Sunday, July 4, 2021

Will a better human strain emerge after the pandemic ?


The Statesman 5 May

The Indian public is trying to cope with the gravest medical crisis in recent history. There is an acute shortage of hospital beds and oxygen, leading to a high fatality rate among Covid patients. Everywhere, people are grieving over the loss of loved ones and there is palpable anger at the lack of preparedness. These shortages which hinder treatment and cost lives make even doctors feel very helpless. Over and above their medical duties, doctors find themselves being pulled in different directions. They are having to get involved in chores such as sourcing scarce oxygen supplies and to get multiple forms signed from relatives. These protect them from liability not related to medicine – such as medicine stocks running out or ICU beds not being available.

Where they were once able to offer comfort and reassurance to most people, they themselves are at their wits’ end. They feel very uncomfortable at having to ask prospective patients to come for admission with their own medicines and cylinders. Outside, at the hospital gates, people wait expectantly, hoping a miracle will happen and an empty ICU bed will surface. Such miracles are rare.

Many people don’t make it to the inside of a hospital and breathe their last on the roadside. Even crematoriums are overburdened and have run out of space. The new mutated virus strain in this wave is causing a lot more medical uncertainty as it is not easily detected anymore. Because the Rt-Pcr tests were designed on the genome of the original strain, they are often not able to detect the presence of the new virus.

Could the virus be having a dormant form like the Varicella Zoster virus (Chicken pox, – which rests in various nerve ganglia and gets active producing shingles years later), when the host immunity is lower or the environment conducive? Maybe this form erupts suddenly once its gestation cycle is complete. Who knows? In India, this massive outbreak has occurred just when the beautiful flowers of spring were blossoming everywhere.

Echoing Darwin’s theory, the virus is trying to survive, by evolving. Whereas evolution in contemporary species is slow, this virus seems to be doing so at supersonic speeds. It also now seems to be taking a faster route to its target organ of choice, the lungs, bypassing the nose and throat areas. And it has cast its net over a much wider area.

We see so many younger people getting infected with Covid compared to the ancestral strain which largely spared the young and healthy.  Matching this uncertainty are various man-made ones. There is uncertainty about the availability of vaccines and their efficacy against newer strains. The data on the disease is not fully reliable or transparent. It does not seem to accurately reflect ground realities.

For example, in many instances, the official death toll has been starkly different from the crematorium records by a factor of 20-25 on some days. Due to this patchy data, it becomes difficult to formulate and test various medical hypotheses.Yet, in the midst of this absolute pandemonium caused by the stealthy attack of the virus, there is a group of people carrying on with their lives with an enviable certainty as if nothing of import has happened.

We have an international cricket league tournament going on towards which already meagre resources are being diverted. People fly off on exotic holidays and post vacation snaps even as journalists post pictures of a profusion of pyres and lines of waiting ambulances.

We have seen elected representatives host crowded public religious events and address large election rallies, totally unmindful of the fact that this can help propagate the virus and spread sickness and death countrywide. This indifference is strange, coming as it does after a severe round of suffering caused by the first wave of the pandemic last year.

Can we really live in a bubble, impervious to what is happening around us? We have suggestions from people to stay happy even as the world around us collapses. Of these, some sensitive souls are truly well meaning. Some others do not want to face reality, and want to bury their heads in the sand. A third group wants to hide reality and diffuse public anger. It may be most healthy to allow feelings and moods to play out in people in their own natural way.

Hiding rage and grief beneath an artificial veneer of inappropriate cheerfulness may adversely impact minds already traumatized with worry and sorrow. A false sense of security may also cause people to lower their guard. Accepting harsh reality may render us better placed to deal with it. Far worse than callousness, are those trying to profiteer from the grim situation.

We have medical vendors who are building up their personal fortunes by selling oxygen cylinders and medicines at highly inflated prices, while people desperately fight to save their loved ones. We even have priests who have hiked rates fourfold for performing the last rites of the deceased. For immediate redressal of the black marketing in medical commodities, the answer is likely very straightforward – the products should be made freely available.

A simple regulation can be made for suppliers and chemists to not sell more than a limited amount to an individual buyer to ensure a more equitable distribution and pre-empt hoarding. The huge amounts of foreign aid in the form of medical supplies coming into India from countries all over the world needs to be transparently documented by customs and distributed to the most vulnerable. The public will feel very reassured if they can track the life-saving goods directly.

Not everything, however, can be painted black. We are also witnessing models of selflessness. People rallying round to help others. There is a sea of concerned humanity, people sharing resources with each other- literally saving lives and stepping in wherever the need arises. Gurdwaras have been at the forefront of providing free oxygen to the community and NGOs are back in action distributing free meals.

Despite having faced severe scrutiny and an acute depletion of funds due to complex regulatory laws, NGOs have still bounced back. Even in an extremely weakened state they are standing tall and inspiring everyone with their work ethic and abundant social responsibility. In fact, in his public address on combating Covid, a prominent leader appealed chiefly to civil society groups and NGOs to help turn the tide. What would undoubtedly add punch to this effort would be for the leaders to themselves lead by example – in terms of wearing masks and ensuring distancing when addressing the public.

