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

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

Interactive textbook with adaptive level of complexity

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

Why is Benzylpenicillin called Penicillin G and Phenoxymethylpenicillin Penicillin V?

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

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

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

JLS: SJG Ayurvedic College, Koppal

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

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

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

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

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


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

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

How is this fair at all?

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

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

How come they ar…

De Quervain's like Pain After CPR

Yesterday I was demonstrating CPR in a life support workshop. Today, I have pain in the left radial styloid process area.What could it be? Searching took me to two pages of interest. One is AAFP's page on diagnosis wrist pain. This page talks about many things including Finkelstein's test which is grasping the thumb with other fingers and then ulnar deviation of wrist. It was negative for me, and I definitely did not have De Quervain's tendonitis.But it could be the same tendons. What are the tendons involved in de Quervain's? The extensor policis brevis and the abductor policis longus which both go through the groove lateral to the radial styloid process. Maybe there was some microtrauma?The other article was about wrist injuries in emergency service providers. It does not look like I have a scapholunate ligament injury. So I decided to read more about de Quervain's.I found an article - Walsh and Miller: Pain about the Styloid Process - which beautifully captures …

A Letter to the Disillusioned Intern (or Medical Student)

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

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

And what did it all come to? Running around like a dog completing errands passed down to you in the strictest hierarchy ever. (It is called dog work, did you know?) Maybe learning a bi…

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

There is a lot of context needed here.

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

I, am an HIV physician and general practitioner of modern medicine. I have pre…

Healthcare With Smartphones?

Imagine this. You are a 36 year old lady working as maid in two houses, not supported by an alcoholic husband, and mother of two school going children. Your husband had a wart on his genitals and now you have it too. It is not particularly bothersome, but you are not sure what you should do about it either.You think it would be a good idea to go to a hospital, but which hospital? Which doctor should you meet? Would they judge you? Do they charge too much money? Is it going to hurt? Whom do you even ask these questions?Enter our app.You will be asked a series of questions in your own language. The questions get more and more specific as you answer them. They will also be read out to you in case you can't read. By the time you have answered about 10 questions, the app knows what your problem is.The app has been fed with a well designed set of protocols/algorithms that need to be followed in each situation. It has a curated collection of resources (hospitals, clinics, labs, lawyers, …

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

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

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

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

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

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

This is a positive change in man…

Way Forward

On 30th of June, SVYM organized a one day session on careers after MBBS at Vivekananda Memorial Hospital.



Interns and/or final year students from Mysore Medical College, Bangalore Medical College, Hassan Institute of Medical Sciences, JSS Medical College Mysore were among the ones who were in the audience.



After the SVYM video, it began with introductory remarks by Dr Chaithanya Prasad, the director of VMH.

Then Dr MA Balasubramanya talked about administrative careers after MBBS. The gist of it was that as doctors, we are already administrating. There is no running away from it. We should embrace that reality and go forward with it.

Dr Kumaran K took the audience through the story of his life in research and thereby had them thinking about how to pursue a career in research.

Dr Ravindranath motivated the audience to take up surgery as a career and showed various alternatives to the MS degree to become a surgeon - majorly about options in various other countries.

Dr RK Nair talked abou…

First PEP - Days 7, 8, 9, 10, and so on...

Well, I lost count.

I didn't miss a single tab. But I have, as usual, missed on writing the experience.

There are indeed some highlights.

First, a house surgeon and his friend from my college came all the way to Nugu and our hospital after reading my posts. I guess I put enough philosophy in his head that he comes back and joins here later.

Then, I'm making good progress in my thesis work, interviewing patients about their perspectives on how they became sick. I have interviewed three patients till today. Each interview gave me a completely different story. I have even moved to Asha Kirana hospital asking permission to interview patients there.

Also, Amazon made three deliveries. My favourite book - The Emperor of All Maladies, my favourite stethoscope Dr Morepen ST 01, and Tripti Sharan's Chronicles of a Gynaecologist. (all affiliate links) 
Finally got a hard copy. Horror stories one after the other. Chronicles of @triptisharan200pic.twitter.com/0Y3D1LFwLf — Akshay S D…

First PEP - Days 4, 5, 6

Days fly by as usual. It's already day 6 and I'm wondering what I did on day 5. (I slept all day).

Day 4 - Monday, 30th April

I had general OPD duty. In essence I was jobless almost the entire day. I sat in the injection room and saw some 10 patients.

This morning I had tried to swallow the LPV/r without any water. It wasn't a very good idea as one of it got stuck to the throat and I almost had to do Heimlich on myself.

