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Zoonotic Infectious Diseases: Local Origins, Global consequences

Engage! – Discussions on active involvement in personal health and global wellness

On December 31, 2019, twenty-seven cases of pneumonia of unknown origin were reported in Wuhan, China. By the second week of January 2020, the first case outside China was reported in Thailand. On January 30, 2020, the WHO declared an international public health emergency. Since those events transpired none of us have escaped the effects of the waxing and waning of SARS-CoV-2 as it has raged around the world over the past 18 months. 

If there is a positive fallout from this event, it is the explosion of international scientific efforts to find a way to control this deadly virus. The first sequence of this coronavirus was publicly available in January 2020, and vaccines were created within the next six months, both achievements as epic as the urgency created by this unprecedented (at least in our lifetime) international crisis. Simultaneously, the origin of this virus is being investigated, and expanding upon the knowledge that bats are the natural host of previous coronaviruses that caused human epidemics, namely SARS-CoV and MERS-CoV, it appears that SARS-CoV-2 managed to jump to humans from bats. In order for the jump to human infectability to occur, mutations occurring in the virus genome create a viral surface protein that can bind specifically to a human cell surface protein; in the case of SARS-CoV-2, this could be a mutation that allows the viral Spike protein to bind the human cell surface ACE2 protein and cause infection. 

COVID-19 structure
COVID-19 structure

This process of zoonosis, involving the adaptation and transmission of infectious agents from a primary host that is either a mammal or a bird to humans, is an evident aspect of over a hundred infectious diseases known to afflict humans. The infectious agent involved could be bacteria, fungi, parasites, or viruses and in addition to known diseases, there is a continuous roster of emerging zoonotic diseases as these opportunistic microorganisms try to find new hosts to live and breed in. Transmission from animal to human may be through direct contact through potential scratches or bites, airborne through droplets for instance, through vectors such as mosquitoes, ticks, and lice, ingestion of contaminated food or water, and by contact with infected vegetation, soil, water, wild animals, etc. Transmission of pathogens across oceans and borders after they have adapted to humans can, unfortunately, become a reality with the ease of international travel, especially if they can achieve efficient human-to-human transmission and become highly infectious, as in the case with SARS-CoV-2. 

Commonly known extant zoonotic diseases include rabies, plague, chagas disease, brucellosis, anthrax, bovine tuberculosis, Japanese encephalitis, zika virus, ebola, and AIDS. All these, and many more, are of direct relevance to India and other tropical and sub-tropical countries including south-east Asia, Africa, South America, western Pacific islands, and parts of Australia where they can be a burden on the public health system and economy. In India, 13 zoonoses are associated with 2.4 billion cases of human disease, and 2.2 million deaths per year. The National Center for Disease Control in India coordinates efforts at early diagnosis and effective containment, and a specific focus is in the handling of animals and regulation of human-animal contact. Peri-urban areas have grown rapidly in India, and are a link between agricultural areas and densely populated sites. They present a risk as there is unregulated livestock-based food production in these areas to meet the increased demand for food products. 

In addition to these existing illnesses, it is estimated that 60-80% of emerging infectious diseases are zoonotic diseases. Change in land use is thought to be a major underlying cause of this especially in Southeast Asia and in tropical and developing countries, coupled with wildlife diversity. Depending on the use that the deforested land is co-opted for, be it monoculture forests, crops. poultry, livestock. housing, etc., different groups of zoonotic species came to the fore. For instance, strong associations of vector-borne diseases were found with monoculture plantations (for instance, rubber), and bacterial and viral diseases are among others associated with livestock farming. In India, which is one of the hot spots for emerging zoonotic diseases, potential reasons for the emerging disease include changing land use, dairy farming, rodent infestations, wild-animal trading, climate change, and improper farming practices. Coupled with these conditions there is a lack of awareness, poverty, and poor access to medical and diagnostics services. Endemics, epidemics, and emerging zoonotic diseases in Australia have been a constant presence between livestock, horses, and humans. These are mostly viral and vector-borne diseases, and a few examples are Nipah virus, Menengle virus, and JE virus. 

Examples of zoonotic diseases and their affected populations.
Examples of zoonotic diseases and their affected populations.

Triggered by the ongoing SARS-CoV-2 pandemic, the World Wildlife Fund has published a report on the zoonotic disease risk posed by wildlife markets in southeast Asia that are involved in wildlife trade and consumption. They urge governments to impose regulations on these activities and reduce demand for high-risk wildlife products. Other comprehensive and phased efforts to prevent and control known and new pathogens have been reported from Congo (monkeypox virus), Ethiopia (rabies), and Georgia (a new zoonotic virus). Of particular concern to India is the potential for it to become a hotspot for future variants of SARS-CoV-2, with global consequences. With its density of population, a priority is to exercise COVID19-related behaviors of masking, social distancing, and vaccination. A second priority is sequencing variants as they arise and following them epidemiologically with outbreaks of COVID19. 

In urban settings, most contact with animals is relegated to pets, household pests, and the consumption of meat and dairy products. Obviously, food needs to be handled with care and cooked well, and pests ranging from rats to mosquitoes and flies need to be eradicated. Although specific viruses can infect dogs and cats, there is currently no evidence that these transmit to humans and cause disease. However, there is some evidence that pets can test positive for SARS-CoV-2, with infection transferring from infected humans. Import and close continuous contact with exotic and wild animals as pets is not recommended. 

L. Iyengar has lived and worked in India and the USA. A scientist by training, she enjoys experiencing diverse cultures and ideas, and writing. Her short story will be included in an anthology showcasing a group of international women writers, to be published in 2021 by The Nasiona. She can be found on Twitter at @l_iyengar and www.liyengar.com.

 

Gopika practicing Kalaripayattu.

Kalaripayattu: Indian Martial Arts Harnessing Female Power

Shakthi! Power! Feminine Energy!

In today’s world women have broken the frontiers of space, air, and water. There is no mountain that they have not climbed, no desert they have not explored. Women have become world leaders; they hold important political and corporate posts. Take our very own Kamala Harris, a woman of Indian descent from California, who has broken the male legacy in our political system in the United States!

Is this just a modern phenomenon? Or has the world failed to see the power of the woman in legends, history, and mythology the world over? 

Bringing this power to the fore in every woman is Shakthi — a special self-defense program for women that focuses not just on the training of the body, but the mind as well. It helps women find that inherent deep spiritual power that made women like Kaplana Chawla, Kamala Harris, Indira Gandhi, or Mother Teresa had in order make a mark in the world.

Offered by Dr. S Mahesh Gurukkal of the Agasthyam Kalari, Shakthi is a program that is not geographically limited. It is within the reach of every woman who wants to discover her inner strength. Not just for self-defense, but to transcend that inner barrier to rediscover herself. Dr. S Mahesh designed this program to capture the fearless feminine essence of women that has been celebrated in folklore and ancient texts. This half-day workshop with hands-on Kalari-based techniques focuses on the mind as well as the body. Confidence and presence of mind are just as important as the lightning-fast reflexes that the trainees are equipped with. 

There is one such story of Ahalya, a demure 18-year-old, who enrolled in Dr. Mahesh’s class three years ago. It was a balmy summer evening when she first set foot in the Agasthyam Kalari in Thiruvananthapuram. Demure Ahalya stood silently staring at the floor. Her father was talking to Dr. S Mahesh about admitting her along with her two younger brothers to regular Kalaripayattu training. She did not think it was going to work.

