Of Blasted Bunions and Cussed Cuboids

November 19, 2024 ~ millennialmatriarchs ~ Leave a comment

I was not born with beautiful feet. And they grew to a pretty unfeminine 6.5 size. I could have still lived with that. But then in my 30s, my right foot also started blooming a bunion. For those who do not suffer with this affliction, it is a word you may not even have heard. But for those of us who suffer, it an everyday reality. When will it start aching? Has it started growing again? Will I find a decent pair of footwear which accommodates the wretched bunion? Has anyone come out with yet another horrific torture-instrument that promises to solve the problem? And does it work? These are the questions we ask ourselves each day.

What is a bunion? Hallux valgus as it is called in medical terms, is ‘a bony bump that forms on the joint at the base of the big toe. It occurs when some of the bones in the front part of the foot move out of place, causing the tip of the big toe to get pulled toward the smaller toes and forcing the joint at the base of the big toe to stick out.’

Actually, bunions are not that uncommon. Experts estimate that about a third of the population of the US is thus afflicted. And why do they happen? Well, it is not a single reason. A combination of factors —family history, abnormal bone structure, increased motion and shoe choice — can cause them. When something puts extra pressure on the big toe joint over a long period– usually years–that can push the joint out of its natural alignment and toward the other toes, leading to bunions. Some of the causative factors are beyond our control, but some things which we can take care of include the type of shoes we wear (narrow, pointed shoes are a no-no); the way we walk (what is called foot mechanics—though not easy, it may be possible to modify our gait so it more balanced); and how long we stand (avoid standing for extended periods of time).

And in yet another blow against the female gender, women are more prone to this! 30 per cent women versus 13 per cent men report this condition. And it is ageist too—people over 40 are more prone to it.

And can bunions be treated? Well, footwear change is recommended (but where do I go, I only wear open toe flats?); bunion pads and taping (of not too much use, believe you me); orthotics–shoe inserts that support your feet (these can help); icing and physical therapy (definitely help). If the pain and swelling are intense, painkillers or steroids are prescribed (fortunately I am not there yet). Surgery is the last resort in very severe cases, but not often resorted to for various reasons.

There are also a number of ‘correctors’ available which physically separate the toes and try to change the alignment of the big toe. These look like medieval torture instruments and have been of dubious utility to me.

Well, if there is any solace to be taken from the fact that very glamorous people have bunions, we can list several such. From Oprah Winfrey and Victoria Beckham, to Kate Middleton and Meghan Markle, from Uma Thurman to Naomi Campbell, the list is pretty long. And considering that they and their feet have to be in the glare of public and media view, we can count ourselves lucky that we can be more casual about our footwear and feet.

I had reconciled myself that I would face pain from time to time, and that I would never be able to wear dainty shoes. But then along came the cuboid! What is this very geometric sounding thing? Cuboid syndrome is a condition caused by an injury to the joint and ligaments surrounding the cuboid bone. The cuboid bone is one of the seven tarsal bones in the foot. It causes pain on the lateral side of the foot — the side of the little toe. A person often feels pain around the middle of the foot, or at the base of the fourth and fifth toes. So while the bunion hurts on the inner side of my foot, the cuboid hurts on the outside of the same foot.

And not to talk of my plantar fasciitis. The plantar fascia is a band of tissue, called fascia, that connects your heel bone to the base of your toes. It supports the arch of the foot and absorbs shock when walking. Plantar fasciitis typically causes a stabbing pain in the bottom of your foot near the heel.

So all in all, I am definitely not Happy Feet!

I wonder why shoe-makers are not taking note of this huge market. If 30 per cent of the population suffers from bunions, surely many of them are yearning for comfortable footwear which is also half way decent looking. There is a pretty big market opportunity waiting!

Incidentally, Bunion is a cartoon strip by George Martin that was syndicated in newspapers throughout Britain and abroad (Canada, Sweden, etc.) in the 1960s and 1970s. Good to know someone found ‘Bunion’ funny!

–Meena

In solidarity with all sufferers of foot-pain, especially my bunion-sister Mamata!

Tragedy in a Paradise: Kuru Disease

October 1, 2024 ~ millennialmatriarchs ~ Leave a comment

Viewers of hospital serials like House become familiar with the names, symptoms and treatments for a variety of obscure diseases, from Wilson’s disease to Fulminating osteomyelitis to Ornithine Transcarbamylase Deficiency to Epstein Barr to Amyloidosis and Sarcoidosis.

But even to a hardened medical-series watcher like me, the most horrifying disease that I came across was in a news report. And the disease is Kuru.

Kuru is a prion disease. A prion is a type of protein that can trigger normal proteins in the brain to fold abnormally. Normal prion protein is found on the surface of many cells. Prion diseases occur when this protein becomes abnormal and clumps in the brain. It then causes brain damage. (https://www.hopkinsmedicine.org/)

This abnormal protein build-up in the brain can lead to memory problems, personality changes and trouble with movement. Symptoms include rapidly developing dementia, difficulty walking and changes in gait, jerking movements of the muscles, hallucinations, confusion etc. Death usually results within a year or two.

