Blissful Life

When you apply skepticism and care in equal amounts, you get bliss.

Author: akshay

  • Public Health Was Always Broken, You Are Just Noticing It Now

    There is this nytimes article about how one pregnant lady who was also breathless couldn’t find appropriate care despite going to multiple hospitals. I find it nothing surprising. Our country’s public health system has never been able to provide appropriate care to people with medical emergencies (or for that matter, any health issue). Maybe now people are noticing because it comes on news.
    There is a limit to how many emergencies can be handled at a time by a small medical team. Even in tertiary care government hospitals, this “team” is a very small one. It usually includes a couple of young doctors – either doing their internship or their residency. And a couple of nurses. And a couple of janitors. It is the same whether you are talking about the ICU or the emergency room of any department. There are no mechanisms for requesting extra hands when there is a spike in cases at any moment. Crises are handled by expediting care (many a times at the expense of quality and/or completeness).
    Imagine this. You are attending to a very difficult accident victim with multiple dangerous bleeds and possible head injury and suspicious breathing. As you are assessing their breathing, another patient comes in with severe pain abdomen. The other doctor stops assisting you and goes to assess the patient with pain abdomen. And then comes in another patient who has a open fracture on both bones of one lower limb. Who on earth is going to take care of this new patient? Well, let’s say the other doctor gives a pain killer to the patient with pain abdomen and let them settle down thus relieving themselves to attend to this new patient. At that moment comes in yet another patient with a head injury. What happens now?
    It becomes worse in the ICU. You could be in the middle of a procedure and there could be a new patient coming in with lots of things to be taken care of. And another patient could crash as this is happening. There are so many things that can go wrong at the same time. But there aren’t ever enough trained hands.
    It is in such situations that doctors refuse to take patients. They know that they can’t give justice to anyone if they take in more patients, especially critically ill. This is where “referral to higher center” happens. Anything can happen, actually – misdiagnosis, unnecessary investigations, miscommunication, death, so on.
    What is the way out?
    Of course, there are a lot of things that maybe potential solutions. But I do have one idea which seems sane.
    Proper “professional” education in colleges
    Nurses can perform any intervention done in an ICU if they are trained and empowered to do it.
    Medical students should be made capable of handling cases on their own.
    In an academic institution there is no dearth of learners. If learners are properly trained and given “professional” education, they can share a lot of workload. Similarly, our country needs to stop putting the doctor at the center of everything and start allowing other professionals like nurses to do more things.
    Above all, there needs to be a culture of quality and improvement. This has to be built from within colleges. When such highly trained teams focused on quality come together, they can do debriefing, build protocols, and create Standard Operating Procedures for managing cases. They will figure out the weaknesses of the system and ask for infrastructure upgrade and many other things necessary to be done to improve the overall system.
    Unfortunately, we are stuck in “long case, short case” mode in medical education. And this is not going to help the country.

  • Glenmark Lies About Favipiravir

    I received from a friend a PDF which happened to be Glenmark’s press release about Favipiravir. The release is full of claims that make it sound like Favipiravir is a wonder drug that is going to solve COVID problems. It becomes my responsibility to refute some of these claims, considering how majority media outlets are doing what they’re best at – exaggerating an already exaggerated PR claim.
    Firstly, we have to verify the claim whether India’s drug controller did approve the drug. The way to do that is visit CDSCO’s website and navigate to approvals -> new drugs. And as per that, “Favipiravir bulk and Favipiravir film coated tablet 200mg” did in fact receive approval on 19th of June for “the treatment of patients with mild to moderate Covid-19 disease” as the 18th entry.
    I do not think CDSCO publishes details of the approval process, about what evidence they considered for approval, etc. Making these processes transparent would be useful for avoiding putting people in great danger.
    The deceptions start from the title itself. “Glenmark becomes the first pharmaceutical company in India [..] blah blah blah [..] COVID” – what does it mean to say “first pharmaceutical company in India in this context? They just want it to sound like this is the first drug for COVID.
    They then start with a bullet point about accelerated approval process which makes it sound like it was CDSCO who wanted the approval to be accelerated so that the “benefit” of Favipiravir can reach everyone. I doubt that’s what really happened.
    They then talk about “responsible medication use” and informed consent. The reality is that this informed consent is necessary because there is no way to know if Favipiravir is really useful in COVID. According to the Telegraph article, the approval was based on a trial on 150 patients. (The CDSCO website does list approval for a Favipiravir trial in May, although this was given to Cipla. Interestingly, the CDSCO website seems to be missing details of any approvals given in April (and Glenmark received approval in late April, as per them))
    In that last pdf they do share the details of the clinical trial. They say they would enroll exactly 150 patients and give Favipiravir to half of them. 75 people!
    Now, next in their bullet point they come up with the ridiculous and unsupported claim that Favipiravir shows clinical improvements of 88% and rapid reduction in viral load. In the text, they do add a citation which points to this PDF report of an observational study done in Japan. This was an observational study with no control arm or anything to compare with. The report itself states this:
      It  should  be  noted,  however,  that  this  study    only    captures    patients    who    received    favipiravir,  which  precludes  direct  comparison  of  the  clinical  course  with  those  who  did  not  receive  the   agent.   Given   that   over   80%   of   COVID-19 patients have mild disease which often improves by supportive   therapy6),   caution   is   required   in   interpreting  efficacy  of  favipiravir  based  on  the  data presented here
    And this is what is cited to support the ridiculous claim in the PR.
    I’m not going to go ahead and waste my time talking about each point made in the PDF.
    But the fact is that saying Favipiravir is useful for treating COVID is as correct as this claim by Patanjali:

