VOLUME

MARCH 2020

THE GREY MATTER

QUARTERLY NEWSLETTER FOR MEDICAL STUDENTS
BASED IN M.I.M.E.R. MEDICAL COLLEGE

Something
in the air
 Tuberculosis: The Math

A total of 1.5 million

people died from TB in
2018 (including 251 000
people with HIV).

MDR-TB remains a public health

Worldwide, TB is one of the
crisis and a health security
Ending the TB 10 leading causes of death
threat. WHO estimates that there epidemic by 2030 is from a single infectious
were 484 000 new cases with among the health
agent. Above HIV/AIDS.
resistance to rifampicin – targets of the
Sustainable
Development Goals.

In 2018, the 30 high TB

Globally, TB incidence is falling
at about 2% per year. This needs
burden countries accounted
to accelerate to a 4–5% annual for 87% of new TB cases.
decline to reach the 2020 Eight countries account for
milestones of the End TB Strategy. two thirds of the total, with
India leading the count.

It creeps up on people everywhere, while they travel in local trains, walk in crowded markets and do so much as breathe

the air that an infected person has coughed in. Aside from all of these appalling numbers and grim statistics, this disease

is both physically and mentally crippling. We call for pre and post test counselling along with regular follow ups to be

included as part of the National Health Programme on Tuberculosis to help patients get through a gruelling treatment

period. Through this edition we hope to encourage medical students across the country to diffuse what Dr. Zarir Udwadia

says is India’s ticking time bomb.

1
2
Dr. Zarir Udwadia on
ST
GUE IEW
ERV
THE
THE PERFECT
PERFECT PATHOGEN
PATHOGEN INT

In conversation with Riya Barar & Damini Narkhede, III/II M.B.B.S.

I started publishing articles in journals when I was doing my

MBBS.  Having the kind of bent towards research that I've

always had and having the opportunity of working in a

hospital like Hinduja that encourages those interests, I

consider myself very lucky. Most private hospitals don't

encourage such activities, but I think it would be really boring

to be seeing patients from morning to evening. It's these

other interests of mine that keep me going.

Q. Tell us about your particular interest in Tuberculosis. 

A. For me Tuberculosis was almost fortuitous.  At the

University of Edinburgh there used to be a really famous

professor by the name of Sir John Crofton. He had

conducted all the initial research on drug resistance in

Dr Zarir Udwadia is a preeminent pulmonologist and tubercle bacilli.  He had retired by the time I got there, but

researcher. He has contributed extensively to the everyone around would speak about this man in hushed

work on drug resistant TB and was the first doctor to tones. I think at every stage of my life a little serendipity has

document totally drug resistant TB in India and among always played a role. This was one of those. Here I was, at

the first few to do so worldwide. this great hospital where this great man had worked. They

He is known recognized widely for his famous TEDTalk would show us the laboratories he used, where he did all his

amongst other things.  drug sensitivity testing to develop the current regimen for

tuberculosis treatment we now use. Though I didn't see many

Q. What are some of the reasons you chose medicine tuberculosis patients in my 4-5 years of training in the UK, an

as your profession? interest developed.

A. I don't think there's anything else I could've done. So it Q. Is there a case you will always remember? 
was either, become a doctor or go bust, and I didn't want

the latter.  Medicine was the conversation at home since I A. Zubain Irani, a young haemophilic who was one of the first

come from a family of doctors. I would often wait in the few patients I saw after coming back from the UK. We have

hospital while my father was seeing patients, so I think it reports showing that he was resistant to Rifampicin, Isoniazid

was in my blood perhaps.  Medicine is a nice way of doing and some of the other first line drugs making him one of the

well for yourself while doing well for others. first patients with MDR TB.  We didn't know how to deal with

him, no one did at that time. I wrote to experts across the

Q. Why did you choose to specialize in Respiratory globe, in those days there was no email, so I used snailmail. I
medicine? got in touch with a world expert on Tuberculosis, Dr. Peter

Davis. He gave me advice, sent some drugs and experimental

A. It was an interest from my undergraduate days. I finally
vaccines.  Zubain had extensive cavitatory lesions and kept
chose it after a process of elimination. I was dreadful with
having major bouts of haemoptysis which were made worse
my hands, so surgery was not an option and perhaps I
by his haemophilia.  We tried everything for 3 years and he
wasn't cerebral enough to do neurology. Since cardiology
eventually succumbed to his disease and died.  I contributed
seemed too high-tech for me, I finally chose Respiratory
a chapter in Dr. Peter Davis' textbook and wrote on MDR
medicine.
Tuberculosis.  I think Zubain must be the person who gets the

credit for inspiring me to work against tuberculosis more

Q. What would be your advice to young future doctors?
aggressively. He taught me so much and I'll never forget him.

A. It's so important to stress that you need a combination of

being very busy clinically, while also developing other

academic interests. That's a bug one should catch from an

early stage.

3
Q. Can you tell us a little about your passion for A lot of these articles are non-pulmonary but, you’ve got to

research? develop an interest in other parts of medicine as well. I

believe that's what makes a really good doctor.

A. I always had an inclination towards research and

publishing articles. Initially, the thrill for publications was Q. What advice would you give your younger self if you
strong, but that's long gone now.  I don't just observe and could go back in time?
treat. I write, research and publish as well. Every Thursday I

dedicate 2 hours to a journal club with all my residents and A. To have a little more fun along the way!

fellow colleagues. It's a pet project and a passion of mine. I

really enjoy pursuing it in addition to being a clinician.  I Q. What are the changes you’ve noticed in healthcare
deliver lectures all over the world now, mostly about over the last 25 years?
tuberculosis. Another disease I specialize in is, interstitial

lung disease. It's a very nice feeling when you're asked to A. Sadly, It has gotten extremely commercialized. Sometimes

deliver talks in some of the best institutes in the world. I get I get cases in the ICU where I’m only expected to monitor the

to talk about what I love while I travel the world. Now I'm a patient’s lungs, while other doctors monitor the other failing

little picky with the locations, however. I only go if it's a nice organs. You aren’t completely responsible for a single

place like Rome or Vienna. patient anymore. When my residents tell me that a particular

case isn’t Respiratory, I always tell them that to be a Chest

Q. You've spent a lot of time training abroad. What is physician, you’ve to be a good physician first. Medicine has

one thing or practice you saw there that you would like also become more corrupt. It doesn’t just depend on the

to see in our country as well?  system but, individuals as well. A doctor must stick to his

principles. One day you’ll reach a stage like mine when if I

A. I spent four years training abroad. Their students are ask the patient who sent him to me, he says I googled you.

prepared very well from the beginning. They teach you how When I see doctors announce proudly that they don’t take

to talk, how to speak at conferences, inculcate interests in cuts, it makes me sad that we’ve to say these things out loud

research, how to write a paper, an abstract and so on.  We instead of it being the norm.

have all patients here, but often we don't know to talk to

them, how to deal with them in the right manner. These are Q. What do you think about the lack of treatment
things which could be stressed on in the earlier stages of a monitoring when it comes to TB patients in private
student's life.  I worked at the Brompton Hospital, which is a setups?
centre of excellence in Respiratory Medicine. It was great to

use tools like CT Scans, which were not widely known at the A. The lack of monitoring is what has caused resistance. We

time.  However, I believe after having the kind of clinical once called 104 private practioners of Dharavi, Asia’s most

experience this country offers and then inculcating some densely packed and biggest slum. We gave them a sheet of

other skills would be the perfect blend for a physician. paper and asked them a single simple question. The question

was, “How would you treat a 50kg patient with MDR TB?”. A

Q. We noticed a Miles Davis poster in your consultation simple enough question which has an easy answer. There are

room. Can you tell us about some other interests of standard guidelines pertaining to it. These were doctors who

yours?  were treating these patients on a daily basis. Out of the 104

doctors, only 4 could write a correct prescription. The rest of

A. I enjoy jazz very much, I play the saxophone. I'm terrible at the prescriptions were so wrong that they would amplify the

it, I've got no time to practice.  I have a house in Alibaug problem of resistant TB. Making a MDR into XDR and an XDR

which is a haven and a retreat for me. I work an intensive 5 into TDR. Just imagine doctors not being able to treat India’s

day week and completely shut off over the weekend. I biggest health problem. Supervision is a must. Regardless of

recharge and get back to a cauldron of patients, which is your patient’s economic or educational background. Even an

just life in Bombay. educated person might fail to take his medication timely. The

treatment for MDR TB goes on for about 2 years. It is human

Q. Tell us more about your Thursday Journal Club. nature to give up on the treatment once you start feeling

better.

A. Every Thursday when the New England Journal of

Medicine arrives, I send the library a list of references. I Q. Do you think pre-counselling could help with this
procure the articles I want to read. I send my fellows a list of problem?
articles I want them to read. That’s my sneaky way of not

reading an article, but still getting to learn!