The pandemic has brought out both the generous as well as the selfish sides of humans – ‘the good, the bad and the ugly’ as the title of a popular Western movie goes. In this macabre dance for survival, hope springs eternal that it is the human species that survives. That it can mutate into a superior species after its literal trial by fire. Our fervent hope is that the new human variant can live in a responsible manner and in greater harmony with each other and with nature. Apart from healthcare resources, what human behaviour patterns prevail may well decide the fate of mankind during and after this pandemic.

(The writer is a Delhi-based medical practitioner)

Sunday, March 21, 2021

As Special as a Woman

 The Statesman, March 2021

International Women’s day will be celebrated on 8th March this year, and as always, one’s thoughts turn towards women. We reflect on their struggles, their achievements, and their sometime extraordinary lives. The theme for International Women’s day 2021 is -Women in leadership: achieving an equal future in a COVID 19 world. I laud some unsung leaders who take the reins of life firmly in their capable hands.

 The first are the girls and women who work in fields, or rear cattle, to keep their homes and hearths running. It seems an ordinary enough life, but in actual fact they effortlessly tackle a daily spectrum of tough challenges. Women in the hills rise early and take their goats for grazing on mountainsides. Armed with sickles, they climb up on trees to cut branches and leaves for a rainy day, while the goats contentedly graze on the grass below. They are compelled to go out and face the elements -rain, hail or snow, and maintain their balance on slippery slopes, to keep their herd well-fed. Not for them the protective gear that professionals or sportsmen enjoy - golfing gloves to grip smooth irons better or the cricket shin pads that save muscular legs from the thump of a hard ball. In the olden days, it was the men who were considered the hunter-gatherers, but women play that role now. A lady in our caretaker’s family, Asha Devi, once bravely snatched her goat back from the jaws of a leopard. Of course, the goat was cooked for dinner by the poor family as it was too badly injured to survive.

In the plains, many young women face perils of a different sort when they go to gather the crops. The predators here can have a more human form. One hears unfortunate tales of many a young girl who is accosted while out in the fields alone or harmed by a stalker whose feelings she didn’t reciprocate. Ancient drawings depict young warrior men heading home after the hunt with animal carcasses slung on their backs. Now we see young girls on village roads heading back with the household water carried on their strong heads and shoulders.

 In the urban areas too, very young girls are literally holding the fort. We had an eye camp in Khora colony recently at a school for underprivileged children. I was concerned whether the children would be able to carry their camp documents home safely to their parents and not lose them. The principal assured me that some children are so responsible that they manage their entire household, even locking the dwelling prior to departure, themselves. She narrated stories of young children who cooked and looked after their alcoholic fathers and other siblings after the demise of their mother. It was remarkable, as also a testimony to her commitment that these children somehow showed up at school daily, even with all these burdens on their young shoulders.

All these women, young and old, keep the wheels of life turning. Despite this, the prevailing social circumstances do not allow women to take pivotal decisions pertaining to their lives. Rigid stereotypes still exist of their destinies being governed by hookah wielding patriarchs sitting comfortably under trees while women face exclusion and marginalization in decision making.

The second group I would like to laud are the fearless and feisty women activists who have been at the forefront of several popular protest movements in India. Many have been subjected to media trolling, bullying by the local authorities and undeserved jail sentences. I have a deep respect for activists because of their high level of empathy for others and their sense of justice which makes them work selflessly. Among many others, we had activists like Pinjra Tod NGO members, Natasha Narwal and Devangana Kalita, fighting for the security of immigrants in far-off states, though they are themselves based in Delhi. I saw a news clip on Natasha’s father (she lost her mother as a child) where he speaks so fondly and proudly of his daughter’s gender related activism. It was very moving. Though many people stand loyally with family and friends through their upheavals; it is activists who are the refuge of strangers in trouble.

History is replete with stories of activists who made great personal sacrifices for the good of the community. Like Nangeli of Cherthala village of Kerala, a poor Ezhava woman who cut off her breasts with a sickle when she was forced to pay tax for the ‘luxury’ of being allowed to cover them (only higher caste women were allowed to cover their breasts in Travancore in those days, anyone else doing so, was taxed). Her actions led to the abolition of the tax.

What is ironical is that people who spend millions advertising their products and lobbying officials to increase their own net worth, are deemed ‘successful’ in society, but activists who work to bring in changes that improve the quality of life of thousands are held in disdain by authorities for their social lobbying.

 The third group I would like to focus on are housewives. A friend gave me a lovely definition of a mother as ‘someone who can contain you’. Indeed, housewives have been the glue holding large joint families together and the generous sponges soaking up the disappointments faced by spouses and children. Like alchemists they turn the nadirs in their families’ lives into opportunities, hope and even positive outcomes through sheer strength of effort and character.  Housewives work long hours without payment and even without adequate recognition at times. They learn to draw their sustenance from the welfare and happiness of their families. A recently released movie ‘The Great Indian Kitchen’ highlighted exquisitely the monotonous and relentless drill in the kitchen that some housewives follow day in and day out, till they are literally ready to drop with exhaustion at the end of a long day of chores.