    #WATCH We appointed a team of scientists after #COVID19 outbreak. Firstly, simulation was done&compounds were identified which can fight the virus. Then, we conducted clinical case study on many positive patients&we've got 100% favourable results: Acharya Balkrishna,CEO Patanjali pic.twitter.com/3kiZB6Nk2o

    — ANI (@ANI) June 13, 2020

    —
    Conflict of interest disclosure: I have 2 shares in Natco pharma worth about 1000 rupees the last time I checked.

  • Is Feminism Brahmanism?

    This post is an analysis on the points made in the transcript of a talk titled “Feminism is Brahmanism” (FiB) and the counter-points raised to it. I know that it is difficult to separate points made by a person from that person themselves. It is difficult to separate generalizations and personal attacks from solid arguments. But nevertheless, I will make an attempt, for my own sake. Because I call myself a feminist and I want my flavour of feminism to be the best flavour of feminism possible.
    Firstly, I have to state my own biases here. I have been pondering over the question “Is Reverse Sexism Possible?” for about an year now. I’ve not had a conclusive answer yet. The first time I read the FiB article I thought I had an answer. Maybe the answer will take another year to be clear. Anyhow, I believe in intersectional feminism as of now. The kind that is being talked about in Data Feminism. And I believe that gender equality is not the only thing that feminism is about or should be about.
    Let’s now move to the original: “Feminism is Brahmanism“
    We have to realize that this is the transcript of a talk and therefore a lot of meaning may have been lost in the transcription process. Also I have no idea on the context in which this talk was given, nor have I been following the speaker to know their background.
    In the beginning of the talk Anu Ramdas makes this point:

    That all these women produced this vast amount of knowledge and some of
    it has been responsible to make my rights possible. They have all
    worked for it. And I should just find it and I am going to find it. But
    in real life that was not the story. The person who worked to make
    education possible for my family was my paternal grandaunt. It was my
    paternal grandaunt who took decisions about her children having to go to
    college and through her effort and clarity of thought the family begins
    to have education as a benchmark we need to get. She is the person that
    I associate, in my life, with education. But feminism is telling me it
    is not her, it’s all these other women. So, either my grandmother (aunt)
    is a feminist and her role is documented in that feminist literature or
    they are disconnected. This reality and the materialized feminist
    knowledge and my real life have no connection. That is the first part of
    the journey.

    And later this idea is revisited

    What have these feminists clarified for me to stop women from spending
    so much of their time searching, fetching, storing water [in most parts
    of the world]? Or about having safe childcare, when their occupations
    are not white-collared jobs. The majority of the women of the world are
    working in agriculture. So how does childcare look for agricultural
    workers and what has feminism articulated about it? In all these
    hundreds and hundreds of books […]
    […]
    So, my conclusion is that this is about ruling class women, 99% of which
    is white women’s struggle. Their struggle of becoming equal to who? Are
    they struggling to become equal to the black man or the Asian man? No!
    They are struggling to become equal to the white man. Their struggle, in
    one sentence, if I have to say: feminism is about the white women’s
    struggle to become equal to white men. While white men are the
    oppressors of the entire world, men and women together. Feminism demands
    all women to help white women win their battle to become equal to white
    men who oppress the rest of the world. And this is repeated in every
    society. Elites of that society adopt this ideology, saying we are
    fighting for all women but all they are doing is fighting to be equal to
    their class men. But all women are recruited to perform this duty. And
    hence I cannot see their achievements, their success as being warriors
    of rights for all women because the water problem has not changed. It is
    not even there in their orbit. Therefore, I have started to see
    feminism as being oppositional to all the historical struggles of
    marginalized people, where men and women, are engaged in. For example,
    anti-caste battles and struggles.