Experts still don’t know a lot about prion diseases. There are several of them, with the most common form of prion disease that affects humans being Creutzfeldt-Jakob disease (CJD). Others include Variably protease-sensitive prionopathy, Gerstmann-Sträussler-Scheinker disease etc.

These are sometimes spread to humans by infected meat products. In rare cases, the infection can spread through contaminated corneas or medical equipment.

But fortunately prion diseases are rare, with about 200 being reported in the US, because unfortunately these disorders are often fatal—there is just no cure.

Even among prion diseases, Kuru is particularly bizarre. It is caused by eating human brain tissue contaminated with infectious prions. But why would anyone eat human brain tissue? Well, it was a widely practiced funeral ritual among the Fore people of Papua New Guinea.

The Fore people live in the Okapa District of the Eastern Highlands Province of PNG. Research in the 1950s indicated that the Fore tribe had a population of about 11,000 people. Of this small number, almost 200 people a year were dying of an unknown illness. As they started investigating this, they ruled out contaminants from the environment, common infections and the possibility of genetic inheritance. They narrowed it down to something in their practices. And then a study of their funerary rituals gave a clue. The Fore people would cannibalize their dead. The anthropologist Hertz uncovered the reason for this—it sprang from love and respect for the deceased. ‘By this rite the living incorporate into their own being the vitality and the special qualities residing in the flesh of the deceased; if this flesh were allowed to dissolve, the community would lose strength to which it is entitled…. at the same time, endocannibalism spares the deceased the horror of a slow vile decomposition’, he wrote.

Children and women were usually more affected by Kuru than men, probably because they consumed the brain as compared to the men who preferred muscles.

‘Kuru’ in Fore means shivering. It is also called the laughing disease because the affected would exhibit sporadic uncontrolled laughter.

The practice was banned in the 1960s by the PNG government. But sadly, the deaths continued for quite a while after that, since Kuru has a long incubation period—30 to even 50 years. So someone infected in the late sixties might have shown symptoms only in the late nineties. The last diagnosed case was in 2005.

Thank God, it is behind us!

Sorry if this has been a morbid and depressing piece. Blame it on the news item which triggered it!

–Meena

Fever Tree

September 17, 2024 ~ millennialmatriarchs ~ Leave a comment

Clay tablets from Mesopotamia mention this deadly disease. Indian writings of the Vedic period (1500 to 800 BC) call it the ‘king of diseases.’ Traces of the disease have been found in remains of bodies from Egypt dating from 3200 and 1304 BC. The 270 BC Chinese medical canon has documented the disease’s headaches, chills, fevers and periodicity. The Greek poet Homer (circa 750 BC) mentions it in The Iliad, as do Aristotle (384-322 BC), Plato (428-347 BC), and Sophocles (496-406 BC) in their works.

The disease? None other than malaria, a disease that has taken its toll on not only humans down the ages, but our Neanderthal ancestors too. In the 20th century alone, malaria claimed between 150 million and 300 million lives, accounting for 2 to 5 per cent of all deaths!

Many have been the scientists who spent their lives trying to understand malaria. Charles Louis Alphonse Laveran (1845-1922) a French army doctor during the Franco-Prussian played a key role. He as the first to postulate that malaria was not spread by bad air, but rather that ‘Swamp fevers are due to a germ’. He was also the earliest scientist to detect crescent-shaped bodies in the blood of affected individuals, and then the four stages of the development of the parasite in the blood. These findings were confirmed by Camillo Golgi. Dr. Charles Ross and India played a huge part in the unravelling of the whole cycle and Ross received the Nobel Prize for discovering the mosquito-stages of malaria.

The story of uncovering the cure for malaria has been dramatic too. For centuries, when no one had a clue what caused malaria, treatments included blood-letting, inducing vomiting, and drastic things like limb amputations, and boring holes in the skull. Herbal medicines like belladonna were used to provide symptomatic relief.

Cinchona-nitida-quinine — *Cinchona Tree whose Bark yields Quinine*

But the cure strangely came from South America—a region not originally plagued with the diease. It was probably brought from the outside around the 16^th century. The native Indians were the first to discover the cure. The story goes that an Indian with a high fever was lost in the Andean jungles. Desperate with thirst as he wandered the jungles, he drank from a pool of stagnant water. The taste was bitter and he thought he had been poisoned. But miraculously, he found his fever going down. On observation, he found that the pool he had drunk from had been contaminated by the surrounding quina-quina trees. He put two and two together, and figured that the tree was the cure. He shared his serendipitous discovery with fellow villagers, who thereafter used extracts from the quina-quina bark to treat fever. The word spread widely among the locals.

It was from them that Spanish Jesuit missionaries in Peru learnt about the healing power of the bark between 1620 and 1630, when one of them was cured of malaria by the use of the bark. The story goes that the Jesuits used the bark to treat the Countess of Chinchon, the wife of the Viceroy who suffered an almost fatal attack. She was saved and made it her mission to popularize the bark as a treatment for malaria, taking vast quanitities back to Europe and distributing it to sufferers. And from then, the use of the powder spread far and wide. It is said that it was even used to treat King Louis XIV of France.

