Blissful Life

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

Author: akshay

  • De Quervain's like Pain After CPR

    Yesterday I was demonstrating CPR in a life support workshop. Today, I have pain in the left radial styloid process area.

    What could it be? Searching took me to two pages of interest. One is AAFP’s page on diagnosis wrist pain. This page talks about many things including Finkelstein’s test which is grasping the thumb with other fingers and then ulnar deviation of wrist. It was negative for me, and I definitely did not have De Quervain’s tendonitis.

    But it could be the same tendons. What are the tendons involved in de Quervain’s? The extensor policis brevis and the abductor policis longus which both go through the groove lateral to the radial styloid process. Maybe there was some microtrauma?

    The other article was about wrist injuries in emergency service providers. It does not look like I have a scapholunate ligament injury. So I decided to read more about de Quervain’s.

    I found an article – Walsh and Miller: Pain about the Styloid Process – which beautifully captures the history of Fritz de Quervain’s initial case descriptions and then Finkelstein’s reviews and so on. The original articles by de Quervain are probably in German (Because Google Translate detects the title so. I initially thought they were in French because I had once enrolled to learn French in Alliance Francaise and it looked similar to what I was learning then). You can, though, read translations in English if you, like me, can’t tell between French and German – references 1-4 on this article.

    Especially the one “on a form of chronic tendovaginitis“. When you read this you find out how chronic inflammations of tendon sheath were “rightly, increasingly being seen as tubercular”. And then de Quervain going on to describe a chronic inflammation due to repeated use. The people who see beyond what they are taught to see indeed get diseases named after them.

    Wait a second, where did “vagina” come into picture? Why is it tendovaginitis? Well, as it turns out, vagina means sheath in latin (and the sword (gladius) is kept inside) and since the inflammation here is on the sheath around the tendons, de Quervain (who obviously is a master of language) named it tendovaginitis. In fact, I see all reference of tendovaginitis going back to de Quervain’s disease. [Side note: Do you still want to use the word vagina to refer to vagina? Are you sure you are talking about vagina, and not labia or vulva?]

    After all that research, now I am now thinking it is the skin over the forearm that is giving me pain as the pain increases when I am softly rubbing over the skin. Maybe it is just a friction burn I got when handling my bag?

  • [jog-journal] Track Change

    Four months, quintals of biriyani, and almost fainting inside the metro day before yesterday because I darted to catch it and came to a standstill immediately. It took me these to realize that I should take care of my health even if Bangalore isn’t as enticing as Mysore to go for morning jogs.

    There is Jayaprakash Narayan Park near where we stay. It does have some water body inside it, but not a lake. There are brick lanes throughout the park and a sand lane that runs through the perimeter. So, today morning when I woke up at 5:40 after ten minutes of my alarm ringing, I decided that I shall resume jogging. Since I’m not a big fan of the calendar days I didn’t have to wait till new year for making a resolution.

    There was a pup about 2 months old tied to the gate of my neighbour’s house. It jumped up and caught my calf with its tiny paws two days back when I saw it. But today it was sitting still, yet vigilant. The Rajapalayam which roamed third main road was sitting in front of its owner’s gate. The German Shepherd (also known as Alsatian, a fact I came to know now when I searched “difference between German Shepherd and Alsatian”) inside was not near the gate and so didn’t bark at me like it usually does. The obese dog at the corner was walking today, for a change. It usually is always sleeping. Maybe it too had a realization today morning.

    By the time I came back even the two Indian Pariahs right next door were up. And the Pomeranian was walking behind the newspaper boy for getting its well deserved pat. The pup had broken its meditation, raised its paws and reached out as far as the leash would allow it to.

    Did you notice one thing? There were no cats around. I’ve never seen a cat do morning walk. Neither one that actually eats cockroaches. Cats are everything that humans should not be – lazy, selfish, and enigmatic about what their thoughts are. And dogs? Dogs set the ultimate standard that humans should strive to reach – persistent, caring, and down to earth about their feelings. You now know why I love dogs more than cats.

    The primary care fellowship and infectious diseases case based learning series are both set to start in January. I remembered it because just yesterday in JeevaRaksha JALS workshop at NATCON 2018, we met some wonderful young doctors with idealism not lost and that spark remaining in their eyes. Hopefully the day after we will meet again and discuss the heroism of incremental care, the wonderful life without “specializing” and the rat race, and a different style of learning and practising the art and science of medicine.

