Category: General

General Musings…

On a day when IMA strikes for NMC Bill in India, it is fair to ask this Poll

I think this retweet and re-poll is a fair question to ask when the #NMC bill has been passed and the Indian Medical Association which is supposedly formed to protect the rights of the practicing doctor (Modern Medicine in India) has asked Doctors all over India to strike work today

Has really the IMA been proactive with regards to NMC ?

Has it really shown a similar protest like the one whcih was witnessed when goons protected by the West Bengal CM beat up a doctor ?

Is indeed the doctor community itself aware of the NMC bill and what it contains ?

Has the striking doctors read the whole bill or is the whole thing just a blind leading the blind / coercion of professional aquaintance ?

I am surprised that in far away land, this poll that I chanced on asks similar questions about their medical association.

You can find the poll below…

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Pediatric Orthopedic & Cerebral palsy Clinic at Thiruvananthapuram

Pediatric Orthopedic & Cerebral palsy Clinic at Thiruvananthapuram

Children with #PediatricOrthopedic disorders, #CerebralPalsy require dedicated care that are rarely available. This is an initiative to start a #CerebralPalsy clinic in an affordable way for patients at the #SriRamakrishnaAshramaHospital #Thiruvananthapuram , #Kerala

@dreaswar
@childortho

#ArtForACause #Wayanad

#ArtForACause #Wayanad

This painting is part of #ArtForACause fundraising series with Dr Sekar Michael and Dr. PA Suresh at ICCONS , #Shoranur for children suffering from #CerebralPalsy ,#Autism and #MovementDisorders

Free Will and Fate – the Macbeth conflict

Free Will and Fate – the Macbeth conflict

Of Free will or Fate : A conflict for the believer whether to put in hard work and free will to attain anything in this world if everything is already preordained by God.
#Poem
#Poetry

#ArtForACause a Painting project by Doctors for fundraising

#ArtForACause a Painting project by Doctors for fundraising

Delighted to announce an #Art Project with Dr. Suresh (Director , #Neurologist , #ICCONS) , Dr. Sekar Michael ( #PediatricAnesthetist, ICCONS) and Dr. Easwar TR (#PediatricOrthopedic & Spine Surgeon , ICCONS) as #FundRaising campaign for treatment of children with #CerebralPalsy, #MovementDisorders, #ChronicPain and #Autism. This will be an ongoing project. #ArtForACause

Kerala Flood : A Tribute to my land

It was late in the day, i was standing at driveway gate turning off the lights to my clinic. I just glanced across the road where the indoor stadia is. This is where young college kids are working round the clock , selflessly for the flood victims. They receive relief materials sent across the border and sort it. Authorities are scant, but I’m told the work is supervised.

I was struck how a fracturing society had gelled by a near cataclysm.

My two lines worth were penned then

I titled it my kerala (ente keralam )

My Kerala

MITRA Medical Trust … our little helping hand to the poor is 3 years old

MITRA Medical Trust … our little helping hand to the poor is 3 years old

Boy are we joyous !

Our MITRA Medical Trust is now 4 years old.

This August 5th we are marking this event with the first public function at #Palakkad, #Kerala with dignitaries and beneficiaries.

We started on this journey 4 years ago, just a little band of friends who managed to get together after 20 years of separation after high school thanks to the newly emerging social networking services of Orkut, Facebook and Whatsapp.

The joy of getting back together about 20 years after out 10th class was marked with a reunion function and post-reunion, we sublimated the camaraderie by resolving to form MITRA, a medical trust to help poor people with treatment.

MITRA stands for Medical Intervention Treatment and Rehabilitation Assistance. Our goal is to lend a helping hand via our internal contributions (as much as possible) to the needy for medical treatment and/or rehabilitation.

Overtime, with the grace of almighty, love of our well wishers we could achieve this and much more. We have been blessed to have the good fortune of delivering help to almost 75 poor patient across a range of diseases disbursing as much as 24 lakh of Indian Rupees. No mean effort considering most of this was from our own internal donations.

A celebration was in order !!

This is then the first ever public function of the Trust. Mr. P.R.Seshadri , MD, Karur Vysya Bank , Mr. M. B. Rajesh MP, Mr. Shaif Parambil MLA, Ms. Pramila Sasidharan, Municipal Chairperson, Palakkad and Father Paul Thekkiniyath will grace the function.

