Know Your Antibiotics!

“What are the five commonly prescribed Antibiotics by you?"

I asked. A very unpleasant question this was for one of our residents seated in a room of about thirty odd doctors during today's very pleasant Bangalore afternoon.

“Augmentin…

Piptaz….

Clindamycin…

Metrogyl…

….mumble…

Dalacin”

He completed after a lot of contemplation. For those commoners who lack the knowledge of antibiotics, the third and the fifth one are the same, the former being the generic name and the latter being its brand name. While he was happy that he got his five, I thought it would never hurt to ask more and went ahead with my rapid five.

Me: “So….what do you give it for?” 

He: ‘Blank’

Me: “How many patients do you give it to on an average?”

He: ‘Blank’

Me: “And how many of them recover”?

He: ‘Blank’

Me: “Do you look at the antibiotic policy of the hospital before prescribing?”

He: ‘Blank’

Me: “Do we have an antibiotic policy in the hospital?”

He: ‘Blank’

I could have gone ahead with my minor dissection on his prescription practice and rationale but the general reaction in the room with department heads, senior consultants, residents and interns was a sight to behold. Working with microbes and antibiotics day in and day out I am of the opinion that the most resistant of all are us Doctors, nobody or nothing else. We are way ahead of all the Multi-Drug, Pan-Drug and Extremely Drug Resistant Microbes that we fret about and deal with in our hospitals.

In the periodical class on Infection Prevention and Control that we conduct for consultants and residents wherein we brief about NABH standards, Standard Precautions, Personal Protective Equipment, Hand Hygiene, Bio-hazard Spill Management, Biomedical Waste Management, Health Care Associated Infections, Surveillance Charts, Antibiotic Policy and Post exposure Prophylaxis the most I could do as a Medical Microbiologist and an Infection Control Officer was to share my little knowledge I have about these issues.

Some days there are few consultants with a ‘rock-solid-will-never-change-my-unit-my-antibiotic-my decision-my responsibility-my patient-I-know-better’ attitude and then some days there are only residents with ‘i-will-only-follow-what-my-head-says’ [read: not the head above his shoulder but the unit head] attitude. Some days there are five in the room, some days about ten and some days there are none. And on all days the laboratory doctors are considered ‘para’-medical and not medical because they see samples, not the patients. The samples are from their own patients is something long forgotten.

Despite all this our quest for training and data collection continues. “To measure is to know, if you cannot measure it, you cannot improve it” so said the great Scots-Irish mathematical physicist and engineer Lord Kelvin. It has not been an easy ride and it will never be, likewise for all doctors dealing with Infection Control especially in small health care settings where constraints are not just with resources but also with the lack of awareness and drive amongst our own peers, it has always been so in most of our Indian hospitals with regards to other situations.

Microbes with novel beta-lactamase enzymes have reached the United Kingdom from our capital and are christened with the city’s name too! New Delhi Metallo Beta-Lactamase! If it sounds very cool and you are a health care personnel you should be more than sorry. At the grass root level we still are far away from deciding on whether to check or not on what happens to the antibiotics that we scribble on our prescription pads. Only the kinds of Nipah Virus can wake us up.

Guidelines and policies are slowly falling into place at all levels but there are hundred other institution and speciality specific issues of Antibiotic Resistance and in the way we approach them, we are facing a silent epidemic and we have a long way to go!

Right Choice, Right Route, Right Dose, Right Frequency & Right Duration-the 5 Rs of Antibiotic Prescription apart, a 6th R would definitely do a lot of good to our patients and also all of us who belong to the medical fraternity- RIGHT ATTITUDE.

A kind request to all my fellow doctors- Know The Antibiotic You Prescribe! If not, we are here at the lab to help.🙂

As you all know we are facing a huge problem of Antibiotic Resistance across the world and India is considered as one of the epicentre of what we call as Superbugs, they are even named after our towns and cities like the famous NDM-New Delhi Metallobetalactamase!🤔

Healthcare associated infections are a huge problem due to antibiotic resistant microbes which increase our hospital stay, they also are a huge expenditure and carry a high risk for mortality.😢

Public perception of the issue is very important in this regard which my doctor fraternity seldom considers for discussion. Since we have to begin somewhere I am carrying out a small survey titled ANTIBIOTIC AWARENESS SURVEY with a few questions to be answered.

