Miss World 2017 to focus on menstrual hygiene

manushiNewly crowned Miss World, 20-year-old Manushi Chhillar, is using her medical background to focus much-needed attention on an issue that is often regarded in Indian society as a subject that is taboo.

At a media interaction on Monday, Chhillar said, “There are very basic things about menstrual hygiene that people are unaware about. One year into medical college, during my project to create awareness about it, I realised that education alone wasn’t enough. We needed to give them a sustainable system women could follow to practise menstrual hygiene.”

In the year ahead, she will be travelling abroad to participate in ‘Beauty with a Purpose’ projects along with coparticipants at the Miss World pageant. “I am really excited that I will be visiting four continents this year and spreading awareness about menstrual hygiene. So, Bollywood is something that isn’t on my mind right now,” said Chhillar, adding that she would want to work with Aamir Khan in a movie though.

Various campaigns advocating lower taxes on sanitary napkins have the beauty queen’s support. “Menstruation is a natural process and sanitary pads are a necessity. They should be available at a low cost. The good thing about my project was making sanitary pads available at low cost and I would like to take it forward,” said Chhillar, who won the fbb Colors Femina Miss India in her journey to the Miss World title.

Another difference that she wishes to make is in her home state of Haryana. “Right after I won even the state and national contests, a lot of young women had queries about it. I am hoping this win will encourage them to take a step ahead… I have been lucky to have very supportive parents but if there is someone who doesn’t have support, they must still never give up. If you have the courage, you will make it through,” said Chhillar.
When quizzed about the ‘Padmavati’ controversy, she said, “We women have one thing in common. We don’t feel persecuted for who we are and face challenges head on. We feel it’s not a women-friendly society at times, but as individuals we set examples and make women confident.” Julia Morley, chairman and CEO of the Miss World Organisation who was present with Chhillar, said, “While India has waited for 17 years (to win the Miss World title), some countries have also waited for more than 60 years.” Priyanka Chopra was the previous winner from India in 2000.

Miss World 2017 wants to be a cardiac surgeon

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If you are a cardiac surgeon in the making, start by stealing a nation’s heart. That could well be the prescription of Miss World 2017 Manushi Chhillar, the medical student whose blue surgical cap recently made way for a jade blue crown.

Fresh from the glow of having ended a 17-year wait for India with the title she won in China’s Sanya City on November 18, the leggy beauty landed in Mumbai early on Sunday, proud of having broken another, more personal, dry spell. “Finally! Indian food after 40 days,” screamed a temporary Instagram post of the 20-year-old, whose eyes lit up when they found an Indian section at the Hong Kong airport on the return journey. Although her mother had packed a suitcase full of ready-to-cook Indian snacks like poha and upma, the sweet-toothed vegetarian wolfed down piping hot “Indian bread and chhola” with relish.

On Sunday evening, she looks like a couture version of a mermaid in an emerald off-shoulder Gauri and Nainika gown paired with matching gemstone earrings, her flawless skin and auburn curls embellished by the dappled evening sunlight inside a five-star hotel. There is a pageant-patented poise about her and the dimple on her left cheek appears unfailingly after every question. “There is more pride in being called India than Manushi,” she says, recalling the grand welcome at the airport with chants of “India, India”.

But her favourite homecoming refrain is: “I have a friend in every country now.” Given that the Miss World pageant had 120 participating countries, that means 119 friends from places with “hard-to-pronounce” names. The camaraderie was so strong that “the final day seemed like a rehearsal”, says Chhillar.

Born to doctor parents Mitra Basu and Neelam Chhillar, modelling happened to the Haryana girl by chance. The extrovert in her loved being on stage and the nerd in her lost herself in her books, says this product of St Thomas School in Delhi who was studying in Haryana’s Bhagat Phool Singh Medical College before she took a break last year.

Manushi Chillar

It was a contest in Delhi’s AIIMS, where she was crowned Miss Campus Princess, that set the tone for her history-making victory—the sixth for India that put it on a par with Venezuela in terms of beauties churned out. After several modelling assignments for print ads, Chhillar found herself crowned Miss Haryana and later, standing at the altar of the fbb Colors Femina Miss India. “I didn’t even know how to do make-up and hair then,” she says.

Though she doesn’t believe in lucky charms, the two rings—a pearl one on the index finger gifted by her mother and a coral one on the ring finger gifted by her father who calls her his dragon—may have worked their magic. She also took a small Ganpati idol gifted by her aunt to the pageant.

