It was LORD KRISHNA who HIMSELF gave this sermon to Arjun, when Arjun was facing the biggest crisis in his life. The complete sermon is compiled in the “Holy GITA”. However, the gist is as under:

Whatever has happened, there was some good in it.
Whatever is happening now, is happening for the good.
And whatever happens subsequently, will again be for the good (which you may be unable to see now).

Is there any reason for you to worry?
What have you lost for which you cry or feel bereaved?
What did you bring with you to this world that you have lost?

What did you produce, which has been destroyed?
You did not bring anything when you were born.
Whatever you have, you have received from Him,
and whatever you will give, you will give to Him.
You came empty handed and
you will leave this world the same way.
Whatever is yours today was somebody else’s yesterday and will be somebody else’s tomorrow.
Change is the law of this world. Hence cheer up and continue doing your job with all your heart and soul. Do not worry about the end result as HE would be determining it.

For achieving ‘millennium development goals’, methods and modalities should be developed for developing nations by refurbishing, revamping and rejuvenating the health care infrastructure for the languishing population in deprived regions of Africa, and South-East Asian region, including India. Amongst the socio- economically deprived, an early age of marriage and pregnancy and thereafter incessant childbearing, breast feeding, etc, does takes it toll on a mother who barely manages all this without sufficient time or proper intervals to recoup her health. Malnutrition, pollution, poor hygiene and sanitation etc, compounds the adverse effects. Children born under such conditions are likewise deprived of better health and nutrition, right since inception, unlike their counterparts from the middle and upper socio -economic classes.

Worse of all, resources generated and allocated for dealing with a specified population soon falls short, both in terms of quantity and quality, usually as a consequence of unrestrained population explosion, with every family usually having four to five children in its fold. Burgeoning population is probably one of the root causes for being unable to achieve the ‘millennium development goals’. For example, health facilities, food, other resources and facilities, meant for lets say 50 persons is soon expected to serve double that number or more. These figures just keep mounting, ultimately overwhelming the resources/facilities, causing disappointment and failure, which is easily avoidable by population control along with rejuvenation of the health care infrastructure.
Family planning measures per say have not been able to produce desired results for the poor communities and the downtrodden, where they are needed the most. Ignorance, non-availability of timely guidance and help, desire to produce a male offspring, and often the need to get as many helping hands, which can be as early as when they are just 5 to 6 years old (by providing ‘nanny’ support to the younger siblings and 2 to 3 years later by helping their parent’s in their vocation or can go out to work for supplementation of the earnings), are perhaps the other leading causes of population explosion needing urgent attention. Health infrastructure for the poor and destitute needs overhauling and rejuvenation. Earmarked zones and teams may be formed, and reinforced if needed. Such teams can be entrusted with provision of maternal and child health care, dispensing free medicines, advertising benefits of family planning and small family norms, while also ensuring compliance of free health check-ups. Population control should be the emphasis. Pollution control, hygiene and sanitation, etc, can also be incorporated in their agenda. Additional properly motivated (and accountable) mobile medical teams can be employed to visit such areas which have a low health seeking pattern/behaviour.

If possibly school education can be made compulsory (absolutely free, along with mid-day meals) for their children when they are five years old, it shall have two cherished outcomes. First and foremost, parents would probably then realize and take home the message that their children would no longer be able to supplement their earnings, unlike what is normally the present trend where most children of the low socio-economic class are sent off by their parents to earn at a tender age of 8 or 10 years at the most. Moreover the factor that their children would continue eating away into their earnings till they are mature enough and would also no longer be able to provide ‘nanny support’ to younger siblings left at home, will probably help push them voluntarily towards adopting family planning measures and make them more responsible. The second definite outcome would be of getting educated generation of the underprivileged as well, who can be a great asset for a community or a nation. They in turn would be our ‘second messengers’, and can help in achieving and sustaining the ‘millennium development goals’.

The Governments of India and the Government of Guyana have already implemented the project on compulsory education of children and banning of child labor. Let us hope that the millennium development goals are achieved, and in this, we all must contribute, as the ultimate goal is to improve the overall conditions of mankind.

Reference:

(1) Chauhan R et al. Re: Towards achieving the "Millennium Development Goals". BMJ 2 December 2006. http://www.bmj.com/cgi/eletters/331/7517/585?ehom#150358

(2) Chauhan R. Towards achieving the "Millennium Development Goals" BMJ 1 October 2005. http://www.bmj.com/cgi/eletters/331/7517/585?ehom#118148

(3) India: The Times of India: http://timesofindia.indiatimes.com/articleshow/1849466.cms

(4) India: The Hindustan Times: http://www.hindustantimes.com/news/181_1761899,00300006.htm

(5) India: The Hindu Business Line:
http://www.thehindubusinessline.com/2006/08/03/stories/2006080300211000.htm

(6) Guyana: Stabroek News: http://www.stabroeknews.com/index.pl/article_general_news?id=43311947

Delivering a baby is a primal and unassisted event for the viviparous community. We humans are slightly different, as matriarchs have passed down their skills and experiences which are used for assisting vaginal deliveries. Thus, rather than being left all alone to accomplish this task, there is usually someone around with requisite skills to assist, although a few deliveries continue to occur unassisted. However, armed with the recent knowledge acquired in the past few decades, vaginal delivery is being made out into an extremely painful, outdated, formidable and complicated event which needs to be shunned in favor of a better alternative – the cesarean delivery. Albeit, vaginal deliveries are still considered handy for the mothers who do not have requisite means as also for the simple folks from countryside, as cesarean deliveries are costlier and everyone can’t afford it. Cesarean delivery is often being made out to be a privilege and is becoming a trend amongst the well-to-do and upwardly mobile and this trend is more or less a global phenomenon. Is it really a privilege, and at what cost? What about the risks and later consequences? Is cesarean delivery really so safe after all?

