Saturday, November 29, 2008

Salutations to the spirit of the Forces

Staying cocooned in the comfort of a lab and schooling atmosphere, thousands of miles apart from my homeland, I did feel the rush of Kargil fever bursting again in my head, when I saw the visuals of Mumbai mayhem captured on live TV.

I am proud of my many batch mates ( Armed Forces Medical College) who have selflessly joined the forces and continue to serve under difficult, and sometimes, almost inhospitable conditions. I salute the spirit that burns brightly within each of them, and feel that my success here is miniscule compared to the sacrifice and service that each one of them is doing to the country.

Let us apply these same principles of selfless dedication and service and believe that an equitable society wherein access to health care is given to each child and adult in India, through our public health education efforts ( very much acheivable...though the odds are stacked against it).
With Best Regards
Raghupathy Anchala

Friday, November 7, 2008

Why we crave love

One of the reasons we crave love, and seek it so desperately, is that love is the only cure for loneliness, and shame, and sorrow. But some feelings sink so deep into the heart that loneliness can help you find them again. Some truths about yourself are so painful that only shame can help you live with them. And some things are just so sad that only your soul can do the crying for you.(Shantaram…By Gregory David Roberts)

The reason love does apart is that it fluctuates vacuously within our self exiled self inflicted wounds that never tend to heal. Sore wounds need a meticulous way of manicuring which comfort and succor rarely provide…

The beauty of imagination lies not in accumulating dreams that are unfulfilled but dreams that will always remain as dreams…achievable, tangible yet always distant (Raghupathy)

Sunday, October 19, 2008

Third eye's perspective on a mind with two views

Resting brain signals are seldom understood. The unconscious brain's thoughts drive the conscious mind's actions. We register many a thing in the awake state, only to blissfully forget them when we need them the most. What compounds the issue is that the brain consumes energy during sleep, which, almost equals that consumed by the awake brain. This dual aspect and functioning of the brain was scientifically explained by Prof. Marcus E. Raicle in the Hoffman lecture given during the annual Science conference, 2008 at the University of Pittsburgh. His laboratory has done pioneering work on the functional MRI scanning ( glucose uptake by particular aspects of brain during sleep and active states) and found that the frontal ( that which regulates frontal and abstract thinking) and occipital( that portion of the brain that regulates vision) areas of the brain consume energy even during sleep states. The pioneering work to explain as to why the brain has to subsume so much energy is still in a nascent stage....Philosophically, this gives rise to two questions....does the sleeping visual brain consume so much to erase out the day's viewings to keep the soul unaffected by all that negativity that floats around? Does the thinking portion of the brain imbibe positivity from thought processing frontal brain in a sleeping state?

Monday, October 6, 2008

Analysis of the dream by my Father

Dear Son,
Your dream and the length of it are interesting.
The ball of fire is nothing but the fire that burns out the impurities and shows us in true and unadulterated from.
The choice between wife and father is not of much significance as the choice is between the new road of life and the old beaten road that is familiar. One gets into the new road after traversing the old road for a distance.
You have chosen for once to see the old familiar road to reassure yourself that the road still exists and saw that it really is still there.
As to the old school and the class room episode, yes, it is true that you were not speaking much for the fear of stammering but you knew all the answers and so were scoring well.Your father guiding you in such situations is quite normal and you were seeing the invisible because your daddy was and is always in your thought process but not visible to others.
Returning to Daddy is only a feel or reliving of the old times when the son looks to Daddy for support and assurance.When the son enters adolescence he tends to estimate himself more and starts disassociating with the middle aged parents, goes about finding a partner to match his energies and satisfy his inner urge.But after a decade or so when he settles into a married life and begets children he starts the father's role and starts realising the importance of the father in his life.Then he wants to tread the old path and relive the old days just to cross check if he is really doing his role well like his father. The ball of fire is an awakening in you to tell you that the new road you have chosen is nothing but an extension of the old one that has taught you the rough and smooth and to remind you that the new road also will be rough and smooth.
It is just preparing you for the parental life ahead.
All the best.
Daddy.