A. Of-course. I give my patients a typed list of the problems

they could encounter and ask them to contact me

immediately if they see some particular side effects.

4
 FUN FACT: He doesn't just have a CV.
He has a separate one for his work on TB!
TAAZA
Q. What do you think about the injustice that is
KHABAR
by Rutuja Pawar, III/I M.B.B.S.
prevalent in our society when it comes to receiving TB
treatment?
HYDROGELS
A. You need to agitate for justice to your patients. The

biggest injustice is that our patients still don’t have access We all know that medicines such as antibiotics have a certain

to Bedaquiline, a lifesaving drug. We had a female patient shelf life and have specific storage requirements. What do we

who was denied Bedaquiline by the government. Her father do when the shelf life expires or the place doesn’t have

had to file a case in the high court. She died at the age of suitable storage conditions? Here’s the solution to refrigeration
18. Fighting for your patients is a must because TB
without a refrigerator! A team of chemical engineers led by
disproportionately affects the poor. Right now only 3
Hal Alper, Professor at the University of Texas developed a
percent of patients of MDR TB have access to it. We are
new way to produce medicines and chemicals on demand and
pushing to make it available for everyone who needs it.
preserve them using hydrogels. The approach could help

Q. What is your view on depression in TB patients? people in remote areas or on military missions, where the

absence of pharmacies, doctor's offices or even basic

A. It occurs even otherwise! If I told you that you had MDR refrigeration makes it hard to access critical medicines and

TB and would have to receive treatment for two years with even daily use chemicals.

six months of injections awaiting you, you’d be depressed It is the first hydrogel-based system to organize individual

just from knowing that. And on top of that you add the drug microbes for in-the-moment production of high-value
Cycloserine which causes morbid depression. We get to see
chemical feedstocks used for pharmaceuticals. This system
cases where the patient was getting better but the drug
effectively uses microbial “biofactories”; basically cells that
made him psychotic and he committed suicide. These old
are bioengineered to overproduce a product. They are then
drugs happen to be very toxic and despite the new drugs,
embedded into the solid support of a hydrogel. The gel
TB continues to be one of our biggest problems. A 1000
material, along with the cells inside, can flow like liquid and
Indians die of TB every single day! A grim statistic that

hasn’t changed.  The corona virus reported 1000 deaths in then harden upon exposure to UV light. To revive the hydrogel

40 days. Look at the press it has gotten while TB continues and enable the production of the chemical or pharmaceutical,

to be a disease of antiquity. one can simply add water, sugar and/or some other basic

nutrients, and the cells will then convert into the product just
Q. What do you think is the future of Respiratory as effectively as before the preservation process. The huge
medicine? benefit is in terms of portability and optimized production.

Products can be produced within a couple of hours to a

A. Biomarkers and genomics! It used to take 8 weeks to
couple of days.
diagnose a case earlier. Now it just takes 8 hours. Thanks to

GeneXpert. That’s a huge difference. Even if you’ve

diagnosed a case one day earlier you’ve decreased the

transmission by a huge number.

MOLECULE OFFERS HOPE
Q. How well prepared do you think India is if the
Corona virus pandemic hits India? FOR HALTING PARKINSON
A. It’s going to be dreadful. Except for ours country’s Parkinson is unfortunately a disease with no halt button

temperature we have nothing in our favour. whatsoever. A promising molecule has offered hope for a new

treatment that could slow Parkinson, something no modality

Q. If there is one message you could give to our Prime can currently do. Typically, by the time people are diagnosed,

Minister regarding TB, What would it be? they have already lost 70-80% of their dopamine producing

cells.
A. The United Nations had a big conference on TB where
While current treatment modalities mask the symptoms, there
every country was present. Except India. India should’ve
is nothing that can halt or slow down its progression.
been right up front because we bear the brunt of most of
Researchers from the University of Helsinki found a molecule
the TB cases in the world.The South African Health Minister
'BT 13' that has shown the potential of boosting dopamine
said, “You can’t stop TB, if you don’t show up.” How can we

eliminate TB by 2025 then? Knowing the scale of the levels and also activating a specific receptor in the brain to

problem, India really has to take some drastic measures and protect cells. BT 13 is a small molecule that has overcome the

also have an increased budget for TB. hurdle of not crossing the blood brain barrier.

5
Shutterbug
MANALI GONDIA

Yashodhan Gurav Tranay Maldhe

II/II M.B.B.S. II M.B.B.S. GMC Gondia

MANALI
MUMBAI

Devashish Negandhi Hait Savla

II/II M.B.B.S. II/II M.B.B.S.

NANDED TALEGAON

Shradha Kadam Advait Joshi

II/II M.B.B.S. III/II M.B.B.S
6
TAAZA
KHABAR 2.0
Novel Coronavirus
by Devanshi Sane, II/II M.B.B.S.
On 31 December 2019, a cluster of pneumonia of unknown their own mouth, nose, or possibly their eyes. Current

etiology was reported in Wuhan City, Hubei Province of China. estimates of the incubation period range from 1 to 12.5 days.

On 9 January, Chinese authorities reported that the cause of During this period the infected individuals show no signs and

this viral pneumonia was identified as a new type of symptoms of the disease, but can possibly transmit the

coronavirus, which is different from any other human infection to others.

coronaviruses known so far.

What are some precautions you can take to prevent

What is a coronavirus and how is it different from a novel yourself from getting infected?
coronavirus? There is currently no vaccine to prevent COVID-19 infection.

The best way to prevent infection is to avoid being exposed

Coronaviruses are a large family of respiratory viruses that can
to this virus. The various protective measures are:
cause diseases ranging from the common cold to the Middle-
(1) Avoid travelling to China especially Wuhan city, Hubei
East Respiratory Syndrome and the Severe Acute Respiratory
province which is the epicentre of the epidemic.
Syndrome (SARS). The strain of coronavirus prevalent now is a
(2) Avoid close contact with people suffering from acute
novel corona virus which is a strain that has not been previously
respiratory infections.
identified in humans called COVID-19.
(3) Wash your hands with soap and water for at least 20

seconds. If your hands are not visibly dirty one can use
What was the source of the novel coronavirus?
alcohol based hand sanitizers.
It’s likely that an animal source from a live animal market in
(4) Avoid touching your eyes, nose and mouth with unwashed
China was responsible for some of the first reported human
hands.
infections. The animal source of the COVID-19 has not yet been
(5) When sneezing or coughing always cover your mouth with
identified. This however does not mean that the coronavirus
a tissue or sneeze into you bent elbow. Do not touch any
can be transmitted to you by your pets.
surfaces without washing your hands.

(6) Frequently disinfect surfaces.

What are the signs and symptoms of the infection and how (7) Avoid close contact with live or dead farm or wild animals
dangerous is it? and avoid consuming raw meat.
The clinical manifestations include a runny nose, sore throat,

cough, fever, difficulty in breathing and in severe cases it may

What is the treatment for the COVID-19?
even lead to pneumonia. The infection can be fatal in older Currently there is no specific medicine recommended to

people and people with pre-existing medical conditions who prevent or treat the novel coronavirus. However, infected

are more vulnerable to becoming severely ill. individuals should receive appropriate care to relieve and

treat symptoms. Those who have fever, cough and difficulty

How is it transmitted? breathing should seek medical care early to reduce the risk of

The COVID-19 can be transmitted from person to developing a more severe infection. Recently, a group of

person. Person-to-person spread is thought to occur mainly via researchers tested a number of anti-virals in the lab for their

respiratory droplets produced when an infected person coughs effectiveness against the new coronavirus. They found that

or sneezes. These droplets can land in the mouth, nose or be Remdesivir stopped the virus from replicating in a lab dish.

directly inhaled into the lungs by nearby individuals. It’s Similarly, the group found that Chloroquine was also effective

currently unclear if a person can get the virus by touching a in stopping the virus from spreading in human cells in the lab,

surface or object that has the virus on it and then touching however clinical trials are yet to be conducted.

7
Coronavirus- BOLO DIDI
Radiological Aspect CAMPAIGN
by Rutuja Pawar III/I M.B.B.S. by Anamika Prashant, III/II M.B.B.S.

The new cluster of viral pneumonia cases originating n India shoulders the highest burden of TB

Wuhan, China, marks the third time in 20 years that a patients in the world with the maximum number

member of the large family of coronaviruses (CoVs) has of drug resistant patients, i.e., patients not

jumped from animals to humans and sparked an responding to the first line of drugs. In this

outbreak. chaotic system, there is often ignorance about

Looking into the radiological findings, majority of the the discrimination and social stigma faced by

patients in their initial CT scan showed the following the patients due to which they ultimately choose

characteristics: to seek support from their peers in order to deal

with issues that the medical system does not

presence of ground-glass opacities,
fully address such as stigma, marital issues,
presence of consolidation,
sexual health and depression.

number of lobes affected by ground-glass or

The stigma associated with it doesn’t allow

consolidative opacities, patients to openly talk about their struggles.

