Quietly flows the Hooghly

Now, dont run me down….. I am merely chronicling yet another morning run from the Running Man! And no, he is not paying me (as yet). We of the Zedd, sometimes think that maybe our brethren have taken to running or biking or even hitting the greens, just to stay out of the way of domestic chores…..

Quietly flows the Hooghly under the Howrah bridge!
Victoria memorial… Reflected in one of the pools around it….
You may become famous… and be commemorated for posterity… however the pigeons dont care too much , and they just do the thing that they do!
This beautiful building looks just as stunning from any angle…The old and the new City… Kolkata 42 on the left and the Victoria memorial on the right flank the rising sun… Incidentally, the building on the left is the tallest in India currently!
Read more about this https://en.wikipedia.org/wiki/Victoria_Memorial,_Kolkata
Kids playing cricket around the Maidan… The Eden Gardens stadium is in the background… What would be interesting is that the Maidan was kept as an open field in the front of the walls of Fort Williams, to serve as a battle field without cover for anyone with the temerity to assault the Calcutta Residency. Though today, in a lighter vein, many a battle (or bottle) are fought over in the numerous little Sporting Clubs (with attached bars) that dot the Maidan.
This is another of those marvellous buildings that the Govt occupies….
Heads Up!! Making light of it! It seems they sure do make a lot of headway in Calcutta….
Our Running Man was wondering if a change in this guy’s marital status would possibly improve his personal outlook on life! For non Hindi speakers, the Tee Shirt slogan literally means Wayward but still a bachelor… It seems that the irony escapeth the man… Its possibly because he is wayward that he is a bachelor… and then once he gets hitched , he might want to go back to being wayward :-]
Flower vendors by the road side…. near the Howrah bridge!

Well, that was another tale from the phone of the Running Man. Methinks there is a reason why every Sunday, he wends his way outwards….. lest he be bound to those chores I alluded to earlier…. I guess this should inspire others to take up running…. or at least telling the better half (gender neutral please!) that the road beckons…. well to each his / her own pursuit…

Let me share with you the relatively un inspiring scene from my window… and the hill beyond it!

The view from my window after a rain drenched week in Pune
Fortunate to have verdant scenery just walking distance away….. I walk not run, unless its when I get shopping lists…..

Till next time that the Running Man posts from somewhere on his runs. I cant resist this aside…. He is careful about his eating and drinking , to avoid getting the runs … ;-]

A run around the Pandals of Calcutta

I am planning on literally giving you , dear reader, the run-around…. A batchmate of mine, who for the sake of brevity we shall call the Running Man, has developed a taste of photographing the route he runs on… we of the Zedd, jest and call it “phogging” (Photographing while Jogging- for the un-initiated)…. Who knows whether its already a trend or what?

Let me run you through some of his photos , taken during the recent Durga Puja festivities in Calcutta. Just FYI, he runs while I personally prefer a more sedate amble.

Mahishasura made of tyres!
Inside the pandal… The tree of life… made of helmets… This pandal was highlighting road safety… Indeed a socially conscious organizing committee, highlighting the most important protector of the head of a biker!
The foreground has a speedometer… Literally to tell the avid Pandal hopper that speed kills!
Midway break at the Rabindra sarovar…. An oasis of calm and peace surrounded by the chaos of the city… which you cannot see ! Reflect on the quiet beauty ….. (not him, he is the beast)
Dada himself was there to welcome the Running Man to this pandal …And Varun Dhawan exhorting usage of scented vests for men to deal with B.O
An amazing pandal indeedy! … To the right are the various images of Durga… While to the left are images of women who have made a difference to society in some way or the other…. Celebrating the real Durgas amongst us!
Trapped in our gilded cages, we are! An illusion created by mirrors within steel cages lined by large flowers on the floor..
This is not a Pandal! Its just to check whether you were actually reading the captions… Luckily for us no one has aspirations to see the insides of this one….. though we all know someone who has been there, done that.
The compound wall of the German embassy… Zoom in to see the lovely street art…
The Maharajah meets Blondhairbraidix (inspired by the comix)
The logo of the “Missing girls”… Highlighting human trafficking…
At the entrance of the Surichi Sangha pandal… The roof is made of lakhs of small wire cages… The pandal was depicting urban decay…
Broken walls… Incomplete structures and a large traditional fan…with the crazy roof above…
The regal idol…
Urban decay .. broken roofs, protruding rebars… All this is a Pandal!!
The Chetla agrani Sangha pandal… Highlighting the modes of communication in the days gone by…. Made of post boxes on the outside…
The inside was grand…. The dome shaped roof was covered with a 3 D model of the entire city of Kolkata… You can see Eden gardens stadium at the bottom right…
The stunning idol of Maa Durga
Eden gardens, Victoria memorial, Howrah bridge… They were all there…

Well thats it for now…. more from the Running man will follow…… in due course. There is a lot of water in the Ganges and a lot of mileage in him, so we can expect to see more .