Today, Ahalya has transformed into a vivacious, vibrant 21-year-old who is the National Champion in the senior category of Kalaripayattu Chuvadu. She receives a monthly scholarship from the government of India and is treated at par with the national champions in all other sports. The dynamic transformation that Kalaripayattu training has brought about has incited her interest in training those all over the world and of all ages via online classes offered by Agasthyam Kalari.

Coming from a very prestigious and traditional lineage of Kalaripayattu maters, Dr. S Mahesh carries a deep spiritual connection to this ancient martial art created by Sage Agastya. His grandfather Krishnan was an extraordinary exponent of the ‘choondani viral marma vidya’, a technique using yogic powers through pointing a finger at opponents that immobilized them. His father is the legendary Kalari master and Sidha expert Sanal Kumar Gurukkal. 

“Fear and alertness cannot coexist actually,” admits Suchitra, a Kung Fu blackbelt in her student days who has recently taken up Kalaripayattu. “Fear shrinks our sense of space. It leads to freezing when there is an actual danger. Martial arts help the mind become fearless. Kalaripayattu is considered the mother of martial arts. Such training must be included in schooling.”

Suchitra practicing Kalaripayattu.
Suchitra practicing Kalaripayattu.

“Thanks to many popular movies, everyone knows about Unniyarcha, the legendary female warrior of Kerala,” Dr. Mahesh Gurukkal smiles, “But the fact is that boys and girls were trained together in Kalaris centuries ago. The gender gap appeared only after the British crackdown on Kalaris and the subsequent revival in the 20th century. But we are quickly gaining lost ground. It is important not just from a physical preparedness point of view, Kalaripayattu transforms the mind to deal effectively and calmly with today’s working woman’s professional stress and work-family imbalance.”

Other than Shakthi, Agasthyam Kalari offers Nalludal, a unique Kalari-based health and fitness program for all age groups; Prana – a breathing-based energizing and rejuvenating program; Akam – Agasthyam kriya for awakening the mind; and Nithyam – a daily program based on authentic Kalaripayattu techniques. 

Sreedevi Pillai had worked in the IT industry around the world for over two decades before taking a break. “Though I had continued by Bharatanatyam training, I wasn’t sure I could start Kalaripayattu training in my 40s,” she says. “So I was surprised at the meticulously individual attention with which the Aashans (trainers) eased us into the different steps and routines in the Nalludal program. Kalari has helped me with my dance as well.”

Sreedevi as part of the Nalludal program.
Sreedevi as part of the Nalludal program.

The online classes are conducted in small batches so that individual attention is not compromised. There are participants from all over the world. The rising popularity of Kalaripayattu, along with the opportunity to start at any age, has led to the opening of Agasthyam offline city centers in different locations.

A lasting testimony to the power of the Shakthi program is Ahalya. In the Kalaripayattu performances that Agasthyam Kalari regularly gives at different venues, Ahalya fearlessly confronts three male opponents armed with swords with her bare hands. Though the action is choreographed, the danger is every bit real. As she brings down the opponents one by one into a pile and takes the victor stance in the end, there is a glimpse of a great future of fearless women being born in Kalaris across the world.

Shakthi! Onward! 

Dr. Arun Surendran is the Director of Agasthyam International Kalari. He holds a Ph.D. in Aerospace Engineering from the Texas A&M University and is the Principal of Trinity College of Engineering Trivandrum. He is also the founder of Adcy.io Cybersecurity Solutions. He was awarded the prestigious Eppright Outstanding International Student Award, the highest honor given by the Texas A&M University to any international student.

 

To Mask Or Not to Mask: With the Delta Variant, Why is That Still a Question?

COVID-19 manifested itself in a new variant this year: The Delta Variant. The beginning of the variant was found in India, where the original strain has already shaken a lot of people and caused immense damage. According to the CDC, the Delta variant accounts for 51.7% of cases in the US. In India, 86% of vaccinated people were infected by the Delta Variant. This variant is a lot more severe and is spreading globally, now warning the third wave in most countries. The endlessness of the virus has brought about the recurring debate of whether or not to mask up. 

Even in the Bay Area, there has been a surge in cases. Officials in various counties have cautioned against the variant and urged people to wear masks. In June, the variant was responsible for 43% of the cases in California. The Bay Area is slowly becoming a hotspot since people have become lax in wearing masks in public spaces, giving way to the variant as it spreads increasingly. 

Some frequently asked questions

When should I wear them? How effective are they? Do I wear a mask if I’m vaccinated? 

Between those that flat out refuse to wear masks and those that wear masks in every setting, these are the string of questions that are most common. It doesn’t help that there are so many perspectives on what exactly is right to do. Do we trust the CDC guidelines blindly? Or should we take things as they come and weigh our best options out? 

When should I wear them? 

Masks should be worn when you are out of your house. Regardless of whether there are fewer people or more people. They offer a preventive measure and also keep the people around you safe. 

How effective are they? 

“The key thing is that studies show that masks help,” states epidemiologist and health economist Dr. Eric Feigl-Ding at an EMS Briefing on July 9th. Masks are efficient in protecting you and the people around you. Dr. Feigl-Ding furthered that double masking is a lot more effective.

According to an article by JAMA Health Forum, when one person double-masks and the other wears a single, 85.4% of cough particles are blocked, and when both double-mask, their exposure is blocked by more than 95%. The article further stated that after the CDC mask mandate had taken effect, COVID cases and hospitalization due to the strain had significantly decreased (by 5.5%). 

“Masking reduces 99-100 % of the infection but with the rest, it’s between 0 and 1%,” informs Dr. Ben Neuman.

Do I wear a mask if I’m vaccinated? 

Yes. There are no two ways about this. While the vaccine acts as a preventive measure against COVID-19, there have since been variants of the virus that are a lot more severe. The latest variant Delta is four times more severe than the original strain. The delta variant is also two times more transmissible than its older counterparts. This makes the vaccine evasive. Meaning vaccinated people CAN transmit the variant.

In Singapore, there were about two dozen cases where the virus carried from vaccinated people to other vaccinated people, ultimately affecting unvaccinated people.

Even in the States, the Delta variant is spreading. We have recently had a surge in cases as the mask mandate was lifted by the CDC. In the past three weeks, cases have been rising steadily. It takes five weeks to determine the results for the variant once tested.

With the variant, only a few changes and effects from the original strain are known. It has been documented that there are mutations that give the Delta variant unknown advantages on the lung’s immune system. 

Masking is not an option

Virologist and Professor at Texas A&M Dr. Ben Neuman talked about his experience as the only masker: “I’m in Texas and the only one that routinely wears a mask. Texas is one of the two clusters with the lowest vaccination rates.” 

The number of people vaccinated in the US has not even reached half the population yet. “There are pockets with less than 40% people vaccinated.” Dr. Jose Perez , Chief Medical Officer of South Central Family Health Center, advocates, “Wear a mask. Especially with people around. Anywhere.”

If this isn’t convincing you to mask up, there is more.

Hand sanitizers and glass shields offer about 0-1% aid against the vaccine if you don’t wear masks.

“People keep doing the things that don’t make a difference rather than the ones that do,” said Dr.Ben Neuman with regards to glass shields and hand sanitizers. As the virus is airborne, plexiglass does just about nothing to prevent it from spreading. Rather than offering shields, it is important to ventilate or incorporate better systems of ventilation to clean the air. But, as there isn’t any immediate action being taken for proper ventilation or disinfection, masking (double masking) works as a shield against the airborne strain. 

