Saturday, June 17, 2017

Augmentin, not nectar

A few days back, I stopped by at a pharmacy to buy some medicines. I overheard two other customers talking.

"Augmentin 625 mg - 10"

"Oh Augmentin. It's a very good medicine."

"You've taken it?"

"My uncle had an infection in his feet. He took this for five days. He was totally cured."

"Ok. I have been asked to take it for a cough."

Well, nothing wrong with that. Except that the second guy's tone was very casual. He sounded like he would take Augmentin for any minor problem.

Many people don't realise the dangers of taking antibiotics without actually needing them. Several studies have shown that bacteria are becoming resistant to several antibiotics. This has a lot to do with indiscriminate use of these drugs.



India, especially has been blamed for allowing pharmacies to dispense antibiotics and several other drugs without prescriptions. Some doctors too are known to prescribe antibiotics where they can be avoided. Patients are happy with the quick-fix they offer.

Apart from having some undesirable side-effects, these drugs could become ineffective over a period of time because they have been used where they need not have been used due to bacteria developing resistance to them.

Scientists would need to go on developing stronger antibiotics which may not always be possible. This, like many other problems of our times is not one that affects us immediately but has disastrous consequences in the long run. We must sit up and take notice.

Here is a very interesting video from Harvard Medical School that demonstrates how bacteria mutate to develop resistance to increasing dosages of antibiotics:


Friday, June 16, 2017

Sapiens by Yuval Noah Harari: Life changing



I came across the book Sapiens when I read a column by its author Yuval Noah Harari in the online version of some magazine. I forget which magazine it was and also what the column was about. The column intrigued me and in the footnote it was mentioned that Harari was the author of the best selling book, Sapiens. I immediately logged onto Amazon and bought a kindle version of the book.

In the book, Harari describes the history of the human species as put together by scientists and anthropologists. Harari first describes what happened after the Big Bang - how Physics began, then how Chemistry began, how Biology began and then finally how History began. Evolution describes the process of how single cells eventually grew into the species Homo sapiens that we call human beings. He then goes on to narrate the origins of the four revolutions that made humans unique: (pasted below from Wikipedia)

1. The Cognitive Revolution (c. 70,000 BCE, when Sapiens evolved imagination)
2. The Agricultural Revolution (c. 12,000 BCE, the development of farming)
3. The unification of humankind (the gradual consolidation of human political organisations towards one global empire)
4. The Scientific Revolution (c. 1500 CE, the emergence of objective science)

All the material in the book is purportedly based on discoveries of various fossils made across the world and theories that explain these discoveries.

Harari's theory of how religions evolved makes for some very compelling reading. It makes you think and question your own beliefs. Is whatever I've been believing in so far nothing but a story of someone's fancy imagination? What is the evidence behind this?

The problem however is not as simple as discarding whatever you've been believing in so far. Science's biggest strength and weakness at the same time is its ever-changing nature. Science has no problem in discarding yesterday's universally-accepted theory in favour of a new theory if facts support the new theory better. Religion, on the other hand, has at its very core a set of unchanging dogmas. Whatever the facts may lead you to believe, religion prefers declaring you a heretic rather than change its core beliefs.

If someone were to discard all his religious beliefs in favour of science, would this decision hold him in good stead forever? What if the ever-changing nature of science cause it to discard some of the basic contradictions it has to religion at some point in the future?

These are some of the many questions that flooded my mind as I read this book. At the end of the day, this decision is up to each of us. This book is one I would recommend to everyone. It is important for each of us to debate the contents in our mind. It is good for us to ask these questions. Sometimes, the answers might not be fully evident. It does not matter. It is good if this forces us to think and not rest our minds in the status quo.

For a quick summary of the book, click here. However, I really recommend that you read the whole book.

Thursday, June 15, 2017

Carpal Tunnel Syndrome


  • I finally have a firm diagnosis for the numbness in the fingers of my left hand
  • It is Carpal Tunnel Syndrome (CTS)
  • I have been having this numbness from late 2015
  • I had consulted a neurologist long ago who somehow missed this diagnosis
  • I consulted another neurologist a few days back, a very senior doctor at Care Hospital
  • He got some tests done which confirmed his initial suspicion of CTS
  • I am scheduled to undergo surgery to decompress the nerve today at around 9 am
  • By the time you read this, I should have been done!
  • Let's hope the surgery helps to relieve my symptoms

When you see something here posted exactly at 5 am...

...it means it has been drafted much before and scheduled to be posted at such and such a date at 5 am.

