Category Archives: General

General Musings…

#ArtForACause a Painting project by Doctors for fundraising


Delighted to announce an Art Project with Dr. Suresh (Director , Neurologist , ICCONS) , Dr. Sekar Michael ( Pediatric Anesthetist, ICCONS) and Dr. Easwar TR (Pediatric Orthopedic & Spine Surgeon , ICCONS) as fund raising campaign for treatment of children with #CerebralPalsy, Movement Disorders, Chronic Pain and #Autism. This will be an ongoing project.

First day was today. Wonderful experience at ICCONS, Shoranur.

Lovely to see that many of the staff from Speech and Audiology participated as well.

We plan to improve this in the next iteration and pool all the paintings we paint ( Dr. Suresh, Dr. Sekar and myself ) to help build a fundraiser.

We will be holding these painting sprints at frequent intervals.

#

ArtForACause

#Art

#Painting

The Empty Rusted Bucket

The Empty Rusted Bucket


An afternoon walk across my backyard where there is an old well inspired this. I had just strolled amongst the tall grass which grows and almost kicked the rusted neglected bucket `.

Sudden inspiration followed and I composed this poem about neglect of what was once useful, now neglected, still owned, but not cared or sought after. Its rusted, unused, leaking but we still had not disposed it : much like our old and aged who worked their heart out but are now neglected in their own homes, un-listened to, if I may refer to it that way. 

The Empty Rusted Bucket
The Empty Rusted Bucket
of Happiness

Of Happiness


Happiness, as in the context of a Hindu (a cultural, subcontinental cultural expression, rather than a narrow religious term) is something that was thought about my the brightest minds. 

Essays,Books, Schools, Religions have been built and nurtured on it’s name. Avatars created, Saints glorified. 

Yet, for an average human in present day world with it’s plentiful amenities and material distractions, happiness seems as elusive as before; sometimes more so. The Hindu always felt its something that comes from within, our very nature, its always there, not something that’s got from outside. Our cravings, which trouble our mind and if obtained satisfy it merely gives us temporary mental satisfaction which subsides the waves of restlessness in our Chitta (A yogic term, mind-space would be a close translation) which allows the pre-existing happiness to shine through. 

A Hindu, views all material happiness as temporary and bitter sweet since all material pursuits are attaching us with action and thoughts in the direction which opens us up for Karma.

So for a  Hindu, happiness is our native state which we have muddled with our desires and pursuits. 

of Happiness
Of Happiness
Cry of the Zealot

Cry of the Zealot


It is a time of churn in India, as anywhere else in the world.

The old secular , leftist and liberal schools which was built learning upon the lessons of The World Wars, the Revolutions of Russia, France, the thoughts of Marx, Mao, Lenin and Stalin gradually had gone stale. What once helped the oppressed people solve their day to day issues had become in some cases initiator of violence or oppression themselves. The Right meanwhile is more appealing to people as it promises to take people back to the Good-Old-Days. It promises the glory days.

For almost 6 decades after independence of India the Left Parties, Leftist policies where popular. Over time, increasing conflicts between the once shunned Right and the ubiquitous Left are common place. Narratives are built with cases of return to old glory in the case of Right and of oppression or class struggle in the case of Left.

The society seems to swing between one form of violence and injustice to another, swinging past the midpoint of peace. While this seems to be a post World War phenomenon, in reality, the fight between thought schools are not new; at least to the South of India. Indian Civilization being so ancient, it has seen similar days in the past. It has lived and survived these to tell its tales.

