A Doctor's Crime

Dr Binayak Sen’s tryst with this country’s government and its laws has dropped the hot question on our plate, “How far should doctors go to help their patients?”

For those of you who may not be aware, Dr Binayak Sen is no ordinary rabble-rowsing doctor. He is a specialist in Pediatrics and Public Health and has taught at the Jawahrlal Nehru University in Delhi. His indoctrination probably started with his joining the famous Christian Medical College, Vellore, one of the few institutions that still inculcate human values and spirit of social service in its students.  His research on “Marasmus and Malnutrition in children” further initiated in him a deep involvement in inter-related issues of hunger, poverty, malnutrition and the wasted lives of poor childen.

 Dr Sen, who has dedicated his life serving the poor and marginalized tribals of Chhatisgarh, soon realized that poverty and starvation were the root causes of malnutrition in rural Indian children and that expensive protein and vitamin supplements could not be the prescription for our impoverished ‘Bharat’, a place quite remote from the glitzy, Forbes-featured, IPL-playing shining “India”, that we are more familiar with.  The Christian training must have infused a dose of altruism in this dedicated young doctor, urging his conscience to prick him all night as he lay in bed while children starved, moaned and cried for food in nearby slums.

What would have been the right path for him? Look away from the misery, sit in a swanky clinic, write prescriptions of vitamins for well-fed kids from affluent urban homes, play snooker and gossip over Scotch in the evenings, as many of us do?

Doctors have their peculiar joys, challenges and frustrations. It is difficult to describe the delight we feel when a critically ill child wins his fight and gives that priceless hug to his doctor before heading home. What is frustrating however is to lose a battle and a life when medical cure was just a notch away but eluded us due to shortage of resources, food, medicines or a little care.

How does one meet the imploring eyes of a child suffering from tuberculosis, rendered feeble and bedridden by the additional scourges of malnutrition and poverty?  Does one tell the tribal labourer parents, who cannot afford his treatment that allowing their son to die might be a salvation for them and their remaining children? And what if the money required for saving his son was a small fraction of what his master spent on parties each evening? Would breaking a rule in his desperation to save his child then amount to a hideous crime?

In 2004 Binayak Sen was awarded the Paul Harrison Award from the Christian Medical College, Vellore in recognition of his outstanding contribution to society, ‘for carrying his dedication to service to the very frontline of battle and for redefining the possible role of the doctor in a broken and unjust society”.

And if this indeed was his crime, should doctors not feel proud to commit it many times! 

As published in HT City ( Hindustan Times) dated 24 April, 2011.

Fasting and Health

The recent indefinite fast undertaken by 73 year old Anna Hazare to protest against corruption has also triggered discussion on the impact of fasting on health.How the body responds to prolonged denial of food depends on several factors such as the person’s weight, age, duration and whether water is permitted.

Glucose is the body's primary fuel source and is essential for the brain’s functioning. When denied glucose for more than 4–8 hours, the body turns to the liver for glycogen, a storage form of glucose, to be used for fuel. At this point, the body also uses small amounts of protein to supplement this fuel. This fuel will last for up to 12 hours before the body needs to turn to glycogen stored in muscles, lasting for a few more days. If glucose is still denied at this point, muscle wasting is prevented by temporarily switching to fat as the fuel source, meaning fat is converted into ketones. Ketones, while not sugars, can be used by the brain as a fuel source as long as glucose is denied.

The body continues to use fat for as long as there is fat to consume. It will generally indicate to the faster when fat levels are running extremely low (less than 7% and 10% of body weight for males and females, respectively) with an increased urge for food. If the fast is not broken, starvation begins to occur, as the body begins to use protein for fuel. Medical complications associated with fast-induced starvation include electrolyte imbalances, fall in blood pressure, rhythm disturbances of the heart, thinning hair, and emaciation. Death can occur if fasting is pursued beyond a point.

Fasting has often been used as a tool to make a political statement, to protest or to bring awareness to a cause, as we know so well from its use by Mahatma Gandhi to get us independence from British rule. Deaths due to hunger strike are however far from elegant. In pre-Christian Ireland, hunger strikers would lay themselves down to die upon the doorsteps of their offender’s homes, a custom known as Troscadh orCealachan. Bobby Sands and nine other Irish republican paramilitary prisoners died in a hunger strike protesting Britain’s treatment of Northern Irish prisoners, while imprisoned Cuban dissident and poet Pedro Luis Boitel died after a 53 day hunger strike in 1972.

The health effects of periodic fasting are however generally positive and has been promoted by most religions. It helps loose weight by shedding excess body fat, improves diabetes and high BP, and has been shown to reduce cancer risk. Studies have shown that periodic fasters have lower risk of heart disease and tend to live longer.

Someone quite aptly commented that a fast would have done a lot of good to the health of our bulging leaders, had they participated instead of the elderly Anna.

As published in HT City( Hindustan Times) dated 17 April, 2011.

Cricket Fever

The English gentlemen’s sober game of cricket has metamorphosed, as we saw in the recent world cup, into one of high excitement and intense passion. In its new avatar it has proved more effective than any other movement in uniting a billion people in as diverse a country as India, since the freedom struggle. We saw Indians unite together and pray to different gods in diverse ways for the common cause of our national achievemnet and pride and Sachin and Dhoni emerge the strongest role models for our kids.

Cricket’s impact on our society and health has indeed been huge. Although it is not our official national game, it is more popular in every nook and corner of the country than any other. Being a team game, it generates camarederie, shared goals and sportsmanship. It is useful in team building exrcises as was demonstrated in Aamir Khan’s movie “Lagaan” a few years ago.

History tells us that the game was devised during Saxon or Norman times by children living in south-east England in 16^th century. Adults started playing itmuch later. Possibly cricket was derived from bowls by the intervention of a batsman trying to stop the ball from reaching its target by hitting it away. The original implements may have been a matted lump of sheep’s wool (or even a stone or a small lump of wood) as the ball; a stick or a crook or another farm tool as the bat; and a stool or a tree stump or a gate (e.g., a wicket gate) as the wicket.

The game’s impact on physiacal health is clearly divided on age lines as the game is still played largely by children. It enhances physical activity, emotional well being and social interactions. It wards of obesity, reduces the risk of diabetes and heart disease, improves cognitive skills, and is a great stress buster.

 Its effect on adults, who merely watch it, is worrisome. Lazy as we Indians are, it provides many the moral justification, especially when cheering team India, to sit idle in front of TV screens for as long as 8 -10 hours and munch on salted chips or nuts, that are high on calories and sodium (bad for our weight, blood pressure and blood sugar levels). Worse is the habit of long drinking binges while watching the game with friends. Liquor sales had spurted to new heights during the last 2 matches of the world cup. Many partied with friends over pizzas while watching the matches. Several adults find entertainment in Navjyot Sidhu’s neologisms and histrionics or Boria Mazumdar’s brand of ‘who-scratched- his-nose-while-taking a run-at-Lords’ type of GK questions. Entertainment and excitement, no doubt, but how are we translating this national obsession into what cricket is meant to be: a physical sport that helps keep our bodies healthy?

 I think adults and girls need to think beyond the current form of cricket and excite themselves with a form that they can play as well. If cricket it must be, the game needs to undergo another metamorphosis to a all-can-play avatar.

As published in HT City ( Hindustan Times) dated 3 March, 2011.