Wednesday, November 27, 2013

Why no dialysis unit in every district, asks the Supreme Court

Acting on a Public Interest Litigation, the Supreme Court of India issued notices to the Union and State Governments asking why there should not be dialysis units in every district of the country to ensure easy access to dialysis for all. In some alarming statistics quoted by the petitioner, Sanjeeb Panigrahi, two people die every minute in the country due to lack of access to dialysis facilities!

I read this on the web on the Times of India site. Scrolling down, you can see some rather interesting comments. People say when there is no proper drinking water access or access to proper sanitation for people in many villages in India, dialysis units cannot be a priority. There is merit in that argument.

People who have been affected by kidney failure and the lack of affordable, quality dialysis facilities hold this cause close to their heart. However, when you look at the entire population and the problems the vast majority is facing, dialysis would rank very low on the priority list. How many people would actually need dialysis compared to the number of people who do not have even the basics like drinking water and sanitation?

The Government must really get its act together and find ways to get out of this mess. While it must focus on basic stuff, things like healthcare can be done by engaging with the private sector. Public Private Partnerships have worked very well and this could be the way forward. The Government does not have the means to provide quality dialysis at every district. It should engage with private players and let them provide the service at reasonable costs which the Government can pay for for people who cannot afford the service.

These kinds of models have been formulated and have succeeded to a large extent in many states in our own country. It is just a matter of replicating the success in other parts of the country. All it takes is some out-of-the-box thinking and some willingness to make the change.

We need someone at the national level to take such bold steps and do something about it. Maybe someone like Nandan Nilekani?

Saturday, November 23, 2013

Steps to setup POP access to Gmail from Mavericks Mail - Part 2 - Setting it up

Yesterday, I wrote about how POP was better than IMAP in at least some circumstances. Today, I will outline the steps to setup POP access to email on Mavericks Mail. I was surprised when I found that there was no straightforward option to do this. Mail assumed you would use IMAP!

I tried multiple things. I setup the IMAP account and then changed the incoming mail server to This was suggested by someone on the internet. This did not work. The syncing continued. Also, mail did not get deleted on the server after downloading. That meant that the account was still behaving like an IMAP account! Then I found this link on the internet which had the trick! Here, I outline the steps to do this.

So, navigate to Mail Accounts. It should open up the Internet Accounts section of System Preferences. In the right panel, click on "Add Other Account...".

Make sure "Add a Mail account" is chosen in the next screen. Now click on "Create...".

The nest screen is the tricky part. This is where Apple hid the feature that allows you to be able to go to the screen that lets you set the account type. If you enter your correct email address and password here, Apple cleverly, rather too cleverly, figures out that you are setting up a Google account and assumes it is IMAP and goes ahead without bothering to check with you. Arrrggghhh!

So, what you do here is enter some wrong email address and some wrong password and then hold down the Option key!

The "Create" button magically changes to a "Next" button! Click on "Next" and you are shown the screen that allows you to specify whether you want the account to be POP or IMAP!

In this screen, you click on POP and then enter for the Mail Server, your full email address for the User Name and your password. Click on Next.

In the Outgoing Mail Server Info screen, enter for the SMTP server and your full email address for the User Name and then your password. Click on Create.

Your account should be created as a POP account! In the Internet Account screen, the account description will show up with the wrong address you entered in the initial part of the setup. You can easily change that by clicking on the Details button on the right when the account is selected on the left and editing the Description field in the resultant screen.

I am now comfortably using my POP account and hopefully my email issues would be a thing of the past. I make sure I regularly backup my computer to prevent losing all my email in the event of a mishap. Yes, this problem is not there on IMAP. But then the other limitations make it worthwhile for me to take the risk!

Friday, November 22, 2013

Steps to setup POP access to Gmail from Mavericks Mail - Part 1 - Why POP?

IMAP has been the preferred way to setup email for a while now. When I started working back in 1997, we only used POP. Over the years, people gradually moved to IMAP and now, when you setup email on Apple Mail, there is no question asked. It is assumed you are doing IMAP!

