Saving the world requires a lot.

            A congressional briefing on HIV/AIDS sounds good and infact is a wonderful opportunity to brainstorm about global public health issues with the elite in public heath industry. Having found one such occasion I was all geared up to attend it. I went out on Black Friday and got myself a good dress for the occasion. To friends I described the event and hoped they would attend the same, providing me company in case the event falls flat and does not meet expectations. Informed people at work that I shall come late to office, if I may; utmost care was taken for the briefing. Knowing my usual habit to sleep till late, my mind was all prepared to sleep before my usual hours the day before the event. But when you least expect it, 'PROBing issues with LEss interest in Me' crop up- perhaps the reason why they are called 'problems'. A good friend needed some help on an assignment and I was eager to help, so I ended up sleeping beyond my usual time but only after finishing the 'problem'. Next day I was woken up by a phone call, guess the night's work was still not complete and another hour was spent helping. 

             Now, don't take me wrong, I love helping my friends and of course they come first before all these stupid 'Save the World' Problems. So once done with the assignment helping, I saw the clock to see I still had around an hour and a half for the event. To make things better, I live in the shadow of the Capitol and a brisk walk would mean I would be at the venue in 15 minutes. So there I sifted through my wardrobe swiftly and took me only a moment to decide what I was wearing. Of course shopping before had helped, but the quick decision was more facilitated by lack of options; I had not done my laundry for the past 2 months. Of for a quick steamy bath, I trimmed and groomed my beard, took extra long to fix those layers of clothes you are supposed to wear to weather the cold out here. Even after having my breakfast, I was still done my 10:58 am and had more than half an hour to reach my venue. I was so happy that today I shall not be late, like I had been on a previous occasion for the same event and venue. I had misread the time to be 11:30 instead of 11:00 am on that occasion, and realised my folly only when I was ready to leave for the event. Nonetheless, I had reached the place only to find I was late and they had run out of space. But thanks to a friend of mine who was also similarly late for the event, I went out for lunch and could use some of the spare time brainstorming elsewhere.

             Standing in my room with half an hour on my hands, I turned to my email account just to confirm the venue. I wrote it down on a piece of paper when something struck me, there was no 3 in the time the briefing was supposed to start; it was supposed to start at 11:00am! I stood there dumbstruck, not knowing what to blame- my poor eyesight or my oversight. I had done everything to be there at the briefing, what else can I do! What a calendar or timer, nah, that is for the old! 

             All dressed up and nowhere to go, I had no option but to forget about the whole thing. "Saving the world" was not for today, I will wear my cape some other day. I can totally empathise with the superhuman police force of India who always arrives late at the scene of crime, its not their fault, so many people have to be on time for this and keeping time with time is not everybody's cup of tea- me included!

PS: I checked the time for the next briefing, it is indeed 11:30 am. But I also went on and did my laundry, so that might be the reason for not saving the world next time!

Quotes of Wisdom III

"Never keep your moisturizer and toothpaste together. Not all things white and liquid taste good."

In absence of her....

"Damn, I had seen it earlier", were the thoughts in my mind as I stood there shifting through the knives and forks in my kitchen. I looked in the drawer, the cabinet, the wash basin, everywhere but to no avail. In desperation I even went to my landlady even she did not have it. It was final then, I had the wine, the occasion and the company but I did not have a cork screw to open the bottle. I could hear Mrs Gaur, my maths teacher in high school, laughing as her words had come true, "One day you will realise the importance of paying attention to detail, and then you will remember me." Not to be outdone, I embarked on a mission to open the bottle come what may. I thought what could a cork screw do that pins, needles and knives cannot achieve. I poked the needles and pins at various angles inside the cork and once I was done, with a smile of achievement, I pulled them but the cork stay put; I was screwed without a cork screw. I tried this and that but the cork would not budge an inch, it had holes all over it but it would just not allow me to get in. Frustrated and out of wits, I decided I would get my revenge, I took the knife and stabbed the cork violently as a man possessed. It bled, it bled wine but only a trickle.

All this while my date was standing along side me and looking at my unsuccessful attempts of being able to poke, but I was hoping that she was dumb and could not put two and two together. The foreplay continued for a while when she passed a snide remark, " We should break the bottle open" she said in humor. A girl suggesting me what is to be done, what is to be done with alcohol, how I should open something, that was too much for me to take. But I had apprehensions too, how will I break it open, what if I will not be able to open it, what if there would be no wine... However, masking my apprehensions, and to display my masculinity to a hilt, I said a yes and even before she could utter another word, I was halfway down the stairs going out in the garden.