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Making Media rich Medical Presentations using Emacs, Org-mode and Reveal.js – Part 1

Making Media rich Medical Presentations using Emacs, Org-mode and Reveal.js – Part 1

Scenario

As a practicing Paediatric Orthopaedic Surgeon, I am called to meeting to present my work. This involves presenting to peers, co-workers, patients and parents of children I care for. Each of these presentations will be with a different focus on a particular topic. 

While this is not an uncommon scenario, the solution to create a reusable presentation slides using #OpenSourceSoftware tailored to individual audience is. Most doctors are not familiar with programming environment  and shy away from anything that is not WYSIWYG. They rely on good old #PowerPoint / #Keynote to save them. At the most some of them may try and use the clunkly #LibreOffice or #OpenOffice if they want to stick to OpenSource. Recently with advent of tools like Prezi, media heavy interactive presentations have become popular. The popular presentation softwares of KeyNote, PowerPoint have also spruced up their animations and transitions to enable them to look more attractive. Still the WYSIWYG nature of these and point-and-click makes them very slow. We could achieve better, faster and more attractive results with using #FOSS tools. 

 

What I use now

For the past few years I’ve been using a combo of 

  1. #LaTeX via #beamer class 
  2. #RevealJS ,
  3. #Emacs, Org-Mode, org-reveal
  4. #HTML5 and #CSS3
  5. FOSS Image and Video editing softwares as required to arrange the media. I mainly use GIMP, InkScape, KdenLive, OpenShot, HandBrake to arrange my media and encode them. 

My choice depends on the demands of the presentation. 

For media heavy, especially video heavy presentations I use RevealJS. For presentations that are more of less static with few videos I tend to use Beamer / LaTeX. What I note below are my experiences as I tried to create a smooth workflow that could replace PowerPoint ( or KeyNote / LibreOffice ) as a tool to create #Medical Presentations. 

Overtime I have refined my workflow and now I find that I am far more productive and my slides can pack much more information than a power point slide. While the more advanced interactions would require some knowledge of JavaScript, and therefore would turn off most doctors, most of what follows require minimal programming use. 

I will detail my workflow to create simple fast layout using Emacs and RevealJS without handcoding of JS and HTML. We will be relying on the RevealJS, Emacs, Org-Mode and ox-reveal package to do the lifting. 

 

Disclaimer : Even though it doesn’t need programming knowledge, ability to use Emacs is a must for this workflow. It is preferable that one is on a Linux OS as the attempt is to go all #FOSS here. 

 

so, here goes ….

 

Aim

To create an visually impressive medical presentation using non Power Point open source (FOSS) softwares.

Tools

  1. Emacs (24.3 or greater)
  2. org-mode
  3. org-reveal
  4. Reveal.js
  5. Chrome Browser
  6. Open source video codecs on the system

Why this and not PowerPoint ?

Over the years Medical Conference presentations have got mature and old tools have got boring. Varied audiences, topics, media content , interactivity required, transitions and animations to keep audiences interested have all changed.

PowerPoint with it’s traditional set of tools is boring to say the least. The point and click interface is slow by comparison to plain text typing. This seems counter intuitive to PowerPoint pandits but I’ve found that once the media is arranged and readied, once can create more far more attractive presentations with the tools mentioned above. 

As far as medical presentations go, the video presentations embedded PowerPoint / LibreOffice have a habit of breaking on stage. I have seen numerous instances of this happening.

And, of course PowerPoint costs 💰💰

It is also Closed Source making it difficult to edit and reproduce when you are with a system where it is not installed.

 

Okay, but why Emacs, why indeed ?

Emacs is Open Source

Emacs is stable

Emacs is good

Emacs is better than #Vim

Emacs has un-paralleled number of extensions and programming support

Emacs has Org-mode… 

 

Okay, So why org-mode, what has that got to do with presentations ?

org-mode is cool

org-mode is simple text

org-mode can be manipulated anywhere with text-editor

Its FOSS

It can be extended with other tools like org-reveal

 

Hm, Okay, but why Reveal.js ?

