“We do not inherit the earth from our ancestors; we borrow it from our children” Dr Sahadev Swain, Wheathampstead,UK

via “We do not inherit the earth from our ancestors; we borrow it from our children” Dr Sahadev Swain, Wheathampstead,UK

“We do not inherit the earth from our ancestors; we borrow it from our children” Dr Sahadev Swain, Wheathampstead,UK

“We do not inherit the earth from our ancestors; we borrow it from our children“, this is one of the most powerful quotes about the environment. I remember reading a story in primary school entitled “ who do we plant a tree for?”

Nowadays I travel a lot by air. When I travel to the developing countries I see huge buildings, what I call concrete jungles, being built on the fields that were being used for the cultivation in the past.

Therefore it is logical to plant trees. I remember in my childhood only the Brahmins ( the people of upper caste) were entitled to plant coconut trees. If people belonging to any other caste planted coconut trees they were told that the head of the household will die within a year. As I grow older I know now the sabotage and conflict of interest.lead to encouraging such belief. My grandfather was a bit of rebellious and you can say a bit mad person in a good sense. He defied such notifications. You can now see the coconut trees in the backyard of my house planted by him are still thriving. Of course, he is dead and died a natural death rather than in one year as predicted by the people with the vested interests,B3C9B005-34C0-46EF-9288-466B816AED3C

I was able to enjoy the refreshing green coconut water when I visited my native place recently. This probably answers partly the question posed in the story in my textbook “who do we plant trees for?”. Like we are enjoying the fruits that our forefathers planted we have a duty for our future generations.

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The famous  saint Kabir d says “In vain is the eminence just like the date tree, No shade for the  travellers and fruit is hard to reach.” Therefore, the trees particularly in the roadside should be shady and must provide edible fruits or enchanting flowers.

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While in the village I did take the opportunity to plant over 100 trees. Not sure it will compensate for my carbon footprint or not. The village Sarpanch also has promised to plant some more trees in the village in the next financial year when more money will be available to him.

 

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In addition, plastic bags are banned in my house. We partly produce our own electricity by investing in solar panels. We use electric vehicles although the jury is out on whether they are environment-friendly or not! Reusing and recycling seem to be the modern-day mantra for a green environment. Are you doing your share of this? Let me know how by commenting on this article, please.

 

The way global warming is going the future generation is now wondering what is there in store for me.B4288954-A709-472F-92D7-7F07E6A135F0

 

We, adults, have to just remind ourselves “ “We do not inherit the earth from our ancestors; we borrow it from our children

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Photo credit Lalit Rout

Letter from a remote village in Odisha: Dr Sahadev Swain,MA,MD,FRCGP

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Dear readers,

I am a General Practitioner (GP) in the UK. I was born and brought up in a village called Shalianch, now in Kendrapada district of Odisha,India.

 

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( taken from internet                                                           )

The village is situated in the middle of nowhere. The village is surrounded by cultivable lands where mostly rice is grown. in my childhood, there was an MBBS qualified private practitioner serving about 100000 population in the area. Right from my childhood I always wanted to be a doctor so that  I  can help of this doctor who was serving the community singlehandedly. After several decades I decided to return to the village with the intention of meeting older people and bid good bye to them, in case I am unable to travel to the village in future. Here is a brief account of my reflection.

 

With due deliberation I decided to live in the house I was born and meet people. I reached the village with my sister’s family. I was welcomed by my cousin’s family who lives in the house. Soon we had to get on with the work.  I had my bag with basic pieces of equipment that I used for my usual consultation room. I also got a prescription pad printed with my personal details. I had collected some basic essential medications particularly if anyone was unable to buy them. We had a fixed time in the morning and in the afternoon. The people were informed and instructed to in one by one. I was ably assisted by a student nurse, an ASHA worker and my sister who is a local AYUSH doctor and her student physiotherapist son by taking turns. The patients came mostly one by one although sometimes they wanted to enter all at once. The stories unraveled one by one.IMG-20191126-WA0023

It is difficult to describe each case in detail but I will like to outland some cases in general and a few cases in specific to bring home  some points of observation.