The tree from which the bark came was Cinchona, a genus of flowering plants in the family Rubiaceae which has at least 23 species of trees and shrubs. These are native to the tropical Andean forests. The genus was named so after the Countess of Chinchon, from the previous para. The bark of several species in the genus yield quinine and other alkaloids, and were the only known treatments against malaria for centuries, hence making them economically and politically important. It was only after 1944, when quinine started to be manufactured synthetically, that the pressure on the tree came down.

Not unusually, the tribe who actually discovered it is forgotten. The medicine came to be called “Jesuit Powder’ or ‘Chincona powder’ or “Peruvian powder’. Trees in the genus also came to be known as fever trees because they cured fever.

May the many indigenous community, their knowledge and their practices which are at the base of so many medicines today get their due recognition, credit and due.

–Meena

Slugs and Snails

July 2, 2024 ~ millennialmatriarchs ~ Leave a comment

Snails: UGGGGG!

Slugs: UGGGGGGGGGGG!

Yes, that indeed is the normal reaction. Both of these creatures are gastropods, a type of mollusk. They are both soft-bodied creatures which are covered with mucus—and it is this which usually makes people go ‘UGGGG’. But they need the mucous to stop them from drying out.

Gardeners hate them too, because some species of slugs and snails (S&S) feed on live plant material. These species are particularly fond of eating soft fleshy leaves and seedlings. Some slugs which stay underground tunnel holes in potatoes and other tubers. Snails and slugs are sporadic pests in those places where damp conditions prevail.

And yes, there are worrisome trends too. Some species of exotic snails and slugs can destroy native biodiversity and multiply madly. They have no natural predators when they travel out of their native lands, and so thrive.

In India, 1500 species of land snails have been reported, but the number of species of slugs is limited. Of these, nine species of snails and 12 species of slugs are pests, including the Giant African Snail, which is a serious problem with regards to fruits, vegetables and ornamental plants specially in the east, northeast and south; the common snail, Helix spp. ; the common garden snail; and the black slug.

These gastropod-pests are a worldwide problem. For instance, the Giant African Snail is native to East Africa. But it has spread to many, many parts of the world, either by stowing away on ships, or being deliberately brought to other countries for experiments, as pets etc. And wherever it has travelled, it is creating problems– over 500 plant species may be targeted by the giant African snail, including most vegetables, legumes, ornamental plants, banana, citrus, etc.

But wait! Before we condemn them outright, we must understand that slugs and snails are generally beneficent to the environment and have a key role to play in the ecosystems, as they are recyclers, feeding on dead leaves, dung and sometimes even on dead animals. They play a useful role in composting. And as important, they are an important food source for birds, beetles and reptiles.

And in recent years, the fashion world has taken to these gastropods in a big way. Snail mucin and slug slime have become popular in the world of beauty. Gastropod slime has been shown to have many beneficial properties–antibacterial, anti-inflammatory and antioxidant, anti-tumoral, anti-aging, tissue regeneration, wound healing etc. Snail mucin contains antioxidants that may help reduce signs of aging like wrinkles, uneven skin tone and sagging. Studies indicate that snail mucin helps with skin regeneration and protects against damaging free radicals.

And let us also recognize that the seriously devastating snails and slugs are often introduced exotic species. There is never anything fundamentally ‘wrong’ about any species. They fit and have a role in the ecosystem where they have evolved. But a species can be in the ‘wrong place’, and then they can cause devastation.

So yes, it is up to us humans to ensure S&S stay where they belong, and don’t travel.

But there is no doubt people, especially gardeners don’t like them. And this is why a wildlife NGO in the UK, The Herts and Middlesex Wildlife Trust and Royal Horticultural Society (RHS) want to challenge negative perceptions. The organisers want to create a positive image for snails and slugs by showing people how they contribute to ecosystems. Campaign organisers hope that by learning to “appreciate and co-exist” with snails and slugs, gardeners can adopt a more environmentally friendly approach. The trust, with the RHS, has produced a guide with tips to “live harmoniously alongside slugs and snails”.

And here is some S&S Trivia

Slugging is a slang term for a skin care technique that involves applying an occlusive moisturizer to one’s face, typically before sleep, primarily as a way to prevent moisture loss.

Slugging-it-out is to fight, argue, or compete with someone until one person wins.

Sluggish isbeing lazy and slow.

Sluggish in the computer world is when you use human-readable terms in a URL instead of a database number or some other form. It supposedly originated when programmers became too “lazy” to look up a proper code or ID for a website, and began naming them using words. Those “lazy URLs” became slugs.

And FYI: Snails move at a pace of 0.029 miles per hour, or 153 ft per hour. If we convert that to human speed, that’s the equivalent of walking almost 3.2 km per hour. Not too bad! So in this too, it seems snails are getting unnecessary flak!

S&S are nice fellows. Let’s not blame our problems on them!

