The first contact with an indigenous community

Video with the testimony of Teresinha Maraskin a nurse that works with indigenous communities in south of Brazil. She works at SESAI (Special Indigenous Health Secretariat) and have an extensively experience working on the ground. This video was recorded during the "1st State Seminar of Health of Traditional Communities: indigenous and Maroon - Rio Grande - Brazil‏" ("I Seminário Estadual de Saúde das Comunidades Tradicionais - Indígenas e Quilombolas " - http://www.sinsc.furg.br/site/isesct/ ).

Arts and Rural Health

Report on Rural Family Medicine Café – Arts and Rural Health
By Mayara Floss

In 7^th of Aug of 2016 we have the Rural Family Medicine Café about Arts and Rural Health. It was present Mayara Floss (Brazil), Amber Wheatley (Virgin Islands/UK), Amanda Howe (UK), Bianca Silveir a(Brazil), Shailendra Prasad (EUA) and Jesse Rockmore (EUA). Also on the social media we have we have a good engagement with feature to Dr. Smruti Mandar Nikumbh-haval (India). Watch it entirely at the link: https://www.youtube.com/watch?v=nY4LboJtIn0  . Further is possible to find at the end of this document more links to all the content that we shared.

Specially this Rural Café was really interesting bringing a Broadview of arts and its interface with rural health. We discussed about a lot of types of writing. Shailey said that the academic writing is a “boring one” but still being a way of sharing ideas, also blogs, short stories and etc. Amanda complemented that writing (even academic) is a way of expressing ourselves and experiences – we write in different ways is for different reasons. I talked about the bool “The Quilt: Experiences of Health Education League” (A colcha de retalhos: vivências da Liga de Educação em Saúde) in a community based project with medical students to write together a book. Also, the Rural Health Success Stories project were mentioned. 

How arts could influence medicine, medical students?

Art can be healing, it is not specific to rural but could be therapeutic - a way of care and promoting health. We use arts to show what we do. Amanda mentioned a Photograph Exhibition in her university were it shows the different perspectives in rural areas and made it very visible: travel, distance, seasons – showing the different rural situations and challenges. Also the learning/teaching importance of arts expanding students perspectives. Writing could help to debrief a self-reflective piece on the day by day – how do you feel? How to deal of this? Arts express the joy of connecting with people, how we link and learn to going forward. Burnout is one of the aspects that arts could tackle.  In USA were is being trained a highly sophisticated professional that it few years is a professional in burnout. One of the answers to fight burnout is finding joy, joy in the work, people that you interact, finding the sense of community and arts have a central role in it.  

In India, they use scenarios created with help of idols sculpture, ancient dance and drama form as health promotion tool to convey live healthy message. Also they have an art form named “kirtan” in which presenter tell a story mixing mythology and also give good incites in between the story relevant to today's era. These presenters are like God to rural population and this is best time to teach them good habits healthy living methods.

Arts is part of the life-learning, we are not a defined project, it is a way to improve ourselves, in rural areas this become more important because mechanisms of expression. Amber and Bianca, brought the idea that simulation of clinical consultations into medical education the arts have a central role in the theatre, expression and creating empathy. It is a way to understand people, being creative, invent a scenario, acting skills.  Also, Amber said that she could learn from one of the simulation scenarios not just communication but that people react in different ways in different contexts – and this shows that things have different meanings of our meanings for it. As she said: “Showing the body is more then just flesh & bone, working beyond perceived limitations”. 

Arts and medical education: Would there be some prejudice that makes students think that it is not important?

