We’re Getting Ready! Are You?

This could very well be the slogan of those nameless faceless entities out there, who are plotting to blow up civilized society as we know it……. Or maybe even shoot at , one group at a time…..

Most of you would have read about the grenade casually tossed into the crowd at a crowded bus station (where else do you expect there to be crowds in India?….. how about movie halls, shopping malls, open areas, wherever…. we have people!) https://timesofindia.indiatimes.com/india/jammu-grenade-blast-police-apprehend-another-suspect/articleshow/68337984.cms

You might also have been horrified about the ‘terror’ attack on mosque(s) in New Zealand (https://edition.cnn.com/2019/03/19/asia/christchurch-attack-intl/index.html) . While this may be an isolated act or a portent of an unstable future , what is real , is that these kinds of incidents will happen, and maybe will happen more frequently, anywhere and everywhere in the world, whether it is the isolated act of a ”madman” or the planned unleashing of terror by quasi religious fanatics.

Let me ask you to have a quick look at an earlier post of mine dealing with Personal Emergency Preparedness
https://deltazuluconsultancy.com/2019/02/27/personal-emergency-preparedness-are-you-ready/

…. Ask yourself at this point …. “Is my family important to me?” , ” Do I have loved ones, people that I care about ?”……. ” Can I do something to prepare myself and my loved ones?”…..

Its as easy as A, B, C , D …….

A – Always be Alert.…… Be conscious of your surroundings…. Be aware of unattended objects , baggage, cars , two wheelers……

B- Be Cautious.….. when dealing with suspicious strangers, or with unidentified objects…. Call the Police or the Emergency Response personnel in your area. They are trained to deal with “situations” , you are NOT.

C – Be Cool…… If you have a plan , you can be “Cool”… Even if you dont have a plan, if you have thought about it beforehand, if you have discussed emergencies with your loved ones, you can play it “Cool”

D – Deal with it.…. Respond… in the best way that you can. Remember you are not trained to deal with Emergencies or Crisis situations… however, you can deal with your family, you can deal with taking care of your loved ones…. Make a plan, and rehearse it, and stick to it.

Or even as simple as 1, 2, 3……

  1. Each family member should memorize the mobile number of one local contact and one out of town contact and preferably the landline number too.
  2. Each family member should understand the importance of sending an SMS (not a whatsapp message) in preference to a “call” at the time of a crisis.
  3. Each family member should know of a pre-decided “safe place” to rendezvous, within the area of residence, within the city , and outside the city……

It goes without saying , that you need to Rehearse, Repeat, Reinforce and Practice .… may sound difficult, however if you truly care about your family and your loved ones, its worth the effort. Remember , the “bad guys” are out there…. and they dont care about you or your family…………………..

YOU have to do , whatever it takes…….

For concerned individuals, those who care about their loved ones, you may reach out to me directly for assistance and guidance, gratis…..

For Corporates / HR Depts / Institutions…. this is a paid service that is worth every bit of the money you will spend on safeguarding your employees!

Contact me at drcariappa@deltazuluconsultancy.com

For those in earthquake prone areas, a simple, easy to read book available at this link is worth a quick look-see, preferably to be shared with all your family members….. https://toolkit.ineesite.org/resources/ineecms/uploads/1057/Basic_Disaster_Awareness_Handbook.pdf

The time to act is ,,,,,,…..,,,,,,, NOW!

Personal Emergency Preparedness! Are you Ready?!

There is a jingoistic fervour in the air with exuberance and the thrill akin to hounds baying for blood. It is indeed aptly said in modern times that “War is where young men die on the battlefield and where armchair warriors tweet and post on Facebook”.

However , this is also the time that is apt for taking stock of the situation post 9/11….. the world can never be the same, with the “War on Terror” having virtually made us prisoners in our own society…..

I am certain that some wise folks must be wondering who is winning, and who is being inconvenienced……

Without coming off as a Cassandra fortelling a bleak future, it is certain that the future of the world as we know it today, will be paved with painful episodes where civilized civic society will be torn asunder by seemingly isolated acts of terror , by the Hydra headed monster of disruptive forces. Without ascribing religious hues to these perpetrators of violence , irrespective of their “cause ” or allegiance, the outcome is devastating for the victims of dastardly actions wrought by these misled and misguided unknowns (the reality being that they are well led and well guided, by their benefactors and controllers).

For a detailed overview of the potential spectrum of threats that we and our loved ones, face as a society, please click and skim or read through as per your choice https://www.ready.gov/be-informed

With the easy access to various forms of explosive materials, and the knowhow to concoct Improvised Explosive Devices (IEDs), terrorists will target gatherings of people as they have been doing in the past, with no intent other than to spread terror. Be Aware at all times of the potential threat to life in crowded spaces, in a vitiated atmosphere. You can click https://www.ready.gov/public-spaces for a detailed outline of actions or you could simply glance through my suggested action list.

Do remember that in times of crises its your training and conditioning that kicks in…… so you need to consciously rehearse and discuss with your family the following….. Repeat and repeat again…. That is the reason why the military everywhere invests so heavily in training …..

What should you and your family members do in case of Mass Attacks in Crowded & Public Spaces ?

While the threat of mass attacks is real, we can all take steps to prepare, protect ourselves, and help others. What are Mass Attacks you may ask?

Bombings in public spaces like the various incidents that happen across the country off and on, 26/11 Bombay style attacks………

Well, how do we Protect ourselves and our families against these incidents?