    I think these paragraphs summarize the premise on which the speaker is making the assertion. The premise is that lots of feminism is just about gender equality. If we assume that is true, then I can easily draw the line from there to how feminism suppresses conversation about caste and how it allows continuation of class structures like brahmanism. (Tangential question: Why should the B of brahmanism be capital? Isn’t brahmanism a concept like feminism? Won’t it be a common noun then?)
    Now let us take the response by Anannya G Madonna – “Ambedkarism is Feminism – A Response to ‘Feminism is Brahminism’“
    The author here looks at various waves of feminism. If I read it correctly, the first wave is equated to white feminism – of equal right to vote between genders.
    Then “womanists/black feminists” gets introduced and in the same vein “Dalit feminism”.
    They then go ahead and give various examples of Dalit feminists who have independent existence and aren’t just agents of white feminists. Later, also, they justify the point that being influenced by white feminism is not a bad thing per se. That the idea of human rights in Europe will apply to India as well, even if the context changes.
    Essentially, I think, the point they are making is that Indian feminism is/should be Dalit/intersectional feminism.
    Another point worth mentioning is that the fourth wave feminism is
    predominantly run by womxn of colour and various ethnicities and
    sexualities where they are taking the reins into their hands.
    Of course they also talk on a different point about Anu Ramdas’ agenda and question their integrity. But perhaps we don’t have to worry about that to answer the question whether feminism is brahmanism.
    We will come back to what Indian feminism is after looking at a few twitter threads.

    As a Dalit woman who has been critical of savarna feminism and savarna feminists, I just want to be absolutely clear that I do not agree with this BS. I’m Dalit, I’m feminist. I subscribe to the politics of Babasaheb Ambedkar, bell hooks, and my Dalit sisters/queer friends.

    — Malarăsculat 🌸 (@caselchris1) May 28, 2020

    NEW THREAD: The ‘Feminism is Brahmanism’ transcript published on Savari is a regressive, reductionist piece of garbage, the likes of which I haven’t come across in a long time. This post is not about refuting it. Dalit womxn and Dalit queer people have put forward their responses

    — Malarăsculat 🌸 (@caselchris1) June 19, 2020

    I just read Anu Ramdas article and I had a few thoughts:
    1. You can’t use google image search results as proof of any sort of point
    2. You just cannot say “feminism is brahminism” when so many bahujans identify as feminists.

    — (((Dominique Fisherwoman))) 💙 (@AbbakkaHypatia) May 29, 2020

    No. I don’t suggest that, i only said the Dalit Feminism is brainchild of Brahmanism. As The Dalit Feminist Standpoint is written by a Brahmin – and the Dalit feminism is a academic, NGO project of Brahmins Savarnas.

    — Dr.B.Karthik Navayan (@Navayan) May 24, 2020

    Every now and then, a significant number of Dalit womxn raise their voice against patriarchy and misogyny within their circles, and every now and then, they are shushed by ‘passionate’ savarna allies, Dalit-Bahujan men, and other Dalit-Bahujan women. https://t.co/u26QZ9GfTy

    — Malarăsculat 🌸 (@caselchris1) May 26, 2020

    @Navayan the whole feminism is against the Brahmanism. And people who are against feminism are themselves slaves of Brahmanism. or probably they have zero understanding of what Feminism is all about. Which eventually means they are oppressors of women.