I am sorry to spoil the party but IMAP sucks in certain circumstances. First off, for people using Gmail as their mail provider (don't most of us do?), even with a fancy custom domain name using Google Apps, the amount of space you have is a paltry 15 GB. Sooner or later, you're going to run out of space. And then your realise that you have to pay a bomb to upgrade.

The other problem is that in a bandwidth challenged country like ours, the whole concept of always staying in sync can get pretty annoying. When I used to look at my Activity window on Apple Mail, it would be constantly syncing!

Problems reached gigantic proportions when I upgraded my old laptop to Mavericks, Apple's shiny new OS. It didn't play well with Gmail. There were all kinds of issues. The issue was with Google's non-default implementation of IMAP and labels and what-have-you! I was stuck with mail that would mysteriously re-appear in my Inbox even after I had moved it to another folder, wrong unread counts and perennial syncing.

Then I bought the new MacBook Air and at this point, I decided that Apple Mail was the problem. So, I downloaded the new mail client that everyone and his uncle was talking about in Mac circles - Airmail. Heck, it was #1 in the paid apps in the Mac App Store! For $1.99, it was touted as a steal. About Rs. 120 poorer, I tried the new app that promised to be the solution to all my email problems. Setting up the email accounts was a breeze. I started using the app. Moved messages around. Seemed like nirvana!

Only, it wasn't. The messages re-appeared in my Inbox! What crap!

It was then that I thought I had had enough of IMAP. I don't want to sync forever. I want complete control of my messages. When I move them to a folder, it should happen RIGHT THERE, RIGHT THEN! Is that too much to ask???

POP seemed to be the solution. People talked about being able to access your email from multiple devices. I could still do that. The way I use email, if I am not in front of my computer, I just want to read the damned email. I don't want to move it anywhere. I don't want to do anything else with it. So, if I set up POP on my computer and IMAP in my phone and tablet, I should be good!

So, I did that. There were some issues with setting up POP on Mail. Apple Mail assumes everyone in the world has perfect internet speeds and everyone in the world has spare money to splurge on Google's upgraded email storage plans. Well, sadly, they're wrong. So, you need to use some tricks to actually setup POP on Mavericks Mail. That's coming up tomorrow!

Monday, November 18, 2013

Being put on dialysis has a mental impact as well

No, I am not saying we turn crazy! Its a more subtle impact. I have noticed this in myself and others a as well. I have changed a lot mentally. I used to be a very confident guy when I was in Engineering College. I am no longer that sure of myself. I am constantly looking for approval, for appreciation. I am filled with self-doubt.

All around me, I see people continuously projecting themselves, showing off their capabilities. I am not even sure of my own capabilities to show them off. In today's cut-throat world, this doesn't work. Being good is simply not enough. You need to let the world know that you're good and if possible, try to get them to think that you are better than you actually are!

When I think harder, I am not sure if it is dialysis in general or dialysis in my circumstances. When I was diagnosed, I was only 21 years old. When you get diagnosed at such a young age, your mind does tend to develop differently. So, is it young people diagnosed with kidney disease who have this problem? When I talk to adults on dialysis, this is not the case. For example, people who have got married, had kids, settled down in life, were working for years - basically had what you would call a 'normal life' and were recently put on dialysis. They don't seem to have the mental issues I have.

It is probably this, then - having what the world sees as 'normal' being taken away from you for no fault of yours. This probably causes the mental impact that I am referring to.

I do sound depressed, right? I am not depressed really. Its just that this whole mental thing comes back to hit me time and again. One small sentence uttered by someone is enough to make me feel like shit for days. I go into this vortex of negative emotions where - you will not believe it - I continuously convince myself that I need to give up and withdraw from dialysis! I feel that I cannot take it any more. I feel that I have had enough. And how did it all start? One small, probably unconsidered sentence from someone.