  • STAY ALERT always be alert to your surroundings and the people around you. Be wary of suspicious movements…. if you train yourself to be aware and alert, you will learn to recognize gut feelings …..  
  • “If you see Something , say Something” 
    Report suspicious behavior, items, or activities to the relevant authorities. DO NOT handle any unknown / unidentified objects!!!
  • Observe what is going on around you and avoid distractions such as texting, listening to headphones or being on your cell phone.
  • SEEK SAFETY – Have an Exit Plan always……
  • Identify exits and areas of protective cover for the places you go such as at work, at school, and community events. When you go into any closed spaces, condition yourself to look for exits and position yourself accordingly. Movie Halls, Auditoriums and any similar places, may have exits. You would be wise to mentally make a note of these, and also check if they are not locked.
  • RUN TO SAFETY  – wise is the man who lives to fight another day…… do remember that  you are more important and precious to your family alive, than dead. A dead Hero is a photo on the wall…… Leave the heroism to those who are trained and equipped for countering terrorists.  
  • If there is an accessible escape path, attempt to evacuate the building or area, regardless of whether others agree to follow.
  • In case of an explosion, hit the ground….. Remember also that sound travels slower than light….
  • Do not come back to the scene to check…..
  • However, if you are cornered, and see no exit path….. Never Give Up. Attack with whatever you have at your access, and give it your all….. thats all you have . Do what you must, to survive. There is no reasoning with an unreasonable person.
  • SEEK COVER AND HIDE In case of any incident, remove yourself from the site of the incident as fast as you can.
  • Dont stop to take photos , selfies, etc etc…. You can update your FB status from safety….
  • You dont want to figure as collateral damage for the next IED do you?
  • Map out places to seek cover. Place a barrier between yourself and the threat using solid objects, walls, and locked doors as protection.
  • PREPARE NOW   Organize and participate in safety drills in places where people gather like home, school, and work.

Ask yourself this simple question now……. “What if?”……

“What if ‘something’ happens and I’m not with my family?”

“Will I be able to reach them?”

“How will I know they are safe?”

“How can I let them know I’m OK?”

Do you have a Personal Emergency Plan (PEP) ?

So how do you make your family PEP ?

First and foremost, Make a plan today!! Dont postpone to the last Sunday of the month, or after you finish off that pending assignment or after your child’s birthday. The “bad guys” out there are not waiting for you to make your plan……

Your family may not be together if terror strikes, so it is important to know what could affect you. Know how you’ll contact one another and reconnect if separated. Establish a family meeting place that’s familiar and easy to find.

Step 1: Put together your PEP (Personal Emergency Plan) by discussing these four questions with your family, and friends, TODAY , to start your emergency plan.

  • Q. 1. How will I receive emergency alerts and warnings?
  • Q. 2. What is my shelter plan ?
  • Q. 3. What is my evacuation route?
  • Q. 4. What is my family/household communication plan?

Step 2:  Consider specific needs in your household.

As you prepare your Personal Emergency Plan , tailor your plans and supplies to your specific daily living needs and responsibilities.

Discuss your needs and responsibilities and how people in your network can assist each other with communication, care of children, business, pets, or specific needs like medical equipment that you or your dependents may need. Create your own personal network for specific areas where you need assistance.  Keep in mind some these factors when developing your plan:

  • Different ages of members within your household
  • Responsibilities for assisting others
  • Dietary needs
  • Medical needs including prescriptions and equipment
  • Pets
  • Location routines, such as school or work locations and timings.

Step 3: Fill out your Personal Emergency Plan – Soft copy and Hard Copy.

You can see a template online and use as a guide to create your own. https://www.fema.gov/media-library/assets/documents/133447

Step 4: Practice your plan with your family and friends. Do this at least every six months….

So, ARE YOU READY…….!!?

Nota Bene: Your Personal Emergency Plan has to have a communications component……

During any terrorist related event or even a disaster, you will need to send and receive information from your family.

Communication networks, such as mobile phones and computers, could be unreliable during such events , and electricity supply could be disrupted. Planning in advance will help ensure that all the members of your household—including children —know how to reach each other and where to meet up in an emergency.

Planning starts with three easy steps:

  • Step 1. COLLECT. Create a paper copy of the contact information for your family and other important people in your life, along with emergency services such as medical facilities, doctors, or other service providers. Type or write in indelible ink or in a laminated card format.
  • Store emergency contact personal numbers under the name “In Case of Emergency” or “ICE” for all mobile phones and devices. This will help someone identify your emergency contact if needed. Have at least one out of town contact in your ICE list.
  • Step 2. SHARE. Make sure everyone carries a physical copy on his or her person , in their bag, purse, or wallet. You should also post a copy in a central location in your home, such as your refrigerator or key tray.
  • Step 3. PRACTICE. Have regular household meetings to review and practice your plan. Do this at least every six months. Practice texting and calling. Have each family member practice sending a text message or calling your out-of-town contact and sending a group text to your mobile phone group list. Discuss what information you should send by text. You will want to let others know you are safe and where you are. Short messages like “I’m OK. At xyz Location” are good.
  • Talk about who will be the lead person to send out information about the designated meeting place for the household. Practice gathering all household members at your indoor and neighborhood emergency meeting places. Talk about how each person would get to the identified out-of-neighborhood and out-of-town meeting places.
  • Discuss all modes of transportation, such as public transportation, rail, or even by foot , for all family members. Regularly have conversations with household members and friends about the plan, such as whom and how to text or call, and where to go.
  • To show why it’s important to keep phone numbers written down, challenge your household members to recite important phone numbers from memory— now ask them to think about doing this in the event of an emergency.