By the time I had was out, the adrenaline had gone and sanity was trying to take over me. I looked back inside the house and saw her descending down the stairs; testosterone took over from where the adrenaline had left and in a moment I was hitting the bottle on the grill. I could have burst the bottle open with a heavy blow, but as much as my testosterone wanted the bottle open, it also wanted the wine to be inside the bottle. Truly ravaged by this hormonal caution, I sat down and tried to brick it open. After a couple of tries, desperation took over caution and bham, the bottle was open. In moments I poured the wine into a pan, and thought of sifting through it for glass, but the estrogens had also started to boil and there I was striking glasses and hoping for more in the course of the night... That that wine tasted like manna, would be an understatement. I did not have a cork-screw that night, but I could screw the cork out.

PS: I got another bottle of wine a couple of days later, and again not listening to Mrs Gaur, forgot to bring a corkscrew. That bottle still sits on the table- eyeing me everyday, wanting not something to open it, but that someone to open it. Waiting for that night, when she will be back, if ever....

How might the ethos of individualism assist and complicate public health efforts to enact anti-tobacco public policy and campaigns.

In an individualistic society like US, the focus is on individuals and their progress and freedom; the rationale behind this being that progress of one man when accumulated by many will lead to the larger good of the society or the country. On the contrary, eastern and south asian societies largely focus on the larger good of the family or the society and individuals are of lesser importance in front of the larger good of the country. The different ethos of individualism affect how people of these varied cultures perceive health policies and enact them. This is especially true for public health problems like tobacco use, where prevention policies may lead to a clash of the individual freedom with the society good.

Although the decision to consume tobacco is largely individual, it is influenced by societal parameters and also influences the society as a whole. In an individualistic society, impression about a particular habit for the whole society is never formed or projected well. Smoking may be considered grossly inappropriate by people and individuals yet in the space of individual freedom, a group impression of smoking being inappropriate is not formed and even if formed, not projected as well on the individual. This is in contrast to other societies where every habit of an individual is scrutinized and a positive or negative connotation attached to these; the society has and projects an image of each individual based on his/her habits. This differing ways in which societies work largely affects the interventions in place and their effect in curbing tobacco use.

Smoking is harmful for the individual and also for those around him, yet most policies in effect largely focus on decreasing use amongst smokers. This is a product of an individualistic society where community is of lesser importance. The ban on smoking in public places is still relatively new in contrast with taxes and warning on tobacco products. Personal freedom is curbed when such policies, as ban on smoking in public spaces is enforced and thus is more difficult to enforce in an individualistic society than others given the same level of human development and other resources. In societies focusing on communities, developing a negative view for a habit in the public has a huge impact. The focus should not be on trying to make the individual to stop smoking by imposing taxes and warning symbols but more on bans in public places which are well circulated within the community. Health messages focusing on harmful effects of passive smoking have a bigger impact on tobacco use than those elucidating effect of active smoking. 

Nevertheless, public health as a field of science is still largely undeveloped in such community societies and largely borrow from tried and tested interventions in the western world where individual is the center of the society. Till these interventions are adapted to differing societal nature, there will be little effect on the public health problem in question. 

Hai milan ki chahte fasle hai darmiya....

Cops....

Waiting for that call which never came, I slept off only to have my sleep broken in the middle of the night. At 2 in the morning, I was lying there in my bed just about to break into sweat but the beads efficiently kept from developing by the fans in the room. The ceiling fan, like a sage was toiling without much ado but the smaller table fan still had to learn, making a noise more than it worked in order to drown the work of the other. And then suddenly the table fan lost the battle and died, it was only after a few moments that I realised that even the ceiling fan had stopped working, electricity had gone. However, the streetlight shining into through my room's window had a different story to tell, someone had purposefully turned off the lights of my home. Still contemplating lying in my bed, I heard her cough but I hoped it wasn't her. I knew it made sense, she was around and had turned off the lights, but I didn't want to believe it as I had little clue of what to do with her. I kept on lying on my bed, lying to myself, knowing that I will have to go and look through the window to see her and clear my doubts, but I rather chose to sleep off. My best efforts of drowning my senses didn't work and I finally stood up and went to the window, once and for all laying all my doubts to rest- It was her. My landlady had a psychiatric condition and having not taken her medication for a couple of days, she was having one of her episodes where she had wandered out of the house without a key for a couple of days.