It was discussed the still poorly interaction between arts and medical curricula, were it was said that we should bring more to the clinical modules, inside of it arts, not an "optional module"' – changing the interface between arts and medical education. Arts do not should be into a module it should be day by day: how we could bring arts in the core module?  In addition, it was mentioned the Narrative Based Medicine and the role of doctor as “anthropologist” and taking/telling stories in medicine. The urge to explore arts more consistently into the curricula. The importance of reading others stories, sharing experiences in arts. Amanda shared her experience into university were students refused an optional module that “it is not ‘medical”, and preferred to just study “medical modules”.  Sometimes arts could not feel like “real medicine”. It exists a parallel with Family Medicine, “it is okay it is about real people, but the specialist is doing the technical stuff”, the prejudice and marginalisation is the same that happens in Family Medicine in general.  Amber brought her experience of doing one module that it is “not medical” with the module “medical, health and society” and other modules in psychology area were some of students liked it and other hated it.  This varies by the background of the students, and in this context arts is much more the orthodox root. Also, the postgraduates students usually have more control of their education and they could bring it more to their curricula. 

The inclusion of arts into the curricula is much more about working smart and not working hard – building relations with artistic expressions, also listening the patients experience – “the patient story”. A lot of time students couldn’t get the whole picture of the value of not doing things that are purely medicine/scientific/textbook and the professor should have the wisdom to guide. However much of the art part that makes you a doctor, having insights in the unknown feeling. 

Jesse is studying in a osteopathic school which understand a person as a mind, a body and a spirit. Non traditional science students and some of the students and how he could visualise anatomy with his background in visual arts versus other science students. And Jesse have a background course in piano improvisation so he could see the patterns, having the ability to see this patterns in medicine. Students are more than scientific: they are eclectic.  

The entry criteria in the context of USA, UK and Australia focus more in the potential of the students and not just the scientific background. However the selection for medicine in Brazil is quantitative and by a test. Bianca said about her experience in her diversity and the burning out in students agenda were a new module will not be welcome and the need to broke the conservative way of learning without arts. 

Does EMR (Electronic Medical Records) reduce the narrative / personalised perspective of the doctor?

Shailey said that the Electronic Records is taking the soul of the narrative, we are expected to be very reductionist in our documentation which are “dry” – it is a challenge for the reduction of the new generation of GPs - we are becoming reductionists. EMR reduces eye to eye contact and reduce doctor patient interactive sessions. It is a doubled sword it will have a bounce of students that will look at it and will say: “Oh my God, what do I need to do this” and will not participate at the same extent that we would like them.  Therefore, this bring the question: “do we open it to everybody or do we deliberated keep to the once who want that” and at the flip side how do we emphasize if you don’t get support of higher ups in the medical education (deans, coordinators), how do we emphasize arts importance? Then, how can we functionally come up with the best curricula to do it?

What is special about rural and arts?

It is the need to discuss more, as an example we have few literature on rural health (not academic one) bringing more arts point of view to show stories and experiences. Arts in rural is a way to share experiences, not  formal but has a lot of impact in the learning process compared to clinical stuff.  We should use arts to bring people together, like a quilt, and by arts we can be together as a quilt. Mayara said “You do not need to be connected on internet to feel connected with the ‘Fortunate man’, you can connect with a song, a poem, and arts can do exceed and make you feel connected with other people” – which is fundamental in places isolated like rural and remote areas. 

Arts could link physicians and decrease isolation of physicians also helping the patients. It is possible to use arts to empower communities, to transform their health, to understand themselves. Amber showed the contrast between her hometown and Wales, saying that she need to adapt to patients reality, not just in communication and the different ways of communicate and comparison, humour to make people to relax – the way that we communicate in rural is much more personal than the way that we communicate in a urban area. Amanda raised the idea that communicating, engaging through arts could be really similar in urban and rural areas giving to people voice and understanding their own lives.  Maybe what is more special about rural angle is that it is less visible and arts have the power to bring people together and think together. Mayara brought the experience of the Indigenous Seminar were a doctor use a clay to made models of women parts and the experience of the Health Education League to draw the parts of the women body in a white paper, so people can show how they perceive they own body, arts is part of cultural competence and physician role. 