Re-learning using your phone ! Use SMS for emergency communications .

If you are using a mobile phone, a text message may get through when a phone call will not. This is because a text message requires far less bandwidth than a phone call. Text messages may also save and then send automatically as soon as capacity becomes available.
Make sure all household members and your out-of-town contact know how to text if they have a mobile phone or device, or know alternative ways to communicate if they are unable to text .

For more detailed info please click on https://www.fema.gov/media-library-data/1440520833367b485ed4517c86bc824061197319f4999/Family_Comm_Plan_508_20150820.pdf

So, ARE YOU READY…….?!!

A ‘tyred’ look at wheels!

Dear Reader,
 
As it nears the end of 2018, let me narrate a wee tale of tyres, before you get all ‘tired’ from the year end wisdom (gyaan) that would be inundating you.
 
Read on, in case you are wondering about what I am rambling about….. read about tyre specifications , with those mysterious alphanumeric codes on your tyre (did you notice them ever?).

Understanding Tyre markings

Tyres have an alphanumeric code system printed / embedded into their sidewall which allows the common man to understand the technical capabilities of the tyre, irrespective of its manufacturer. 

Being able to read this information will help you maintain your tyres, and choose new ones when the time comes.
Needless to say, you would not be reading this if you didnt understand the basic fact that tyres save lives….. Remember noticing those shreds of tyres you see on our highways….. BLOWOUT ! the ever present danger to our lives on highways….. 
How to read a tyre
(Image Source : ATMA website) 
 
This code provides information on the tyre‘s construction (e.g. radial), its size, its load-carrying capacity and its speed rating.
For example, the code commonly seen on most cars may be such as this below :-

P 205 / 65 R 15 95 H

P or no letter at all indicates a passenger car tyre.

205 – Section Width

indicates the nominal section width of the tyre in millimeters (i.e 205mm).

65 – Aspect Ratio

indicates the tyre’s aspect ratio, a comparison of the tyre‘s section height with its section width (65 indicates the height is 65% of its width).

R – Radial

indicates radial ply construction.

15 – Rim Diameter

the nominal diameter of the wheel rim (15 inches)

95 – Load Rating

a symbol indicating the maximum load capacity at which the tyre can be safely operated.  95 represents a maximum load of 690 kg per tyre

Load Index
81
82
85
86
87
90
92
95
96
Max Load/tyre (kg)
462
475
515
530
545
600
630
690
710
 
H – Speed Rating
is a symbol indicating the maximum speed at which the tyre can be safely operated, subject to the tyre being in sound condition, correctly fitted, and with recommended inflation pressures. Here H represents a maximum speed of 210 kmph,

Speed Symbol

Max Speed Capability(Km/h)

Speed Symbol

Max Speed Capability(Km/h)

L

120

T

190

M

130

U

200

N

140

H

210

P

150

V

240

Q

160

W

270

R

170

Y

300

S

180

Z

240+

Production Date
The date your tyre was produced is indicated by a four-digit code showing the week and the year.
Tread Wear Indicators
The letters “TWI” show the location of the tyre’s tread wear indicators. You should check these indicators regularly to ensure the tread is sufficiently deep. The minimum tread depth is in most cases 1.6mm. Please refer to your Car Manual to locate this TWI or look closely at the photo below:- 
 
Tyres may look good and look “like new”, which is what I assumed that mine were  OK.
 
 
 
 
Entering the Madikwe Game Reserve in Southern Africa, 2008 – Nissan Sunny
Personal Experience

I have survived (with the blessings of the Almighty), two tyre bursts in succession, on a traipse across Northern Botswana in 2007. At high speeds that too…. 120kmph was the prescribed speed limit there.

My second burst tyre was “brand new” to look at, but possibly had nestled in the comfort of the dicky of the car in the sweltering clime of Singapore for all of three years!! Trivia nugget  – most second hand cars sold in Africa are from the South East Asian region, where it is apparently uneconomical to ply cars older than three years….!  To cut a long story short, in the succeeding paras, I shall endeavor to convey the essence of my recommendations from the Public Health perspective…. Anyway, you could invalidate your insurance when driving on ‘worn tyres’! 

A worn tyre will also reduce the effectiveness of your brakes, acceleration and steering. The deeper the tread the more grip you have. It is not just unsafe to ignore the minimum tyre tread depth, it is illegal in certain countries such as South Africa ! There is a legal minimum tread depth of 1.6 mm, for all four tyres on a car, and this can be checked and a fine imposed in South Africa. The way to check it crudely is to put the head of a matchstick in between the treads and if it stays put , the tread depth is ok. 

When buying a car second hand, always assume that the tyres are as old as the car is , however “new” they may look…… Rubber has an expiry date, a parallel example would be other household rubber goods, which are usually marked ” use before expiry and protect from sunlight and excessive pressure”! Your car tyres see a much tougher life in their journeys.You could also use the example of condoms, which when old get brittle and crack! Accordingly please consider buying new tyres as per the rating specifications of your car (check the Car Manual). The rating clearly indicates the maximum speed that your tyres can bear. 