If this healthcare issue is of concern to you please participate and help us doctors analyze where we all stand. Thank you, your participation and feedback is highly valuable.🙂

Here is the link :

https://www.surveymonkey.com/r/WN7FKHG

-R.

The Ministry of Utmost Happiness-Book Review

“To The Unconsoled” 

Arundhati Roy writes in the dedication page of ‘The Ministry of Utmost Happiness’. And what can console in a better way than berries and plums of the summer and rains for breakfast on a Sunday morning. A bowl of ripe jamuns and kokum juice soaked overnight is just like Roy’s writing, pungent and poignant. I began this book with a presumption that some weekends and reads especially when it is after two decades, they are truly meant for shattered stories.

I read ‘The Ministry of Utmost Happiness’ like a perseverative reader determined to understand the intent of Roy’s words. What clearly stood out for me was the fact that there is no middle ground when it comes to having an opinion on this second work of fiction of hers written after two decades. You either like or dislike. 

There are very few writers who go beyond prose or poetry, between heights and depths of life and living. A lot here depends on the reader’s intellect and interest on many issues and events that have shaped today’s India, so if somebody reading the book does not feel connected I rather not blame the writing. Of course the plot lacks linearity and is greatly influenced by her viewpoints which can be interpreted in a hundred different ways. The incidental mentions of the you-know-who people leaves us with a chuckle, not for the humour but for our own lack of concern and action.

I am impressed by the distinctiveness of this book for two reasons. Firstly the theme is absolutely haphazard, like scattered pieces of a very difficult jigsaw puzzle which can never be solved or fixed. The characters and events are like tiny motes of stardust in the same sky, connected nevertheless. Every issue of political, social and more so everyday significance talked about directly or indirectly oozes out a strange kind of individuality parallel to the author's thinking.

Secondly the idea that nothing should bring down or berate anybody’s or anything’s existence; no species, no nationality, no gender, no caste, no status, no education, no belief, no religion, no occupation, no upbringing, no law of the land, no establishment or no other human, that by itself was thought provoking and impressed me greatly. 

Her description on many issues, particularly the part on martyrdom has left me transmogrified. We live in a world that makes us as well as breaks us. The breaking is what we end up focusing on. One thing’s for sure. Call it anti national. Call it dissident. Call it wail. Call it bestseller. Call it exceptional. Call it much awaited. It really does not make a difference. Call it ‘The Ministry of Utmost Happiness’ and read it, that’s all that matters.

-R.

Variar Bakery- A Walk Down Memory Lane

Take a stroll on the 12^th main road in Rajajinagar of Bangalore and a waft of sweet baked scent will drag you to the legendary bakery of OG Variar & Sons located in an inconspicuous corner near ESI Hospital. Govinda Variar, a native of Kerala is the founder of this place who used to bake at night with rented ovens and sell them during the day in Guttahalli. Eventually he opened a bakery in Rajajinagar in 1955 and the popularity kept growing. They also have a branch near Dhobi Ghat on Chord Road. The aroma in fact defines the traffic junction, that’s the only thing that makes waiting for the signal to turn green bearable.

Nothing in the world matches the yumminess of their Dil Pasand laden with all the tutti-frutti and coconut or the perfect puffiness of their Veg Puff with the right amount and kind of vegetable stuffing. The ever loyal customer base of these bakers par excellence will agree with me. Their range of biscuits and fresh breads are a must try. Fortunately they do not use any preservatives or colouring substances. A team of the most cordial men clad in white will attend to you one by one, mind you there maybe serpentine queues while their signature items like milk biscuits, ‘benne’ biscuits and ‘khara’ biscuits fly off the shelves when they are still warm from the oven.

Transactions for the ladies are easier here; we have a separate ‘Ladies Counter ‘to attend to our orders. I remember Appa asking me to stand at that particular counter so that we could get our order faster. There was a time when people used to buy these items from the bakery in modest amounts. These were small luxuries of life which were brought home only on special occasions, if brother or I wrote our exams well or our cousins were visiting home. Today I saw some pistoriophiles at the counter buying biscuits and cakes in kilo grams!

 One of the most exceptional things about this place is its originality. No matter which day of the year you go their biscuits, breads and cakes taste remarkably the same.  Therefore binging on them might not be good for health as Govinda Variar himself opined once but trying them is definitely a must! Today I literally walked down the memory lane and got a lot of their goodies home.

-R.

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