Credits: the Running Man! Those of you who know him, well you do know him. For the others, well, he is a good friend, an excellent athlete, a great father, and I hope his lovely wife will opine that he is the true Beast to her Beauty in perfect Disney style, and thats all you need to know. Blogged with his explicit permission.

Z Batch Devashish Sharma Memorial Monsoor Cup 2019

2019- yet another year goes by (well , we are almost there)….. We just about managed to squeeze in the 2019 edition of the aforementioned Cup, just as the rains have begun petering out.

Zedd Batch, (the one and only), had earlier decided on a bigger and shinier trophy this year onwards, from its humble beginnings as a teensy weensy little cup instituted by the then Warden in 2013 (no guesses) with a cash prize (beer money), to now figuring in the inter Batch points tally for the overall Championship (thanks to Atul’s efforts).

The ‘new’ Z Batch Devashish Sharma Memorial Monsoor Cup

On 24 Aug 2019 we witnessed a closely contested match between D3 and E3 batches. Lots of effort was put in by the ‘bhai’ batch [this is the terminology for the batch immediately senior to the freshers (F3)] , however they could not withstand the aggression and ballplay of a more experienced D3 (who are winning the trophy for the second time running)!

Futsal requires short passes, speed, agility and aggression!
The Winners for the second time ! D3 Batch

To read about the story behind the Monsoor Cup please click https://deltazuluconsultancy.com/2018/09/03/monsoor-football-at-afmc-pune/ 

We cannot but remember our batchmate, whose name figures on the Trophy and yes, its the same guy after whom the Parade Ground is named. Read a bit more about Capt Devashish Sharma , Kirti Chakra …. https://deltazuluconsultancy.com/2018/07/22/capt-devashish-sharma-kirti-chakra-posthumous/ 

Rain Rain Go Away…..

Or actually not ! Though we in India may be reeling under the onslaught of heavy rainfall today, in just a few days the rains will soon be a memory from the past, and we will be looking forward to the next monsoons to revive the parched earth of the subcontinent. Such be the fate of the Indian people, living through every year dependent on the vagaries of a perfidious monsoon since the past five thousand years.

We need rainfall, and we need better civic infrastructure for sure! We need roads with drainage and traffic systems that work in the monsoon too. Well, this post is not about rainfall or the civic system…..

During the rainy season, its the best time to be planting tree saplings, so that we may have trees in the future to green the planet for our future generations….

Schools today are encouraging their students to connect with nature. http://greenwave.cbd.int/en/home “Each one, plant one” is no doubt a good idea, however we need to be thinking out of the box to bring about a paradigm shift in our environment.

I recommend that though ordinary tree plantation is good, it might be better to go about it in an organized manner and undertake community plantation…. Check out the Miyawaki method http://bengaluru.citizenmatters.in/how-to-make-mini-forest-miyawaki-method-34867

https://www.afforestt.com/methodology

Govts across India are supporting tree plantation, interested individuals may contact their nearest Forest Officer

https://maharashtra.mygov.in/en/group/mission-plantation/

Do mass tree plantation drives work? Maybe yes /Maybe No ? Its your call….. https://www.downtoearth.org.in/blog/forests/the-logic-of-mass-tree-plantations-63861

Some responsible corporates are undertaking innovative ventures where you can sign up for a tree to be planted on your behalf…. check out http://tplgreenthumb.com/

We had the pleasure of visiting a Larsen & Toubro factory site, where the visionary management team has tried out the Miyawaki technique successfully. An enthusiastic team of engineers took it on as a hobby, and transformed the campus into a green paradise. Its easy to do, easy to maintain and the results are evident.

I will suggest and strongly recommend that interested folks who fancy having green thumbs should try to explore the Miyawaki technique at a community level.

Lets green the earth, and hope for more rainfall, regularly , rather than in deluges. And as we cannot do much about the rainfall other than pray, lets do something about the trees which we all can plant.

04 Aug 1962 …… AFMC Pune

May the Fourth be with you!

Poona or Pune, whatever the name may evolve into, AFMC will remain the Armed Forces Medical College, my Alma Mater. Irrespective of national rankings etc etc, this Indian Medical School will always be Numero Uno for me and for nearly 8000 others who call AFMC home. The story started decades ago, 04 Aug 1962 to be precise. https://afmc.nic.in/

And my journey started exactly on this date in 1987. Its been a roller coaster ride, exhilarating in its highs, thrilling, chilling, you can add any more words that you like , ad lib, and its been that, from wide eyed undergraduate student, to jaded postgraduate resident, to enthusiastic Member of the Faculty, to being the custodian of the morale of the boys, (not morals!). Been there , done that.

