the money comes from charity, eh? typical.

A separate patient survey of 237 children found one in three did not receive any funding at all for their wheelchair.

And 1/3rd of the children dont receive any help whatsoever. Wonderful, you silly twits in the government. Do something!, get off your fat backsides and give this money to the kids. Or else, we will take the money for your shoes and give it to the kids. I bet that then the money will be found very quickly, no? And then when you read something like this, you feel so sad. I quote:

Family doctors are failing to provide improved services for patients, despite being paid tens of millions of pounds to do so, a report claims.

Technorati Tags: Children, Charity, United Kingdom

Tall and Shrinking Muslims, Short and Growing Europeans

Dr Bhaskar Dasgupta — Thu, 5 Mar 2009 09:01:13 EST

I have written about the Arab Human Development Report before. It is indeed shocking to read about how the Arab lands are now. It does concern the rest of the world, because the Arabs and this region play a very big role in the religious wars and terrorism now roiling the globe. The Arab Development report points to various issues that the region has to grapple with. Obviously, Human Development is a comparative study, you compare the performance of the other countries to the Arab lands to check how far they are apart.

But what happened in the past? And I don't mean along the lines of Bernard Lewis’s What went wrong type of analysis. Where did the divergence happen? Well, I think we have a partial answer to that question. As is well known, the anthropometric (height/weight etc) dimensions of human beings is a good indicator of economic and human development. In other words, there is a good correlation and causality between good nutrition, good economic development, reasonably good height / weights.

So what was the difference? An article, Tall and shrinking Muslims, short and growing Europeans: The long-run welfare development of the Middle East, 1850–1980 by Mojgan Stegl & Joerg Baten of the University of Tubingen in Germany, published in the Explorations in Economic History came into my in-box recently.

They have done a sterling job in collecting anthropometric data from a staggering variety of sources and have combined it to provide some very interesting data. Without going into the intricacies of how they managed to do it, this is their first graphical result of the heights of the populations they studied.

And these results are statistically significant, the authors ran some standard statistical tests to make sure that the populations, samples etc. etc. are accurate. So how did the wages bit turn out around the inflexion point? They calculate real wages in Istanbul and industrializing countries in grams of silver per day (weighted by population size).

Curious result, no? It shows how the divergence in urban and rural areas emerge. The main improvement in the west happened in the cities, because if you strip out the cities, then the performance was about the same as urbanised Istanbul. Here’s another way of looking at the economic impact by comparing GDP per capita:

Not looking good, is it? If you go the whole hog by applying PPP and adjusting for population size, you get this picture:

So what were the other reasons given by the authors - besides the obvious economic development driving nutrition? Well, they point to the fact that in in many areas around the Middle Eest, people lived next to animal husbandry, and given that this was a concentrated protein rich diet, their heights and weights were quite good. However, as as the number of people living off animal husbandry in the Middle East started to drop, right at the same time, the supply chains in Europe improved with developed economies and better farming technologies. Diseases were further controlled and the graphs say it all. The Arab / Muslim (so as to incorporate the non Arab world of Turkey) world in the Middle Eest has steadily lost ground since then.

Now you can definitely incorporate the elements of colonialism, history, imperialism and the like, but that will make it a bit more difficult to ascribe differences in nutrition to imperialism, no? Does this mean that till about 1900/1910, Arab/Muslim imperialism and colonialism was still existent and then it was overtaken by European imperialism so the story flipped? I wonder what the situation will be in another 100 years of time?

Technorati Tags: History, Arabs, Middle East, Europe

Cecilia Makiwane Hospital, Symbol of Hope and Courage in South Africa

Amitabh Mitra — Sun, 1 Mar 2009 10:36:34 EST

I saw a documentary film recently on Al Jazeera about Chris Hani Baragwanath Hospital, affectionately called Bara in Soweto, South Africa. Soweto remains the biggest black township and is synonymous with the struggle against the apartheid. It made me write this photoessay on Cecilia Makiwane Hospital in Madantsane. Mdantsane remains the second biggest township in South Africa, situated in the province of Eastern Cape, it provides the leadership to the new South Africa.