Arts is also a way to deal with burnout in rural areas. Jesse stated that arts is also a possibility to treat and monitor the patient, bringing the example of patient with dementia that was monitored by her GP by their capacity of understanding a film and draws. In addition, the therapeutic use of music, were people with dementia respond to it. Further, arts is able to show realities like the movie Amour that showed the violence and the difficulties of caring. Also, the project of the Twitter/Facebook brought the  #RuralWomenGP project. 

In today's brand factory era arts could be an old fashion thing but once you provide a good example this thinking may change.  

Read more:

Indication by Shailey - The Country Doctor Revisited : https://thecountrydoctorrevisited.wordpress.com/

Indication by Amanda – A Fortunate man : https://www.amazon.co.uk/Fortunate-Man-Country-Vintage-International/dp/067973726X

Indication by Mayara - The Quilt: Experiences of Health Education League (Selected chapters translated into English): https://www.academia.edu/23681181/Selected_Chapters_translated_into_English_of_the_book_The_Quilt_Experiences_of_the_Health_Education_League_

Indication by Mayara - Causos clínicos Blog: https://causosclinicos.wordpress.com/

Indication by Mayara – Balsa 10 Blog: http://balsa10.blogspot.com.br/

An inspiring story of Organ Donation which started from blood donation

Chandan Kumar

Hi I am Chandan Kumar, son of Sri Narendra Narayan Singh. I am a  Physical Instructor in R.K.D senior secondary+2 high school, Rajepur Lakhna, Sahebganj Block, Muzaffarpur district, Bihar, (India).  My native place is Birpur Singhara mahua vaishali Bihar (India).

I usually go to nearby hospital, where ever I reside,  and meet patients to know their cause of sorrow. I also want to know how their sorrow could be route out from the root. Once upon a time, I got an opportunity to go to hospital in my town’s government  hospital and heard some people were talking amongst themselves that if blood was available at the right time then this life could be saved. I began to think our population of country is 125 cr. In spite of it we are facing the scarcity of blood at the right time.  Day and night we fight each other that leads to flow of blood in vain that is useless. It is far better if we donate blood for maintaining the harmony and fraternity. We must donate blood 2-3 times in a year. Due to this every one can get new life after availability of blood accordingly. This idea came to my mind when I was wandering and searching for O- blood donor for my only loving sister Vandana. At that time I didn’t know what to do.

Suddenly I thought I should also donate blood and also encourage others and god automatically solved my problem. My sister got a blood donor and god saved her life. I swore for saving life of any religious community person of world,  I would donate blood 2-3 times. I also thought at that time that if relations break, they can be mended. But if they slip due to unavailability of blood then it cannot be regained at any cost.       

After this incident I informed everyone they must call me for blood, if in urgent need. You may be poor or rich; Hindu, Muslim, Sikh, Christian, Buddhist or Jain, I would donate as it’s my duty to save life.

After few days, my neighbor called me from his clinic and requested for blood for a seven year old child. I said it’s a holy deed and the best in this universe, that my blood would be  used to save the mother’s sentiment like her baby. Really, she was too poor and in this world I have seen very few people help the poor in need indeed. My eyes filled with tears at that time. She thanked me and her eyes were telling me, God would always keep you happy. Friends, really I was amazed. She belonged to a Muslim community and I was from Hindu community. If any negative feelings would be in her mind for Hindu community they would be erased. In Spite of it, I was thinking only one thing that I will donate blood to her baby for her mother, that’s why she could call her mother (Maa) mom. Or I will donate blood for her mother that’s why her baby mother could call her baby as her name accordingly kept by and for humanity.

I was also thinking, we should always keep humanity in our mind and make others aware to keep the thoughts for humanity, to maintain the purity of life. We all are son of God only. I thought, I should do something better for them, I should be thankful to God. The child’s life was saved, her mother was happy and kissed her child  now and again and thanked me. But I thanked God  Who gave me this opportunity to donate blood without any fear and hurdle. I pray to all, we must donate blood.