Having lived with a psychiatrist in the making, I had some idea about how the medical system works over here in USA and thus, thought of calling the police. I dialed the three digit number for the first time in my life, a lady was on the other end and I went of saying it was a nonemergency call but I was interrupted in between. She asked me if I wanted police, ambulance or a fire brigade. After pondering for a moment I thought of trusting the medical world over everything else, "Ambulance", I said. Again I went on explaining my predicament, but the lady cut me in, asking for an address where the ambulance was wanted. I replied back, realising that like any other customer care experience, I was going through a set of automated choices that and that I had no option but to choose one of them, the human element present at this emergency number just to detect for your impending frustration and thus the efficiency of their system. Having learnt a bit, I waited for her to put up questions to which I gave answers and I was done in a couple of moments- or rather she was done. Another couple of moments and I saw the customary blue lights flashing in front of my house, enlightening the otherwise dark interiors.

I was out there in a flash and found the paramedic talking to her himself, she has approached herself. I walked up to him and found him in pretty much the same state I was in, confused about what to do and wanting to get away at the earliest. In a few words he explained it to me that he would be unable to help me, sinking my heart. Asking me to contact the police he gave me a hope which withered away when he explained what conditions were required for them to take her to a hospital and a make her get treatment. Having only experienced the Indian police, I immediately stereotyped the policemen here to be unfriendly and wanting in all earnest not to have any more than an advisory role. The paramedic understood my problem from my ashen face I guess, and offered to ride down a block to a cavalcade of police cars about a block down the road. He left and the next few moments were the longest in my life. I was standing outside my home with her, I was afraid that I had been left alone to take a righteous decision- talk to her and take her inside the home or stand out with her till the cops arrived- both of which were not very appetising.

My worries were over when I saw the cars riding towards me stop next to me and take over the scene. 

What transpired next was a cautious approach to make her agree to be taken to the hospital.  Still apprehensive that they would not believe me that the situation was grave enough and taking leaps and bounds reached up for my house-mate, waking her up from the middle of a sleep and informing her what was happening down there. I just couldn't let go my male ego even at this instant and refused to ask her to come down, leaving it on fate, which was somehow not on my side. She offered a 'K', and bahm, the door was closed leaving me standing there cursing myself. After some time the cops had to use a bit of a force for her own good. I was done for the night. 

I turned back and with leaps and bounds crossed the flight of stairs and dived into the comfort of my room. The whole episode lasted less than an hour however, it will take me another life to finally come to terms to the fact that cops doing their job is not a 'heaven'.

Guyana from an Indian's eye

With every seat occupied, people were sitting on the floor, each one of them carrying more than just the customary two pieces of luggage. Well oiled hair, wailing children with neatly done plaits and a red ribbon, people sitting in customary groups defining family space, adults with slightly bulging abdomens - an obesity level defining prosperity, dull colored shirts tucked in trousers with slippers below, and youngsters in cheap gawdy jeans, t-shirt with big watches or bracelets. A typical Indian setting one would guess, in fact I was so sure that if the strong air conditioner inside the airport was not working, I would be able to infuse the typical Indian odor formed from an admixture of oils, perfumes and sweat. Half drowsy waiting for my midnight flight, I tiptoed between slumbering people and could find an empty seat in some corner. I was trying to catch my forty winks when I woke up, startled by a mobile ringing to the tune of "Jab dil na lage dildaar, hamari gali aa jaana!". And so started my trip to Guyana, a country more famous as a part of West Indies cricket team in India than anything else.

 

The plane journey was largely uneventful, except for my cussing at the sadistic TV screen at my seat, which suddenly had a brain of its own and stopped playing anything, although I could browse through the menu and see all the movies and serials I could have watched. I can vouch that TV screen was an 'Ichchadhari Nagin' and had taken this form for revenge, I could hear her laughing and saying, "Pichle janam mein tumne mujhe bahut sataya tha, ab meri baari hai!". Passing through the immigration and customs was a breeze and soon I was sitting in a taxi speeding towards the capital city of Georgetown. Within minutes of the start of the journey, the driver started fiddling with his ipod while driving with one hand on the steering and scant regard for the twists and turns of the road coming up ahead or people trying to cross the road- ah, I felt so at home- I was so missing that reckless driving!!! I really pity all those road raged Indian drivers who have the horrible experience of driving in USA, who have to control the urge to skip lights and bottle up their day's frustration than take it out on the crossing pedestrian.