Saturday, October 4, 2008

Quest for the meaning of a dream

Last night was very restive one...for once I remembered my dream...may be it was the exhaustion of staying caffeneited and uptight in the Falk library reading mundane books on Infectious diseases...or maybe the effect of the walk in the Highland park area in the chilly October air ...or for once, let me be straight forward...Yes, it could have been the effect of the tired legs not accustomed to the strain of thinking out aloud!
I was tranported to the realms of Douglas' Hitchhiker's ride to the galaxy and was placed on a ball of fire asking to choose between hitching a ride with my wife or my father. Strangely I chose to ride with my father..and after a bumpy ride, we landed somewhere in the midst of my adolescence on an known territory ( where else, but my almamater, St. Paul's High School, Hyderabad). We were again asked by the ball of fire to choose the roles we each had to play...I chose to be myself for a change and Daddy had to follow suit to be an observer. He was invisible to others and seen only by that eternal flame which guided our journey from 2008 to somewhere in 1988.
Time machines have seldom the habit of staying for us to catch up with them, but, in this case, we could choose to stay on in 1988 or fly back to our current destinations. Dad wanted to see me in his new role of observership and rightfully, I wanted to end this shoddy operation as soon as possible.
Along came the teacher who always used to harass me for being a laid back back bencher etc..( who seldom answers in the class, but who scores well in the examinations). He started to prod me to read me the verse on Panchatantra (the jackal and the drum story, which in a nut shell, talks about fear and the conquer of it by people who investigate and find out the source of fear). The stammering was about to start again, but seeing my Dad stand there in the classroom, I somehow lost my fear and recited the whole verse without any more hurdles. Dad listened to my recitation and immediatley summoned his power to quit when wanted ( remember that the ball of fire gave us those powers)...
Strangely , it took me the whole of 20 waking years ( 1998-2008)to find him waiting just where we took off...he was waiting for me to come to him. The moment I reached him, the ball of flame left and we were left standing and facing the current turmoils. After a moment's hesitation, I asked him as to why he orphaned me and left me alone in that school setting. His benevolent eyes had the answer and the response was just the same. This time he handed me a paper and walked slowly away into the setting sun with the instructions to open the paper just as the sun came out alive the next day...
Well I must have been very sleepy for these 20 years to find the waking sun already up the next day. Bright sunshine, unheard of in Pittsburgh in October was staring at me...I missed the bus again...What must have been in that paper??
I have ask my Dad for the answer...

Friday, September 5, 2008

Rock on,don't compromise...Vadu's teachings

Public health field gives all of us a scope for finding our happiness in creative pursuits that see happiness and joy in others' life. I have learnt it the hard way. Childhood memories of selflessness were replaced by the selfish motives of power, success and fame in youth. The flip side is that these aspects are required for the drive within you to succeed!! The downside comes when these consume the mind and you dont listen to the heart..It took the summer research project'08 in Vadu ( 40 kms from Pune) to learn these bitter truths and the true meaning of life.

We set out to test the hypothesis that the efficacy of Beta agonist drugs wanes in Bronchial asthma subjects as the subjects age, whereas the efficacy for anticholinergic drugs increases as they age. The subjects were being recruited on a war footing by means of extensive leather hunting expeditions down the countryside of the scenic Vadu. I had a timeline to adhere and had to factor in the extra efforts to weed out the many false negatives that were creeping owing to the stringent guidleines we adopted to diagnose an asthmatic.

In pursuit of my subjects to do the reversibilty testing for lung function measurements, a portable spirometer ( an equipment that measures your lung capacity, which is compromised in smokers and asthmatics) was hired from Chest Research Foundation, Pune and we set out to do a rural sample from Vadu and an urban sample from Pune. The villagers were amused to find a pot bellied ( hey I am overweight and not obese...Ok)perspiring "town guy" conversing with them in broken Marathi and trying to find out their complaints in haste and moving from patient to patient in a harried and a very hurried state. They naturally did not open up to me the initial few weeks, but the bonding of the local social workers and my overt enthusiasm and covert slyness in coaxing them to find out about their farm income, farm state worked wonders for me during the later weeks.

I seized up my operation from the word go and planned out whom to approach ( MSW, panchayat), whom to avoid ( old men who waste my time by seeking out a detailed examination from any doctor treats for free...I later learnt that my view was distorted and wrong), whom to maska ( women, naturally...alcoholism was so rampant that most of the households are run by women here..who says that empowerement has not touched feminism....my apologies if your rustic daggers are being sharpened by this comment)

This approach paid me rich dividends..results came out to be stat significant ( here comes SAS 9.1, the great American statistical software that has whitened my hair more than my wife's scoldings could have ever acheived..trust me she is naive )and our hypothesis came out to be true for smaller airway function than for the major airways.

On the last day of Vadu victory lap, an old man approached me and offered tea at his humble house...out of respect and seeking an early end to this torture of drinking sweet Indian tea ( Yes, an year in US has made me an Indian), I made my way to his shack after he called out again that tea has been prepared...the first thing that striked me was that he was sober and very calm in calling out my vocation in life. His sayings in marathi were "aami thumcha abhari hain...Vittala ne pathawale gaon sathi thumhala" Translated literally, it means that " We are grateful. The Lord Vittala has sent you for the betterment of the village" Cmon...give me a break..I came for a specific purpose of publishing a paper, impressing my UK advisor in US( I believe that even after shifting continents,we have still yet to get over the inferiority factor), putting a name for myself in the field of asthma epidemiology ( sadly figures lack in India for respiratory morbidity).