An actively developed FOSS Tool with a community

Allows 2D stacking of slides permitting nesting

Plugins and all the JS/CSS/HTML5 goodies can be integrated

Very good slider-presenter notes

PDF export option for handouts

Very nice transitions and animations

Good builtin themes and literally infinite customisation options as per CSS

Works very well with slide-projectors and remote tools to advance slides

 

Okay, but why use org-mode / org-reveal with Reveal.js ?

Org-mode is cool, easy, transparent text typing

org-mode is structured and nested just like a regular presentations would be

One can easily do a text-only sketch of a presentations by typing out a few lines of text in org–mode formatting and out put a neatly animated stacked presentation in Reveal.js

If one were to code HTML and JS with Reveal.js, it would be considerably opaque, with HTML markup and JS obscuring the structural details of the presentation.

By integrating org-mode, org-reveal and reveal.js we are integrating all that is good in respective tools while sticking to what the non-programmer user ( an average medical professional ) would like to do – type text and structure the presentation.

 

So, How to go about making one ?

Part 1 : Preparing the ground

Step 1 :

Install GNU-Emacs > 24.3

 

Step 2 :

Update package-archives and use Melpa archive.

Update org-mode.

 

Step 3 :

Install ox-reveal package

 

Step 4 :

‘require(ox-reveal) in your .emacs file

 

Step 5 :

Download and keep the Reveal.js file in a folder.

Note down the path to the folder relative to the folder where the presentation will live.

If you have Bower installed you can just do bower install revealjs

 

Step 6 :

Create a folder where your presentation will live. 

Inside the folder create subfolders for Images, Videos, Scripts, CSS styles and other documents which may be needed for the presentation. 

Now we can create the main file of the presentation – the Org-mode file using Emacs.  Org-mode file is a simple text file which can be opened using any other text-editor. It has the extension of  “.org”

While using Emacs and Org-Mode, however, it provides lot of goodies. Org-Mode in Emacs has lot of extensions one can install that extends it functionality. One can for example use the same org-mode file to output HTML, LaTeX, and PDF. 

So let us create the main presentation file. I title my presentations the following way, giving it context, separated by underscores : <topic>_<audience>_<date>_<venue> . For example if I am giving a public talk on Cerebral Palsy at my home town of Palakkad, on July 30th,2019 , I would title my presentation like this : “CerebralPalsy_PublicTalk_Palakkad_30072019.org”

This allows me to keep separate org-mode files for different audience and keep using the same images, videos etc.. Therefore I am fully portable and self-contained when I have to whip up a presentation tailored to any particular audience – technical or non-technical. 

C-x C-f  in Emacs  to the file you want to create with .org extension.

C-C C-# to insert Template for a Reveal.JS presentation.

If you have ‘ox-reveal loaded it should be available as a choice.

Once chosen it will list some options at the top of the org-mode file.

We will need to provide the path to the REVEAL_ROOT directory to the place we have stored the reveal.js library. This path is relative to the folder where the file for presentation lives. 

Once these are done, It is important to get the images, videos ready. They have to be edited using FOSS tools for editing photos and videos. Once edited they’ve to be named properly so that we can reference them in our presentations. 

 

This completes the ground work required to start writing the presentation. While this may seem a lot of work, one must remember this is one time effort.

We will deal with the actual creation of  org-mode file, the options while using Reveal.JS in the next part ….

Sanskritam at IIT

IITs has been asked to teach Samskritam … read all about it !

…..screamed our electronic media. The reaction has been mostly negative. Occasional person voicing some positive comments. Twitter has been abuzz, specifically with people and blogs quoting Deputy CM of Delhi, Mr. Manish Sisodia to the effect that whether the nex-gen JS version is really worth the upgrade over Samskritam. What better could one expect from a party whose leader is a self-confessed anarchist.

Armed with my usual salt ( a pinch is too small a dose. I take spoonfuls ) considering the state of our media I searched for the full press release of Ministry of HRD to find out what it actually said. Unfortunately there is no press release so far in public domain from Ministry of HRD on this. What was projected and decided without a debate was from her statements in Loksabha.