In the times of the COVID pandemic housewives have faced exceptional challenges – increased demands on their time from family members confined to the home, the frayed nerves and tempers of relatives displaced by the turn of events, increased incidents of domestic violence and reduced outlets for relaxation for themselves (in the form of friends or outings). Yet they have soldiered on, graciously believing that they have not been singled out, that others are facing their own challenges during the pandemic. As always, they think empathically of others.

In the professional world, a lot of care and enormous amounts of time go into apportioning credit for work done, and dealing with the angst of professionals who feel they did all the work but someone else got the pay hike or promotion. Yet at home, the same detail of appreciation is rarely meted out by the ‘head of the family’ or other members to the Atlas- like woman holding up the family’s personal world on her shoulders.

On International Woman’s day 2021, let us celebrate each and every woman as a special being with an important role to play in the changing world. That means shattering the barriers that hold back women. Let us truly hope that this women’s day is a turning point where women find a greater respect for their voice, their work, their thoughts and get to realize their full potential.

Wednesday, December 23, 2020

Sustainable Actions in an Uncertain Time

 The Statesman, 14 December 2020

The Corona virus pandemic has brought in its wake sickness, unemployment, stress and uncertainty. Despite being overwhelmed on multiple fronts, people are struggling valiantly to make the best of a bad situation. The younger generation in particular has shown remarkable forbearance. As my daughter’s friend ruefully put it – “I went out to college and excitedly began the process of carving out an independent niche for myself in the world, yet here I am …. back to square one, cocooned in the family nest and confined to the house”.

We all think about a better future for our children but how do we go about ensuring that under such trying circumstances? After some ‘triaging’ what springs foremost to my mind as being of vital importance is: understanding and building up immunity to higher levels, practising kindness and compassion more abundantly, realizing how mother Earth is suffering along with us, and helping her heal simultaneously.

Nowhere has the role of immunity been highlighted more dramatically than during this pandemic. At one end of the spectrum, it supresses the infection so efficiently and stealthily, that patients are alerted to its presence only if perchance they test positive for Covid. At the other end, our immune system itself can harm our body by over recruitment of immune mediators - the much talked about ‘cytokine storm’. Studies of diseases that cause autoimmune microangiopathies (involvement of small blood vessels) or Leprosy, where the type of immune response varies depending on the bacillary load are among those that can help provide valuable insights into treatments.

In his book “Quantum Healing’ Deepak Chopra speaks eloquently of the elusive ‘switch’ which connects an abstract thought to a concrete neurotransmitter molecule and thus translates an idea into tangible action. Somewhere behind this mystery lies the fascinating potential ability to be able to consciously unleash complex immunological cascades in perfect balance. However, till we make this magical evolutionary leap, we can rely on a balanced diet as well as freely and abundantly available resources: sunshine - known to play a mitigating role in seasonal affective disorder related depression; massages, laughter, playing with pets – all of which release endorphins (natural mood elevators and pain relievers) in the body, and meditation with its scientifically proven ability to induce structural changes like an increase in grey matter as well as its beneficial effects on calming the mind, boosting immunity, steadying our heart rates and lowering blood pressure.

Kindness and thoughtfulness, often underrated, have never been of greater importance. Nowadays we often find ourselves dependent on total strangers. Elderly people living far away from their families are being looked after by neighbours with whom they may not even have interacted earlier. In hospitals, we find young and old patients, unable to fully fend for themselves, who are cut off from the loving care of their families while admitted. However, many of the doctors and nurses who tend to them often go beyond the call of medical duty and act as a surrogate family to them. With the work and study from home format and social gatherings being best avoided, a far larger slice of the population is now experiencing loneliness, depression and isolation. Unlike before, we can’t always rely on our usual pillars of strength to be there for us – for all over, people are fighting their own battles and their resources and reserves are stretched. Yet there is a virtual bonding amongst strangers. People share their experiences and advice generously on social media. Sometimes a heart- warming post can provide a surge of hope to someone sitting halfway across the world.

In the initial days, kind heartedness towards those who had contracted Covid was not much in evidence. In some places, Covid positive individuals were shunned by neighbours. Petty-minded landlords even turned away doctor and nurse tenants who worked at hospitals, to safeguard themselves. However, an overall social awakening towards being kind and helpful was discernible with thousands of ordinary citizens reaching out to support the migrant labourers in India for example. Some elderly patients in Europe made the ultimate sacrifice for their fellow humans when there was a shortage of ventilators - giving up their chance in favour of a younger patient.

Another entity that desperately needs a show of kindness is planet Earth, who is reeling from a pandemic of human acts that have relentlessly depleted her reserves. Earth’s ‘lungs’- her forest cover, have been greatly weakened by profit-driven and uncaring human activity. Even as we humans hope and pray that we contract the asymptomatic version of Covid if at all, yet our lifestyles of consumerism leave mother Earth violently symptomatic. These manifest as natural disasters– devastating floods, strong cyclones, raging fires and the like. Perhaps now is the ideal moment for each one of us to be a frontline worker in healing the Earth.