A google search bar recommended question on the masking:

“Do I wear my mask blue side out?”

Yes. Please wear your masks that are disposable blue side out. 

Swati Ramaswamy is a recent graduate from UC Davis and an aspiring creative writer.

 

Tending to Your Tulsi Can Provide Psychological Relief

Growing up in a South Kolkata apartment overlooking a busy street, Amartya would often see his mother, steal herself away from the daily household chores and spend a few moments in their tiny balcony, overgrown with an odd number of plants that she grew. From Tulsi (where she would unwaveringly light a lamp, come wind or hail), a crimson hibiscus, some speckled crotons, and the usual seasonal marigolds or rustic nameless carnations, Amartya’s mom had a special place in her heart, and her house for innumerable fauna — caressing their leaves, talking to them as they were her own children, coaxing them to bloom, against all odds.

Hibiscus flower

Even as a child, Amartya knew that those few moments his mom spent with her plants, as the evening sun settled in behind the neighbor’s house, was something special. Moments that gave her mom respite from daily conundrums and energized her to face all odds while raising a family of three children. Looking back, Amartya would be insanely jealous at his mom spending her time with her plants, but somewhere understood that it was something his mother needed. And as years went by, her love for plants grew on him like the tendrils of the creepers that his mom kept, tangled their way up the veranda grills.

Thus, when Amartya decided to shift to the US, triggered by memories of his mother, he quietly packed in saplings of his childhood plants into the oversized suitcase that carried his meager belongings as he ventured out to start afresh. And thankfully, for him, hibiscus, tulsi, and speckled crotons helped create an oasis of sorts, in his rented apartment in East Village.

In March 2020, the COVID-19 pandemic struck. Amartya, a confirmed bachelor, was confined within the walls of his apartment along with the foliage, comprising of a few other South Asian varieties of plants he had amassed over the last 5 years. And truth be told, he admits that they provided him with a respite from all the turbulent news he heard outside. Much like his mom, years ago, Amartya says he quickly steals away some time from his daily work and house schedule to tend to his plants, talk to them, and disappear from the harsh reality of present times.

In fact, with physical distancing measures to contain COVID-19 having included closing beaches, playgrounds, and parks, adding to the challenges to our mental health, experts, too, opine that having a slice of nature at home does support human well-being.

For those who are lucky enough to have a backyard, a 2017 study, presented in Preventive Medicine Reports suggests that gardening can offer benefits such as reductions in stress, anxiety, and depression apart from improving physical fitness. 

However, if one stays in an apartment, indoor gardening too has its own benefits. A volunteer, who participated in a study, published in Urban Ecosystems that highlighted the importance of nature in urban living said that having a small vegetable garden and flowers in pots makes him happy — a sentiment Amartya echoes, saying that seeing things grow in the city, even as everything around him is in disharmony is a beautiful and calming experience. 

Scientists find that tending to one’s garden helps suppress the sympathetic nervous system activity and diastolic blood pressure and promotes comfortable, soothed, and natural emotions.

Indoor microgreen garden

Experts have often hinted at the importance of nature in one’s mental and physical well-being, but it is only now that it holds even more truth as active interaction with indoor plants can reduce physiological and psychological stress compared with mental work.

While most people think houseplants are just a way to beautify an indoor space, having a few plants scattered around the home can also provide one with emotional wellbeing during the pandemic. Amartya, on his part, believes that apart from the scientific jargon associated with indoor plants, looking at those plants, not only evoke a sense of nostalgia, but watering, pruning, and caring for the vegetation helped him maintain his sanity even as everything familiar around him, suddenly dissipated into the unknown.

Umang Sharma is a media professional, avid reader, and film buff. His interests lie in making the world a better place through the power of the written word.

 

The Microbe Connection: Disease, Health, & Ayurveda

Engage! – Discussions on active involvement in personal health and global wellness

Part 1 of this article was published in India Currents in May. It highlighted the establishment and development of the human microbiome through infancy into adulthood and described the role that the environment plays in this. In this article, we explore the many facets of health that the microbiome is involved in. 

Sometimes termed the second genome, the idea that microbes are involved in the regulation of our physical health including digestion, cholesterol, and chronic disease may be more intuitive than the possibility that they also play a role in modulating mood, stress response, and psychiatric conditions. While these studies include those performed in the laboratory as well as the field, they serve the practical goals of initially understanding the mechanisms by which microbes interact with human physiology, and secondly the conversion of this knowledge into human therapeutics. 

Microbiome effects on gastrointestinal (GI) health are not surprising. As an example, scientists sequenced the microbiome (including bacteria-bacteriome, viruses- virome, and antibiotic-resistant bacteria- resistome) of urban and rural/tribal populations around Nagpur, India, and found distinct associations of bacterial species with individuals suffering from diarrhea and those that were normal. This included Clostridium difficile (C. diff) which can cause symptoms ranging from diarrhea to inflammation of the colon. Diarrhea was associated with a move to urban locales and with environmental changes such as antibiotic use. 

Your gut biome.
Your gut biome.

Bacterial species associated with good GI health seemed to cross cultures, and the same species were also reported in studies conducted in Africa, the Americas, and Mongolia, providing impetus to use this knowledge to promote GI health and function. 

As mentioned in Part 1, chronic diseases such as diabetes and obesity are associated with urban microbiome profiles. While most of these studies analyze fecal samples to study disease demographics, others have focused on vaginal health. Just as in the gut, there is an optimal microbiome in the skin at this site that serves a protective function. Dysbiosis (disruption of microbial communities) causes susceptibility to other infections including sexually transmitted diseases and AIDS. 

These direct effects of the microbiome arise from the manipulation of resident populations and out-competition by unwanted organisms. Longer range effects are also seen on distant organs resulting in physiological disturbances that contribute to disease. 

Fascinating studies of the soluble molecules and alkaloids that the microbes secrete are ongoing, along with their effects on local and distant cells. The so-called gut-brain axis is a prime example of this. The stress response is primal and important for survival and is mediated by a well-studied pathway involving the hypothalamus-pituitary-adrenal gland. It is also thought to be involved in stress-related diseases such as anxiety and depression. Several studies, including a pioneering Japanese study, have shown that microbiota in the gut influence this pathway in a way that affects behavior, possibly at the very basic level of regulating neurotransmitters in the brain. The link between autism and GI problems is well known, and other studies have suggested that gut microbiota may be involved in Parkinson’s disease, and even in the regulation of mood and personality. 

Cancer also seems to have several potential dependencies on microbes. The best known is cervical cancer which is commonly caused by human papillomavirus infection. More recently a bacterial species have been found associated with colorectal cancer, and may be implicated in the growth and spread of these tumors, and other gut bacteria create conditions in the large intestine that are more conducive to cancer growth. About 700 species occupy the oral cavity, and some of them are thought to influence head and neck cancers, and also other GI tumors. Microbiota are known to alter the immune response to a tumor, and on the flip side, dysbiosis of the oral microbiome is seen in several GI cancers, and this could become a tool for early detection of these cancers.

The microbiome is known to change with age, and this aging microbiome could contribute to cardiac insufficiencies seen with age. The maintenance of biodiversity along with regular exercise is thought to slow the aging process. Other studies suggest that microbes influence basic physiological processes such as inflammation and immune reactions that underlie such manifestations as bone loss and allergies. In fact, these broader effects may be orchestrated by the microbiome that colonizes a human at infancy, and which plays a role in instructing the body on how to recognize ‘self’ from ‘non-self’ and react to the environment. 