  • A Letter to the Disillusioned Intern (or Medical Student)

    Disillusionment. It happens to the best among us. It has happened to you? Welcome to the club.

    After all, who wouldn’t be disappointed? You could have become anyone – an architect, an engineer, a teacher, a scientist, a mathematician. Yet you chose to become a doctor. Of course it was your calculated choice. What a fantastic profession is it, after all? When a doctor talks to a patient, she is a teacher, an artist; when a doctor is diagnosing an illness, she is a detective, a scientist; when a doctor is communicating, she is a writer; when managing an emergency, she is a leader; in her career, she becomes an administrator, a guide, a policy analyst, a visionary. A doctor’s profession is an incredible melting point of careers. Unique, interesting. And above all, serves humankind like nobody else.

    And what did it all come to? Running around like a dog completing errands passed down to you in the strictest hierarchy ever. (It is called dog work, did you know?) Maybe learning a bit of medicine here and there, but if it is up to me, can I really handle a pregnant lady with eclampsia? Or a polytrauma? Will I be able to diagnose appendicitis in time? Am I doing the right thing even? What am I doing to patients? Does this hospital have anything? Are patients really being treated like shit or am I feeling so because I am treated like shit? What about IAS after internship? If this is how it is going to be, why would I even think of a post-graduation in medicine? Ah, I wish I could be in my bed. When did I last sleep? Should I really have taken an ECG on that guy before putting an NG tube like my PG asked me to and killing him? What salary do people in other states get when they do compulsory rural service? Heck, do they even do compulsory rural service? Will I ever get laid? If I eat this biriyani, will I be able to lose the weight after internship? Dude these 5th term students suck. They answer everything. Where did I keep that guy’s X-ray? What is the point of this education system? Am I mad? Is this life? Please stop this.

    It is the system. The horrible horrible system. It needs to change. People need to change. India will never improve. Horrible corruption. There are only 20,000 PG seats for 65,000 graduates every year. And then there are foreign graduates too. Life is going to be a rat race. Everyone is behind money. Have doctors always been like this? “Noble profession” it seems. LOL. When there are so many patients, there is no way things can be better. Patient load has to decrease. Examination system has to change. It is just this one year of internship. If I survive this somehow, that would be the end of all pain. Well, maybe 3 years of PG also. But why do PG? What is the point? Does it stop anywhere? They say MD Pediatrics is not enough because “it is saturated field”. Super specialization. Super super specialization. And to do what? Or like my friend, I should also try to go outside the country. They say Australia has too few doctors for their population. One thing is for sure. This system sucks. I don’t want to be anywhere near it.

    Woah, woah! Hold on for a moment. I thought this letter is going to be an answer to my confusion. I know what the problems are. Do you have an answer? If no, please ***k off so I can move on with my ***king life.

                 *        *         *

    Dear Intern (or medical student),

    Hang in there. You have done so well. You will keep doing well. Don’t forget, you have a gift – you think!

    Let me quote you Kabir.

    सुखिया सब संसार है खाए अरु सोवै।
    दुखिया दास कबीर है जागे अरु रोवै।।

    Now I don’t know what Kabir meant by it. But what I read is this: “The entire world is happy – ate well and slept; but Kabir (you) is sad – up and crying”

    Woken up and crying. That’s what you are. And guess what? That’s the first step of enlightenment. Gautama Buddha was a happy prince in a palace till one day he went out and saw suffering in his kingdom; Gandhi was sitting in first-class before he got kicked out; Greta Thunberg should have been in school this Friday, but she saw wildfire in Sweden this summer.

    Woken up. Different people get woken up at different times in their lives. Devi Shetty apparently after meeting Mother Teresa. Steve Jobs had Zen Buddhism on LSD. Some don’t wake up in their entire lives. So what if you are in medical school? You have been woken up. And now there is no going back to sleep either.

    I have got some very good news for you.

    The first good news is that you are at the lowest point in your life. How is that good news? Well, because the only direction you can go from here is “up”. And that is where you are going to go.

    The second good news is that you are not alone. There are not many people like you, but there are people like you. They are variably called as “crazy”, “whack ass”, “visionary”, “odd”, “interesting. hmm.”, “crazy”, and so on (depending on who is talking about them). There is no easy way to find them though. They could be in your batch, in your college, among your professors, in a forest, sitting at home, they could be anywhere. They could even be writing blog posts to their juniors.

