Father, in this contemporary sketch of a place in the world where giants roamed, warrior-like you entered tall, confident, and armed with science and humanity.
A profile of courage and integrity.
Into this wild, untamed Kenya, on the east coast of Africa, you marched in, in step with the raw power and magnificent bearings of the lions, the towering herds of elephants, the elusive cheetahs, and a superabundance of the wild creatures of this natural world.
Born and raised in Hiran, Punjab, trained as a medical doctor, you, Dr. Amar Nath Bowry, embraced the Hindu philosophy of ‘Karma Yoga’. At 23, you and Lila Wati, your young bride of 17, left your beloved families behind to sail across the Indian Ocean.
Soon you discovered that because of the inhospitable living situation for the native populations in Kenya, death and disease were common occurrences. Along with poverty and lack of resources, the scattered rural populace was preyed upon by a plethora of diseases like Malaria, Sleeping Sickness, Bilharzia.
Ready to face the challenges head-on, with a fervent zeal, you embarked on a mission to help and heal this land. Undeterred by hardships, to fulfill this noble mission, you dedicated 35 years of your life to Kenya. While accomplishing your goal brought you unlimited satisfaction, it all came at the cost of pain and separation for your young family.
Respect All. Love All – was the Mantra that propelled your compassionate heart.
India was always Home. After 35 years, you returned, finally, to be part of that revered Indian soil.
Sixty years! Time must be playing some tricks!
Father, I cannot believe, you have gone sixty,
I still know you as being around me
You are still with me!
Your joy in being alive; your healing, nurturing soul
That won over a vast array of patients and admirers.
Your serene, calm composure, your engaging smile
You truly knew how to listen.
We just spoke.
We told you of our unfathomed lives
Our brow-creased misgivings.
In your bright, knowing eyes
Read safety in a protective gaze,
A guidance, a gentle nod of approval.
There, and then, I vowed never to disappoint you.
You perhaps knew you were dying!
We were with you for the last four months
Watching and rejoicing in your company;
Your fun and games with Nishi and Achal
Your youngest grand-children.
We did not know you were in pain
You looked frail, yet so dignified
With a mischievous twinkle in sunken eyes.
Your pale lips said a lot; only if I knew how to read them!
But you did not let a shadow cast.
The luminosity of your eyes, deep blue!
The doctor asked if they were always
That intense, ocean blue!
Was it ‘The Brightest Flame before It Extinguishes’?
My heart knows: The sparkle of my life
Still is enkindled by your gentle, joyful nurture.
Your Love has encompassed
My whole being!
In my new beginnings with Dhruv
You launched my life on a personal journey
Of Wellness, of Abundance
I thrive in your blessings.
You will be twenty and a hundred, in two months.
The world is richer, the earth full of loving warmth
For you journeyed through it once
Sowed and nourished seeds of life
With an eternal spring of joy!’
— Usha Dhupa
Usha Dhupa (Nee Bowry) was born in Kenya to Indian parents and has lived across Four Continents. She studied English Literature at Delhi University and a published author of ‘Child of Two Worlds’. She loves to write poetry and stories in English and Hindi.
Sukham Blog – A monthly column focused on South Asian health and wellbeing.
My wife’s oncologist recommended a palliative-care consultation during one of her checkups. This was the first time we heard about it and my wife, subsequently, received beneficial palliative care alongside her ongoing treatment for cancer. Since then, I’ve continued to learn more about palliative care and how it helps patients living with various kinds of serious illnesses. I’ve also realized that most people know very little, or are misinformed about palliative care. We need to understand this relatively new medical specialty; it can do a lot for us and our loved ones in the event of a serious health issue.
Palliative care is specialized care for people living with a serious illness. It is a type of care focused on providing relief from the symptoms and stress of different kinds of serious and chronic, progressive illnesses, and is provided in addition to, and concurrent with, ongoing medical care. It supports the patient’s ability to feel better while undergoing treatments which could be intense and sometimes not well tolerated. The goal of palliative care is to improve quality of life for both the patient and the family.
To palliate is to make something – for example, a disease or its symptoms – less severe or unpleasant. Palliative Medicine is relatively new. It has its roots in the work of Cecily Saunders and Elisabeth Kübler-Ross in the 1960s. The term Palliative Care was coined in 1974 by Dr. Balfour Mount, a surgical oncologist at The Royal Victoria Hospital in Montreal, Canada. It was recognized as a field of specialty medicine in Great Britain in 1987, the same year that Cleveland Clinic started the first Palliative Medicine service in the United States. It became a board-certified subspecialty of medicine in the United States in 2006, just 15 years ago.
Let me repeat: Palliative care is specialized care for someone living with a serious or chronic progressive illness, focused on providing relief from the symptoms and stress of the illness, to improve quality of life for both the patient and the family. It is based on the needs of each individual patient and can be provided at any time during his or her illness, along with the treatment he or she is already receiving, regardless of the prognosis, expected trajectory of the disease, or age of the patient.
What, specifically, does palliative care do? It provides relief from pain, nausea, constipation, neuropathy, shortness of breath, or other side effects and symptoms caused by the illness and/or treatment. It helps when patients and their families have trouble coping with the illness and are anxious, depressed, stressed, or fatigued, and enables them to better carry out their daily tasks and do the things they want. Palliative care can also improve the quality of life for both the patient and his or her family.