In June 2016, I was on tour of pilgrim (holy place) like kedarnath dham, Badrinath Dham, Yamunotri Maa, Maa Gongotri, Haridwar. After completing this tour, I moved for the grace of my father, Mother Grace to touch their leg in Delhi (Noida). After this, I also decided if I am in Delhi, I must donate blood for needy. I moved to Delhi AIIMS and donated blood voluntarily. When I come out from the campus of AIIMS some people were crying and talking each other. They had sufficient money but they could not get an organ at that time and lost their relative. It was very shocked. I thought that after death our organs are being burnt in cremation. So, it would be far better, if we donate all the organs that would be useful for saving lives and I should do this also.

Actually friends, I thought only corneas and kidney could be donated. But I saw a  card where kidney, liver, heart, lungs and corneas were mentioned. I donated maximum as I could after enquiry.

I never discussed this with my parents before donation. But when I informed them they were proud of me. I was also inspired by the film actress Aishawarya Rai and daily news paper Dainik Bhaskar in Muzaffarpur. Sometimes situations creates holy pressure to do something better at random.

Friends if you could not get blood or organ we could lose the relation or person. They cannot come back at any cost. So, why you cannot be a someone, for someone, who could get your organ at the right time.

Why some people can’t donate all the organs of the body. That can save priceless lives. Without thought I donated all my organs of the body, which will be useful for saving lives. It does not matter to whom my body organ would be donated. He may be poor, rich, Hindu, Muslim, Sikh, Christian, Buddhist, or other community ,my friend or stranger. I think always for saving life. If my enemy will demand my organ indeed, if he is in need, I pray to doctor without any differentiation, must put my organ to him to save life, that’s why he may move for positive life. After knowing this, that his life is saved by whom, whom he wanted to destroy, has donated the organ, I think he would always do better for humanity.

I have written in the donor card to whom my part of body be donated, requesting him, he also do what I had done for him after death. I pray to all the person of our country and  Internationally/Universally that never flow the blood of human in vain with the negative sentiments of quarrel, donate blood for saving life only. Do not cut the body part, donate your body part, that’s why this donated body part could save the life. Due to this sentiment, national integration, fraternity will light up. Whole universe will be integrated with love and peace in whole world India has lighted up, presently lighting up and in future India will be always light up and spread the message of love, peace and sacrifice for humanity.

High blood pressure? What's that?

 

Dr.Smruti Mandar Nikumbh-Haval

           It was a busy weekday evening OPD. Various patients were pouring with their multiple problems. I was helping everyone with my best capacity. And then came this middle aged gentleman. Mr. X 40 year old shopkeeper and a known face of the town. He was all OK no complaints as of but slightly panic. Reason a G.P. told him his B.P. was very high. He need lipid profile (?) and physician urgently as his B.P. was 180/130 mm Hg. He went to him for a casual OPD visit of cough and cold. In past he has only faced fatigue, vague chest pain, sweating on and off which was normal according to him as he is on field for work most of the time.

          It was an emergency and need admission preferably intensive care. So many complications came to mind intracranial bleed, MI, target organ damage etc.

         I first noted his B.P. all over again. It was still 180/130 mm Hg. Frightening as I know my resources were limited especially in late evenings as all OPD referral options get close by then at district level. Only option remains is emergency room but this fellow was not ready for admission as next morning he has a big consignment delivery order to handle.

           Human nature money is more important than health. My grandpa always says "Sar Salamat Toh Pagadi Pachas" means health is sound rewards are awaiting for you. Health is wealth.

         I was losing a battle as doctor with a businessman but was determined and with God's wish I took the challenge to treat him as outpatient ambulatory care.

             Sometimes it’s better to take calculated risk and treat patients rather than losing and send for more doctor shopping at the end lose a life. I did his E.C.G. no major changes of MI were there but left ventricular hypertrophy changes were there.

        I gave him usual instructions of salt restriction, diet modification, rest etc along with suitable anti-hypertensive medicines. Also warmed him to come to me for follow up next day as advised.