-Meena

The Healing Touch

March 28, 2024 ~ millennialmatriarchs ~ Leave a comment

Almost all of us have been, at one time or another, a patient or the caregiver to a patient. And perhaps one of the enduring memories (good or bad) of that experience may be that of the doctor who treated. From the days of Hippocrates, known as the Father of Medicine, the ‘doctor’ is one of the key actors in the story of life and death.

There was a time, not all that long ago, when the “family doctor” was the first and last word in attending to every member of the family, from babies to the elders. Most of these are still remembered, not so much for their specialized skills, as for their comforting presence and availability, and their personal engagement with the patient. In most cases, the patient was known to the doctor from childhood onwards. Thus the diagnosis and treatment was closely linked not just to the physical, but also to the psychological aspects. Often it was ‘much less about specific diagnosis than it was about knowing the person in front of you and the illness they have, and sometimes the outcome depended much less on the nature of the illness than on the nature of the patient.’

Over time, with advances in the science of medicine, and the new developments in technology that enables more accuracy and depth of diagnostic tests, the medical profession started becoming more and more dependent on these tools. So much so, that in recent times, the first visit to the doctor results in returning with a list of “tests”, based on the results of which, the doctor would begin, at the next visit, to even “look at” the patient, let alone proceed further in diagnosis and treatment. No doubt these advances have led to a deeper understanding of disease and medical conditions, and have hugely benefitted their treatment. But such advances have made modern medicine so high-tech, research-oriented, data-driven and time-crunched, that somewhere along the way, this has led to the ebbing of the “human touch”, as it were, in the relationship between doctor and patient.

There is however, a section of the medical profession which is promoting the revival of the practice of this ‘human touch’. They believe that physical examination is a key to developing trust between patient and physician. Dr Abraham Verghese is a passionate and leading advocate of this school of thought.

Dr Abraham Verghese is perhaps better known as an author. He became known for his book Cutting for Stone, and his recent book The Covenant of Water has been acclaimed. What is perhaps less widely known is that Dr Verghese is a practicing physician and teacher of medicine, who strongly endorses as well as practices what he calls ‘the ritual of the physical exam’ as the most important aspect of developing trust between patient and physician. He believes that the physical exam is a humanistic ritual that builds trust and creates the crucial bond between physician and patient—a bond that is at the core of quality health care

Abraham Verghese started his medical education in Ethiopia and completed it in India at the Madras Medical College, both places which followed the British system of medical education that put great emphasis on learning to read the body as a text. In an interview he recalled that he had the most wonderful teachers who were incredibly skilled at reading the body as a text. He feel that this is a dying art today. We are getting so enamoured with the data and the images, the CAT scan and the MRI. But sometimes we can lose sight of the human being. …When what patients really need is something simpler and they need to be listened to, they need to be cared for.

Even as he follows this practice as a sacred ritual, Dr Verghese has been working to institutionalize this in the United States where he has worked for several decades. He founded the Center for Medical Humanities and Ethics at the University of Texas, San Antonio where the motto was ‘Imagining the Patient’s Experience’. He is now a professor for the Theory and Practice of Medicine at Stanford, where his old-fashioned weekly rounds have inspired a new initiative, the Stanford 25, teaching 25 fundamental physical exam skills and their diagnostic benefits to interns. Verghese feels that doctors spend an astonishing among of time in front of the monitor charting in the electronic medical record, moving patients through the system, examining tests results. In short, bedside skills have plummeted in inverse proportion to the available technology.

The objective of this initiative is to emphasize and improve bedside examination skills in students and residents in internal medicine, and advocating for a similar national effort at all medical schools. Verghese himself teaches students at patients’ bedsides instead of around a table. As he says: I still find the best way to understand a hospitalized patient is not by staring at the computer screen but by going to see the patient; it’s only at the bedside that I can figure out what is important. A part of you has to be objective and yet you have to sort of try to imagine what the patient is going through.

This approach has sparked a movement of Bedside Medicine which believes that the bedside encounter between a patient and physician is central to the practice of medicine. There is also The Society of Bedside Medicine, a mission-based global community of clinician educators dedicated to bedside teaching and improving physical examination and diagnostic skills. Its purpose is to foster a culture of Bedside Medicine through deliberate practice and teaching to encourage innovation in education and research on the role of the clinical encounter in 21^st-century medicine.

For many of us who wish for the return to the ‘family doctor’ in an age when this is almost an extinct species, the Bedside Medicine movement spells a ray of hope. This week is celebrated in America as National Physicians Week. In India also we mark Doctor’s Day on 1 July. While this day is marked by thanking doctors, it may also be a good time for physicians to remind themselves of the sacred bonds between the patient and the healer. In the words of Dr. Verghese At its very nature, the experience of medicine, the experience of being a patient, is very much a human experience—patients require the best of our science, but they don’t stop requiring the Samaritan function.

–Mamata

Sleepy Time…World Sleep Day

March 12, 2024 ~ millennialmatriarchs ~ Leave a comment

We who sleep well, generally take sleep for granted. But it is when we cannot sleep that we begin to appreciate how important it is. As adults, at some point of time, we all probably have experienced short-term insomnia which can last for days or weeks and is generally caused by or a distressing event. But some of us suffer from long-term insomnia, also called chronic insomnia.