I really am not sure how to change this. I know I make a difference to at least a few people. I know at least some people love me. But this small trigger is enough for me to disregard all that and just start thinking my life is worthless. I start thinking of all the things I do not have. I start looking at people around me living 'normal lives' and feel bad. In these circumstances, even watching someone do something as harmless as gulping down a glass of water will set off a negative reaction in me, "Look at him gulp down that chilled water! I can't even do that!"

Is there a solution to this? I have no clue! I can't change people and what they think or say. I have to find a way to change the way I think. Not sure how, though...

Wednesday, November 13, 2013

Aashayein 2013 in Delhi

To be honest, I expected a low turnout at our first Aashayein in Delhi. Many reasons were given. Delhi patients don't come for these kinds of events. It was very cold. Very few people would venture out on Sundays. I was also apprehensive about the how the patients that would come would behave. I had heard all kinds of stories about 'Delhi patients'! They are rude, they are not pleased easily, they are very rough!

Thankfully, both my fears were unfounded. By 10:30 a.m., the hall was full. The patients and family that attended were excellent. All well behaved. All very curious. All very eager to learn more about their disease.

Initial glitches

When we reached the hall, we found that the arrangements were still incomplete. At the last minute we were told that the audio cable from the laptop to the amplifier was not long enough which would make playing audio from the laptop impossible. The way we were told, it seemed that there was no solution. However, I asked Mandeep, our BD guy from Delhi to talk to them and sure enough, the cable was arranged! All the initial glitches were fixed soon enough and we were all ready in time!

My Hindi surprised me!

I spoke almost entirely in Hindi. I am not very proud of my Hindi generally. However, I didn't do a bad job at all. The words came easily. I also used some fancy phrases. "Jahan na pahonche ravi, wahan pahonche kavi!" when I was introducing Dr. Madan, who did some poems and "Inhone bada hi madhur kanth paya hai" when I was introducing Asif, who sang some songs.

My entire talk as well was in Hindi and I was really happy the way it went.

Questions, questions, questions

We had two nephrologist talks, one dietician, one patient and one vascular surgeon talk about various things. One thing was common among all. Everyone had a ton of questions after every talk. All kinds of questions. One thing which you would imagine is that the questions ought to be generic questions and not about some individual condition. However, a lot of questions were very specific. This goes to show that patients just don't get enough time from their doctors. In a country with more than a billion people, there are only 800 nephrologists! How much time can a doctor spend with each patient?

Each patient is different with a specific set of problems. Nephrologists in our country are very, very busy. They don't have the time to look up specific issues and are forced to adopt a one-size-fits-all approach.

After every talk, we had a hordes of patients swarming around the speaker asking all kinds of questions! The funniest scene was patients gathering around the vascular surgeon pulling up their sleeves and asking the harried doctor to check their fistulae!


The lunch was usual Aashayein style - one counter for patients and one for the rest. The patient lunch had no salt and was made by leaching vegetables and not using other things forbidden for dialysis patients. As Sandeep and I made our way to the lunch counter, I headed to the patient counter. Sandeep wondered why I was going there. I don't have any diet restrictions despite being on dialysis because I do daily dialysis.

"To express my solidarity with the patients! They go through a lot!" Sandeep followed me there. He wanted to express some solidarity as well, I presume!

After my first helping, I moved to the non-patient counter. Sandeep asked me why? "Family members go through a lot as well. Might as well express some solidarity with them!" ;-)

A great experience

At the end of the event, I had many patients and their family members come up to me and thank us for organising the event. Many of them said that after seeing me, they got tremendous hope that they too can live long, productive lives. Until now, they thought that dialysis meant end of life as they knew it. But now, they were inspired that they have a shot at a normal life as well.

This was gratifying indeed. If all the effort you spent has made some difference to the people who you wanted to reach, it feels really good. In the middle of the run up to the event, I had got a little tired with the amount of effort that goes in to this and the enormous pressure that is there on all of us preparing for the event. I was wondering if it was all really worth it.

