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.”

Patients of female surgeons may have better outcomes: Study

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Patients treated by female surgeons are less likely to die in the first few weeks after operation than those treated by their male counterparts, a study claims.

Studies have shown that women and men practise medicine differently, although little researchexists on differences in learning styles, acquisition of skills, or outcomes for female and male surgeons.

Researchers led by Raj Satkunasivam from the University of Toronto in Canada compared outcomes for patients undergoing one of 25 surgical procedures by a female surgeon with patients undergoing the same operation by a male surgeon of the same age in the same hospital in Canada.

To ensure the two groups were well balanced, patients were matched for age, sex, presence of other conditions and income. Surgeons were matched for age, experience, volume and hospital.

The main outcome was a combined measure of death, readmission to hospital and complications 30 days after surgery, researchers said.

A total of 104,630 patients were treated by 3,314 surgeons (774 female and 2,540 male) over the study period (2007-2015).

The study published in The BMJ found that patients treated by female surgeons were slightly less likely to die within 30 days, but there was no significant difference in readmissions or complications.

There was also no difference in outcomes by surgeon sex in patients who had emergency surgery, where patients do not usually choose their surgeon, researchers.

Results remained largely unchanged after accounting for additional factors like case mix (differences in a patient’s condition), researchers said.

Possible reasons underlying better outcomes for patients treated by female surgeons are not clear, although it may be related to delivery of care that is more in line with guidelines, more patient centred, and involves better communication, they said.

“Our findings have important implications for supporting sex equality and diversity in a traditionally male dominated profession,” researchers said.

Doc, 31, kills self with drug injections

Varde’s residence; Friends recall him as a cheerful guy. Divorced two years ago, he was keen on remarrying

In an incident that has left the medical fraternity shocked, a 31- year-old orthopaedic surgeon at LG Hospital, Ahmedabad died of vecuronium overdose on Tuesday. While sources said Dr Mehul Varde is believed to have killed himself by injecting four times the normal dose of the muscle relaxant, which is used as part of general anaesthesia during surgeries, mystery shrouds the death as the doc did not show any signs of depression as per sources.

The alleged suicide took place between 2.30 pm and 7.30 pm at Varde’s fourth floor residence at Ishaan in Prahladnagar. According to the police, Mehul’s father Dr Ramesh Varde had been calling him on his cellphone repeatedly. Since he did not answer the calls, the worried father alerted Varde’s friend Neha Joshi to check on him. The door of his residence was broken into when Mehul did not answer the doorbell. He was rushed to Shalby Hospital where he was declared brought dead at 8.30 pm. What is intriguing is that Varde, an MS in Orthopaedics and a senior resident doctor in orthopaedic department, had attended the operation theatre at LG Hospital on Tuesday at 9 am, hours before the incident.

And according to his colleague, he did not seem depressed at all to take such a desperate step. “He was normal and like always he laughed and made others laugh. I could never have imagined that he could take such a step. He has always been jovial and a happy-golucky guy,” said a doctor on condition of anonymity. Apart from the fact that Varde got divorced two years ago and that his father runs a hospital in Deesa, his colleagues do not know much about his personal life. Fatesinh Pargi, PSI and investigating officer in the case, said, “Varde had divorced his wife two years ago. He was staying alone at his friend’s place and did not leave any suicide note behind. We will be investigating the cause of suicide. We will examine call details, scrutinise the postmortem report and question his friends and hospital staff to learn the exact cause of his death.”

‘Had placed a matrimonial ad’ 
A doctor at LG Hospital said the reasons certainly had to be personal. “He had already tendered his resignation and was set to join Zydus Hospital from July 26. He had also inserted a matrimonial advertisement in Ahmedabad Medico News, an Ahmedabad Medical Association bulletin, looking for a doctor pursuing post-graduation after MBBS.” It was understood that things were looking up for him before he suddenly decided to take the desperate step. LG’s Medical superintendent Dr Rajesh Shah said, “Dr Mehul Varde had joined LG on April 24, 2016 and had given his resignation on June 26, 2017.

He had given no hint of depression to his colleagues and friends at the hospital.” Deputy Superintendent (anaesthesia) Dr Charuben Pandya said, “He was an extremely good looking doctor who would have given any film star a run for his money. He studied at a University in Pune to become an orthopaedic surgeon and had worked at the VS Hospital before he joined LG. In fact, he and his mother had approached me and I had recommended his name for the post here.” Charuben said, “Vecuronium is given as muscle relaxant during the anaesthesia procedure that completely stiffens the muscles to keep your body still during the surgery. Normally, a dose of 1mg per kg of body weight is given to patients undergoing surgery.