As one can imagine dissecting these complex interactions is very nuanced, and is a work in progress. Thus, therapeutic interventions that are currently being explored may seem unsophisticated, although they have provided relief. Fecal transplants are being explored with some success for the treatment of recurrent C. diff infections, and more experimentally for inflammatory bowel disease and immune dysregulations. The idea behind this approach is that the re-introduction of microbial diversity, when this has been compromised, restores a healthy microbiome. Here encapsulated fecal material from healthy individuals is administered orally to patients, or transplanted directly into the colon. More recently, fecal transplants have been shown to improve the efficacy of cancer immunotherapy treatments. Although donors are extensively investigated for their own microbial flora among other medical tests, and recipients closely monitored, these therapies are considered experimental and are administered when tested treatments have not produced results. 

Microscopic view of a virus.
Microscopic view of a virus.

Information about the balanced existence of human microbiota including bacteria, viruses, protozoans, bacteriophages (viruses that attack bacteria), and even parasites continue to emerge. While we are still learning the complexities of this dynamic organ, we can proactively work towards maintaining it, in the same way that we try and maintain good heart health. Regulation of diet and the conscious incorporation of pre- and probiotic foods is an easy start. Prebiotics are comprised of indigestible fiber and are present in fruits, vegetables, and whole-grain, and are important for the growth and maintenance of the gut microbiome. Probiotics are fermented foods that contain beneficial microorganisms and include yogurt, kimchi, and tempeh. The incorporation of spices such as turmeric, black pepper, and ginger have the ability to modulate gut communities and gut health. Ayurveda follows a holistic approach to optimal health, and maintenance of a healthy microbiome is an integral part of this. Understanding its relevance in terms of the doshas (vata, pitha and kapha) is one approach, and so is its modulation by diet, sleep, exercise, and regular purging of the bowels. 

A recent mega-study conducted across 60 cities in 6 continents over 3 years studied the ‘urban microbiome’ and identified thousands of as yet unidentified species of bacteria and viruses in mass-transit systems. While there may be several practical uses for such an atlas, it gives credence to the concept of madi that was, and probably still is, followed in orthodox South Indian families, where extreme importance is given to cleanliness in terms of both personal hygiene and the home, combined with strict observance of dietary regulations. At a personal level, the rigorous COVID-related cleanliness regimens that I am currently following are very much in line with this!

Good and bad microbes exist, and we need to nurture the ones that are necessary and be cautious of the rest. Our co-evolution with these ancient organisms has a design, and while their empirical value was recognized by ancient systems of medicine including Ayurveda, we are still unraveling the details of their complexities. 

L.Iyengar has lived and worked in India and the USA. A scientist by training, she enjoys experiencing diverse cultures and ideas, and writing. Her short story will be included in an anthology showcasing a group of international women writers, to be published in 2021 by The Nasiona. She can be found on Twitter at @l_iyengar. www.liyengar.com

 

 

Fading leaves signify Dementia (Image by Tolga Ulkan)

Amma Has a Dementia Diagnosis. What Now?

Sukham Blog – A monthly column focused on South Asian health and wellbeing.

Last month, we talked about what we should do if we were concerned about Amma’s recurring memory lapses. In this article, we explore options and describe the steps to be followed if Amma receives the diagnosis we were dreading – tests that confirm she is in the early stages of dementia. Her symptoms are consistent with an underlying progressive and irreversible illness that is causing damage to the complex system that controls cognitive function: the neurons or nerve cells in her brain, and the networks they form with other neurons. These symptoms could be caused by any one of a half-dozen diseases; Alzheimer’s is the most common one to affect older people. Parkinson’s disease also often leads to symptoms of dementia.

It is never easy to receive such a diagnosis. The news is earth-shattering, not only for the patient but also for the entire family circle. A vibrant individual will slowly but surely lose his or her identity, mind, and sense of self, and slowly forget all lived events; forget everything and everybody – as though that life never happened. Like a frame from which a precious photograph slowly fades until it is gone. The patient lives unaware in this wicked prison, while those around her agonize helplessly. These cruel diseases strike not just the patient, but the entire family. Perhaps we’ll find a cure one day. Perhaps we’ll find more ways to delay disease progression and reduce the symptoms, enabling a longer, meaningful life.  Science and medicine have made progress in the past couple of decades, and there is hope of more to come in the future. In the meantime, what is the best we can do to cope?

Strategies to help with the dementia diagnosis.
Strategies to help with the dementia diagnosis.

Amma’s diagnosis calls for a mobilization of the immediate family to participate in a strategy session with her. You should look at Amma’s circle to decide if any of her close and intimate friends should be included. The objective of this effort should be to develop short and long-term plans that address several different issues, including: dealing with the emotional impact of the diagnosis on Amma and the rest of her circle, understanding the diagnosis and treatments available, making financial, legal, and personal plans, addressing safety and living arrangements, understanding all available support, and developing a comprehensive care plan that puts Amma at the center, and considers the impact on her family and very close friends.

Some excellent tips provided by the National Institute of Health and the Alzheimer’s Association serve as a guide and starting point for this strategy session. While the main focus is the newly diagnosed patient, much of this applies to his or her circle as well. I’ll describe in brief what’s available to Amma in these two resources. It is very important for all involved to be open and honest with Amma, and with each other about what lies ahead; to share and understand one another’s perspective.

When one hears of the diagnosis, the gamut of emotions covers a range that includes denial, anger, resentment, depression, fear, loss, grief, and a sense of isolation.  These emotions will be with you for a while, and you’ll need to find healthy ways to deal with them. The Alzheimer’s Association provides many excellent suggestions. Know that you are not alone; that there is a large community out there living and coping with dementia and its impact, and you can draw on them for learning and support. Talk to the doctors to learn more about the disease and its likely progression and the available treatments. Find out if any clinical trials might benefit you. While a cure is still not in our grasp, the medical profession is learning more and more about the disease and how to handle it.

You will have to learn to live with this disease, and an important step is to share the diagnosis with those who matter in your life. Continued interaction with them is an essential part of your life, and knowing about your diagnosis and normalizing it is the healthiest way to maintain and grow your relationships with them. Be prepared for varying and unexpected reactions from others. Take your time doing this; the sharing will raise new emotions. Remember that there is no more stigma associated with dementia than with a diagnosis of heart disease or cancer. Know that this is not your fault! As the disease progresses, your abilities will change. Accordingly, you will need to prepare yourself for role changes, for gradually becoming more dependent on others.  This reality can be very difficult for many; however, it is the new reality.  Openness, honesty, and trust on all sides are essential.  

Develop a detailed plan for your future that covers legal, financial, living, and end-of-life decisions. Make sure that those legal and financial affairs are in order, and prepare an updated Advance Health Care Directive as soon as possible. Get a good understanding of the resources that may be available to you. Take a deep look at your living arrangements. You live alone right now. Do you need to plan for a different arrangement, either now or sometime later? 

Safety and the ability to take care of yourself should be prime considerations. Prepare to give up your independence, and accept that it is okay to get help from others. Make plans for a transition to living arrangements that best suit you and your family, one that will provide the support and care that you need. Proactively build your own care team that could include family, friends, neighbors, and medical professionals. Avoid isolation and stay socially connected. Learn about all the support services in the area where you live. Get educated on all the treatments and clinical trials that may be available for your particular condition. Understand what drugs are available to delay cognitive decline, and ease any symptoms that you have. Find out if any alternative treatments or medications are available.