I was struck for a minute..I just looked into his eyes and realised the vocation of my life...on the way back to Pune, I strived to recollect the good things that my visit to the village has done...nothing...nothing but my own selfish motives came to the forefront. What prompted the humble soul to elevate me to that high altar..answers are missing..questions keep galloping...

Life gives us a small glimpse of the future when we are still learning the intricacies of the our respective complex lifestyles. It gives us a bigger glimpse when we are still nurturing our thoughts on learning the nitty gritties of getting along well in the complex societal heirachies. The final glimpse is cast in iron when we see the purpose and the truth in our actions and "reward punishment" cycle.

The critical thing that drives mankind is ego and satisfaction, which, if not nurtured in the right direction see a lot of negative thoughts and emotions creeping into our already compromised positions in life. Compromise is in itself a never ending spiral, a viscious one indeed that has got a big inlet and an small outlet that borders on frustration and unhappiness. The lesson I learnt was not to compromise on the joy seen in other's peoples lives when we serve selflessly.

I came back to US and practically forgot about it, until an e mail came from one of the MSW's stating that she incorporate her name, if ever the paper gets published!!!

RASA BHARITAM MADHURAM...WORLD JUST GOES ON..U LEARN AND ADAPT....

With Best Regards
Raghupathy Anchala

Wednesday, August 27, 2008

Public health challenges in India

Public health challenges in India:
Are a billion people too much to handle? Pessimistics will view the picture as crumbling infrastructure coupled with an ailing , albeit non existential primary health care sector. Optimists see it as a manpower driven nation on the revolution bandwagon. I see it as a nation that needs nurturing of appalling public health awareness levels. People endowed with knowledge can care for themselves. They do not need the powers that be to tell them what is good or bad for them. The critical public health issue with our nation is that clear cut guidelines are seldom implemented. Policy and advocacy matters are so clearly flouted that it is no wonder to see apathy of the common public to matters of grave public health importance. It is indeed sad to note that only panic mobilizes our populace. It is this callous image that we have of public health that needs a change for the better.
The biggest challenge is the twin epidemics of chronic diseases and infectious diseases that are steadily making inroads even into the bucolic communities. Sanitation and hygiene have improved considerably since the past 30 years only to be replaced by scarce facilities/resources for the burgeoning population. An ever growing middle class with burgeoning consumerism attracts it’s own pitfalls. Statistics are pointing to a trend of increasing lifestyle disorders, but that is just the tip of the iceberg. Primary prevention with adequate focus on public education will go a long way in reducing the increasing burden of cardiovascular and Lifestyle related diseases
Imparting education to grass root level health care workers makes an enormous difference. Oral rehydration therapy is a case in point. The scourge of infant related diarrheal diseases came down on account of widespread education of simple sugar and salt therapy imparted by Angan wadi workers. My initiation into public health started with this simple concept of imparting knowledge to the entire field staff involved in my rural communities. Medical knowledge needs to be simplified and demystified for the public to appreciate the fact that simple preventive measures can make a big difference in their quality of life care and medical costs.
It needs a good ear and a clear sight to look into the future and most importantly to share a common vision that has inputs from all those involved in the health care sector. For a country steeped in ignorance and economic impoverishment, education on public health issues is far paramount than allocating budgets. A case in example is the AIDS pandemic and MDRTB. A majority of CSW’s know about condoms, but they don’t bat an eyelid if a client pays them extra money for unprotected sex. Similar is the case with TB. RNTCP is making rapid strides in converting sputum positive rates thanks to the educative initiates taken by the local health workers. Educating that sputum conversion is important than X ray diagnosis to basic health workers has made such a difference.
Hence, I wish to write, communicate, pursue research and educate the common public and empower them. To achieve that, the lack of public attention to health, the persistence of the notion that health is a personal responsibility (and ill health a personal or cultural failure) needs to be changed.

Life and faith

I believe that faith comes from an understanding of our own selves. It is only in testing times that one's character comes out.. I have to take a leaf from Arjuna's travesty with destiny....some how the justice that the above one does to good ones counterbalances the very purpose for which he has created us..Life is a quagmire with an inverted mirage that seems so near with bifocal lens but which is clearly seen with a true conscience

Tubercular musings

A very eloquent and poignant article has been written and published in this week's NEJM on TB. Though the writing skills of this young Physician from India are extraordinary, what touches me the most are his narrative skills...""[life is] the existence of what, in actuality, has no inherent ability to exist, but only balances with sweet, painful precariousness on one point of existence in the midst of this feverish, interwoven process of decay and repair."