This is especially seen in women who find it

degree of lobe involvement in addition to overall lung
difficult to open up to their family.
“total severity score,”
The Bolo Didi campaign brought about a stir in

presence of nodules, our nation when film-maker and TB survivor,

presence of a pleural effusion, Rhea Lobo decided to set up what she calls a

‘pay-it-forward’ programme for women battling

presence of thoracic lymphadenopathy (lymph nodes
TB. Her two minute film on the stories of fellow
of abnormal size or morphology),
survivors was screened at the 50th Union World

presence of underlying lung disease such as Conference on Lung Health held in Hyderabad in

emphysema or fibrosis. October 2019. Women who would watch her film

on YouTube would contact her via Facebook or

WhatsApp. The conversations would invariably

Dr. Chung (Assistant Professor in the Department of
start with, “Didi, can you please help me?”.
Diagnostic, Interventional and Molecular Radiology in the
Some cries were more desperate, wanting
Mount Sinai Health System in New York, N.Y) said, “We
contacts of doctors and counsellors — basic
can’t rely on CT alone to fully exclude presence of the
information that should, ideally, not be this hard
virus”.
to access.
Moving on to the structure of the virus: SARS-CoV-2
Rhea soon realised that other survivors like
(COVID-19) particles are spherical and have proteins
Nandita Venkatesan had also been receiving
called spikes protruding from their surface. These spikes
similar messages, asking “Didis” for any and all
latch onto human cells, then undergo a structural
help. While the Indian health system is still
change that allows the viral membrane to fuse with the
struggling with the burden of tuberculosis,
cell membrane. The viral genes can then enter the host
survivors like Rhea and Nandita are relentlessly
cell to be copied, producing more viruses.  The
working towards their goal of spreading
researchers found that the SARS-CoV-2 spike was 10-20
awareness. They are trying to organize patient
times more likely to bind ACE2 on human cells than the
groups and start virtual institutions for women.
spike from the SARS virus from 2002, enabling it to
Initiatives like these will help India combat TB
spread from person to person more easily.
and will especially help those patients who are

falling through the crevices of the health

system.

8
 HUMAN RIGHTS
AND TB
by Sahiba Maniar III/II M.B.B.S.

"
A gloomy room. A window on one end. Masked mouth.

Emaciated body. He stared at the grey walls until food

"Treatment begins
was served. Over 10 tablets everyday. Not one visitor

to check up on him. Doomed. Devastated. Depressed. with cure

Such is the life of a TB patient. Tuberculosis (TB) is

and continues

"
caused by Mycobacterium tuberculosis. But that might

not be what kills the patient.

with care."

Leading globally, India accounts for 27% of the total

patients who have contracted tuberculosis, and having

Optimum healthcare requires the patient to have
the highest number of drug resistant tuberculosis
access, availability to the facilities at a cost the
cases. Ever thought about why this looming sword slits
community can afford. It is essential to streamline
the throat of our nation year after year?
healthcare with the rights of people living with and

vulnerable to TB, including but not limited to the rights

Tuberculosis is mainly identified to be a disease of
to life, health, nondiscrimination, privacy,
poverty. A lack of awareness and implementation of
participation, information, freedom of movement,
human rights fuels the spread of TB by creating
housing, food, water, and benefit from scientific
conducive economic, social and environmental
progress. It is a powerful deterrent right from when the
conditions. Vulnerability, poverty, discrimination and
symptoms of TB start developing to the whole process
ignorance blanketed by political superiority and
of treatment and even extending to after complete
societal negligence limit healthcare to a privileged
cure.
few.

Isolation, ignorance, lack of empathy and social

Hence, the groups most associated include people
stigma attached to tuberculosis is the root cause of
living in poverty, ethnic minorities, people affected by
depression and loss of motivation to live. A feeling of
caste-based discrimination, women, children, HIV
hopelessness looms over the patients reducing their
patients, prisoners, homeless persons, migrants,
zeal and zest for life and overall mental health
refugees and internally displaced persons. They are
hampering the treatment and quality of life there on.
more likely to be exposed to conditions that are
Prevention begins with awareness and continues with
favourable to acquiring TB and less likely to have
responsibility. Treatment begins with cure and
access to the knowledge and resources necessary to
continues with care.
maintain and preserve their health.

Despite innumerable efforts in the past decade, India

The principle of nondiscrimination is fundamental to
still leads in the global index of tuberculosis.
public health. Article 25 of the Universal Declaration
Everything in the system is questionable. Everything
of Human Rights guarantees each individual the right
questionable is a concern. And every concern should
to a standard of living adequate for the health and
be addressed. This change starts with you. You owe it
well-being of himself, which is often a subject of
to the doctor you yearn to be. You owe it to the
neglect in our country. We are calling for equality.
patient you hope to treat. You owe it to the society

you belong to. Until then, your patients shall succumb

Equality for basic necessities. Equality for life. How
to TB and the society shall be bulldozed by ignorance.
poorly does this reflect upon us as a society?

9
 TB, or Not TB- That is the question
A Survey conducted by Saneeka Vaidya, II/II M.B.B.S.
Out of all the patients affected by Tuberculosis, India stands first with 27% of the total patients. Lack of adequate

healthcare facilities to treat the disease and prevent its spread along with the lack of awareness among masses is

responsible for this global dominance. "Tuberculosis is a disease that is transmitted only from human to human, so there are

no sources from water, no sources from animals," says Dr. J. Walton Tomford, M.D., staff physician with the Infectious

Diseases Department at the Cleveland Clinic. Simply providing non-contaminated food or clean drinking water for

eradicating TB is not enough. Spreading awareness about its symptoms for early diagnosis and treatment is necessary.

Understanding the ways in which Tuberculosis spreads and it's prevention is beneficial for its eradication. In this edition,

team The Grey Matter surveyed over 340 people with no medical background to assess their awareness about Tuberculosis.

According to you, how does Tuberculosis spread? According to you, should a person suffering from Tuberculosis

be isolated, i.e., forced to eat and sleep separately?

Yes
No
Don't
Know

According to you, which organs are affected Do you know about the BCG Vaccine given for the

by tuberculosis? prevention of tuberculosis?

Yes
No
Don't
Know

According to you, is tuberculosis curable? According to you, what are the primary signs and

symptoms of pulmonary (lung) tuberculosis?

Yes
No
Don't
Know

10
 Anahita Shroff

Final Year M.B.B.S.

Grant Govt. Medical College & Sir JJ Group of

Hospitals, Mumbai
RNTCP to NTEP
On the move against TB. Transforming the fight towards elimination.

by Gauri Purohit, III/I M.B.B.S.

On January 1, 2020, India's TB control programme got a The strategies included in NSP for awareness and

change of name. It is no longer known as the 'Revised implementation are-

National Tuberculosis Control Programme (RNTCP)', but

has been rechristened as the 'National Tuberculosis 1. Mapping and identification of the priority

Elimination Programme (NTEP)'. population across the country

2. Inclusion of map population in NIKSHAY for state

The change in name is in line with larger goals like
and district specific action plans for the identified
eliminating the disease by 2030 and achieving
population.
betterment of health and well being of the society. With
3. Established priorities for action which will be based
a view towards attaining this ambitious target, a change

in name of the programme representative of the ultimate on the analysis, need, effectiveness, feasibility and

goal of eliminating TB was thought to be necessary. resources.

4. Customised advocacy and communication for the

Dr. Raghuram Rao, Deputy Director (TB), Ministry of
defined priority population.
Health and Family Welfare, has rightly stated that –“TB is
5. Use of rapid molecular technologies and better
not just a disease, but a socioeconomic problem”. It
diagnostic modalities.
requires every section of society to be playing its part in
6. Early linkage to NTP Spectrum of supportive services
fighting to end the disease. Poverty reduction strategies

are the cornerstone of battling a disease like till the completion of treatment and follow up for up

Tuberculosis in India. to 2 years

7. Intersectoral and inter ministerial coordination.

To further achieve these targets, the health ministry is
8. Intensive efforts for TB case detection using novel
implementing NSP i.e. National Strategic Plan (2017 to
approaches.
2025). The NSP aims to deal with the disease with a
9. Use a campaign approach to address TB in the
DETECT- TREAT- PREVENT- BUILD approach.
priority population.

The goals to end TB have received a much needed boost 10. Community encouragement, participation and

with the World Health Organisation stating that- engagement.

indigenously developed molecular test (TruenatMTB) for

diagnosing pulmonary and extrapulmonary tuberculosis Traditional coping strategies will no longer be enough

and drug resistant tuberculosis has high diagnostic to compensate the blow to national economy and the

accuracy. Being battery operated, it will be a Diagnostic instability of societiy that TB, drug resistant TB and

tool to be used in the peripheral TB centres of India. In concomitant HIV / AIDS cause. The deadline for action

the first step, TruenatMTB will be available at CHCs and is today and fortunately, we have the means to oppose

would slowly be extended to PHCs. the disease.

