True Love...

Handle with Care...

Few weeks ago, I was among my colleagues, and during casual chit-chat somebody asked…What is true love? And the weirdest and the most unexpected answer which came, we all knew it for sure, was a mere sarcasm and nothing else...but in our hearts we all wished it be true... Not just for the guy who said so, but for all of us so that when we say, "My true love is My wife!" we better mean it...from the core of our hearts!!  

True love is such a cliché...For some, its what Jane Austen’s Mr. Darcy and Miss Elizabeth Bennett shared amongst themselves in the famous romantic novel Pride and Prejudice, for some its the chemistry shared between Bella Swan and Edward Cullen of Twilight Saga epic…and for some it’s the on screen chemistry of Varun (Humpty) and Alia (Kavya) of Humpty Sharma ki Dulhania fame…! 

For me, its none of the above…!! For me true love is not something...which should be such a rare commodity…or which has to be looked for in epic novels or movies or out of the world stories… For me it has to be present amongst us only…among common ordinary people…leading daily ordinary lives!!

I believe, true love is...when someone who despite knowing your darkest of dark secret, which you literally are ashamed of to share with anyone, doesn't judge you or label you with some permanent tag but gives you a chance to  improve yourself… When someone whom you have hurt beyond all measures knowingly or unknowingly, not only forgives you but loves you back unconditionally… When you have found someone with whom you are not afraid to share your funniest of funny ideas, weirdest of weird fantasies...who are aware of your most irking of habits yet ignores it... someone who sleeps with head on your chest despite the fact that you actually snore like a pig and you on the other hand, lying on bed at night with eyes closed can proudly sport a subtle smile on your face for you know that there is someone lying just next to you with his/her arm around you, who is always there for you no matter what! 

If you are amogst the luckiest few then you probably have found 'the One' and are currently spending your life with him/her deeply satisfied and madly in love...despite having all the daily discord, disagreements and what not!

And for those of you who are not as lucky as the above mentioned ones...I would still call you guys lucky if you did have 'that one' in your life at some point of your life but unfortunately you two are no longer together for what-so-ever reason/s!! Its an amazing feeling...isn't it? To know that you have/had someone who at times understands/ understood you even better than you understand yourself!! Cheers to all those who have even faintest of idea about whatever nonsense I am talking about...!! :-)

And for those who don't have 'the one' yet in their lives I feel sorry for you...! You have done everything but lived! You may have worked/studied/played etc but not yet lived!!! So, I guess, its time.... Take a break...Get out, explore and LIVE..LAUGH...LOVE...ENJOY!!! 

Virat (@viraat_k)

New Delhi

Swachh Bharat: My Litter, My Responsibility!

               Today while going through the different newspapers, felt really good and somewhat accomplishing that this 'Swachh Bharat' initiative got such a support from all sections of society. I had this gut-feeling yesterday while I was standing along with our Prime Minister at Valmiki Sadan, where he interacted with the Safaai Karmchari of NDMC and from where he started this movement, that it would definitely turn out into a mass movement!

I am not saying this just because I am still in awe of his persona or I was lucky enough to physically meet our Prime Minister (by the way I had never imagined that!!) but rather I am convinced by his belief as well as by his actions that together we can make India clean and much better place. And when he said, "yeh kaam sirf aapka nahi hai, hum sabka hai!" (this is not just your work, but of all of us!) while interacting with safaai karmchari of NDMC! and soon after that he borrowed the broom and started sweeping the pavement along with them. This only shows that, not only his words but his action too are in sync with his beliefs! 

                       One more thing makes me believe that this dream of Swachh Bharat is not just dream but an achievable reality! Let me elaborate it a bit...by default we all inherently love cleanliness. It's just that our standard of cleanliness varies and also the extent of surrounding that one sees fit to keep neat and tidy varies... Even someone who is homeless and has to spend nights on footpaths love cleanliness for he does clean the area where he is going to sleep! I would even go to the extent and say this - Everyone Loves Cleanliness and No one likes things in shabby state!"