It is a scheduled drug that is not available over the counter but it is not difficult for a doctor with his licence to procure it.” Judging from the ampoules found near the body, Dr Varde had injected four times the dose. Dr Kalrav Mistry, MD psychiatrist at Shalby Hospital, said, “Young doctors undergo a lot of stress much of which is work, financial, relationship or family pressure related that can cause depression. This appears more like a case of undiagnosed depression because of adjustment problem. There is tremendous stress in medical profession and stigma associated with psychiatry disorder. Divorce and marriage anxiety have a big impact and lead to depression. Also most common means of suicides by doctors are lethal medication overdoses.”

Sarkari Doctor’s Poetry

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Guest article by Dr. Mayank


मैं थक गया;अब तू ही बोल।
कैसे करूँ तनहा तुझसे;PHC में हर बुखार control?
उधर amoxy ने आवाज दी,
डॉक्टर साहब अभी मैं stock में हूँ पड़ी।
पर चेतावनी है;ध्यान दें,
किसी भी मरीज को चार कैप्सूल से जादा न लिख दें।
मैनें फ़िज़ूल की उससे बहस की,
चार कैप्सूल से तुम्हारा कोर्स पूरा होगा नही।
amoxy हंसीं और साथ में septran भी,
लगता है इस डॉक्टर की PHC में पोस्टिंग है नई-नई।
बोला बगल में betadine का बोतल खड़ा,
महीनों से बिन ढक्कन पड़ा-
सुन लो ये डाक्टर बाबू,
अगर चाहते हो मरीज रहे काबू,
तो दवा का पूरा कोर्स भूल जाओ,
और मुझे तो बिन ढक्कन खोले ही घाव पर लगाओ।
तब तो एक बार के बजट में,पांच साल चलूँगा,
अपने अंदाज़ से ख़त्म किया तो साल भर खलूंगा।
अब पानी मिले savlon की बारी आई,
बोला वो मुझसे-भूल जा मेडिकल की पढाई।
तेरी पढाई के इलाज़ से,
नही कोई मेल सरकार के मिज़ाज़ से।
सरकार का सिर्फ एक काम ,
खोलो अस्पताल सरे-आम।
फिर दिए दिखाय,
जनता को सारे उपाय।
कि हमने PHC खोल दिया है,
डॉक्टर मौजूद रहे चौबीसो घंटा;ये बोल दिया है।
हॉस्पिटल में सारी सुविधा निःशुल्क उपलब्ध् कराई जायेगी,
dial करो 104/108;एम्बुलेंस घर पर दौड़ी चली आएगी।
पर ये नेता जी शायद भूल गए,
104/108 आये दिन रहती है garage में खड़े।
और बिन सुई-दवाई,
कैसे इलाज़ करे मेरा डॉक्टर भाई।
इतने में cotton और gauge ने अपना expiry date का लेवल खोला,
और पुरे antiseptic अंदाज़ में बोला-
इतना प्रवचन डॉक्टर साहब क्यों सुनते हो,
सरकार की कागज़ी बातों को क्यों चुनते हो?
कैसे सिमित दवाओँ से हर मर्ज दूर हो,
क्यों डॉक्टर स्टॉक के हिसाब से दवा लिखने को मज़बूर हो?
इतना तो kidney tray में पला बढ़ा,
बेचारा artery forcep;जो अब है जंग चढ़ा।
भी बता देगा,
कि अब मुझसे कोई काम न होगा।
फिर भी उस scissor से,
जाने कैसे-कैसे,
आप काम निकाल लेते हो।
और सरकारी आदेश में,
ढल जाते हो आप भी उसी परिवेश में।
कि हर पेट की बीमारी की दवा MTZ है,
ठीक हुआ तो हुआ;नही तो हम आपके कौन हैं?
अचानक गुस्सा हुआ R/L का bottle,
दिया जवाब in sum total,
क्या पूछते हो PHC के डॉक्टर से,
कभी पूछा उनसे;किस दर्द से हैं वो गुजरे?
DNS बोला intracath के साथ,
भाई N/S तुम्हें नही पता;क्या है बात।
D 5% बोल रहा था,
सारे सरकारी राज खोल रहा था।
कि नेताओं का ये फार्मूला है पुराना,
कैसे अपने area के पब्लिक को है उल्लू बनाना।
एक PHC हॉस्पिटल बिना किसी संसाधन के खोल दो,
उद्धघाटन करो और public को बोल दो।
आज से हर बीमारी का इलाज़ यहीं होगा,
जो डॉक्टर समय पर नही पहुंचें;मुझसे कहना होगा।
पर नेताजी अपने उद्धघाटन किये अस्पताल पे विश्वाश नही कर पाते हैं,
और अपनी सर्दी-जुखाम का भी इलाज़ करवाने;air ambulance से मेदांता से अमेरिका उड़े जातें हैं।
अब सिलाई का धागा,
कोने में पड़ा अभागा,
बोला-ऐ PHC के डॉक्टर,
मुझपे एक अहसान कर-
जिससे मेरी आत्मा तृप्त हो जाये,
जब भी कोई नेता चोट खाये,
अपने उद्धघाटन किये हुए अस्पताल में आये,
जहाँ तुझे दिए हुए है बिठाये,
मुझ से सी देना उसका जख्म;बिन xyolocaine लगाये।
डॉक्टर तू भविष्य है,
कैसे तुझ से कोई खेल पाये।
और deriphyllin dexona की कसम,
Omez Rantac के साथ पूछे तुझसे हम।
क्या बेरोजगारी इतनी भारी है,
की 5 1/2 साल की पढाई पे;5 साल की सरकार भारी है??????