My batchmates of the Zedd, a couple of years ago , decided to get our act together to ‘give back’ formally, to our alma mater, and wound up setting up the Zedd Batch Grant, through the AFMC Alumni Association.

The Zedd Batch Grant funds completed and published Research Project based scientific papers by Undergraduate medical students of AFMC, and this year also supported the Indoors Club to revamp their ‘thing’.

Anyone can contribute to the Zedd Batch Grant, to utilize the formal structure of the Grant process, and benefit AFMC. Just send off your contributions to the AFMC Alumni Association Bank Account, c/o the IOB and drop an email to the Secretary specifically mentioning “Z Batch Grant”.

Zedd Batch is now officially 32 years old……

    

Students receiving the 2019 Grant at AFMC Pune on 03 Aug 2019

Ethics and personal integrity! The CCD saga…

Cafe Coffee Day transformed the social scene in India with its laid back style and presence on virtually every street corner in our cities. Even though I belong to Coorg, the land of coffee I am not much of a coffee drinker…. Still, I have spent many an hour with my wife, my friends, my colleagues, and nowadays with my laptop for work! But then this post is not about the success story that the world knows about mostly.

As per the news reports on the web, V G Siddhartha – Owner of Cafe Coffee Day – reportedly has committed suicide. His body has been recovered from the Netravathi river, 2 days after he went missing.

His story, when it is discussed threadbare in the weeks to come, should serve as a stark reminder of the fragility of life and its transient nature, financial and /or professional success notwithstanding.

I would consider this unfortunate incident to be a wake up call for all of us to just re-orient ourselves and our mindsets (and that of our spouses and children too) for not focusing solely on success, but also to equally be able to handle failure and the social pressures it brings along with it.

It should be a lesson for us all that as long as our personal and professional work ethics are strong, failure should be treated just as another one of life’s s experiences and not be the end of it all.

This also brings to focus that being in touch with our inner self and having a strong spiritual core (please note its spiritual, not religious) is very important for humankind to view life more positively.

Therefore investing in one’s self on an everyday basis is vital for ‘happiness‘ and ‘success‘.

Reading of books, whether on your phone or in hard copy (preferrred), healthy associations at work and in life, good friends, balanced nutrition, daily exercise and most importantly, peace of mind, are vital ingredients for a successful life.

At the very centre of it all, *honesty to the cause* (whatever that may be) and to one’s self , *personal integrity* and *ethical conduct* in your work life and personal life seamlessly , needs to be not just a choice, but a chosen lifestyle !

Its a time to introspect, for all of us , to check towards where we are hurtling!

Let us all resolve to be *honest*, *straightforward* and *ethical* in our daily lives, from today onwards!

We can indeed be the change that we want to see!

Sir, Should I join the Armed Forces ? A common question posed by young medical students of a certain premier medical school! Many answers, tough decision, dilemmas…. for parents and the young doctor (to-be) alike

This write up is by my much loved batchmate Surg Cdr (Dr) Vivek Kumar, Navy Veteran (MD Internal Medicine and Intensivist) , presently Chief Intensivist at the Sir HN Reliance Foundation Hospital Mumbai.

Reproduced with his permission , and narrated suitably by his friendly neighbourhood Sp…. I meant batchmate.

It was originally published in the Dhanvantari issue of 2016 ( Page 119 ).

It has always been a pleasure for Vivek to write for ye olde College magazine, and if I remember correctly, he was also the student editor nearly three decades ago, a post I would have loved to have held, however other pastimes beckoned (said with a devilish cackle, please note). There are many stories which could come easily to his mind instantly, however that time around he wrote on the most common question that was posed to him over the few years that he was posted on the Faculty of Dept of Internal Medicine at the Armed Forces Medical College, Pune. This is a question that was oft asked to me too, when I was shouldering the responsibility of making sure that 95% of the kids stayed out of trouble (the classic bell curve, remember?). Just as an aside, among the many hats I wore while at AFMC, I was also the custodian of the morale of the boys. Not moral-s.

And the question is simply , To be or Not to be! Well, actually, the question is “Should I join the Armed Forces or not?”