The most acceptable version seems to be …

Accordingly, IITs have been requested to teach Sanskrit language especially with reference to study of works which contain scientific knowledge,” Irani said

This is based on the report submitted by N. Gopalaswami, who headed a committee formed by Ministry of HRD in Nov. 2015 for promotion of Sanskritam as a language. This was set up to look into and recommend measures to integrate its  study with disciplines such as mathematics, physics, chemistry, medical science and law. It will suggest changes in Sanskrit education in schools and universities and modern ways to impart Sanskrit education.
Eventhough Ms. Smriti Irani has clarified that it would be an elective, the media is still abuzz with people commenting on this, each looking at it with their lenses.

I cannot understand…

How a language which has given birth to most of the Indian Languages we speak today in many states or influenced the rest heavily could be such a politically fought tool.
How Sanskrit the language cannot be decoupled from opression, cateism, exclusivity, hindutva, brahminism and aryan-dravidian politics. If it is because it brings back bad memories to some, why dosent the language English bring back memories of British Oppression, Elitism, Exclusivity, Divide and rule politics and Missionary work ? Why dosent Arabic/Persian raise questions about Islamic suppression and atrocities ?
You hate the oppressor, not the language that he/she speaks.

What’s in a name ?

The language is a language. The time when Sanskrit was widely used – nobody seems to know when this was – but lets assume a safe year of 1000 BC, there still seems to have other languages that drew from it and thrived. It was a pan-indic-religious languages. Lets face it.  Hinduism, Buddhism, Jainism have large volumes of works written in it. Its not this only-Brahmin heritage.
The so called Dravidian ( which itself is a Sanskrit word ) languages are all heavily drawing from Sanskrit. Being a native speaker of both Malayalam and Tamil and student of Sanskritam I can say that both these languages draw heavily from it. Its a myth that Tamil just grew alone and is untouched by Sanskrit. The poster boy of Tamil Literature, Thiruvalluvar and his Thirukkural itself has many Samskritam words in it.All the Thevarams praise the Vedic Gods and include plentiful Samskritam to convey  untranslatable concepts.
It is my regular question set to my tamilian friend when it comes to opposing anything Hindi/Samskritam:
If Thiruvalluvar himself did not want to cleanse non-Tamil words from Thirukkural, why do the tamil politicians bother to clean tamil of sanskrit/ north-indian influence ? Do the modern tamilians claim to be better tamil lovers than Thiruvalluvar ?
If tamil is really an independent language, how come tamil legends talk about Agasthiyar ( a vedic Rishi) as the one who created Tamil ?
How a vedic God Shiva become the first Tamil Sangam Leader ? 

 

Why .. Why … Why do people love to hate it ?

The answer is that Sanskritam hatred is convenient and beneficial.
Let see how many birds one can kill with one stone – just by opposing Sanskritam.
  • 1  : Hindutva lovers / Sanghis / BJP
  • 2 : Hail Dravidian Identity and Tamil nationalism
  • 3 : Project modernity and upwardly mobile culture
  • 4 : Hey, its not as if I dont get a job if i dont study it.
  • 5 : Brahmin:  you oppressor, take that

In short ..

It’s a soft target. It has ‘X’ marked on it for any passer-by’s convenience. A quick punch. The vent. The pleasure. Un matched for the number of political/philosophical schools it pleases at the same time – commies, aaptards, congis,dravidians, upwardly mobile…


So do we need to protect, revive and reinstate Samskritam ?

If India has to go back to the glory days when it attracted people from distant lands to come and learn at its Universities at Takshashila and Nalanda,  when its riches were stuff of lore told in other lands, when we were living in a different century than the rest of the planet, we need to first find out what worked for us. We need then to find out what went wrong. Then we can understand whether we can go back. If we already have it there is no need to reinvent the wheel, but to look at ourselves we need the lingua-franca of the golden ages to understand its literature.

I am not talking of searching for lost technology for building airplanes, of doing genetic works, but I am sure all those wise men who trooped to our famous universities did so for a very good reason. We’d be fools to not look into our own culture and history to get us back where we were, for that’d be the most natural step to take. We have already been there, done that. We can do it again.
Lets hope good sense dawns, once the dust settles and India can get back to where it was.

A gentle yet clear brushing off of the cobwebs of the so-called Aryan theory and all its vicious corollaries is therefore absolutely necessary, especially for the South, and a proper self-respect created by a knowledge of the past grandeur of one of the great ancestors of the Aryan race — the great Tamilians.