What is meant by quality of life? That depends on the patient! He or she defines what is important at that moment and in the future. The palliative care team works with the patient and his or her family to understand what’s important and what matters most to them, and takes that into account to formulate a treatment plan and provide the best possible support to help realize those goals.
I used the phrase palliative-care team. Care is provided by a specially-trained, multidisciplinary team that typically includes doctors, nurses, medical assistants, social workers, chaplains, and other specialists. This is because palliative care extends beyond a patient’s physiological and medical needs and addresses other factors that may be affecting their quality of life, including psychological, spiritual, and social needs. These needs vary from patient to patient. In addition, they can vary over time for a given patient.
Needs could include: help with figuring out what medications should be taken and when; thinking things through, and weighing options when faced with decisions on a suggested next step in treatment; help navigating the complexity of a large hospital when referred to different specialists or when various tests are ordered. Sometimes stress can overwhelm the patient, caregiver, or another family member, and they could benefit from having a caring listener, or just a hand to hold for a while. The costs of treatment are a huge concern for many of us, so the assistance of a qualified individual to sort through financial questions might be valuable. When serious illness brings up existential and spiritual questions, trained chaplains could provide answers, solace, comfort, and a compassionate presence. Nutritionists who understand the patient’s diagnosis and condition can help address dietary concerns.
Palliative-care specialists treat people living with many types of serious and chronic illnesses, regardless of their age, stage of the disease, and whether or not they are still receiving curative treatment; these include cancer, congestive heart failure, chronic obstructive pulmonary disease (COPD), kidney failure, Alzheimer’s, Parkinson’s, Amyotrophic Lateral Sclerosis (ALS), and other life-limiting diseases. Pediatric palliative care is an upcoming specialty. During the current pandemic, it’s an essential part of treatment for those who have contracted COVID-19.
Many confuse palliative care with hospice and believe a recommendation for palliative care implies the patient has a condition that will imminently end his or her life. This is not correct. Palliative care can be very useful for those managing a long-term illness. Quality research provides evidence that the early introduction of palliative care provides all the benefits described above, and results in fewer hospitalizations, a reduced burden on the family, and greater satisfaction overall. Hospice is a form of palliative care for those patients judged to be approaching end of life – and typically have six months or less left to live – who decide to focus on comfort instead of prolonging treatments.
I hope this has helped you better understand Palliative Care and dispel any related misconceptions.
Mukund Acharya is a regular columnist for India Currents. He is also President and a co-founder ofSukham,an all-volunteer non-profit organization in the Bay Area that advocates for healthy aging within the South Asian community. Sukham provides curated information and resources on health and well-being, aging, and life’s transitions, including serious illness, palliative and hospice care, death, and bereavement. Contact the author at email@example.com
Sincere thanks to Drs. Neelu Mehra at Kaiser Permanente, and Kavitha Ramchandran & Grant Smith at Stanford Health Care – Palliative Care Physicians who have contributed greatly to my understanding of Palliative Care.
With sincere thanks to Trung Nguyen at Pexels for the use of her beautiful photograph.
Sanjiv is the quintessential 40-year-old – an engineer, working as a marketing professional with an FMCG company. Full of dreams and full of life, always smiling, super intelligent, the center of attraction of any gathering, the best son to his parents, the most caring brother to her sisters, and a doting father to my 11-year-old boy. He is a young heart wanting to achieve something big and also enjoy it to the fullest. His friends would describe him as an absolute gem.
We met at our MBA school and became best friends instantaneously. While I tried to keep finding the best girlfriend for him, we both fell in love ourselves. We got married a few years later in 2007 and now we have a son who is 11-year-old and three of us were leading a small happy life.
Last year our lives turned upside down. Sanjiv was diagnosed with high-risk blood cancer – Acute Lymphoblastic Leukemia B – in May 2020. We were absolutely shocked, as there is no family history of cancer. We were informed that the cure was few rounds of Chemotherapy ultimately followed by Bone Marrow Transplant. We had one day’s notice to decide and commence the Chemo as his case was very acute.
Post his first chemo, Sanjiv developed an extremely rare and troublesome fungal infection while he was immunocompromised. This got us into a vicious cycle as the fungal infection prohibited further chemo treatment without which cancer would not go away into remission. By early November, cancer showed up on his skin as leukemia deposits. His condition worsened with leukemia in the blood, leukemia in the skin, and fungal infection in the body. That’s when doctors in India raised their hands and told us that MD Anderson Hospital in Houston, USA was our best hope. By mid-November, I moved to Houston, temporarily, along with Sanjiv and my son.
Treatment is definitely possible, but prohibitively expensive.
Doctors here are trying to balance out the chemo and infection treatment to get him ready for a Bone Marrow transplant. We are done with 2 rounds of Chemotherapy and there have been lots of complications post Chemo, and now we await BMT as a final step. BMT is a very intensive process where the body’s immune system is being rebooted and can be complicated as well. The positives news is that the leukemia in the bone marrow is under control, skin leukemia is being treated with Radiation and the bone marrow transplant is now being discussed with the best doctors here.
The last 8 months have been extremely draining for us as a family- physically, emotionally, and financially. All our life’s savings have been used up in the treatment in Mumbai and America.