Examples of how the Jains and Buddhists – The Heterodox systems- had frequent conflicts with Shaivas (Worshippers of Lord Shiva ) and Vaishnavas (Worshippers of Lord Vishnu )  – the Orthodox systems – are detailed in Tamil Scripture of Periya Puranam. There are even descriptions of impalement, immersion in lime, drowning a saint in ocean tied to rope, and several such mass attempts at conversion to a school of thought. Well, if one looks critically at these, convert-or-perish instances of those times, it was no different from the crimes committed by the IS terrorists now where they behead non-Islamists. Yet, these beliefs co-existed, albeit with friction, with royal patronage to a particular school of thought.  The Royals were rarely  ‘secular’ , to use today’s terminology. Yet, there seems to be times in past where the saints seem to come from all stratas of society and they were respected equally. In Periyapuranam and elsewhere in South Indian history, there are references to a number of saints who have come from humble social backgrounds ( which now belong to oppressed social classes ) and are equally respected – and in some cases more – by the peer saints and followers alike. This does seem strange when we consider that South India actually required a Temple Entry proclamation to allow the commoners from “lower castes” to enter the temples again in 19-20 century. This was about 500 years after the saints from the very same castes were actually venerated. So we really are not sure when the social degradation happened. One thing is certain. Depending on ones ideology – left or right, one can choose to go back to either a past where caste oppression and persecution existed or to one where they apparently did not . I use the word ‘apparent’ because here I have to go by the scriptural records and not actual rock edicts themselves.

[ 

Some terminologies I use in the poem I am translating here to stimulate further reading : 

'Austere Potter' : Saint Thiru Neelakanta Kuyavanar, first saint listed by Saint Sundarar in his list of 63

'Shepherd'  : Saint Sri Thirumoolar, composer of Thirumanthiram

'Toddy and fish loving incarnation' : Sri Mutthappan, Kannur, Kerala

'Fearless tiger mounted battlegod of yore'  : Sri Ayyappan of Sabarimala, Kerala

'lowly ox' : Ochira Parabrahmam, Ochira, Kerala

'first monist' : Adi Sankara , Kaladi , Kerala composer of Manisha Panchakam

]

Recent rise of right wing in India has witnessed renewed conflict between Left  and Right at various levels ; political and otherwise. Some of these have been peaceful, but many especially in the district of Kannur, Kerala State  has been especially bloody. The once popular Left movement in India is on the wane as it is losing state after another. The right on the other hand is on the rise. Probably the Left has moved away from the minds of people and Right is occupying the space.

It would be nice if there is no violence and lasting peace. My wish.

Cry of the Zealot

Cry of the Zealot

Ode to The Monkey


India’s tryst with Yoga is deep rooted in symbolism and runs deep into its spiritual classics, poetry, theory, ritualistic practice, grand-mother story telling and visual art forms. The pervasive, repetitive and at times outwardly silly, unreal, mythical symbolism is probably one of the factors that has prevented the pillages, marauders and missionaries from destroying what India now offers to the world. They probably thought its too silly to be having anything worth annihilating.

Breath, the Monkey mind are common symbolisms in the epic written by sage Valmiki – The Ramayana. Hanuman,  the ‘monkey God’, is literally  Hanu (kill) and Man (mind).  He is the symbol of Yoga and since he is the son of Wind ( Vaayu-Putra) . He is also the symbolism for halting the mind, going beyond it by practicing breathing techniques and meditation which enables the union of estranged devotee ( the Sita, literally born of earth) and eternal soul (Rama, The God, literally one who charms) held apart in an Island by the forces of darkness ( habits of body, mind and the Ego )

All observing non-changing soul bound is thus dipped into the erroneous identity with the body by the chord of breath. This identity can be reclaimed by tracing its origins back via the breath, the Hanuman, and killing the mind enables the realization that one is nothing but the never changing, unborn, undying unary eternal soul.

This is union we seek. This is the union that brings peace.

To the Monkey Mind and quietening breath which kills it then , 

ode-to-monkey

I am Shiva : A tribute to an unmoving belief


It has been a tough month for the home state of Kerala, which is grappling with the worst flood in a century.  It has been a testing time for humanitarian work, for beliefs, for politics … for everything.  Theories abound as to what caused the floods ranging from human disruption of natural ecosystem, divine wrath, Solar Minimum year, weak El-Nino/a effect, a mix of these and several other variations of these theories.