The context of this NSP for TB elimination in India is to What we need to do for implementation and success of

provide sustained, equitable access to the high quality this programme is to come together and FIGHT BACK.

TB treatment, care and support services, responsible to Every Breath counts. Stop TB. Together we can!

the community needs without financial loss, thereby

protecting the population, especially the poor and those

vulnerable to TB related morbidity.

12
The Yash Factor Advice to MBBS students?
My advice would be enjoy your MBBS. These days

won't come back in your life. Balance work,

Dr. Yash Kallurwar hobbies and studies properly. Learn and explore

NEET- PG AIR : 24 new things. All these things together give value to

your life. Studies should only be a part of your life

and not everything.

When did you start preparing for NEET and
how did you do it?
I started my preparation for NEET during

internship. I read from the notes that I had made

in

many
the classes

MCQs as
I had  joined,

possible and

time to time. I revised the subjects 2 to 3 times

each. I guess if you are planning for NEET, it is

tried

gave
to solve

tests
as

from

c rtex
important to revise as many times as possible.

Revision is the key for NEET.

How does it feel?

At first it felt surreal, but now it feels good. This

was something I worked really hard for.

What do you do in your free time?

I love to binge watch TV series and sleep during

my free time. I also like playing cricket and table

tennis, but I am a little lazy when it comes to

going out.

How did you manage to balance your work

and studies during your internship?
I used to motivate myself to study every day

after work. The most important thing is to keep

going. A lot of people who started studying in

the beginning gave up later because of the

frustration. I would take a nap after coming

back from my duties and then start studying.

If you could go back in time, would you do

something differently?
I don’t think so. That is not how life works. I have

amazing friends and had a fruitful MBBS. I don't

want to change anything!

ANSWER

What speciality do you hope to pursue?

I would love to pursue either Medicine or

Radiology.

13
Tuberculosis amongst healthcare T
ES
professionals. You’ll get used to it. GU ICLE
by Samira Davalbhakta, III/II M.B.B.S.
ART
B.J. Medical College & Sassoon General Hospital, Pune

Our clinical rotations in the hospital include 15 days of the prevalence of latent TB amongst medical professionals was

postings in the TB ward. We were all afraid. What if we get nearly 50%. This means almost half of their study population

infected? What will we do? Will we have to spend months, or were unknowingly infected with tubercle bacilli and could

maybe years for the treatment? It was only after we realised acquire the active disease at any time. This emphasises the

that TB stood for Tracheo-Bronchial and not Tuberculosis that importance of screening amongst healthcare professionals for

we were relieved. TB, just as we would screen employees for any other disease

acquired at the workplace.

This fear of contracting a debilitating disease from patients

exists in all healthcare fields and for good reason. Medical In fact, most experts consider it an occupational disease. Then

residents have a 15 times higher risk than the general why doesn't Tuberculosis get the importance that it should

population of contracting tuberculosis (TB). Despite this, the regarding prevention amongst healthcare professionals? Why

practice of protection seems to be lacking. It is very aren’t all students made aware of which patients have active TB

uncommon to see resident doctors or nurses wearing N95 and told to wear the N95 masks? Why aren’t all residents

masks! treating these patients made to compulsorily take preventive

measures?

One might ask, what is the big deal? Once diagnosed with TB,

the individual can take the proper treatment, be cured and India has the highest burden of TB disease. A report published

get back to work. There are three issues with this statement : by the WHO estimated that 10 million people had TB in the

One, be cured. The course of treatment could take anything country in 2018. This is more than 3 times the population of Pune

between six to eighteen months depending on the resistance city, which follows that the healthcare workers treating these

of the TB bacillus. This means taking a break from work for a patients are at a high risk of contracting the disease.

long period which can have serious implications on a medical Nonetheless, nationally representative data is lacking. We are

career. Two, social stigma : TB comes with its own set of social not aware of how many healthcare workers contract TB in a year

problems. People follow the dictum ‘prevention is better than or which regions have the highest incidence of the same.

cure’ very strictly when it comes to interacting with individuals

who had an infection in the past. Medical personnel who Such data will form the platform upon which effective

contract the disease face job application rejections preventive measures can be implemented. According to a study

(unofficially) or a decrease in the attendance at their clinics, published in the journal of Emerging Infectious Diseases, by the

which defeats their purpose of entering into the medical field introduction of TB transmission control measures the annual

in the first place. incidence amongst healthcare workers can be reduced by upto

81% in countries with high incidence of TB.

Finally, diagnosis. Most health care personnel who get The insufficient use of preventive measures could possibly stem

infected with TB develop a latent disease. Here, the bacilli are from not only the authorities, but also the victims of the disease

not actively multiplying, but are kept in check by the person’s themselves.

immune system. Though these individuals cannot transmit the

infection to others, the lifetime risk of developing active TB Although fear exists, there is a certain sense of denial, or rather

disease in the future is 5-10% with most of them developing it a psychological defence mechanism that is displayed by the

within the first 5 years of infection. This highlights the necessity healthcare workers. This is encouraged by the ‘invincibility’ that

of identifying the latent cases. The impediment to this, is passed on to juniors from their seniors, who believe that

however, is in the name itself- latent. If there are no symptoms, contraction of the disease by themselves is highly unlikely. This

medical professionals are not likely to come forth. has created an atmosphere of ignorance, which has spread a

misguided and fallacious bubble of safety around those

Compounded with the absence of compulsory screening responsible for providing the preventive measures, and those

procedures amongst them, diagnosing latent TB is quite responsible for implementing them. It is necessary to gradually

difficult. In a meta-analysis published in 2016 of 18 studies deflate that bubble with managerial activities and

consisting of 10,078 participants regarding the prevalence of administrative and engineering controls along with the adoption

latent TB amongst healthcare workers in high burden countries of N95 respirators, before it unwittingly pops.

14
 ANANDwAN
An account by Jai Jabade, III/II M.B.B.S.
As a kid I wasn’t completely unaware of Anandwan, Hemalkasa The next day, we got an opportunity to dress the ulcers of

and the Amte Family. I had heard stories about them from my patients with leprosy. At 5:30 am everyday, all patients would

grandparents, yet the knowledge I had was very limited. This was come to the hospital for dressing and only then would they

until I visited these places a couple of months ago. resume their daily activities. After that we visited the old age

In January this year, I got a wonderful opportunity to visit home, where we met with elderly patients having advanced

Anandwan and Hemalkasa. It was a seven day trip and the main stages of leprosy.

purpose of which was to socialize with the residents and get to Soon after, we visited Muktangan which was a play school as

know their lifestyle. well as an educational centre especially for children of those

With a lot of expectations, I, along with 28 other medical disabled by leprosy. One afternoon after lunch all of us

students from various colleges, boarded the Sewagram Express distributed cakes and biscuits to the elderly in the old age home

from Mumbai. It was a 17 hour journey to Warora, in the and chocolates, slates and colour pencils to the children in

Chandrapur district of Maharashtra. From here, Anandwan was Muktangan. The happiness on their faces has been etched into

about 5 km away. my memory forever. This is when I realized how such small deeds

Anandwan which means 'Forest of Joy' is a community founded by towards those in need can give us immense joy.

the legendary Baba Amte for leprosy patients, social outcasts, We also had a discussion with Dr Vikas Amte , the elder son of

differently abled people and socially backward tribals. From the Baba Amte. He told us about the hardships Baba Amte had to

moment we entered the gates of Anandwan, we felt the peace face while developing Anandwan and the administrative

and the positive energy I had heard about as a child. We had difficulties that they are currently facing. Despite being a

breakfast at the community mess of Anandwan after which we doctor, he had constructed dams using tyres and buildings with

started with the tour. low cost materials without using any iron rods. He told us how

We first visited the 'Sita Ratan Leprosy Hospital’. It is a 50 bedded leprosy, a non fatal disease which can get cured if treated in

hospital with various health care facilities to treat the needy. We time, is shunned by society while other fatal lifelong diseases

left the hospital with a feeling of deep admiration, especially like diabetes and hypertension are openly discussed

when we found out that the entire hospital is managed by a everywhere. This was indeed thought provoking.

single doctor. Then we visited 'Sandhiniketan' (Home of In the Miyawaki Forest (which is a mini forest created by

Opportunities) where vocational training is provided to the Miyawaki method of afforestation), we planted some saplings

residents for their empowerment. ourselves.