On 5th July 2020, Ikonkar Manmohan Singh Sandhu, a young 23-year-old boy, died from an opioid overdose in Michigan just months before he was to be married. He is by no means an isolated case in the Indian American community.
A small group of doctors are sounding the alarm on the nation’s opioid crisis. Dr. Arun Gupta is one of those who is urging health authorities to wake up to this catastrophe, which is ripping through communities with scant regard for race, gender, educational level, or financial standing.
To be fair, before COVID-19 ravaged the country, the growing opioid addiction was giving the nation’s health officials sleepless nights. The pandemic put this issue on the back burner and while more Americans are dying from the virus, it can be just as deadly if left unchecked.
Opioid overdoses have killed more than 70,000 young people annually between the ages of 18-54 for the past five years. In 2011, the CDC reported that overdose deaths superseded auto accident deaths for the first time in 32 states This is now true for all 50 states. The organization also reported that more than 700,000 young Americans have died between 1999- 2017 from polydrug overdose. That number is expected to be as high as one million by the end of 2020. The report further states that “preventable disease & retroactive analysis show that most of these deaths were unintentional.” Isolation, stress, and the depression, that came in the wake of the pandemic are shooting cases through the roof.
“Parents are burying their children and children are burying their parents,” says Dr. Gupta.
Dr. Gupta is quick to rid you of the rosy view that Indo American families have been unaffected by this affliction. It is a growing trend in the community, he says, largely due to parents’ unrealistic expectations for their children and the reality of facing conflicting cultures. What worsens it, is that many are either in denial or wary of seeking professional help for fear of being stigmatized or shunned. These are lives that could have easily been saved, he laments, much like the case of a distant relative who died because the family hesitated to reach out for help or were unaware of the problem.
A physician for 34 years, of which 14 are as a doctor of addiction management, Dr. Gupta has seen enough to be worried. He has been charting the surge in cases throughout the nation for the past decade and is seeing it played out at his doorstep – the rural region of Monroe, Michigan where he runs his private practice.
For 11 years, Dr. Gupta was the local prison doctor where he saw the interplay of drugs and death up close and the ineffectiveness of the administration’s efforts to curb it. This pushed him to change tracks from being a general physician to addiction management. Rural communities, he observes, are more prone to opioid addiction than urban areas where the population is better educated and have higher-paying jobs. The problem is compounded when there is family instability, lack of education, poverty, physical, mental and sexual abuse in childhood, mental illness, or addiction both in the family and the patient.
So why are addictive opioids prescribed in the first place and how do they hook us? About 25 years ago, pharma company Purdue, manufacturers of the painkiller Oxycodone, pushed the government to sanction prescribing painkillers for non-cancer-related pain. The American Pain Society also classified pain as the fifth vital sign after blood pressure, pulse, temperature, and weight. Statistically, 40% of the country’s population is in chronic pain and many require pain medication to carry out their daily activities or even go into work.
Addiction starts innocuously enough with a prescription for a painkiller to treat post-surgery or chronic pain as in instances of back pain. Consuming these painkillers diminishes the pain but also brings on a euphoric feeling as it raises dopamine – the brain’s pleasure hormone. Celebrities like Michael Jackson were known to use them before a performance, a term referred to as, “spotlight euphoria.” Additionally, it changes the perception of reality for those dealing with psychological issues such as an inferiority complex or anxiety, these people now start “liking themselves and feeling good.” This altered reality quickly spirals into an emotional and social need followed by dependence and cravings for the painkiller.
The signs of addiction are evident in drastic mood changes, lethargy, or impaired decision-making, among others. Discontinuing the painkillers could lead to a host of withdrawal symptoms such as chills, tremors, body aches, bone pain, vomiting, diarrhea, or irregular respiration. However, Dr. Gupta clarifies that not everyone gets addicted to painkillers and the risk of addiction is only about 10%.
Soon, Oxycodone grew so popular that it began to have, “street value.” When prescriptions ran out, users turned to the streets where it could be obtained illegally. Hustlers began faking health issues to procure and sell these painkillers giving rise to the term “pill-mill.” The cost of one milligram of Oxycontin is one dollar so someone using 1000mg was spending $1000 a day. While insurance took care of legitimate prescriptions, those who were addicted were shelling out their own money. This, of course, was done in connivance with “some doctors who played the game.” Dr. Gupta estimates that about 1000 doctors have been apprehended so far for violating this practice and have “tarnished the image of doctors.”
There is an obvious connection between mental disorders and addictive disorders and its consequences can sometimes be life-threatening. Doctors, however, are required by law to treat pain with painkillers even if there is a sense/awareness that this medication could become addictive to the patient. On the other hand, if doctors practice caution in prescribing pain medication, they risk a bad review on their practice, something every doctor understandably wants to avoid.
In 1999, the Center for Disease Control went on record for the first time and shared its report of 4000 young Americans who died from drugs. The government scrutinized the problem and rolled out the Drug Addiction Treatment Act of 2000. For the first time, this law allowed practicing doctors to learn and treat addiction with an FDA approved drug. The law also stipulated that any practicing doctor could complete an addiction program and receive an X DEA license which would allow them to treat 30 patients per month for a year. If the doctor’s records are found in order, they could treat 100 patients per month. Past President Barack Obama signed a law that would allow some doctors with specific credentials to treat 275 patients a month. This number was controlled to prevent its misuse but sometimes the best-intentioned laws have unintended consequences.