It is deeply ironical that the planet once provided us pure air abundantly, yet we polluted it to the extent that we have to sip clean oxygen out of cylinders. To restore the green status quo there are several initiatives that can be taken both at an individual level - such as growing plants and vegetables in our own backyards to the government level - establishing far more universities for plant and wildlife studies, strict environmental laws that protect forest lands from road construction and mining and not allowing shops/kiosks in gardens, to prevent littering in and concretization of green spaces.

We can also reduce the ‘toxins’- plastic and concrete – from the surface of the Earth by a determined plan to use alternatives. Currently, one needs to reduce the additional load of plastic waste generated by the life- saving personal protective equipment (PPE). A good viable alternative is PPE made from recyclable material for example, maize outer leaf husk (fairly waterproof) or otherwise soap paper. The small, rectangular soap paper strips that are popularly used during travels can be manufactured in longer shapes – such as PPE overalls. Soap paper is naturally virucidal (soap molecules have a lipophilic component that binds to the lipid cell membrane of viruses, inactivating them) and very affordable. We can consider decreasing the use of alcohol-based sanitizers. Here too soap (in liquid form) could be a potential alternative. Also, it may be worth doing a study to see if blowing soap bubbles into the air (a useful talent that most kids excel at) helps to inactivate airborne viruses by adhering aerially to them. Moreover, when the bubbles burst, they would provide a fine protective film on the surface they rupture against. We can similarly make a deliberate attempt to reduce the use of concrete by removing it from where it is not really needed - for example from pavements. Pavements anywhere can be made simply of pressed mud with a brick edging only. This will help in replenishing the groundwater better, prevent flooding of roadsides in the rains and will allow trees to be planted on pavements which will discourage two wheelers from appropriating them.

To my mind, this pandemic brings a single message for mankind -that it is imperative to follow a sustainable lifestyle. If our collective actions now begin to spring from consciously caring about our own well-being , thoughtfulness towards our fellow humans and genuine love for Mother Earth and its species, this terrible suffering would be partly comprehensible.

Tuesday, August 18, 2020

A Meaningful Rakhi Gift

 The Statesman, July 31 2020

The much-celebrated occasion of Raksha Bandhan is around the corner. This used to generate considerable excitement when we were young. We made rakhis with Anchor thread and brushed them with used toothbrushes until the thread fibres shone.We then braided little beads onto the two side threads left long to tie them around our brothers’ wrists. Brothers busied themselves selecting the most thoughtful and appropriate gifts for their sisters. Rakhi highlights the strong and enduring bond between siblings. Sometime ago, someone asked me what the best gift was a brother could give a sister.

I felt the best gift was for the brother to truly understand his sister. I thought that one of the best ways in which this could be achieved was for the brother to step into his sister’s shoes for that day. To undertake the daily chores she does, visit the places she visits and so on.

Today, I feel the brother can go one step further and intervene to ensure that his cheerful, sprightly sister has a bright and safe future. He can oppose his sister’s child marriage with all his heart if he encounters it. If his affirmative action helps his sister to continue to enjoy her childhood, complete her education and be saved from the stress and physical danger of a teenage pregnancy, there can be no greater gift. Child marriage is a rampant social evil that has destroyed many young childhoods that should ideally have been spent in pursuit of knowledge and in gaining confidence.

Globally, in around 21 per cent of marriages, girls have been married off before the age of 18 – that is about 650 million girls. Out of these about 250 million were married even before the age of 15. One third of the child brides in the world reside in India. Though the scourge of child marriage affects both girls and boys, the proportion of boys is far lower. The median age of marriage of a girl in India is 16.8 years (much below the legal age of marriage for girls which is eighteen years), while that of boys is 22.6 years (which is higher than their legal age of marriage, twenty one years).

Though cognizant of the complex social pressures including poverty, lack of physical safety and many others that compel people especially in rural areas to marry off their daughters early, I feel the human price of doing this is paradoxically far steeper. The deaths due to teenage pregnancy are two times higher in girls aged less than 18 years and three times higher in under 15- year-old mothers. Though our country is showing a slight dip in maternal mortality in the last decade from 130 per 100000 in 2014 to 122 in 2017, this figure is still unacceptably high. Pregnancy-related complications are the cause of the greatest number of deaths of girls in the age group 15-19 years. Poignantly, that is the very age when young children are deciding their futures and what they dream of achieving in life.

To have your childhood abruptly cut short because of a forced marriage and then to have your life cut short because of pregnancy complications seems a tragic waste of potential. Apart from outright mortality, many girls are left with permanent damage to their pelvic areas or urinary systems from the ravages of pregnancy on such a young body. This makes them have permanently morbid conditions for the long term and contributes to a lack of self -confidence. Not only is the mother’s health at risk, but the babies born to teenage mothers are more likely to be preterm, of low birth weight, or stillborn. They also have a higher morbidity and mortality rate. It is estimated that 15 to 18 per cent of children born worldwide have low birth weight (less than 2.5 kg) representing more than 20 million births a year.