Baba Amte always wanted Anandwan to be self-sufficient and

hence agricultural industry, hand-looms, power-looms, woodwork,

handicraft and allied industries were developed. Residents work

in any of these departments in exchange for free-of-cost food,

housing and healthcare. Many women working in the hand-loom

industry were blind but the perfection with which they were

making clothes, towels was awe-inspiring. Dried banana barks

and rice straws were used to make greeting cards and

handicrafts were made of plastic waste, saline bottles, cold drink

bottle corks.

We were fortunate enough to witness one of the most amazing

activities- 'Swaranandwan'-Orchestra of Anandwan, where there

were beautiful performances by abled and differently-abled

people alike. The ease with which they performed inspite of all

the difficulties was applauded by all.

15
After having an inspirational, eye-opening

Anandwan, we headed to Hemalkasa. It is a small village

trip through
The Prince
about 6 hours away from Anandwan. In 1973, Baba Amte had
by Niccolo Machiavelli
started 'Lok Biradri Prakalp' in this village which is now

supervised by his son Dr Prakash Amte and daughter-in-law Book review by Aryan
Dr Mandakini Amte. Kulkarni II/II MBBS
We were shown videos of how the Madia-Gond tribe were
Writers and poets have always
skeptical to interact with Baba Amte when he first met them
aspired to achieve a certain degree
because they mistook him for a revenue officer who would
of immortality through the
exploit and harass the tribal people. Language was also a
timelessness of the written word. The
huge barrier at that time, but Baba eventually made them
philosopher, politician, writer and
believe that he had come for the betterment of the people
diplomat, Niccolo Machhiavelli did
by giving up all the comforts of his life and adopting a
precisely the same when he wrote
rudimentary lifestyle like that of the tribal people.
his famous or infamous
The next day after visiting the 'Animal Ark', a home to the
(depending on how you perceive it),
animals which were abandoned by the Madia- Gond tribe,
'The Prince', a book that remains as relevant (if not more) in
we left for Somnath Prakalp. Somnath is a small village
today's day and age as it was in 16th century Europe.
established by Baba Amte in the Tadoba buffer zone. It was
No thicker than a handbook, this treatise holds tremendous
set up to rehabilitate those cured of leprosy. Agriculture is
potential for upheaval, so much so that it remained banned by the
the backbone of Somnath and has made Somnath self-
Catholic Church for over 200 years. This book lets us leave all our
sufficient in food production and the surplus is distributed to
traditional notions of morality at the door and delve deep into this
the neighbouring villages, including Hemalkasa.
beautiful piece of literature. He wrote the book when he was
We eventually returned to Anandwan. Having some time on
banished from Florence by the Medicis (an affluent banker family
our hands before we had to leave for the train, we decided
that ruled the city state of Florence). The reader takes on the role
to visit Anand School for the Hearing and Speech Impaired.
of a prince to whom Machiavelli is preaching his knowledge of
It was a lovely and a heartwarming experience to interact
polity and of dynamics of power and the actions of men.
with them. Then with a heavy heart we had to bid it all
In the initial part, he explains the different types of republics,
adieu.
kingdoms and principalities and how to obtain power and

All the experiences I had throughout the trip were unique. maintain the prince's rule over them and gives valuable lessons in

Every person I interacted with was different but everyone thwarting one’s enemies, waging wars, conquering and colonizing

had one thing in common – they were all content with their newer states. He does so by giving examples of contemporary

lives. The impact this trip had on me is something I cannot Europe, the history of Greece and of kingdoms of Alexander and

fully express. It taught me lessons of self-sufficiency, humility, Darius. The latter part of the book weighs some of the more

self-reliance and selfless service. There can’t be better philosophical questions revolving around power. Here, he

examples than Anandwan, Hemalkasa and Somnath of what thoughtfully approaches the famous dilemma of what's better; to

perseverance and working in unison can achieve. This trip be loved or feared and which image should a ruler want for

has made me realize the importance of working towards himself and ultimately beautifully condenses the entire mediation

in one line, “A ruler should be such that men love him according to
betterment of society. I am looking forward to participating
their own will and fear according to the will of the prince”.
in more social events like this one. I have experienced
Several similar problems are considered in this section, a few
immense happiness in helping others, now it’s your turn.
among them being liberality and meanness, clemency and cruelty,

piety and craftiness and how to have an even handed temperate

view towards all of the above and how and when to use virtues

(both good and criminal virtues) as means to achieve certain ends.

The essence of Machiavelli, he himself says is this, “One should be

a fox to discover the snares and be a lion to terrify the wolves”, a

statement that's worth pondering on for ages, in my opinion. In

short, the book not only strips us of all pretense and of our rosy

view of the world and exposes the bare self, the vileness of men,

the immorality of their deeds and the extents to which they go to

hide them but also advises us on expert ways of doing all of the

above and this according to me is the reason why the book has

such shock value.

Though traditionally deemed a taboo by the so called holier-than-

thou moralists, this book was found in the studies and by the

bedsides of several philosophers, politicians, leaders, writers and

other men of eminence, and I'm hopeful that after reading this it

shall be read more, discussed more and put to application to

achieve the ends best for the masses and that there shall emerge

newer and worthier princes even from amongst us.

16
 Pigment

'BLACK BEAUTY' 'CONTEMPLATION' 'IT'S TIME TO ROAR'

Apurva Chaudhari Madhumita Sahoo Apurva Chaudhari

I M.B.B.S. II/II M.B.B.S I M.B.B.S

'MAA SARASWATI' 'INFINITE' 'NRITYA'

Shruti Kandgave Dnyanada Lolage Madhura Patil

II/II M.B.B.S III/II M.B.B.S I M.B.B.S

17
 ed muse Soham Sadekar, III/II M.B.B.S, SKNMC

For someone who is a final year M.B.B.S. student, I consider myself just the

right amount of fun and serious combined. I’ve been passionate about art

ever since I was in school. Be it theatre, elocutions, playing tabla, poetry

recitations, I’ve tried it all!

After all this time, I’ve learnt that the key to making your way in this world

of cut-throat competition and crushing pressure is to try and strike a

balance. Undeniably, academic excellence is important, but it is also

equally necessary to involve yourself in extra-curricular activities. I, for one,

have always loved football. So, I started playing intercollegiate football,

taking interest in the organization of the college fest. Becoming the sports

secretary really helped me improve numerous aspects of my personality

like my communication skills and versatility among others; none of which

can be developed in closed lecture halls.

I have realized over time that hospitals are large classrooms where we are

being transformed from students to doctors. Cultivating communication

skills and interpersonal relationships with patients is the best part of

learning a subject through the medium of postings.

College life, besides staying on track with studies, is incomplete without the experience of hostel life. It is a beautiful

experience. I made friends who stuck by me through thick and thin. My professors, peers and this hostel life changed me

from feeling super homesick to feeling at home in a new place.

All said and done, I’m someone who takes life one day at a time. So I like to keep exploring, finding what I love and

pursuing that with all my heart.

Gautami Kashyap, III/II M.B.B.S, MIMER Medical College

Having parents who are doctors, I was lucky to have grown up listening to

medical interactions and ever since then all I have wanted is to be addressed

as ‘Dr.’ Now I know that I would rather want to be competent enough to earn

it.

What fascinates me about medicine is that it’s a science that comes closest to

human emotions. I like the empathy that comes with it despite it's stringent

clinical protocols and academic demandingness.

I feel that, while competition is inevitable and we are all here to excel, we

have just begun to understand the vastness of medicine. We need to inculcate

in ourselves that, as much as we need to be on our toes, we should have space

for ourselves where nobody and no stress can percolate. That space, for me, is

Bharatanatyam. While doing my Arengetram in 11th or completing Visharad last

year, I have realised that I study better for my lectures after having attended

the week’s dance class.

I feel more confident as a person under stage lights, be it dancing or

anchoring. It doesn’t matter how good you are at any art, what matters is how

much you smile through the process.

As my mother tells me, it’s hard to relate to the world when you’re confined to a college campus and fail to explore the

beauty of art & other hobbies.

So, what life has taught me so far is that while you owe M.B.B.S. the best of your efforts, what makes you a good medical

professional is the ability to handle all other aspects of life without getting overwhelmed by it.

18
 Dr. Suyash Gore, Alumnus, MAEER's Physiotherapy College

The journey from junior college to graduation teaches us many things. I, for

one, chose to learn a selected few and learn them well, and here I am. I

completed my graduation at MAEER’s Physiotherapy College in March last

year. Since then, I have worked with the national rowing team, with the

under 16 FC Pune City team for Hero Juniors league and recently with the

North Eastern Warriors in the Premier Badminton league.

As a teenager who was strongly influenced by rap culture, poetry and

literature, initially that is what I wanted to pursue. It was a time when I had

started reading the works of Gulzar, Rumi and others like them. So, I began

adapting my love for words into my own writing and considered making a

career out of it. However, after much encouragement (and persistence)

from my family, I decided to take up the entrance exam to step into the

mainstream sciences of medicine.

