I ain’t you

I smiled. Because you did.
You were happy and assumed I was.
Maybe I was, or was I?
Then you grew grim, I felt crippled.
Forgot my other happy self.

Did you see that? Oh, how would you.
I was just a mirror
You could see only what I could.
I stood there absorbing all that came through
Reflecting your emotions, having none of own.
I made you look good 
Yet at times, ugly
You thought I could absorb more
Like an endless black hole, so did I?

But then came fierce, sharp as it can be.
I was confused maybe because you were,
It reached to a point
Where the line was crossed,
where you broke and so I did too.

I am now numerous pieces of mirrors
Trying not to reflect you or any passerby
But shine my own light, in my own style.
As bright and bold as it can be
Clear that my emotions are not yours
and that hurts but what is true is I ain't you.

I ain’t you

What I wish they had told me about Therapy

Very nicely written article on how therapy is useful. Can totally relate to every bit of this!


By Anushree M.D.

“Ma, I think I’d like to see a therapist.”

Well, it sure isn’t pleasing for Ma to hear. Actually, it isn’t pleasing for anyone, but it would be better if people could at least accept it.

Picture this: one in every three people suffer from a mental illness at some point of their lives, and this disables such a huge fraction of our society, affecting every aspect of our development, and the quality of our lives. This is a true fact. But no! We’ve got to label it as taboo and stigmatize “crazy” people, because that, my friends, is what society’s still doing.

Growing up, I saw how one of my dear friends was not the sanest of people, and about 8 years after he should’ve first started seeing a therapist, he finally did. When I too asked to go for therapy on account of feeling oddly…

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What I wish they had told me about Therapy

Voices for quality

Do you remember the last time the restaurant didn’t serve you the soup in time? To add to that it was unnecessarily spicy. I remember mine. The first thing that comes to our mind in these situations is feedback. I mentioned it directly to the waiter. Not exactly for them to replace the soup or be apologetic, but in a way to voice out that “this is what I felt about your soup, which is unacceptable to me. ” This establishes that the user has the power in the service delivery chain and the user is fully aware that he/she is entitled to high quality soup. Further, it also makes sure to send a message that, “to improve the experience in your restaurant, you’ll have to change so and so…” ensuring that the providers have the chance to know what the issues are. No, I don’t always give negative feedback, I did write a nice google review for a haircut recently that prove it.

The point being, feedback, grievance reporting and redressal systems have a major role in improving services, user satisfaction, and hence fulfills the the overall objective of the service being delivered. It’s the providers’ responsibility to put in place a system for collection of true feedback and equally the responsibility of the consumers to give honest feedback that is useful. (Now, don’t ask me how the 5 seconds smiley feedback in the supermarket is useful)

Even in private hospitals like Apollo, I remember the ward door being knocked more number of times by the management staff compared to the health staff for all kinds of feedback. “Was the shifting to ward smooth? How do you find the food?” etc But what happens when we look at the services delivered in primary healthcare centers? In Government hospitals which serves mainly for the population of low socio-economic status? It is safe and unpleasant to state that currently there is no efficient way of feedback or grievance redressal mechanism in these facilities where the users can voice their experiences and troubles. Is it because they are paying less or no money at all? Should quality of healthcare be linked with money? Is power for the users linked with money? Answers aren’t simple. There are several layers of issues (longer than the list below) when this system is considered:

  1. Users’ awareness regarding what services and quality of services they are entitled to, is minimum. They are not sure of what is actually expected in a hospital, from a doctor and so on.
  2. Currently there are no mechanisms to collect this kind of feedback in a hospital or PHC where number of people served are in plenty.
  3. Even if say, the mechanisms are in place, and the feedback is collected, can they be redressed in the current system

This is regarding the lack of feedback/grievance reporting and redressal system at the patients level. The same holds good at the staff level. I hear every now and then from the time I was an intern, that glove supply isn’t available or drugs for treating heart attack needed to be procured by the patient’s family from a pharmacy in the city even if was mid-night, but nothing could be done. Because the power to procure the drugs that a doctor/nurse uses to save patients often doesn’t lie in the doctor or nurse’s hands. Also the administration is often left with no feedback to improve. I’m sure there are informal ways to report these issues. But, does this ensure accountability? Like the quote, “if it’s not on paper, it’s vapor”!