At the end of the event, I got my answer. A resounding YES!

Friday, November 8, 2013

Pune Diary

I have been a couple of times to Pune in the past. Both times it was en route to the hill town of Mahabaleshwar. Once it was on a holiday with family and the other time it was for cousin Pooja's wedding. The wedding was in the last week of December and I remember the nights in Mahabaleshwar were biting cold!

This time however I was actually going to Pune for the launch of our eighteenth dialysis centre. Vikram and I went to the airport together and from there hopped on to the Air India flight to Pune. I have heard many stories about the horrors of traveling by Air India. Thankfully, our flight was without any hitches if you do not count the old, less than beautiful air hostesses.

There are airports and there are airports

When we walked into Pune airport, we were quite surprised with it. Very old school, no modern facilities, very, very basic. Contrast that with our Hyderabad airport and a sense of pride fills you! Many people have rated Hyderabad airport as one of the best in the country. I am not a frequent flyer to give that kind of verdict but Hyderabad airport is definitely very good! Pune, on the other hand could really do with some modernisation. It is after all, one of the most important cities of the state of Maharashtra.

Jehangir Hospital

We drove straight down to Jehangir Hospital from the airport. The hospital was very well done up. Not five star but tastefully designed. There were wildlife pictures taken by its Chairman adorning the walls that added a cheerful flavour to the hospital's interiors. We made our way to the dialysis centre and were very pleased with the way it had come out.

We realised over the next couple of days that the hospital's entire team right from the Chairman, Sir Cowasji Jehangir BT and the CEO, Mr. George Eapen to the administrative staff to the clinical staff and right down to the ward boys, everyone had this warmth exuding from them which made our visit to the hospital very pleasurable. The hospital is known to have high ethical standards and we could feel this throughout.

They organised a dinner in our honour that night and the top management of the hospital attended. We got a chance to meet the Chairman, Sir Jehangir, some of the trustees and the nephrologists. First time a hospital partner did this for us!

Differing pooja styles

We have a small pooja during the launch of all our units. With eighteen centres across the country in  places as varied as Alleppey in Kerala down south and Agra in Uttar Pradesh up north, it is striking to see differing styles of the same pooja! I guess the basic pooja might still be the same - probably from the Vedas - but local flavours get added and the pooja keeps getting small modifications over generations. Over centuries, the final outcome looks entirely different in different parts of the country!

The Pune unit pooja happened on the 6th of November around 9:30 in the morning. We had Vikram, a senior member of Jehangir Hospital and our nephrologist partner Dr. Shrinivas Ambike sit for the pooja.

"... and I declare the unit open!"

The inauguration followed the pooja. So, we had the rather funny ritual of everyone inside the unit go out of the unit by bending to cross the inauguration ribbon! The unit was inaugurated by the Chairman, Sir Jehangir and the CEO, Mr. George Eapen. There was the traditional lighting of the lamp by Vikram and me and other Jehangir Hospital staff. Everyone present was thrilled with the way the unit had come out - bright and cheerful with the NephroPlus green doing its bit to add life to the interiors.

Home sweet home

Vikram and I took the evening flight to Hyderabad. We had received an SMS that morning that the flight would now take 2 hours instead of the planned one hour! We figured that they were putting us on a slower flight. When we enquired at the check-in counter though, we were told that it would take an hour and fifteen minutes. This brought some cheer!

I finally got home and was relieved to be home after a very tiring couple of days. When I am not on my routine home-office-home schedule, I tend to drink more fluid than usual. This happened this time as well. I was up by about 5 kgs at least. There was a feeling of chest congestion by the evening. I was very happy to get on to the machine and have the excess fluid removed. I really need to find a way to restrict fluid when I am traveling. It is not impossible. I did a fantastic job during my Oceanside weekend where I missed dialysis for 2 nights and managed quite well. Its just that since this is only one night, I take it a little easy!