At this point of time, let me just add a little bit of info which you already would know…. there are many AIIMS across India now, premier or aspiring to be, run by the Govt, autonomous, having equally high medical education standards and facilities, having a much higher subsidy per student, with low (low) fee structure, negligible living expenses, and Yes, wait for it…. No Bond, or Govt service liability of any form………. I will not state the obvious info you already know about AFMC

Vivek has seen many students take a well-thought of decision in this matter and also an equal number who just tagged along with the decision of their friends. Like all processes in today’s corporate world, decision making is a structured process and in his original article , Vivek suggested a way to go about making a career choice.
In 2015 when he was approached by an International recruitment firm for the post of Consultant, National Health Service, United Kingdom. he had to prepare for an interview and it was while doing so he realized how systematic the NHS team was in assessing candidates for recruitment. While preparing for the interview he had to go through a standard set of questions, at the end of which he realized that making a career decision is a structured decision making process and not a series of chat sessions at the College Canteen.
An interview usually starts with “Tell us about yourself” followed by “Take us through your CV”. This is followed by the obvious question “Why do you want to join this trust?”, “Why should we give this job to you?”, “What can this trust offer you?”, “How will you contribute to the trust?”, & “Why did you quit your last job?” In answering these few questions you speak about yourself and your work but more important about your resolve to join a new organization and how you will align your career plans with that of the trust. This single question “Why do you want to join this trust?” sets you thinking. Vivek had to open a diary and keep writing points as they crossed his mind. For someone who was more used to writing up case notes and giving orders , this opportunity for introspection apparently set him on the path to liberation. This, at a stage of his life when he had completed 22 years of commissioned military service and two years of private practice in a corporate hospital. He had never gone through this exercise before, or even spent 5 minutes on pondering over any similar issue at any time in his life.

Vivek could remember our batchmates of Z who had moved out to civvy street by coughing up the required Bond money, a couple of lakhs in rupees in the early Nineties in India, was still a lot of money. – For some, the decision was part of the patriarchal hierarchy and for others it was a default decision reached at, by a process of exclusion, i.e. excluding the option of joining the Forces. If you spend time pondering over this question it will become clear that you need to have a good knowledge about the organization, a fundamental flaw with all of us whether we join or do not join the Forces. Our knowledge of the Indian Armed Forces or the British or American health systems is paltry and most of it is anecdotal, based on hearsay, or watching TV serials. As far as the Armed Forces Medical Services was concerned, Vivek’s knowledge at the time of his Commissioning was limited to that about AFMC, a few establishments, some ranks, availability of liquor, sixty days of annual leave, and the options for post-graduation.

As an afterthought, Vivek commented candidly, that he spent 22 years in an organization that he had joined based upon this limited mostly hearsay knowledge!

And when he was preparing for the NHS interview he had to read up a lot about the organization, the hospital he was planning to join, their future plans, the job requirements, besides being clear about his own career and life plans.

A proper answer to this single question (“Should I join or not”) will definitely clear your understanding of any system that you wish to join. Because , it is a system that you are joining, any which way that you look at it… irrespective of location in the world.

The basis of your decision to join a new organization has to be very clear, e.g. “NHS is a leading health care delivery system, it will give me a platform to excel in my field, it is a fulfilment of a dream to be part of an evolved medical system, and so on”.

Similarly you should write down the points you feel are for and against your decision to join the Forces. This process can start in the First Term and culminate after the IX Term results. At no stage should your career options compromise your academic performance. No slacking please! The desire to excel must outplay all career choices. Your first goal must be to achieve merit in all subjects, and gain knowledge through reading (of books and journals as relevant). Once you have achieved this goal you can go ahead and navigate through your list of pros and cons about joining the Forces.

The next set of thought provoking questions for Vivek was “Where do you see yourself in five / ten / twenty years from now?” But then he was always an ambitious bloke…. for me, I am quite happy seeing the future just in five year instalments.

Vivek, with refreshing candour admits that he had never thought on these lines when joining the Forces in 1991. Indeed one has to sit down and look ahead at life from a different perspective. Our future vision usually ends at post-graduation or a speciality examination. We all suffer from short foresight and very long hindsight. He suggests imagining yourself in a workplace of your choice ten years down the line. He assures you that this visualization is a totally different experience. He wished that he had imagined himself in specialist appointments outside the protective and insulated (and insular) cloak of the Forces. The reality is that there are numerous avenues and opportunities outside the cocoon and in the Medical Corps is different for those posted to AFMC versus those posted to other medical establishments within the Forces, and between the IAF, IN and Army its all too dissimilar too.