                       Its this deep rooted love for cleanliness govt. needs to tap on! We all keep our houses clean. We set beds in morning, sweep and mop our floors (or get these things done by a paid maid)... this again only proves that we love clean surroundings. Similarly, in societies that are better maintained and are frequently visited by civic bodies (like garbage collector etc) are not only clean from within but also outside the houses! 

                  So all that is to be done is just provide basic facilities to society and the domain of cleanliness will gradually enlarge and soon will engulf the whole nation! Well I am aware that its way easier said than done... while authorities need to worry about infrastructure and support issues, we as individual need to work a bit on our own to help improve the situation. We all need to make conscious efforts not to litter on streets, parks, footpaths, roads etc. just the way we don't litter in our homes! 

                       Also, one more thing that we can do is segregate the garbage at our homes itself... its far more easier to segregate a kilo or two of garbage at source than nearly 10 million tonnes of garbage at final disposal point. (The figure is derived from the fact that on an average household garbage produced per person per day in a city like Delhi is nearly a kilo. Multiply this with population of Delhi and you will get the daily garbage produce of our city!!) And this, segregation thing, is quite doable!! 

                          Nearly 74% of daily household litter consists of Paper/Cardboards (30%), Vegetables (23%) and Dust, Cinders and misc. (21%). While vegetables can be utilised as organic compost in kitchen garden (if you happen to have one) and others can be bagged into one and disposed to garbage collectors. Even if you don't have a kitchen garden all you need to do is make separate baggage for vegetables (organic) and the other contents (inorganic) of this 74% part of household garbage. Luckily, we are a country which recycles a lot of inorganic wastes! 

                         As far as the remaining 26% of garbage is concerned its produced in small quantities in regular households. It mainly consists of Glass (10%), Metals (9%), Plastic (4%) and Textiles (3%). These can be stored for sometimes at the source of production itself (that is, household) and disposed off in a while say every fortnight or month. This way a lot of burden will be taken off from final disposal sites and hence will improve waste disposal management. It's high time now, we all need to step up for this cause which is for our own good. Let's make it a policy..."My Litter, My Responsibility!" Let's stop blaming civic bodies for not installing adequate numbers of litter bins in public place...trust me they are not needed! As astounding as it may sound, Japan one of the cleanest country is among the country with lowest number of garbage bins in public place per 1000 people.

So, lets do it...let's make Our Home, a Clean Home; Our Neighbourhood, a Clean Neighbourhood; Our Village, a Clean Village; Our City, a Clean City; and Our Nation, a Clean Nation...!
Together We Can, and together WE WILL...!! Let this cleanliness drive not just be a 2nd October symbolic thing...let's inculcate it into our habits and also into our children's habits. 

Come on, Let's realise Mahatma's saying, "Cleanliness is next to Godliness!"

Jai Hind!!

Dr. Virat Kuntalam (@viraat_k)

Medical Officer,

New Delhi Medical Council

Parliament Street, 

New Delhi 110001

The Learning Enemy - Ticking Time-Bomb within us...!

                    Have you ever imagined why defence and offence strategies of our security forces are so Top Secret!? It’s simple because we  don’t want our enemies to be prepared for what all we have in our stock!!! 

                   Same principle applies to the vast world of microbes (pathogenic - disease causing microbes to be specific). We would not like the Salmonellas (typhoid causing bacteria) Vibrios (cholera causing bacteria), E. colis (many gut and urinary tract infection causing bacteria) and many others to be prepared for the gamut of antimicrobial agents (mainly antibiotics) that we today have and which we use in patients suffering form these diseases.

                 Therefore, need of the hour for we as doctors is to use antibiotics (for that matter any antimicrobial agent!) judiciously and cautiously… It’s really distressing to see the use of higher/next generation antibiotics for simple infections that too without any evidence (e.g. Culture sensitivity reports etc). But we all health care providers are more or less aware of this monstrous problem…and frankly speaking bit scared too…at least I am.. Specially after the emergence of ‘SuperBug’ few years back…!