    — Vaishali paliyal (@VaishaliPaliyal) May 25, 2020

    What we see in these is that there are two view points and one political issue.
    The political issue appears to be that there is an attempt to cover-up patriarchy inside Dalit communities. I don’t know much about the background of this.
    But the differing view point is easy to figure out.
    One side (mostly consisting of Dalit feminists) believe that their kind of feminism is what “feminism” is (or should be). And that is reasonable.
    The mistake made by Anu Ramdas’ side seems to be that they don’t acknowledge these Dalit feminists at all. They say that all of Dalit feminism is brahmanism NGOs telling Dalits what to do.
    If they had said “Dalit feminists exist, but so do Savarna feminists and the latter is same as brahmanism”, I think both sides would have agreed.
    The question remains though. What kinds of feminism do we see around us? Are all of these feminists subscribed to the fourth wave of feminism? How much of them don’t oppose brahmanism? Perhaps there’s no way to systematically measure this. But I have a sense that intersectional feminism is slowly catching up in India.

  • How Not Having a Computer Science Degree Makes Me a Good Programmer

    I didn’t go to an engineering college. Looking back, I’m very glad that I didn’t. If I had gone to an engineering college in India, I would probably have dropped out very quickly.
    This post is not about how engineering colleges waste 880,350 years of India’s youth every year. But if anyone teaching in an engineering college is reading this post, I would urge them to read “Teaching Tech Together” and think about their pedagogical approach to teaching adults. These days, people become adults (at least in learning psychology) even more quickly than before.
    Being on my own has put me in a perpetual beginner’s mode. I’m always learning. I’m never sure about something. I often seek better ways of doing things. I keep reading the documentation. I keep reading tutorials. I keep building and rebuilding mental models.
    I do not learn from textbooks. While textbooks may make things easier in some way, they also remove a lot of details from you. A language might have introduced a new feature with an accompanying blog post that includes details about alternate approaches they tried and why they chose the final one they chose. A textbook might not go into such details. A lot of that meta information is lost. A lot of my learning has come from comparing different approaches and learning why the differences matter.
    I do not learn for a pen and paper exam. This is a universal mistake by higher education departments. Why on earth do we have pen and paper exams in professional fields like engineering and medicine? What good is being able to write 2 pages about a “wrapper class” or about “diabetic retinopathy” if I cannot use wrapper classes in my programs or prevent diabetic retinopathy in my patients, respectively? The way someone learns when they have to write about something is very different from the way they learn when they have to use something. It is the same as learning bicycling. In India, you can have a PhD in bicycling without knowing how to ride a bicycle. Because we do not evaluate tacit knowledge.
    In being self-taught I evaluate myself. And that puts the learner me in a very difficult spot. The evaluator me knows exactly how much the learner me knows. And therefore, the learner me is forced to continuously plug holes in the knowledge framework. It is also a real-time, continuous formative assessment that I go through every day. Even before I open the code editor I know that I don’t know how to do something. A lot of my learning happens on my mobile phone browser when I’m traveling or eating.
    —
    Last day I was faced with the question, what is a good learning resource to start programming as an adult learner?
    I thought about it for a while. As per teaching tech together, the mental models have to be built first. The problem with sending a learner with no background in programming to “learn x in y minutes” websites is that many of these courses do not approach it pedagogically either.
    Then I thought, perhaps a pedagogical approach that happens online would utilize the instant feedback that learning programming through javascript can give in the browser. So I searched “learn programming through javascript” and reached on a course by Google. Interestingly, in the prerequisites of the course is a brilliant course called “Think Like a computer: the logic of programming“. This is a good start. (Although it starts with object oriented programming and I would love to see a similar course for functional programming. But of late I’ve been thinking OOP and FP are the same at some level and so it doesn’t matter).

  • What is a “Normal” Human?

    Under the JK Rowling tweet about “erasing the concept of sex“, I found an interesting article: You Can’t Be a Feminist Without Acknowledging Biological Sex.
    It brings up an interesting point:
    The existence of people born with Syndactyly, for example, does not mean that humans don’t normally have 10 fingers and 10 toes.
    I think this is at the heart of the debate. What is “normal” and what is not.
    There is a wonderful TED talk by Aimee Mullins titled “The opportunity of adversity” (coincidentally, I had blogged about it 10 years and 2 days ago)

    In it she brings a view of “disability” that should make anyone question the concept of normal.