This one did.
Only 4300 doctors in the US can treat 275 patients a month and Dr. Gupta is one of them. It’s a drop in the ocean for the estimated 20-40 million people who need help overcoming their addiction. There are more than 100,000 healthcare providers in the country that include doctors, nurses, and physician assistants who have the necessary X- DEA credentials to treat opioid use disorders. But less than 20,000 are actively involved in dealing with the growing opioid epidemic in the country. This lack of access to a healthcare provider aggravates the problem leading to more deaths than recoveries. Meanwhile, the pandemic has not made things easier. There is excessive stress and limited counseling due to the shutdowns and prescriptions cannot be given on the phone without the necessary drug testing. This explains the rise in overdose deaths and addiction cases in the past nine months.
Apart from flawed policy, the American Society of Addiction states that every doctor who graduates from medical school is required to study addiction management. There are 179 medical schools and approximately 9000 residency programs in the country and not one of them teaches this course. Moreover, addiction management is not considered on par with other areas of medical specialization and neither do insurance companies view addiction like other chronic diseases such as blood pressure or diabetes.
In 2002, the drug Buprenorphine was approved for addiction treatment and ten years later another drug Zubsolv made it to treatment plans. These drugs block the opioid receptors in the brain and reduce a person’s craving for the painkiller. Another ingredient in the drug, naloxone, reverses the effects of opioids. Together, they prevent withdrawal symptoms and deter the abuser from snorting or injecting it. Dr. Gupta pairs medication with counseling, and non-addictive medication in cases of insomnia or anxiety. Recovery takes anywhere from six weeks to six months depending on the severity of the addiction, but the struggle to remain clean continues for the rest of their lives.
With death rates from opioid misuse surging, more than 500 laws were enacted in the last 10 years against doctors, pill mills, and pharmaceutical companies to curb the problem but this has only exacerbated the issue. Addicts are now forced to go to the streets instead of visiting a doctor for treatment. Dr. Gupta notes that national autopsy results over the last 5 years consistently show that fentanyl, heroin, and cocaine are the first three drugs in more than 55% of the people with drug overdose deaths as opposed to prescription medication.
Over the past few years, Dr. Gupta has presented more than 150 talks to schools, doctors, healthcare systems, and social organizations like Rotary clubs and the Kiwanis Club to highlight the gravity of the problem and his message that addiction can be cured. He is talking to elected officials to leverage their influence and galvanize the government to rethink the limit of patients and allow greater access to people who want to overcome their addiction.
Addiction, he warns, has become synonymous with a death sentence in this country.
Manu Shah is a freelance writer covering Indo American news.
The Boy Refugee is a seminal work, a one of a kind book by Dr. Khawaja Azimuddin, a well-known gastrointestinal surgeon from Houston, Texas. One could ask why this fact is important to mention in a book review, but the answer is clearly within its pages.
This book is non-fiction, one which details a segment of a journey, that of a young boy of about 8 who spends over two years of his life as a Pakistani prisoner of war (POW) along with his family in the town of Roorkee, India. This saga started in the year 1972 following the birth of a new country called Bangladesh (former East Pakistan) in December 1971.
During the year 1947, when the British hurriedly left their partitioned empire, lines were drawn on the basis of religion and two countries namely India and Pakistan came into being. It turned out to be a bloodbath. History repeated itself in 1971 but these timelines were drawn on the basis of language while another country was born out of Pakistan named Bangladesh. Many perished during this time as revenge often overtook reason well into the year 1972.
Khawaja Azimuddin’s minority Urdu-speaking family was on the losing side of the resulting historical events. The regional and global chess players were also in the picture as the movement by the Bengali majority, which gave many sacrifices, achieved its goal of independence with India’s direct military action. And the Urdu speakers in the area, many who preferred a united Pakistan, suddenly became unwanted refugees like Author Azimuddin, in the land of their birth.
“This book is dedicated to refugees all around the world,” states the writer right from the onset.
Sometimes the biggest challenge for non-fiction writers is how to make their book interesting enough for readers. The fact of the matter is that very few books have been written on Bangladesh’s independence in 1971 and its aftermath by those that lost (or from those who were not in any position of influence at that time). And none have been written from this particular viewpoint that of a 10-year-old boy (at the time) who was caught up in one of the furious funnel clouds of history.
This is where the reader will discover a truly unique book. Dr. Azimuddin today is accomplished in many ways and has helped many of his patients in fighting cancer in Houston, Texas. But in this book, he is an innocent kid taking us on a journey from Dhaka (Dacca then) though most of northern India to Roorkee. Through his childhood lens of wonder, we get a look at war, camp life, human relationships, and survival. His parents, siblings, and friends all have a major role in The Boy Refugee, but one cannot forget his “Little Green Suitcase” of notes and memories which one can describe as equally fascinating.
He lets us share his observations through such sentences here: “The Abduls, our house helps, were among the Bengalis. I was quite sad that they had left and without them, I felt very alone in our huge house. I went out to the backyard to play with my pet pigeon, Kabooter. I’d had six pigeons but a few weeks ago, all but one of them had flown away. Perhaps they too had sensed a need to return to their families. Kabooter was the youngest and had stayed behind, he was very attached to me.”