Another source of support to consider is Palliative Care. This medical subspecialty is available in most large hospitals and medical clinics. A multi-disciplinary palliative-care team works alongside the medical care team to help the patient and family address their psychosocial, spiritual, and medical needs. They can help improve the overall quality of life, manage symptoms like agitation, poor or altered sleep, pain, and distress, advise families on what to expect over time, and provide guidance for decision making.

Amma, you have a life-changing diagnosis, but with a detailed action plan ready, with a good support system and a self-care plan in place, you can live well and look forward to a healthy life in which you focus your energy on what matters most to you! 

Mukund Acharya is a regular columnist for India Currents. He is also President and a co-founder of Sukham, 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 sukhaminfo@gmail.com

With sincere thanks to the Alzheimer’s Association and Tolga Ulkan at Unsplash for the use of their images.

 

The Intersection of Parenting and Mental Health During a Pandemic

When Shruti got the chance to relocate to the U.S. at the end of 2019, little did she know that her life-changing decision would be one of the hardest she ever made. Cradling a two-year-old and a teenage boy in tow, the recently-divorced IT professional shifted to Silicon Valley with the hopes of starting afresh in January of 2020. A few months down the line, everything came crashing down.

When the lockdown happened in the US, after the country faced devastation with the COVID-19 pandemic sweeping across states, Shruti had barely settled down. She had to get her elder son into a school and got a friend to help take care of her younger one as she geared up for office. Things did not go according to plan and suddenly Shruti found herself stuck at home with a teenager who had no friends in the new country and a youngster who needed constant attention as she tried to reshuffle her home and work-from-home environment. She was not the only one.

For 32-year-old single-mother Neha (name changed on request), life changed drastically when in March 2020 the COVID-19 pandemic swept across the world. Her younger son, Viraj, was 15 at the time and was studying in the 10th grade. Starting March 16, schools in Maryland were closed and the world descended into uncertainty. Her son was stuck at home, cut off from social life. The sight was uncanny and like us, everyone was unaware when the normalcy would return.

For Neha, seeing her son Viraj at home was especially difficult. Prior to the pandemic, Viraj used to meet his friends, played outdoor sports, and preferred engaging in co-curricular activities. Many like Viraj were forced to be in isolation indefinitely. Thankfully, Viraj had friends in the neighborhood, so despite having inhibitions, Lucia allowed him to play basketball outside with a few other youngsters from around her house.

There are thousands like Neha across the U.S. for whom the pandemic brought about fresh challenges. It has been particularly strenuous for single parents trying to work and care for their youngsters. Everyone has been more anxious and worried during the pandemic. Younger children may not have the words to describe their feelings but are more likely to act out their stress, anxiety, or fear through their behavior. This in turn can upset parents, particularly if they are already stressed.

A study published in the Canadian Journal of Psychiatry finds that lone fathers and lone mothers have higher rates of mood disorders and SUDS (Subjective Unit of Distress Scale) than their married counterparts, which is indicative of the disadvantages of this sort of a family structure that might have negative consequences for all parents.

Let’s face it, the ever-shifting demands of parenting in a pandemic are leading to stress, anxiety, and depression, not to mention economic hardship for those forced to leave their jobs to care for their children.

According to the American Psychological Association, home in the age of COVID-19 has become the office, the classroom, and even the gym. Parents are struggling to not only keep their children occupied, but also to oversee their education as they continue to do their daily chores, finish office work and take care of other necessities in their family life. Daycares have shut down amidst the pandemic and parents or a single parent has to simultaneously take care of their youngsters while they are online fulfilling their professional obligations. 

Shruti, has since then, flown back to India with her children, thanks to one of the many government-sponsored flights bringing back ex-pats to their native countries. She looks back at those fear-riddled stressful months when she and her children were stranded within four walls, she notes that, while it is normal to feel fearful, anxious, or stressed given the current situation, there are ways one can de-escalate the mental-health issues of parenting amid the COVID-19 pandemic.

So what should parents do to ensure proper mental health for themselves and their children?

For starters, the APA suggests that parents should set boundaries within the home space since they tend to blur when work life and home occur at the same place. Setting specific boundaries that separate the work from the home environment helps the child and parent have a safe haven within the home. 

Experts also opine that while it is impossible for either parents or their wards to put in normal hours during such stressful times, one has to maintain a routine, even if it entails a child to stay up later than usual to finish a particular work. Routines enable families to cope with stress and be more resilient.

Finally, relaxing screen time will allow youngsters to stay connected with their social circle and ease parental stress. 

Hope these tips help you during this transitional time!

Umang Sharma is a media professional, avid reader, and film buff. His interests lie in making the world a better place through the power of the written word.

 

Dharmacracy in Mental Health

This article is part of the opinion column – Beyond Occident – where we explore a native perspective on the Indian diaspora.

A recent study by the US Centers for Disease Control and Prevention (CDC) showed that 20% of all teen hospitalizations in the US between January 1 and March 31, 2021, were due to psychiatric emergencies. In addition, a University of California San Francisco study found a “75% increase in children requiring immediate hospitalization for mental health needs” in 2020 over a year before. The study also found a “130% increase in the number of children requiring hospitalization for eating disorders” and a 66% increase in the number of suicidal adolescents (ages 10-17) in the emergency department.  

The Children’s Hospital Colorado declared a ‘State of Emergency’ for youth mental health.

 The last 18 months have been one of the toughest for kids in recent times, no matter how we look at it. However, we can also argue that most of the pain and suffering inflicted upon them during this period have resulted from politics and unscientific policies of school closing. Kids stuck at home; not able to go to school for the whole year; not able to play sports, participate in tournaments, plays, and musicals; not able to visit family and grandparents; not able to see faces hidden behind masks; not able to attend or host birthday and graduations parties —  they all have had a cumulative effect on children’s mental health and overall wellness. 

Add to this the news of socio-political strife; violence; lawlessness; non-stop pictures and videos of burning funeral pyres being played on our TV sets, newspapers, and social media feeds; scarcity of oxygen and other medical supplies for COVID patients, including our friends and family. These combined, present a commentary of a stark, bleak, and gloomy situation of the world we live in.  

How we explain what is going on around us depends on the way we look at the world. Most of our present-day ideas have been shaped by the Western worldview. This worldview is predominantly atomistic that uses binaries such as ‘either/or,’ ‘true/false,’’ ‘left/right,’ ‘for/against,’ ‘liberal/conservative. These antagonistic binaries are in constant conflict with each other. It is also a worldview of excluded middle. 

The ordering of the world, in this worldview, is anthropocentric. Human beings are considered the central entity of the universe where only human life has intrinsic value. In contrast, other entities are resources that may justifiably be exploited for the benefit of humankind. 