 

After some Caribbean songs, I heard an obscure Hindi song playing in the car stereo, I was impressed that the driver could recognise my nationality and hand a song to play for me, although obscure. It was followed by another song that I could never heard but seemed from that 'forgettable' era of late 80s and early 90s. The mystery behind the obscurity of these songs was broken from the third song, when a popular 70s song was being sung in the same voice as the two previous ones albeit a little squeaky voice and added beats - truly reminding of those cheap remix albums that you can hear blaring in buses and auto-rickshaws across India. Excited I asked him in Hindi, but seeing his befuddled look, I had to repeat myself in English, " So people speak Hindi here?", making my careful deduction question irrelevant.

 

Just as we entered the city, I could see a deity being carried by procession of people, effectively blocking the traffic. The frenchman, who was also on an official WHO visit and accompanying me from the airport, was piqued with interest and asked the driver about the procession. I immediately had a hunch that it was Lord Ganesha and that perhaps it might be 'Ganesha Chaturthi', I was raring to blurt it out but remembering my old medical college friends I exercised some restraint and allowed the driver to speak, who did not have to much to offer except that is some Hindu God. Later I did found that it was infact Ganesha Chaturthi, and I could only cruse my well-meaning friends who taught me the word 'restraint' especially when I did not know about things!

 

If there were still some doubts left about the Indianess of the place, the blaring Shammi Kapoor in his black and white twist dances on the TV in the hotel reception area, laid to rest all of them. The cable itself had songs and the K serials playing all over them and the bazaar was laden with shops selling Indian dresses and having Indian names; infact the president's name itself 'Bharat Jagdeo' has an India in it. However, none of the above could have prepared me for what I was going to witness the following morning- my first day at the WHO office in Guyana. By the end of the first hour of the day I had met nearly all of the staff, when I ran into an Indian guy and we started talking. After exchanging pleasantries and detailing my origin (Kanpur), he informed me that he hailed from Gujarat. I remarked off-handedly that I did my MBBS from Baroda, to which he responded, " Which year?" I was befuddled at his question as it didn't make sense to me, if he had not got my city he should have asked which place, if he got the city then why was he asking anything, was he asking about my 'ear' cause he could not see it hidden under my turban? Like a mind reader he fathomed my inner turmoil from my blank face, and also from the long two minute pause after his question, and he added, 'I am an alumnus from Baroda Medical College- I passed in 2000.' What followed was a long discussion of what has and has not been going in the college, but meeting a guy from my own 'Baroda Medical College' out in the middle of nowhere (or so I presumed till that time), was a spooky experience.

 

I can confirm that the first song that I heard enroute to Guyana was not an accidental aural stimulation- it was meant for me- it was India away from India.

 

"Jab dil na lage dildaar, hamari gali aa jaanaa...."

Quotes of Wisdom II

Cooking plain rice with salt is a bad idea for a bachelor. Sometimes you may want to eat the same rice with milk and sugar; salted rice in milk is an exotic yet not an appetising entree.

Quotes of Wisdom

Don't hold a fork in the same hand as a tissue to wipe your face. You may end up with an unwanted nasal piercing!

Spanish Meetings

Today was a day of meetings and not-meetings. From 9 am in the morning when I was in the office till 7 when I finally left the office- it was meeting after meeting. Although the first one in the morning was k, I couldn't speak much. The next two ones were an exercise in understanding people and what they were saying from their body language and hand actions- cause the meetings were entirely in Spanish!!!

To top it, it was all technical- things I was hearing for the first time and that too in Spanish or Espagnol... Great exercise, by the end of the day I could make out atleast what were the different weird sounds they were making, especially the four words I could understand were: Uno, Dos, Tres (from the famous Ricky Martin song) and 'Si' or yes in spanish....

Of course I was passing on my uncomfortableness to any one and everyone who dared a look at me. I was constantly staring at the speaker, following discussions with swift movements of my head, as if looking at the lips move would make do for my virtual deafness. Nonetheless, despite my best efforts to look involved and interested, the head of communicable diseases did ask me at the end if I understood Spanish. Much to my dismay I had to reply in the negative, however, I guess it was better that I did not understand any word or else I would have realised much earlier what I found out in the last presentation which was in English- that all those people were going over the same muck but only the name of the disease changed.

Resting in peace of hindi songs and english language at my place right now, tomorrow is another onslaught of a crash course in Spanish.

