Blissful Life

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

Author: akshay

  • How To Travel in Bangalore

    I’ve been traveling extensively in and around central Bangalore for the past 6+ months. I have experimented with various modes of transport and various tools that assist finding the right transport in these journeys. Today when I met Nishan on his first day of a new life in Bangalore, I realized I have been traveling long enough to give some travel advice.

    Disclaimer: This may not apply to all parts of Bengaluru, especially the Electronic City side (which actually should come under Chennai metro)
    What is the best way to travel in Bangalore? It depends. What time is it? Where are you going? How much time do you have?
    BMTC
    BMTC is the most connected public transport system in Bangalore. The frequency of buses is usually inversely proportional to how badly we want to reach somewhere quickly. But, if we leave enough time to wait for the right bus, there will always be a bus. 
    The BMTC app on play store is a hit and miss. If you’ve used it successfully in a particular route and if the time is before 8pm there is a high chance that the “Trip planner” will show buses that actually are plying. In fact, in such situations the information is so accurate (location, bus number plate, etc.) that I’ve been thinking about an Uber like service on top of the BMTC app.
    There is a monthly pass if it works for you. For ₹1100 in ordinary buses and ₹1700 in AC buses you can travel wherever you want how much ever you want for a month. These passes can be got from any of the bus stations. There is also a daily pass which can be got from bus conductors.
    Metro
    Namma metro is simple. It either goes where you are going or it doesn’t. Indiranagar, Jayanagar, Majestic, Mysore Road, Yeshwanthpur – these are best connected by the metro. The unfair advantage metro has over any other means of transport is that at 7 o’clock when the entire road network is jammed up, the metro rail just flies over the traffic.
    In rush hour, if possible, always choose metro.
    Get a metro card. It saves 15%. It can be recharged online. And it can be kept in wallet which allows you past gates by waving the wallet over them.
    Uber/Ola/Rapido/Speedo/Ludo/Bodo/whatever-do
    Uber and Ola are for business class travel. Also, when it is late night and there is no other way to travel. Rapido is for teenagers who aren’t afraid of dying. Avoid all these unless absolutely trapped.
    Google maps
    The only tool you need to figure out the best route to anywhere is Google maps. It may not always get the timing right (especially for buses), but it always calculates the quickest route. Use the public transport tab. Use options and choose “subway” whenever there is a chance. Experiment with the starting/ending point a bit and there may be more convenient routes.
    When using Google maps for planning travel, always be mindful of the time of day for which the calculations are made. Change this in the “arrive by” or “depart at” setting.
    To conclude, traveling cheaply in Bangalore is possible. The secret is in planning and timing. Use the tips I’ve laid out with your own judgement and enjoy traveling!

  • Product Idea: “Explain My Prescription To Me” Service

    Many doctors have very little time to spend with the patient. So little time that sometimes they start writing prescription before even arriving at a provisional diagnosis. Imagine how then, would they explain to their patient why they have written a particular tablet for them?

    Is there a product/service idea in this vacuum of counseling that should have been provided by the doctor? Are there people who are not able to ask the right questions to the internet to find the answers?

    Perhaps there should be an app that is front-end for a prescription description service. The user uploads their prescription and also attaches a short voice note with their symptoms. This goes to a doctor/nurse/pharmacologist/pharmacist at the back-end who responds by reading out the prescription and counseling the patient about what the medication is, what it does, what side effects can be expected, etc.

    The counseling of each medicine can be recorded and reused for the next patient who is prescribed the same medicine. That way, the time required by the specialist is minimized. If a patient can afford and requires a longer, customized consultation, they can request that for a higher cost. Then it can work economically as well.

  • What Can an Individual Do?