    Humans tend to call as “normal” what is “common”. If 99% of people look and act in one way that is what most people call “normal”. But “normal” has a connotation that is completely different from “common”. The opposite of “normal” becomes “abnormal” – something to be corrected, something that shouldn’t have been. And that’s why the word “normal” creates all kinds of problems.
    This has disastrous consequences. People with mental health issues are stigmatized against taking help because they get labelled “abnormal” by people who lack experience in understanding the spectrum of human existence. What is uncommon isn’t abnormal. It is just uncommon.
    Let’s come back to the case of fingers. Do humans “normally” have 10 fingers or “commonly” have 10 fingers? What makes 10 fingers normal? Since we are using scientific terms like “syndactyly”, let us also take a step back and look at the science of evolution. The way life evolves is through random genetic changes. All the diversity on earth (including human species) is the result of millions and billions of “mistakes” during cell division. Is there, then, anything abnormal about having a genetic makeup that causes a visible change in appearance from one’s parents? Aren’t there a lot of genetic differences between every individual on the planet (many of which perhaps don’t cause visually apparent differences)? What is the rationale behind arbitrarily calling some set of human characters as “normal”? “Common”, sure! But “normal”?
    Let us take a human being born with 10 fingers. What if they lose a finger in an accident? Do they become abnormal? Sure they have lost a finger and probably a lot of functionality associated with that finger. You could call them “disabled”. But watch the Aimee Mullins talk above again. Calling them “abnormal” creates unintended alienation. See how labeling people is a very hard thing?
    That is the context in which saying biological sex can have only two normal values – “male” and “female” – creates problems.

  • Do You Think All Human Beings Are Equal?

    At the end of Srimathi Gopalakrishnan’s post titled “Sexism in Medicine : The Eternal Confusion and The Innocent Mistake” there is a link that goes to areyouafeminist.com
    *SPOILER ALERT*: Take the test, if you want to.
    There are only two questions on that site which tests whether you are a feminist.
    1. Do you think all human beings are equal?
    2. Do you think women are human beings?
    When you answer yes to both these, you are confirmed to be a feminist.
    It seems like everyone would pass this test. Where are we deceiving ourselves though? Why isn’t the world full of feminists when it is so easy to be one?
    It is the first question. “Do you think all human beings are equal?” We tend to think that we think all human beings are equal. But are all human beings equal?
    What would explain a wage gap between two people doing the same job? What would explain a wage gap between two people who spend the same number of hours on their respective jobs?
    One could say that the wage differs because the output of two people doing work for the same hours is not equal. If a smart programmer codes for an hour she might produce better, readable, and maintainable code than a not-so-smart programmer does in 4 hours.
    In the free market, all that matters is the market value of what one produces. If what you supply is a rare resource, you are paid more, and vice versa.
    If it isn’t market price, what is it that we mean when we say all human beings are equal?
    Is there an “intrinsic worth” of human beings that we consider to be equal in all human beings? “When there is a pandemic, every life will count the same“? I say bull shit to that. There is a pandemic right now. The measures adopted to tackle it are grossly inconsiderate of the needs of a large number of people in our society. Even during life or death situations, “intrinsic worth” of humans is nowhere counted. What use is an equality which has no role in reality?
    This is where the question “Do you think all human beings are equal?” fails to be useful.
    The right question to ask is “Do you think all human beings should be equal?” That is a progressive and a transformative question. It accounts for the inequities in our society and asks us “Are you willing to make amends?”
    It also paves way for a deeper discussion on the reasons for inequities. It makes us introspect on what we are willing to give up in the effort to make all human beings equal. It forces us to acknowledge privilege and to be inclusive. It makes us rethink social and political order. It makes us question what rights are and what rights should be. It makes us wonder what it means to be a human.
    Do you think all human beings should be equal?

  • More Than a Word: Neo-Colonialism in Today’s Vocabulary. | BMJ Global Health blog

    “Resource-limited settings” is a term that I’ve to now reconsider.

    I have used it in the past to talk about Vivekananda Memorial Hospital. But when I think about it from the perspective that this article brings, VMH was the most resource rich hospital I’ve seen. Sure, there may not have been a ventilator ICU or a neurosurgeon. But the lack of such materials had always been compensated by other invaluable resources – dedication of staff, community level mobilization, and holistic approach to healthcare.

    How can we measure “resource richness” of a facility only along the dimension of medical devices available in that place?

    More Than a Word: Neo-Colonialism in Today’s Vocabulary. | BMJ Global Health blog

  • How Many Genders Are There In Our Languages?

    I stumbled on Trans 101 website today. The videos in there are literally the best I have seen in the past few weeks.

    I’m embedding the first video, but there are 6.

    Head over to the Trans 101 website for the rest.

    I learned a lot of things while watching the videos. Reading them all in this post would take you longer than simply watching the video. So I’m not going to write about all that.