        He agreed as I was not spoiling his next day deal. We had few periodic sessions of regular follow up and things settle down. Eventually we did his 2 D Echo, TMT to my relief it came normal. We also gave him prophylactic aspirin keeping his lifestyle and high risk nature. He was found to be pre diabetic range with HbA1c 5.9.His father is a diabetic so told him relevant advice in terms of lifestyle modification which I was sure he won’t follow. He LOL my advice saying doctor I don't like sweet. It’s that I am a jaggery sell & dealer during my stock purchase I have to eat it as part of my bread and butter. Nice excuse that was. :P

          We worked as team for next few months & things were under good control. We tried step down therapy but his body was more hungry for anti-hypertensive so we have to maintain 2 drugs with him.

             But after couple of regular visits he disappeared again. I sent so many reminders personally, through friends but he did not turn up for 3-4 months. Till one fine day he came as his old symptoms have begun again and this time chest pain was more severe in intensity. This create panic in his family. His mother and adolescent son brought him back to me. I assessed him. We were back to square one with B.P. 180/130 mm Hg.

               It was my turn to get angry bird now as he had stopped all medications 3 months back due to some family problem and was under assumption that now things are under control. I felt very bad as his old age mother and son was accompanying him but he was so careless for his own health.

I learnt a family medicine principle all over again Patient Centered Care. I was a religious follower of same but this time I forgot to stress on one important element of it - Role of Family and Friends. So vital it was.

         It’s good at times to black male patients emotionally for their own benefit. I scold him but same time made him realize if he still want to take care of his parents in old age, don’t want wife to get widow in middle age and son to lose school education and continue the family business he has to stay healthy. Health is real wealth. It’s not maintenance free you have to take care of your own health. This scold gave him a insight I felt. As I can see his heart weeping silently. Some after load reduction.:-).

            He promised again that he will remain compliant this time onward. Lucky he was as there were no fresh changes in his E.C.G. fresh changes.

            Gradually his B.P. came down, aspirin worked for his chest pain and other cardiac evaluation came normal. But his HbA1c has increased to 6.2. Now his journey towards diabetes has begun all thanks to his own negligence. Ironically this patient's younger brother is also a hypertensive but except once he never came for follow up.

           From this case I learnt that good counseling; compliance won't work long term if we don't involve family and friends in long term management of chronic diseases.

           With my Project SurekhUsha Kavach we try to improve life of many such Mr or Mrs X,Y, Z. It cost 1% knowledge at times and 99 % human emotions in treatment of chronic diseases. Awareness campaigns against hypertensive disorders are very much essential as common man need to know about importance of blood pressure control, regular treatment and complications associated with it if ignored. Thank you. Almighty bless us all.

___________________________________________________________________

Brief Description about the author
Dr Smruti Mandar Haval  (Dr. Smruti Subhash Nikumbh);  M.B.B.S.D.N.B. (Family Med),M.N.A.M.S.,P.G.D. Diabetology  & Geriatric Med; Certified International Diabetic Educator by Project Hope & International Diabetes Federation (IDF) USA; Consulting Physician in Family medicine, Diabetology, Preventive Cardiology, Thyroid disorders  & Geriatric Medicine; C.E.O. Sukarmayogi Publishers, Sankeshwar Dist: Belgaum, Karnataka; Assistant Professor, Department Family Medicine, USM-KLE IMP,Belgaum

Blog: drsmrutihaval@blogspot.com
        drsmrutimhaval.blogspot.com

Area of practice- Sankeshwar, Dist – Belgaum,Karnataka. Epidemiology of your area in brief: It’s an semi rural area covering more than 50 km radius including many villages. Its USP is it’s an border area connecting borders of Maharashtra and Karnataka which makes it an multiethnic area. Common chronic health diseases are diabetes, hypertension, asthma, hypothyroidism etc.