Cecilia Makiwane was born in the Mac Farlane Mission in Victoria within the district of Alice in Eastern Cape in 1880. Her father was Elijah Makiwane and mother was Maggie Majiza. She studied in the Lovedale Girls School in Victoria, Alice. Cecilia Makiwane studied nursing and she holds the title of being the first black woman to be licensed as a professional nurse in 1908. Several honours have been bestowed upon Cecilia and show the regard with which the medical fraternity holds Cecelia. Amongst them are: a statue of Makiwane being erected in 1977, a hospital in Mdantsane near East London being named after her and the nursing tradition of observing a day of prayer on January 7 (the date Makiwane was admitted ). She passed away in 1919.

Having worked in a number of African countries, I came to Ciskei during the apartheid era. Ciskei was an independent homeland country and Mdantsane remained within its confines. The Ciskeian Government built the hospital and named it after her. It is a tertiary university affiliated referral hospital which once boasted of a thousand beds. A number of doctors from overseas sacrificed their lives while serving in this hospital during the apartheid era. Cecilia Makiwane Hospital remains a symbol of hope as it is the symbol of anti apartheid struggle, courage and catering to thousands of patients till this day

Sunrise at Mdantsane

The sculpture of Cecilia Makiwane

With nurses in traditional dress

Patients being air transported from remote areas

Flying Medics of Mdantsane

Indigenous plants and flowers within the hospital campus

An indigenous flowery plant

America's Healthcare Crisis, Part I

Ashoka Chakra — Sun, 1 Mar 2009 05:02:22 EST

A few months ago, one of my neighbors (lets call him Q) was driving from Pennsylvania to New Jersey on I-78 when he began to feel unwell. He felt weak and nauseas, and had a headache. Q managed to work half the day, but then his condition deteriorated. After calling his wife, he drove home, without informing his physician about his condition. The wife waited at home, wondering whom she would hear from first – her husband, the emergency medical services, or the highway patrol. He did end up reaching home safely, without causing a wreck or injuring other drivers on the highway, but they ended up going to the emergency room that night.

The story gets more fascinating at this point. After many tests in the ER, Q was hospitalized. He had a history or high blood pressure and was about 100 pounds overweight. Disregarding his doctor’s advice to loose weight and exercise, he had carried on, concluding that he was too young to worry about strokes or heart attacks. After all, he was only in mid-thirties. But Q wasn’t too young, and he ended up with a stroke. Fortunately for him, there was no permanent neurological damage. Unfortunately for him, the tests revealed another problem – he had a mass in his neck that was detected by computerized axial tomography (commonly known as the CAT scan). That it required a CAT scan to identify a mass that should have been detected by a physical exam is a point that will be addressed in a subsequent column, but to cut a long story short, he was suspected of suffering from a lymphoma. Many tests followed, most of them unnecessary, with attendant expenses and anxiety, till he was proven to be cancer free. And then, Q lost his job. While the company laid-off others as well, undoubtedly his case was complicated by medical bills. A few months after this, I asked Q what medications he was on, and he looked at me with a vacant expression and said, “I don’t know.” He now has trouble finding a new job that is commensurate with his experience and training. Part of the reason is the health care premium his new employer would have to pay.

This story reveals several aspects of what is wrong with the health care system, such as the attitude of patients, doctors, lawyers, and insurance companies. This column addresses the behavior of patients.

We in America have gotten used to being taken care of by someone else and over a period of time, have lost the sense of responsibility. Health has become the responsibility of everyone but the patient. However, shouldn’t health the patient’s own responsibility? Why should the government or a doctor be responsible? A doctor IS responsible for providing guidance and counsel. However, the ultimate responsibility is that of the individual. And if that individual chooses to live on a diet of hamburgers, fries, and considers watching sports on TV the best way to exercise, is it a surprise that obesity, diabetes, hypertension, and heart disease ensue? While suing physicians may enrich John Edwards and his ilk, it won’t solve the problem.