India has the highest number of pre-term babies in the world – about 25 per cent of the overall share. Over 25 million babies are born annually in India and about 1.7 million have low birth weight – below 2.5 kg – and 0.4 million have very low birth weight – below 1.5 kg. Several articles in peer-reviewed journals provide data establishing that the young age of mothers – less than 20 years and low birth weight of mothers – BMI < 18.5 per cent were both risk factors (National Family Health Surveys of India) for low birth weight babies. Low birth weight and prematurity are associated with higher rates of stunted growth, chronic illnesses like obesity, diabetes and cardiovascular diseases in later life and neurological problems relating to cognition and neurodegeneration.Such children are also at risk of retinopathy of prematurity (ROP), a potentially blinding condition.

Prematurity is a leading contributor to neonatal mortality. India’s own infant mortality rate is 32/1000 live births (2018). Low birth weight babies are 40 times more likely to die in the first month of life. Thus, we can see that babies born to teenage mothers start life with a huge disadvantage. There are other social implications. Reports such as the 2006 one by International Centre for Research on Women highlighted that girls married under the age of 18 were twice as likely to be physically assaulted by their spouses and to feel that this was justified. The study of psychology tells us that children tend to internalize the blame for events around them. If a child bride who is mentally immature decides to take upon herself the blame for being beaten by her spouse or the ill health or low IQ of her child, you can imagine the mental stresses she would be living with for a lifetime.She and her spouse would also not be in a strong position to bring up their children well, if they are young and inexperienced about life. 

The UN World Health Assembly goal is to achieve a 30 per cent reduction in the number of infants born with a weight lower than 2500 g by the year 2025. Reducing the number of child marriages will be a powerful way to achieve this goal. It will also pave the way for gender equality.

 In 2017, a small group of social activists including myself had worked on a PIL on equal age of marriage for girls and boys (which currently stands at a differential of 18 years for the girl and 21 years for the boy respectively), since the Constitution recognizes all citizens as equal. The exact age would be the decision of medical experts and child rights activists who understand the deeper nuances. But having an equal age (whatever it may be) would shift the mindset away from child brides for older men. Though ultimately our PIL did not come up for discussion for reasons outside our control; a ray of hope is that recently the Union government has constituted a task force to examine the issue of child marriage. It could either support the NGOs dedicatedly working in the field of child marriage for several years or else, working jointly with them, come up with an effective solution to curb child marriage. This would address a multitude of issues in one stroke – overpopulation, illiteracy, gender related disadvantages such as domestic violence and wage gap.

So, awaken brothers! If you can picture your smiling and carefree sister, whom you played with lovingly as a child, turning into a mental and physical wreck because of a forced early marriage, it should bother you greatly. This Raksha Bandhan, give your sister a gift born out of deep courage and love. Do all in your power to prevent her from getting married before the legal age of 18. Gift her your unconditional support to realize her full potential.

(The writer is a Delhi-based medical practitioner)


Monday, July 20, 2020

The virus that won’t go away

The Statesman, 10 July

The ‘new normal’ is a term we often see used in journalistic writing nowadays. It pertains to the drastic changes in lifestyle and work pattern brought about by the corona pandemic. There is one area though, where another pernicious virus lurks that is fairly resistant to eradication – the virus of disparity between the genders.
Across diverse fields, women have been judged harshly, have had to struggle harder and have been compensated less for the same amount of work.

Consider sports. Several youngsters, like my son, enjoy playing and watching basketball. Though there are slight differences in the game for women and men, such as the ball size and the distance of the free throw circle etc., the hoop height from the ground is the same – ten feet. A fancy trick in basketball is ‘dunking’ where the player jumps up and literally slams the basketball into the hoop. More men are able to dunk than women. Their games attract more audiences. Is it because women have less sporting ability? Not so. It is because the courts and hoop heights are designed keeping the average male height in mind. Ideally the hoops should be higher for men, given that the average male height across countries is more than that of their female counterparts.For example, in 2020, the average male height in the USA is 175.3 cm and the average female height is 161.5 cm and in India it is 166.3 cm and 152.6 cm respectively. This difference holds across all countries and is significant. Though allowances are made for male competitors with lower weight categories in certain sports, this thinking has not extended fully to factoring in gender. Structural parameters remain the same whether it is swimming pools or games courts or hoop heights.
Women earn less in sports events partly because they are judged on standards calculated for masculine weight and height. While this has probably caused them to excel more, the talent required to do this has not been well acknowledged. 

In the armed services, there are ongoing discussions on whether women are fit for actual combat roles or not. There is no doubt they are. With the sophisticated weaponry available, one doesn’t necessarily have to be physically very strong to handle it, though strength may be a desirable asset otherwise. Good, sharp reflexes and training are what is needed. The issues are actually more about logistics and additional infrastructure that the military will have to provide along with the patriarchal reluctance to taking orders from a woman.