An intuition kicked in when she entered the final five. That was when she caught a glimpse of her parents in the audience. “I instantly felt that something good was about to happen,” Chhillar says about the “emotional” moment that was the spark for her final answer which was lauded by many for reigniting a dormant debate on the economic worth of an otherwise thankless job—motherhood. “To me, my mother is very beautiful and the epitome of a woman. She knows how to balance a busy professional life with family life,” she says.

The 20-year-old is a Kuchipudi dancer—she wowed everyone at the Miss World pageant with her dance moves —and is also a poet who has captured moving experiences in the dissection hall, pressures of practicals and emotionally demanding clinical postings in words. During her first posting in surgery, for instance, she came across a breast cancer patient who had come in with her four-year-old child. “It was a serious case at an advanced stage. I felt helpless as I realized you cannot cure, you can only assist. I called up my father to ask how he handles such cases,” says Chhillar. “He told me it’s important to keep your emotions in check.”

As one of the winners of the Beauty With A Purpose contest at Miss World 2017, she hopes to turn the spotlight on menstrual hygiene. As an MBBS student in rural Haryana, she had come across women who used wood pulp and torn curtains instead of sanitary pads. “They had no access to sanitary pads and some felt shy asking shopkeepers for one,” says Chhillar, who had later tied up with an initiative selling affordable sanitary pads.

In the next few days, she will be visiting her friends in other countries for their respective Beauty With a Purpose projects. The cardiac-surgeon in the making says she also wants to build non-profit hospitals in rural areas to help make cardiac surgery more accessible to villagers.

When a doc gets too attached to a patient

 

Siddhartha Mukherjee2

Every medical case, to paraphrase the writer Viet Thanh Nguyen, is lived twice: once in the wards and once in memory. Some of what follows is still intensely vivid, as if it were shot in high-def video. Other parts are blurry — in part because I must have subconsciously deleted or altered the memories. I was 33 then and a senior resident at a hospital in Boston. I had been assigned to the Cardiac Care Unit, a quasi ICU where some of the most acutely ill patients were hospitalized.

In mid-September, I admitted a 52-year-old man to the unit. I’ll call him M. As medical interns, we were forewarned by the senior residents not to identify too closely with patients. “A weeping doctor is a useless doctor,” a senior once told me. Or: “You cannot do an eye exam if your own eyes are clouded.” But M.’s case made it particularly hard. He was a doctor and a scientist — an MD, a PhD, like me. He must have been about 15 years ahead of me in his schooling; I could imagine him returning to my class in med school to teach us “Patient-Doctor,” in which students are taught how to deal with real-life patients. He was now an assistant professor — it seemed like such a victory to have that title — and ran a small laboratory. I knew a student who once worked with him. Six degrees of separation? There was barely one.

Earlier that year, in March or April, M. became short of breath in the middle of his run. His legs turned cold and blue. He had dizzy spells and lost words in midsentence. He saw a cardiologist — presumably one of his own colleagues — and the diagnosis was amyloidosis, a mysterious heart condition in which misfolded proteins begin to be deposited in the organs of the body. Sometimes the proteins come from cancer cells; sometimes from poorly understood sources. The deposits choke the organs: heart, liver, blood vessels, kidneys. “And then, bit by bit by bit, I was all pro-te-in,” he said dryly, paraphrasing the Tin Man in Oz. We laughed.

M. needed a new heart. I’m writing this casually, as if you go to the used-heart salesman on Long Island and pick one up on a three-year lease. Hearts are notoriously hard to find; someone has to die for you to get one.

M. was on a list of supplicants. His own heart, meanwhile, was failing so precipitously that he needed constant medical monitoring. Weird, deadly electrical rhythms arose out of his dying cardiac muscles, like ripples on a stagnating pond, necessitating defibrillating shocks to reset his rhythm. Fluid pooled in his feet, and the skin on his calves came off in strips.

There was a second reason to monitor M.’s status. Hearts are so rare that patients have to be under constant surveillance to ensure that they are in the best possible condition before receiving the donor organ. An innocuousseeming infection, or kidney failure, can spiral out of control after the transplant. “If it’s bad now, it’ll only be worse later,” the transplant nurse told me, grimly.

And so we watched him. Every vital sign — temperature, respiratory rate, heart rate — was dutifully recorded. I was on call every third night. I would stop by to say hello to M. and wait for the transplant nurse to come around. He would be puzzling over 40-across on the Sunday crossword. She would check his numbers. “Maybe there will be one tonight,” she would say, before signing off for the day.