You must have an idea of how life is for those working in medical & non-medical units, not just the romanticized Technicolour version, but the daily grind. Before Vivek’s NHS interview the interviewers had sent a brochure which described a day in the life of a Consultant in his speciality, the call duty rotation, the leave programmes, familiarizing him with the job requirements and expected lifestyle. Similarly you should be familiar with the working schedule, duty requirements, and standard lifestyle of a serving Medical Corps officer. It is preferable to find out the details yourself rather than base it on hearsay. Ask yourself “Can I fit into this job profile?”, “Is this I want to do in life?” Clear all your doubts by personally interacting with Officers of various ranks. They are all usually very approachable and always glad to give a patient hearing to a young doctor- to- be! Get the facts straight!

Iron out all the discrepancies between your perceptions of the job and the actual scenario, by hearing of it from those who have served and are serving. Test your comfort levels on completion of this exercise. You will know what you are getting into and even if you have no choice, this exercise will help you understand the “system” better and make your life peaceful. Even today, for many of us, the pride of having worn the uniform and serving our country overrides all our personal desires. Indeed for me personally, my Maroon beret and my uniform was the single major source of pride (apart from my family) during my 26 years of military service, and now in the thereafter. I am proud to have served in the military, and supported our fighting troops. Given a choice, I would do it all over again!

One of Vivek’s interviewers for NHS job was someone from the Human Resources Dept. He briefed Vivek about the values & behaviours of the particular NHS hospital. These included pride, respect, empathy, consideration, compassion, and dignity. He directly asked Vivek if his own values matched their value system. The NHS wanted its staff to “live our values & deliver the best patient care”, to have “fulfilling & enjoyable place of work”, to exhibit “right attitude & behaviour contributing to a positive patient and staff experience”, designing a “crucial role for each individual” and finally motivating people into “putting our heart into what we do”. Vivek truly wished that he had looked upon the Armed Forces from this perspective prior to joining . The Indian Armed Forces still remains one of the largest organizations in this country. It offers a platform where one can serve with pride and dignity and live up to one’s personal values. Like any organization in the world there are shortcomings but in no way will these ever compromise your personal values.

To put it in other words if you feel you have to compromise upon your personal value system while in the line of duty, you should be strong enough to take a decision to adhere to your principles and either work at improving the situation or just letting go of the situation without compromising your principles. Its a choice that is to be made every day in an adult world. A doctor in the Armed Forces is an Officer and a doctor. The sense of pride in working for the honour of the country and a strong sense of duty is reflective of the spirit of ‘Dharma’ .

To summarize, in his original article, Vivek spelt out a few questions which a young medical student must answer before making a career decision. All these answers must be based upon extensive research done by the student himself or herself. The best way to do this research is to interact with as many people whom you feel are learned and wise and whom you see as a role model .

Once you start the process of answering these questions you will find that there are many more questions arising which need to be addressed. Take your time and do so till no questions are left unanswered. Discuss this with your batchmates, with your senior batch friends, with your well wishers, with the Canteen tea guy, with your parents, with whoever you want…. Discuss ad nauseum. The truth shall set you free, and the truth is that you are the one who has to own your decision. You are then your own boss to make a career decision for your self.

If you feel confused after reading this article whether Vivek or I want you to join or not join the Armed Forces, then I have to clearly communicate to you that this write up is not about our preference but about indicating to you a path that you may tread to go about making career decisions.  We both left military service voluntarily after nearly two and a half decades of military service and colourful experiences to last a lifetime. Grateful to have been on the journey with our brothers in arms.

In the final analysis, this is all about you , young AFMCite…. Be the Change that you want to be…. Live the dream that you want to….Just have a plan to live it with honour and dignity…. Only you can choose the path you need to be on… that is Dharma, to do because you must!

Mosquito Borne Diseases – A bit more…

Mosquito borne diseases, with Malaria predominating amongst these, are verily the scourge of humankind since times immemorial (I was about to write ‘mankind’, then remembered that I should try to use the gender sensitive term instead) . While there may be media and public hype about Elimination / Eradication / Control of diseases like Malaria, in my opinion, there are far too many variables involved in malariogenic conditions, ranging, from deforestation (and afforestation), climate change, unchecked and unplanned urbanization, evolving vector bionomic variations and most importantly human behaviour. Hence , I doubt that we will ever be able to move beyond ‘Control’ of malaria despite well meaning intentions to strive for ‘Elimination’.

The Mosquito borne diseases that city dwellers, (like you , me and our parents and our children) need to be concerned more about are Dengue and Chikungunya! Different kinds of mosquitos transmit these , as compared with malaria, which is less of a threat in cities today, and more likely to be contracted when you travel.

From the Govt of India website (National Health Portal)

In case you are diagnosed with Dengue, do note that there is no cause for panic. Usually, it is self limiting, however its best to keep a close watch on your clinical condition, and that is best done by meeting your neighbourhood doctor (preferably allopathic).