All my short stories are written completely and then scheduled to be released one part each day typically early in the morning.

Even this post and tomorrow's post have been already written and scheduled to be released at 5 am.

Wednesday, June 14, 2017

Winds of change - 29


(This is the concluding part of a short story which is entirely a work of fiction.)

Immediately after the press conference, the footfalls into the hospital started shooting up. People felt that this was a hospital that stood for the ethical practice of medicine. This was a place they could trust.

During the daily reviews of the numbers, Vasudha and Manav were elated to see the impact of all their efforts coming together. They carefully reviewed all the data to ensure they were not missing anything. They also reviewed department and doctor-wise figures weekly to see if anything was amiss.

At the end of the second month, the hospital showed a very healthy growth compared to the previous month.

This trend continued month on month. Vasudha called a meeting of all the doctors and the Admin team. She shared the results with all of them and thanked them for their co-operation. Without their co-operation, this would never have been possible. The doctors were also very happy. They were earning more than what they were earlier. They felt really nice that all this was possible without succumbing to the unethical practices that had become so prevalent in the profession of late.

Soon, the hospital felt that it was running short of space. They had to regularly refuse patients due to this. They began having a wait-list for procedures and treatments like dialysis. Vasudha decided to expand the hospital, A new block would be constructed. She scheduled a meeting with the old investors and discussed the high level details. Soon, a plan was put together. The old investors decided to fund the entire expansion in return for a further stake in the company.

In under two years, the new block was ready. Swami Keshavanand inaugurated the new block. Vasudha was extremely happy with the progress being made. She realised that what they were doing in Narayana Hospital was breaking new ground in healthcare delivery in the country. She hoped that other hospitals would follow suit in implementing their model.

She heard informal reports of hospitals in other cities adapting the so-called ‘Narayana Model’. People were very intrigued by this new paradigm being seen for the first time in the healthcare sector.

Vasudha never felt the need to keep the intricacies of her model secret. She felt that the entire healthcare industry could benefit by moving to this model. She strongly felt that there was space for everyone and not one or two but even a hundred Narayana Hospitals would not be enough to cater to the growing needs of Indian patients. She joined the board of some hospitals which wanted her to guide them to implement the ‘Narayana Model’.

Soon, several such hospitals started switching the way they worked and Vasudha advised many of their founders and owners on running their hospitals.

She kept stopping by at the ashram to pay her respects to Swamiji who always guided her to do the right thing. She believed that the peace she felt at the ashram helped her connect to the ideals of her late husband and this proved to be a very important reason behind her success.

Epilogue

Vasudha was sitting in her cabin one day when she got a call from the PA of the Union Health Minister. Apparently, the Health Minister had got to know about the new model of healthcare that Narayana had adopted. The minister wanted to meet Vasudha to understand the ‘Narayana Model’.

Vasudha flew down to Delhi the following week and met with the Health Minister. They discussed the Narayana model at length. She also discussed the various problems she had encountered, some in her own hospital and others while helping other hospitals adopt the model. The minister was intrigued.

The minister told Vasudha that the PM was very keen on exploring the possibility of rolling out Universal Healthcare in the country. He wanted her to be associated with the project. Vasudha was thrilled. She agreed immediately.

On the flight on the way back, her mind wandered to the day when Sheshu talked about his plan. She felt very sad that she had not allowed it to be implemented for a while longer. The truth, she realised, was that she had never thought it would work and that is why she did not even help in the implementation. Had she thought of all the ideas she came up with when the plan was being rolled out the second time, perhaps, Sheshu would be alive today!

She wiped off the tear from her cheek as she looked out of the window into the clouds.

Tuesday, June 13, 2017

Winds of change - 28



(This is the twenty eighth part of a short story which is entirely a work of fiction.)

Manav ensured that the top newspapers and television channels were invited for the press conference. Vasudha made a detailed presentation on their model of healthcare delivery and how it addressed the ills present in the current models. Then she would bring in how the two doctors tried to thwart an honest attempt at beginning a revolution.

On the morning of the press conference, Vasudha and Manav were extremely tense. This was their one big chance. If the press caught on to the story and gave it widespread coverage, it could mean the success of their plan.

They intentionally did not release the press note that is customary before a press conference saying that it would be released after the hospital representatives spoke. The conference hall soon filled up with journalists and AV crew from the top newspapers and television channels.