Pan American Health Organisation

I have only been at my internship for a week and a half but already I have seen a lot, a lot of what it is to be in a big organisation and how things are achieved. They say that a minimum of 2 years of experience is required for almost all jobs in the field, but I guess they have a reason for that. I came into this organisation hoping to be in the thick of situation, a place where decisions are taken in split seconds and lives changed continuously- a panglossian view of the world is what every colleague of mine walks out of the school with. It takes time to come to realise and then some more to accept that significant advances in the field of providing health to all are only achieved by constant and committed efforts, most of the time moving at a snail's pace. The optimism and belief in our abilities when we leave the school ready to enter the world soon gives away and for a brief moment you are left in a lull- bereft of sense and direction. This is what internships are all about, a grasp on the practical view of the world. I have been in thick of things over here in PAHO, have been dealing with numbers and policy recommendations not made at a local or community or state level but at a regional level. The reach of my work is immense and that in itself is satisfying. No doubt that when I see the speed at which work is done, not because work is not being done but because of the layers of authority and official decorum of getting work done.,I feel that the whole idea of a world organisation is a sham and needless. I feel all the work is being done at the ground level and my work sitting right at the top is of not much use, I could do much more working there in the field. Nonetheless, the field worker would not be able to function were we not here in the larger organisation which ensures funds exist and reach the person in the field. We ensure that those working at the grassroots work in a fashion that ensures maximum utility of their effort, that they do not end up achieving the same results but in a much less efficient manner. The machinery works, works slow, slower than we expect it to, but changes of the sort that we imagine have not happened overnight and will not happen.

More of my ramblings later.

Isolation of Extensively Drug Resistant (XDR) Tuberculosis Patients

Tuberculosis (TB) has been a scourge for the human society since time immemorial. In recent decades, the disease has gained significance as a public health problem in USA; increased incidence of TB has been reported owing to the HIV epidemic. Public health system has responded by isolating patients when they are infective and ensuring their proper and complete treatment. Completing treatment is vital to prevent latent infection and to decrease the development of resistant strains. The recent emergence of extensively drug resistant tuberculosis (XDR-TB) has posed a new challenge for public health. XDR-TB is highly fatal with only 30% clinical cure rate being reported. The routine public health response to TB cannot be justified for XDR-TB, particularly as treatment has a high failure rate; isolation of infective patients remains the only other viable option. The present paper addresses isolation as a strategy for containing XDR-TB infection in USA and analyzes its ethical justification.

TB is a public health threat as most Americans have never been exposed to the disease and run the risk of getting infected if exposed, which is higher in immune deficient states like that of an AIDS patient. But unlike other highly contagious respiratory infections like influenza, TB requires a close contact for a relatively long term for transmission (Victorian Health Government Information, 2008). XDR-TB strain of mycobacteria tuberculosis has a higher resistance to medication, but it is not a more virulent strain. The concern in spread of XDR-TB is that the disease is highly fatal (Singh, 2007). Prevention of disease, rather than treatment, takes precedence and thus, isolation of infective XDR-TB cases is necessary (Childress, 2007).

Isolation is a time tested strategy for preventing the spread of TB. A patient is isolated particularly when he is infective, which is defined as the presence of mycobacterium bacilli in the sputum of the patient. Isolation could be voluntary on part of the XDR-TB patient or be enforced if he/she were to not comply with directives. When enforced, isolation would infringe upon the right of freedom of an individual, yet he would be a threat to public health if not isolated. The 'harm' principle proposed by John Mill ethically justifies isolation (Parmet, 2008). He believed that limiting the liberty of an individual is justified if it is done in order to prevent the person from harming others. Professor Lawrence Gostin has stated:

Classic liberal philosophers from John Stuart Mill to Joel Feinberg, argue that,

while individual freedom to engage in self-regarding behavior is near absolute,

"other-regarding" behaviors have distinct limits. (Gostin, 2003).

If the individual is infective and knows the risk he poses to others, then he should choose to isolate himself or can be forced into isolation (Ergo, 2007). However, the use of force is justified only if the person acts as a threat and not if he is only a risk to public health. The distinction between threat and risk has to be elaborated here—a person is a risk if he has a contagious infection but is a threat if he knows this fact and makes a deliberate or negligent act of infecting others. Knowledge of disease status and the level of risk posed to public health are necessary before a XDR-TB patient can be coerced into isolation.