It's the day we went to Nugu and savoured garlic bread and churmuri prepared by all the ladies.


On the way back Kishan & Suchitra ran out of petrol. So I had to empty a 1 litre bottle of water into my throat and fill petrol in it. Swathi and I went on a scooter ride after about an year today.

Day 5: May day

All I remember of this day is sleeping all day. I tried to get some useful work done after waking up in the evening. But having finished dinner, I slept again.

Ah, ah. I also sent an email to the canteen manager regarding the legality of "c…

First PEP - Days 1, 2, 3

After having done the "Perfectly Messy Prefect" series and "Jog Journal" series, I have now gotten the opportunity to start a new series - on Post Exposure Prophylaxis.

Let's start with the good news. I put a central line in a patient (that's my first time after MBBS and the first time I was confidently doing it on my own).

This patient who's been admitted with Cryptococcal antigen showing 3+ in their CSF needed lots of amphotericin for two weeks. Putting amphotericin in a peripheral venous line is okay, but it can soon lead to thrombophlebitis and both patient and doctor will have a hard time managing it. So we decided that it must go through a central line.

And it was imperative that this happened in the new emergency department that was inaugurated the same day. Dr Ram was around and his guidance is better than the ultrasound guidance he gives.



First thing we settled was whether the artery went lateral or medial to the vein. Of course it goes lateral…

Patient Inclusiveness in Rounds, Sex Between Serodiscordant Couples, Role-plays, PrEP, PEP, Anti-Retroviral Drugs, Drug Resistance, and what not!

This weekend was fun! I am grateful to a lot of people for it being so.

It started Saturday morning with grand rounds, as usual. We were joined by Dr Ramakrishna Prasad (RK), Dr Ashoojit, and Dr Praneeth Sai. RK was leading the rounds. And he introduced the concept of patient/family centred rounds wherein we include the family in the discussion and make them feel a part of the process.

That meant I talked to the patient in front of everyone and let him describe his problems in his own words. This allowed gleaning certain facts of his life that were also much useful later in the day while talking about other aspects of care in HIV.

What followed was journal club by Dr Swathi in the training hall. She presented "Living with the difference: the impact of serodiscordance on the affective and sexual life of HIV/aids patients" a topic that greatly interests her.

They interviewed 11 carriers and based on the theme of sexuality after HIV infection between serodiscordant couples foun…

Documentation in Medical Records

I have documented my love of documentation elsewhere. I blog to document my life.

I'm not perfect at it. Nobody ever can be. Because perfect documentation would take more time than the original act of knowing.

Imagine. If you were documenting a visit to a nearby tourist attraction. How would you document it perfectly? You could definitely write about it in much detail. But how much detail is enough detail? Would you be writing about everything that you saw on the way? Would you be writing about your thoughts on what you saw? Would you document the planning process? Would you care about other sensations like smell, warmth, etc?

Recording a video might capture more detail. But a video can't really capture your thoughts unless you speak into it. Even then it can't capture your reflections unless you reflect loud while shooting yourself. But how much can you videograph? Where do you store these videos

Maybe it's possible to categorize and selectively review any moment fro…

Fellowship in HIV Medicine - Interview

A day before independence day, after the long wait of more than three months, the FHM interview took place at SVYM office.

I was on duty and was checking on a newborn with tachypnea (probably transient tachypnea of newborn) when they called me upstairs for the interview. I had others fill in for me and ran to the interview room.

My friend Swathi went in first and sitting outside I could hear them talking about the challenges faced by a clinician and public health worker in managing HIV because of the stigma associated with it and how by consistent effort we can influence at least families of HIV infected people to look at it like any other disease.

I had practised multiple times the answer to why I wanted to join FHM. I look at it as a course in infectious diseases and India is a country still struggling with infections. My personal interests and career choices are probably going to take me to places where being good at managing infectious diseases would be an advantage. Also, SVYM…

Do Cats Get HIV?

Blalock-Thomas-Taussig shunt is a surgical technique used in colouring Blue Babies pink.

Last week we had a baby who was referred for cardiac evaluation come back with a report saying she had Tetralogy of Fallot and needs a BT shunt. The parents had not gotten it done yet. Still, the baby wasn't blue. Because she was too anaemic to have enough deoxygenated haemoglobin to be cyanotic.

I had to watch Something the Lord Made that night. It is the heart-touching story of how B(T)T shunt was developed. If you don't cry with Vivian Thomas at the end, you should probably check your cardiac functioning.

In the backdrop, there are dogs. Blalock and Thomas would perform their surgical experiments on dogs. Countless dogs who have lost lives for (human and animal) science. Thank you dogs!