It must have been on the third or fourth week of M.’s hospitalization, sometime late in the evening, that the transplant unit called up to the ICU. A kid had dead-ended his motorcycle on the expressway. He was declared brain-dead, but his heart was intact. M. was on the top of the transplant list. I half-ran, half-walked to his room to bring him the news. He had been dozing through most of the day and night — a sign, perhaps, that he was having trouble pumping blood to his brain. He woke up, smiled wearily and then drifted off to sleep again.

Around midnight, I was paged to the unit. “He’s spiked a small fever,” the unit nurse said. She tried to look at me blandly. “It’s nothing,” she wanted me to say. “It’s not real. Get back to work.” “How small?” “101.”

“Well, let’s retake the temperature.” She measured it again. 101. His systolic blood pressure had also dropped ever so slightly — a few, barely discernible notches. I paused for a moment, weighing my choices.

“Try another thermometer. And check the pressure again. Actually, let’s wait and try in 10 minutes.” She brought another instrument out from the nurse’s station. M. began to sense the slowly building hubbub in the unit. He sat up woozily. “Do you feel anything wrong? A chill?” “Nope,” he said. “Nothing.”

I examined him, pore by pore, looking for a potential source.

The nurse entered the room and made a tiny motion to see her outside. I met her by the nurse’s station. “Should we record the temperature?” she asked, whispering, as if the intercom might be eavesdropping.

The stakes could not have been clearer to both of us. If we put the number in the chart, M. would temporarily fall off the list for the next morning. The transplant surgeons at this hospital, I knew, would never risk taking a febrile, potentially septic, patient to the operating room.

I felt paralyzed. Medicine depends on looking at data objectively, dispassionately; a decade of training had taught me that. But it also depends on understanding that tests can mislead us, that data can deceive: What patient ever fits squarely into an assigned box? My fingers hovered above the computer, where I was meant to write my note and record the fateful temperature spike, but I found that I couldn’t type a word.

At 1 am, I called the attending physician. I felt foolish: I imagined her scuffling around her nightstand for her spectacles, anticipating a question about an acute cardiac crisis. Instead, there was a mumbling, hesitant resident trying to decide whether to write a note. But she understood immediately. She walked through the details of the case. Had I really evaluated the infection? Yes, yes, I reassured her — or rather, tried to reassure myself.

“It’s really your decision, Sid,” she said. “But you’ve got to consider that in some other hospital, there’s some other young guy — a doctor, with a PhD — waiting for that same heart. If your patient goes to the OR infected, he’s not going to make it, and the new heart is going to die with him.”

I put the phone down and turned to the nurse. The fever had come down to 100 degrees. What if we hadn’t measured it in the first place? How about all the things we don’t measure? Muscle tone? Wakefulness? If a temperature spikes in a forest… I returned to the computer, tried to type my note, hesitated and stopped again.

I wrote my final note at 2 in the morning. Temperature: 101 degrees, currently 100. No obvious source of infection. A chest X-ray showed no signs of pneumonia. A complete history and physical exam was unrevealing. Awaiting blood-culture data.

At rounds the next morning, I felt as if I had let the team down. I presented the case quietly, feeling the eyes of my co-residents burning holes into my skull. No one had any questions.

There were just a few more days left in the rotation, and I went to say goodbye to M. His fever had subsided on its own after that overnight spike. “I’m sorry,” I said, and he nodded.
M. died of a fatal arrhythmia a few weeks later. No other heart became available. The fever never returned.
Mukherjee is the author of ‘The Emperor of All Maladies: A Biography of Cancer’

Female physicians make professional adjustments for home responsibilities: Study

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Female physicians are more likely to make professional adjustments to accommodate their responsibilities at home, according to a new study.

In particular, male doctors tend to have more help at home for childcare or elder care, the study authors reported online November 21 in the Annals of Internal Medicine. Nearly half of the spouses of male physicians stopped working professionally, versus 9% of spouses of female physicians.

“Although some might argue that the decision for women to stop working professionally, especially after having children, is volitional, I think it’s very hard to disentangle the influence of societal expectations from that ‘choice,’” said study author Dr. Dan Ly of Harvard Medical School in Boston, Massachusetts.

In earlier work, Ly and colleagues had found that the gender earnings gap among doctors has remained at about 20% for the past three decades. Furthermore, among physicians who teach at medical schools, women are less likely to obtain the highest rank of full professor.

