BREASTFEEDING (World Breastfeeding Week, 01 - 07 August)

Ads distort the truth. And so in the mid 20th century the ads promoted the myth that 'formula' feeds were better for the babies than mother's breast milk. Sustained research finally broke the myth and the truth re-emerged: mother's milk is the best for the baby.

Breast milk is easily digested, has a near-perfect mix of vitamins, protein and fat that help baby grow and gain the right amount of weight, has antibodies that fight off viruses and bacteria, and reduce baby's risk of having asthma or allergies. "Babies who are breastfed exclusively for the first six months, without any formula, have fewer infections, respiratory illnesses, and bouts of diarrhoea." And fewer visits to hospital and to doctor.

Research suggests that breastfed babies have higher IQ scores in later childhood,  have reduced risk of  SIDS (Sudden Infant Death Syndrome), and of diabetes, obesity, and certain cancers.

For the mother, breastfeeding burns extra calories and helps her lose pregnancy weight faster;  releases the hormone oxytocin which helps the uterus to return to its pre-pregnancy size and may reduce uterine bleeding after birth; and  lowers the risk of breast and ovarian cancer, and perhaps of osteoporosis.

Breastfeeding is also A key to Sustainable Development. That is the theme of the World Breastfeeding Week 2016. "Breastfeeding is not only the cornerstone of a child’s healthy development; it is also the foundation of a country’s development" - UNICEF and WBW message.

Among the several ways in which breastfeeding contributes to sustainable development, a few are: breastfeeding is natural and low-cost, is affordable, and therefore contributes to poverty reduction; it entails less energy when compared to formula production industries; it reduces the need for water, firewood and fossil fuels in the home; it is ecological compared to formula feeding which implies dairy farming that often puts pressure on ecology; it provides all the water a baby needs, even in hot weather, whereas  formula feeding requires access to clean water, hygiene and sanitation; it entails less waste compared to formula feeding: industrial formula production and distribution lead to waste that pollutes the seas and affects marine life.

So promote breastfeeding. It is good for the baby, for the mother and for sustainable development.

                                                            Breastfeeding in rural India

THE AIRPLANE AND THE THUNDER GOD

                                                             Thunder god of the sea

 

               Supercell - This storm was reaching an incredible height of 55,000 feet into the sky, almost                              twice the height of Mount Everest. It was soon producing large hail.

                                           Aircraft Weather Radar Display in the Cockpit

A week since the IAF AN 32 disappeared over the Bay of Bengal. What happened to it?

It was smashed by the storm god, Indra - that's my hypothesis

Flying in the clouds, the AN 32 encountered a line of thunder squalls, including supercells, across its flight path. The tops of these cells are much higher than the AN 32's ceiling so it could not fly above them. It could not fly through them because they are a complex, violent, whirl of updrafts, downdrafts and cross currents. AN 32 had to weave a path avoiding them. It used its weather radar (WR) to do that. On the WR, magenta and red indicate the areas of most severe turbulence and heavy rainfall or hail; yellow indicates moderate turbulence and uncomfortable ride for the passengers; and green indicates little drizzle and little or no turbulence. Magenta/red is always avoided; attempt is to fly through the green or, if inevitable, then, as briefly as possible, through the yellow.

Flying in green takes you between the cells in a line of cells. But alas. Sometimes the whirl and violence in the space between the cells is even more violent than in the core of the cell. This was the case in this instance. The AN 32, still in clouds, flying on instruments without visual reference, was suddenly caught by a violent down draught that made it fall at the rate of thousands of feet a minute. The pilot pitched the aircraft (a/c) nose up to increase the a/c's angle to air (angle of incidence, AI) and thus increase the a/c-lift and reduce the rate of fall. But suddenly there was an updraft and the AI shot up much beyond the AI at which aircraft control is lost. Aircraft stalled, tumbled and began to fall. The violent whirl made it fall sometimes nose way up, sometimes way down, sometimes right-side up, sometimes on its back, sometimes on its side, . . . . As it tumbled through the sky one, or both , engines failed.  In this situation, flight instruments do not tell what the aircraft is doing. Pilot has never before faced such a situation. In the absence of visual clues, he is disorientated, that is doesn't know what aircraft is doing even if the instruments were to tell him.