For city driving you can soldier on with your old tyres, but when going on a long drive, consider the change of tyres as an investment in safety, for your family and you. The old info about tyre pressure and balancing / alignment still rings true…. so check your pressure  ( car tyre, and maybe once a year, your Blood Pressure too) regularly.

And get your tyres rotated and aligned / balanced every 10,000km. Tyre experts recommend changing tyres every 80,000 km or 2 years, whichever comes earlier, if you drive on highways. However please refer to your car manual for further info. 

While concluding , I must take this opportunity of advising you to “Buckle Up !!” that includes the passengers in the rear…..Research has proven that seat belts save lives, thats why these are there !  Children must never be allowed to sit in the front of a car without seat belts properly positioned, and just because it is not legally enforced, do not ignore child restraints in the rear of passenger cars. Safe motoring !

Philanthropy and CSR – What is the difference?

‘Charity’ and ‘Philanthropy’?

Charity, etymologically traces itself to the “Late Old English (in the sense ‘Christian love of one’s fellows’): from Old French charite, from Latin caritas, from carus ‘dear’”. Being a noun,  a ‘Charity’ essentially is “an organization set up to provide help and raise money for those in need”.

The legal basis on which such an organization can be constituted in India, is the Indian Trusts Act, 1882. Further regulation is under the Charitable and Religious Trusts Act, 1920 . With the legalese out of the way, lets get down to the brasstacks of the subject d’jour. 

Tracing its origins to the early 17th century: via late Latin from Greek philanthrōpia, from philanthrōpos ‘man-loving’, philanthropy, is defined as the desire to promote the welfare of others, expressed especially by the generous donation of money to good causes. 

Hinduism akin to and amongst other religions promotes the giving of alms to the needy which can be construed to be similar to the tenets of ‘philanthropy’ which is on a much larger scale. That said and done, to avoid any religious controversy, and to abide by the old military dictum of not discussing religion or politics , let it suffice to be stated that philanthropy is charity on a larger scale,  affecting larger populations, with a lot more resources at stake than an individual can bring forth.

Corporate Social Responsibility

As per the UNIDO (United Nations Industrial Development Organization), Corporate Social Responsibility is a management concept whereby  companies integrate social and environmental concerns in their business  operations and interactions with their stakeholders. CSR is generally  understood as being the way through which a company achieves a balance  of economic, environmental and social imperatives (“Triple-Bottom-Line-  Approach”), while at the same time addressing the expectations of  shareholders and stakeholders. In this sense it is important to draw a  distinction between CSR, which can be a strategic business management  concept, and charity, sponsorships or philanthropy. Even though the  latter can also make a valuable contribution to poverty reduction, will  directly enhance the reputation of a company and strengthen its brand,  the concept of CSR clearly goes beyond that. The perspective taken is that for an organization to be sustainable, it must be financially secure, minimize (or ideally eliminate) its negative environmental impacts and act in conformity with societal expectations. 

The Companies Act, 2013, a successor to The Companies Act, 1956, made CSR compulsory. In India, CSR is compulsory for all companies- government or private or otherwise, provided they meet any one or more of the following fiscal criterions :

  • The net worth of the company should be Rupees 500 crores or more
  • The annual turnover of the company should be Rupees 1000 crores or more
  • Annual net profits of the company should be at least Rupees 5 crores.

It is mandatory that of the net profits earned by such a company as above, that at least 2 percent of these profits is spent on CSR related activities. 

Read this post for more info if required  https://blog.ipleaders.in/csr-laws-india/

Tata Motors – as an example of CSR

https://www.tatamotors.com/corporate-social-responsibility/

Not just dependent on the enforceable provisions of the Companies Act 2013, since many decades, Tata Motors has expressed its commitment to sustainable development, where business goes hand in hand with societal wellbeing and environmental consciousness. They have been running CSR programmes under various umbrella themes as follows:-

  • Aarogya – Health
  • Vidyadhanam – Education
  • Kaushalya – Employability or Skilling
  • Vasundhara – Environment
  • Amrutdhara – Drinking Water
  • Aadhaar – Community Development
  • Seva – Volunteering

Tata Trusts – as an example of Philanthropy 

http://www.tatatrusts.org/article/history

On recently becoming associated with the Tata Trusts as a Consultant / Tech Advisor for their various philanthropic health initiatives, it was an eye opener to realise the extent and depth of the philanthropic ideology of this Trust set up by the visionary Jamsetji Tata nearly 125 years ago!

Since its inception, Tata Trusts have played a pioneering role in transforming traditional ideas of charity and introducing the concept of philanthropy to make a real difference to communities.Through grant-making, direct implementation and co-partnership strategies, the Trusts support and drive innovation in the areas of healthcare and nutrition; water and sanitation; energy; education; rural livelihoods; natural resource management; urban poverty alleviation;  enhancing civil society and governance; media, arts, crafts and culture; and diversified employment. The Trusts engage with competent individuals and government bodies, international agencies and like-minded private sector organisations to nurture a self-sustaining eco-system that collectively works across all these areas.  (details are on their website )

http://www.tatatrusts.org/article/inside/about-tata-trusts

Project Prayaas in Uttar Pradesh

Gorakhpur district lies in the eastern part of Uttar Pradesh, bordering Nepal, situated on banks of Rapti River. Gorakhpur and its surrounding region is mainly a rice growing area, with clay-ey soil and a very high water table, prone to flooding in the rainy season. This region is endemic for Acute Encephalitis Syndrome (AES) amongst its peoples and there are many deaths due to AES every year.