I distinctly remembered on morning in #Palakkad as it rained. This was before the floods. The first day of several that were to follow that first drenched and then drowned the state. As I drove from Coimbatore, a border city of Tamil Nadu to Palakkad, Kerala for work at about 8 am. As I drove past the western ghats I saw that the rain clouds hung so low and it was an eerie drive to say the least. Never in my memory have I seen clouds so low. I knew something was amiss. I called my wife and told her something was not right. Nothing however prepared me or my state for what was to come.

The rains started barely minutes after I drove into Palakkad. It had been drizzling the night before, but it just got heavier and heavier. Pounding continued for 2 days and flooded north Kerala first. Then it subsided for a day over Palakkad on Saturday leaving it in floods, something that the natives bragged they’d never seen.

But still nothing prepared Kerala for the destruction they were about to witness in the coming week. Rain pounded Kerala (especially middle Kerala) in coming days and left it battling floods, death and destruction.

In midst of the destruction speculation emerged that this maybe a divine wrath (specifically of Sabarimala deity Ayyapan) and other exhorting people to ‘pray for Kerala’. Needless to say, the non-believers camp rejected these with their own rebuttals and even some going to the extent to labelling prayer as useless. Their argument being that prayer at this hour of crisis is useless. What is required is working hands at ground zero.

Of course, these arguments represent a variant of the believer non-believer clash that has been there since time immemorial. At times of crisis like this where any argument of a merciful divine force does not appeal with rampant, apparently unreasonable destruction all-around, it is a time to reflect on ones belief.

These lines were penned before the flood, on the day of heavy rains in Palakkad that preceded the flood. Even just seeing the rains it was amply clear that something was grossly wrong. These rains were not normal. I knew it as going to be trouble. The lines was also partly meditative, as I prayed for rain to ease.

These lines are a tribute to the constant tug of war in nature and in spirit that tests our beliefs : whether it be theistic or atheistic. Man constantly asks God, but…

This was also penned before, this a tribute to the my home state.

 

I_am_shiva_r.png

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


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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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.


India’s battle againt Polio…

World

A few days ago, Ramesh Ferris took his first ride on a motorbike. Born in India and raised in Canada, Ferris made the journey into rural India to meet Ruksa Khatun, the 3-year-old girl who is the last child in India known to have contracted polio. This weekend, as the nation quietly marked two years without a single infection by the wild poliovirus, that child’s parents wondered how they were going to manage the surgery her doctors say she needs on a foot crippled by the disease.

Ferris would understand the gravity of their situation better than most. After he was paralyzed by polio as an infant, his birth mother was unable to provide him with the care he needed and placed him in an international orphanage. He was adopted by a family in Canada’s Yukon territory, where he grew up, eventually becoming an advocate in the global…

View original post 1,142 more words

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

Plone based Open Source Intranet Solution for Hospitals


As discussed in my previous post I have implemented an Open Source Intranet Solution in my Hospital, Ortho One Orthopaedic Speciality Centre, Coimbatore, India.

This is based on Plone. Customisation have been done to suit and hospital work flow. Necessary add-ons have been added to achieve the desired functionality along with custom scripts. Basic styling has been done to keep it simple and presentable.

Plone is served from an Ubuntu Server 12.04, 4GB Ram and 500 GB HDD. The processor is Core2Duo. This is a staging server. We may be shifting out once we have fitted the gaps and are ready to go live. That said the existing hardware serves well.

Here are a few screenshots:

Intranet Wall

Intranet wall for file dumping, discussions, chats, announcements.. even secret meetings !

Chat on Intranet.. Too lazy to create events, pages ? Chat away…

Staff Leave Calendar

Staff Leave Calendar

Intranet Login Page

The Login page…

Intranet Discussion Board

Discussion Board for the Intranet.

 

Guide to Successful Open Source Software Implementation in Hospitals – Some Difficulties That Needs to be Crossed..


      Its the age of Great Leap Forward..