On the other hand, dharma is the universal law that connects the individual to the rest of the world in a quantum way — that is, it is the same righteous law that binds each element of the cosmos. The Mahabharata defines dharma in the following manner:

  • dharma is so-called because it sustains and upholds the people: hence whatever sustains is dharma.
  • dharma is propounded to secure the good of all living beings: hence, whatever fulfills that aim is dharma.
  • What comes from the love for all beings is dharma. This is the criterion to judge dharma from adharma.

dharma is the spirit of Indic culture. The very essence of a Dharmic life lies in maintaining the equilibrium of the opposites. The opposites, including good and evil, are seen as complementary. Neither can be denied or completely suppressed without running the risk of creating dissonance, both within individuals and in the world around them. This duality of opposites creates and maintains the equilibrium throughout cosmology.

dharma sees conflicts and dissonance as ‘burdening of the Earth,’ which is the disturbing of the equilibrium at multiple levels.  These conflicts are a product of one’s relationship with oneself (not all conflicts are with others) and other elements of the cosmos. Hence a solution must also arise from that relationship. For inner conflicts, one has to look within oneself. Blaming others doesn’t help. Beyond self, as the dissonance and chaos get louder and stronger, the earth gets even more burdened. When the burden gets to unbearable levels, an avatar takes place to unburden the earth finally. Everything starts again afresh. The Dharmic time is circular (kalachakra), not linear.

The concepts of dharma, karma and klesha form the understanding of the cause of all sufferings. The doctrine of karma is defined as the result of an individual’s intentional action through body, speech, or mind. One of the most potent assumptions of the doctrine of karma is that one is in complete control of his/her destiny. Therefore, whatever happens to an individual is a predictable outcome of his/her own choices over time. The theory of karma also states that life does not end at the death of the physical body, and the result of one’s action can be felt in the next lives to come. 

The ultimate goal of life, according to dharma, is Self-realization — the realization of one’s inner Self.

In the Dharmic tradition– Hinduism, Buddhism, and Jainism– meditation, yoga, and the interplay of philosophy and life occupy a vital place. Patanjali’s Yoga Sutra (2nd century BCE) explains the yogic techniques to overcome klesha (human misery) and achieve the desired union between self and Brahman, the Supreme Consciousness. The source of klesha is raga, the attachment to worldly desires, and dvesh, the repulsion we feel towards objects that give us unhappiness. The two, combined with avidya (ignorance), asmita (ego), and abhinivesh (attachment to life and fear of death), are the sources of all kleshas.

dharma has a lot to offer in every possible field and situation, including mental health. But, unfortunately, we tend to gloss over the basic Dharmic tenets and their profundity. However, these tenets take on new meanings when applied with conviction during extraordinary uncertainty and trouble. 

Avatans Kumar is a columnist, public speaker, and activist. He frequently writes on the topics of language & linguistics, culture, religion, Indic knowledge, and current affairs in several media outlets.

 

Quest of a Modern Day Yogi in America

Come walk with me

I’ve been revisiting the rich teachings and wisdom of my Vedic heritage as I traverse my golden years. Examining them through the lens of the world around me today, I realize the need to re-interpret Vanaprastha and Sannyasa for myself, for the present day in which I live. Back in those ‘golden-olden’ days, society looked after an individual entering Vanaprastha; he or she did not have to worry about the next meal or a roof overhead.  Today, so many of our fellow seniors cannot see beyond a meal for the day. How can they possibly contemplate transitioning from the obligations of a householder? How can they detach from society to enter introspection? How best can the more fortunate among us – those who have enjoyed a decent life, and are now reasonably secure in their circumstances – deal with the ‘emptiness’ of the transition from Grihasta?

Come and walk with me for a while on my quest to be a modern-day Yogi in today’s America, and I’ll tell you.

Historic path to self-realization

Patanjali’s Yoga Sutras is a collection of around two hundred statements, observations or truths that describe the science of Yoga in its entirety. The Yoga Sutras describe the Raja Yoga, or Ashtanga Yoga – the eight-step practice that enables individuals to attain self-control, discipline, internal clarity, peace and ultimately self-realization or Samadhi – the ecstatic union of the individual with the cosmos. Scholars believe these primary scriptures of Yoga were written around the 2nd century BCE. Through the intervening centuries, philosophers and learned sages have been pulling at the threads of Patanjali’s work, translating and explaining them for our consumption.  

Each stage or limb of Ashtanga Yoga builds naturally on those that precede it. The first four limbs are designed to help us gain control over our bodies and become aware of ourselves. When you or I talk about ‘practicing yoga,’ we are referring to Asana, the third limb which follows Yama and Niyama.  The postures we practice – often referred to as Hatha Yoga – help us maintain physical health and well-being.  In addition, they promote self-discipline, focus and concentration, and prepare us for meditation. Pranayama, which literally means life-force extension, is the fourth limb of Ashtanga Yoga, and consists of breath-control techniques to rejuvenate the body and extend life. It is either practiced on its own, or integrated into Hatha Yoga routines. 

The next three stages, Pratyahara, Dharana and Dhyana are preparation for the last, ultimate stage: Samadhi. They involve a conscious withdrawal from the outside world and an effort to transcend external stimuli to focus increasingly inward. This cultivation of detachment and an increased effort to concentrate and singularly focus inward, while leveraging the training in posture and breath control leads naturally to Dhyana: meditation or contemplation.

Meditation or Mindfulness?

In Eastern philosophy, cultures and tradition – whether it be the scientific path of Yoga or one of the more monastic forms of Buddhism, meditation is a practice that combines inward focus and concentration with controlled breathing, allowing individuals to follow their breath to an inner harmonious state. Harmony, peace, tranquility, and compassion both for self and others should follow.

The prevalence of meditation in other cultures and religions, including Judaism, Christianity, and Islam has traditionally been described by scholars as self-administered techniques for inner transformation. Attempts to link meditation and spirituality have created controversy. Western meditation typically involved the reading of religious texts, prayer, and contemplation.  Worldwide interest in Eastern forms of meditation and their adoption began in earnest around the middle of the 20th century as travel increased. The same period witnessed a rapid decline of religion, especially Christianity, in the US, Europe, and most of the Western world. This trend, coupled with a marked increase in stress and mental-health issues induced by the unrelenting pace of modern life and work began to drive people to seek other sources for comfort and healing; to the practice of meditation and the health benefits that accrue from it.  A growing body of scientific evidence verifies what Patanjali taught centuries ago: regular meditation improves physical and mental health; it reduces blood pressure, helps with digestive disorders, eases the symptoms of anxiety and depression, improves sleep, and promotes physical changes in the brain that promote better overall health.

We often hear the term mindfulness these days; some use it interchangeably with meditation. There are differences, however. Meditation is a practice, while mindfulness is a state or quality. 

Dr. John Kabat-Zinn, creator of the Mindfulness-Based Stress Reduction (MSBR) program defines mindfulness as “the awareness that arises through paying attention, on purpose, in the present moment, non-judgmentally.” 

Mindfulness is a cultivated behavior, the process of focusing one’s attention. We can derive a lot of value by making it part of our way of life. Mindfulness and being in the moment are key to building resilience and overcoming adversity and stress. The essence of mindfulness is embedded in the practices of Ashtanga Yoga. 

Whether you are on the Ashtanga path towards the ultimate goal of a Yogi, an agnostic, or a disbeliever; whether you practice this or that religion or are an atheist, whether you are on the modern-day treadmill seemingly getting nowhere, or attuned with Mother Nature with days filled with purpose, the regular practice of meditation is good for your body, your mind, and your soul. Regardless of what terminology you use – mindfulness or something else, the ability to focus your attention and be in the present moment with equanimity is worth developing.  Attributions to East or West and distinguishing between shades of meaning may be interesting philosophically or may make for a robust debate, but they do not change the individual outcome. Meditation, pranayama, and mindfulness transcend culture, religion, and national or political boundaries. They have intrinsic value. Pranayama and meditation should be part of all stages of our life journey. I’m trying to make them part of mine.