    Forwarding a message I received from Dr Dharav Shah who is creating a wave of change in youngsters across India making them abstaining from the first puff and the first drink so they lead a healthy and happy life without the poisons we love.
    Do watch the video. I had tears only once, but your mileage may vary.
    —————————–
    Dear friends,
    Last week i had forwarded TEDx talk of Dr Taru, who had worked in a district hospital of Bihar. The NGO with which she was working, needs doctors for similar work in district hospitals in Bihar.
    If you know any surgeon, Gynecologist, pediatrician or Anaesthetist who would probably like to take up this challenge for 6 months or more, please inform them about this opportunity to contribute. Please forward this ad in your medico groups
    Are you upto the challenge of being an agent of change, working towards improving Emergency services in a progressive Bihar?
     Positions: 
    1. WHO-CARE Global Surgery fellowship – *Specialist Obstetrician*:
    2. WHO-CARE Lancet Global Surgery fellowship – *Specialist Surgeon*: 
    3. WFSA-RCoA-CARE* fellowship – *Specialist Anaesthesiologist*:
    4. WHO-CARE Paediatric fellowship – *Specialist Paediatrician* First referral SNCU services
    *WFSA: World Federation Societies of Anaesthesiology RCoA: Royal College of Anaesthesiology
    In a concerted effort to improve the health indicators, CARE-India, has been working with the Govt. of Bihar, has been working since 2010 towards a healthy Bihar. you may have seen TEDx talk of Dr Taru Jindal was working within this model at the Motihari district hospital.
    You will be a member of a high-performance team of specialists (Anaesthesiologist, Obstetrician, Paediatrician and a General surgeon) working within the District Hospital – which WHO has recommended as the key facility for the delivery of Emergency care. The mode will be continuous and intense engagement with clinical work and clinical mentoring for 4-6 months at a single facility to impact the Emergency care metrics as outlined by the Lancet Commissions.
     The Govt of Bihar has agreed for an initial pilot of 5 district hospitals, with a rapid scale-up to all 35 district hospitals and the First Referral Unit (FRU) hospitals.
    Salaries and working conditions will be in keeping with International health NGO standards. 
     Safety and accommodation are a priority for our personnel at CARE-India. While there are many Government, University and Non-Government agencies supporting this program, you will be on the employee payroll of CARE-India (and not of the Govt of Bihar nor the WHO).
    For clarifications and to apply write with your CV: Dr. Nobhojit Roy, Team Lead, Systems Strengthening, CARE-India (nroy@careindia.org) with a CC to Dr Monali Mohan (monalimohangupta@gmail.com). Or text/WhatsApp on 98212-91225.
    This TEDx talk is about a young doctor's experiences while she tried to bring about change in a district hospital in Bihar.
    Do listen when u have time. It's a cool story 😊

  • Reviving community medicine in India: The need to perform our primary role | International Journal of Medicine and Public Health

    Link to original article: http://ijmedph.org/article/217

    This is a very thought provoking article I came across yesterday. It says that the actual role of a community medicine specialist is as a family doctor in primary health centres.
    My college had a "preventive and social medicine" department. Now it all makes sense.
    If you look at community medicine departments in the present situation you see that they restrict themselves to TB, HIV, Leprosy, or whatever diseases have a national program on them. No national program? Out of scope of community medicine. And even within these, the role that community medicine department likes to play is that of a CME organizer. I do not remember a case discussion in community medicine in my college days where the patient was actually in front.
    What community medicine needs is a practice base. 
    Read the article here: http://ijmedph.org/article/217

  • Interactive textbook with adaptive level of complexity

    This is an idea I've been having since a long time. I think it is relatively easy to implement as well.

    We need textbooks like we have online maps. Textbooks that give you an overview first and then let you zoom in to any part and get more and more details. The deeper we go and the more details we have the harder will the level of complexity be. So, a beginner can probably zoom out and get a large overview of all the topics they need. Someone who already has the overview can zoom in at a part and get some more details. Then, they can zoom in again and get more details, and again, and again till they reach the maximum available information.
    Writing such a textbook may seem complicated but all it takes is some amount of reorganization of thoughts and marking sentences by their level of complexity.

  • Making Time

    Yesterday Swathi and I visited Anivar and Joshina and their kids. It has been at least 5 months since we started planning this visit. And we finally made time for it, yesterday.
    The moment we stepped inside Noonu and Ilan were on us – showing their toys, making us read story books, laughing at jokes, jumping, dancing, and purely enjoying. I burst out laughing at one particular joke in Balarama and could not control myself for half a minute. We had lots of food for stomach and mind.
    I had asked Joshina about her work some time in the recent past. She told me about her current life philosophy which resonates with what Anivar told about his life philosophy a few weeks back, both of which struck a chord in me. The following is what it boils down to.

    The society will expect superhuman things from you. Whenever you do something, there will be a few people to ask you about that next thing that you haven’t done. If you keep trying to satisfy all these “next things”, you will never be able to keep up. Because it is humanly impossible. But more importantly, you will be happy only if you are doing the things you want to do and those are things that bring you happiness.
    A few weeks ago, I had said to myself “the secret to getting things done is to have more things to do”. I think I was not entirely right. The focus should never be on getting things done. The focus should be on finding out things worth doing.
    Today, coincidentally, I read Make Time: How to Focus on What Matters Every Day (affiliate link). I started it today and I made time to finish it today. And now I have made time to write this blog post today. The book gave me a strategy to implement the theory I learned in The One Thing (affiliate link).
    The idea is to focus on life and not let it wither away. To focus on things that make sense to you. Things that are meaningful to you. Things that you will regret not doing. Make time for those things.