People are happy, work goes on.. life is kind of strange with no BSOD but people are still carrying on.

One thing they are unhappy about.. They have to work. Gone or the days when their trusted OS used to giveway under then leaving them staring at a BSOD so that they could make a quick call to the IT in charge and go out for a coffee.

Excuses for work delay have come down.

So how did we get ourselves in this mess ?

We had to struggle.

What follows is a first hand account and a general guide for all Doctors who wish to implement Open Source Solutions / Software or Linux based systems at their workplace but are afraid to take the plunge.

For the technically minded Mr. Kumaran (http://kums.in) is preparing a more technically heavy note full of implementation details. Please watch that space.

 

Essential Reading

1) How we moved to Open Source at our hospital

2) Intranet &PACS

3) My Open Source EMR

4) EMR Implementation

Planning ::
==========

– Sit down and think what we want our computers to do for us and define a budget.

– This will dictate what software & hardware you need to get that
job done.

– Make the right Hardware and Software Investments. It is very easy to
get convinced by the vendor to invest more in features you may never
use / need.

– You need to choose you FOSS projects carefully.

http://www.ohloh.net/

http://www.sourceforge.net

gives you indices that help you decide the popularity of the software.

– Look Before you Buy: Always check the Linux Compatibility of the
hardware you are going to purchase after you have installed Linux.
While many will work out of the box, some will work after tweaking,
some may not work.

– Get the right persons for the job. There will be an element of luck
here. If you are, then you will find somebody passionate abt this. Consult them.FOSS enthusiasts and ready to help.

– Do your Homework: I worked for 5 years trying out one solution after another before settling on the ones I wanted. Since I know the work flow of my hospital, I naturally know what suits it the best.

– Keep it cheap. It can be done. Cost is important, even if you are willing to pay
more. Bargain hard. Buy only what you want. Dont by what you are
sold.

– Interoperability within and without your office. This is important.
When going down the not-so-beaten-before track. Detractors are many.
Complaints will be raised. It will be irritating. Don’t expect users
to share your idealistic vision. Every complaint needs to be
listened to and most of them can be safely ignored. Some of them
will give an idea of the gap that needs to be bridged.

– After-installation-service – accessibility, response time, ?365X24X7.
This needs support. If you have an in house reponse team that knows
FOSS solutions, then thats good, otherwise you may need to buy
support. My Open Source friends tell me that Red Hat support is good
and is value for the money paid. Decide on support. Lord Murphy is
always watching. Depending on the level of in house support there may be some investment here.

– Staff training had to be spot on so that there is no excuses
to put up your hand and say `open office is too tough`. This is the
most important. Implementation will fail otherwise. Management will
be inundated by complaints of `non-working’ computers. In our
Hospital. Mr. Kumaran cleverly themed Cent-OS to look list Win7.
Most users tech-savviness ends are very `iconic`, so thats all that
will require.

What did we do ::
=================

– Even when we had the WinSystems I stood firm and never let the management invest in MS office. It was unnecessary. Complaints were many ranging from inability to open external files to difficult UI.

Some of the complaints, especially UI related were somewhat relevent, but I decided not to pay heed. These have settled down.

– Avoiding repeated investments to tide over a initial improper investment: The Pros kept telling us to invest in Teminal Server License but we stood firm. I kept telling the management that that takes away the advantage of cost and that I could run it better without any further investment by installing Linux. There needs to be a strong FOSS enthusiast in whom the management has trust. Otherwise the Corporate win.

– Kept to a budget: When we cut off all the frills like antivirus, firewall, terminal license we cut off all the recurring expenses.

Know what you want and buy only that. They will try to sell you more; thats their job. Let them do theirs, and you do yours.

– Choose your FOSS projects you wnt to implement: Now that you have got the courage to implement, use only well maintained and mature FOSS projects. We have Cent OS , Ubuntu, Zope & Plone, mysql, postgresql, dcm4che,JBoss – all mature and well maintained. For EMR you can use Open EMR, Open MRS, GnuMed, GNU-Health. There are several DICOM viewers you can use depending on the data you want : Oviyam, Mayam, Osirix(Mac), Aeskulap, GingkoCADx, inVesalius and many more. ImageJ is useful with its Java plugins for image analysis.