And so the AN 32 tumbles and falls and is smashed onto the sea, or is broken to pieces in the air. In either case, the result is the same. A catastrophe.

AN 32's was not the first fatal accident caused by extreme turbulence. On 02 May 1953, a British Airways Comet, the first jet airliner of the world, crashed near Calcutta. "Structural failure of the airframe during flight through a thunder squall. In the opinion of the Court, the structural failure was due to overstressing which resulted from either:- (1) Severe gusts encountered in the thunder squall, or (2) Overcontrolling or loss of control by the pilot when flying through the thunderstorm."

On August 6, 1966, Braniff Airways Flight 250, a BAC 1-11 jetliner, crashed. Aircraft structural failure due to extreme turbulence was the cause.

On April 4, 1977, Southern Airways Flight 242, a DC-9-31 jetliner, made a forced landing on a highway after losing thrust on both engines in a severe thunderstorm .

On June 1, 2009,  Air France Flight #447, Airbus A330 jetliner, encountered a line of towering thunderstorms  in mid-Atlantic Ocean. The autopilot disconnected leading to a stall. The pilots mis-compensated for this by pitching the aircraft nose up instead of down. Flight crashed in ocean.

So the AN 32 was not the first fatal accident due to weather; and it will not be the last.

Let me finish this tragic tale on an optimistic note. On Christmas Eve December 24, 1971, a lightning bolt struck and ignited fuel tank on a commercial flight. All 91 aboard perished except a 17-year-old German girl, Juliane Koepke. Strapped to her seat, she fell 10,000 feet to the   Amazonian jungle of Peru. She survived with a broken collar bone and popped eyeballs. For 10 days she wondered through the jungle and swam down a river till she happened on a lumberman shack and was rescued! Many documentaries were made on this miracle including one by Werner Herzog, the well known German film director and producer.

I close with prayers for the 29 aboard the ill-fated AN 32.

Eid (ईद)

Khushiyun Ki Shaam Aur Yaadoon Ka Yeh Samaaan
Aapni Paalkoon Py Haargiz Sitary Na Layein Gey
Rkhna Sambhal Kr Chand Khushiyan Mere Liye
Mein Lout Aaaon Ga Tu Eid Manayein Gey…!!!

 - Victims of terror attack, Dhaka, 1–2 July 2016

ईद
खुशियों की शाम और यादों का सामान,
अपनी पलकों पे हरगिज़ सितारे न लायेंगे
......रखना सम्हाल कर चंद खुशियाँ मेरे लिए
......मैं लौट आऊँगा, तो ईद मनाएंगे.......!!!

ढाका ,1-2 जुलाई 2016 के पीड़ित

 Floral tribute to victims, Holey Artisan Bakery, Road No 79, House 5, Gulshan 2, Dhaka, Bangladesh

Victims: from left to right: Abinta Kabir, Faraaz Hossein and Tarishi Jain + 18 others.

Faraaz Hossein, a Bangladeshi Muslim was allowed to leave by the terrorists but refused to desert his friends and fellow hostages.

He was a student at Emory University, USA, and was a Phi Eta Sigma (ΦΗΣ), ie, member of USA's oldest and largest honor society for college and university students.

DOCTORS' DAY [01 July: India, National Doctors' Day]

The good physician treats the disease; the great physician treats the patient who has the disease. -- William Osler 

He is the best physician who is the most ingenious inspirer of hope. --  Samuel Taylor Coleridge 

What is the best part of being a doctor? That's like asking: what's the best part of being alive? clearly, being alive is the best part of being alive. And so is  being a doctor the best part of being a doctor.

Rhetoric apart, being a doctor is more than having specialist knowledge in a specialised field. It is being human and being humane, above all else. To be human means realizing that your knowledge is limited and that you will fail from time to time. To be humane means to have compassion and empathy no matter how trying the times.