    It is difficult to find them, but if you find them, you are family! There is very little need to talk about what you are going through, because they know what you are talking about. And they can feel your pain. And they want you out of it as soon as possible. And out you will be, shortly. Because there is a better world out there.

    A world where you can spread your wings and thrive. One in which patients are people and doctors are people and a consultation is a life long relationship. One in which knowledge is not just consumed but also synthesised. One in which a doctor is more than just a doctor. A world where you are revered not for specializations but for being a human. A world in which you can realize your true potential without worrying about hierarchies. A world of endless possibilities.

    So stop crying. And buckle up, for, there are things to be done, systems
    to be fixed, patients to be treated, lives to be made, and doctors to
    be delivered safely into the new world. And yes, you have earned
    yourself an invitation. Reach out to the undersigned and we start our journey right now.

    Take care,
    Someone who was you a while back

                 *        *         *

    Too much literature? Just want to know what I am talking about? Drop me an email, or telegram me

  • 11 Years of Blogging

    I am on Blogger since November 2007. It is 11 years this month.


    When I began, it was just me exploring the Internet. Everyone was making blogs back then. And I had to make one too.

    I made one. Then I made another, and then another. I have created some 36+ blog on blogger. I made one for my village, for my city, for my school, for my other school, two for my college, one for my university, one for pre-med preparation, one for physiology, one for biochemistry, one for anatomy, one for boss linux, one for scouting, one for APJ Abdul Kalam, one each for all subjects that fascinated me. The vast majority of them are bare barring one or two posts.

    Facebook, Twitter, and others took the crowd away and in turn the publishers. I have written countless posts on Facebook only to lose them all when deleting my account.

    But it wasn’t about the medium. It was about the act. Expression of an opinion. Free speech. Archiving thoughts and information for posterity. In fact, the latter is the philosophy behind my website learnlearn.in.

    Thank you @freephotoscc for sharing these awesome photos on https://freephotos.cc/ for free! 🎁

    Blogging helped me develop a perspective on things. It made me think more concretely and in depth about whatever I wrote about. And I wrote about a lot of things.

    It also gave me a rare confidence of accomplishment. I was creating things rather than consuming. And on the internet, the creators are one rung above the consumers. It is this confidence that propels me on a path of building things.

    I am excited about this milestone. And the result is going to be more things from me for you to read.

  • Photograph 51, Bangalore Little Theatre rendition

    In my 6+ years in Mysore, I’ve seen around 6 plays. 2 plays that I don’t remember, and 4 times “Madhyarathriya Thiganegalu” by Rangayana.
    Come my second week in Namma Bengaluru, I witnessed a 1 hour 30 minute spectacle called “Photograph 51” by Bangalore Little Theatre. Oh, where do I start about this heart warming, yet insanely funny and intellectual play?
    The venue was JRD Tata Auditorium. There were scientists and senior citizens taking up majority of the seats. The stage was set as a dimly lit Chemistry lab. The story of Rosalind Franklin.
    “The play is about the race to solve the structure of the DNA and the role of Rosalind Franklin who provided the critical evidence for this. For a long time, she never got the credit and this play highlights her efforts in science at a time when the doors of science were not open for women.”

    The introduction by the director and his daughter set the tone for what was about to come. Photograph 51 is that image of the DNA taken by Raymond Gosling and made the mystical thing a little less mystical.

    As soon as the cast walked on to the stage, the narration started, by none other than the actors themselves. This is one of the many exciting things about the play. There is no narrator. But there are many narrators. And they are all part of the play as well. The narration is sometimes weaved through dialogues. The fourth wall gets breached many times, but what do you call the wall between the narrator and the actor?

    Then there is the wit. If I were to put the play in one genre, I would choose comedy over history, feminism, and science. But it is not a comedy play. The wit never bothered the story. Wit was always self-contained either in soliloquies or in quick exchanges between the actors.

    There is love. There is passion. There is heartbreak. There is reality. This play is a must watch.

    And for that matter, they are performing it one last time on 29th September in Bangalore. Head over to BLT’s website for more information.

  • Understanding the 1/5 Unconstitutionality of Aadhaar and What You Can Do About It Today

    What is the difference between a monarchy and a democracy?

    I am Tipu Sultan. I rule the kingdom of Mysore. I ensure that my kingdom flourishes. In order to ensure that, I will make certain rules. I will punish those who do not follow the rules. Welcome to Mysore.