    In the second video Margot makes a point about how she felt incredibly happy when her mother introduced her to others as her “daughter”. That made me think about non-binary individuals. What word would they be happy about when their parent calls them that?

    What about a non-binary parent? What should their child call them?

    I soon realized that there are a lot of words, especially in the context of relationships, that are very much based on the (obsolete) binary concept of gender.

    A quick search revealed a Washington Post column where a parent is confused on how to introduce their child. What caught my attention is not just the answer to that question. The question also included a reference to the orientation of the child. That made me realize how very problematic our language’s poverty is when it comes to gender and sexuality. When a transgender male is attracted to females, are they called homosexual or heterosexual?*

    Perhaps it is better to not name anything anything and just call it all a spectrum.

    Perhaps it is useful to name a few things. I don’t know.

    Anyhow, there is this wiki on gender neutral English that’s useful. And this writing guide is helpful for bloggers like me who have in the past abused repeating names as a way to avoid pronouns.

    As an aside, while looking through the wiki I also remembered how I could never find a word to describe Swathi when filling out a form. Partner? Sounds like we’re directing a company. Beloved? Who writes that on a form? Significant other? Too colloquial. Our languages really need to grow with the growth of civilizations.

    Coming back to the point about written forms of communication. What happens when you want to write about someone and they are gender fluid and prefers to be referred by pronouns that match how they are feeling at any moment? I hope all fluid people are cool not to care about pronouns in such scenarios.

    *What does orientation actually mean? Is someone’s orientation determined by what gender expression they get aroused by? Is sexuality only about arousal?

    There seems to be some answers in The Genderbread Person which is a cool website. They have broken “attraction” into sexual attraction and romantic attraction. Perhaps the concept of orientation needs to be thrown away altogether?

    Now, there is one more unresolved thing in my head. It is about an umbrella term for all whose gender expression or gender identity are socially complicated by their anatomical sex and the societal expectations of whom they are attracted to based on that. LGBT doesn’t include everyone. Queer is derogatory for some. LGBTQIA+ is the term I am thinking of using these days. But, this wiki has some alternatives.

    What is pretty clear, though, is that our spoken language has to pick up a lot of these words.

  • “Risks” vs Risks

    Decision making is almost always complicated by uncertainties. The more information that can provide context, the more stakeholders that are part of the decision, the better the chances of reaching a good decision.

    In the past few weeks, world leaders have had to make very difficult decisions. Lock down entire country? Put money into healthcare? Risk economic disasters to prevent health disaster?

    I guess the biggest problem they would have faced in making these decisions is uncertainty. Because medicine is a field of uncertainties. The first thing a doctor learns when helping patients is that they can never be sure of anything other than the fact that they have to act. Diseases, cells, organisms, molecules, environment, human behaviour – there are a lot of moving parts in medicine. Parts that you can’t control. Parts that you can’t even predict.

    A doctor is a performance artist who uses an imperfect science to help alleviate suffering. In Osler’s words, “Medicine is a science of uncertainty and an art of probability”. I’ve been fascinated by the range of dilemmas a thinking doctor faces in routine practice. When choosing who gets a ventilator they get to act God. When choosing what information to convey to the spouse of a person newly diagnosed with HIV, they get to play the Supreme Court. And not to forget the countless times they get to act human when seeing raw humanness play out in various scenarios – first breastfeeding of a newborn baby, last bye-byes before surgery (oh, thinking of it, I’ve never seen a family wave bye-bye in India. Maybe I’m watching too much of medical TV series), pain that persists even with the strongest painkillers, so on.

    We were talking about uncertainties. Yes. That’s what makes life really difficult in the field of medicine.

    Let’s take one specific question. The use of masks by public during COVID-19 pandemic. Should they wear it? Should they not?

    Let me break it down.

    What do we know about how the virus is transmitted? Just enough. We think it is through respiratory droplets and contact.

    What does that mean? A respiratory droplet is any drop that comes out of a person’s nose or mouth. It could come out while coughing, sneezing, even while laughing, or shouting. Contact is, well, contact. Touch. Touch anywhere where those respiratory droplets could have been. Surfaces, hands, wherever.