Mill also argued that although harm principle provides a necessary justification for limiting a person's liberty, yet it was not sufficient enough (Parmet, 2008). Thus, even if isolation were to reduce the risk of harming others, it may be unjustified. Infectivity in XDR-TB varies along a spectrum from highly infective patients with mycobacteria in the sputum to minimal infectivity seen in people with latent infection and suspected exposure to XDR-TB (Selgelid, 2008). Isolation can be justified for highly infectious patients who are a public heath risk but not for people with latent infection or suspected exposure. Defenders of isolation would argue that even a minimal risk of spread of XDR-TB should be countered and even people with latent infection should be isolated. However, individuals with latent XDR-TB infection can be compared to people with HIV- both carry a minimal, yet possible risk of spread of a fatal disease. Restriction of individual liberty in this scenario is not in proportion to the potential harm that can be caused to others (DuBois). Provided that people with latent infection take regular treatment and those with suspected exposure use a face mask until a confirmatory diagnosis is reached, none of them should be isolated.

In case of TB, isolation is limited for a period of time of infectivity which may last from 2 weeks to 2 months, yet it is a comparatively short period of time. In XDR-TB the period of infectivity may last for months to years, sometimes until death. Consequently, isolation would be required for life for some XDR-TB cases. This may not resonate well with the moral norms of most people and lesser restrictive alternatives may be sought. The use of face masks by the infective individual would serve the same purpose of isolation and is not as restrictive. Yet, this strategy may be fraught with a higher risk of spread of XDR-TB if not properly used. Nevertheless it is a viable solution which should be considered as an alternative strategy for preventing spread of XDR-TB. An infective XDR-TB case may be isolated in a hospital or at his home. Clearly, isolating him at his home than at a hospital would be less restrictive and hence, more justified. For a homeless person, isolation in hospital may be the only possible alternative, yet the environment should be such that it favors treatment of the individual like an improved ventilation system.

Conclusion:
XDR-TB is a highly fatal disease and isolation of XDR-TB patient is ethically justified. Yet isolation is highly restrictive and should be limited to infective XDR-TB cases, with use of face masks favored wherever possible. When required, isolation should be enforced only after informing the person of his diagnosis and explanation of potential threat to public health. Home isolation should be preferred to hospital isolation.

References:

Childress, J.D., et al (2002). "Public Health Ethics: Mapping the Terrain," Journal of Law, Medicine and Ethics, 30(2), 170-178.
DuBois, J. "Justifying Decision When Values Clash", www.emhr.net
DuBois, J. "Framework for Analyzing Ethics Cases", www.emhr.net
Ergo. "Medical Ethics and Moral Dilemmas." Leitmotif- Reason as the Leading Motive. 15 Dec. 2007. 01 Dec. 2008
Gostin, L. O. (2003). Dunwoody Distinguished Lecture in Law, When Terrorism Threatens Health: How Far are Limitations on Personal and Economic Liberties Justified? Florida Law Review, 55, 1105–1170.
Parmet, W.E. "J. S. Mill and the American Law of Quarantine." Public Health Ethics Advance Access published on November 1, 2008, DOI 10.1093/phe/phn029. Public Health Ethics 1: 210-222.
Selgelid, M. J. (2008). Ethics, Tuberculosis and Globalization. Public Health Ethics, 1(1), 10-20.
Singh, J. A., Upshur, R., & Padayatchi, N. (Jan 2007). XDR-TB in South Africa: No Time for Denial or Complacency. PLOS Medicine, 4(1), 19-25.
Victorian Government Health Information. "Tuberculosis - air travel for patients with TB - guidelines." 15 Jan. 2008. State Government of Australia. 02 Dec. 2008.

Swine flu is a pandemic! So...?

Swine flu was declared a pandemic by WHO of level 6 on June 11. So is the world going to come down and is an apocalypse round the corner? Apparently not.

" As it stands today, there is little cause for immediate panic. Out of 30,000 odd infected by swine flu, only about 145 (June 12 WHO figures) have died. This is comparable in severity to seasonal flu infections, whose annual death toll worldwide is 200,000 to 300,000. If this level of severity continues, then it is unlikely to be more than a mere blip in global health scenario. WHO's chief flu expert Keiji Fukuda in his June 9 briefing said that with more around the world becoming infected, immunity to the virus will build up. At that point, this A (H1N1) variant will be just another seasonal strain, joining three others—including a human A (H1N1) strain—that are currently circulating. Read this at http://www.politicalaffairs.net/article/articleview/8713/

The concerns in flu are not of mortality or morbidity but that of mutation. The present drugs - zanamivir alone or with a combination of oseltamivir are potent to counter the infection. Nonetheless, with the spread of the virus and thus the number of replications the virus might be undergoing, the chances of a viable more potent mutant form only go up. That is the reason for scare in most cases if any. So even though we have a pandemic on our hands the severity of the disease is not high and so our response should be normal and not guarded. However, where does our Indian government stand in its response to the flu?

