What Can an Individual Do?

Forwarding a message I received from Dr Dharav Shah who is creating a wave of change in youngsters across India making them abstaining from the first puff and the first drink so they lead a healthy and happy life without the poisons we love.

Do watch the video. I had tears only once, but your mileage may vary.

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Dear friends,

Last week i had forwarded TEDx talk of Dr Taru, who had worked in a district hospital of Bihar. The NGO with which she was working, needs doctors for similar work in district hospitals in Bihar.

If you know any surgeon, Gynecologist, pediatrician or Anaesthetist who would probably like to take up this challenge for 6 months or more, please inform them about this opportunity to contribute. Please forward this ad in your medico groups

Are you upto the challenge of being an agent of change, working towards improving Emergency services in a progressive Bihar?

 Positions: 

1. WHO-CARE Global Surgery fellowship - *Specialist Obstetrician*:

2. WHO-CARE Lancet Global Surgery fellowship - *Specialist Surgeon*: 

3. WFSA-RCoA-CARE* fellowship - *Specialist Anaesthesiologist*:

4. WHO-CARE Paediatric fellowship - *Specialist Paediatrician* First referral SNCU services

*WFSA: World Federation Societies of Anaesthesiology RCoA: Royal College of Anaesthesiology

In a concerted effort to improve the health indicators, CARE-India, has been working with the Govt. of Bihar, has been working since 2010 towards a healthy Bihar. you may have seen TEDx talk of Dr Taru Jindal was working within this model at the Motihari district hospital.

You will be a member of a high-performance team of specialists (Anaesthesiologist, Obstetrician, Paediatrician and a General surgeon) working within the District Hospital - which WHO has recommended as the key facility for the delivery of Emergency care. The mode will be continuous and intense engagement with clinical work and clinical mentoring for 4-6 months at a single facility to impact the Emergency care metrics as outlined by the Lancet Commissions.

 The Govt of Bihar has agreed for an initial pilot of 5 district hospitals, with a rapid scale-up to all 35 district hospitals and the First Referral Unit (FRU) hospitals.

Salaries and working conditions will be in keeping with International health NGO standards. 

 Safety and accommodation are a priority for our personnel at CARE-India. While there are many Government, University and Non-Government agencies supporting this program, you will be on the employee payroll of CARE-India (and not of the Govt of Bihar nor the WHO).

For clarifications and to apply write with your CV: Dr. Nobhojit Roy, Team Lead, Systems Strengthening, CARE-India (nroy@careindia.org) with a CC to Dr Monali Mohan (monalimohangupta@gmail.com). Or text/WhatsApp on 98212-91225.

This TEDx talk is about a young doctor's experiences while she tried to bring about change in a district hospital in Bihar.

Do listen when u have time. It's a cool story 😊

https://youtu.be/RRRFK2rgAgQ

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 there a list of all Penicillins? Who maintains this list?

After figuring out what Penicillin A and B was, I remembered Alexander Fleming. If Fleming discovered Pencillin, then we should start with him.

So, here's Fleming's 1929 paper where he describes the discovery of "mould broth filtrate" which for convenience he decided to call "penicillin" : On the Antibacterial Action of Cultures of a Penicillium, with Special Reference to their Use in the Isolation of B. influenzæ.

He wrote the fungus closely resembles P. rubrum. Some people "corrected" him later. Some then corrected the corrections.

Okay, so in 1929, there was only one Penicillin and it was Fleming's Penicillin.

Then, for almost 10 years nothing happened. That's when Ernest Chain and Howard Florey came into the picture. They figured out a way to get good Penicillin. As early as 1940, they discovered Pencillin resistance. An Enzyme from Bacteria able to Destroy Penicillin. If you want to read more about the interesting history of the discovery of penicillin, read this review.

What Chain and Florey synthesised apparently was different from what Fleming discovered and therefore they initially named it Penicillin A and filed a patent. Later, they renamed it to "notatin" to avoid confusion. They also wrote this brilliant article on how they used it on some patients.

Van Bruggen and others in 1943 described another compound from Penicillium which had bactericidal activity and was different from any of the Penicillins till then and named it Penicillin B.

It was soon clear that Penicillin A and Penicillin B were identical. This compound is now called Glucose Oxidase.

From then on, it was mostly about improving on the techniques and therefore most literature is on patent articles. Here is one where Penicillin F and Penicillin G is described. I have no clue why they skipped over C, D, and E.

Around this time, people started producing all kinds of Pencillins.

As I could not find the list anywhere, I decided I will make that list. Here it goes.

Penicillin A - Glucose Oxidase
Penicillin B - Glucose Oxidase
Penicillin C -
Penicillin D -
Penicillin E -
Penicillin F - C14H20N2O4S
Penicillin G - Benzylpenicillin
Penicillin H -
Penicillin I -
Penicillin J -
Penicillin K - Natural penicillin
Penicillin L -
Penicillin M -
Penicillin N - Natural penicillin
Penicillin O - Almecillin
Penicillin P -
Penicillin Q -
Penicillin R -
Penicillin S -
Penicillin T -
Penicillin U -
Penicillin V - Natural penicillin
Penicillin W -
Penicillin X - Natural penicillin
Penicillin Y -
Penicillin Z -

Please let me know if you find the missing items.

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.

The happy picture of the candidates from day 1