Management of AES cases is done at Encephalitis Treatment Centres and the BRD  Medical College Hospital which remains the only tertiary care referral center for the entire Gorakhpur division (comprising Maharajganj, Kushinagar, Siddharth Nagar, Deoria, Basti, Gorakhpur). Cases from Bihar and Nepal are also are referred to this hospital. A new AIIMS being constructed at a rapid pace in Gorakhpur, may enhance the quality of care presently available in the region. 

Besides the shortage of tertiary care services, there is poor accessibility to basic primary health care in the region, due to various intrinsic and extrinsic factors.  Hence, a combination of Primary Prevention and Secondary Prevention measures are considered to be the best approach in dealing with the paradigm. Facility strengthening and capacity building can proceed pari passu with the adoption of the Primary Health Care approach. 

The Tata Trusts have recently launched a ‘Best Practices’ demonstration program in one Block each of Gorakhpur and Siddarth Nagar Districts , to undertake a Primary Health Care based approach relying on strengthening and empowering the ASHA workers on ground.  

Through a judicious mix of on ground, hands on activities , centred around the pivotal role to be played by local communities, the Project has field workers “Cluster Coordinators” , interacting closely with ASHA workers at the peripheral echelon of the health care hierarchy, ascending upto the level of the PHC.

Mobile Medical Units, staffed by a Doctor, a Nurse, a Pharmacist and a Lab technician have also been envisaged and launched as an outreach component of the Project, in conjunction with the State Govt. At a recent launch of this MMU in end Sep, the Chief Minister Yogi Adityanathji , stated unequivocally, that his Govt is striving to ensure that basic healthcare reaches the villager, through incremental steps, and requires the assistance, participation and cooperation of all concerned persons to make the endeavour a success. 

Gorakhpur MMU launch
Hon’ble CM of UP flagging off Mobile Medical Unit van in Gorakhpur in end Sep 2018

Mobile Medical Unit – the role

Support to Mobile Medical Units (MMUs) under the National Health Mission (NHM),  is a key strategy to facilitate access to public health care particularly to people living in remote, difficult, under-served and unreached areas. The objective of this strategy is to take healthcare to the doorstep of populations, particularly rural, vulnerable and under-served areas.  It must be clearly known to all partners that the MMU is not meant to transfer patients and is not meant for emergency management of patients as it is not equipped and designed for such a role. The National Ambulance Service is to be contacted in case of emergencies. .

MMU services are envisaged to meet the technical and service quality standards for a Primary Health Centre through provision of a suggested package of services under 12 thematic areas-

  • Maternal Health,
  • Neonatal and Infant Health,
  • Child and Adolescent health,
  • Reproductive Health and Contraceptive Services,
  • Management of Chronic Communicable Diseases,
  • Management of Common Communicable Diseases & basic OPD care (acute simple illnesses),
  • Management of Common Non-Communicable Diseases,
  • Management of mental Illness,
  • Dental Care,
  • Eye Care/ENT Care,
  • Geriatric Care and
  • Emergency Medicine. 

You can have a look at the MMU Operational Guidelines here Mobile_Medical_Units NHM

Health Care Seeking Behaviour

Based on an assessment of the situation on ground , through a mix of Key Informant Interviews, Focused Group Discussions and general feedback, it is understood presently, that the health care seeking behaviour of the populace is the key area requiring to be focused upon. Essentially, people need to be sensitised to early recognition of illnesses (especially AES),  the need to seek treatment early, to seek treatment from appropriate sources and to not delay in such actions.

The pervasive influence of the media would be a major force multiplier , and needs to be suitably oriented, to ensure that appropriate coverage of future epidemics / outbreaks be done, along with highlighting of role in moulding societal behavioural responses. 

Gorakhpur media interview

The media are equally partners  and stakeholders in any campaign focussing on people at large, and need to appreciate their own potential and responsibilities and possibly seek technical support and advice from appropriate sources.

 

Primary Health Care – What is the Hullabaloo all about?

Conventionally, ” primary health care is about caring for people, rather than simply treating specific diseases or conditions.”

Primary Health Care is made up of three main areas:-

  • empowered people and communities;
  • multisectoral policy and action;
  • primary care and essential public health functions as the core of integrated health services.”

Primary Health Care graphic

“Primary Health Care can meet the majority of an individual’s health needs over the course of their life.

A health system with a strong Primary Health Care system as its core delivers better health outcomes, efficiency and improved quality of care compared to other models.

We need health systems with strong Primary Health Care if we are to achieve universal health coverage and the health related Sustainable Development Goals.”

http://www.who.int/primary-health/en/

The health related Sustainable Development Goals are :-

You can also check out the World Health Statistics data visualizations dashboard  here

http://apps.who.int/gho/data/node.sdg.tp-1?lang=en

If you were to trace the history of the Public Health system in India, it would be wise to have a quick look-see at the seminal Bhore Committee Report.

Bhore Committee Report Vol 1

Bhore Committee Report Vol 2

Over the years, the concept of Primary Health Care has evolved, one would like to say , keeping pace with times, however public health practitioners are well aware of the time lag delay in such grand public schemes……

The watershed moment in Public Health for the people should be considered to be the Health for All Declaration of 1978.