“To try to explain some of these gender differences in pay and professional advancement among physicians, we have begun to look at home life,” Ly told Reuters Health by email.

Ly and colleagues looked at Census Bureau data between 2000-2015 to understand occupation, income, hours worked outside the home and graduate education status for 30,900 male doctors and 17,600 female doctors. They also looked at the number of children in families with a male doctor, a female doctor, or two doctor parents.

They found that 17% of male doctors were married to female doctors, whereas 31% of female doctors were married to male doctors.

Income, hours worked outside the home, and graduate education status differed greatly between female spouses of male doctors and male spouses of female doctors.

Overall, 52% of female doctors’ spouses had a graduate degree, compared to 40% of male doctors’ spouses. In couples with one doctor, the number of children was higher in families with a sole male physician versus a sole female physician. In addition, for all women, the average number of paid work hours decreased as the male spouse’s paid work hours increased.

“We think one possible reason for this is that societal expectations for women to reduce their professional hours to care for children exist, even for physicians,” Ly said.

Future studies will continue to look at the decisions that couples make about balancing each other’s careers and how having children factors into those decisions, he said.

“It’s important to understand why women in medicine and other professions might be facing unique challenges, even today,” Dr. Reshma Jagsi, director of the Center for Bioethics and Social Sciences in Medicine and the University of Michigan in Ann Arbor, told Reuters Health by phone.

“Those of us in Generation X were raised with expectations of the egalitarian division of labor at home and work, and we might not expect the findings seen in studies like these,” said Jagsi, who researches the gender pay gap and gender domestic differences in medicine but who wasn’t involved Ly’s study.

Jagsi and colleagues are monitoring several new programs that have been implemented to help doctors at work and home. The Doris Duke Charitable Foundation, for example, gave grants to 10 medical schools as the Fund to Retain Clinical Scientists to fund more mentorship and career development opportunities for early-career doctors, especially for those with extra caregiving burdens.

“Patients benefit when the medical workforce includes the most promising doctors in our society,” Jagsi said. “We need both women and men in the medical workforce, and we need to figure out ways society can alleviate the greater challenges faced by female physicians.”

Three yrs mandatory service for Goa PG students

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Health minister Vishwajit Rane recently made it mandatory for postgraduates from Goa Medical College (GMC) to provide service for three years, as per their bond, after completing their masters education.

Rane told TOI that doctors completing their MD in various specialities will be soon posted in government hospitals and health centres across Goa on a rotation basis. The idea is that people seeking medical support, and who live in different corners of the state should not have to travel to district hospitals for speciality treatment.

“The bond will be strictly implemented from now. After the bonds were invoked, some doctors have been posted at Ponda and Mapusa. The orders for postings of another 25 (doctors) will be issued soon. Once all health centres across Goa are covered, we will know the total requirement of doctors. Then we can fix a figure of our requirement. Once we arrive at this figure, we will work out a rotation system for the doctors,” Rane told.

Under this system, the doctors will have to serve in different health centres as per a pre-decided schedule during their bond period.

The rotation system is expected to bring down the burden on Goa Medical College and Hospital in Bambolim, and Hospicio in Margao. Patients will also be spared the trouble of travelling more than 30kms, at times, for speciality treatment. GMC even sees patients from as far as Canacona and Quepem seeking treatment at Bambolim.

Rane said that as the bonds were not invoked until now in Goa, the provision for the payment of the postgraduates’ salary was also not made so far in the state budget.

“In the upcoming budget the provision will also be made for those who will be completing their postgraduation. We get sufficient funds under the national health mission, which can be utilised for the purpose. They will be drawing salary from the directorate of health services,” said Rane.

Respite to MD, MS aspirants as Govt relaxes condition of bond

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Taking a soft stand over its earlier decision, Maharashtra’s Medical Education Minister Girish Mahajan announced relaxing the condition of completing one year bond for MBBS students. This has paved way for the students to appear in Common Entrance Test (CET) for admission to post graduate course.

Earlier, the Department had made it clear that the student found not completing the bond, would not be allowed to appear in the National Eligibility Entrance Test (NEET) necessary for taking admission to post graduate medical courses.

The Government’s fiat hit the students like a bolt from blue as PG-NEET examination is just two months away. The students were in a fix as much of the time could be wasted in legal battle. The experts, while defending the Government, termed it as ‘right order but at wrong time’.