    Okay. So we know how the virus comes out of a person. But how does it enter someone else? No points for guessing that the respiratory tract is a major route for entry of respiratory viruses into someone. That includes mouth and nose. But turns out respiratory viruses can enter body through eyes too. (Warned you about uncertainties, didn’t I?) Luckily for humans, the largest organ of our body – the skin – is also a very protective sheath that makes our hands, legs, and so on less likely to be ports of entry for the virus. (Like I tell the people who come to me scared of HIV because they touched someone infected with HIV, even if a bag of blood full of HIV falls on your bare hands, unless there is a cut on your skin, there is no need to be scared. Of course, they then ask about the possibilities of microscopic cuts. But that’s another story and this snippet of that story is included to make a point that there are “risks” and there are risks.)

    Now, what do we know about masks? The medical masks that we are talking about? They can definitely protect someone’s nose and mouth from other people’s respiratory droplets. But that’s all they can do. They cannot protect their hands. They cannot protect their eyes. And the mask itself gets contaminated while protecting the mouth and nose of the wearer (Important point. The external surface of the mask is where all those respiratory droplets, if any, should get caught).

    What do we know about people? We know that people touch their face a lot. You just touched your face while reading this article. Your nose is itching as you’re reading this sentence.

    When a human goes out during the pandemic to buy grocery, they have to deal with many things. Around them, there could be a large number of people who have never seen SARS-CoV-2 in their life. They could also be walking among asymptomatic carriers who are shedding their virus in respiratory droplets. They could be touching surfaces which a carrier coughed into 10 minutes before. They could be inhaling respiratory droplets from carriers. Respiratory droplets could land on their eyes. Droplets could land on their hands and they could then touch their eyes/nose inadvertently. Droplets could land on their masks and they could then touch their masks inadvertently. Their mask itself could be a makeshift one with towel that they hold in front of nose and mouth (where the external most surface is their own, pretty, hand). And that hand could then inadvertently touch their eyes/nose.

    Do you see the risks and the risks that masks mask (pun intended)?

    Yes, theoretically masks decrease the risk of transmission by a tiny bit. But practically, probably, they don’t.

    On the other hand, there are some real risks of people wearing masks to grocery shops.

    The first thing that happens is we all run out of masks. Including the health care workers and people who care for COVID-19 infected at home. (Of course this has already happened in many cities). These people are now at definite risk for contracting infections because they deal with definitely sick people and for very long durations which increases their exposure. Many of the health care workers do not become sick, but some of them do. When they become sick the entire system is demoralized. And we don’t want that to happen when we are about to face a pandemic that nobody is sure how to deal with.

    That is why WHO and CDC and others insist that masks should be used rationally.

    Does that mean, if we had unlimited supply of masks, it would be okay for public to wear it when going out to fetch grocery?

    If you are a person who wears a helmet while walking on the road, yes.

    Of course, how could I miss this, yesterday when I went to the grocer’s, I was wearing a helmet with the glass visor closed all the time.

    — Akshay S Dinesh (@asdofindia) March 28, 2020

    Okay. Update: I haven’t considered at all the chance that you’re an asymptomatic carrier who is spreading the disease to others. In which case, suddenly there is a non-trivial effect where masks prevent the respiratory droplets from getting out of you in the first place. Uncertainties here are the proportion of asymptomatic carriers and their infectivity.

    I really don’t know.
    Update on May 30: There is piling evidence that masks are useful for source control. And now that the pandemic is well distributed inside all countries, the calculations of risk also has to change. Right now, the governments would have had enough chance to ramp up PPE production and meet healthcare needs. Right now you are at a higher risk of being an asymptomatic carrier than you were at the beginning of the pandemic when overall prevalence was low. So, yes, wear a mask. It may not protect yourself, but it will protect others.

  • Understanding Socialism

    A few days ago one of my colleagues had expressed the idea of decreasing the pay gap between the highest paid employee and the lowest paid employee in our organization. I didn’t give a lot of thought to that at that moment.

    Yesterday morning YouTube showed me a video of Sunil P Ilayidom in which he talks about Gandhiji. I’m embedding that one here. It is in Malayalam.

    Somewhere in the middle he talks about how Gandhiji was in South Africa till his 40s and didn’t know how the poorest Indians lived and then how once he returned from South Africa Gandhiji walked into the hearts of Indian farmers. He talks about how Gandhiji’s political campaigns always started with the real life problems of the common person. And he talks about how Gandhiji’s first Satyagraha in India – the Champaran Satyagraha – was fought with the simple demand that farmers should get compensation for their crops.

    If you can understand Malayalam, Sunil Ilayidom’s talks about Gandhiji (powered by YouTube recommendations) makes you sit and listen for hours and hours together.