  • Why is Benzylpenicillin called Penicillin G and Phenoxymethylpenicillin Penicillin V?

    This one took a lot of searching. My initial hunch was that the G and the V stood for amino acids. G for Glycine and V for Valine. I thought, maybe, if these amino acids were not substituents, at least they would be the precursors involved in synthesis of Penicillins. I had also heard the word “Penicillin Gold” somewhere suggesting that they could be acronyms as well.

    After some searching around, there was a chance discovery of this page on some encyclopedia that said “The different forms of penicillin are
    distinguished from each other by adding a single capital letter to their
    names. Thus: penicillin F, penicillin G, penicillin K, penicillin N,
    penicillin O, penicillin S, penicillin V, and penicillin X”

    Now I knew there are more letters and these are chosen just because they are in the alphabet and not because of anything special. So the question became, why these letters? Did they start with Penicillin A and go down all the way till Penicillin V and even X? Is there a list of all Penicillins? Who maintains this list?

    After figuring out what Penicillin A and B was, I remembered Alexander Fleming. If Fleming discovered Pencillin, then we should start with him.

    So, here’s Fleming’s 1929 paper where he describes the discovery of “mould broth filtrate” which for convenience he decided to call “penicillin” : On the Antibacterial Action of Cultures of a Penicillium, with Special Reference to their Use in the Isolation of B. influenzæ.

    He wrote the fungus closely resembles P. rubrum. Some people “corrected” him later. Some then corrected the corrections.

    Okay, so in 1929, there was only one Penicillin and it was Fleming’s Penicillin.

    Then, for almost 10 years nothing happened. That’s when Ernest Chain and Howard Florey came into the picture. They figured out a way to get good Penicillin. As early as 1940, they discovered Pencillin resistance. An Enzyme from Bacteria able to Destroy Penicillin. If you want to read more about the interesting history of the discovery of penicillin, read this review.

    What Chain and Florey synthesised apparently was different from what Fleming discovered and therefore they initially named it Penicillin A and filed a patent. Later, they renamed it to “notatin” to avoid confusion. They also wrote this brilliant article on how they used it on some patients.

    Van Bruggen and others in 1943 described another compound from Penicillium which had bactericidal activity and was different from any of the Penicillins till then and named it Penicillin B.

    It was soon clear that Penicillin A and Penicillin B were identical. This compound is now called Glucose Oxidase.

    From then on, it was mostly about improving on the techniques and therefore most literature is on patent articles. Here is one where Penicillin F and Penicillin G is described. I have no clue why they skipped over C, D, and E.

    Around this time, people started producing all kinds of Pencillins.

    As I could not find the list anywhere, I decided I will make that list. Here it goes.

    Penicillin A – Glucose Oxidase
    Penicillin B – Glucose Oxidase
    Penicillin C –
    Penicillin D –
    Penicillin E –
    Penicillin F – C14H20N2O4S
    Penicillin G – Benzylpenicillin
    Penicillin H –
    Penicillin I –
    Penicillin J –
    Penicillin K – Natural penicillin
    Penicillin L –
    Penicillin M –
    Penicillin N – Natural penicillin
    Penicillin O – Almecillin
    Penicillin P –
    Penicillin Q –
    Penicillin R –
    Penicillin S –
    Penicillin T –
    Penicillin U –
    Penicillin V – Natural penicillin
    Penicillin W –
    Penicillin X – Natural penicillin
    Penicillin Y –
    Penicillin Z –

    Please let me know if you find the missing items.

  • JLS: SJG Ayurvedic College, Koppal

    On 6th March, Wednesday JeevaRaksha team did the first JLS (JeevaRaksha Life Support) course in an Ayurvedic college in Karnataka at SJG Ayurvedic College, Koppal.

    I took Hampi express on the night of fifth and reached by about 9 in the morning and the workshop had already started by the time I reached the venue. The participants were enthusiastically interacting with the facilitators.

    Choking was my topic and for the first time I had a “choking charlie” for demonstration. After a small lunch we had the scenario trainings and tests. A lot of candidates became eligible for being trainers.

    That evening Ramya, Sahana, and I went on top of Gavisiddeshwara Temple and watched a beautiful sunset.

    On Thursday, the training of trainers took place with the candidates who were selected on the previous day. All of them showed real potential to be great facilitators.