Avoiding disease should be the first health care priority and responsibility of an individual. That includes proper diet, exercise, vaccinations, and common sense actions such as wearing helmets, seatbelts, avoiding unprotected sex, etc. It is acknowledged that genetics, age, and environmental influences affect even those who are careful, and that is where the second priority comes in.

The second health care responsibility is to understand and educate oneself to disease(s) that afflict a person and also to familiarize oneself to the therapeutic modalities. If an individual has hypertension, s/he needs to know about the disease and the therapies available (which includes drugs and non-drug related activities such as diet, etc). Unlike Q, who did not his medications, a responsible individual should not only know the names and doses of the medications but also the side effects and interactions with other medications. In the Internet era, knowledge is not hard to come by and is no longer an excuse.

The third health care responsibility is to follow instructions meticulously. If exercise is advised, it should be followed. If an antibiotic is prescribed, it should be taken as prescribed, and not stopped half way through.

By taking responsibility for our own health, we can help save the health care system from a catastrophic breakdown.

The Healthcare Crisis, Part One

Ravi Kulkarni — Thu, 26 Feb 2009 08:28:32 EST

There is a big crisis in the health care system (some would like to call it sick care system). The prices are going up by 10-15% every year, and correspondingly the insurance premiums. There is a tuberculosis epidemic that is threatening to breakout anytime, even in the developed countries. The chronic diseases, such as cancer, diabetes, hypertension continue to plague us with no solution in sight. The pharmaceutical companies and the medical community have managed to find palliative measures that keep a patient alive for a long time, but there is no true cure for many health problems. Every new drug invented, every new procedure developed is costlier than the one before, but with few exceptions, most of them do not cure the patient. Instead they keep him or her dependent on the system for a long time, with attendant expenses and unwanted side effects. Even antibiotics which saved so many lives in the 20th century have become ineffective against increasingly virulent and resistant bugs.

Every spoke in the wheel of health has had its own role to play in creating the mess we find ourselves today. Let's start with the health care professionals. General physicians seldom get to spend enough time to understand an individual patient, his or her lifestyle or diet. More than 50% feel they are overworked. More often than not, it is a quick enumeration of symptoms and some lab tests and a prescription. Physicians are happy to prescribe antibiotics and other strong medications even when they are not strictly called for. The pediatricians are the worst offenders of overprescribing antibiotics. Majority of the cases do not even need them because the infections are viral. This not only creates super bugs, but also weakens the immunity of a child. My reasoning is simple – if you give a crutch to the body, the body stops making an effort to heal itself and comes to rely on the crutch. See this article on antibiotics. Specialists such as dentists and orthopedics doctors are even more culpable. Often they tend to treat individuals like mechanics treat your cars – the more repairs the better – for them. This is not to say that there are no ethical, sincere and loving doctors around. But often they become unwitting part of an establishment that is too hard to navigate and change.

Next come the insurance companies. They show no interest in ensuring that an individual gets proper health care. For them every medical expense is another expense and it is their stated goal to reduce this expense. For example, most insurance policies do not cover preventive measures such as multi vitamins or supplementation. Most policies won't cover the membership of a health club or give discounts if you are an active member. Most often they are not interested because the employers who provide the biggest chunk of insurance policies, keep changing the insurance companies frequently. Thus insurance companies have zero incentive in keeping an individual healthy.

Then come the pharmaceutical companies. While they have done some wonderful work in the past in developing life saving drugs, now they are in a rat race. Their credibility lies in tatters due to recent scandals. Peddling drugs that are of dubious efficacy, suppressing research that shows negative aspects of their drugs, bribing doctors to prescribe more medicines, encourage doctors to use the drugs off label, you name a perversion, they have indulged in it. The scandal goes on and on and with no end in sight. What is worse, there is hardly any liability for the individuals who consciously swindle the society. At the most they get a slap on their wrists.