When I started off in first year, I was misled by my own inhibitions about physiotherapy and it took me four years and a short

course about sports to realize that this is what I was cut out for. So, while I still aspire to write my way into people’s minds

someday, I am as much excited to keep working as a physiotherapist and discover new avenues wherever I go. That’s the

take-away message I’d like to share with all the students who will soon find themselves in a world of opportunities when

graduation is done and dusted. Explore all possible fields and find your calling. When you do that, you will do justice to

yourself and your patients.

Dr. Karan Parikh

I did my undergraduation from Rajiv Gandhi Medical College

in Thane. We were a very small batch of just 60 people and it

became progressively smaller as the years went by, because

you know, MBBS.

One of the things that made my experience great was

exploring aspects of being a doctor beyond what the text

books offered. I became involved with the organization,

Medical Students Association of India and worked with

organizing exchange programmes in the country.

It taught me a lot about how India approaches things

differently compared with health systems across the globe

and what it has to offer.

I did, however, enjoy PSM. I know a lot of people don't see it that way. I always thought there is so much more to the

subject than the toilet diagrams we were made to draw. I'm incredibly grateful for those years because it was then that I

realized I couldn't see myself being a doctor in an office providing a service that countless others would be providing on

the same street. I realized, I would rather fill a gap where it needs to be filled. That's how I decided to involve myself in the

field of global health.

I've had opportunities to explore health care for a month in Chile, attend the World Health Assembly at the WHO and

engage myself even more in understanding public health from a global perspective. I'm so grateful for having had all those

experiences because they motivated me even more.

I currently work with MSF India (Médecins Sans Frontières/ Doctors Without Borders). It's a different world where I work

now. Sometimes patients travel 5-10 km on foot just to get one paracetamol. I see 5-8 dozen or maybe more patients

infected with malaria in a day.

That's the most heart wrenching of all, but making tough decisions is part of being an MSF doctor. I remember this one

time, we traveled by car from far off with a lady whose pregnancy needed monitoring. That day it rained so much that the

river we needed to cross by car had become too harsh. We had to wait a whole evening to be able to get her to a medical

facility. Experiences like these are shaping me and motivating me even more to work where help is needed. I like to think

that I live a dual life now. One is attending big conferences on the other side of the world and the other is trying to learn

some Gondi, the language the tribals speak in the area where I work. I know everyone doesn't have this privilege, but I think

if each individual involved themselves in something that really gives them a sense of purpose, we'd be seeing a lot of great

things happening in the world.

19
 Brachial Lights, Camera,
Plexus Prescription
of The Anatomy Department Do you love watching medicine related movies?

Sandeep Ashok Khalkar, Here's a list of movie recommendations compiled by

Laboratory Assistant, Anatomy Richa Sinha and Atharva Pawar, I M.B.B.S.

In Conversation with Khushboo Doshi &
Unnati Shukla, I M.B.B.S. 1. Awakening
Based on true events that are documented in the Bronx

I have been working in hospital, it's a story about the awakening of encephalitis
the Anatomy
patients and the hospital staff during a clinical trial, not just
department as a
from their catatonic states.
laboratory technician

since the past 15

years. Working in a 2. Coma

medical college, I get Indulge in this medical thrill and join Dr. Susan Wheeler as she
to see body donations
tries to discover the mystery behind the doors of OT 8. Healthy
frequently and a part
young patients operated in that OT are declared brain dead
of my job extends
and there is definitely more than what the eye can see.
beyond the roles of a

lab technician. As a

person who meets the 3. Patch Adams

relatives of the
Bring out your red foam noses and balloon animals because
deceased who come
we are heading to the paediatric ward!
for body donation, it is
This movie talks about treating patients as humans rather than
essential to provide

them with reassurance cases and is the best way to laugh, cry and find yourself

& make this procedure excited to work as doctors.

simpler for them.

4. A Beautiful Mind
Telling them about how this is a great deed for the field of
Imagine if the people most important to you weren’t gone,
science and education is of utmost importance. It gives me
weren’t dead, but never existed.
satisfaction to be able to help them through this difficult
Experience the compelling journey of Josh Nash discovering
process. The best part about my job is the students. One
the game theory in A Beautiful Mind.
incident that happened in the anatomy department dates

back to 2006, when a student was somehow locked in the

5. Something the Lord made
dissection hall after the lecture ended and he was locked
Watch how a black janitor makes a ground breaking discovery
inside for over 30 minutes. How he managed to stay inside
to cure the blue baby syndrome shattering walls of racism and
after clearing the entire dissection hall is a mystery left
discrimination.
unsolved. Over the years, I have managed to learn how to

identify histology slides, briefings for students have also been

6. One flew over the Cuckoo's Nest
helpful to me. Dr. Shashank Vedpathak has helped me in
The movie shows the mental trauma suffered by prisoners and
identifying histology slides. Dr. Belsare ma'am has helped me in
the ill-treatment towards the mentally unstable. Watch this
identifying embryo models. Dr. Dhanaji Jadhav, Dr.Vivek
struggle of a prison break from the insensitive clutches of the
Nirmale and Dr. Sonali Khake have taught me how to recognize
system.
various bones and body parts. The reason behind the anatomy

department being the favourite among students is the faculty.

7. Contagion
The professors understand the students'' problems and solve
The movie winds personal tragedies to the large scale effects
them through their teaching and guidance at every step. A
of an epidemic. It is a must watch especially in today's times
student's life is all about the fun moments and mischief, but
with the buzz of Corona virus in the air.
taking education seriously is really important. Medical students

are a reflection of the society and should understand their

8. The Diving Bell and the Butterfly
responsibilities. My only advice to the students is to respect.
It is a film about a man who experiences the"locked-in
Respect the cadaver, respect the teachers, respect the non-
syndrome," where he is alive and conscious, but only able to
teaching staff and everything else that makes your education
communicate by blinking an eye. Watch the movie to find out
complete. The only way of earning respect in this world is by
how he writes his memoir by the only means of communication
giving respect.
left to him.

20
DIAL GUE Q. Would you care to share a case that has left an impact
on your mind?

DR. ANEESH BHAT, A second year engineering student who had recently parted

ways with her boyfriend, following which she suffered mental

HEAD OF DEPARTMENT, PSYCHIATRY
trauma and tried to commit suicide. After 17 days of treatment

and admission in the hospital, she was referred to psychiatry.

In conversation with Aishwarya Puranik During her counselling, I put forth two questions before

III/I M.B.B.S. her- "What is the aim of your life?And what do you want to do

with your life?". She was blank, even in the subsequent

Dr. Aneesh Bhat is a Psychiatrist and Professor in M.I.M.E.R.
sessions she didn't have an answer. She was put on treatment
Medical College. He did his undergraduation from GMC,
and follow-up for 3 months. She came back after 3 years and
Nagpur and post-graduation from GMC, Calicut.  He is
was very happy and had also got a job in an IT company. She
currently pursuing his MBA and doing a digital marketing
said, "Thank you doctor for saving my life. I have understood
course from Manipal University.  Previously, he worked as an
the aim of my life".  I asked her what it was. She continued, "I
assistant professor in KS Hegde Medical College, Mangalore
need to take care of my parents and also give importance to
and joined M.I.M.E.R. in 2016.
myself. I want to be a productive individual of the society. That

is what I want to do. My aim is to save others like me, who

Q. How did you decide to become a psychiatrist?  impulsively try to commit suicide for the small bad incidents in

life".  She has started an organization where she helps IT

professionals with depression or with suicidal thoughts. Till

I have always enjoyed the subject. I also believed that it suited
now she has succeeded in saving 35 lives. They meet every
my interests and personality.
evening and together teach street children. With just two

questions she changed her life.

Q. How does it feel to have a close insight of the
human mind? Q. Since our edition is about Tuberculosis, what do you
think are the effects of  long-term treatment of
I would say it's a privilege to understand your own mind,
Tuberculosis on a patient's mental health?
emotions and thoughts first. To be able to manage your mind

is something great in itself. In our profession, the mind and Medications of Tuberculosis cause depression and also

body are treated as separate entities, with the mind getting a psychotic states. As a psychiatrist, I need to treat both.

back seat. Most of the diseases with psychosomatic Deteriorating health and immunity also add to their ill mental

components are not given enough attention in terms of health. Few medications themselves like, isoniazid lead to

treatment. As a pyschiatrist, I can see how the mind affects depression. Not every patient needs to be treated, only those

the  body. Diseases like hypertension, diabetes, who show symptoms. However, it is very common, around 2-3

immunological conditions, psoriasis, pain and headaches out of 10 patients go into depression. Daily medications and

have a strong mental component associated with them. I feel societal rejections are also other contributing factors.

blessed to be in a profession where I can study other's mind

and treat them.