Improvements are fundamental otherwise we would have remained hunter- gatherers and cave dwellers. For improving outcomes of delivery, planned vaginal delivery and cesarean delivery have been two such improvements. Cesarean method was developed to overcome certain complications which could be detrimental either to the mother or her baby. Based on evidence, certain indications were developed for cesarean delivery, which ought to be respected and followed. When planned home births with certified professional midwives are safe[3], surely the planned vaginal deliveries in hospital would be safer still. We also know that women in the planned vaginal birth group who had spontaneous or instrumental vaginal delivery were less likely to experience death or serious morbidity than were those who delivered by emergency cesarean birth. Notwithstanding, the indications for cesarean delivery have now perhaps been overtaken by an ‘educated choice’, convenience, and ‘on request’ for being fashionable and trendy these days. Whose convenience and preference are we talking about? Once the pains start, graduating from the first stage to the second takes time and then there always would be the third stage to follow and would require careful monitoring all throughout. It also requires patience and perhaps it may also be remotely associated with missing out on quick bucks. On the other hand we have cesarean experts who have clocked 10 minutes or even less and this process gives enough freedom and choice so that one can plan to have a baby during a weekend, sharp at 0911 hours GMT for example, if that is the preference.

In Canada alone, the rate of cesarean births has increased from 5.2% in 1969 to 25.6% in 2003, and from 19.7% of all cesarean deliveries in 1994 to 28.3% in 2001 in USA. Consider the overall workload when these figures would reach 75% or more. If the general consensus still remains in favor of elective caesarian deliveries, we should then get prepared for 30 to 100 or more deliveries by elective caesarian sections daily that would have to be done in every busy urban or sub-urban hospital. The responsibility shall be over and above the normal commitment towards health of the society that every hospital provides. This fashion has all the potentials of becoming a trend setter, with a global fall-out. Does the developed world (ignoring the developing countries at this stage of reasoning) have sufficient experts, hospital beds, paramedical staff, etc, to take on this additional responsibility which will be colossal? Once the trend is established, are we still to imagine that the post caesarian outcomes will continue to remain at its present best levels. More importantly, would we be able to switch the tide back towards planned vaginal deliveries thereafter when, sooner or later, we may want it to be restituted? Then, why must we push vaginal deliveries to oblivion? [1]

Reference:

1. Chauhan R et al. Pushing vaginal deliveries into oblivion. CMAJ 19 Feb 2007. http://www.cmaj.ca/cgi/eletters/176/4/475#7451

Rumours are rife about bird flu. It must not be seen as if the inevitable doom is fast approaching. More than the bird flu per se, it is the rumours that can cause more harm. People all around are eager to catch on every tidbits and news on the latest developments on this score. Not wanting to be sitting ducks, the clever may have already started taking proactive actions to fend against the doomsday, including stockpiling of antiviral drugs. Some Governments would likewise be stockpiling various antiviral drugs or they may be forced to take similar proactive measures by public outcry or public demand, despite it being impossible to predict which drugs will be effective against the new pandemic strain of influenza that would be on the front at that point of time. Panic and anxiety can be highly infective, much more than the H1B5 virus, sufficient to push the sales of antiviral drugs that may start selling faster than hot cakes and the multivitamins. For the developing world which already has its hands full with multitude problems, ‘bird flu’ would just be an extra burden to survive with, while having to divert some of their meager resources towards the cause of bird flu.

Mankind has witnessed many pandemics having come and gone. Perhaps this one would be no different. Each and every new case may not be severe or life threatening as the severity of illness would depend on many different factors. Moreover, many persons would already have developed certain amount of immunity through undetected and undiagnosed clinical or sub-clinical infections. Sooner or later this pandemic would surely burn out to return some decades later. In the interim and thereafter too, there could be so many other ways as given in ICD (International Classification of Diseases) that a person may suffer from. Therefore must we start panicking for thousand different reasons as each of the listing therein can be potentially fatal? Notwithstanding their wanton culling, for all we know, the birds may be having a good time by having convincingly frightened the man.


Intention is not to sound like advocating complacency. Prophylactic measures must be instituted and re-emphasised. As is usual in any pandemic, the weak are the ones who will suffer the most if and when the bird flu strikes. Therefore the old and infirm, pregnant or nursing mothers and the young are to be specially protected, including timely vaccination. Furthermore, protection and support would also be required for the immuno-suppressed and their contacts. Public has to be educated about the measures to check and prevent aerosol spread and the value of quarantine (forced or self imposed). Tips on self-care need to be disseminated and to be encouraged. Congregations as well as travel may have to be restricted in the affected areas. FLEXIBLE policy guidelines on prophylaxis, admissions/ discharges, and use of anti-virals and antibiotics will have to be formulated and disseminated.

Dr. Rajesh Chauhan