This brings us to the fourth spoke – the regulator – FDA in America. For all practical purposes they do the bidding of the pharma companies. It is a revolving door at the FDA, often professors and researchers with deep connections to pharma industry head the FDA. While there is a process to certify and monitor drugs, FDA uses its big stick to beat back any attempt by alternative medicines to address a market need. In the States, no supplement or food producer can make a claim that his ware can cure anything. There are many such instances where a traditional (really traditional like an Ayurvedic preparation) can and does alleviate a certain condition, but they are not allowed by FDA to make that claim or at least FDA won't certify them. According to FDA, something is a drug only if it has gone through certified clinical study. No matter that these clinical studies are conducted by the interested parties, and that the traditional medicines have gone through millennia long trials. A lot of the funding for FDA comes from the pharma industry itself.

The final spoke is the consumer. This is where the biggest blame lies in the whole system. People tend to believe that a doctor knows everything. We are ultimately responsible for our own health – failure to recognize this simple truth often results in fatal consequences. People go to doctors with their mundane problems and accept prescriptions which are often not necessary. Doctors have become very defensive because of the ever hanging threat of malpractice lawsuits. So they will choose the strongest measure even when a wait and watch method will work just as well. We are too lazy to choose a careful diet that's suitable for our lifestyle, genes and body. We do not exercise enough. We eat and drink a lot of junk food. In the end is it any surprise that we are at the mercy of harsh chemicals and - at best - indifferent professionals?

In the second part of this article I will write about some of the methods we have adapted to ensure a healthy lifestyle.

Hepatitis - In HIV's Long Shadow

Shantanu Dutta — Sun, 22 Feb 2009 06:06:15 EST

The story of the hepatitis B outbreak in Gujarat has not received the attention it deserves. More so because Hepatitis B is not the typical jaundice that comes around in the monsoon season every year and then trails off as the rains dry up. This variety of Hepatitis is chronic in nature; has no cure and is potentially more dangerous than HIV and AIDS, the mode of transmission for both being the same.

At last count thirty four people had been felled by the virus and this piece of news need not be the last word on the subject as The Gujarat health department says that this death toll could raise, as about 50 persons are still being treated in different hospitals. It has now been established that unsafe syringes and injection needles has caused the spread of hepatitis B in the Gujarat town, what is now being seen as one of the biggest hepatitis B outbreaks in the country.

Following the inevitable knee jerk reaction, the government has clamped down on many doctors and chemists claiming medical negligence. Doctors have apparently been using unsterilized and used recyclable syringes meant for single use but it is quite likely to be a case of too little action and too late. Although the cases of hepatitis B have thus far been found in Modasa taluka of the Sabarkantha district, it is quirt possible that the virus may be spreading in neighbouring districts also as the use of unboiled syringes and disposable syringes being recycled is not likely to be confined to just one location. The hepatitis B virus is transmitted through contact with the bodily fluids of an infected person. The virus can be transmitted via unprotected sex or sharing of contaminated needles. Pregnant mothers also tend to pass it on to their babies.

Chronic carriers have an increased risk of developing liver disease such as cirrhosis or liver cancer, because the hepatitis B virus steadily attacks the liver. Considering that these are exactly the methods by which HIV spreads, Hepatitis-B virus (HBV) remains a major public health problem with an estimated 350 million carriers worldwide, out of which 40 million are in India. HBV is more infectious than Hepatitis-C or the Human Immunodeficiency Virus (HIV) and chronically infected individuals readily infect unvaccinated members and sexual partners. Hepatitis B is a disease more lethal than AIDS, claiming more lives in a day than the latter does in a year.

The whole episode highlights at least three things. Firstly, the depths to which the medical profession continues to sink: doctors, let alone contribute to any cure or healing are now actively contributing to patient deaths, breaching the sine qua non of the medical profession of doing no harm. Secondly, the need for blood safety and prevention of transfusion associated infections in the country has come to the fore and though because of the spotlight has been there for long on the blood banks to screen blood, not just to rule out Hepatitis B but also HIV, a lot still remains to be done.

Thirdly Hepatitis B is an expensive disease to treat and the results are not usually so encouraging, with an efficacy of only 30-40 percent. However, a relatively affordable vaccine is available to prevent it and Hepatitis-B vaccination has now become the part of the primary immunization of infants in many countries and is being administered in many parts of India in the National Immunization Program. But this is not generally known and widely administered in India, which is why the people in Sabarkantha fell victim to it in the first place. May be the deaths occurring in Gujarat and the international attention it is drawing, will make a difference in the numbers of people queuing up for the vaccine and the government making it available at far more cheaper rates than presently available.