Q. Could you share with us some effective tips to have a
healthy mindset?

Q. How would you describe the role of a psychiatrist in You have to just do small things for a healthy mind and body

one line? like you should exercise regularly. One hour of 'Me Time' is

definitely possible, where we can engage in some

The mind conducts the orchestra of our body. So I'd say
recreational activities like 30 minutes of exercise, 10 minutes
psychiatrists are the people who treat the Maestro.
of meditation and regular sleep cycles can be followed. Ask

yourself For how many hours do you use WhatsApp or mobile

Q. Which are the common psychiatric disorders that phone? We can reduce the use of mobile phones and give

you've seen and what causes their prevalence? that time to ourselves. Share whatever goes in your mind with

someone. You can always write a diary to express your

Most commonly we get anxiety disorders and mood thoughts just like Anne Frank did. Lastly , don't have erratic

disorders. Depression is also common now. Nowadays, sleeping habits. Normal circadian rhythm keeps everything

stress related conditions are on the rise- family problems, normal.

burnout syndromes, impulsive suicidal ideations. Even

couples come into the OPD often. The causes mainly Q. What are some recreational activities you enjoy?
include not giving time to each other, excessive use of
I enjoy trekking, travelling and spending time with my friends. I
digital technology, not giving enough time to oneself and a
love watching good movies and reading good novels. If given
complicated relationship status. Absence of recreational
an hour of free time, I'd prefer to go on a bike ride!
activities is also causing these conditions.

21
Q. What are the common
challenges today's
students are facing?

Mainly competition,
AN OPEN LETTER
both in education and

professionally.

Excessive use of social

THE OTHER GIRL SERIES
media is damaging.
Hey there!
Regulated and

productive use is
I’ve been contemplating the concept of self love a lot. I
needed, not excessive.
have always believed that being critical of oneself was
You release more
a good trait. To me, it was always the only way to
endorphins by talking
Art work by remind myself to keep learning, keep growing and
to your friends than by
Arshiya Barmare, doing better.
meaninglessly scrolling
III/I M.B.B.S.
through your phone. 
I recently realized two obvious facts:

Substance abuse is another common occurrence now and 1. I am the only person who is going to be with me all
would reduce if people have an understanding about peer
my life.
pressure.Many students are aimless in their life. If you have a
2. A child that is brought up with love and care is
charted out aim, then only you can plan your studies and
usually more confident than one brought up with
career properly.
criticism.

Q. What is the one change you would like to see in

These two things made me wonder if all the cheesy
M.I.M.E.R.?
blogs about self love were true. Picture giving yourself

all the love and understanding you give to the people

MIMER is doing a lot for social causes. I would like to see more
around you. Imagine cultivating a healthy internal
being done for community health and students' mental health.

Volunteers from each batch can be trained to recognize

atmosphere. In other words, picture being your own

symptoms. We are planning to conduct the same because if a best friend. Letting words like, “You are unstoppable”,

student is capable of identifying symptoms, that'll help a lot. “Everything is going to be alright” and “Dude! You don’t

know how amazing you are” become your internal

dialogue.
Q. Why is the suicide rate high among doctors, especially
psychiatrists?
Hold yourself accountable, but let yourself grow into a

more fearless individual. Let’s face it, no matter how

Even doctors are not immune to stressors. There's a stigma
nice anyone is to you, the only thing that matters is
among doctors, very few approach psychiatrists. Even when a
what you believe about yourself and how you feel
doctor gets gastritis, he treats himself. The problem with
about yourself. Imagine what would happen if we all let
treating oneself is many times things go out of hand. Even a
ourselves grow by surrounding ourselves with love.
psychiatrist should approach a psychiatrist.

Some of us are so quick to give our hearts to others,

Q. There is increased awareness of mental health in the
but what about the person who needs it most? The
urban population. Have you noticed this change in the
body that is up and about all day, the mind that works
rural population as well?
and overworks itself for you. We recharge our phones

every day, let’s not forget to recharge ourselves.

Yes, under certain government schemes, awareness

programs are conducted in rural areas; regarding mental

The only way to know what all those cheesy blogs are
health, mental illness and identification of symptoms. They
about, is to try them out for yourself. I know I will,
do take it seriously, rather they approach a doctor if
definitely.
suffering from a mental illness. People in urban areas have

more stigma associated with approaching a psychiatrist.

If I asked you to make a list of everything you loved,
Though rural people feel that it is because of a deity
how long would it take you to name yourself?
(possessed), they'll approach a doctor in case they feel

disturbed. Things are now changing in India. The young

Love,
generation does approach psychiatrists.
The Other Girl

22
TUBERCULOUS OTITIS MEDIA S T
E
GU ICLE
Not
v e r y d a y ART
Yo ur e e a r d i s c h arge

by Dr. Abhishek V. Menon 

3rd year ENT resident, KEM Hospital, Mumbai

Tuberculosis as an entity spares few tissues in the human

body, and the ear is no exception. On the occasion of World

Tuberculosis Day, I thought I’d talk about the various aspects

of this fairly uncommon otological variant of the menace that

is TB.

Do keep in mind that TB otitis media, like any affliction of the

middle ear, presents with similar but vague complaints of ear

discharge and decreased hearing. On an average, I probably

see at least 15-20 patients presenting with ear discharge

every day in the OPD, but almost never does one keep the

differential diagnosis of TB ear right on top.

But there are a few times where one is forced to try and think

out of the box in order to try and clinch the diagnosis. I’d like

to introduce this 46 year old gentleman, Manu. He presented

with chronic left sided ear discharge since 6-7 months. Right Ear- Hearing sensitivity within normal limits.

It wasn’t hard to miss the left sided facial paralysis, was it? Left Ear- Profound sensorineural hearing loss
That’s what raised more than a few red flags in my head as to

what I was going to be dealing with. On asking Manu, he said We went ahead and operated on this patient, and on

that his facial asymmetry was present since more than 3

encountering the same granulations in the mastoid
months.
cavity, excised and sent them for histopathological
Mind you, I still hadn’t thought that this could’ve been TB. My
examination as well as a GENE XPERT, which surely
primary D/D was a left sided unsafe chronic suppurative otitis
enough, confirmed the diagnosis of tuberculosis. Manu
media (CSOM), which as my 3rd minor friends would
was then given a 6 month course of anti-TB drugs,
(hopefully!) concur, commonly presents with chronic ear
following which he obtained a completely dry ear,
discharge and is known to cause facial palsy as well. But
although unfortunately his facial nerve function and
what really caught my attention were the pale granulations
hearing on that side could not be salvaged.
that I found in the left ear canal on visualizing with an
In hindsight, one could conclude a few pointers from this
endoscope.
case. Tuberculosis of the middle/ inner ear is almost
This along with a profound sensorineural hearing loss on the
never a primary disease, and is usually a result of blood-
left side further fuelled my suspicion of it being tuberculous
borne (haematogenous) spread of the TB bacilli from
otitis media.
another region of the body harbouring the infection and

that makes it imperative to elicit a past history of TB in

the patient or his/her immediate family members.

Additionally, such a case where the signs on

examination, typical as they were, were far more

exaggerated than usually seen in CSOM should

definitely alarm the Otorhinolaryngologist and think in

line of a tuberculous cause. Either way, a clinician must

promptly diagnose such a case and immediately

administer the appropriate treatment so as to lessen the

morbidity of the patient to a bare minimum. Hopefully,

this would raise some awareness about the existence of

(*Consent taken before using photographs) such a rare yet important manifestation of tuberculosis.

23
DIAL GUE
DR. VAROON JAISWAL
Professor, Physiotherapy

In conversation with Revati Pathak,

Final year BPTh

1. Where did you complete your undergraduate and

postgraduate studies from?
I completed my undergraduate degree from Ravi Nair

Physiotherapy College, Wardha (2006) and postgraduate

(MPTh) in Cardio-respiratory sciences from Dr. DY Patil

College of Physiotherapy, Pune (2009).

2. What motivated you to choose cardio-respiratory My role models have been the wonderful therapists

PT as your speciality? who taught us and helped shape us as human beings

Firstly, my UG professor, Dr. Sunitha Narayan’s teaching and as therapists. I aspire to do the same, to make a

sowed the seed of my love for cardio-respiratory difference in people’s lives.

sciences. Secondly, during my ICU postings at Acharya

Vinoba Bhave Rural Hospital, we saw and treated a lot of 5.  How has the field of research in physiotherapy
oral surgery patients post-op, amongst many others for changed from when you were in college to now?
intensive care physiotherapy. During this time, I realized When I was a UG student, MUHS introduced the

how big a difference our treatment is making in the concept of research project presentation in final year

prognosis of these patients. But it is no cakewalk and is a (in 2004). With limited technology and information on

challenge in itself. That was motivation enough for me. I our hands, we were clueless. We did what everyone

knew this field would give me satisfaction and at the was doing at the time- look up a research study online,

same time, be a feat in itself. and perform it in the best way we could, given the

circumstances.