Doctors cry for ‘clerical-error’ jail shield

Image result for ima dilli chalo

Doctors nationwide today asked the Centre to protect them against violence from patients’ relatives and modify multiple laws, including one they said threatens doctors with jail for “clerical errors” and another that might close down the smaller clinics.

The Indian Medical Association (IMA), a private body of doctors, has organised what it describes as the country’s largest congregation of medics here to articulate a “memorandum of demands” that association officials say seeks to address issues detrimental to doctors and patients.

A senior IMA official said that 53,767 doctors had signed a petition sent to the Union health ministry demanding a law or ordinance to curb violence against doctors and independent modifications to the Clinical Establishments Act of 2010 and the law that prohibits foetal sex determination.

The memorandum also urges the government to abandon a proposal to replace the Medical Council of India, an elected body, with a medical regulatory panel of nominated members.

“Doctors in India are unhappy – the government needs to take up each of these major issues,” IMA national president Krishan Kumar Aggarwal told PG Times.

“We’ve explained these concerns to senior health ministry officials; we now want the government to act quickly.”

Praveen Togadia, a cancer surgeon and international president of the Vishwa Hindu Parishad, was at the meeting and joined the calls for changes to the Clinical Establishments Act.

Although states such as Assam, Bihar, Jharkhand, Rajasthan and Uttar Pradesh have adopted the act, health activists say none of them has implemented its rules in full.

Togadia said: “The Clinical Establishment Act should be amended because in its present form, it will only hurt people.”

The act’s rules require nursing homes and hospitals to maintain what some IMA members say are “unrealistic standards”, including specific ratios of beds, doctors, paramedical staff and floor area.

Doctors fear that the smaller nursing homes and clinics might be forced to shut for their inability to maintain the required ratios.

“Most patients still seek treatment from small clinics. If they shut down, the patients will be forced to turn to corporate hospitals, which lack the capacity to meet the demand,” Togadia said.

He cited an example of how a corporate hospital might charge Rs 100,000 for a treatment service available at a smaller private clinic for Rs 10,000.

Sunil Kumar, a medical practitioner from Patna who was at the meeting, said the implementation of the Clinical Establishments Act would cause “nearly half of all clinics in rural Bihar” to shut down.

At least three private hospitals in Delhi kept their outpatient departments shut till 2pm today in “solidarity” with the IMA campaign, a senior doctor at one of these hospitals said.

“The most important thing that is uniting us is the violence against doctors. There is poor understanding of disease among most patients and their families, but the patients’ expectations are always high,” the doctor said.

The IMA estimates that three in four doctors in the country have during their career experienced violence from patients or their relatives.

Sex test row

The IMA is also demanding changes to the law that bans foetal sex determination and requires doctors to maintain detailed records of the ultrasound scans performed on every pregnant woman. The association says that doctors should not be punished for “clerical errors”, referring to lapses in record-keeping.

But this demand has angered health activists and women’s organisations, who view it as an “insidious attempt” to protect wrongdoing by doctors who reveal foetal sex for a price.