You can check out this bold declaration here ….

Alma Ata Declaration 1978 WHO

In the succeeding years, as Govts across the world struggled with different models of health care and the aspirations of their people, the 2008 World Health Report focused on this issue, as it was realised reluctantly that possibly Health for All by 2000 was an utopian dream.

Primary Care Chapter World Health Report 2008

The Govt of India, constituted a Task Force for the roll out of Comprehensive Primary Health Care, the report of which can be read here…

Report of Task Force on Comprehensive PHC Rollout

For an overview of the strategic process for Integrated Patient Centred Care, have a look at this….

Overview_IPCHS_final

In the present times, nearly 40 years after visionary world leadership set the pace for progress in Primary Health Care, there has been a Global Conference on Primary Health Care held at Astana, Kazakhstan in end Oct 2018 from which has emerged the Astana Declaration , which you can read here….

Astana Declaration

It is hoped that the ensuing years shall see the full operationalization of the principles of Primary Health Care in regions that need this the most. Let us not just wait and watch, let us be a part of the change ……

So , what is this comprehensive package of Primary Health Care Services all about ?

  • Comprehensive Primary Health Care includes the delivery of a package of preventive, promotive, curative and rehabilitative services delivered close to communities by health care providers who are sensitive, have an understanding of local health needs, cultural traditions and socioeconomic realities, and are able to provide care for most common ailments, enable referral for doctor or specialist consultations and can undertake follow-up.

 

  • Services include those that :-
    • can be delivered at the level of the household and outreach sites in the community by suitably trained frontline workers,
    • services that would be delivered by a team headed by a mid level provider
    • the referral support and continuity of care within the district health system comprising the Primary Health Centre (PHC), Community Health Centre
      (CHC) and District Hospital (DH).

 

  • The conditions listed for preventive, promotive or curative action can be broadly categorised into the following groups:-
    • Care in pregnancy and child-birth.
    • Neonatal and infant health care services
    • Childhood and adolescent health care services including immunization.
    • Family planning, Contraceptive services and Other Reproductive Health Care services
    • Management of Common Communicable Diseases and General Out-patient care for acute simple illnesses and minor ailments
    • Management of Communicable diseases:
    • Screening and Management of Non-Communicable diseases
    • Screening and Basic management of Mental health ailments
    • Care for Common Ophthalmic and ENT problems
    • Basic Dental health
    • Geriatric and palliative health care services
    • Trauma Care (that can be managed at this level) and Emergency Medical Services

Primary Health Care graphic 2

As per the Report of the Govt of India Task Force, for the ‘Organization of Service
Delivery: Institutional Architecture’ ,  Primary Health Care has been conceptualized as the care provided for a local community, by a primary health care team. Each of the services listed above has preventive, promotive, curative and rehabilitative
components.

Services for each of these components can be provided at various levels.

  • Family/Household and Community Level: This would be provided by community level workers-ASHA, Anganwadi Workers (AWW), community volunteers, school teachers, etc. Services at this level include counselling, health communication in addition to basic screening and community level curative care. It also requires the active support of the Village Health, Sanitation and Nutrition Committee (VHSNC) functioning in coordination with and under the leadership of the Panchayati Raj Institution (PRI). The ASHA and AWW would be considered members of the  Primary Care team.

 

  • Health and Wellness Centres: In order to move comprehensive Primary Health Care closer to people, existing sub centres will be converted to Health and Wellness Centres (HWC). There would now be one Health and Wellness Centre for every 5000 population. Such HWC would provide the services listed above by a primary health
    care team, led by a train ed mid level health care provider. Health Sub centres would be upgraded to provide this larger package of services, which is comparable to the range of services presently being provided in the sector level Primary Health
    Centre (PHCs). Existing Sector level PHC (one per 30,000) would also continue to provide the set of services as envisaged in the Indian Public Health
    Standards (IPHS). In effect, therefore, every existing health sub-centre (now to be renamed the Health and Wellness Centres) would provide the package of services described above, and referral for consultation with an MBBS doctor and follow up.

IPHS Guidelines for SCs 2012

  • First Referral Level: Referral support is an essential component of primary health care. It includes general medical and specialist consultation as relevant and the first level of hospitalization at the level of the First Referral Unit (FRU), which would now need to provide services beyond emergency obstetric care. While FRUs should be at the level of the block level PHC and/or CHC, in practice in many parts of the country for now, such first level referral service package would be available only at the level of the Sub Divisional Hospital (SDH) or District Hospital.

IPHS Guidelines-PHC-2012

It is indeed a deep insight into the reality of the situation, that there has been specific recognition of the fact that for a person with a health care need, irrespective of whether in rural India or in the urban areas of the country, that the experience of care should be one of seamless continuity.

The categorization into promotive, preventive, curative or rehabilitative care, or into self care, home care, primary care, secondary or tertiary or even into modern medicine and indigenous medicine, etc., are secondary considerations, for the individual.

The primary concern that every affected individual has, is in attaining and retaining
a state of well being and relief from pain and suffering and, where possible, averting death, for himself  /herself and his / her family.

Can we deliver ? As a progressive / progressing nation, with aspirations to the world stage? Do we have a choice? Do we have answers, or do we only pose questions? Let us all be a part of the change, and let us reach out to the very root of a great nation, its people. 