To understand this argument better, one need only to look at rural areas where women do considerable heavy lifting, be it lugging water, grass or firewood. They carry enormous bundles on their heads. This has not changed even now, when many men are present at home. Men rarely lend a hand with these demanding physical chores in their own homes. If women can be relied upon to do the heavy lifting of several kilograms at home, why cannot they be entrusted with lighter rifles? 

The bias against women has crept in a little into our laws. If we see the debate raging around abortion we find that the legal system chiefly focuses on ‘independent rights of a foetus’ versus the mother’s right over her own body.
Why should the advocates of a foetus’ independent right to life not debate equally energetically its right to enjoy the lifelong protection and financial assistance of its father as well? Why is the concern and care limited largely to its being born? Even in the case of unwed parents, there are laws in some states that accord the biological fathers some custodial rights over the child though he is not married to the child’s mother. Conversely, however, on the subject of abandonment of the family by the biological father, the onus rests on the spouse to file a specific case. My daughter, a law student, shared some research on how mothers are even retrospectively made accountable to the foetus in some cases in USA and elsewhere. In the Grodin vs Grodin case from the Michigan court of appeals in 1980 for example, there was an attempt by the child to hold the mother liable for taking Tetracycline antibiotic (prescribed by her doctor) during pregnancy which caused the child’s teeth to become discoloured as a result.
There are thus people who seek to curtail a woman’s rights over her own body, snatch away her privacy and her choices and even cast aspersion on the legendary maternal instinct she shares with the members of her sex. Meanwhile, there is scant debate on the responsibility of older males producing children, even when medical journals inform us that the offspring of older fathers (more than 35 years of age) have reduced fertility and an increased risk of birth defects, some cancers, and schizophrenia. Instead, of being held negligent in any way, men are lauded for their ‘virility’ even at an old age.

The legal system thus does not seem to pin equal responsibility on the father as a parent. The norms of society end up placing additional stresses on women at the most vulnerable period of their lives – during pregnancy. A woman may be battling daily fatigue and nausea. The nearest good quality gynecological care may be available only very far away. The woman is often not supported with help in daily chores or ensuring she has the best nutrition. Sometimes, she is even blamed for being careless if she accidentally slips or gets hurt. Far less emphasis is laid on the conduct of the father in maintaining a peaceful and harmonious environment at home during the pregnancy. At work, women lose out on wages and career growth when they exceed the stipulated period of maternity leave. Why can’t the government make it a point to create adequate jobs that women can execute from home? Why must women pay a heavier economic price than men for the privilege of parenthood?

 Recently, there was a case of a pregnant student activist seeking bail. Pregnancy was not accorded a special ground for consideration of temporary bail for her. It is well established that pregnancy can carry risks to the life of the mother and needs special care. This is reflected in many areas; insurance companies do not agree to new insurance for a pregnant woman till after the post-delivery discharge; pharmaceutical companies clearly state on drug labels whether a drug will harm the foetus if taken during pregnancy etc. When the welfare of companies and fetuses can be factored in, why must women have to fight for concessions for themselves before the judiciary?

We must recognize all these prevalent subtle and overt biases if we seek to establish a holistic ‘new normal’ way of life that is equitable. Will the ongoing pursuits of those working towards gender equality slowly usher in a more just ‘new normal’ or will it need the advent of a magic vaccine? Without factoring in the critical aspect of gender, we will simply be lurching from one abnormal state to another.

(The writer is a Delhi-based medical practitioner)

Wednesday, May 13, 2020

Ambrosia or a sip of destruction?