The innocence of youth reveals many truths in the book. The role of the Indian troops in safeguarding some of the Urdu speaking community after the birth of Bangladesh gets some mention: “The Indians knew that if they abandoned them, the Biharis would be killed in masses, and fearing international condemnation, they felt obligated to protect us, at least for the time being. And so, by a twist of fate, our enemy became our savior and protector.”
On the creation of a new country and its aftermath, its real impact on the Biharis can be felt through this work too: “During these days of confusion, no one knew exactly what to do or what would happen next. We knew that East Pakistan was no more and that, we Biharis were not welcome in Bangladesh. But West Pakistan was far away. Essentially, we were stateless.” (A reminder here to our readers that many of these Biharis are still living in refugee camps today in Bangladesh).
There are competing narratives on what really happened in the years 1971-72 in former East Pakistan. There was considerable loss of life as a new country, known today as Bangladesh was born. Parts of this book will not please some large groups, depending on which narrative they adhere to. But we all know that a 10-year-old boy can be as frightfully honest as he wants to be on sharing his observations. Dr. Azimuddin has not written this book from the perspective of any one country. His lens throughout its pages is overtly human and in parts really absorbing.
Ras H. Siddiqui is a South Asian writer and journalist based in Sacramento.
“All conditioned things are impermanent – when one sees this with wisdom, one turns away from suffering.”
In times of chaos and tribulation, it seems wise to refer to the teachings of those who sought to understand suffering. Impermanence is the word that comes to mind, yet humanity finds comfort in permanence.
At the August 14th Ethnic Media Services briefing on the science behind COVID-19, doctors on the frontlines reaffirmed the motif I had been seeing – a contradictory society seeks change, yet is resistant to it.
This moment of truth in American history requires quick and consistent change. I wonder, can we rise up to the challenge?
Dr. Ashish Jha, Professor of Global Health at the Harvard T.H. Chan School of Public Health and the Director of the Harvard Global Health Institute remarked “America may have the worst response of any country in the world, to this pandemic” and added that we were in the same position, if not worse condition than Brazil, Russia, and Turkey. Further, he stresses that success with outbreak control has nothing to do with imposing government structures, the culture of the country, or the wealth of a nation.
“It’s tempting to look for explanations for why other countries are doing better”, cautions Dr. Jha. He logically builds to the conclusion that where we have failed is in deploying ONE action effectively across all states. That is all that is required. With one-third of the U.S. population on the brink of succumbing to the pandemic, one third already fully at risk, and one-third managing to keep the pandemic at bay, mismatched messaging is wreaking havoc. Without a coordinated response from strong federal leadership, the COVID death numbers will not plateau.
The onus of information dissemination and access to resources lies heavily on those in positions of power but behavioral change can come from the top-down and the bottom-up.
Impermanence. The ability to adopt thought that lasts for an undetermined period of time.
No one wants to be in lockdown. No one wants to wear a mask outside. No one wants to continuously get tested.
Just one of these, fully implemented and enforced, could be the key to end suffering.
Dr. Nirav Shah, Senior Scholar at Stanford University’s Clinical Excellence Research Center and an elected member of the National Academy of Medicine, informs his research from the positive COVID control he has seen in Asian countries where schools remain open. He notes, “Right now there is a false choice between lives and livelihood.” That choice drives contention and spreads misinformation.
What is needed to re-open safely?
Early warning systems, broad & efficient testing, effective quarantine/isolation, adequate treatment capacity, actionable data collection, and vaccines.
He brings forth antigen testing as the cheaper, faster method to detect COVID. Cost-effective and almost instantaneous results, I am feeling more optimistic as he continues to speak.
Early warning systems and actionable data collection rely on the immediate transfer of information to an online database to make it accessible. Temperature monitoring using a thermometer linked to the internet would increase the efficiency of detecting COVID hotspots and roll out timely mandates required to limit spread. Dr. Shah’s blend of technology and the pandemic is the obvious way to move forward. Daily reporting is the necessary next step.
So why haven’t we already been using this technology?
“We really need to start to think about a fundamentally different approach that protects privacy and lets public health [professionals] do their job”, Dr. Shah frustratedly shakes his head.
He is moving fast and hits a wall with effective quarantine/isolation and vaccines. The U.S. has expended no energy to strategize or provided resources for isolation and most vaccines are a year out still.
“We are not anywhere close to doing well”, ends Dr. Shah.
It seems Dr. Shah and Dr. Jha come to similar conclusions – the United States has the resources and the intelligence to rewrite the course we have taken with regards to the pandemic.
A grim message but I leave with positive outcomes. Testing is changing and so is data collection. Mitigation and prevention of COVID is plausible.
Can we adapt? Can we change? Can we make space for impermanence in our lives to end suffering?
Srishti Prabha is the Assistant Editor at India Currents and has worked in low income/affordable housing as an advocate for children, women, and people of color. She is passionate about diversifying spaces, preserving culture, and removing barriers to equity.
A decade ago, when I was a first-year medical student, I worried that modern medicine and pharmacology were based on animal products. I had been raised in a strictly vegetarian Jain household and had been taught to respect all living things. Thus seeing monkeys and dogs in cages used for experiments and dissections disturbed my belief system.
Fast forward to 2020. First the good news: physician training in American medical schools no longer requires animal dissection. But with the tragic coronavirus pandemic, my old concern about animals seems quite trivial. It seems that we should do anything and everything to save humans from suffering.