Novice Interpretation of Dreams

Suresh Naig — Sat, 7 Feb 2009 05:12:35 EST

Do dreams have meanings? This single question had generated many answers in the past and I am sure many more are in the queue. Many a time a single dream would throw different meanings, and all the meanings might appear right. I started reading many books to understand my dreams, but the more I read the more I was confounded and I solicited the views of many learned pundits to decipher my dreams.

Had it not been for the recurrent dream, I would have stayed happy like all my other friends, singing duets with Hemamalini and Waheeda Rehman, around a tree. My dream was like a cardiologist’s expression of a certain heart condition- "regularly irregular", in haunting me.

For a very long time, I used to get up in the middle of a night, soaked in sweat. I used to dream an elephant chasing me and my feet stuck in ground like an automobile stuck in slush, not in a position to move. By the time the elephant comes menacingly close to me, I used to get up from the bed soaked in sweat. The dream was recurrent for two reasons, primarily because of my fear of the huge animal and secondly, not even once I had allowed the dream to complete, by waking up in the dead of night. Taking pity on me, a wise man in our neighbourhood, who was respected for his divine disposition, advised me to visit a local Ganesha temple regularly for 21 days to rid of my haunting and incomplete dream. Closing his eyes in trance, he pronounced that I had left a vow unfulfilled in my earlier birth to Lord Ganesha, which gets reminded in this birth through the haunting dream.

My visits to the Ganesha temple had to be abandoned in less than two weeks, since the regularity of my elephantine dream increased with my regular visits to the temple. The wise man was very creative like all soothe Sayers, he declared, ‘God wants your previous karma to linger for some more time and that’s why you could not complete your 21 days visit to the temple’, which I believed for a long time, until I came across a well read person with a scientific bent of mind, who believed little in God and very little in previous births.

He narrated the famous dream of Singer, which was instrumental in perfecting the sewing machine. He said, ‘Singer had perfected everything other than the needle for the sewing machine. He was confused as how to mount the needle in sewing machine, which had a hole at its hind portion. One night he dreamt, that he lost his way in a forest and surrounded by aborigines. He suddenly woke up and got an answer for his pressing problem, because he saw all the aborigines were carrying spears, with a hole in the front.’ My session stopped with him as abruptly as it started, from his very first proclamation. He told me with an air of superiority, ‘all your dreams, I am sure would have been only in black and white and never it was colourful.’ He had only reproduced what he had imbibed from many books and had it not been for the timing, he would have succeeded in convincing me.

Only the previous night than his pronouncement, I had dreamt Rakhi attired beautifully in a pink coloured saree confusing me sufficiently, since that saree was the favourite of the most favourite girl in our neighbourhood. As I grew in age my fear transformed to inquisitiveness, to find the climax of my dream which was prolonging like the never ending TV serial, but to no avail. The dream had abruptly stopped, queerly coinciding with my marriage. However I could not muster enough courage to discuss the haunting dream and the timing of its culmination, to my healthy wife who always considered an hour-glass figure as unhealthy.

There was one dream which turned out profitable for me, due to an innocent interpretation by a wealthy aunt of mine. When I narrated a phenomenal dream of mine, of visiting a temple in a wooded area on a river bank, and curiously worshipping the presiding deity carved out of an onion, my aunt became emotional and said that her family deity, “Marthanda Bairava”, who is fond of accepting onion as offering, had blessed me through my dream. That dream was phenomenal, as it bestowed on me a sizable inheritance from her, but the real reason for that dream was due to my unusually high quantity of raw onions ingested during dinner from a Marwari Bhojanalya and going to bed without brushing.