Poetic indeed..to describe the effects of TB !!!
http://content.nejm.org/cgi/content/full/358/11/1092?query=TOC

Do read through the entire document as his feelings of service in US are echoed by all of us who feel that our motherland needs more of the reverse brain drain...

Best Regards
Raghupathy Anchala

Nobel laureate thoughts

We at Pitt were fortunate to hear Nobel Prize winner for 2007 deliver a key note address on his ongoing research activities. Univ of Pittsburgh Medical school (UPMC) has had a rich history in that whomever they call to deliver the Hoffman Key note lecture has gone onto win the Nobel Prize in the field of Medicine/Physiology. (This is an ongoing probability tug of war that UPMC always beats the odds in calling the right person to deliver the speech for the past 7 yrs!!).

The atmosphere was so hallowed, the alumni hall was packed to the hilt, there was a genuine air of warm expectation in the wind, (which contrasted to the cold wave biting all of those who were not able to enter the hall..watching outside on the giant screen). Anyways, our Infectious dept Indian guys managed to wrangle out the black tickets( Trust me , habits really stick on and they help u when in need) and we were let in albeit with a bit of suspicion by the surly matron. The irony was that our sincere Profs were left out standing...The talk was on and the great man succintly talked on the Genetic models in mice modelled to develop human diseases. He tranfected the mice with oncogenic (cancerous) genes (in embryo)....and managed to develop histopatholgical and gross lesions that exactly resembled human cancer in vivo. Later on, came the exciting breakthrough acheived due to endless hardwork and night awakenings. They followed the same techniques and applied it to the brain circuits!!. They managed to transfect the mice with HOX genes...that caused pathological grooming (mice continously scratching and pulling out the hair, even to the extent of neglecting food and sex). This model was so akin to the human Obsesive compulsion disorder ...and lo..there was big breakthrough in the scientific world. The talk went on to describe the neuropsychiatric conditions that can be and on existing current models. It ended with a standing ovation and the house was thrown open for discusion. Nobody wanted to disturb the applecart ( so full of bountiful grants that may be denied if they questioned the great man!). Probably it might have the perennial itch to walk upto the podium and face the camera and look into his eyes / to prove to my advisor that all the goofs I do in Journal clubs can be excused with this grand entry of mine into the regal world of research/ to find out the passion which the great man had for his work..whatever may have been my state at that time.... I managed to muster the courage (my hands were literally tied down by my friends)..., nervously walked upto the mike and asked him (stammering came back to haunt me after a gap of 12 yrs) as to WHETHER HE EVER THOUGHT OF MODELLING ANIMALS TO FIND OUT PSYCHOLOGICAL MANIFESTATIONS OF POVERTY.

I managed to ask a real hard core basic sciences researcher on somethinh which even economists struggle to answer. Come to think of it...It must have been the position paper that I had to write for Public health overview 2 credit course on Poverty that must have been subconscioulsy working in my stupid grey cells at that point of time. There was stunned silence for a moment and then the audience slowly and nervously began to talk of the relevance of the question and on the goof up that I created. The over 65 +faculty sitting in the front row turned on their hind legs to find out who this champion of poverty was!. The fact that the nobel laureate should choose to drink water at that point of time added to the haunted silence of those 5 seconds. (How I wished the earth would swallow me). The desolation in the air was dispelled by him in the end. He started recounting his 8 childhood yrs which he spent on the streets of Italy. (For a brief period of 8 yrs, he was separated from his mother and spent his early childhood in penury). His apt reponse was that environmental factors and genetics are two issues which are distinct , but linked in a way by society. Mice kept in the same cage..one given food and the other starved..tend to be aggressive in the initial days, but later on come to accept their positions, very akin to our real worls situation. It is what is fundamentally called adaptation. He asked me to focus on the real world outside for this daunting question and to come back to him with data on socio economic conditions and behavorial adaptations to model the same in animals. So . in the end , it was DATA!!! and adaptation. All of us come from middle class background and we have never seen real poverty at close quarters. When we go back into our respective careers and look at the ground situation in India, I think we should be sensitised to the disparity in the diaspora of the Indian mentality and strive to negate the perceived notions of "Oh! It doesnt affectme". In the end, I was vindicated when my position paper on poverty received only 80% mks, because I have never experienced it. I have consciously tried to highlight my feelings so that I can sensitize many of you to show that Great people are indeed humble and always have a humble beginning like any one of us!!. Have a great weekend..but spare a thought to the social revolution on ur social outings this weekend. Bye for now.. I do ramble a lot!!
Raghupathy