    We are the people of India. We will decide what happens in India. We will elect representatives among us to make rules for India. We will keep changing these representatives. We will ensure there is social, economic, and political justice; that there is freedom of thought, expression, belief, faith, and worship; that there is equality of status and opportunity among us; and we will promote among ourselves fraternity assuring the dignity of each of us and the unity and integrity of India.

    Which of these places would you want to be born in? Mysore or India?

    I was born in India. I was not born when India was in hundreds of pieces and ruled by different kings. Neither was I born when India was under the British emperor. I was born after Indians came together, said “enough is enough” and claimed India for themselves, and having drafted for themselves the Constitution of India, decided to live by it as a democracy where justice, liberty, equality, and fraternity will prevail. Thank goodness I was born in a democracy.

    Here is a picture of the constituent assembly. Whatever they discussed while drafting the constitution is available on the Loksabha website. Reading through the constituent assembly debates is in my bucket list as well. 

    Anything more than incremental change is hard. Except during revolution. During revolution, change is the norm. India’s independence from Britain was a revolution. Because of our experience with monarchy, we chose democracy as our governing moedel. A strong constitution is fundamental to the survival of a democracy. We drafted a strong constitution taking inspiration from various strong democracies. We set that in stone. We set our democracy in stone.

    The beautiful thing about principles is that well-thought principles rarely need to change. For example, Mahatma Gandhi made truth and non-violence his principles. He could live his entire life on those principles. It is principles that give rise to many of the organizations we see around us. When the principle dies down, the organization too. The way we operate, the rules we follow, the things we do, everything can change. But the principles won’t. Indian constitution defines the principles of our nation. Whatever happens in our country should be in line with the principles laid down in our constitution.

    Think about it for a second. The constitution is the foundation of our democracy. If we do not uphold the constitution, we are destroying our democracy, we are giving up on all the principles that the constitution stands for. Hold that thought.

    The constitution alone is not sufficient to run a country. Which is why the constitution allows for setting up of legislative, judiciary, and executive branches for the democratic government. Legislative to write laws. Judiciary to read laws. Executive to execute laws. (Like Unix file permissions). And there is clear power separation between the branches on who can do what.

    The distinction between branches work well when everyone is doing just what they are supposed to. Law gets passed by legislature that from October 1 people should ride their vehicles on the right side of the road. Police fine or even arrest people who are riding on the left side on Gandhi Jayanthi. They are produced before the court and the court gives them the punishment prescribed in the act.

    Things get murky when the constitution is involved or invoked, though. Vrinda Werkijal who was arrested on October 2nd, goes to the court and says “It is my constitutional right to ride on the road as I please. Rather than punishing me, you should strike down the law that says I can’t ride on the left side.” Then the court would be happy to point out to Werkijal that there is no constitutional right to ride on any side of the road and put Werkijal in jail.

    But, imagine the law was about free speech. Say UP passes a law tomorrow that says people should not use the word “beef” in the state. Abhish Mathew could go to the court even before he gets arrested and argue that the law is against the fundamental right of freedom of speech and therefore should be struck down. Easy peasy.

    Wish everything was so black and white. Many laws are huge. Huge in terms of the components in it. Take Aadhaar Act itself. It has 59 clauses spread over 8 chapters. And many of these are complicated compounded sentences with multiple sub-clauses. When an unconstitutionality claim on such a thing is claimed, it will indeed take months of litigation and thousands of human hours to decide on constitutionality.

    In short, there is only one argument against aadhaar: it ensures surveillance while claiming to ensure welfare and does not even ensure welfare.

    Let us imagine. What does it take to decide on this case? Even for a person who is not influenced by politics and not corrupt, it takes deep and philosophical understanding of:

    • the constitution
    • how surveillance damages democracy or how privacy is important in democracy
    • the disproportionate power that entities with access to big data obtain
    • the technology that is running behind aadhaar
    • the reality of welfare delivery in our country

    Unfortunately, superficial understanding of these won’t do. Someone with superficial understanding would say things like, “hmm, aadhaar will help catch terrorists”, “hmm, we can save money by removing fake accounts in the PDS”, “hmm, you don’t have to worry about surveillance if you have nothing to hide”.