The necessity of sleep, and what the lack of it can do to us, cannot be underestimated. Doing research on this subject is difficult—after all, we cannot deprive people of sleep to check what happens to them. But the general observation is that after 24 hours without sleep, cognitive effects similar to having a blood alcohol concentration of 0.10% (which is higher than the legal limit for driving) can be seen. Anxiety and agitation set in. Performance on tasks declines, making people more prone to errors. There may be changes to visual perception. After 48 hours without sleep, people may begin to have blurry or double vision, which may progress into distortions of reality and hallucinations. After 72 hours without sleep, a person may begin to slur their speech or walk unsteadily. Hallucinations become increasingly frequent and complex. As people near 120 hours without sleep, they may experience a rapid and severe decline in mental health. This may include symptoms of psychosis, where a person becomes detached from reality and has complex delusions and displays violent behaviour. (https://www.sleepfoundation.org/)

So it is not at all out of place to have a World Sleep Day. This is celebrated on the Friday before the Spring Vernal Equinox, and falls on March 15^th this year. It is organized by the World Sleep Day Committee of the World Sleep Day Society, to emphasize the importance of sleep and address common sleep-related issues that many people suffer from.

Human beings generally need between seven and nine hours of sleep, but sleep requirements vary widely across species, as do sleep habits. The general trend is that herbivores who are the prey species not only sleep less in terms of absolute time, but they sleep for shorter periods at a time. Not surprising, considering predators may attack them anytime. And in general, larger animals need less sleep than smaller ones. This is because larger animals have to spend longer time in searching for and eating food.

And to lighten the mood, here are some interesting animal-sleep facts: Impalas specially male impalas hardly sleep, having to be vigilant about predator attacks at all times. Walruses can go for 84 hours without sleep. When they do sleep, they can sleep anywhere on land, on the bottom of the ocean, even floating. Elephants sleep only 3-4 hours per night. They sleep standing, leaning on a tree or termite mound, or lying on their side. If they lie on their side their sleep is less than 30 minutes, as otherwise their internal organs may get crushed.

An intriguing question is, do migrating birds sleep and if so how? Many birds are on the wing for weeks or months, and they fly day and night, day after day. Then what about sleep? Well, studies on frigate birds have found that they sleep even as they fly! Their power-naps can be as short as 10 seconds! They also have a technique whereby only half their brain sleeps while the other half remains functional. But not all migratory birds do this—many actually take pit stops to eat and sleep.

Well, these species are lucky to be functional with so little sleep, but humans aren’t. So on this Sleep Day, resolved not to take sleep lightly. Get the minimum quota. And if you can’t, talk to a sleep specialist.

Happy zzzzzz…

–Meena

Fighting the Disease, Fighting the Stigma: Marking Leprosy Day

January 30, 2024 ~ millennialmatriarchs ~ Leave a comment

Humanity spent a few years in fear of Covid. A few decades were spent in fear of AIDS. But millennia have been spent in fear of leprosy.

Leprosy is oft-mentioned in texts of yore. In Hindu mythology, it is often the result of a curse. Samba, son of Krishna and Jambavati, was cursed with the disease by his own father for constantly harassing his stepmothers (even otherwise, he seems to have been a pretty painful character). Later, when Krishna learnt that Samba was himself led into the misdemeanor by Narada, he wanted to take back the curse, but could not. Krishna advised Samba to pray to the Sun God for a cure. Samba did so—in fact, the Sun Temple at Konark and Multan (the temple does not exist and its exact location is unknown, but may have been in present-day Pakistan) are supposed to have been built by him. As a result of his devotions, he was cured.

The tale of Reunka is a fairly typical misogynistic one. She was the devoted wife of Sage Jamadagni, cursed with leprosy by her husband for a momentary lapse—for a moment being attracted to the Gandharva King. She was advised to bathe in Jogala Bhavi a nearby lake, and was cured. But sadly, when she returned home, her husband was still furious, and commanded his sons to kill her. The first four refused and were cursed by their father to die, but the fifth, Parashuram (yes, he who was an Avatar), obeyed his father. Jamadagni, pleased with Parashuram, granted him a boon. Good sense prevailed and Parashuram begged for the revival of his mother and brothers. A repentant Jamadagni is supposed to have foresworn anger, and lived happily with his wife ever after.

Leprosy also plays a key role in the Mahabharatha. Shantanu, father of Bhisma, Chitrangada and Vishitravirya came to the throne because his elder brother Devapi had leprosy. If it had not been for Shantanu’s attraction first to Ganga and then to Satyavati, the Mahabharat war may never have taken place.

Islamic and Biblical references to leprosy also abound, and Jesus is supposed to have cured the disease with his touch.

Through the ages, leprosy was feared as a curse of the Gods, and the only salvation was a boon from them. The social ostracism and rejection by friends and family was as much a suffering as the disease itself.