We medical professionals need to USE ANTIBIOTICS WISELY, NOT WIDELY!

                   So, with this article I basically intend to enlighten the 'non-medico’ segment of the society. Why today? Because, Indian Academy of Paediatrics has undertaken this MISSION AAA (Avoid Antimicrobial Abuse) and is celebrating the Rational Antibiotic Use Day (28 September 2014) and Antimicrobial Awareness Week (28 September 2014 - 05 October 2014).

               Most of the common illnesses like Common Cold, Flu, Diarrhoea are basically caused by viruses…and hence use of antibiotics are redundant. They will not help you get back to office any sooner…! And so, for you- as patients its of utmost importance that you get over this inherent urge to buy prescription medicine over the counter from the pharmacist. ALL ANTIBIOTICS ARE PRESCRIPTION MEDICINES meaning thereby, its illegal to buy them without a valid prescription… and its rightly been that way.  Text below will make you understand why its important.

                      In 1953, there were more than 7,50,00,000 cases of malaria per year! And it was a huge public health burden. Govt. of India launched NMEP (National Malaria Eradication Program) and there was free lance use of DDT to kill the mosquitoes. It did work, temporarily though, bringing malaria cases to all time low of  50,000 cases per year in 1962!! But in next 10 years the number of cases rose 12times…leading to catastrophic failure of program. This happened because of the natural selection! Use of DDT killed the susceptible mosquitoes but spared the once which were resistant to DDT and in next 10 years these multiplied and led to increase in cases of malaria. Had other strategies would not have been undertaken, malaria and death due to malaria would have risen back to same 1953 level. Life subsists and so does mosquitoes and malaria. And by the way, this led to change in approach by govt. which reflects in name of malaria programs over the years: started with NMEP---> National Malaria Control Program (NMCP)---> Intensified Malaria Control Program (IMCP)!!

                        There was a period when we, kind of, lost our track as we were so goal oriented.! In order to decrease the cases of malaria and malaria related death we started giving presumptive treatment of malaria to all cases of fever suspected to be due to malaria, specially in malaria endemic regions. And we used Chloroquine the most common drug for malaria. As expected, it did bring the cases down initially but soon number of cases started to rise due to development of Chloroquine resistant Plasmodium spp. (parasite that causes malaria) but fortunately, this time we were intelligent enough to see the trend early and literally stopped the presumptive treatment. Now we use anti-malarials only in proven cases of malaria (either by microscopy or by RDT- rapid diagnostic test Kit). 

                        Another example where inadequate treatment (mainly premature stoppage of medicines prescribed) leading development of such a dreadful disease is: Tuberculosis!! Once easily treatable under DOTS (directly observed treatment short-course) program, TB is now rapidly transforming into difficult to treat MDR (multi drug resistant) TB, even more difficult to treat XDR (eXtremely drug resistant) TB and now there is TDR TB on the horizon...! (totally drug resistant, though WHO avoids the use of acronym TDR as it gives hint of hopelessness!). This is all because we as patient don't stick to the prescribed regimens...the moment we start feeling well we tend to forget about medicines...and leave the treatment mid way!! And remember is a contagious disease. If one has MDR TB, one will spread MDR TB!!! 

                  Similarly, when we take antibiotics irrationally we put selection pressure over microbial population. Sensitive microbes die…resistant ones survives…and now whole resource is available for the resistant ones which flourish rampantly…and the worst part is Resistant bug replicate into Resistant BugS!! 

             Also, Its important to take antibiotics for prescribed duration and in prescribed dosages. Most of the time you start feeling better just after few doses of medicine. Its because majority (NOT all) of disease causing bacteria are killed by the first few doses of antibiotics (provided right antibiotic has been prescribed!!). But you need to take the complete dose of medicine so that the infection is completely eradicated. If you take meds for sub-optimal duration there is always risk of relapse of illness with greater severity. 

REMEMBER, If we SAVE Antibiotics TODAY, They will SAVE us TOMORROW!!”