" In India, while primary health centres and hospitals lack vital life saving medicines, under the pressure of headlines, Indian government stocked up on Oseltamivir earlier and may do so again. To compound this folly, the Indian government head disregarded the generic version of the Oseltamivir being manufactured by Cipla during the outbreak of bird flu and decided to buy the more expensive one from Roche under the "mistaken" belief that Roche really had a valid patent. Ultimately, the Indian Patent Office did not grant Roche a patent for Oseltamivir, paving the way for generic manufacturers such as Cipla to meet not only Indian requirements and also supply to other countries. 

Its easy to criticize in retrospect any policy decision, much less preemptive actions are always ones to be targeted more. Nonetheless, that the government did sit up and take a stock of the situation is in itself commendable as most of us usually expect a lackluster response from the Indian government.

All in all keep a watch but don't get psyched up by the tag pandemic.

At sea

I am not a perfect guy nor will I claim to be. I came into this world and my parents guided me through my life telling me what was wrong and right. It was a beautiful time cause everything had well defined boundaries. But then somewhere along this way, I left them behind and ventured out into this world on my own. I had friends there who were travelling the same path and kept me company. I started burning my fingers and learning life and world the hard way, yet it was fun cause the friends made it worthwhile. Often you made mistakes but your friends forgave you cause they were innocent and travelling through the same road making the same mistakes and knew that you were not perfect but you did aspire to be. But even they got lost and what remained was you and the world. Alone and at sea, where there was land all around you yet the closest one was below you. Often I swam alone with no direction but a sense of purpose, a purpose to find land and my destination. A purpose to be able to stand straight on my feet without any fears. On this journey I met you and found that perhaps it was not the destination that mattered at all. I was having such a lovely time swimming along with you, wading through the waters, gulping a lot of that salty water but it was ever so sweet, cause I saw your smiling face along side me after each one of those moments. I hoped at times that I may have chosen the wrong path, that land was never to be found and that I could swim with you forever. Many a times I swam away but you called me back taking my name and telling me the right path. I was foolish, I thought you were wrong at time and would take my own sense to be perfect but I realised it was not about being right, it was about being with that one person who could make you smile and about whose smile you care and would do everything in the world just to be with her. Even if it meant to stop heading anywhere and just to stay afloat in one place with that person seeing her each low or high tide, each night, each day and never get tired of it. In you I have found that person, that solace of having a partner that would be with you on all journeys. Who would saunter along with you if you wish and giddy up when you liked, that person that you can take for granted yet you never do, that person around whom you want to spin your life around. No person is perfect and nor will she be, nor will I be. We both will make mistakes but when you do make a mistake you go back to the person who would be willing to embrace you with open arms, and if she makes a mistake you would be not act sensibly but wait up for her to turn back and look at you and see you there standing and waiting for her with open arms. It is these trials and tribulations, going away and standing ground, being hugged and hugging back that you make a life perfect cause you have both walked wrongly but had the other person to tell you that you did err and had the other person to correct you and guide you ever and forever.....

I hope one day I would be that person to you to as you have been to me. Forever in love with you.....

Astrology or Astronomy?

Humans have an innate desire to know. It is this desire that has spawned over generations to create the world that we reside in today. When we say a man has a desire to know, we assume that the man is thinking rationally, according to the present socially acceptable norms of rationality, and is progressing towards a state of higher knowledge. There is a positive connotation attached to the desire of knowing and any act motivated by this desire is deemed 'right'. However, society has changed over the years and centuries, what was rational yesterday is considered foolishness today and vice-a-versa. An apt example would be the distinction between astronomy and astrology. Although both are based on the study of stars and its movements, we consider astronomy to be the science which is enlightening and astrology to be one with blind faith. Perhaps that may be true, for astrology is from the era when stars were still considered deities and gods were in plenty. The pagan culture of the day infused in men the fear for natural forces and assumption of a heavy influence on their present and future. Rocks, stones, and boulders everything was worshiped and treated with awe and reverence. From this culture originated the study of stars, which had mesmerized man for long.