Because I practice sports medicine, I’m not with the frontline of clinicians tending to those with COVID-19. As such, I’ve been struggling to understand what Gandhiji would be doing if he were alive today. What should I be doing?
Here are a couple of quotes from Gandhiji that you might find of value. My own sense-making of Gandhian principles follow the quotes.
“There is a divine purpose behind every physical calamity.”
“I do not want my house to be walled in all sides, and my windows to be closed. Instead, I want cultures of all lands to be blown about my house as freely as possible. But I refuse to be blown off my feet.” (M. K. Gandhi)
Thank you for this opportunity to consider Gandhiji’s response to the coronavirus. I imagine that he would have taken a multi-disciplinary approach.
Young Mohandas Gandhi had been both a trained and untrained nurse. As a child, he had tended to his ill father by sitting at his bedside and perhaps massaging his father’s head and legs. As a young man returning to India at the end of the 19th century, he confronted the Bubonic Plague and served his brother-in-law; while the ayurvedic treatments could not save his sister’s husband, he learned something about himself: “my aptitude for nursing gradually developed into a passion.” He famously used this aptitude for the healing profession during the Boer War in South Africa as the founder of the Indian Ambulance Corps. And through the rest of his life, he nursed himself through many fasts and served those with serious illnesses. His patients ranged from his wife and other immediate family to members of his ashrams and lepers whose stigmatized condition he championed. I recall this medical biography to suggest that, as a man of science, Gandhiji would have surely been at the frontline today serving COVID-19 patients in the ER or the ICU.
But Gandhiji understood that science has its limits. He wrote, “To state the limitation of science is not to belittle it.” I imagine that he would have recognized this crisis as an opportunity to head off larger crises. To be sure, he would have used his political talent to support organizations like W.H.O. to mitigate the socio-economic risks of future pandemics. But I believe that Gandhiji’s greatness lies in his multi-generational vision for humanity. The earth – all of it, and all of its creatures – was a Gandhian home. Not only would Gandhiji have directly faced the respiratory challenges of the coronavirus, but he, also, would have used the present danger to open windows and minds to confront even greater ecological, social, and spiritual catastrophes like climate change, enduring inequality, and cruelty to animals.
Using his tools of satyagraha, swaraj, sarvodaya, and ahimsa, Gandhiji would have encouraged us to be in satyalogue with each other, in truthtalk, about what we’ve learned about ourselves and each other during this pandemic.
Regarding your question about what you should be doing, I suggest using all of the gifts bestowed upon you from your religious upbringing and your medical studies; kindly consider how you can use that knowledge for your private spiritual growth and our public universal uplift.
Dr. Rajesh C. Oza has published a compilation of similar Q&A pieces addressing dilemmas that we face in the 21st century. His book Satyalogue // Truthtalk is available on Amazon.
Tigers killed the prehistoric animals, man killed the tigers, and now microbes kill the man. This sequence has been a part of our planet. Our mortal enemy is historically shrinking in size but the destruction caused by IT is getting progressively more devastating because of our lifestyle. A sweeping annihilation of human beings was neither unprecedented nor entirely unexpected.
I remember the words of our Previous Dean at Emory Medical School, who joined us from the National Institute of Health some years ago, that our most threatening enemy is going to be microbes because they have been on this planet far earlier than us and we can never compete with their rate of reproduction.
The only advantage of their vicious visit this time is the lessons they are leaving behind. I do not want to enter the details of the devitalizing vital statistics of this pandemic. Everyone knows them beyond our choice. They will be talked and written about for decades to come.
Some Lessons To Be Learnt: The tragic toll of life that the pandemic has taken will not go entirely in vain if we draw some harsh but needful lessons therefrom.
Lesson 1 – Microbial World
We are surrounded by and inhabited by a microbial world. We have to recognize the good ones from the bad ones. Giving them names such as “evil”, “monsters”, etc. makes no difference to them. They are totally blind to gender, nationality, race, age, and any such outer epithets. We saw how this pandemic eclipsed many royal members, politicians, and physicians. They have no respect for Churches or other religious places either. Many churches were their starting places. They besiege and kill indiscriminately. To keep such Bacteria at bay with the help of scientists is our only available recourse.
Lesson 2 – Indian History and Mythology
I find our Indian History and Mythology to be very instructive in this regard because we have survived many diverse disasters and catastrophes. When we find our disassociation from society so unbearable, remember that Lord Buddha, Shankaracharya, Lord Swaminarayana, Shree Rama, Pandavas have had all their share in living a secluded life. If we are talking about deaths of human beings en masse, we have witnessed many grim tragedies of smallpox, cholera, plague that frequented our country. AIDS still lingers in our memory.
If we are talking about the sudden loss of wealth, India has seen it perhaps more than any other country. I specifically think of Rana Pratap who lost everything he had and was in an exile when his wealthy businessman Bhamasha offered all his wealth and rejuvenated his spirits. I mention this particular episode to remind us that we should follow such an example to support the rebuilding of our adopted country. I believe this is a splendid opportunity for us to pay back our dues to this country by helping restore our sagging economy.
Lesson 3 – Social Distancing
I stand corrected if I am wrong, but we needed to reaffirm our familial cohesiveness. Let us evaluate how we handled our continued togetherness while in seclusion. How cohesive, supportive, and mutually fulfilling were we as a family.