In case you are diagnosed with Dengue… Read the above infographic. Seek medical attention early!

At a recent Round Table meet between the Govt of Odisha and the Tata Trusts along with implementation partners, the situation of malaria prevention and control was discussed at length and many interesting insights were gained. This South Odisha based Project has been covered in an earlier blogpost https://deltazuluconsultancy.com/2019/05/27/there-is-more-to-malaria-than-dealing-with-the-mosquito-a-tale-of-hard-working-field-workers-in-south-odisha/

‘Rectangular’ Table Bhubaneshwar, Odisha 18 Jul 2019
Highlighting the Test Treat Track approach in the hinterland of Odisha
News coverage kind courtesy Bob John of Tata Trusts Corporate Communications Team

Cricket and the Bhagvad Gita

“I guess they just flattered to deceive… ” this might well be the common sentiment coursing through the common Indian cricket fan! After a scintillating performance through the World Cricket Cup 2019, to virtually deflate in the semi Finals, to the chagrin of a billion people (there are a few million in India who do not follow cricket).

Well, the solace one could derive is that the BCCI (yes, its a corporate entity) team is looking good, looking like real athletes, and performing on all engines. The responsibility of failing to bring back the Cup can be put at the doorstep of luck, the weather, strategy hiccups and whatever suits you!

However, for any true blue cricket maniac, all could be forgiven, given the nail biting finish that was witnessed on Sunday night 14 July 2019.

New Zealand and England fought it out, in the true spirit of cricket, with dogged perseverance , exemplary fielding, great team spirit, and gutsy strength of temperament! In the end, it was nothing but sheer luck that yanked away the Cup from the Kiwis! This match indeed will be firmly etched in many memories, there will certainly be no acrimonious recriminations, there will be a bit of sadness undoubtedly, however there will be a feel good factor at play for sure.

Two evenly balanced teams, highly professional in their approach, skilled in their strategem, joisting for the Cup in the hallowed grounds of cricket, in an equipoised match that was intensely engaging till the very end.

Giving it their best! Yes, thats the message that I hope that young folks across the world can take home. Give Life your best, and dont worry about the outcome!

According to the Bhagavad Gita, one may practice and incorporate in one’s life, the concept “Nishkam karma,” or action without desire. To put it simply, if one is not attached to the consequences of one’s actions, then one will gradually and ultimately free oneself from the bondage of karma. 

Meaning that the New Zealand – England final of the Cricket World Cup 2019, illustrated perfectly the concept of Nishkam Karma…… irrespective of what was eventually the outcome, both the teams gave their best, you could see it in each and every moment of the game….they were playing from the core of their beings, and yet behaving with dignity and decorum towards each other.

कर्मण्ये वाधिका रस्ते मा फलेषु कदाचन। 
मा कर्म फल हेतु र्भूर्मा ते सङ्गोऽस्त्व कर्मणि॥

Karmanye vadhika raste, Ma phaleshu kadachana
Ma karma phala he tur bhuh, ma te sangotsva karmanye

Do your best , each and every moment of the day , on each and every day of your life. Dont think of the fruits of your efforts…. dont even be concerned about this at all!

The view from Harrison’s Folly near Mahabaleshwar, July 2019

You may not smoke! However Tobacco still endangers you and your loved ones!

Nonsmokers breathe in the same toxic chemicals in tobacco smoke as the smokers do, with similar, although smaller effects. The smoke nonsmokers breathe is known as secondhand smoke and the process of breathing secondhand smoke is called involuntary smoking or passive smoking.

The smoke contains thousands of toxic chemicals, including benzene, cyanide, cadmium, lead, radioactive polonium, benzo(a)pyrene, ammonia, carbon monoxide, and nicotine. These chemicals cause many diseases.

Secondhand smoke (or ETS) is a very serious form of indoor air pollution. For example, in the USA secondhand smoke causes about 3,000 lung cancer deaths a year, compared to less than 100 lung cancer deaths per year from traditional forms of outdoor air pollution.

Secondhand smoke causes and aggravates asthma and other breathing problems, particularly in children. It is also an important cause of sudden infant death syndrome (SIDS).

While most discussion about passive smoking have concentrated on lung cancer and breathing, the effects on heart disease are more important. The chemicals in secondhand smoke poison the heart muscle, interfere with the ability of blood vessels to adjust themselves to control blood pressure and flow, increase the buildup of blockages of blood vessels (which lead to heart attacks), and make blood stickier. The net effect is that there are about 15 times more deaths from heart disease caused by passive smoking – 35,000-62,000 deaths annually in the USA – as lung cancer.