Vasudha began with poise. She thanked the journalists for coming and attending the meet. She then went over her presentation. Once she started covering the part about the two dishonest doctors, there was a lot of commotion in the room. Manav noticed people getting onto their cell phones. Soon, more and more journalists started coming in. Manav knew that they had succeeded.

Once the presentation was completed, Vasudha and Manav fielded questions from the journalists present on the finer details of the plan and the action being taken against the doctors.

By that evening, the medical community of Rajahmundry and in fact the entire state of Andhra Pradesh was shaken with the news emanating from Narayana Hospital. The national television channels also gave coverage to the news which was huge as generally, national channels do not cover even big stories from a place like Rajahmundry. The next morning, all newspapers of the state carried this story as the headline. Narayana Hospital, its new healthcare delivery model and the corrupt doctors were on everyone’s mind that day.

The hospital got numerous calls. Vasudha’s cell phone was flooded with congratulatory messages and messages of support. Almost all the doctors of the hospital got calls from people they knew asking about the new model and the corrupt doctors.

That evening, Vasudha and Manav met in Vasudha’s cabin. They reviewed the status of the plan. They discussed the possible impact of the press conference and the wide publicity they had got. They decided to keep their expectations low since they knew how the press behaved. One new story the next day and everyone would forget about the hospital.

Vasudha sent an email to all the doctors and Admin team of the hospital thanking them for the support during this crisis. She encouraged them to go back to their regular work and not get distracted with all the hullabaloo that was caused by the events of the past few days.

The careers of the two doctors in Rajahmundry was finished. No one wanted to be associated with them. Even the hospitals they were engaged with while working for Narayana refused to continue their relationship as it would be a major image problem for them. They left Rajahmundry for good and started their practice elsewhere.

(The story concludes tomorrow.)

Monday, June 12, 2017

Winds of change - 27


(This is the twenty seventh part of a short story which is entirely a work of fiction.)

Over the next few days, each of the remaining parts of the plan got rolled out.

The Vigilance committee got into action. They would pick up the copies of the prescriptions and check. The Departmental Committees started interfacing with the Medical Representatives to evaluate new products and other consumables. The surveys were also rolled out.

The Marketing Campaign was the most visible aspect of the project. Huge hoardings of the hospital were set up in the city’s busy junctions and nearby towns. A TV and radio campaign was also run simultaneously. The goal was to get people aware of the way the hospital was being run and encourage them to try it out.

Vasudha and Manav would review the numbers on a daily basis.

Soon, the first month of the project drew to a close. At the end of the review, Vasudha and Manav did a detailed review of all the numbers. They were disappointed to see nothing much had changed overall. They decided to do a department by department analysis. They found that while all other departments had shown a minor growth compared to previous numbers, the orthopaedic and cardiology departments had actually shown significant dips.

Vasudha asked Manav to get doctor wise figures for these two departments, Manav took a day to drill down further and then reported back to Vasudha. They found that while some doctors in the department had shown better numbers, there was one doctor each in both the departments who had shown huge declines in the numbers. Vasudha and Manav started brainstorming on what the problem could be. They called Dr. Madhusudhan to discuss the findings. It was important that confidentiality be maintained around this in order to be able to figure out the problem and fix it.

Dr. Madhusudhan was instructed to have one person each from his team closely follow each of these two doctors and their activities during the next two weeks. They were asked to be extremely careful in their work so as not to raise any suspicion.

At the end of two weeks, a beaming Dr. Madhusudhan walked into Vasudha’s cabin and presented his findings. The two doctors were regularly sending their cases to other hospitals. One of them had already started performing some surgeries in other hospitals. Dr. Madhusudhan handed over documentary evidence in the form of prescriptions, notes made on rough paper in the doctors’ handwriting, CCTV evidence and recorded patient voices.

Vasudha called Manav over and showed the report to him. Now the question was how they should handle this? Manav suggested that they talk to the doctors in private, confront them with the evidence and give them a last warning. Dr. Madhusudhan, on the other hand, felt that terminating them was the only way they could send a strong message to the entire hospital that they meant business.

Vasudha said she agreed with Dr. Madhusudhan. Termination letters were typed out and sent to the two doctors immediately. The other doctors were also informed about the decision along with the rationale behind the decision. The two heads of departments came to meet her and requested her to give the two doctors another chance. Vasudha refused to listen.

Manav then had a brainwave. He suggested that they hold a press conference and announce the termination. They would also go into the reasons behind the termination. They could cover in detail how they were trying to bring a change in the way healthcare was delivered. That way they would get a lot of publicity  and that too for free!

Vasudha loved the ideal.