“The IMA has shrewdly combined this demand with its other demand of protecting doctors from violence,” said Sabu George, an activist tracking female foeticide for three decades.

“No one supports violence against doctors, but they are also trying to dilute the provisions in the sex determination law that will allow doctors to violate the law and escape scrutiny.”

George added: “The crime of revealing foetal sex and contributing to abortions of female foetuses cannot be dismissed as a clerical error.”

Doctors’ overwhelming participation in IMA’s Dilli Chalo movement

Doctors’ overwhelming participation in IMA's Dilli Chalo movement

In what was perhaps the largest peaceful Satyagraha against the many issues confronting the medical fraternity in the country, doctors, MBBS students, and others associated with the profession participated in huge numbers in the Dilli Chalo movement held today.

The movement was a fitting conclusion to the intensive month-long campaign by IMA aimed at raising awareness on and bringing to light the issues faced by the medical profession. IMA is a unified voice and the collective consciousness of the medical profession in the country.

The Protest March started at 8:00 AM from Rajghat and reached the Indira Gandhi Indoor Stadium by 11:00 AM. Earlier, the office bearers paid homage to the Father of the Nation Mahatma Gandhi at 6.30 AM.

Over 70,000 doctors from all over India participated in the event including representatives of National Medical Associations such as Federation of Obstetrics & Gynecological Societies of India (FOGSI), Indian Academy of Pediatrics (IAP), Association of Physicians of India (API) and the Cardiological Society of India (CSI) amongst others. Those not present in person joined the movement digitally over a live webcast.

Speaking at the deliberations, Dr K K Aggarwal, National President Indian Medical Association (IMA) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “This is one of the toughest times for the medical fraternity. This Satyagraha comes after the realization that enough is enough, and that repeated pleas and appeals by the medical fraternity have materialized into nothing but reassurances. The agitation among doctors has been evident for a long time now. New draconian acts imposing penal provisions on clerical errors and violations of clauses not linked to medical treatment under the PC PNDT Act and West Bengal Clinical Establishment Act are not in the interest of the profession and therefore, the society at large. The need of the hour is collective action and decision which would do justice to this profession.”

The last few months have seen several other initiatives by the IMA on this front such as STOP NMC Sathyagraha, two National Protest Days against violence on doctors, NO to NEXT strike in medical colleges, and the National Black Day against West Bengal Clinical Establishments Act. Other than this, 3 action committee meetings and 2 meetings of Federation of Medical Associations of India were also conducted.

Adding further, Dr Marthanda Pillai, Past President, IMA and Dr Ravi Wankhedkar, President Elect, IMA, in a joint statement, said, “It is imperative for both doctors and patients to understand that their relationship is a sacred one and that the dignity of the profession needs to be upheld. It won’t be wrong to say that justice has been denied to doctors even within the framework of the constitution of India. This movement should not be misconstrued as a strike or an agitation of any kind. Its sole aim is to serve as a wake-up call to the government and take urgent action.”

Addressing the huge gathering of medical professionals, Dr Vinay Aggarwal (Past President IMA) and Dr R V Asokan, Chairman, Action Committee, added, “This protest is an indication that medical professionals will no longer take any form of injustice. People are indulging in violence against doctors, which is further being condoned by governments and other institutions. Prescription rights of doctors are being trampled upon, which can have disastrous consequences for patients. There is absolutely no end to the injustice being heaped upon the medical fraternity and this noble profession. This movement should be enough to urge the government to take urgent action failing which the agitation is only bound to increase.”

The Dilli Chalo movement aimed to address the following demands by the medical fraternity.

* Criminal prosecution of medical negligence and clerical errors to be an exception
* Stringent central act against violence on doctors
* Capping the compensation in Consumer Protection Act (CPA) on doctors
* Professional autonomy in treatment and prescriptions
* Amendments in PC PNDT, Central Clinical Establishment Act (CEA), West Bengal CEA Act
* No unscientific mixing of systems of medicine
* Empower MBBS graduates
* One drug – One company – One price
* Implement inter-ministerial committee recommendations in six weeks
* Single window accountability
* Single window registration of doctors and medical establishments
* No to NMC: Amend Indian Medical Council (IMC) Act to maintain professional autonomy
* Uniform final MBBS exam instead of ‘NEXT’
* Uniform service conditions for service doctors & faculty
* Same work – Same pay – Pay parity – No to adhocism
* Fair conduction of NEET exam
* IMA member in every government health committee
* Central anti-quackery law
* Reimbursement of emergency services provided by private sector
* 25000 family medicine PG seats
* Aided hospitals and retainer ship in general practice
* Health budget of 5% of GDP for universal health coverage

Why I miss the good old GP who kept it simple

Guest article by Ruskin Bond

Customs change with the changing times, but not always for the better.