About a young couple and their fight with stigma of infertility

 Dr.Smruti Mandar Nikumbh-Haval

About a young couple and their fight with stigma of infertility

              Hypothyroidism is a kind of under diagnosed disease in rural area unless or until it reaches to the goitre stage. Biochemical diagnosis is an easy way to diagnose it in early stages. Good and reliable labs is a big challenge in rural area.
              Mrs. Patil is just one such patient for me.She was dealing with her primary infertility 2 years post marriage.She and Mr. Patil are a happy go lucky couple where Mr. Patil  is a project manager where Mrs. Patil  is a house wife .
             Before coming to us in month of march Mrs .Patil was suffering from sudden onset of weight gain ,irregular menses,change in voice,facial puffiness,lethargy,depressed feeling - all classical symptoms of hypothyroidism but due to lack of knowledge about it she never approach any doctor.
              Irregular menses was a regular complaint for her since menarche but no one ever investigate for her actual cause.Afraid of developing neck swelling and changed voice she approached my mother in law who is a practising OBG consultant and a generalist practitioner too.In rural area female patient still prefer a female doctor as they find more comfort with them.
              We at Rukmini Hospital,Sankeshwar diagnosed many cases of hypothyroidism in last one year as we find few symptoms are hypothyroidism are very common in this area.
              But Mrs. Patil  was a classical case hence she immediately ordered a thyroid function test which showed her TSH > 150.
             As I deal with many hypothyroid patients now post my successful CCMTCD course from CDI,Pune my mom in law send her to me.The couple was very anxious when they mate me as they saw a young doctor sitting next to them.They were in doubt whether to continue with me or not as one of there fear was we practice in a family set up.Just to retain patient in set up my mom in law sent them to me.
            Appreciating there anxiety I stated my discussion with them and made them understand that its not a major disease but if we don't treat in time it can cause some complications .Also I  made them understand that what ever symptoms she is suffering now are all because of hypothyroidism and once we correct that with thyroxine they will reduce.
           We started her with 100 mcg thyroxine daily and advised repeat follow up TFT after 8 weeks.After 8 weeks her voice was clear,facial puffiness was gone and her weight has also reduced but menses were still absent.We did few modification in dose and decided to wait for another 2 months as HP axis may take some time to adjust but still amenorrhoea persists.
           She happen to mention then that she usually resumes menses only when she used to get hormonal supplements from experts for same.Then I thought of PCOS and refer her back to OBG consultant to rule out PCOS  and hormonal regulation of menses along with ovulation induction if indicated .To God's grace she did not have PCOS and  responded well to HRT and ovulation induction.She is carrying now and hope will deliver a healthy baby.

Conclusion:
         Take home message I learnt from this patient is patient education,counselling and in time diagnosis is very important.Only treating the symptoms superficially is not the only thing but going to the root cause is equally important. If prior physicians would have thought of hypothyroidism in her adolescent age she could not have reached this stage of severe presentation. Every patient is a new lesson to learn which we may not be able to learn in our medical school.
       At last thank you almighty for giving me transient healing hands and power to counsel, educate patient correctly. Also I am thankful to CDI team for teaching me right principles of management of thyroid disorders.:)  

Suggestions for strengthening rural healthcare and Role of WoRSA:To create database or educational materials this will help primary care physician in rural area all over the world in awareness of about hypothyroidism. Our south East Asia belt is more prone for this as our soil lacks iodine. Good regular biochemical and clinical screening can help to reduce its prevalence.WoRSA can grant some screening programmes in rural area to improve rural people’s health.

___________________________________________________________________

Brief Description about the author-
Dr Smruti Mandar Haval  (Dr. Smruti Subhash Nikumbh);  M.B.B.S.D.N.B. (Family Med),M.N.A.M.S.,P.G.D. Diabetology  & Geriatric Med; Certified International Diabetic Educator by Project Hope & International Diabetes Federation (IDF) USA; Consulting Physician in Family medicine, Diabetology, Preventive Cardiology, Thyroid disorders  & Geriatric Medicine; C.E.O. Sukarmayogi Publishers, Sankeshwar Dist: Belgaum, Karnataka; Assistant Professor, Department Family Medicine, USM-KLE IMP,Belgaum
Blog: drsmrutihaval@blogspot.com
        drsmrutimhaval.blogspot.com

Area of practice- Sankeshwar, Dist – Belgaum,Karnataka. Epidemiology of your area in brief: It’s an semi rural area covering more than 50 km radius including many villages. Its USP is it’s an border area connecting borders of Maharashtra and Karnataka which makes it an multiethnic area. Common chronic health diseases are diabetes, hypertension, asthma, hypothyroidism etc.