Diabetes appears to be a huge problem in the village. n a village of 150 households there were at least 40 known cases of diabetes. There were different levels of awareness about the disease Some of them were very aware and took their medication regularly. But many of them were unable to afford the expenses of buying regular medications. Some of them mentioned about taking other forms of therapy like homeopathic or Ayurvedic medications. Some of them, however, were so confident of the mercy of God that they did not feel the need for taking any medication either for diabetes or hypertension.

However, some of them did attend reputable diabetic clinics. They were given written leaflets about a detailed diet plan and other advice. I tried to organize a joint consultation morning for all the people with Diabetes. However, it was challenging. My intention was they can learn from each other about diet, exercise, medication and whom to consult. In the end, I ended up consulting them individually to give customized advice.

 

Musculoskeletal conditions were the next most common presenting problem. Osteoarthritis was particularly relevant to the elderly population. The involvement of knee, hips, and back were problematic for both men and women. There was difficulty in squatting for defaecation in addition to limiting the day to day activities. The men who were the main bread earners from farming activities were unable to perform their usual jobs. But it was heartening to note that some of them retained their mobility by continuing to use bicycles. However, I saw one of the most severe forms of osteoarthritis of the knee resulting in fibrosis, muscle wasting and complete lack of flexibility . as a result the person was completely bedridden. This added an additional burden of caring for the women of the house particularly when the men were out in the town to earn a livelihood.

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Low vision particularly due to cataract was very common This I thought was one of the most common causes of blindness that could be prevented or cured. I did come across a woman with night blindness that was resistant to vitamin A treatment. This condition in a middle-aged woman who has been recently widowed and with interrupted electricity supply in the village and toilet outside the house adds to the plight of the woman if she has to go to the toilet in the middle of the night. I later gathered she may have retinitis pigmentosa. She was reluctant to take up my offer to go to the ophthalmologist for further diagnosis because of a lack of resources.20191119_092500

Hypertension appeared to be a common problem among the villagers. For one of them stroke was the first presenting problem. Many of them did not know they had hypertension and others did not see the importance of taking regular medication. Although this person survived the stroke the physiotherapy, medication and regular check-up in a tertiary care center are very expensive for the family. Not to forget that this middle-aged man will not be able to do farming that he used to do. Also once a stroke happened I saw how difficult it is for the family to provide aftercareIMG-20191125-WA0008

 The incidence of road traffic accidents  is increasing  due to improving road conditions and moremotor bikes and other veicles . Some of them are fatal.accidents . The survivors are also left with a lot of physical and mental morbidities morbidity due to trauma and posttraumatic stress disorders.

There was also  also delayed diagnoses of cancer due to lack of screening facilities . Eeven after the chance diagnosis  proper treatment and follow up in thecancer centres were out of reach for ordinary families.

 

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End of life care was also difficult due to the complete lack of resources. I witnessed the struggle of a family in even providing a comfortable bed to the dying. Bedsore in the shoulders are not very common but was present in the person I visited.

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I did encounter acute cases of asthma. I was puzzled by higher incidence of allergic rhinitis in the village,maybe the dust, pollen or grass are the allergens!

This is in addition to the burden of communicable diseases. I did encounter cases of typhoid and tuberculosis.

My letter from the village will be incomplete without mentioning my visit to the school or me helping plantation of about one hundred trees in the village.

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I enjoyed the company,curiosity and intelligent questions from the students. I was able to pay my respect to some of the surviving teachers. However, I did notice that there were still no toilets for the boys at school! There is also no computers in school!

IMG-20191126-WA0022 How has it changed my life?

My encounter with abject poverty has taught me

  1. Do not complain. Be grateful for what you have.
  2. A liitle act of charity can change some ones life.
  3. If you walk one step the world walks two steps with you. So take the first step yourself.
  4. At the end there is thank you most of the time!IMG-20191125-WA0159

How is it relevant for Family medicine?

  1. I feel I was able to deliver health care to everyone with the help of low tech instruments because of my training and expertise in family medicine. Therefore, the quality of postgraduate training in Family medicine is essential for the provision of universal and quality health care coverage at the ground level.

 

  1. Besides my long experience and knowledge, my long-standing relationship with the villagers helped me to gain their trust.