I do miss the old GP, the family doctor, who would turn up at your house at short notice. You had only to give him a ring or send him a message saying you or one of your loved ones was down with the flu or mumps or some mysterious fever, and he’d be around in a jiffy. Years of experience enabled him to make a quick and usually accurate diagnosis and he’d write out a prescription on the spot. If he thought it was something very serious he’d direct you to the nearest hospital. If he was a good doctor, his very presence would make you feel better. He’d put his stethoscope to your chest, feel your pulse, look at your tongue, prod your tummy, and make you breathe deeply and say ‘Aaah!’ You took his pills religiously, and sooner or later you felt better.

Such doctors are a dying breed. Today, young doctors open smart clinics or join city hospitals, and if you want to see them you must stand in line with dozens of other patients. In spite of all the advances of medical science, sick people multiply by the day and our cities are flooded with nursing homes and diagnostic centres. Strange that in this age of scientific and medical wonders, the world should be sicker than ever.

Diabetes, impotency, heart disease, cancer and various viral infections ensure that our medical services are overstretched. Gone are the days when a worried parent would say ‘Send for the doctor’. Now it’s ‘Go to the doctor’ or ‘Send for an ambulance’. No one is likely to come and sit by your bedside.

So I miss those doctors, now retired or long gone, who would do just that. There was Dr Jwala Prasad, for instance, a dear man who smoked quite heavily, and who owned one of the three or four cars that plied on the Mussoorie roads back in the 1960s and ‘70s. He was famous for his phrase “Nothing to worry about.” No matter how ill you were, in pain or racked with a fever, he’d pat you on the shoulder and say, “Nothing to worry about. You’re going to be fine!”

And it actually helped! Such is the psychology of illness or wellness.

Another friendly neighbourhood doctor who I miss is Dr Bisht. I had only to ring him up, to tell him I was in dire straits, and ten minutes later I would hear the splutter of his old scooter as it drew up below my steps. “Pulse is a bit fast today,” he’d say, after a brief examination. “It’s the blood pressure again. Don’t tell me you have fallen in love again?”

“What’s that got to do with it, doctor?”

“Falling in love always raises the blood pressure.”

In his infinite wisdom he’d hit the nail on the head — or the lover on his aching heart. The remedy? A long walk in the woods. “Keep walking. That will do the trick.” His theory was that a little exercise was the best remedy for most ailments.

Well, the good doctor has long since retired, but the other day I met him when he was enjoying an outing with his grandchildren, and I could see that he was most anxious to do something for my well-being. At eighty, I do still occasionally fall in love, but on this occasion I had nothing to complain of — no dizziness, no irregular heartbeat, no melancholia or other symptoms of the love-sick — just a seasonal cold. So I told him I had a cold.”

“Take plenty of vitamin C,” he advised. “And drink lots of water.” Well, I have been taking Vitamin C for a week, and I am looking like a lemon, and passed a lot of water, but a cold is a cold and it will go in its own good time.

I haven’t been so lucky with dentists. As a small boy I had protruding teeth, so my mother took me to Dr Kapadia in Dehradun, a famous dentist in his time. But a painful prod from one of his instruments resulted in my screaming and kicking him on the shin.
“Take this boy away,” he told my mother. “Don’t bring him here again.” With the result that I still have protruding front teeth.

But it’s better than having dentures. I have an elderly actor friend who was given the role of Count Dracula in one of those vampire films which are all the fashion these days. The trouble is, he wears dentures, false teeth, and when he grins or grimaces he doesn’t look at all like a vampire.

“You’ll never get those teeth into a beautiful neck,” I told him. “We’ll have to do something about them.”

So I took him to one of those street dentists who ply their trade on the outskirts of our pilgrim towns. He took out his file and sharpened my friend’s false incisors until they glittered. Our hero looked like a real vampire with the sharpened incisors. But he didn’t get the part. On taking the heroine into his arms and attempting to plunge his teeth into her beautiful neck, his dentures shot out and he was left toothless.

As Donald Trump would say: Sad.