Photo Essay: St. Barts in London

Dr Bhaskar Dasgupta — Tue, 3 Feb 2009 07:43:05 EST

Last year, I had to lecture on offshoring at the Worshipful Company of Information Technologists. But typically, Muppet BD arrived a few minutes early, so I took the opportunity to wander around this part of London as I have not been spending much time there. (you can click on the photos to get a bigger image). Here's the location. View Larger Map

This is the Worshipful company's hall. And a lovely little hall it is too.

If you are blessed with a bit of an active imagination, you can just imagine how this place used to be, just outside the old London wall, dim, narrow and dingy streets and the old curiosity shop at the far end.

This area is surrounded with other company halls. You can see the sign which leads to the Founders Hall, belonging to the Worshipful Company of Founders. (hint: foundries? geddit?) There's the Founder's Hall on the right hand side picture. See the hall with the flag?

Another couple of views of the St. Barts Church.

Lovely pink flowers on the way.

A sign on the side of the church, talking about Damien Hirst.

The letter box for the church on the left. It's a very old church, established in 1123 AD. Here's the history of this lovely old building. It is venerable, look at the flagstones, sunken and broken, now has a warning traffic cone sitting on top!

The stone work is impressive and quite detailed. On the right is another view of the stone windows. Notice the iron bars? Bloody hell, that would have taken some casting. And you bet it will be safe, but looking at the size of the bars, I wonder if they are not only for security, but also for scaffolding or structural support? Looks like it, no? Interesting ironmongery.

The walls were coated by these flint like rocks which are mortared in. From a distance, they do not look impressive, but on a close up one can see they have a strange unique beauty. On the right, we see a checkerboard design on the walls, between those flint like stones and actual stones (Albion stones?)

The transept side of the church. Lovely statue up there but too high up for me to make out who it is. You again see the two windows with the interesting ironmongery. On the right are the solid oak doors. There is a specific word for these doors which escapes me at this moment. (Is it called transept door?, or facade door? can anybody please confirm?)

Here is the north eastern side of the church and as we move to the right, the fence shows the entrance from the side to the churchyard. You can see how venerable and ancient the walls are. No wonder this church has been used in so many films.

A lovely bed of flowers adding a nice and colourful touch to the weather-beaten walls.

The fence. I like the buttressing ironwork. Pretty heavy duty stuff. Moving a couple of feet inside, you can see that it is actually not such a big yard, just a few little bits and bobs. Notice the plaque at the bottom of the tree next to the path?

The bloody pigeons have *shat* all over it, but you can still make it out. It says, "Taxus Baccata (English Yew) Planted by the Revd. Dr. N. E. Wallbank Rector and Rev. Brooon Elowre, Treasurer of the Hospital to commemorate the 650th anniversary of the foundation of the Priority and Hospital of St. Bartholomew in SmithField".

Did you catch the name of the tree? English Yew? This tree has an ancient lineage and has a fascinating history, read the wiki article in here. This tree has connections with Caesar, Avicenna and what I knew before, the use of the wood to construct the famous English Longbow, the feared weapon. Fascinating history about this tree and its use in the longbow, but I am digressing.

I noticed this grill on the ground. Seems like a cover for a passageway which has now been made defunct. Can you see the erosion on the foot of this buttress wall on the right? Looks extremely old to me. I guess the church keepers kept on increasing the height of the ground slowly over the centuries and now you end up with the church base far below the ground level.

Usually a churchyard contains numerous graves, and for a millennium old church, this yard would be expected to have absolutely huge numbers of them. But no, not many graves at all, and whatever was left, was too decrepit and worn away (yes, from the pigeon droppings as well, bloody things are feathered rats, disgusting acidic droppings create havoc with stonework). Apparently they moved all the gravestones to the sides, see the picture on the right and the next one. The gravestones are cemented into the wall. Obviously, they no longer relate to the actual burial place. Something strange here, I need to do some more research about why this happened.

The angle of the corner of the building which encloses the Radiating Chapel (I think, I did not get a chance to get inside the building). But this church has been torn down, set fire to, bombed and what all, so it has a very eclectic collection of architectural styles)

Well, you have been told off (but more on this later), no drinking in the churchyard, but the right hand sign shows that the garden is maintained by the Worshipful Company of Gardeners.