Dr NS Prashanth and R Balasubramaniam have actually laid out this as one of the action points in their book “Towards a healthy India”.

There exists a Centralized Public Grievance Redress And Monitoring System (CPGRAMS) and similar portals at the state level but it doesn’t ensure micro level feedback.

Arogyashreni – GRAAM’s 3 year project on community monitoring of primary health centers illustrates what it takes to make community monitoring work successfully and provides evidence that community participation in health is the right way to go. It used IVRS to get information and feedback from the community regarding the PHCs they were utilising. You can find more about it here.

So, going forward, we need different approaches to ensure an efficient feedback/grievance redressal system at multiple levels of users and multiple levels of healthcare. This will:

  1. Provide voice and power to the users who otherwise are just silent takers of any quality service.
  2. Improve the awareness of the users regarding patient rights and what care they are entitled to
  3. Increase the accountability of the providers
  4. Facilitates the processes of quality improvement

Some modes of doing this could be:

  1. IVRS like the one described above
  2. App based with regional language
  3. I heard from a nurse in Kenya that at their PHCs, every morning when the patients are waiting for the doctor, the nurse engages them where they voice their concerns regarding the system verbally and that is reported and acted upon. This gives a space for improving the awareness of patient rights
  4. Having a dedicated staff to ensure this process

This is something I’ve been planning to work on. Collecting such feedback doesn’t by itself redress the issues but it’s a major and first step towards it.

Voices for quality

It’s a new jar

Pieces are plenty,
Can see a new one after each blink
Should I pick them all?
Do they even belong to the same jar?
Maybe I can just escape
The pricks, the confusion,
And the overwhelming search.

When did the jar slip?
The beautiful crystal that proudly shone
Displaying magnificent colors
Changing as the light did,
Not caring if it were in safe hands,
Hands that became numb,
And barely knew their responsibility.

Maybe the jar was merely an illusion
It was never meant to be
But the pieces I can still see
If only I can cherry-pick them and
wedge them together
Into something more tangible,
More real and less daunting.
File:Broken glass bottles hazardous waste in dispersed quantities ecotoxicological question 07.jpg
It will be less beautiful, 
Definitely less intimidating
But isn't that how a jar must be?
I'm not sure, this one too may reach the floor
Shattering into even more number of bits
But maybe that's how a new jar is born
With more care, and reality each time.

It’s a new jar

Let’s not be the ant who follows

Conformity is not a new word for me. I had heard it in the context of gender non-conformity. But recently it has occurred to me that social conformity is society’s way of bullying without the victims of bullying realising it. Thanks to Dr Ashmeet.

Conformity is a type of social influence involving a change in belief or behavior in order to fit in with a group. I wouldn’t go into the technical details of the types of social conformity but would recommend to read about it here as it is quiet interesting.

So have you felt awkward to go and begin conversations with speakers in a conference when your friends are with you but feel no barriers to do so when you’re attending the conference alone?

This is a classic example of conformity issue. Though you would want to converse with new people, make new connections, talk about your ideas, one holds oneself back to conform to the group around. The fear of being “over smart”, “stupid”, “irrational”, “different” are the threads that are invisibly yet tightly stitched to us by the society. And this could be dangerous to one’s freedom and the ability to do things with free will or attain success or failure which are either not less important.

In school, this can take the form of having groups with shared attitudes, and teasing/ criticising/ excluding other individuals with “different” views and abilities.

This reminds me of the quote Will smith says in the Pursuit of Happiness, “Don’t ever let someone tell you that you can’t do something. Not even me. You got a dream, you gotta protect it. When people can’t do something themselves, they’re gonna tell you that you can’t do it. You want something, go get it. Period. ”

This need not always be in words. Someone holding back in expressing their views or ideas, their style in dressing, in presenting, in order to conform to their groups is the deepest way in which the society is telling him/her that “you CANNOT do that!”. Because this is not only external but has become a part of that person. Like a sesamoid bone, but one that is not harmless. I now wonder how difficult it must be for the people with don’t conform with their gender. That must be a fight every minute.

This article explains about how ants act as one unit and follow the team with less individual variation. It also explains the three possible reasons for social conformity:

  1. Power of habit which simply keeps perpetuating itself.
  2. Fear of punishment and social ostracism.
  3. Power of inertia and unwillingness to change
Image result for ants walking in a line

How does one deal with social conformity?