-Use the LTS version of the OS if possible. Install it on the staging system first. Train all the staff, get them to use it everyday and stress the system. This will give you an idea as to what kind of server you need now and when you expand in future.

– Training. It is important to train the staff. This is paramount. Our Admin Officer (AO) who also looks after IT complaints goes around doing all the minor trouble shooting and doubts. Once the staff realise work has to be done with this, they keep quiet and try to learn. We do Plone/Zope training many times a week. The software vendor and our AO do the Hospital Software training. The basic use of a Linux thin client interface has been taught. The theming is very handy for bridging the gap.

– Firewall. Set up a linux firewall and set up basic access rights to prevent unauthorised access to internet. Setup a secure Wireless. This will help access to Intranet, PACS, EMR over mobile and touch devices and also allow remote access.

Accept the Sore Areas:

===============

Medical Presentations: Right now its only MS office. Even Mac guys have trouble presenting many times; atleast in India. This will need users to use their personal MS office products to prepare their presentations. Sadly Libreoffice Presenter leaves much to be desired. It can do the basic .ppt export, but cannot be relied upon

Printer Support: This will need you to look before you buy. If you have expensive existing systems please evaluate. We could not use two network printers (Sharp)after switching over. They are both aged, so replacement is an alternative.

External DICOM applications: Many patients come with CDs with bundled DICOM viewer software. This may not work in Linux ; even under wine. Depending on the type of practice this may be a problem. In our current practice most patients come with printed films so it is ok. Some of the DICOM viewers open / the CDs can be opened with Aeskulap, but GE PACS cd usually dont.

.docx files: People send you MS Office files of all kinds. You cannot expect them to save it in a legacy format. Ubiquity of MS Office and Win make them expect a reply when the files are received. MS office 2007 – 2010 files are an issue. Simple ones open. Extensive use of animation, graphics causes improper rendering. Usually Office communications are bland letters which open without an issue. For academic presentation use, we suggest you rely on a personal copy of MS Office in you laptop.

Hopefully these basic guidelines will help people to switch. This is first hand account. That should be encouragement enough.

We have made it happen at our Hospital. It is comfortable. Transition has been very smooth with most users not even knowing the OS has changed. They only feel the computer is faster.

Please feel free to leave comments in case of any implementation queries.
As I said before watch http://kums.in for technical updates.

My Hospital runs Linux (OR) How we closed the Windows & Opened the Doors


The Great Dream …

This post is my dream .. or has been for about 4 years.

A day that my hospital runs on full Open Source Software.

First a little about me. I am a practicing Paediatric Orthopaedic and Spine Surgeon. I am a Open Source enthusiast. I started using Linux 6 years ago and for past 4 year I am using it almost exclusively at work and home. The only time I use Windows is for the odd gaming. I do Python programming – web & desktop.

When we moved into our new hospital premises, set up 2 years ago, to start on a good note and to save start up cost I set up an Open Source Intranet (Plone) and Open Source PACS for my use at the Hospital. I also started developing my own EMR project that I speak abt in this blog.

I dreamed that the hospital will implement an all Open Source Solution. I advised them likewise.

They seemed to listen. Then FUD (Fear -Uncertainty-Doubt) took over them:

How can we follow the advise of this Non-Professional ?

What happens if we have a trouble in future and then he cant help us ?

Where do you find the Linux certified guys to help you ?

What happens if Linux is sold off to come company and it becomes a paid?

(Yes, they did actually say that ).

So they sell themselves to the “Professionals” . Our Management was no different.

It was advised that our Hospital will need the best server, a professional firewall, latest antivirus, and all windows machines. Individual desktops were advised, even for Reception area ! . This along with the latest MS Office and all the great accompaniments. … It was not cheap – It was not meant to be. The offer looked really good. The guileless management was tempted to say ‘yes’.