The Government’s intention though pious but could they have not brought it at the start of academic session itself, cried parents.

Meanwhile, Government counter-attacked the parents’ argument that it was told to them at eleventh hour. The new circular issued by Government stated, “It was not informed to the students at eleventh hour. The students are informed about the condition of completion of rural stint during their admissions to MBBS itself. We just reminded them whether they have completed the bond or not.”

According to parents, students could shift their rural stint to post-PG also. They should be allowed to appear in CET and after their PG they would complete the bond. The parents argued that Government should have put stringent condition well in advance. Indian Medical Association, too supported parents’ stand.

Meanwhile, Dr Praveen Shingare, Director of Directorate of Medical Education and Research (DMER) sent a letter to Minister requesting him to defer the decision and impose the condition for the students appearing in CET in the year 2019.

When contacted, Girish Mahajan, who agreed to the parents’ demands and decided to defer the decision, told, “We are asking students to complete the bond within next two years or face the consequences. We also are not against any student.”

New medical bill will affect quality of healthcare in Karnataka: Doctors

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The Karnataka Private Medical Establishments (Amendment) Bill 2017, which proposes to regulate private medical services by fixing prices for services and prescribing punishment for doctors in case of irregularities in pricing-related matters, has put the Karnataka chapter of Indian Medical Association (IMA) and the state government at loggerheads. The bill is scheduled to be tabled in the assembly next week.Private doctors have termed the bill draconian and are protesting three clauses – setting up of a grievance redressal cell as a supervisory body with powers to act against doctors up to the extent of jailing them, exclusion of government hospitals and price-capping on treatment in private hospitals.

The IMA and private practitioners want the government to consider recommendations made by the committee headed by former Chief Justice of Karnataka high court Vikramajit Sen. “Justice Sen had said there cannot be two sets of rules for private and government hospitals. However, this bill leaves government hospitals out of the ambit of legislation meant to ensure efficient and timely treatment for patients and curb malpractices,” said Rajshekar S Bellary, president, IMA Karnataka.

The government must bring all government-run hospitals under the ambit of KPME Act to ensure quality healthcare, said Madan S Gaekwad, president of the Private Hospitals and Nursing Homes Association (PHANA). “We don’t want any price control by the government. The patient charter should be included as a guideline for all doctors and not as a law,” he added.

According to H Nagendra Swamy, senior president at Manipal Hospitals, none of the proposals made by the Justice Vikramajit Sen Committee has been considered.”Following our protest in June, a joint select committee was formed. However, the government still came up with a bill that will neither benefit patients nor any other stakeholder,” he said.

“It is necessary that we take this extreme step (protest) as our survival is at stake,” a statement by the Surgeons’ Association said.

TNGDA seeks more centres for NEET PG exam

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Tamil Nadu Government Doctors’ Association (TNGDA) has sought the National Board of Examinations (NBE) to allot more centres for NEET (post graduation test) in Tamil Nadu. The association also wanted the Centre and NBE to increase the number of candidates that can be accommodated in each centre.

TNGDA State secretary N. Ravisankar told on Wednesday that the number of seats allotted to the centres in Tamil Nadu were exhausted by Wednesday and the aspirants were now forced to look for centres in other States.

“The number allotted for each centre is inadequate in Tamil Nadu from where around 10,000 aspirants are to write the examination. Even centres in Kerala, Karnataka, Andhra Pradesh and Goa are full in one day. It will be a tough task from the side of working and non-working MBBS graduates to travel to other States to write the examination.

The Centre and NBE have to intervene in the issue and allot more centres and increase seats,” said Dr. Ravisankar.

Chennai, Coimbatore, Madurai, Salem, Tiruchi and Tirunelveli are the centres in Tamil Nadu. The examination is scheduled to be held in January 2018.

According to him, the online application facility that started on Tuesday was crippled with server issues due to which more than six hours were needed to fill one application. The examination fee is Rs. 3,750 and that has to be paid online. “Once a centre is selected and the fees paid, an applicant is not allowed to chose another centre. With server issues consuming more time, applicants are not able to look for vacancies in other centres as fee has already been paid. E-filing of the application involves six stages and applicants are not able to proceed beyond second stage due to server issues,” he said. Though aspirants can apply for the test online till November 27, lack of availability of seats in centres within the State is a major concern that will force many people to stay away from attending the examination, Dr. Ravisankar added.

He said that the State Government should pressure the Centre to permit doctors from Tamil Nadu to write the examination in the centres within the State itself.