Heading towards Liberation

In Vedic culture, the path of Ashtanga Yoga weaves through the four Ashramas or stages of spiritual life.  Beginning with Brahmacharya or student life, the Ashramas set a living framework and define spiritual practices based on the duties and responsibilities required at each stage of life, as the individual progresses on a path towards ultimate self-realization or Samadhi.  Brahmacharya sets the foundation, provides learning about family life and community, teaches spiritual practice, and provides yogic training. The second stage of life is spent as a Grihastha or householder – raising and supporting a family, following one’s worldly interests, continuing to drink from the fountain of Jnana, and carrying out the teachings of Bhakti and Karma Yoga. Once these responsibilities are fulfilled, the individual begins to withdraw from the world into the transitional stage of Vanaprastha, counseling the family and community while becoming increasingly more detached, with decreasing attention to the world and surroundings. Attention instead turns inward in preparation for the final stage: Sannyasa or renunciation, working towards the attainment of Samadhi, and ultimately seeking Moksha or salvation.

Every religion and culture addresses Moksha –liberation from the state of being human to become one with the cosmos or some higher power – in its own terms, and with its own descriptions and definitions of both the pathway and the ultimate end state. The Bhagavad Gita describes three margas or pathways: Bhakti (devotion), Jnana (knowledge), and Karma (duty or service). You will find proponents and devoted followers of each approach. The descriptions, discussions, and discourse on each alternative, and the relative merits of one versus the other would fill a small library. 

While commenting on Adi Sankara’s renowned devotional hymn Bhaja Govindam, the elder statesman and writer C. Rajagopalachari stated “the way of devotion is not different from the way of knowledge or jnana. When intelligence matures and lodges securely in the mind, it becomes wisdom. When wisdom integrates with life and issues out in action, it becomes bhakti. Knowledge when it becomes fully mature is Bhakti. If it does not get transformed into Bhakti, such knowledge is useless tinsel. To believe that knowledge and devotion, jnana and bhakti are different from each other is ignorance.”

Intuitively, and from an objective viewpoint, one could argue – and I do – that ultimately all three paths overlap. I would leave the distinctions to philosophers and debaters.

Re-defining my path

This sets the stage for the central tenet I wish to present. Each of us is formed by our experiences. The older among us were born in India, growing up in an environment with traditional culture and roots, in society and familial environment that formed our values and guided our practices of daily living.  We now live – either in India or relocated in our adopted countries – in a modern world that has transformed significantly in the space of a generation. During this transformation, we’ve had to adapt to a new way of life.  We’ve changed in many ways and adjusted to different societal norms and thinking. The attitudes and practices of daily living have changed for most of us. I would argue that in either era – then or now, most people would not move all the way up the ladder of Ashtanga Yoga and attain a level of Yogic discipline and practice to be prepared and ready to renounce their way of life and enter Sannyasa in a quest for Samadhi. A few might, but not most.  To the rest of us today, I pose the question: can we adapt the guidance of our ancient Yoga Scriptures and build for ourselves the model of a modern-day Yogi?

I posit that we should embrace the conceptual basis of Vanaprastha and Sannyasa spiritually, and adapt them for our modern times. We should treat Vanaprastha not as a time for transition and withdrawal, but as a time for liberation and increased activism. During this stage of life, Bhakti Yoga provides enrichment, courage, and support as we sustain ourselves in the face of the realities of aging. Let’s leverage this support to actively pursue the path of Karma Yoga –selfless service to others – and work for the benefit of our communities, always dipping into the ocean of Jnana to learn how better to serve our fellow man. Continue to find strength and comfort in Bhakti Yoga.  By doing so, we will find our Sukham – joy and fulfillment.  As we continue our service, we will slowly but surely embed tiny fragments of ourselves in our fellow human beings, and find our own salvation through each of them. We will successfully make our transition to an ecstatic union with the cosmos.

Mukund Acharya is a regular columnist for India Currents.

AACI doctor with patient (Image from AACI's website)

AACI & Bank of America Partner to Support Health Care Access and COVID-19 Vaccination

AACI announced that it has been awarded a $20,000 grant from Bank of America to help bolster its critical healthcare and medical services related to a lagging COVID-19 vaccination rate among Santa Clara County’s hardest hit, low-income, immigrant communities. This funding comes on the heels of a Bank of America $10,000 sponsorship to assist with its Asian Americans and Pacific Islanders program development.

COVID-19 has disproportionately impacted the underserved individuals AACI serves, many of whom face significant health disparities and complex barriers to care. According to the California Dept of Public Health, vaccination supplies exceed demand in some of Santa Clara County’s poorer neighborhoods, but there are some positive signs. For instance, San Jose’s 95116 zip code where just 43 percent of its 43,000 residents were vaccinated in mid-April, saw that percentage jump to 57 percent three weeks later.

To keep the momentum going in its vicinities, AACI actively distributed flyers and other marketing materials in several languages, including Vietnamese, Chinese, Tagalog, Farsi, and Spanish as part of its push to eliminate obstacles to seeking aid and encourage vaccination for those who want it. Now, funds from the Bank of America grant will allow for coordination and outreach around additional vaccine community events, as well as provide access to safe transportation for AACI clients.

AACI also will allocate a portion of the grant toward its domestic violence shelter support and meal delivery for seniors, along with general operating financial assistance. Bank of America’s other recent contribution to AACI funded panel discussions geared at broadening the conversation around anti-Asian hate speech and hate crimes.

“Bank of America’s grant support gives AACI an extraordinary opportunity to maintain essential services to our marginalized and vulnerable ethnic community members,” said Sarita Kohli, AACI president, and CEO. “Our expanding partnership with Bank of America now allows us to concentrate on our most urgent needs while our day-to-day operations carry on without pause.”

“AACI’s multi-cultural, multi-lingual approach to its work in Silicon Valley addresses the daily challenges diverse populations face. This Bank of America grant supports AACI’s efforts to educate impacted populations about COVID-19 vaccinations and other critical resources,” said Raquel González, Bank of America Silicon Valley president. “AACI’s long-time presence in Silicon Valley is a testament the many individuals and families who rely on their important services and the impact they continue to make.”

In addition to its COVID-19 efforts and primary care services, AACI offers seniors to youth alike behavioral health counseling; HIV outreach, testing, and education; shelter and services for survivors of domestic violence and human trafficking; specialized services for refugees and survivors of torture; advocacy; and youth and senior wellness services.

About AACI 

Founded in 1973, AACI serves individuals and families with cultural humility, sensitivity, and respect, advocating for and serving the marginalized and ethnic communities in Santa Clara County.  AACI’s mission is to strengthen the resilience and hope of our diverse community members by improving their health and well-being. Our many provide care that goes beyond just health, but also provides people a sense of hope and new possibilities. Current programs include behavioral and primary health services, substance abuse prevention and treatment, a center for survivors of torture, shelter, and services for survivors of domestic violence and human trafficking, senior wellness, youth programs, and community advocacy.

 

Is Oxygen Costly or Is It a Global Crisis Overlooked?

Tell A Story – a column where riveting South Asian stories are presented like never before through unique video storytelling.