Let us create a scoreboard of self-assessment. Did the familiarity breed conflict or care? I was so happy to see children playing and couples freely walking on the street…People talked to each other while walking. I rarely saw this before. Maybe we need to restructure our life to promote togetherness.
Lesson 4 – PTSD
Watch out for PTSD Post Traumatic Stress Disorder. During and after this excruciating experience, our deeply felt exhaustion is bound to come on the surface.
Many of us would be compelled to recognize the loss of lives and jobs that we sustained. Wounds often bleed later after the trauma is inflicted. Depression, suicidal thoughts, addictive tendencies, a lingering fear may push us to a state of psychosis. We may need to nurse each other with kindness and compassion to promote our combined healing. No social distancing at that time!
Lesson 5 – Nature
Let us also have a critical look at ourselves. There is a precise and piquant Indian saying that when one points one finger at others, three fingers are automatically pointing at him. We have violated the fundamental Laws of Nature over the last several years. From the time of Rigveda on, we have stressed the five elements of Nature, which deserve to be respected as our basic constituents – water, wind, fire, earth, and sky. These should be maintained in harmony to retain our planetary homeostasis. We have thoughtlessly violated the respectful restraint that we should have exercised over them. This is not a superstition but an obvious proof of our violation of the Laws of Nature. There is a rising Global outcry to revert our course and trace our steps back from this grievous misdemeanor. We are OFFLINE now but need to be ONLINE to secure our future. Recognize our faults and repair them.
Our slumber has been long enough. Let the dawn break.
Bhagirath Majmudar, M.D. is an Emeritus Professor of Pathology and Gynecology-Obstetrics at Emory University, Atlanta, Georgia. Additionally, he is a poet, playwright, Sanskrit scholar, philosopher, and a priest who has conducted about 400 Weddings, mainly Interfaith.
Let’s talk about one of my favorite meals….a delicious plate of nothing. Prep time is zero minutes and physical and mental health benefits are unlimited. Nihaal Karnik, a third year medical student at Ross University School of Medicine, writes about his personal experience and reviews some of the latest research on a topic close to my heart, intermittent fasting (aka IF). Don’t miss some of my thoughts at the end on how I have used IF personally and clinically.
Overview I just finished working from 5 a.m. to 10 p.m. Yup, the ever glamorous lifestyle of a medical student. The last meal I ate consisted of 2-3 hard boiled eggs I scarfed down as I ran into the hospital; because, even at 5 a.m. I am considered late for a day of work. I’ve arrived home only to see an empty fridge and realize no restaurants are open. I need to eat. I’ve read every blog post, seen every interview, and even heard from doctors that I should be eating every 4-6 hours. I mean I cannot possibly miss this meal, right? Not necessarily. Skipping a meal or two may not be the worst thing for me. In fact, a growing body of evidence suggests that missing meals (fasting) may be to my benefit.
Intermittent Fasting (IF) represents a unique approach to nutrition. The approach intends to burn fat and produce muscle when combined with a proper exercise regimen. The name underscores basic principles of the program: fasting for intermittent periods of time.
Research suggests a wide number of benefits: potential protective benefits against various cancers, fat loss, muscle building, curbing hunger cravings, as well as increased insulin sensitivity (refer to other posts on diabetes and insulin resistance). This article aims to introduce readers to IF while providing some basic background on the principles of this model. Hopefully this read encourages our audience to research IF and explore the possibility of incorporating IF into one’s own daily routine.
The basic principle centers upon caloric restriction for extended stretches of time. The idea behind this is two fold:
1) It falls in line with ancestral diet principles and
2) Induces hormonal responses that promote fat burning, muscle building, and overall well being.
The majority of blog posts and literature surrounding IF introduce it to us in the context of paleo dieting. The average cave man did not always have a fridge full of food to satisfy his primal hunger. Instead he went through cycles of feast (eating) and famine (fasting).
Incorporating an approach that keeps the body in between a fasting and fed state is a natural extension of our ancestral diet. Excessive feasting serves as a major contributor to the variety of metabolic symptoms that plague society, today.
Furthermore, hormonal changes govern IF’s effectiveness. The key hormone discussed here is Growth Hormone, a natural hormone that regulates metabolism and is released by the body during the following phases: starvation, extreme/intense exercise, and rest. It is involved in muscle synthesis as well as lipolysis (fat breakdown). Proponents of IF outline that fasting states induce the release of extra growth hormone—thus helping to promote simultaneous fat burning and muscle growth.
Potential Benefits In addition to the obvious benefits of muscle mass development and fat burning IF has a number of potential benefits.
These may or may not include: 1. Satiety (feeling nice and full). This may seem counterintuitive but studies show even alternate day fasting (see more below) may promote satiety. 2. Diabetes. Promising research shows that IF may be an effective alternative to calorie restriction and weight loss to prevent diabetes. More research is pending and the authors themselves conclude more research is needed to make definitive conclusions. However preliminary reviews of IF as a way to combat diabetes are promising. 3. Help combat eating disorders by tackling restrictive eating and body image issues. 4. Cardioprotective (hearty healthy) benefits. New research suggests IF may even protect the heart and lead to weight loss.