The Statesman , Tuesday  12 May
Alcohol, which was in the news recently when liquor shops re-opened after a gap, has been central to human existence since ancient times. The Egyptians indulged in wine making and the Greeks had a deity for wine - Dionysus. Old ethnic groups had their own sacred drinks. The Mayans had their Balche’ and the Voodoo religion, its Clairin. Special herb-infused drinks were used to cure anything from sore throats to back aches. The significance of spirits has not lessened over the ages.
As curious youngsters we pleaded with our parents to allow us to have one sip from their glass of liquor. More often than not, when teenagers did get to have that first sip, it was a disappointing anti-climax. Most would screw up their noses in disgust and feel extremely cheated. Thus we became acquainted with the meaning of the phrase ‘it is an acquired taste’.
I ventured beyond a sip, to my very own first glass, when I joined medical college. In a celebratory mood on my birthday, we went to dine and drink at a local restaurant. One friend kept me company and the other girl declined saying someone had to look after the first two!
Apart from sampling it, we students learnt about alcohol and its effects in our pharmacology class. A pharmacology textbook authored by Lawrence gave one of the most memorable charts depicting the effects of alcohol through a series of funny drawings.  I can still recall the property of ‘easy distractibility’ depicted by a car driver driving with his face turned sideways, looking at a lady on the  pavement even while a pole looms in front . Or of ‘over cautiousness’– where our friend in the car simply refuses to overtake a slow animal-drawn cart. Shakespeare too has painted a vivid picture of the effects of drink in his play Macbeth. A character notes that it provokes ‘nose painting’, ‘sleep’ and ‘urine’. The nose painting likely alludes to a facial flushing seen in some who have a greater sensitivity to the effects of alcohol. 
During our medical education we learnt how alcohol induces poor motor coordination, impaired judgment and drowsiness. Regular alcohol consumption is causally related to several medical conditions such as hypertension, vitamin B12 deficiency, hand tremors, liver cirrhosis, and pancreatitis among a long list. Some of these can be attributed to increased cortisol (the stress hormone) levels in the blood. In Forensic medicine, we learnt about how crude alcohol containing methanol caused acute swelling of the optic nerve and induced the sudden blindness we would read about in the papers after spurious liquor had been consumed. We discovered that there are two main categories of alcohols here - local country liquors like Arrack, Tharra, Daru etc. and the Indian made foreign liquors (whisky, rum and such - apart from the directly imported foreign) and of course illegally fabricated drinks which could be anything! Much later during post graduation we learnt of the effects of alcohol on the eyes such as possible accelerated age related macular changes, and changes to the nerve–tobacco and alcohol related amblyopias.
Alcohol is a substance which can induce addiction. Signs of chronic alcohol dependency, as distinct from its repeated abuse (which may have social, medical, or judicial consequences) are many (eleven criteria in the DSM book) and include: increased tolerance to alcohol (greater quantity required to achieve the same effect), impaired control over drinking and drinking despite adverse effects relating to work, relationships or health. A reformed alcohol addict from a de-addiction centre was invited to our college to speak and discourage students from travelling down the path of addiction. He narrated his story in a lively manner, using English words matching the proficiency of an Oxford don. The most important word of course was ‘sobriety’.
We students also gained a firsthand account of alcohol abuse from one of our bais (house- keeper) in the hostel. She worked very hard to nurture and educate her family, but was often waylaid by her unemployed husband who made off with her salary to buy alcohol and frequently ended up drunk.
Later, as interns, we attended to victims of road traffic accidents brought on by the excesses of alcohol. Apart from enhanced recklessness, alcohol seemed to bring on a flood of emotions as well. I vividly remember how copiously some of them would weep if we scolded them about drunk driving, after tending to their wounds. A recent study in The Journal of Clinical and Diagnostic Research (July 2015) tells us that of 200 drivers in a hospital in northwestern India who reported to the trauma emergency services, 54% had medical evidence of substance abuse and in 40% of cases the substance was alcohol.
Our army life found us with easy access to liquor. Some traditions included alcohol as part of the proceedings – such as drinking beer with the junior commissioned officers (JCOs) on Holi or newly promoted officers drinking from a chalice filled with alcohol into which their brand new pips had earlier been submerged. Being able to hold one’s drink was considered a coveted ability.
The associations continued in civil life. We enjoyed Urdu poetry where wine has always been an important topic. A gamut of emotions was linked to wine drinking – it was a refuge from unrequited love, it induced euphoria, and sometimes a welcome oblivion. Bars were described as extremely inclusive spaces. A memorable evening of Sufi music left an indelible imprint on my young mind. One of the song couplets which received thunderous applause from the audience translated as “People construct houses of worship…then set about excluding folks from them. Hindus are declared infidels at mosques. Muslims are declared infidels at temples. It is suggested that instead of building these houses of worship, build liquor bars (maikhanas) as they are the most inclusive places. At these, even infidels are not considered infidels.”Poetry clearly extolled the virtues of drinking.
Real life was a different story. Our work with the gender and social aspects of medicine helped us become more aware of the widespread impact of alcohol on domestic violence. Many studies linking alcohol to intimate partner violence are reported in well-respected journals which publish on alcoholism, family, psychology and interpersonal violence. A study by Carol Cunradi et al in 2009 of over 800 male and female industrial workers in the Journal of Family violence, reiterated this association between drinking and intimate partner violence for both male and female workers and additionally highlighted that male unemployment played a significant role as well.
Fast forward to recent news pertaining to alcohol - we saw long lines waiting to buy alcohol, largely without distancing or police supervision. The stated aim was to revive the economy through the sale of liquor. This however, is a moot point. Is this the ideal time to open liquor shops? Should economic revival be based on encouraging a habit which could later lead to addiction? A heavy drinker tends to suffer from poor nutrition and vitamin deficiencies. Added to this is the current spike in unemployment, relative starvation of many, and domestic violence at a high peak .Is it not the need of the hour to operate with caution and safeguards when introducing another element, that is alcohol - into this potent brew of uncertainties prevailing during this Corona pandemic? 

Friday, April 10, 2020

To Post or not to Post

 The Statesman 2 April 2020

(This article examines the dilemma of numerous posts on Corona Virus - is it a boon or a bane?)

'To post or not to post’ seems to be the collective mental dilemma of the present time. A strong case has been made for staying away from the huge overload of information related to the Coronavirus. Conspiracy theories abound about its origin and spread. Well known personalities have advocated not thinking about or discussing the virus for some amount of time. Yet others insist it takes a toll on our mental health and can induce unnecessary panic. There are concerns about the authenticity of some posts. Many wise folks rightfully point out this is an excellent time to ‘look within’
My point of view is to have a continued conversation on the subject. Here’s why I think this is a good idea.