 

  1. The patience and respect by providing privacy, full attention and active listening and the dialogue with the family increased the patient’s (and doctor’s) satisfaction.
  2. Family Physicians are the leaders who can be instrumental to deliver care at the village level. The Family health Centres of Kerala provided the perfect model for the rest of the country

5. Will telemedicine help for remote access? only time will tell.

6. We need “Setu” program of the Academy of the Family Physicians of India to reach out to the villages.

Now that I know so much about the village I wish I was their permanent family physician! How nice it will be if every village like mine had their own family physician? Is that not a utopia at the moment?

Thank you for your attention,

Yours sincerely

Sahadev Swain

NAMMA BENGALURU: FMPC 2019: SOME PERSONAL REFLECTIONS

 

Date- set and go. The date was set for the conference about 2 years ago.  The month of August is the rainy season in India. We don’t like visiting India at this time. The dry heat in Delhi, rain, and humidity in Odisha and flooding in Mumbai are to be expected at this time. The traffic in Bangalore gets worse in rain.  However, my wife and I have always attended FMPC  in the past and this one was not to be an exception. However, a health scare to my own health made the journey almost on the verge of cancellation. But my determination and some sort of stubbornness resulted in the cancellation of the cancellation and we set off!

We actually reached the town two days ahead of the conference. We are overwhelmed by the hospitality extended to us by our host who are parents of a close friend!69063852_10156167962246916_7134017790498832384_n

We went around Bangalore mainly using public conveyance like metro to places like Lalbag and ISCON Temple. Not to forget the dining experience at MTR! So we were already initiated to the concept “Namma Bengaluru”!WhatsApp Image 2019-08-01 at 15.31.26

Bangalore city, unlike other Indian cities, has a unique feel. The newer technology nicely blends with the traditional streets in the city.

As per the conference, as international faculty, has also shown exceptional hospitality in terms of accommodation, travel, and food to us. Thank you, the organizing committee. My wife and I are extremely grateful!67532140_1350590568430032_7315851102195286016_n

A record number of ( about 600) of delegates attended the conference. There was something for everybody. The 3 satellite postgraduate sessions were oversubscribed.

66736132_441009243145014_58259895635410944_oThe conference was inaugurated by a lineup of dignitaries .it looked colorful. The guests included the president of the national board of examination, Dr. Abhijit, an eminent cardiothoracic surgeon, the Vice-Chancellor of Rajiv Gandhi University. The Mayoress of Bangalore impressed all of us all with her simplicity. Although I did not understand fully her inaugural speech in Kannada what I sensed that she was intrigued by the concept of family Physicians. It would be nice to have one doctor ( Kutumba Bidya) to go for all the need of your whole family rather than visiting the umpteen number of specialist separately. The inaugural function is always prolonged than planned. It was heartening to see the groups like AFPI Kerala and individuals being recognized for their outstanding work. I will particularly mention Dr. DN Sharma memorial prize for the best thesis award that I had instituted in the memory of the general practitioner of my village and my first role model.

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What I was also particularly pleased about the release of the book we have been trying to edit with for a while. This was actually one of the reasons why I did not want to cancel my journey at the last moment.book cover

 

The editing the book has brought me in contact with many family Physicians. This has also given me a chance to look at the development of family medicine in India. 

 

The FMPCs also give me a chance to look at the development of Family Medicine in India up close. I distinctly remember there was hardly 30 people around the table in the general body meeting 1st FMPC at Delhi. Slowly the number and the stature of the leaders have grown over the period of time. So also the number of delegates attending the conference. It is always heartening to see the growth of family Physicians in India. The young doctors who used to be volunteers as residents are now holding faculty positions and conducting the meetings and sharing sessions effectively and efficiently. Certainly, something very exciting to observe!

 

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What was particularly heartening to see the democratically elected executive of the AFPI and the financial transparency of other organization in the form of audited accounts in the general body meeting of this year.

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In organizing conferences large-scale like this money is always a worry. The FMPC conferences are unique in a way they are not sponsored by large multinational pharmaceutical companies. However, the organizers informed that all the stalls were sold easing the financial pressure. I’m sure it is only possible but the negotiation power and influence of the organizers.

The conference was a feast of scientific programs. The scientific committee is the grandmaster of the whole orchestra. I’m sure they have to invite, design and select the speakers and the sessions to make the learning experience of the delegates enjoyable. Many sleepless nights for peer-reviewing the abstracts as well. In addition, a lot of struggling and juggling of the sessions and the rooms available.