Models of IF The basic idea of IF may be simple enough. However, for those who may seem intimidated by the challenge of fasting, don’t worry. A number of IF techniques exist to appeal to beginners and experienced fasters alike. Literature suggests most people may feel uneasy for the first 7-10 days. So, if you decide to partake in this new regimen do not be discouraged by mild irritability or uneasiness with the adjustment. Although the idea of fasting may be simple, readers often wonder what to eat during prescribed meal times. The theory of IF does not mean one can eat whatever they desire during his or her feast period.
Adherents still need to incorporate healthy eating habits (e.g. non-processed foods, loads of fresh veggies, and good hormone free/free range meat).
For instance, if I were to eat a meal or two during my feast window, it may consist of a huge spinach salad with grass-fed beef, avocado, and a healthy dressing. Or, I may decide to have some fresh fish with steamed veggies. The point is that the feast period does not mean one can instantly hit the closest drive thru window since there was a prolonged fasting period.
Below is a small list with brief descriptions of some of the more popular ways individuals may approach incorporating IF:
Alternate Day Fasting—One of the more popular methods. Proposed by Dr. Varady of the University of Illinois, the diet aims to offer patients a more inviting approach to fasting. Instead of incorporating a daily fast, the diet asks patients to fast every other day. Varady recommends 500 calories during one meal every other day. Her research, although young and ongoing, is quite promising. Patients who abided by this approach were a) more likely to continue this diet long term and b) actually restricted calorie intake on their regular/non-fasting days. Researchers theorize they restricted calories on non-fasting days since their bodies became adapted to the new approach.
12/12—A great approach for beginners. This simply suggests that patients have a 12 hour fasting window, and a 12 hour feasting window. A popular schedule may be to fast from 7pm to 7am.
18/6—A variation of the 12/12 model: here patients fast for 18 hours and feast for 6. One schedule maybe to eat only from 1 p.m.-7 p.m.
Occasionally missing a meal—Some people just listen to their bodies and skip a meal from time to time. Proponents of this model suggest not forcing a meal may help curb binge eating and be beneficial when periodically used.
Conclusions Intermittent fasting represents a new way to approach caloric restriction. Although research concerning the metabolic benefits of this approach is promising, larger studies are needed to support clinical claims. Those interested in the diet should definitely research more about the topic. Combining this approach with a proper diet may offer individuals a way to achieve new body and metabolic goals.
So, at 10 p.m. at night I have two simple choices. I can go to bed and enjoy the potential benefits of my fast. Or, try to get a quick meal given the annals of conventional wisdom. As I mentioned earlier, it may not be a bad thing to skip this particular meal. Enjoying the perks of integrated fasts may make me a bit stronger, leaner, and hopefully a wiser medical student…though I guess the literature is still pending on that last wish.
Dr. Ron’s Clinical Insights on Intermittent Fasting I am personally using and prescribing intermittent fasting for selected patients. However, many of my patients are coming in with significant micronutrient deficiencies and weight gain from under eating, overstressing and over exercising. Often these are women. I don’t initially recommend IF for these patients. I need to make sure these patients are well-nourished to replete these missing nutrients and we have to work on stress reduction and life balance which are top priorities. Eating more frequently may have to be initially implemented to replace key nutrients. Once we restore nutrient deficiencies and any hormonal and metabolic imbalances and patients start feeling better, they can then incorporate IF into their lifestyle plan. IF used in the right context can potentially increase lifespan and reduce inflammation. However, adding IF to a nutrient-deficient diet can make matters worse and I have seen inflammatory markers and body weight actually increase as a result.
For individuals who are eating a very high carbohydrate diet, adding IF may backfire since it can generate extreme hunger followed by compensatory binge eating. You need to first fix your eating habits, with a focus on adding healthy fats, proteins and more plants, which will act as a natural appetite suppressant. Once your body and metabolism are prepared, then IF can be used effectively. I have busy patients who generally skip breakfast already, thinking they are fasting, but then they overeat processed foods and excess carbohydrates later which worsens their weight and underlying health issues.
Finally, I highly recommend you fast with a purpose that goes beyond just weight loss and achieving ideal body composition. In most cultures fasting is a selfless act devoted to some higher spirit, rather than the somewhat egotistic pursuit of ideal body composition. Just reflect on the list of fasts undertaken by Mahatma Gandhi if you need inspiration to selflessly skip just a single meal. If the word “fasting” sounds too spartan, just call it “meal skipping.”
Try fasting for a departed relative, your favorite god, a specific life goal or higher purpose, etc. I personally have noticed that on IF days I can think more clearly, exercise longer and stronger, and meditate with greater focus. There are times I do use it for somewhat selfish purposes. For example, I use it strategically for important meetings and presentations as a cognitive performance enhancer. It beats caffeine or stimulants since its natural and you avoid the inevitable “crash” from stimulants. If I knew about it in my earlier life, I would have used it for school exams. Today’s students flood their systems with sugar and caffeine…just think sodas, frappuccinos and energy drinks, which are staple fuels for kids today.
Giving IF a higher purpose will make it more effortless, will allow us to practice selflessness which all of us can benefit from, and in the end, you will still enjoy the physical and mental benefits.
Ronesh Sinha, M.D. is a physician for the Palo Alto Medical Foundation who sees high risk South Asian patients, he blogs at southasianhealthsolution.org, and co-hosts a South Asian radio show on health.