Then they thought they’d double check with me, just in case.

The Great Deliberation followed.

One looked at the order, I chopped off half of it. Why do you need a comp with Core2Duo, 320 GB drive, 4GB RAM and Win7Prof  for Reception, Cash ?. All that they ever use to is to login to our Hospital Software.

I suggested all Thin Clients, Open Office, Linux on Server. Firewall with Linux. No antivirus software. Intranet with Open Source and Open Source PACS system. Desktops only for Doctor chambers and Media editing.

After mustering courage and ample dosage of FUD from the Professionals, Management decided on Windows Server & Win Thin Clients. They were whining all the while saying that my idea is ill advised. I suppose he would considering that I trimmed the budget at least 5 -6 lakhs of Rupees.

So it was going to be a huge server we may never use with features and specs that many small IT companies may not have or want or need or use : Sonic wall firewall, MacAfee antivirus, MS Office on all Desktops the list went on and on… There were ThinClients at all stations and Desktop at Doctors rooms and other important admin areas only. IT was Windows everywhere.

The Professionals offered to set up the Server with domains all the security stuff. It was bundled with the purchase.

Things had barely gotten off the ground after a year of struggling to set it up. Then a 2 year jinx started.

The Great Depression followed.

The Thin Clients which needed to work with only our Hospital Software (written in Java) needs Firefox. Most stations needed this software for the daily work. Even though we had purchased the ThinClients after testing with Firefox and our Software, after implementation it was horridly slow. CPU was clocking   100 % the moment we use the software on Firefox.

The ‘Pros’ blamed it on Thin Clients. They told Mangement we told you so. You needed Desktops. Buy it and it will run things smoothly. Blame game between the ‘Pros’ and the software vendor started.

They could not sort it out for over two years. Work at the hospital suffered. We needed to replace the Thin Clients at the high workflow areas with old desktops to that we could serve.

All the while I kept telling them you move to Linux it will be all right, but they needed a ‘Pro’ to tell them that. Of course, they would not. They tried to sell us more. After `considerable study` at their HQ and evaluation of the software, they said it will be all right if the server did all the processing and asked us to shell out more for the Terminal  License for Windows.

I put my foot down and said no. I said I could make it run smoothly under Linux if they wanted, so they had better come up with a better option.

Things dragged on with no news from them even after 1 year. The Management was frustrated. Then Windows cracked and light came through. The Management decided to Open the Doors.

The Great Revival followed.

Enter Mr. Kumaran (http://www.kums.in)

Cent-OS it was then for the main server with customised `really thin` clients. One week of testing with VirtualBox and couple of flashed thin clients and the Managements saw the light of what I was saying all the while. All processing at the server. Hospital Software is fast. Staff are happy. Work gets done. Management is happy. Work get done with no money spent.

Now we have fully converted. Printing is an issue because of the WinPrinters we had purchased. Luckily most of the are aging and needs to be replaced.

The Great Leap Forward …..

Open Source Intranet Platform

  • Intranet has been customised and installed.
  • Used everyday at our Hospital now.
  • It runs Plone with add-ons and custom scripts.
  • Currently we are `fitting the gaps`
  • Scheduled implementation is due next month.
  • Staff seem to like the concept and are getting the hang of it.

Open Source PACS

  • Set up and running at full tilt
  • Currently in testing.
  • Scheduled implementation in a months time.

Our setup now contains

  • A main Cent-OS Server serving the Thin Clients
  • A Desktop with Ubuntu 12.04 PACS Server (Staging)
  • A Desktop Ubuntu 12.04 Intranet Server (Staging)
  • A Desktop Ubuntu 9.04 Server for the Hospital Management Software Maintained by Software Vendor. We need to migrate this as it is aging.

So, what are we leaping to ?

  • Open Source EMR
  • Open Source ERP
  • and more…..