 

A menu for a healthier life! Random thoughts on our everyday choices…

IMG_1781
Somewhere alongside the Pacific Ocean, contemplating the future

At times, I let fancy take flight, and think that maybe I should become a “Life Coach”. But then who am I to fancy this….. Life itself is the best coach that there can be. Provided of course one wants to learn, to adapt, to improvise and to overcome, the slings and arrows of outrageous fortune…..

Over the course of the past few decades, I have often parted freely with advice, solicited or otherwise, and always considered that the person who take advice is far wiser than one who gives such…..

What follows is a message I composed for WhatsApp , to send to my friends….. piggybacking on the ever popular concept of eat all you can Buffet meals , which pile on the calories and satiate you guiltily.

And lest you think that it be original…. Well, is there anything original on the Internet?

I will gladly acknowledge the source, if I can find one….or if someone wants to lay claim to these.

So , dear reader, here is a buffet spread for you to indulge in!!

A meaningful life …. the style – choice is yours.

We start with the premise, that you agree that Health is actually the only true wealth. 

Starters: (pick any 2)

1.   Get up early (you can accomplish 20% more during the time frame of 0500h to 0800h)
Do note that to get up early you have to sleep early! So switch off your smartphones at least half an hour before your intended bedtime, and your TV too in case you are the kinds who keeps these TVs in the bedroom.

2.      Exercise for at least 30 minutes on most if not all days of the week (you have no choice with this)!  Do anything that counts as exercise. Install an app that monitors your steps in the day, on your smartphone. I personally use Pacer (available on the app store).

Try to aim for at least 10000 steps a day. Studies have found that having an app installed on your phone makes an individual competitive, in trying to achieve the 10000 steps per day challenge. 

3.      Meditate /pray/ visualize positive things/do yoga for 30 minutes every day. Breathe deep, breathe long….

This is your ‘me time ‘ don’t relinquish it for your phone or for the TV …. try not to check your phone till you finish with ‘me time’. 

Main course (pick any 6)

  1.   Dress well at all times along with having good shoes and proper socks  (this is mostly applicable to men, as the ladies usually dress and adorn themselves well enough…. Dont have ‘home clothes’ !
  2.  Outsource everything, which is not your core competence .
    You cannot do everything… let someone else do for you what you cannot or should not. For example, let a CA do your tax returns, let a cook make food for you, let a maid clean your house for you.  
  3.  *Reduce your mobile time by 30 % * The new IoS 12 has a feature which monitors your screen time for you. Delete all unnecessary apps and unsubscribe from Notifications and Alerts.  
    Exit all unnecessary WhatsApp groups and don’t forget to Switch off the phone , at least half an hour before sleeping
  4. Take bold decisions!  Do what you have always been scared to do . (No one wants to die with regrets – do you?)
  5.  Train your brain to think creatively every day. Try to do different things to exercise your brain~ start playing some new sport, go to new restaurants, visit a garden or a park  and look at other people, listen to different music genres, watch others playing, spend time with senior citizens and those older than you ! Dance if you can, sing if you must. Read the newspaper every day. 
  6. Do good for others, anonymously if possible. Give of your time to others! Be a part of something bigger than yourself ! When you are a mere dusty picture on the wall, what will people , your family , remember of you, 10 years along the road? 
  7. Start completing things left undone. Discard unwanted & unused stuff from your house and your mind.

Accompaniments (Must have)

  1. Watch one movie in a cinema hall/ play in an auditorium every month (get off your phone and meet real people)
  2. Read at least one fiction book in a month and one self improvement book every six months.     Donate your old books to school or college libraries
  3. Take at least 2 vacations in a year       Go on…. for whom are you working or saving money for? Travel enriches the soul, and contributes to the economy. Travel in style, eat frugally, drink minimally, shop less, see more.  

Desserts (pick all)

1. Devote at least one hour a day for family and friends

                Give people your time

2. Smile at all possible times and especially if no one is watching you … make it a habit

3.  Every month get in touch with one old friend or batchmate with whom you have not spoken for years

Paan 

The sweetest of all Paans—– Laugh often!!

Hope you had a lovely meal!

Have an Awesome Life!!  It’s your choice , remember! You can eat as much or as less as you like . You have already paid for the buffet that life is,. 

Nota Bene :

This is not just another of those copied forwards….. it’s edited , proof read and value added!

With love and best wishes to y’all ! And to your loved ones…

Cari

As I have spent a considerable time in the Himalayas, this may be considered as the gyaan of penance.

 

 

A simple alphabet for health!

How safe is the Food we consume?

Adulteration of food is defined as “the addition or subtraction of any substance to or from food so that the natural composition and quality of food substance is affected”. Adulteration can be deliberate by either removing substances from food items or varying the existing natural properties of food intentionally.

Adulteration can also be unintentional due to ignorance, carelessness or lack of facilities for maintaining food quality.

Either way, Adulteration of food is something that will directly affect the health of your family and you! 