    But if you go read the critiques of aadhaar, you can hear deeper perspectives on how biometric authentication is probabilistic and how arbitrarily a threshold setting configured on a software can either declare you undeserving or deserving for your fundamental rights; on how design choices enabled illegitimate enrollment which has lead to ghosts and fakes in the database – the very thing you set out to weed out; on how democratic voices are stifled in a surveillance state; on why Rajya Sabha is indeed a part of the parliament; and so on.

    Relevant section from Supreme Court judgement on Aadhaar’s constitutionality

    So, why would someone feel like aadhaar is unconstitutional while others don’t? Why is it 1/5 unconstitutional? You know the answer, don’t you?

    If you would like to spend more time crying over spilt milk, read from page 568 onwards of this PDF file.

    What you must do now

    As a citizen of India, it is in your own best interest to ensure that the democracy continues unharmed. The best way to do so is to elect representatives wisely. That is not an everyday choice though. But you do have a choice every day to engage with the government. For example, ministry of electronics and information technology has invited feedback on a draft personal data protection bill. The bill is riddled with issues. First, read analyses of it. Here are a few links:

    Looking at loopholes in sections of the Bill pertaining to data ownership, RTI and more
    Loopholes pertaining to empowerment of children, consent and surveillance State
    India’s data protection draft ignores key next-generation rights

    Then, write to the ministry with your comments.
    Through Ministry directly
    Through Maadhyam

    Be a good citizen. Live in a strong democracy.

  • Why Jacob Vadakkanchery’s Arrest is the Best Thing for Naturopathy, AYUSH, and the State

    There is a lot of context needed here.

    To begin with, Jacob Vadakkanchery is a self-proclaimed healer naturopathist from Kerala who goes around asking people to believe that modern medicine is harmful for health. His arguments are so basic and trying to respond to an argument he raised had me writing a 1200 word blog post in Malayalam explaining what science is and whether medicine is a science. He was arrested in the second week of September by Kerala police for asking people not to take Doxycycline prophylaxis (in the aftermath of the floods) under at least section 505 of IPC. Section 505 is one of those sections which exist owing to the “reasonable restrictions” over freedom of speech and expression in the interest of public order as per Article 19 of the Indian Constitution. It punishes people who spread rumors that are likely to disrupt the society unless they are based on reasonable grounds.

    I, am an HIV physician and general practitioner of modern medicine. I have previously worked in a hospital where Ayurveda was regularly practiced alongside modern medicine.

    Now, let us get to the matter. After Vadakkanchery’s arrest, there was a discussion in my circles about how it was wrong for the state to run Government naturopathic hospitals on one side and arrest people for taking stances against modern medicine rooted in naturopathy on the other side.

    Isn’t it true? If you recognize natruopathy (or AYUSH) as a valid system of medicine by opening hospitals and offices for the same, are you not also paving way to firm believers in those systems to make everyday statements that insult families of cancer victims, make doctors and hospitals look like villains for providing standard care, and makes those who think question the role of scientific temper in our discourses?

    Many times the prescriptions of modern medicine are directly contraindicated by the principles of alternative medicine. How is it that the government is allowing two such opposing systems to exist together? What is the government trying to tell people? Whom should a person go to when they get sick?

    Here are my thoughts.

    It is not the government’s responsibility to tell people what to do. Actually, the government does not have any power to tell people what to do. The government’s role, in a democracy, is to abide by the Constitution which is written by the people for themselves and “govern” the state. So let us leave the government out of the question.

    How did we end up with such systems, though? I think the answer is simple if we try to understand what these systems are and what they represent.

    Self-preservation is a fundamental drive of all living things. Humans must therefore have started thinking about the art of staying alive from the beginning. What humans also tend to do is form theories based on what they see and understand. We form theories for everything. In fact, what we call science is a continuous reforming and refining set of theories based on observations. But these theories are limited by what we can observe and imagine is happening.

    Our imaginations become more accurate representation of reality when we can observe more closely and in more detail. That is how science keeps growing. The idea that there might be something that transmits diseases from one person to another was imagined by observing people living together getting the same disease one after the other even before the invention of microscope. Later, when we invented microscope, this imagination became observation. Then we moved forward imagining things which a microscope could not show us. That is how science happens.

    In that spirit, Ayurveda is a science. Or to put it more correctly, Ayurveda was a science. From the set of observations that could have been made centuries ago, whatever could be imagined was indeed science at that time. AYUSH is a set of outdated imaginations based on observations that does not include all that can be observed with the state of affairs right now.