The first and the important step is to understand what it means and recognise what a huge role it can play in society and in individuals precisely. If one feels like one is affected by it, constantly recognising it and restoring the importance of freedom, free will and individuality more than conformity would be an active exercise one has to do in his/her daily life.

Actively discourage those attitude of people especially in schools and youngsters which reinforce that conformity is the norm and the single right thing to do. Even if you’re a role model, a teacher, a parent, scientific enquiry, questioning, allowing to express one’s views and encouraging debates and healthy arguments is the real attitude that shapes someone.

So next time you’re thinking twice before doing something/stepping up think –

“Am I trying to to be the ant that follows or is this really what I don’t want to do?”

Let’s not be the ant who follows

Exploring mode

I usually describe myself a stick. Not because I’m as thin as one but because I’m as inflexible as a stick.

But I joined contemporary dance class at the Natya Institute of Kathak. This is a fancy famous place in Malleswaram started by a great dancer Dr Maya Rao and a lot of wonderful dancers have arose from here.

Am I trying to be one of those amazing dancers? Na..like my teacher says “enjoy dancing, give your body a chance”.

I’d been admiring contemporary dance since high school and lately I saw a short video of my friend in the US dancing so beautifully that I wanted to learn.

So what if it’s hard? So what if I’m a stick? What if i have no prior background in dance? So what if I’m 25. I’m not getting any younger anyway!

So I decided I’d go for it. Bought a T-shirt that says “Explore mode” and attended a class. After that day’s class, this week I’m trying to fix my sore muscles before I get back to my second class 😛

Exploring mode

HIV talks

We reached the venue of the collaborators meeting – Southern Sun Mayfair Hotel which was just a muddy road away from the hotel we stayed La Maison Royale.

So the meeting is an annual event that University of Nairobi conducts to bring in all the collaborating universities together and share each other’s work, plans, successes, failures through plenty of presentations and tea. We raised our hands that this was our first annual meeting. I was very pleased with the tag they gave us hanging with the beads of Nairobi flag colors. It read ” STD/AIDS collaborative research group annual review meeting”. The room was appropriate and cozy for the term “meeting” because I had imagined a large hall like in conference with less chance to interact with the presenter. I was told that this meeting was mostly always has been about HIV because a lot of research happens in HIV in Kenya but this time, a section was added on the last day on emerging and Zoonotic viral infections where our talks were given space.

Very interesting talks came along. After hearing the updated situation of HIV in Kenya from the director of National AIDS Control Council (NACC) there was a talk on how PreP is being scaled up in Kenya. PreP was a part of the government program! I was very happy to hear that. It has done quite well and I could tell this not because of that talk alone but because a driver asked Tina about PreP once he learned that she was a doctor. Also saw this wonderful poster in a special treatment centre. It has succeeded so much that now they’re doing all other studies around it to address other issues like contraception usage and pregnancy rates among PreP users and ?higher incidence of STI in PreP users.

Nelly Mugo , from KEMRI talked about how Undetectable=Untransmittable evidence was established with a series of studies

Picture from her presentation showing all the studies that went through to prove U=U

During coffee I asked her how this concept has been hard to find application in India due to lack of viral load testing as a regular monitoring tool in the national program. I learnt that it is done annually at Kenya, but still there are doubts from the health care professional in using the concept. Just like every where else. Talking to her gave me the confidence that I could talk to anyone. People were welcoming and there were no boundaries/barriers/hierarchy/weirdness. Harison Lagat talked about the PrIYA study (PreP implementation in Young women and Adolescents) where standardised patients were used to improve counseling for PreP. I loved the concept of standardized patients and the power of the tool for medical school learning. Noted this down as a tool for learning and testing that can be used for our primary care fellows to be.

That evening there was a special talk on “Improving Maternal and Child health Services- Lessons learnt from Uttar Pradesh” by Vikas Gothalwal, IAS officer and the Executive Director of UP-TSU working closely with University of Manitoba and IHAT. Their work was very interesting as the funding was through Bill and Melinda Gates but integrated with the State government and acted as a technical support. Hence though the initial interventions are through this funding, the state Government adopts it after the success of the pilot study and further funds it.

That evening ended with a nice dinner at the hotel and looking forward to meeting our colleagues at KAVI.

HIV talks