 

 I was impressed with the customized mementos.

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There were inspirational books as a present to the speakers and unique concept indeed organizers have certainly been very thoughtful.68261237_10156167961566916_2628389443916005376_n

The material of the bags is of special note!

 

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The keynote speakers chosen were inspirational. Dr. Rao raised the important issue of stress among the doctor’s and advised to utilize customized methods to suit individual circumstances from sports, exercise or meditation for de-stressing. He also advised being mindful of the emotions of the patients that are transmitted to their physicians ,Dr. Pandya highlighted the importance of cooperation between primary care and secondary care Physicians. He recommended the importance of creating group Practices for family Physicians. I thought his interpretation of artwork from the Tate Museum “the doctor” was very interesting.

The orthopedic surgeon demonstrated state-of-the-art work being done at the Sparsh hospital. The  NBE president promised an additional 500 seats for family medicine. The Vice-chancellor of the Rajiv Gandhi  University promised to write to all the medical colleges in the state of Karnataka to start family medicine departments.

Dr. Shailendra Kumar cautioned the audience about the inappropriate use of technology and particularly not to use technology in the wrong order.  For example not to order CT scan first without talking or examining the patients.in that case, one will be doing a disservice to the patient and will be chasing” incidentaloma” s. He also highlighted that unique selling points of family medicine are:  first Contact, continuity, comprehensiveness, coordination and contextual care. He also brought to our attention the unsolved problem of abusing technology for the life support of terminally ill patients AFPI  special interest group may be called upon to solve this important complex ethical problems. Dr. Prasad highlighted the importance of co-production value of the patients as partners as opposed to evidence-based medicine. I can paraphrase this we should be routinely asking our patients; “what is the matter with them” and” what really matters to them?”  he ended saying family medicine has a responsibility to save medicine. That way, I’ve always believed this is more relevant in the Indian context.

Our very own AFPI president Raman Kumar in his presidential speech made a very emotional appeal. He brought home that the violence against the doctors is like shooting the messengers for the bad news.  The public is expressing resentment against the politicians for poor investment in the government health sector in India.  He highlighted that just like “roti, kapada, and makan“,  health is an essential commodity for each citizen.

 

As per my own sessions, the release of the book “why family medicine in India” what a proud moment for me. The VC of RG University and the president of the National Board of examination were present at the time of the release of the book. The book seems to have aroused a widespread interest. This also allowed me to be the part the” meet the authors”  session in the inspiration room. The session was conducted well, with two other authors. Dr. Rao and Dr. Smruti. Dr. Smruti conducted the interviews watch contract in a “10-minute consultation Style”. The authors discussed what made them write the book, what audience they had in mind. It was highlighted that it is always difficult to find a publisher.

What I found interesting and unique this time was the conference app. Keeping up with the theme of the conference ” Technology and innovation” it was first for the FMPC 2019. However, my phone is registered in the UK, and when  I want on to download the app it said that this app is not available in your country. Therefore as a  chair, I had to rely on my co-chairs to interact with the audience.

It was lovely to hear the story of family medicine from different parts of the world. It is the continuity of care and the mutual trust between the doctor and the patient appeared to be the common theme. While there is a commonality between the UK and Australia the development of family medicine appears to be patchy in the south Asian countries. However, Sri Lanka and Nepal appear to be further in the journey than India. It was loud and clear that we can all learn from each other.stories975525283787_162896109398654976_o

I also conducted a session on mindfulness for Family Physicians. My co-facilitator was an experienced family physician from Tata health. It is a well-known fact that stress among Physicians is very high, so also the suicide rate among doctors. Mindfulness is one of the evidence-based practices known to reduce stress. Mindfulness-based therapies now an accepted method of treatment for anxiety and depression.

 

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I felt  the session was interactive and there was a lot of participants participation

 

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I sincerely hope that Tata Health will take it up for the Professionals.

The conference is not only about the events that happen in the confinement of the halls. it is also about what happens over a cup of tea and coffee. Therefore it is very important to build up coffee time to the program.