    The happy picture of the candidates from day 1

  • On (Not) Judging People

    Human beings have an in-built sense of “morality” that they routinely apply against everything that they come across. There are multiple ways one’s sense of what is moral and what is immoral emerges – including religion, upbringing, exposure, rationality, mental health, and so on.

    Is morality necessary?

    Morality is necessary. Not just because it allows people to live together without killing each other. But also because it helps an individual answer their own questions about what to do in any particular situation. It is the moral compass that often shows the direction to forge.

    Should we use morality to judge others?

    A distinction needs to be made before answering this. When “judging” someone, are you judging the person or their action? The answer matters a lot.

    When you judge a person for a particular action, you are labeling that person as “good” or “bad” based on that action. For example, if you see the CEO of a company scolding an employee for a “small” thing and judge the CEO to be a bad person, you may be making two mistakes.
    1) You do not know the reasons why the CEO is scolding the employee. It may even be for the good of the employee in the long term.
    2) By labeling the CEO as a bad person, you have created a barrier between you personally and them which might make it difficult for you to work with them.

    There are several cases where reason 1 does not apply at all. For example, say the CEO is actually doing something, say, being corrupt, which they themselves might not be able to defend.

    But reason 2 is more important for someone who is trying to get things done. People are not dispensable. Human resource is hard to come by. If you start judging people by a few of their actions and dismiss them as “bad”. If you make it impossible for you to be working with them. Then you have one less person to work with. And when we are all humans and everyone will have some or the other “follies”, especially when you are viewing them through your sense of morality (which, having been formed by your own unique experiences in life, is going to be different from anyone else’s sense of morality), judging people will soon leave you with nobody you can work with.

    In other words, every human is different. If you keep looking for people who think, walk, and talk exactly like you to forge teams, you will never be able to move forward.

    But, does it make sense to judge actions? Yes. As long as the judgement does not spill over to the person as a whole. In fact, judging actions is natural and direct consequence of morality. But extrapolating that judgement to an entire person is human bias.

    But what if someone is wrong in all areas of their life? I think it is quite right to be mathematical here. The total value of a person is the sum of all their individual values and the added value that interaction of values give them.

  • Why are the question papers of NEET PG not available anywhere?

    If you are a medical student, you know what I am talking about. The PG medical entrance test, called NEET PG, is a proprietary test conducted by National Board of Examinations. You have to sign a non-disclosure agreement to attempt this test. You cannot, according to the agreement, disclose the questions asked to anyone. Neither does NBE publish the question papers anywhere.

    How is this fair at all?

    For comparison, all the JEE advanced question papers from 2007 are put on the official website of JEE advanced. The USMLE website has content description booklet, plenty of sample questions, and practice tests. While the NBE’s website proudly writes everywhere that their exams (not just NEET, all of them) are “proprietary“.

    This would not have been a problem if NBE was some private body which conducts test for the sake of individuals. But NBE is not that. NBE is an autonomous body under the Ministry of Health & Family Welfare. NBE is not a private entity.

    How come they are doing this then? Well, turns out they have been doing this for years and nobody dared to ask. The DNB exams have been happening the same way from the beginning. Candidates take DNB exam with no knowledge of what they will be assessed on. Professor Suptendra has written about this in this IJME article titled “A farce called the National Board of Examinations“.

    I have filed an RTI yesterday with the following content:

    I, as a citizen of India, hereby exercise my right to information granted under sec (6) of RTI Act, 2015 by requesting the following.

    1) Please provide me with the questions asked (including answer options) in the NEET PG Entrance exam held on Jan 6, 2019.

    2) Please provide me the answer key of the above questions.

    3) Please provide me with the questions asked (including answer options) in the NEET PG Entrance exam held on Jan 7, 2018.

    4) Please provide me the answer key of the above questions.

    5) Please provide me with the reason why there was a non-disclosure clause at the beginning of the NEET PG entrance test held on Jan 6, 2019.

    The information may be emailed to my address: asdofindia@gmail.com

    Thank you

    This was addressed to National Board of Examinations. I’m sure the response will be “proprietary test”. Also remember that NBE makes 30 crores profit on NEET PG registration alone with no sanction from MoHFW.

    What are students supposed to do to prepare for NBE’s proprietary examinations? Go to entrance coaching institutes? Read textbooks and continue working? The atmosphere around entrance tests is so tense that students are scared to prepare on their own. They are forced into joining medical entrance coaching centers.

    But why? How can a test that decides who gets access to the very few postgraduate seats in India’s medical education system be made proprietary? Are you saying that only students who have the time and resources to go to entrance coaching centers should be able to prepare and score well? Should only people with time and money be becoming pediatricians and gynecologists?

    What will that mean to India’s health system?