It is appalling to see such a colossal struggle for the air we breathe. If someone would have suggested ten years back that oxygen would soon become an essential medicine that is scarce and needs to be carried with you for emergency care, we would have brushed aside the idea as bizarre. Unfortunately, it’s a reality now faced by billions of people around the world. 

Covid-19 second wave has toppled the crux of the global healthcare system, especially in India. With over 200,000 new cases reported and over 3,000 deaths per day, the unforeseen repercussions have left the Indian population vulnerable.

The scenario is not just limited to India but over 20 countries across the globe, who are facing the same crisis. And the prime concern is the dire need for oxygen, which is vital for the recovery of Covid-19 patients. India requires nearly 16 million cubic meters of oxygen per day, meanwhile, the global oxygen unmet needs have tripled over the last four months from less than 9 million cubic meters a day to more than 28 million. The dramatic shift did not happen suddenly; lethal oxygen shortages had hit many parts of Brazil, Mexico, South Africa, Afghanistan early this year. 

Unknown to many, global health experts had raised a red flag much before the pandemic. Oxygen production, supply, and access were never prioritized and left long-neglected from the entire health system planning process. Even though oxygen plays an indispensable role in emergency treatments for pneumonia, accident trauma, childbirth, and many other medical procedures, hardly a few hospitals across the world are self-equipped to provide oxygen to a patient by his or her bedside. There is a dearth of oxygen storage capacities at hospitals with no proper pipe connectivity. 

Though oxygen constitutes 21 percent of the atmosphere and medical oxygen can be harvested directly from the air, the essential facilities like PSA plants are limited and the local governments didn’t pay any heed to develop this sector until the pandemic created an emergency –  leaving the destitute patients to hoard expensive options like oxygen cylinders and concentrators, especially when oxygen produced otherwise via plant is 10 times cheaper. 

The World Health Organization (WHO) was approached by various countries citing these requirements years before the pandemic even began, but unfortunately, no measures were taken. It has now launched a COVID-19 Oxygen Emergency Task Force to measure oxygen demand, secure supplies, and provide technical support. Estimates show to clamor for immediate funding of nearly US$90 million for 20 countries. It is believed that Covid-19 was just a trigger and the global oxygen crisis is here to stay.

Tell-A-Story brings to you an in-depth analysis of the global oxygen crisis – the emergency faced by 20 countries, how it all began, what needs to be done, and the global oxygen task force measures to contain the damage that, otherwise, could become an unimaginable catastrophe. 

Suchithra Pillai comes with over 15 years of experience in the field of journalism, exploring and writing about people, issues, and community stories for many leading media publications in India and the United States.

 

Nidhi Kirpal Jayadevan practicing Yoga.

My Yoga Toolkit To Ease Anxiety

Yoga has always afforded me a sort of mental vacation that helps recenter my focus and energy. It probably sounds a bit esoteric. But let me explain. I find the routine of a few sun salutations, twists, an inversion, the quiet heaviness of shavasana, and some full belly “Oms” revitalizing. After which I breathe deeply with renewed energy, ready to take on and make the most of the at times, challenge-filled fluidity of working from home and remote school, for instance.  

More recently during this anxiety-inducing pandemic, as I worry about our family’s safety in India or read about the ever-spiking cases and crumbling health care system there, my intermittent and improvised yoga practice allows me to calm my nerves and think more positively. I hope for a happy day when we are able to travel to India with our two boys, so they may be able to see their grandparents, aunts, uncles, and cousins, in-person, and I, my folks.

I am by no means a certified yoga instructor – merely a yoga enthusiast who has turned to this ancient Indian practice every now and then at various stages of my life for over two decades now, reaping its wonderful benefits. Every time I surrender to my mat, I rise in a strange mind-body-soul harmony, gently yet firmly, reminding me ‘to just be’. To accept, be grateful, make the most of ‘now’, mindfully and intentionally going about my day.

While I am cognizant that everyone has their go-to activity or means to de-stress and relax, like listening to music, running, taking a short nap, or reading, yoga is mine. The reason I was drawn to it is because it made me pause and slow down my pace of life and mind. I also very quickly realized that yoga doesn’t have to be complicated or enigmatic. It doesn’t need much equipment, space, or time. It’s easy and beneficial. I can do it whenever I want and for as long as I want (or can). 

So, over the years, I have devised my own ‘yoga toolkit’. It has helped me mindfully navigate the curveballs at work and as a full-time parent. And it continues to assist me today, as I, like millions of others navigate this global pandemic, making sense of it, praying for a better tomorrow.

To stay calm, centered, rational, and in control, I often resort to the following yoga tools. I don’t necessarily follow these sequentially or attempt to go through each of them. I simply do what I can.

Breathe deeply for that much-needed clarity.

We breathe all the time. Why not make it conscious and intentional? It’s cathartic and effortless. The two things we all value, especially these days. Focusing on my breath for a few minutes magically helps me hit that reset button. And we all know, taking a pause can help us rationally re-evaluate a variety of situations – personal and/or professional.

When under stress, do the downward dog.

You may end up doing it a LOT. It’s no secret that our current reality possibly fills the most formerly self-assured people with doubts: small, big, and huge. Often! But when has a bit of stretching, sculpting, toning, and blood flowing to the brain been a bad thing? It not only helps us all take that much-needed pause but forces us to see the world from an upside-down (different?) perspective.

Create space between the ears and shoulders.

This is something we don’t even think about but can do all the time – while sitting, standing, and lying down. Just pull your shoulders down and straighten your neck to create some space between the tips of your ears and the tops of your shoulders. Not only check your posture but also feel that stress release. You’ll likely feel taller, more in control, and will look graceful too. Tip – you can add to it by tucking in your tummy, working those abs. But don’t forget to breathe!

Relax in child’s pose.

Again, a little bit of flexibility and stress/ blood pressure reduction can’t be all bad! A time to rest, and reset, and secretly build flexibility and work those abs.

Massage the top of your head and the nape of your neck.

Isn’t that what they did when physically going for a massage was a possibility? Granted, it’s not the same as getting that divine massage, but it’s certainly something. Creating some scalp blood circulation apparently helps with hair growth too.  

Lie in Shavasana for that divine sleep and mental reset.

A few minutes of Shavasana prior to a nap or hitting the sack for the night helps me breathe deeply and relax, setting me up for some quality rest time. Tip – a scalp massage with some meditation music prior only makes the sleep deeper and more restful.  

In summary

Feel free to harness the power of this ‘Yoga toolkit’ alone or with kid(s), your spouse/ partner. It’s relatively simple and doesn’t entail much. Best of all, it’s iterative. Pick what you feel like. Add to it if you want to. If a backbend or headstand is part of your practice, go for it. If you want to just lay down, massage your head, and tune out breathing deeply in Shavasana, do it! It’s also indulgent. Remember to work with your energy levels and time commitments. Don’t endeavor for that perfect pose. These tools can be hugely gratifying, relaxing, and mentally and physically centering. Something we all crave and can benefit from.  

Here’s wishing us all the very best, as we surge forward with positivity, gratitude, and mindful intention.

Om Shanti, Shanti, Shanti, Om…….

Nidhi Kirpal Jayadevan is an avid reader and a yoga enthusiast. Her pre-kids life was dedicated to the complex field of Communication Sciences. After choosing to be a full-time mother, reading and playing with her high-energy boys has been a fascinating journey. It has (re)kindled in her a sense of wonder in all things small. She constantly sees the world through little eyes, applying simple learnings to deepen life’s meaning for herself and her family.