Being a doctor is rewarding because it is challenging, a continuing learning process. Human body is complex.  How it works amazes and scares you; makes you humble. And just as you think you understand most of it in your speciality, new mysteries, new challenges, new protocols, new medicines, new information, new data, and new lines of treatment appear. So you are always the challenged, always the learner, never the master.

Even when you have seen a thousand patients with same symptoms, done a thousand of the same surgery, you are alert, on the lookout for that one minute difference that could dramatically affect the outcome for the patient. Medical literature is full of stories where missing out that one minute difference cost the patient dear. And though you are trained in decision-tree based algorithm to diagnose and evidence based  medicine to treat, that is not enough. Because medicine is more than just science. It is art. It is the instinct borne out of knowledge, experience, and is, well, a sort of sixth sense that you develop over a period of time being a doctor. That is why, as a study in the US has shown, an experienced doctor makes up his mind on patient's ailment within seconds of seeing him; a new doctor will struggle for hours and still be hard pressed to diagnose.

The greatest pleasure a doctor derives is when he helps a patient beat the odds, recover from a hopeless situation, walk out of the hospital when everyone thought he never would. Doctor's joy then is no less than that of the patient's family and friends.

Doctor's reward comes not only from treating a patient's illness, but also from helping him with his loneliness, fear, anxiety; reward comes from knowing that you make a difference in the society; reward comes from knowing that the society holds you in esteem for that reason.

If you are seeking financial rewards, then medicine is not for you. An MBA can, and does, earn more. And getting MBA takes less time. And in the present times of commercialism and malpractice suits, the financial rewards have become even less. In the US, professional insurance for the hardest hit speciality, Ob & Gyn, is upwards of $ 200,000 a year. For these reasons many physicians in the US have given up medicine. You may find a gynaecologist selling cars.

Doctors have the joy of helping people out of their misery, getting them to feel well again. And the sorrow of delivering bad news to the patients and their near and dear ones.

But then life is a mix of triumph and tragedy, of joy and sorrow.

MOTHER'S DAY (Sunday, May 8th)

Of all the rights of women, the greatest is to be a mother

Would-be mothers and new mothers: breast milk is the best feed for your baby. But you and your baby are unique, and the decision is up to you. 

Breast milk has the vitamins, protein, and fat that your baby needs to grow; it is easily digestible; it has antibodies that fight off viruses and bacteria; and it reduces the risk of the baby being affected by asthma or allergies. Babies who are breastfed exclusively for the first 6 months, have fewer ear infections, respiratory illnesses, and bouts of diarrhoea. Therefore, fewer trips to the doctor, and fewer hospitalizations.

Breastfeeding may also lead to higher IQ of the baby. It may also lower the risk of obesity and diabetes, of certain cancers, and of  SIDS (sudden infant death syndrome). But more research is needed to establish these claims. It is certain though that the physical closeness, skin-to-skin touching, and eye contact all help your baby to bond with you and  to feel secure.

Breastfeeding burns extra calories, so helps the mother lose pregnancy weight faster; and releases the hormone oxytocin, which helps the uterus return to its pre-pregnancy size. It may also reduce uterine bleeding after birth; and may also lower the risk of breast and ovarian cancer, and  of osteoporosis.

And it saves you money: you don't have to buy baby feed, bottles and other items.

A mother makes enough milk to meet baby's needs. The thick, yellowish, breast milk - the "first milk" or colostrum - you make for the first few days after birth, is ideal for the newborn and helps her digestive tract to develop.

Under certain conditions - if you are undergoing chemotherapy, have HIV, have active tuberculosis etc - breastfeeding should not be done. Your doctor will advise you about these.

Use hands, or a breast pump, to extract breast milk for use later. You can store it in a refrigerator for up to two days, and in a freezer for up to six months. Stored milk should not be warmed up in a microwave because that destroys some of its immune-boosting qualities. Warm it in a bowl of warm water. Your baby may take a few weeks to get used to breast milk in a bottle.