Life..Just before Death..But not Less

 Dr Sonia Singh

Hello friends,  I am Dr Sonia Singh, in charge of the multi drug resistant tuberculosis (MDR TB) ward at Indira Gandhi Institute of Medical Sciences in Patna.

I would like to share my experience about MDR TB patients who have the right to get treated and cured like other patients, but many a times they are devoid of their rights as a patient and as a human!

I write about a student of class 12. He acquired MDR TB infection most likely from the hostel. He was admitted in MDR TB ward and we started treatment after pre treatment evaluation. His general condition at the time of admission was fair so he tolerated medicines well. To our surprise, he was not accompanied by any family member or relative and he did not call them when asked. Finally he confessed that he did not want anybody to know about his disease else they might boycott him at every level; in the family, society and the school. We counselled him nothing like that would happen and that the family is meant to give all kinds of support at hours of need.

He had high blood pressures, so along with MDR TB drugs antihypertensives were planned. Then the patient said that he was afraid to see the nurse and we thought about the possibility of white coat syndrome. He was finally discharged after 7 days. We counselled him again; although he was suffering from a difficult condition , if he adhered to the drug regime he would be totally cured and would be a healthy person in the society. At the same time we advised him to use mask to avoid spreading infection to others. He left our ward happily and is coming for follow up in OPD along with his parents .The best part was that he continued to study throughout his stay in the hospital and was very much concerned about his future and career. (Picture: the patient reading a book )

I conclude my story with mixed feelings. When I was  appointed, my fellow colleagues discouraged me from joining such an infectious ward but my family supported me. They said being an FP I should not turn away from my duties towards society as MDR TB is a new threat to society.I read detailed literature about MDR TB and MDR TB wards and found that health professionals were prone to get infection. So I presented the design of MDR TB wards with adequate ventilation, Ultra Violet Germicidal Irradiation Techniques (UVGI), use of N-95 respirators and also trained nurses to work with full safety. Rest I leave to Almighty!

Some patients often complain that they are ill treated by DOTS-PLUS supervisors and counsellors. We approach them and request not to hate patients but to help them.

We also advise yoga, meditation, positive thinking, listening to music etc. to patients so that they are able to cope with tough situations of life with ease.

I know, it is not so easy but at least a full attempt should be give to Lives..just before death!

Human kindness

Amanda Howe

©AmandaHowe2016

My friend walked down the lane
Was entranced by the green wood,
And the wet lushness,
And the long horizons,

And lost himself amid this English fervour.
He asked a working man for help,
Who sent him home.

We laughed, and ate,
And were glad of our time together.

I thanked my neighbour later -
He asked about my friend
“Nigeria” I answered.
He nodded wisely -
“I didn’t think ‘e cum from round ‘ere”….

I would be glad
If more dark strangers met such kindness
In this land.

_____________________________________________________________________

My area of practice is in the edge of a city, with poor people and some better off, but the region (Norfolk) is very rural by English standards. Our students go to practices where the nearest hospital can be 40km away. The epidemiology is typical, mostly NCDs of lifestyle and ageing, though with farming accidents commoner because of the local employment in that area.

When I first came to Norfolk the non-white population was only 3% though it has risen in recent years., especially in the university and hospital areas in the city. As my poem suggests, foreigners can still be a novelty in some parts. I thought of this story when the UK voted to leave the EU, much of which was led by the press and rightwing politicians promoting the fear of immigration-hence the last part of my poem.

©Amanda Howe July 2016