    Now here is the most important sentence I am going to say. Outdated does not mean wrong altogether. If that is the case, the medicine I am practicing today in India is already out of date by a few years compared to Western world and I am completely wrong to practice that medicine. That does not make sense. It is okay to use the best of what is available. In HIV, there is a medicine called TDF which has a lot of side effects on the kidney and has been replaced by TA in the West. But it’s not yet widely available in India. So, should the 1 million people who use TDF not be using TDF? Absolutely not! Oral rehydration solution is an invention that is absolutely stunning. But for simple diarrhea, drinking plenty of fluids might just be enough. So, if I do not give someone ORS when they have diarrhea instead ask them to drink plenty of fluids, am I making a mistake? No.

    Similarly, AYUSH makes sense for people who do not need modern medicine and for people who cannot access modern medicine no matter what. Take a close look at the clauses I used.

    “People who do not need modern medicine”. A lot of conditions do not need modern medicine as a must. A simple cold with cough, a simple cut, obesity, psychosomatic illnesses.

    “People who cannot access modern medicine”. When I was working with SVYM near Mysore, I became acutely aware of this. For populations of about 20,000 there simply is no surgeon available. The two obstetricians who are in different towns in the taluq have to coordinate with each other to ensure that when they take a Christmas vacation with family, the 20 ladies who are expecting do not suffer. Do not even ask me about how the on-call system of doctors could run. AYUSH practitioners are a luxury for rural Indians. MBBS doctors – an Utopia.

    This is the context where AYUSH and modern medicine do not just exist together, but are forced to work together.

    These are not the only reasons though. There is an element of human touch that goes missing in medical practice now. This leads to people seeking comfort from people who give that touch. Homeopathic medication might be placebo. But if placebo is the only medication that works for a particular condition, and if modern medicine practitioners are not able to give that placebo, then why not homeopathy? If in one 30 minute visit to an ayurvedic practitioner I can get relief from my headache, my grandmother’s knee pain, and my child’s cough, why will I visit someone else? Where is the modern medicine family doctor?

    It is in this context that government opens its own naturopathic centers. This context, though tiny by definition, includes a large population of our country. Therefore, it is very important that we define this context well and nurture the continuum of care when there is a change of context. For example, a pre-diabetic who was being managed with lifestyle changes by an AYUSH practitioner will need a modern medicine consultation when they become a full-blown diabetic. At that point, it must be possible for the AYUSH practitioner to understand their limitations and refer them to the modern practitioner. At the same time the doctor at the modern medicine end must be sensitive about the context the patient is coming from and be willing to accommodate and include the system that the patient has easy access to in their prescription.

    This is not happening now and cannot happen as long as practitioners of different systems do not understand their strengths and weaknesses and are not willing to collaborate on behalf of the patient. Where there is no trust and understanding, there cannot be collaboration.

    When people like Jacob Vadakkanchery go about stating ill-based arguments against vaccine and doxycycline, they need to be stopped, arrested if need be. If they are not stopped, it would be ignoring all that human beings have achieved in the pursuit of science.

    Only when the enmity ends can people begin to learn about each other and understand each other’s strengths. The enmity can end in only one way. AYUSH will have to accept that their role is in a limited context. They will have to learn their limitations and refer patients to modern practitioners before it is too late. And modern practitioners will have to understand the issues in their practice and make use of AYUSH practitioners.

    This is not a natural collaboration. It needs to be forged into place. Some organizations like SVYM may have been able to do it successfully. But it is in the best interest of the state to enable this collaboration to emerge at a national level. Pitching one against the other is not going to work. And that is where Jacob Vadakkanchery’s arrest is the right thing to do.

    What to do with BM Hegde though?

  • Healthcare With Smartphones?

    Imagine this. You are a 36 year old lady working as maid in two houses, not supported by an alcoholic husband, and mother of two school going children. Your husband had a wart on his genitals and now you have it too. It is not particularly bothersome, but you are not sure what you should do about it either.

    You think it would be a good idea to go to a hospital, but which hospital? Which doctor should you meet? Would they judge you? Do they charge too much money? Is it going to hurt? Whom do you even ask these questions?

    Enter our app.

    You will be asked a series of questions in your own language. The questions get more and more specific as you answer them. They will also be read out to you in case you can’t read. By the time you have answered about 10 questions, the app knows what your problem is.