Sometimes vessels in your breast become congested and the breasts feel hard, painful and swollen. Using ice packs and hot showers alternately can give relief. Releasing breast milk also helps.

See your doctor if your breasts become unusually red, swollen, hard, or sore; or unusual discharge or bleeding from your nipples; or baby not gaining enough weight.

Enjoy motherhood. All love begins and ends there.

Tahitian Woman and Two Children - Paul Gauguin (1901)

ELLORA

On this year's World Heritage Day, I was at two World Heritage sites: Ajanta and Ellora.
Ellora, to me, is more special than Ajanta.
Ajanta is only Buddhist. Ellora is Brahmanical, Buddhist and Jaina - the three major faiths of India. Ellora is thus a symbol of religious harmony - that we so much crave for these days - during 05-10 CE when the Ellora caves were cut into the vertical rock face of Charanandri hills in Aurangabad district.
Of the 34 Ellora caves, 17 are Brahmanical, 12 Buddhist and 05 Jaina.
Brahmanical cave 16, the Kailasnath Temple, is a wonder of workmanship and architecture. It is "one of the greatest monolithic sculptures of the world." It is dedicated to Lord Shiva, as are the other Brahmanical caves. In the corridor at the rear of the main shrine are icons of Shiva pantheon.
Buddhist cave 10 is among the best of the 1200 Chaitya temples - a shrine or a prayer hall with a Stupa at one end - built in India. The cave's facade, the flying gandharwhas for example, is exquisitely carved and much admired.
Cave 32 is the most notable Jaina cave. Jaina at Ellira developed a distinct style of their own by blending the Buddhist and Brahmnical styles of architecture, sculpting and painting as exemplified by the sculpture of Sidhayika in cave 32.
Ellora caves are spread over two km distance. A ferry bus is available but much walking is required. A bit tough in hot weather. Visit in Nov-Feb - my advice.

 Kailashnath Temple (cave 16) canopy

 One of Shiva pantheon in the corridor at the back of the shrine, Kailashnath Temple

'Flying Gandharvhas,' facade of Buddhist cave 10

'Siddhayika,' the Goddess of Wealth and Prosperity, Jaina cave 32

The art of ART

Fertility is God's gift to women. And to men. But the gift is not equitable. A few have more of it, a few have less of it, and a few have none of it.


So God created science. And science created ART - Assisted Reproductive Technology. But ART is an art, not just science. Just as art depends on artist, so does ART depend on the ARTist - the practitioner. Just as the artist becomes more skilled with practice and experience, so does the ARTist. So the right question to ask is not what the success rate of ART is; the right question is what the success rate of the ARTist is.
IUI - Intra Uterine Insemination - was the first ART. Its first reported use in humans was in 1943. It is still in use. For a woman of 35, IUI success rate after three cycles is about 55%; for ART, it is 75-94%. For IUI, the rate dips sharply with woman's age: 3-14% for woman of 45; for ART the dip is hardly any. Has the time therefore come to discard IUI?


No. IUI Is simple, inexpensive, least invasive, easy to learn and perform and thus poses little or no risk to patient. In certain conditions, it has very good chance of success. ART is difficult, expensive, more invasive, more difficult to learn and preform and thus poses a little more risk to patient than does IUI. IUI therefore must be retained. It offers the patient a choice. And serves patients who cannot afford ART or who reject ART for social or religious reasons.

PS:
I Chaired a session in the International Conference on ART at Goa, 29 April - 01 May, 2016.

Dr Yacoub Khalaf, Consultant Guy's & St Thomas' Hospital and Kings College, London, was the keynote speaker.

Chairperson's address, International Conference on ART, Goa, 29 April - 01 May 2016

 Prof Sadhana Kala, Chairperson, and Dr Yacoub Khalaf, keynote speaker, International Conference on ART, Goa, 29 April - 01 May 2016

Her Excellency Dr Mridula Sinha, Governor of Goa, inaugurating The International Conference on ART, Goa, 29 April - 01 May 2016.
Dr Sinha is a littérateur. She has authored more than 40 books.