Blissful Life

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

Author: akshay

  • 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?

  • PGDMLE Paper 3 – Medical Professional, Patient & The Law – The Legal Relationship

  • PGDMLE Paper 4 – Law & Medicine Some Emerging Issues

  • PGDMLE Paper 2: Law and Health – an Interphase

  • PGDMLE Paper 1

    It's been a long time since I posted any question papers on this blog 😀

    I've been doing a distance course in medical law & ethics from National Law School Bangalore. I love the course. So much so that I didn't take exam the first time so I could extent the duration.
    This time I had to take at least two papers. (I'm taking four, and skipping dissertation for next time).
    This is paper 1 which is common to all diploma courses (among child rights, cyber law, and so on).
    I've ticked the questions I answered.

  • Good Riddance, WhatsApp!

    I took the jump. Deleted my WhatsApp account.

    Yes, I know. There are too many important groups. There are people who can’t use email or other means of communication. Coordination of so many things will become difficult. What harm is there in keeping the account, and not using it? What if there is an emergency?

    But, I am sorry. I deleted the account.

    The idea isn’t new. Pirate Praveen doesn’t have a Whatsapp account. Prashanth NS doesn’t use Whatsapp. Cal Newport advocates digital minimalism. All in all, plenty of people have done well without WhatsApp and actively inhibit WhatsApp usage. But I won’t ask you to uninstall WhatsApp just yet. Maybe at the end of this post.

    WhatsApp is a good chat app. It has a simple interface. It works consistently in poor connectivity areas. It has various features that make chat easy. It may not be the best. I personally prefer Riot (a client of Matrix protocol) and Telegram for chat. But, WhatsApp still does its job.

    Maybe it is chat that I do not like. Synchronous messages create a sense of urgency. The delivered/read ticks on WhatsApp forces me to respond quickly to messages. Maybe I’m not ready for that. Maybe I want to respond to messages when I want to.

    Yet I use other chat apps. I use Telegram extensively. I use slack. What’s the difference?

    Perhaps I should start from the beginning. First, we invented the telephone. We could talk to each other at a distance. That is a definite value addition. You no longer had to travel long distances to talk to people.

    Then there was internet. With that came email. The good thing about email was that you could send it across very quickly to large number of people (like mailing lists) and people could skim through many many emails very quickly.

    There also was blogging. Blogs are like books. People may read you. People may not read you. A million people may see it. Nobody may see it. Blogs fulfilled the role of people wanting to reach out to the world and influence the world.

    Then, there was the mobile phone. And with that came SMS. SMS was sort of like email, and sort of like phone call. It was designed to be short. It was designed to be direct. That allowed for quick, non-distracting, short message updates.

    That is the point at which chat apps come to the picture. The biggest feature of a chat app is the group chat. Individual chats are just like SMS, but with pictures and videos they could be called SMS on steroids. But group chats is an entirely different paradigm. Group chats let people talk to multiple people at the same time. Sort of like a broadcast, but multi-way broadcast. That allows quick coordination of large groups.

    I almost missed social networks. Social networks are like the sum of all the previous innovations. They combine the intimacy of group chats with an experience similar to walking through a virtual world and influencing a large number of people.

    All of these are not without consequences. Firstly, our attention is now deeply fragmented. We have a thousand things we can engage with at any point in time. In the attention economy everyone has to shout louder to be heard. Soon everyone is shouting even more loudly. It becomes like a party floor where nobody can hear nobody else.

    Secondly, it is so easy to bombard each other with messages that sooner or later people get strong opinions about things. And that makes for a heavily polarized world because people always tend to have differing opinions.

    Thirdly, and most importantly, people are unable to work on hard problems with their mind into it because that requires focus and peaceful mind. I have a very big hunch that this is the biggest reason why economies world over are failing – because people simply aren’t productive any more.

    All that said, now I can state the reasons why WhatsApp and Facebook (and more recently twitter) are especially to blame.

    The way Facebook is designed, you connect to your friends and family. And then you hear from them. Sure you can connect with various organizations, etc. But yet, nobody keeps their connections devoid of family and friends. This “social” prat of the social network makes it a very mediocre place. There is a very good chance that the best people you can listen to on any particular topic is not in your social circles. The best writers, thinkers, or analysts on the planet probably didn’t go to the same high school as you did. Therefore, if you wanted to put your attention on the best things on any topic, Facebook is a very bad place.

    Similarly, WhatsApp is designed for people who know each other well (well enough to have each others’ phone number) to communicate. Even with group chats, you are probably not going to share groups with very smart people. WhatsApp, therefore, has the same pitfall as Facebook. It encourages mediocrity and conformation.

    Apps like Telegram and Reddit do not have this problem. (Although the attention economy is still a problem there). And therefore WhatsApp gets an extra negative mark there.

    And then, there are all the other reasons. WhatsApp is not free software. WhatsApp is owned by Facebook. (And since the last update it clearly shows on the splash screen that it is owned by Facebook). And Facebook is evil in various ways.

    Of course this post would be incomplete without me telling how I actually managed to pull this off.

    First, I had notifications turned off for WhatsApp through Android settings. It had been that way for months. Essentially, I would see WhatsApp message only when I opened the app.

    But, about a month back, right around the time CAA was passed, I started doing another thing. I used a firewall app called NetGuard (which doesn’t require root) to block internet to WhatsApp. And I hid the WhatsApp icon in the Niagra launcher I use. And I turned off background data (just an added measure because NetGuard anyhow stops background data). And I changed my WhatsApp status to let people know that I won’t be online. And I changed my profile picture with a message that I won’t be online. And then I kept silent for days.

    The first time I did that, it was in solidarity with the people suffering from internet shutdowns in India. When I logged in after about a week, I noticed that I hadn’t missed a lot of important messages at all.

    So, I tried it again. This time I did it for two weeks. And this time too, I hadn’t missed anything important. My patients could either directly call me or my clinic manager for appointments. My colleagues could message/call/email me any important thing from the WhatsApp groups. And I was insulated from all the “Merry Christmas and Happy New year” gifs.

    The only reason I wouldn’t go ahead and delete WhatsApp was that I wanted access to the past messages. Or so I thought as you will see in the next paragraph.

    Today I thought I would install WhatsApp Business and set up an “auto-respond while away” message for giving people who contact me a fairer warning that I won’t be reading their messages. But turns out that feature works only if you turn WhatsApp on and let it receive messages. While trying to switch to WhatsApp Business, I also lost the chat history (because for some reason it restores only from Google Drive backup while switching between WhatsApp and WA Business). And then I realized that I probably don’t need access to my chat history.

    To sum up, I had enough time away from WhatsApp and I was convinced that WhatsApp was an unnecessary evil and that life without it would be as convenient, if not more. And so I just went into the settings and deleted the account.

    Now, nobody can inadvertently wait for a response from me because they won’t be able to message me. And I can do my own deep work.

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