While my wife was enjoying an important session in the inspiration room about how to set up your own practice we literally cornered  Dr. Rao to write his biological account.  I also established a connection with some family Physicians.corner 2019-08-04 at 08.43.28

I’ve now been invited to attend the next FMPC  and the  WONCA rural conference in Dhaka.   Professor Sasidharan has promised to come to Odisha so that we can together convince the Chief Minister of Odisha to create Kerala model of family centers in Odisha.

Because of some of my own health problems my travel was going to be canceled. But for my stubbornness and my wife’s cooperation, otherwise, I would have missed all the fun! Looking for a bright future for the family medicine in India and globally I sign off!

My story of climbing story bridge

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My wife Anjali read somewhere that story bridge in Brisbane is one of the three bridges in the world where you can climb up the bridge. She’ is always more adventurous than me. I have always the fear of height. Therefore, I wasn’t very keen initially. However, who can resist the persuasion by the wife ( even Rama could not) . We booked our tickets for the event.
As usual I was very anxious. The fear of unknown was almost killing me. We wanted to know where this place is and we reached the place after crossing the ferry . After talking to the receptionist and having a look around with the bridge I was a bit more reassured.
We were much more relaxed on the day. It was a twilight climb. The day was sunny with tolerable temperature. We reached much in advance after crossing Brisbane River by ferry. There was butterfly in my stomach and I started comfort eating ice cream and running to toilet before the event.
The leader arrived in time. The young man was a student of aerospace engineering . We were 6 in the group. We were given appropriate dress .Then we all had to pass the alcohol breath test. We were given some safety instructions. The guide was cool and reassuring. For the elderly couple from Brisbane it was a surprise birthday gift for the wife and the other couple was visiting from Oxford,UK.
All checks done . We were ready to climb. My heart was racing. We started climbing up the stairs. My wife was cheering me up. We were attached to the side bar for safety. The gate behind was closed and it was clearly declared to us that we have now reached the point of no return.
We marched on. on step at a time one by one the team leader was keeping an eye on us. After reaching the first station the guide asked how was I doing I said that I was fine but “can I go home?”,the obvious answer was no way! I was thinking inside me at least I am not going into the MRI tunnel or under the knife of surgeon for prostrate or bowel operation. I am still in good physical and mental health. So march on!
We reached the viewing station. The view was really breath taking. Lovely breeze was flowing, and the sun was setting behind the skyscrapers. By this time I was happy. The fear of unknown had somehow disappeared.
We marched on happily . Photographs were taken by the leader. The real treat was for our own retina.There was some commentary about the various land marks of the city.
The heart had stopped racing and the mind was calm and content.. There was some sense of achievement at the end! Ready for some other adventure at some other corner of the globe!best story bridge group photo

The Ripple Effect : a tribute to Nishant Satapathy

It was later in the evening. We were returning to our seaside hotel after attending a gala marriage ceremony event of daughter of our common friend. In the taxi I talked to my friends son from America. We briefly talked about my plan to visit to a care home called Adruta.

Adruta
Adruta Children Home (A unit of RAWA Academy) has been doing pioneering work in the field of rehabilitation of the deserted, unclaimed, parentless and destitute children since 1998. Our objective is not only to ensure healthy upkeep of the children but to provide proper education for their complete development.

A few months later I got a phone call from my friend mentioning that his son wants to talk to me. I explained him about the organisation. He said he will be visiting Adruta. That phone call was indeed one of the happiest moments of my life.

A few days later I get this message “Hi Sahadev Uncle.. thank you for me know about Adruta. I went in June this year to the orphanage and truly had an incredible experience. The girls had such great enthusiasm for learning and it truly inspired me. I actually taught them English and had a great conversation with them. I am in contact with Sagarika madam and am already raising some funds here in Arizona to help support the organization.”

This was Nishant . This is a young man trying to do something For the children to the best of his ability.

The story goes further.
“Hi Uncle.. I wanted to share some progress I have made in my pursuit of helping Adruta. Over the past two months I have raised over $150. In addition to bringing awareness about the noble cause, I actually met an upcoming senator candidate and current congresswoman of our state of Arizona who congratulated me and thanked me for my passion in helping the organization. I have attached a photo of this accomplishment. “
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Nishant also presented to local Asian channel about Adruta.

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I believe in the act of charity the definite beneficiary is the donor. I t certainly gives me great pleasure to be associated with such young people who certainly will achieve the heights of kindness for the humanity.
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