There was a very narrow passageway at the bottom. With a tiny gate, that couldn't be more than 50 cms wide. If you follow the passageway, you can see that it ends at a tiny door. Looking down on it, I felt like Alice in Wonderland like the picture below:

See what I mean about the bloody pigeons? I can identify with this song "Poisoning pigeons in the park" by Tom Lehrer. Mind you, the people living around the church yard are no better, poxy chaps were dropping, erm, the rubber receptacles which are discarded as an integral part of post coital activities. Philistines, I tell you. In a church yard, of all places!

Despite the presence of the sign forbidding any consumption of alcohol in the church yard, you still have this wino who was there.

Looking back at the church, see the sunken door on the right? The entrance to the church is down a ramp. Just shows how the surrounding land has gone up over the centuries due to soil accumulation and and and.

Here is the walled off garden. I wasn't sure if this was church property or some body else's garden, but what the heck, here you go.

Another sign for St. Bart's and then a shot of a tree, with a nest. I think its a magpie nest but I am not sure.

If I turn around, I see this absolutely wonderful tiny doll like ancient gatehouse.

Made in 1242 and restored in 1932, see the smaller picture on the right? Just look at it, the beams of wood are hundreds of years old, the window panes are held together by lead casings. Absolutely brilliant.

As you step outside the gate, just to the left you find this rather hidden war memorial with a beautiful black Christ on a crucifix. The gate stonework is beautiful, and the brick wall on the right is obviously a much later addition, which has hidden a now bricked up side archway. A poppy wreath is delicately kept below the war memorial. The whole thing is rather sad, with some boxes of potato crisps and stuff just lying around (suspect it's from the convenience store), with plastic bags and a discarded newspapers. How soon you forget. The inscription is particularly poignant:

"Hallowed in Christ, Be the memory of all the gallant men and women who fell in the Great War for the Freedom of the World, they shall yet stand before the throne an exceeding great army and in that last muster shall be found these our own beloved".

followed by a list of names of those who have fallen from various regiments, arranged by rank. It is a bit curious about why this was placed here, and the collection of names and regiments. Hmmm, another mystery. The road is called as Little Britain. Curious name, no? The gatehouse looks so strange, juxtapositioned between two totally different styles of buildings.

But moving on as I was running short of time now.

This is the corner of St. Bartholomew Hospital. A plaque is setup, which was erected in 1870 by the protestant alliance. A few chaps were burnt to death near this spot way back in 1555 -1557 (John Rogers, John Bradford, John Philpot, etc.) It has something to do with the fight between Catholics and Protestants.

We come to the plaque on top of the entrance to St. Barts Hospital. I am going to quote this from here.

Founded by Rahere, formerly a courtier of Henry I. It was founded, with the Priory of St Bartholomew, in 1123 by Rahere, formerly a courtier of Henry I. A vow made while sick on a pilgrimage to Rome, and a vision of St Bartholomew, inspired Rahere to found a priory and a hospital for the sick poor at Smithfield in London. In the early medieval period the sick were cared for by the brethren and sisters of the Priory, but gradually the Hospital became independent. It was using a distinctive seal from about 1200, and by 1300 had its own Master. By 1420 the two institutions had become entirely separate

Finally you have the memorial to WIlliam Wallace, who lead a fight for Scottish Independence, who was captured and put to death near this site in 1305 AD. The death was pretty gruesome, and I quote:

Following the trial, on 23 August 1305, Wallace was taken from the hall, stripped naked and dragged through the city at the heels of a horse to the Elms at Smithfield. He was hanged, drawn and quartered — strangled by hanging but released while still alive, emasculated, eviscerated and his bowels burnt before him, beheaded, then cut into four parts. His preserved head was placed on a pike atop London Bridge. It was later joined by the heads of the brothers, John and Simon Fraser. His limbs were displayed, separately, in Newcastle upon Tyne, Berwick-upon-Tweed, Stirling, and Aberdeen.

They REALLY did not like him, did they? There are couple of additional plaque's on the wall below the memorial.

Full slide show here.

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