Corona virus posts/articles encourage discourse in real time. In this uncertain and rapidly unfolding situation, we don’t have the luxury of formal medical trials with long - term follow up results. All that we can bank on right now is an exchange of medical information, experiences, and ideas of those countries that have had a head start on having had to grapple with the disease. As a professor from AIIMS said ‘there is more learning in the corridors of the science department than in the laboratories’. He was alluding to the discussions between colleagues as they passed each other in the hallways, picking each others’ brains or offering solutions. It is well known that universities acquire their reputation not only from the infrastructure and staff but largely from the students they attract. Prospective pupils know that much of their learning will be from the animated brainstorming with their bright, talented peers. In a rapidly evolving, global and complex medical situation, it makes a lot of sense to communicate in all spheres - medical, social, civil; to ensure better coordination and allotment of resources. While doctors are exchanging medical information on treatments and susceptibility to the disease (older age groups are more vulnerable than younger people), geography and climate; epidemiologists, social scientists and economists among others are analyzing how and why the virus has travelled faster to some countries but not others. Technology and textile companies are focusing on equipment supply and upgrades. Successful state and country models are being highlighted.

There are posts which suggest radical conspiracy theories. People delight in being the first ones to post new and sensational information in their respective online groups. This raises eyebrows and can also inflame passions and stress. These posts, however, serve a very useful purpose. To be able to accept or reject the allegation prompts one to search for the truth and a lot of useful data is put out that can help one make up one’s own mind. There are the various conspiracy theories surrounding the virus’s country of origin, China, especially the nature of its origin. Whereas some feel it was due to cross contamination from Pangolin or bat viruses from China’s wet market, (there a lot of live fish and animals are in captivity prior to being slaughtered and sold)                                                                                                                                                             others talk about the viral research laboratory in Wuhan. For example, a published article (authored by scientists from Wuhan Institute of Virology, Universities in Shanghai and Peking and Australian Animal Health Laboratory) in the Journal of Virology , as early as Feb 2008 describes the successful experimental exchange of viral nuclear material between a SARS human infecting virus and the Corona, Horseshoe bat infecting virus. 

Due to the lockdown and the important role of social distancing in breaking the chain of virus transmission, people are confined to their homes. There are some who live alone. Many need to talk about this overwhelming experience with others and understand how they are coping. Some people relieve their isolation by following up on posts related to the virus and some people their fear. I followed a thread on Twitter where a health professional wanted to know how patients, who reached the respirator stage, fared. Several doctors from across the world shared their experiences which left her feeling more reassured. Posing questions, sharing apprehensions and interacting gives people the sense that they are all together experiencing this challenge. No one needs to face it alone.

For all the accurate statistics and real life video shared by recuperating patients that may induce a sense of fear, there also abound many uplifting messages. Some of the spiritual messages talk of how the Coronavirus is a positive force, compelling us to reprioritize our lives. Messages encourage us to build our innate immunity; they underline how deeply connected we are-literally our lives are in each other’s hands. Wildlife enthusiasts are posting wonderful pictures of how animals are seen in larger numbers, now that humans have receded from many common natural spaces. Contact numbers of government shelters/ NGOs distributing food or collecting donations are shared. Doctors who are working long shifts without breaks are sharing their experiences and drawing their energy from the overwhelming support and gratitude they receive on their timelines. Due to a high transmission risk through doctors and hospitals as well as an enlightened decision to channelize medical resources towards COVID and emergencies, routine OPDs have been closed down in many countries. Doctors who are temporarily at home (or working in shifts) keep abreast on the disease through media and personal communication. A medical colleague told me how she is enjoying surfing through messages and savouring the ones that really appeal to her. 

Moreover, diversity of opinion on any subject is very important. For global issues like climate change and the Corona scourge among others, people largely hear the political viewpoint as the official one. But how a politician looks at a scientific subject is vastly different from how a healthcare official or a scientist or even a patient views it. Myriad perspectives help create a holistic picture in our minds. Political announcements, though relevant as they outline the overall picture, don’t tell us the minutiae. We decidedly need other voices to fill the gaps.

We can either look the problem squarely in the face and not get intimidated by the news surrounding it or we can choose to bury our heads in the sand much like the ostrich and just hope that it will blow over. Will it create a panic? It is difficult to say. As a family member pointed out - many people in our country have a fatalistic attitude and believe in destiny. Such people are not likely to panic easily. Also there are controversies about fake and real posts. To clarify, one can check the source (e.g. standard E newspaper sites should be reliable) or references, as well as rely on posts of known people (those you know personally sharing their experiences or opinion) or verified handles.

For those who are as overwhelmed by the posts around the virus as they are by the virus itself, they can just switch off from the welter of information. They can do so secure in the knowledge that if they feel like connecting to their wider ‘family’ in the world at any time, all it takes is the tap of a button.