3. What do you think about the current status of the It has been really wonderful to see how far students

field in our country? Do you think it needs more have come since then. We have seen them come up

advancement/ improvement? with innovative ideas with minimal assistance from

Google and professors. It won’t be wrong to say that

The field of cardio-respiratory physiotherapy needs more
Google has really brought a positive change in the way
advancement in terms of patient awareness, mass
we read about research and everything new that
education and bridging the communication gap between
comes up in the field. Once you ensure that an article
the physicians and physical therapists. People need to be
is authentic and verified, you will be amazed by all the
sensitized about the role physical therapy and exercise
interesting information you find about your field!
plays in prevention of nearly all cardiovascular diseases

that are gaining prevalence. To give the simplest

6. What does the current research say about the
example, the cardiac rehabilitation programs that our
role of physiotherapy in tuberculosis?
patients in the cardio-respiratory OPD are undergoing
Physiotherapy in tuberculosis has come a long way.
are giving us great results. It helped most patients bring
There was a time when it was considered to be
down their resting blood pressure as well as blood sugar
contraindicated. Today, we are trained to weigh the
levels to low-risk levels. So, in my opinion, infrastructure
potential benefits to harm. More often than not, it so
and other advancements are secondary to awareness.
happens that the patient leaves the hospital weaker

than when he first came in.  This is where our role is

4. How did you decide to take up teaching, and how paramount. In an acute care patient who has low O2
has your experience been so far? saturation due to accumulated secretions, chest
I have always been passionate about teaching. I started
physiotherapy plays an essential role in assisting the
teaching as soon as I completed my PG.
removal of these secretions.

24
Once a patient is stable and under adequate treatment,

The best kind

it is our responsibility to ensure the patient is ambulatory,

his muscle mass is maintained and improved, his strength

and endurance are preserved. We, as therapists, are

of Salary
often able to gain the patient’s trust and acceptance

towards the treatment he/she is undergoing and that

can pave the way for patient compliance.

6. What has your experience been with tuberculosis

patients? Can you tell us about a case that left an
impression?
When I was a student, it was very hard-hitting to see the For a doctor, the most valuable payback

plight of the patients suffering from tuberculosis. All for their work is patients' appreciation

these years of practice has taught me that the cases are and their kind words of gratitude.

only the tip of the iceberg (as I’m sure PSM has taught Here's one such incident, Dr. Maya
us). I think we fail to see the bigger part of this. The
Kshirsagar shared with us.
wide-spread practice of spitting, the neglect and

ignorance, the stigma, the non-compliance- they’re all a

result of lack of awareness and education.

As a PG student, one day during the rounds of the Chest

ward, we encountered a patient, a young girl who was

diagnosed as a case of XDR TB. The physicians had One day, while checking patients in the

clustered around, and were discussing the treatment Community Health Centre OPD, an old

options. They were debating between palliative care and man came in. As a routine, when I started

full-blown multi-drug therapy. After an intense discussion taking down his complaints, he started

of the pros and cons, it was decided to go ahead with thanking me for saving his granddaughter.

supportive care. I still remember the look of confusion He kept praising the efforts I take for my

and helplessness on her face, while the doctors debated patients. His granddaughter was in a

over the course of her treatment, and her life. She took a serious condition, when they first came to

DAMA in the next few days and did not return. This was me. Due to the unavailability of adequate
my foremost first-hand experience and it has stayed with
facilities I had suggested them to go to a
me.
better hospital. Taking the word of a

previously cured patient, he trusted us. He

7. What would you like to tell the youth that is going was pretty sure that we'll do everything
to be the future of physiotherapy?
possible and she'll be out of danger soon.
To start with, learn to weigh what you’re giving and what
“I have seen your sincerity and the efforts
you’re gaining when you pursue something. Set your
you take for your patients. I have seen the
priorities straight. To all those wishing to pursue a
amount of care taken by you for your
Master’s abroad, make sure you come back and work for
patients. Thank you so much and God
your own country. There is so much untapped potential in
bless you.” The happiness in his eyes made
this country, you’d be surprised. Don’t wait around for
me feel proud of my profession.
things to work out and for opportunities to spring up,

create opportunities wherever you go. If you’re worried

about how much respect or validation our field gets in

our country, let me tell you that any person doing

dedicated, compassionate work in the community earns

If you have any such good
everyone’s respect. Don’t try to live up to someone else’s
appreciation notes or messages
definition of success, find your own goal, your own dream
from your patients, please write to
and pursue it with all your heart. While you’re at it, don’t

forget to create a positive, memorable impression in us about them at our mail,

people’s lives. thegreymatter.mimer@gmail.com

25
What did you do this ES T
GU ICLE
14th Feb? ART
by Wiktoria Maria Izdebska
Medical University of Bialystok, Poland
"The best way to find yourself is to lose it in the service As they say, real love is sometimes difficult but it is worth

of others.” Mahatma Gandhi every single effort. Especially love for medicine, as it equals

love to humanity.

We recently celebrated St. Valentine's Day, one special

day when the entire world wants to feel the thrill of love. St. Valentine was a Christian Bishop and martyr who

On that day, being single or in a relationship or being became a patron of lovers and people with mental

helplessly in love with someone who has no interest in illnesses. As far-fetched as it may seem, love makes us all

you or simply not being interested in anybody, matters. martyrs at times, especially as medical students and

physicians. Despite the optimal use of our knowledge to

Celebrating St. Valentine’s day is different for save a patient's life, there are times when a patient

everybody. Some say, “I don’t need one in three hundred breathes his last.

sixty five days to show my affection”, others crave

celebrations like those shown in American movies or So what makes us wake up the next day and take another

Taylor Swift’s songs. night shift? What makes us study and carry on our medical

journey? If it is not doctor’s love, I don’t know what it is.

What if I told you that going to a hospital for work on St.

Valentine’s day can be the perfect way to spend the

the
day? Why? I feel a hospital is the only place where you

can witness such concentration of real love.

Love is not just about pretty dates and showing

affection in conventional ways. I believe it's genuine

project
love when the surgeon checks up on the freshly

operated patient, one extra time. Or when a nurse visits

the patient, after duty, to make sure they're okay. Love is

seen in a paramedic’s fight against death for a patient’s

life or in the teacher's perseverance to help students by Aishwarya Puranik III/I M.B.B.S.
understand the human body.

For me, as a medical student, love means dedicating Amidst all the hustle in life, we've got to slow
myself to my dream profession, for service of the
down and channelize our mind to the simple yet
community. Love for medicine, love for research- that’s
meaningful thoughts.
what makes me wake up on time in the morning and iron

my white coat. It is what makes me stay up until morning

Analyze it your way, think deeper and you might
to finish studying for a test, and unstoppably advocate
unveil new aspects of your mind.
for changes in medical education and equal access to

healthcare. I won’t say that love for medicine is easy- it

never was. Medicine broke my heart every time I opened "HOW DEEP ARE YOUR CONNECTIONS?"
my exam sheet and didn’t know the answer to the first

10 questions or when the patient I was examining, If actions from those thoughts are set in motion,
complained about the terrible state of healthcare in the
that'll be a wonderful win.
country.

26
 Akash Ganesh Wagh 

III/I M.B.B.S. 

Grant Govt. Medical College & Sir JJ

Group of Hospitals, Mumbai

 TEAM

Back row (L to R): Saneeka Vaidya, Mohak Tilokchandani, Richa Sinha, Reeya Malankar, Unnati Shukla, Arshiya Barmare, Revati Pathak,
Poorva Jage, Sayee Sangamnerkar, Shreya Govalkar, Madhumita Sahoo, Ankit Pal, Nupur Chaturvedi
Front row (L to R): Khushboo Doshi, Manasi Joshi, Atharva Pawar, Aishwarya Puranik, Alisha Shaikh

Co-Editors : Saneeka Vaidya & Creative Head : Madhumita Sahoo

Nupur Chaturvedi Creative Team : Shreya Govalkar,
Associate Editor : Aishwarya Puranik & Manasi Joshi, Ankit Pal,
Revati Pathak Poorva Jage
Copy Editors : Alisha Shaikh & Cartoonist : Arshiya Barmare
Mohak Tilokchandani Public Relations : Atharva Pawar,
Junior Editor : Khushboo Doshi Reeya Malankar, Richa
Photography : Sayee Sangamnerkar Sinha, Unnati Shukla

ADVISORY TEAM

L to R: Avanti Patwardhan, Damini Narkhede, Riya Barar,

Siddhi Rangari, Hrushikesh Hendre

Co Founders and Co Editors : Damini Narkhede and Riya Barar

Copy Editor : Avanti Patwardhan
Public Relations : Hrushikesh Hendre
Creative Editor : Siddhi Rangari

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