Any person who “adds an adulterant to food so as to render it injurious for human consumption with an inherent potential to cause his death or is likely to cause grievous hurt, irrespective of the fact whether it causes actual injury or not, shall be punishable for a term which shall not be less than 7 years but which may extend to imprisonment for life and also fine which shall not be less than Rs 10 lakh,”.

https://www.businesstoday.in/current/economy-politics/fssai-proposes-life-imprisonment-for-food-adulteration/story/279601.html

The top 10 foods which are prone to adulteration in India

http://www.scind.org/183/Health/top-10-food-products-prone-to-adulteration-in-india.html

Some additional links to give you inputs that indeed Food Adulteration is a problem and that we need to be aware of it. 

https://www.dw.com/en/food-adulteration-a-rising-problem-in-india/a-5958444

https://mediaindia.eu/social-vibes/the-menace-of-food-adulteration/

You are invited to have a look at a YouTube video on Food Safety testing prepared in a collaborative project by a very talented colleague. (Scroll down to the bottom of the page which opens up when you click the following link…..)

https://deltazuluconsultancy.com/consultancy-services/food-safety-management-systems-consultancy/

 

abundance agricultural agriculture arm
Photo by icon0.com on Pexels.com

 

Mass Gathering Medicine

 

What is a Mass Gathering ?

(WHO)

More than a specified number of persons (1000 people to > 25 000 people)

  • at a specific location.
  • for a specific purpose. 
  • for a defined period of time.

 

A modified definition by-Polkinghorne et al :-

Events attended by a sufficient number of people and of sufficient duration to strain the planning and response resources of a community, state or nation.

If your interest is piqued enough….read more about Mass Gatherings 

http://www.who.int/ihr/ith_and_mass_gatherings/mass_gatherings/en/

https://www.thelancet.com/series/mass-gatherings-medicine

https://www.ijidonline.com/article/S1201-9712(17)30334-X/fulltext

A presentation on the fundamental concepts of Mass Gathering Medicine in the context of the Kumbh Mela was recently given to students of a premier Science Education Institution in Pune (no guesses).

WhatsApp Image 2018-09-05 at 4.45.19 PM

The students were very receptive in their attention and the questions were indeed thought provoking. The future of Science and the Country seems to be in safe hands with these young people , given their interest and curiosity.

If you would like to have a look at the detailed presentation, given elsewhere as a Webinar for the World Association of Disaster Medicine, with a target audience of Public Health and Disaster Medicine Professionals, just click on….. (its about an hour long)

 

After this tremendous opportunity to lead a Study team from the Armed Forces Medical College Pune, India, to evaluate the preparedness status of the Kumbh Mela , first at Allahabad, India in 2013 and then at Nashik, India in 2015, a comprehensive, layered module on Mass Gathering Medicine, with an extensive interactive component including table top exercises, was developed and rolled out for Undergraduate and Post graduate students of the AFMC, as also for MPH students of the University.

I am indeed grateful to my then HOD, Dr Mahen and the overall Head of the Medical Services, Dr Joshi, to have afforded me the opportunity to witness and study at close quarters the spectacular spectacle of thronging humanity.

As an aside, I did not bathe in the waters during the Kumbh Mela, maybe in the mistaken belief that I had no sins to wash away, or maybe I was sceptical in my faith about the quality of the water.

Monsoor Football at AFMC Pune

Monsoor Football

The above link will (hopefully) lead you to an article written by Col Tommy Verghese, Retd, giving the background story of the “Monsoor” football tournament conducted every year at AFMC (you guessed right, in the monsoons)! This article was published in an earlier iteration of Dhanvantari (that annual College magazine which no student ever reads through, other than to glance at the cartoons !).

IMG_2756
From a past tournament

The shiny new avatar…. note the snazzy Z

The winners from 2013 onwards

The new Monsoor Cup being presented to the College administration

Capt Devashish Sharma, Kirti Chakra (Posthumous)

It is with undeniable pride, with a lump in my throat, with a tear lurking at the corner of my eye, with overwhelming emotion , I state , in all due humility, it is my privilege to aver that I am from the same batch of the Armed Forces Medical College (the Z Batch) as Capt Devashish Sharma, KC.

http://gallantryawards.gov.in/Awardee/devashish-sharma

On 10 Dec 1994 Capt Devashish Sharma was serving as the Regimental Medical Officer, 26th Battalion the Punjab Regiment of the Indian Army.

During a cordon & search operation in Dangarpur village (J&K), he shot a fleeing militant and himself sustained bullet injuries. Despite being wounded; he continued to render effective medical care to the other wounded soldiers and evacuated them to the hospital, prioritizing them ahead of himself in the time honoured tradition of Officers of the Indian Armed Forces and succumbed to his injuries in the process, making the supreme sacrifice for the Nation..

 In recognition of his exceptional bravery in face of the enemy and unsurpassable devotion to duty, he was awarded the KIRTI CHAKRA (the second highest peacetime gallantry award of India), posthumously on 26 Jan 1995.

He remains the first AMC officer and the first alumnus of the Armed Forces Medical College, Pune, India to receive this award.

In his memory, and combining the love of students of AFMC for Football in the midst of the monsoons, and the pre-MS Word autocorrect era  of the late 1980s, when the Monsoor Cup came into existence, Z Batch has been conducting the informal ‘nothing official  about it’, “Z Batch Devashish Sharma Memorial Mansoor Cup” every year in July – August since 2013. The more rain the better…. who can resist the slush and the slipping and sliding….

The inter Batch Futsal Tournament with a sparkling rolling trophy at stake and a cash prize for the winning team is conducted every year within the hallowed precincts of the Boys Hostel . Every year , one Batch has etched their name on the trophy! Who will it be this time in 2018, in the immediate aftermath of the World Cup?

This here is a photo from one of the past editions of the tournament.

IMG_0613

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