Gandhiji Leprosy — *Gandhiji viewing* *what is presumed to be* *Mycobacterium leprae*

In the last few centuries, many brave souls have worked hard for the relief of these sufferings. Gandhiji was at the forefront of the fight against the fear of leprosy. Pictures of him tending to Shri Parchure Sastry, a learned man whom Gandhiji respected very much, are often seen. Sastry even made his home in Sewagram with the agreement of all the Ashram inmates.

Vinobha Bhave was another Gandhian leader who worked in this field. He and Manoharji Diwan established Kushthadham (Leprosy Centre) at Dattapur in 1936.

And of course, the selfless work of Baba Amte and his wife Sadhantai, is legendary. He was a Gandhian and active in the freedom struggle. But how he came to leprosy work is interesting. He encountered a leprosy patient one day, and it is the fear and revulsion he felt that led to deep introspection, and the decision to devote his life to this work. He not only wanted to help the patients, but also create a society free of “Mental Leprosy”, ie., the fear and misunderstandings associated with disease. He founded three ashrams for patients and devoted his life to them. The Gandhi Peace Prize and the Ramon Magsaysay award were only a few recognitions of his service.

Dr. Noshir Antia is another individual who contributed enormously to the rehabilitation of leprosy patients. He is known as the father of Plastic Surgery in India and established the first department in the country devoted to this—the Tata Department of Plastic Surgery at the J.J. Hospital in Mumbai. . His interest in this subject began when he saw the disfigurement of leprosy patients, and started to pioneer surgical techniques for correcting these. Apart from surgery, he also started research facilities to study the disease and fought against the discrimination against the sufferers of this disease, and for their rehabilitation. Dr. Antia passed away in 2007, but his legacy continues not only through the generations of doctors and surgeons trained by him, but also through the NGO he founded—the Foundation for Research in Community Health

World Leprosy Day is observed on the last Sunday of January. In India, with a slight tweak, and to mark Gandhiji’s contribution in this field, it is observed on 30 January, coinciding with his death anniversary.

The theme for the day this year is “Beat Leprosy” which calls attention to the dual objectives of the day: to eradicate the stigma associated with leprosy and to promote the dignity of people affected by the disease.

As Vinobhaji put it, the critical thing is to beat mental leprosy—the fear of leprosy. And our experience of recent diseases has shown us that fear is not the way to react to any disease. Scientific understanding and empathy are!

–Meena

Two books which may be of interest:

‘Autobiography of a Doctor’ is Noshir Antia’s tale of his life.

‘Covenant of Water’ by Verghese Abraham has leprosy, its treatment and the social discrimination as an important theme.

Oh Sh*t!

January 23, 2024 ~ millennialmatriarchs ~ Leave a comment

The last few weeks have been peppered with cleaning cat-poop of the lawn. A particular cat has taken to using our garden as its favoured toilet. Now we are spraying the lawn with a suspension of coffee grounds and haven’t had an episode in the last few days. Fingers crossed.

But the whole trauma got me thinking about poop in general.

And I realized how many words there were for this. In fact, the number of synonyms for faeces is proof of human fascination for the subject.

There is wide variety of terms for poop, and though some of them are interchangeable, there are also very specific ones– for certain types of animals or species or used in certain circumstances. Here are some of them so our vocabulary in this area can go beyond shit and crap!

Faeces is the most generic term, and the word comes from the Latin word faex, meaning “dregs”. Excrement, Excreta and Stool are also fairly generic and mean the solid wast released solid waste from the bowels of a person or animal. bowels of a person or animal Ordure too is similar—the solid waste solid from the bowels of people or animals.

Here is a look at a few other terms:

Droppings: Faeces of animals.

Dung: Solid waste from animals, especially cattle and horses

Scat: Animal faeces, particularly of wild carnivores

Spraint: This is the dung of otters.

Fras: These are the droppings/faeces of insect larvae

Manure: Manure is organic matter that is used as fertilizer in agriculture. Most manure consists of animal faeces but may also include compost and green.

Guano: This is accumulated excrement and remains of birds, bats, and seals, valued as fertilizer.

Worm casts: These are the excrement of worms. Earthworm casts are prized as fertilizer.

Fecal Pellets: An organic excrement, mainly of invertebrates.

Fewmets: In hunting terminology, these are the droppings of deer and other quarry animals by which a hunter identifies his targets. Another term used in hunting is Spoor which can indicate a track, a trail, a scent, or droppings especially of a wild animal

Fewments: For science fiction fans, this is the term for dragon droppings!

Coprolite: Fossilised faeces of animals that lived millions of years ago.

Paleofaeces: Ancient faeces, often found as part of archaeological excavations or surveys.

Rabbits, hares and related species produce two types of fecal pellets: hard ones, which are the real poop; and soft ones or cecotropes, which are partially digested food which they eject, and eat again!

In medicine and biology, scatology or coprology is the study of faeces.

The study of such excrement is of course of use to doctors in the diagnosis of various medical conditions. It is also of great importance in obtaining an understanding of wildlife behavior, and the environment as a whole. Scat analysis can yield useful information on animal populations and their distribution across a habitat, how many males and females there are, what they are eating, their health condition and from all these, information on the health of the habitat itself can be deduced. Scat analysis is sometimes faster, easier and cheaper than many other means of studying animal populations, and it is possible to get a lot of information about animals non-invasively. It is also possible to extract DNA from poop and this has helped identify species characteristics.