    The app has been fed with a well designed set of protocols/algorithms that need to be followed in each situation. It has a curated collection of resources (hospitals, clinics, labs, lawyers, etc) which are guaranteed to give you quality care without judging you or making you feel uncomfortable.

    The app might suggest you to get over the counter paracetamol for a fever it thinks is not serious. But for your wart it is suggesting that you consult a dermatologist near you.

    You can book an appointment with her through the app at a time convenient to you. Your data will be passed on to her with your consent. Later at the clinic you can start from where you stopped.

    Information is strength. Knowledge is power. As a doctor, I have witnessed countless situations where patients struggle because they did not know the right room number or doctor’s name. What the app does is eliminate those knowledge barriers by presenting trustworthy and relevant information in a friendly interface.

    The possibilities that this idea brings are endless.

    It can be tied together with a call center where people who do not have a smartphone can be given service.

    A subscription based service that gives discounted rates for various medical tests and consultations can be introduced.

    Micro-insurance schemes cab be brought in.

    Transgenders can be employed as distributors of the app to otherwise hard to reach strata. They can be given additional training to be able to work more or less like ASHAs in the community.

    Otherwise hard to navigate healthcare facilities can be easily navigated. (Think of how easy google maps has made walking around an unknown city)

    The bottlenecks:

    Affordable healthcare providers. Whom do we have?
    Government is cheap. But what about quality and comfort?

    It might be possible to tie up with private companies under Corporate Social Responsibility to fund the charges at private hospitals. But the costs can become too high too soon.

    An intelligent mix match of services public and private using a friendly application can solve this in my imagination.

    And that is what I am working on now! Ping me if you’re interested to join forces.

  • Reimagining Kinnars (Hijras) as Health Workers for Reproductive & Sexual Health

    Supreme court struck down section 377 a couple of days back. India is moving forward in the right direction. There is still a lot of work left to do.

    We see kinnars (hijras) working on roads asking people for money. They are “strange” humans in other people’s mind and when people look at them all that comes to their mind is their gender issues and sexual connotations of those.

    This strangeness might be the reason why people are unwilling to give them jobs. Could we turn this around?

    Reproductive and sexual health is a topic that is absolutely neglected in our education system. There is plenty of embarrassment in discussing topics related to sex as well.

    What if, then, we put them both together? What if we empower kinnars by giving them training and other resources required, to go into the community and work for reproductive and sexual health? Like ASHA workers they would promote health. They can even distribute interventions like condoms.

    This is a positive change in many ways:

    • The kinnars themselves gain a better understanding of health
    • This can become an income generating opportunity for them
    • The perceptions about transgender community can slowly be changed to a positive one
    • Otherwise hard to reach strata of society can be reached
  • Bridges, bridges, everywhere

    I’m a Bangalorean now. I have a metro card as well. For about a week now, I have been talking to a lot of people and reading (also searching for 1BHKs around IISc). Turns out there are not many secrets in answers to “What to do in life?”

    There were a few points that made sense and helped me gain immense clarity. I’ll list them down.

    Immanuel Kant: Mark Manson’s post on him is a nice read on the kind of moral philosophy that we can have. It is slightly complicated but boils down to “strive to be the best, if not you’re doing injustice to yourself”.

    Remember it was the same idea that propped up earlier with reference to Gita.

    In fact, Priyanka Chopra lists down 12 rules in her breaking the glass ceiling talk which sounds similar as well – be fierce, fearless, and flawed.

    Stoicism: Talking about fears, Tim Ferris made a really nice TED talk on defining fears and defeating them. He gives an excellent tool to practice stoicism. And stoicism is an absolutely useful “-ism” in times of uncertainty.

    Bridges: The place where I have to go to isn’t really somewhere that people frequently go to from my place. Therefore, I have to build a few bridges to that place. The only issue is to differentiate bridges from hangouts.

    Money: There are a few important lessons about money.

    One is that money saved is indeed money earned. If you can decrease your expense, you won’t need a huge income.

    The other is that money created is a measure of value created. If you are building a product and want to know if it really adds value to the world, just count how much money has been generated by the product.

    Integrity: When we talk, we need to walk the talk. This doesn’t mean you stop talking about anything that feels important to you. It means that you should keep pushing. Talk, then write, then do, then do more, then do maximum, and then keep doing.

    Bed bugs: Bed bugs are really pesky pests. Do not try to adjust with such annoyances. Overcome them.

    Failure is not a choice. But success definitely is.