While the tobacco industry continues to claim that the evidence that passive smoking causes disease – particularly lung cancer – is controversial, every independent authoritative scientific body that has examined the evidence has concluded that passive smoking causes many diseases. Moreover, the evidence that passive smoking causes disease is not new.  Source : https://www.who.int/tobacco/research/secondhand_smoke/about/en/

How tobacco endangers the lung health of people worldwide

The multiple ways that exposure to tobacco affects the health of people’s lungs worldwide include:
 

Lung cancer. Tobacco smoking is the primary cause for lung cancer, responsible for over two thirds of lung cancer deaths globally. Second-hand smoke exposure at home or in the work place also increases risk of lung cancer. Quitting smoking can reduce the risk of lung cancer: after 10 years of quitting smoking, risk of lung cancer falls to about half that of a smoker.

Chronic respiratory disease. Tobacco smoking is the leading cause of chronic obstructive pulmonary disease (COPD), a condition where the build-up of pus-filled mucus in the lungs results in a painful cough and agonising breathing difficulties. The risk of developing COPD is particularly high among individuals who start smoking at a young age, as tobacco smoke significantly slows lung development. Tobacco also  exacerbates asthma, which restricts activity and contributes to disability. Early smoking cessation is the most effective treatment for slowing the progression of COPD and improving asthma symptoms.

Across the life-course. Infants exposed in-utero to tobacco smoke toxins, through maternal smoking or maternal exposure to second-hand smoke, frequently experience reduced lung growth and function. Young children exposed to second-hand smoke are at risk of the onset and exacerbation of asthma, pneumonia and bronchitis, and frequent lower respiratory infections.

Globally, an estimated 60 000 children die before the age of 5 of lower respiratory infections caused by second-hand smoke. Those who live on into adulthood continue to suffer the health consequences of second-hand smoke exposure, as frequent lower respiratory infections in early childhood significantly increase risk of developing COPD in adulthood.

Tuberculosis. Tuberculosis (TB) damages the lungs and reduces lung function, which is further exacerbated by tobacco smoking. The chemical components of tobacco smoke can trigger latent infections of TB, which around a quarter of all people are infected with. Active TB, compounded by the damaging lung health effects of tobacco smoking, substantially increases risk of disability and death from respiratory failure.

Air pollution. Tobacco smoke is a very dangerous form of indoor air pollution: it contains over 7 000 chemicals, 69 of which are known to cause cancer. Though smoke may be invisible and odourless, it can linger in the air for up to five hours, putting those exposed at risk of lung cancer, chronic respiratory diseases, and reduced lung function. 

How to Improve Lung Health ?

The most effective measure to improve lung health is to reduce tobacco use and second-hand smoke exposure. But knowledge among large sections of the general public, and particularly among smokers, on the implications for the health of people’s lungs from tobacco smoking and second-hand smoke exposure is low in some countries. Despite strong evidence of the harms of tobacco on lung health, the potential of tobacco control for improving lung health remains underestimated.

Call to action

Lung health is not achieved merely through the absence of disease, and tobacco smoke has major implications for the lung health of smokers and non-smokers globally.

In order to achieve the Sustainable Development Goal (SDG) target of a one-third reduction in NCD premature mortality by 2030, tobacco control must be a priority for governments and communities worldwide. Currently, the world is not on track to meeting this target.

Parents and other members of the community should also take measures to promote their own health, and that of their children, by protecting them from the harms caused by tobacco. Actionable points could be as follows :-

  • Do not allow any form of tobacco within your house.
  • Get your Office / Society to ban smoking in “Public Places”.
  • Display “No Smoking” signs as per specifications.
  • Designate Smoking areas for those unfortunate people who are enslaved by tobacco.
  • Encourage your friends and relatives to quit smoking completely. Always keep in mind that there is no such thing as cutting down on smoking. You have to QUIT.

The time to act is NOW!

Did you know that India is a signatory to the Framework Convention for Tobacco Control Read more here…… https://www.who.int/fctc/about/en/

The Govt of India has issued various public notices on the promulgation of various Tobacco Control legislations, since 2004. (available from http://www.tobaccocontrollaws.org/legislation/country/India)  The provisions of the relevant Act and the various Rules thereto are intended to safeguard the health of the general non smoking public, as it is scientifically proven that passive smoking is as dangerous (if not more) than smoking itself.

As per the various laws in India, there is : –

  • Prohibition of smoking in public places.
  • Prohibition of advertisement of cigarette and other tobacco products.
  • Prohibition of sale of cigarette and other tobacco products to a person below the age of eighteen years.
  • Prohibition of sale of tobacco products near educational institutions.