    Another point that Gandhi made which SPI reiterates is “The world has enough for everyone’s need, but not enough for everyone’s greed.”

    Yesterday evening we had our weekly ECHO session in the primary healthcare fellowship and Dr Vivek Kumar from BHS told the story of a lady who was diagnosed with Tuberculosis a second time in the last 1 year (after taking 6 months of ATT the first time). Her haemoglobin was 6.9, weight was just 35kg, and it seemed like even if she took ATT continuously forever, her body might not have enough strength to protect herself from tuberculosis. In that context he described how the average haemoglobin in men, women, children, everyone in the villages he serves in is about 8-9. For about 5 minutes I could simply not believe that this could be explained by nutritional deficiencies alone.

    So I searched online and found out a paper by last years’ Economics Nobel Prize winners about fortifying grains to reduce anemia. This study was done between 2002 and 2009. Which means this is a well-known problem. People live in abject poverty and there is absolutely nothing that seems to work.

    Our discussion rightly turned to policy changes that maybe required to bring change. Dr Vivek mentioned Aajeevika Bureau as an organization that was working with farmers to help them secure livelihood.

    We also talked about community based participatory research which is the idea that any kind of research should begin from the community, be designed and developed by the community, and be owned by the community to be ultimately useful for that community. People from outside have their limitations in understanding what works, and what doesn’t. When I was making this point I was imagining Dr Vivek as an insider, and me as an outsider. But then Dr Vivek replied reaffirming the point and considering even himself an outsider. And I had the realization that even being co-located with the community doesn’t make you an insider.

    Today morning on the bus I was reading Che Guevara’s “Global Justice: Liberation and Socialism” and a paragraph stood out at me:

    “The way is open to infection by the germs of future corruption if a person thinks that dedicating his or her entire life to the revolution means that, in return, one should not be distracted by such worries as that one’s child lacks certain things, that one’s children’s shoes are worn out, that one’s family lacks some necessity.
    In our case we have maintained that our children must have, or lack, those things that the children of the ordinary citizen have or lack; our families should understand this and struggle for it to be that way. The revolution is made through human beings, but individuals must forge their revolutionary spirit day by day.”

    I should probably be reading carefully the Pedagogy of the Oppressed soon. But this paragraph in the context of yesterday’s discussion made me think about poverty and the reasons why we are struggling with elimination of poverty.

    Two related points.

    The “combined total wealth of 63 Indian billionaires is higher than the total Union Budget of India for the fiscal year 2018-19 which was at Rs 24,42,200 crore.“

    Pirate Praveen had once said this:

    “Every privileged person thinks its their god given
    mission to help the poor and show their kindness. They do not want to
    acknowledge that their privilege is the result of historic oppression
    and they are part of the reason why they remain poor. They think poor
    people needs charity and kindness. What we really need is a conscious
    collective effort to end systematic oppression of people and that will
    need questioning of our own roles and privileges. Accepting our role in
    creating the poor is much harder than feeling good about helping poor.”

    Putting it all together made me finally understand the problem. The problem is us. The capitalists. The people who believe that a software engineer’s time is worth 10 times more than the farmer’s. The people who believe that it is okay to accumulate wealth and make profit.

    The free market will never pay a farmer well. The free market is stacked against farmers. Why is it that way? Why are things priced based on their demand and supply rather than their intrinsic value?

    Because that works well in favour of those few who are privileged to accumulate wealth. For things like food, they won’t have to pay a lot. And they can use that money to spend on things like AC cars. They can hire a home-help for 4000 rupees a month and get them to cook for them. They can hire cheap labour and sell the combined thing for much higher value. And they can keep all the profit.

    The farmer may spend all their time in the farm. Like a full time employment. But if you can pay not for that time, but for the onions they produce, it may turn out to be much cheaper. Which means you can buy more onions for the same money. And you sell those onions at a higher price. So, your profit increases. While the farmer remains poor.

    This is how it works. The entire system of capitalism is based on rich becoming richer and poor becoming poorer. “Specialization” and “rare-resources” are ways to become rich. And once you are rich, you have the license to exploit the poor.

    Socialism is where the farmer sets the price. (And not a “free” market). The farmer demands what is their due. The farmer does not have to give up their life to produce a season of crops. The farmer can say their “full time” is equivalent to that of a software engineer. And who would you be to deny?