                    Other important thing is, microbes are enormous in number. Just 1gram of your faeces may have somewhere around 100 million-1trillions of them!!! And even though rate of mutation (random change in genetic material of an organism leading to change in its characteristics) is very low, mere number of these little bugs make it a significant event for them. Its nature’s experimentation for betterment of the organism. 100 experiment may fail, 1000 may fail, may be million experiments fail…which is unfair for them…but they are in trillions..!! Someday some random iteration in genetic material may work… and nature’s experiment continues creating newer forms of bacteria…some of which are inherently resistant to our antibiotics…but as long as these are in the company of their own 'cousins and nephews’ we have no problem as they have to compete with trillions of bugs to grow and survive with limited resource! 

Problem occurs when we use antibiotics irrationally and sub-optimally! This creates favourable condition for resistant ones by wiping out the billions of competitive sensitive bacteria…now all the resource is available for these dangerous bugs and they multiply!!! 

The other worrisome fact is we have already made antibiotics which act on all known targets of bacterium…there are hardly any novel antibiotics in pipeline. Also, in past decade or so there were only a few antibiotics which were produced. On the other hand bugs have developed resistance to all known antibiotics…fortunately they all are not present in same single bug so far…but if we continue like this with antibiotic abuse that SUPER BUG is not very far from reality…!

            So, irrational-sub-optimal and rampant use of antibiotics must stop. Otherwise, there will be so many superbugs that we probably will not be able to contain them! Instead of self medicating seek the expert and get optimal treatment…

Stay active…stay healthy…Do well!!!

Dr. Virat Kuntalam

Medical Officer

New Delhi Municipal Council

Parliament Street, New Delhi 110001

The Exercising Habit...

         Early morning yesterday...by early morning I mean- around 7-7:30am and please, don’t take it any other way..7:30am is early morning! At least for me!!! :-) I was at Talkatora Garden. Although, I was there for the physical fitness test of security personnels that NDMC (New Delhi Municipal Council, which happens to be my employing body as well) is recruiting and before all the equipments could be set up I had some time to explore the beautiful garden…after all, I had not been an early bird of late…specially on a weekend…! ;-)

         The garden is really beautiful and soul comforting. The chirps of birds, and playful shouts of children, that routine-synchronised-animated but altogether necessary loud laughters which you can hear in any garden/park of Delhi by the group of people mainly in their 60s and beyond…the sound of water at water fountain….the footsteps of jogging individuals…the excerpts of political chat by mostly older people while taking their break after certain amount of physical activity…the panting of competitive youngsters who just dashed the extra 50 meters-or-so after their self-set distance for the day...

          I really had forgotten that there are still so many people who are not only awake but fully functional that too so early!!! And among all these hustle-bustle

of early morning...I saw another of group of individuals at the far east corner of the garden near the cricket ground…this is that side of garden which is adjacent to Mother Teresa Crescent Road…There were individuals of all age groups…The sight at first amazed me..and later pleased me as a doctor! 

          I saw three generations of a family: the Grandfather, the Father and the Son working out together..and no need to mention that this habit inculcates in the younger generation from older generation itself. If you are active, likelihood that your son will lead an active and healthy life is fairly high..and so it is for your grandson provided your son is active too…! 

           Having said this and due credit given to the individual/family…I would not be just if I don’t mention the efforts taken by the NDMC and its staffs to provide and maintain the equipments at public parks/gardens like this one which make exercising fun and not something which is tedious and brings wrinkles on forehead…! These are the equipments which NDMC recently purchased from Garden Gym.

           Its amazing how simple basic facility encourages people to be active and thereby healthy… Though, initially it may seem like futile investment but as a doctor I can say this small initiative will translate into a greater good for I know a healthier society is a productive society… Not only this initiative will reduce the burden on heath care delivery system but also increase the outcome from each and every involved individuals.

           I would be happier to see more sets of such equipment in different corners of Talkatora Garden and also in other parks/gardens of NDMC and Delhi as well…! :-)

Stay Active...Stay Healthy...!! 

Dr. Virat Kuntalam
Medical Officer,
Palika Kendra,
NDMC