Vide various Gazette of India Notifications, smoking is strictly prohibited in a public place, which is defined as any place to which the public has access, and include auditoria, hospital buildings, educational institutions, restaurants, public offices, libraries, public conveyances, open auditoria, railway stations bus stops, etc.

Tobacco products under the Act include cigarettes, beedis, pipes tobacco, hookahs and chewing tobacco.  Snuff, pan masala, gutkha and tooth powder containing tobacco are also listed.

We all are aware that the consumption of tobacco in any form is extremely harmful to the health of an individual directly , and secondarily to those in his immediate surroundings, i.e women and children of the family. This passive smoking affects all Non-smokers, with women and children being the most affected by this indirect smoke pollution.

For the reader’s information, it is mandatory to display at all public places including community facilities, a board of a minimum size of 60 cm x 30 cm in English or Hindi as applicable, with the warning “No Smoking Area – Smoking Here is an Offence”.

30cm x 60cm Sign for Display at Public Places

This board should also contain a circle of no less than 15 cm outer diameter with a red perimeter, of no less than 3 cm width, with a picture in the centre of a cigarette or a beedi, with black smoke, and crossed by a red band. The width of the red band across the cigarette shall be equal to the width of the perimeter.

While smoking or consumption of tobacco is an individual’s choice, hence it is presently not banned in a democratic system. However smoking indiscriminately is what is banned, i.e in front of others (who may not have a choice in inhaling the smoker’s second hand smoke). This is in the public’s interest. We must understand this nuanced statement. A non smoker has a right to breathe clean and untainted air!

Hence the approach that we should advocate is that simultaneous with the banning of public smoking, specific areas in office complexes, community facilities etc be designated for smokers to use, and signposted as such. These sites are not to be near thoroughfares or be common rooms frequented by others or be near AC / cooler fitted windows. As a strict rule, all air-conditioned spaces are to designated as “No Smoking areas”.    

It must also be appreciated that the masses consume copious amts of gutkha, which is far more harmful to their health. As it is, further to dirn of the  Supreme Court, it is illegal to sell gutkha in plastic sachets, which is still the norm. Hence we do periodically read news reports of seizures of large consignments of this banned item.

It is requested that the readers of this post may please reach out to those in their circles of influence and solicit their participation in the “Say No to Tobacco” initiative currently underway in the country in the interests of promoting of health of our people and their families, both the smoker minority and the non smoker majority.

SMOKING : THE ROLE OF THE HEALTHCARE PROFESSIONAL

For those of you who are medical practitioners, please know that when it comes to tobacco use, health professionals have the opportunity to help people change their behaviour. Their involvement is key to successfully curbing the tobacco epidemic. For example, if dentists warned all their patients that smoking causes excess plaque, yellowing teeth and contributes to tooth decay, as well as a five-fold increased risk of oral cancer, the impact on smoking would be dramatic.

Studies have shown that even brief counselling by health professionals on the dangers of smoking and importance of quitting is one of the most cost-effective methods of reducing smoking. Please refer to Cochrane Reviews website for the meta analysis based recommendation on this. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000165.pub4/full

“Does advice from doctors encourage people who smoke to quit

Advice from doctors helps people who smoke to quit. Even when doctors provide brief simple advice about quitting smoking this increases the likelihood that someone who smokes will successfully quit and remain a nonsmoker 12 months later. More intensive advice may result in slightly higher rates of quitting. Providing followup support after offering the advice may increase the quit rates slightly.”

Ideally, health professionals should lead by example and should act as role-models for their patients, by ceasing to smoke, and by ensuring their workplaces and hospitals are smoke and tobacco-free.  The message to be conveyed to all patients in clear terms is :-  “If you use any form of tobacco ….QUIT. If you don’t, then don’t start”.

Doctors and Dentists must utilize every opportunity afforded to convey the “SAY NO TO TOBACCO” message, and must endeavour to question every patient about tobacco usage and offer advice and counseling on giving up tobacco during every professional interaction, irrespective of the nature of reason for seeking healthcare.

A simple model for interventions applicable in all patient care settings to be adopted by healthcare professionals  is the “4 A approach” https://www.nature.com/articles/4810266

  • Ask for tobacco use  (at every med consultation)
  • Assess degree of tobacco use
  • Advise on cessation (at every patient contact)
  • Assist / Arrange in quitting (when patient requests)

If you are a Doctor, go on, Ask your patient and help him / her!

If you are an interested individual, what are you waiting for ? Go ahead change the world one person at a time.

If you are in the Corporate environment, you can get in touch with me at drcariappa@deltazuluconsultancy.com to help you design and develop a customized workforce oriented Company level Tobacco Impact Mitigation Policy that is aligned with International Best Practices and fully compliant with the law of the land.

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