Talking about dogs, there are cats too. I found this post on reddit.

Cats don't get HIV - it's Human Immunodeficiency Virus, for viral Lords' sake. Or maybe there is a Feline Immunodeficienc…

CPR - To Terminate Or Not To - That is the Question

Unlike with many other resolutions I figured out that today is the first day of the month only after resolving to be productive today. As a part of that I woke up about an hour early and started seeing my babies in ground floor general ward. (Oh, did I forget to mention, I'm in charge of Paediatric patients since more than a couple of weeks now).

But I hadn't even figured out why Atenolol was prescribed to the child with hepatorenal syndrome and not so high BP when I was informed that I had to cover general OPD in Kenchanahalli hospital today. As I had the experience of missing the van going there for being a minute late last time, I didn't take risk and ran away after instructing the nurse to withhold Atenolol.

It was only when I was halfway over the bridge that connects our hospital to the other side of Saragur that I realized that the Atenolol was not for BP, but to control the heart rate - tachycardia and gallop rhythm. I told the consultant paediatrician about how du…

The Sour Grape

I have been told by at least one person (and I think many more might have the same idea) that "I have disregard for postgraduate entrance examinations and am working where I am currently working like it is something heroic because I find entrance examinations difficult to crack, because I'm incapable of getting a good rank, and I am just finding excuses that I can't figure out what postgraduation to do, that I don't want to lock myself in a garage to learn".

To them I would say, maybe you are right.

Maybe I am an idiot.
Maybe I barely passed MBBS.
Maybe I should not have been a doctor on the first hand.
Maybe I do not have the aptitude to crack entrance exams.
Maybe I am not even smart enough to do the "right" things in life.
Maybe I am stupid.

But, guess what?

I don't care.

My choices are entirely mine. My outlook is formed by my thought processes and I can live with the same. Maybe I don't fit your definition of success. Maybe I don't fit …

My Idea of a Perfect Electronic Medical Record System

The COWs are coming to our hospital.


Our hospital might soon switch to an Electronic Medical Record system. And this will bring in Computer on Wheels, COW as they're affectionately called in other hospitals.
While that makes me more happy about where I'm working, it also brings back a lot of ideas I've had during medical school. I have seen hard problems for humans that are pretty easy for computers to solve. I have seen processes that could be hastened by leaps and bounds if computers were involved even partially.

The Perfect Electronic Medical Record System The perfect EMR does not just record what the physician or nurse puts in. It is an intelligent assistant that does some thinking of its own and comes back with suggestions and autofills for the physician or assistant.

For example, when a child comes to you and her mother says she has fever, you start entering "fe..." and the EMR autofills fever. Next you can enter the duration from a dropdown menu. Also asso…

Joining Swami Vivekananda Youth Movement

Till yesterday, I had thought that I had joined Vivekananda Memorial Hospital.  But, yesterday there was an orientation session for new employees at this organization. And the events made me realize that I have indeed joined, or want to join, Swami Vivekananda Youth Movement, the parent organization of VMH.

SVYM's story is very heart-touchingly written in the blog of Dr R Balu (RB).

I am not aware of any other organization which has the story of its inception so beautifully and lucidly laid out. RB's experiences that led him to start SVYM are relatable. And he has made it possible to connect dots from those strokes of inspiration to the concrete structure that exists today.

But Dr M A Balasubramanya nevertheless described the same in a couple of hours yesterday. Some of his words dug deeper than I expected them to go inside my mind. I was expecting him to speak about how they had to undergo a lot of hardships and struggle to reach where we are. He did. But I wasn't expectin…

VMH - first few days

Getting to Saragur from Mattanur is a tricky business. The shortest route isn't necessarily covered by public transport. My initial plan was to reach Mysore via Virajpet-Hunsur and then take a direct bus to Saragur. But later, I dropped it in favour of what my mom suggested - get down at Hunsur and take a bus that cuts through the corner.

So I did get down at Hunsur. Turns out, in Hunsur there are two KSRTC bus stations. One is for urban buses - the one I got down at. The other, inter-village rural bus service, is where I would find buses to Saragur. Luckily it is walkable distance between the two stations. At the rural bus stand, there was a bus to HD Kote. It's 11 more kilometres between HD Kote and Saragur. But there was no direct bus to Saragur. So I got into the HD Kote bus.

And that was the slowest bus ever. It stopped at every house and couldn't accelerate faster than a turtle. At HD Kote bus stand, there was a city bus going to Saragur waiting for me.…