The scientific temper that we associate with astronomy, has a basic tenet that man should strive to know. Knowledge has a positive value expectancy attached to it. Yet, this knowledge has to be based on scientifically verifiable facts. Isn't that a more parochial outlook than you would expect from an enlightening science? If something is based on science its correct else it is false. Is that not a vicious loop where knowledge has to have science which is derived from knowledge of science. Where is the creativity here? Can no new hypotheses be made without being scorned upon, or assumptions made without proving them? Isn't science itself based on assumption. Let me elaborate this point further.

We believe that all natural organisms exist to breed and further their race. Reproducing is a natural part of life and perhaps the only goal of life. Here the positive value expectancy is based on life. Anything that furthers life is positive and so is reproduction, which extends life or creates a new life form. Everything that decreases or ends life is negative- death, manslaughter, suicide. Diseases are negative as they carry the potential of ending life. Whatever we have learnt after that is based on this basic tenet that life is positive- yet can any one suggest a way of verifying this information? What is life itself was negative in a different ecosystem or in a way we still do not know and are unaware of ?

Some of you may consider this to be absurd, but so was it absurd when someone thought or making a screen you could read this blog on a few centuries from now.

The innate desire to know can be extended to one's future. Should a man not be interested in knowing what does the future hold in it for him? Why not, he should. Then why is astrology, that predicts your future with uncertain precision, looked down upon? Why do humans have to take decisions based on the presently accepted social norms of rationality. Had Rutherford given his model of an atom today, people would have scorned on him yet he is considered as someone who boldly lay a hypothesis, although false, that has led us to the discovery of quarks today. Astrology may not be correct, but can we not look into ways of predicting the future of a person based on some permutations and combinations and make that a science. It does not have to depend on stars, normal human actions and the environmental knowledge, mixed with market predictions and health statistics could end up making a good prediction for any person. What we need is not to scorn over astrology, but the way it is practiced today. Man will always hunger to know his future and sooner or later we will have to explore how to do that.

Human

Isn't it strange, whenever we have a fight, all we remember and discuss are the negative things, never the positive. Why is it human to take all the good things for granted and worry only about the negatives. Just like sadness and anger why don't we remember every time we were happy, glad, or ecstatic? Most of our actions and reactions are based upon how and when we we felt when we were hurt, and you try to weed out the root cause for that hurt, but are our actions to bring in that event or person that brings happiness to us on the same level of intensity? Do we work more to avoid hurt or more to get happy?

As humans we are satisfied if in a relationship we have a long average phase interspersed with small times when you get happy. Contrarily a person that makes you ecstatic but also ends up hurting you once too many is considered a bad choice. But isn't it agreeable that the more happy a person can make you feel, the closer you get to that person and thus larger the hurt that you have when he/she doesn't match up to a certain prefixed funda of yours. However, I am no different and tend to focus on the negatives more than the good times and taking decisions based on them.

Sometimes

Sometimes in life you are confused and without light, but not ready to admit it to others. At least not to ones who used to be near and dear to you because you wonder if they would see you in a lesser light given your doubts and apprehension. They have always marvelled at your uncluttered decision making process and have looked up to you for this. At these moments you don't want to show them your weak human side. It is beyond doubt that everybody goes through this process, but when you have always wondered why people have had these moments it is hard, maybe egoistic not to accept that a such a thing can mar you too. Nevertheless, in spite of these conflicting thoughts the problem, the conundrum remains and you keep on leading a life with doubt in your mind. This just in turns affect your own decision making and further increasing the confusion - a vicious cycle. It is very easy to break it- just talk to someone, but your ego and your own perception of people comes in the way. This more so if you want to go on a path much less travelled and fraught with risks, as most people would advise you to the contrary- the normal safe path. The mere reason you are confused is that you are not able to prove it yourself that the path you want to take is right, which to many means risk free. In fact you are also looking for that solace that the road less travelled is so because people never slowed down to see that one and that the home at the end of that road is something people never aspired to be at. You are fine with the road being less frequented but not one that is a mine-field. However, how are you ever to know about this else ask someone who may have followed it, but if only you could find someone like that for you have already branded it as a less frequented path. Amongst all this confusion I reside, holding on to my beliefs and making myself believe that all will be rosy, and if not then I will have the resolve to weather it out. I can relate to the anxiety and strength of character, the resolve and the driving force of all those explorers who have   risked it all, some could make a name and some, people think, may have died of shame. I wonder what I will be branded as a pioneer or a fool, but I will risk it, risk it all.