So it’s not just 4-year olds who have a fascination for this subject. Many adults make it their life’s work, and their chosen tool in getting to know more about the world!

–Meena

Cough, cough…

September 26, 2023 ~ millennialmatriarchs ~ Leave a comment

For the past few weeks, I was plagued by a cough. I am assured by sources that it is very good for me to cough—for instance, the Cleveland Clinic says ‘A cough is a natural reflex that is your body’s way of removing irritants from your upper (throat) and lower (lungs) airways. A cough helps your body heal and protect itself.’

I am yet to be convinced!

There are apparently many ways of classifying coughs. One is related to how long they last. Acute coughs are those which start suddenly and last a few weeks. Sub-acute ones follow infections, and last for a month or two. Chronic coughs persist longer than 2 months. And Refractory coughs are chronic coughs which don’t respond to treatment.

Another way of classifying them is in terms of whether or not they produce mucous. Dry coughs are those which do not. Productive or wet coughs bring up phlegm or mucous.

Some coughs come on at night, and are called nocturnal or night-time coughs. Others are day-time coughs.

Some types of coughs produce distinctive sounds and indicate the underlying condition: e.g., the whooping cough where the cough sounds like a ‘whoop’ is a specific infection. A barking cough may be an indicator of croup. And when coughing is accompanied by wheezing, it may be associated with some infections or with asthma.

Vaska plant — *Vasaka plant, native to the Indian subcontinent, forms a basis for many cough syrups*

And what about treatments? Well, you can take a cough syrup, a lozenge or rub on something.

Of cough syrups also, there are different types: Suppressants or antitussives do their job by blocking your cough reflex. These are for dry coughs and that itch in the throat. Then there are Expectorants, which thin mucous and phlegm, making it easier for them to be coughed out. There are also combination cough syrups which typically combine expectorants with decongestants and an antihistamine.

Rub-ons or topical applications include trusted household names like Amrutanjan.which has a nature-based cold relief balm. Such products usually have menthol and camphor, and applying them to the throat offers a soothing sensation in the area and relieves some of the associated pain.

Cough drops are the tablets we keep in our mouth, which soothe our throats and give us relief from coughing. These are used to temporarily help relieve symptoms such as sore throat, throat irritation, or cough. They work by providing a cooling feeling and increasing saliva in the mouth. Home remedy equivalents are sucking on cloves or cardamoms.

There are research studies which show that actually, not many of these store-bought medications really work any better than home remedies. The good old haldi-doodh (now fashionably called Golden Latte) is a tried and tested way to soothe the throat. A kada or decoction of tulsi, black pepper, cloves and assorted spices is often effective. Ginger tea with lemon is a sure winner.

Gargling is also an effective way to manage coughs. A salt water gargle creates a sort of osmosis effect and the salt concentration draws fluids and bacteria from the mouth, Salt water gargles neutralize swelling, and pain, and help soothe the throat region. The salt water breaks up mucus and irritants in the throat. Gargling with a salt water mixture also helps neutralize the throat acids, which helps to suppress bacterial growth.

Steam inhalations help too–they help to soothe and open their nasal passages when they have a cold or sinus infection. The warm, moist air is thought to loosen mucus and relieve symptoms.

I hope you don’t have a cough. But if you do, you are probably in good company—in the US, it is apparently the top reason people see a doctor – over 30 million visits a year.

–Meena

Health Activist: Banoo Coyaji

September 8, 2023 ~ millennialmatriarchs ~ Leave a comment

Among the recently announced Magsaysay Awards is Dr Ravi Kannan, an Indian surgical oncologist who has revolutionized cancer treatment in Assam through people-centered health care.

The citation for the award lauds the doctor’s ‘devotion to his profession’s highest ideals of public service, his combination of skill, commitment, and compassion in pushing the boundaries of people-centered, pro-poor health care and cancer care, and for having built, without expectation of reward, a beacon of hope for millions in the Indian state of Assam, thus setting a shining example for all.’

The Ramon Magsaysay Award, Asia’s premier prize and highest honour, recognizes greatness of spirit shown in selfless service to the peoples of Asia.

Thirty years ago this award was conferred upon another Indian doctor whose life and work reflected the same spirit that the above citation lauded. She was Dr. Banoo Jehangir Coyaji who was not only a medical practitioner, but an activist who used her profession and passion to change the lives of thousands of women in remote geographical areas.

Banoo Coyaji was born on 7 September 1917 in Bombay. She was the only child of Pestonji, a civil engineer, and Bapamai Kapadia. She spent her early childhood with her parents, but when she started schooling, her mother sent her to live with her grandparents in Pune, where she attended the Convent of Jesus and Mary. Thus Banoo grew up in a large loving household among aunts, uncles and cousins; while the family was affluent, the children were brought up to be disciplined. While many Parsis of the day were supportive of the British, Banoo’s family was nationalistic. Banoo herself was deeply influenced by Gandhiji and his philosophy.