We stick, in spite of Western theories, to that definition of the word “Arya” which we find in our sacred books, and which includes only the multitude we now call Hindus. This Aryan race, itself a mixture of two great races, Sanskrit-speaking and Tamil-speaking, applies to all Hindus alike.

-Swami Vivekananda, Aryans and Tamilians

Would you wear a garment without a blouse?

At a politically tumultuous time when you’re not even sure what secularism, nationalism, sedition, freedom of speech in particular and freedom in general (aazaadi) is, we have here a  peice on what constitutes ….for want of better words , shall we say and in the process provoke a redefinition of the word ‘decently dressed’. Thought provoking for the impartial inquirer, revolting to the convent educated elite, too much for even the liberalism chanting neavueau-upworldly mobile, slap in the face for ultra-conservatives. All at the same time. Are we staring at the truth here – for isn’t not truth said to be unpleasant/uncomfortable ?

This piece was a reaction to seeing a room full of amazing black and white photos by Sunil Janah of women who were topless. Like the below photo of a Hill Maria Woman from Bastar.  Courtesy of the …

Source: Would you wear a garment without a blouse?

Interventional Pain management and Palliative Pain Care – a write up on Cancer Pain

Coimbatore Pain Clinic

 

Commemorative day for Cancer passed us by, mostly un-noticed amidst the din of modern self centered life. Here is an article by my dear friend and senior colleague Dr. Sekar Michael who runs a Coimbatore Pain Clinic at Coimbatore, Tamil Nadu, India and is actively involved in treating under priviliged cancer patients.

This was published in Times Of India, an Indian News Paper.

Is Medical Administration a wasteful expenditure ?

In continuation of my previous blog article: How many Administrators does it take to run a Hospital ?, the brevity and conclusion of which interested me so much that I went deeper into this subject.

A link from that article drew me to an article by Kevin MD on the subject of health care spending.

In India, as in the USA where health care spending is something worrisome, this should make very interesting reading.

It is no secret that there is no love lost between Administrators and Doctors in most institutions.

Usually the Administration claims that the doctors don’t justify the amount being spent on them by the Hospital in terms of salary and other facilities provided. This data seems to point otherwise.

As the final word on this is yet to be spoken, still every bit of more reading I do on this topic seems to affirm the feeling I always had : That I was right

See the link below for an interesting article on what the author thinks about this.

Claims are backed up with some data from US Presidents advisors…

Administration comprises one of the biggest factors for health care waste.

But does health reform do enough to streamline it? It’s doubtful.

Consider the following chart presented by David Cutler, a President Obama advisor:

Health care administration is a source of medical waste

In other words, for every one doctor there are 5 more are employed to do administrative tasks.

And, frankly, it’s ridiculous. As Dr. Cutler says, “There is a lot of money spent doing things that in no other industry do we tolerate.”

Health reformers are hopeful that the money spent for electronic health records and claims processing will cut down on the bureaucracy. But it’s doubtful. Because universal standards for health IT are fragmented and difficult to implement, it’s unlikely that digital systems are a viable answer. If anything, I can see electronic records creating more positions, such as IT support, that will further bloat the administrative side of health care.

This is compounded by the impending transition to ICD-10 — with a 10-fold increase in coding complexity.

Read More Here:

http://www.kevinmd.com/blog/2010/04/health-care-administration-source-medical-waste.html#more-43828

How Many Administrators Does It Take to Run A Hospital?

Dr. Wes: How Many Administrators Does It Take to Run A Hospital?.

I always asked myself this question…

How many administrators does it take to run a hospital smoothly.

They are apparently employed to make doctors life smooth which leads to better working environment and better patient care. .. well, at least in theory. In practice, things are a lot different.

So, I started searching. I was sure I was not the only one who was having these thoughts.

This is an interesting blog article on that subject. A very short one, but serves the purpose.

How Many Administrators Does It Take to Run A Hospital?

From KevinMD:

… for every one doctor there are 5 more are employed to do administrative tasks.

And, frankly, it’s ridiculous. As Dr. Cutler says, “There is a lot of money spent doing things that in no other industry do we tolerate.”

If you want to find out how many administrators it takes to run a hospital, ask yourself how many work on the weekend.

That number should be just about right.

-Wes

 

Once you have finished that,  please see this article for more data on this and wasteful hospital expenditure