One of the big influences in Banoo’s life was the family doctor Edulji Coyaji who was known in Pune for treating the poor as well as the rich. It is he who encouraged the young school graduate Banoo to study medicine. Sixteen-year old Banoo joined St. Xavier’s College in Bombay for pre-medical studies, following which she pursued medical studies at Grant Medical College in Bombay, completing her MD degree in 1940. In the meanwhile she met Jehangir Coyaji, her mentor Edulji’s younger brother, and an engineer. The two married in 1941 after Banoo completed her degree. In 1943, she moved back to Pune where Jehangir worked, to set up house. Although she had an MD in gynaecology, Banoo joined Dr Edulji in his general practice. One day Dr Edulji told her that she was to go to KEM Hospital, as they were in urgent need of a doctor.

KEM was a private charity hospital that had been founded in 1912 by Pune’s leading citizens. When Banoo entered the hospital in May 1944 it had only forty beds. Primarily a maternity hospital, most of the patients were poor women, many who came from remote areas when their medical condition had reached a critical stage. The women also came with other medical issues so the small staff had to be prepared to treat any emergency. The workload was relentless and they worked over 18 hours a day. Banoo and her husband moved into a flat above the hospital so that she was able to attend to her young son, as well as her patients.

In 1947 Banoo and her husband were among the millions who witnessed India’s tryst with destiny as we became an independent nation. Around this time Banoo also made her first major intervention at KEM hospital. Having treated, over the years, women whose health had suffered due to child bearing issues (too many children, too early or late pregnancies, and the toll of unattended childbirth) Banoo opened Pune’s first birth control clinic. She was joined by Shakuntala Paranjpe a social worker and family-planning advocate who helped her reach out to women and promoted birth control classes for local women. This was a revolutionary initiative for the time.

This was the start of many new developments that took KEM hospital from being a small maternity hospital to become a full-fledged general hospital, and one of the leading charitable institutions in Pune. To achieve this Banoo had to be continually fund-raising, adding new equipment and wards as and when she got funds. All the while she took no pay from the hospital.

Working tirelessly to maintain and grow the hospital, Banoo had no time to attend to something that had always been at the back of her mind. This was the question of what was happening in the villages from where patients often came with serious health conditions. In the late 1960s Banoo felt that it was important that the medical services should reach the villagers before the villagers needed to come to the city for treatment. She began exploring how KEM’s services could provide this outreach. Her team started by identifying a poor rural drought-prone area in Vadu Block, about 40 km from Pune. She approached the Health Secretary of Maharashtra government with the offer that the hospital run the block’s Primary Health Centre. This was agreed upon. In 1972, KEM set up a small outpatient clinic in Vadu. Maternal and child care, and family planning were the early priorities of the programme. From the beginning, KEM had emphasized the importance of research linked to its ongoing medical and public health programmes. In 1972, Banoo Coyaji seized an opportunity to establish a research society at the hospital.

While the first step to outreach had been achieved, Banoo felt that this was still a treatment service to those who came to the clinic. She felt that it was preventive care which could make a real difference, which addressed not the symptoms but the causes—sanitation, clean water, nutrition, and antenatal care. She felt that this would be best done by the local people themselves. Thus she asked each village to recommend a man and a woman who could be trained to serve as part-time health volunteers. The newly recruited volunteers underwent a comprehensive three-week training with a holistic approach to health and a healthy environment. The volunteers returned to their villages as community health guides, forming the grassroots base of a pyramid of healthcare services connecting their villages with KEM hospital at the top.

As the experiment showed results, there were suggestions that it be scaled up. In 1980 the model was introduced into the adjacent blocks of Kendur and Nhavra, where the village panchayats had passed a resolution inviting them to come. But the implementation had numerous challenges. However by the mid-1980s, Banoo Coyaji’s multifaceted interventions in Vadu were bringing about a quiet transformation, not just in human health but in the health of the local environment, and in the capacity and confidence-building of the local population, especially the women.

By 1987, many elements of the Vadu model were accepted by Maharashtra state. These included KEM’s process for selecting and training village health guides, its insistence upon retraining middle-level health officers and on continuing education for its field staff, and its effective patient referral and grassroots record-keeping systems. This model was later used in many developing countries.

In 1988, with the help of the Indian Council of Medical Research, Coyaji launched the Young Women’s Health and Development Project to support an experimental training programme for girls. Aside from lessons in health, hygiene, personal development, and family life, the girls also studied population issues, the status of women, and the importance of education for girls. A second component of the programme involved learning vocational skills such as sewing, knitting, embroidery, crochet, and making costume jewellery and decorative items.

Thus Banoo Coyaji’s vision and the work of the KEM-trained volunteers went well beyond health and family planning to encompass literacy, livelihood options, legal advice, and even the support to question social issues like dowry. It was always a challenge, but as Banoo said All social change is slow. And very profound social changes indeed are needed before India’s women can achieve their full potential.

Dr Banoo Coyaji continued to work for the causes dear to her heart till she passed away on 15 July 2004. In addition to the Magsaysay Award she received many national and international awards, including the Padma Bhushan.

–Mamata