Featured post

Many Uncomfortable Truths, And My Appeal

Disclaimer: These are my personal views surrounding the tragic death of my student.

Yesterday, I attended the funeral. There was a large police contingent and media presence. Everything was controlled by the police and other officials. Everybody who was somebody came to pay their last respects. However, many attended the funeral for optics. Their priority was being in the media coverage and making public statements of condolence and sorrow.

The parents were inconsolable, yet were unable to grieve in private. Cameras recorded every moment as part of a live stream. There was no dignity in death also. I felt disgusted by what I saw and deliberately stayed away from camera view. I was not there for self-promotion or publicity. What should have been about the deceased had been hijacked to be about others.

Since the time of the event, several narratives have emerged. I cannot vouch for the veracity of any claims as I have only second-hand information. However, I have had time to think about the incident in some detail and will attempt to articulate my thoughts below as responses to claims.

Claim: The attacker was addicted to ganja (marijuana) and received treatment from a de-addiction centre.

Response: How did he develop this addiction? Where did he obtain the contraband from? Who are all involved in the supply of drugs? Why is no action taken against the drug mafia? How many more are affected by this menace?

Claim: The attacker was not in police custody, and had been brought by police for treatment since he had an injury to his lower limb. In fact, the attacker had himself contacted the police and complained that he was being attacked.

Response: The police is expected to have a high index of suspicion at all times. Whenever they receive a complaint they are ordinarily expected to conduct a preliminary enquiry before taking action. If, as claimed, there was nobody with the attacker when the police arrived, how did the police verify his claim that he was being attacked before (in effect) granting him protection?

Claim: The attacker was behaving normally and suddenly became violent.

Response: The police is expected to identify those who behave suspiciously, including those under the influence of alcohol or drugs. Why was the police unable to suspect the attacker of substance use when his appearance (from visuals in media) is clearly abnormal?

Claim: Several policemen were unable to restrain the attacker.

Response: If true, how was it possible for a single intern to pull the attacker of the deceased?

Claim: Policemen fled the scene when they were attacked.

Response: Aren’t policemen given training on how to control aggressive or violent persons? Isn’t the police expected to use its training to subdue miscreants to protect innocent civilians? If the primary duty of the police is to protect citizens and maintain law and order, did the police discharge its duty in this case?

Claim: The Casualty Medical Officer (CMO) and other staff were present during the incident.

Response: What was the role of the CMO in assessing and resuscitating the deceased? What first aid was provided to the deceased at the government hospital? Why was the deceased shifted to a nearby private hospital? Who authorized the transfer and on what basis? Was it not possible to stabilize the deceased at the government hospital?

Claim: The deceased had a pneumothorax that resulted in her demise.

Response: Why was this not detected during medical assessment either at the government or at the nearby private hospital? Why was this possibility not considered especially since the victim had multiple stab injuries including on her torso? Examination of the respiratory system could have revealed abnormality before and after intubation even in the absence of radiography.

Uncomfortable truths

The police was neither prepared nor trained for such a situation. Even if they were, it must have been a long time ago else their training would have kicked in instinctively. To ensure preparedness, regular training/ refresher sessions are necessary.

The majority of medical students, doctors, and healthcare workers are women. The physical differences in size, strength, muscle mass, etc. between men and women make it highly unlikely that they will be able to defend themselves against attacks by one or more violent/aggressive men. Martial arts training may be helpful in certain situations, but will be a poor substitute to systemic changes resulting in safe working environments.

There is a shortage of resources in both public sector and private sector healthcare institutions. These include funds to install CCTV cameras, barricades; manpower to ensure round-the-clock presence of skilled personnel capable of dealing with such situations; and appropriate equipment for crowd control among other things.

There is widespread use of alcohol, drugs, and psychotropic substances. However, there is limited awareness on how to identify individuals experiencing withdrawal symptoms/drug-induced psychosis, or methods to restrain/control them to prevent harm to self and others. Law-enforcement agencies, and healthcare workers must be able to identify and manage the entire spectrum of drug-related behaviours.

There is a decline in clinical skills among medical graduates. Students do not invest in acquiring clinical skills (history-taking and physical examination), so depend on external sources of information (monitors and sensors to obtain blood pressure, pulse rate, etc; and laboratory investigations to arrive at a differential diagnosis/diagnosis). Faculty encourage and promote such behaviour by failing to strictly insist on skill acquisition, and permitting incompetent students to progress. Coupled with an overall erosion of values, we now have students and graduates who do not possess the necessary skills to clinically assess patients, and simultaneously fudge patient details without assessing the patient. As hardly anybody seems willing to insist on either skill acquisition or integrity, we are now producing medical graduates who are both incompetent and untrustworthy. In the long term this will result in avoidable loss of lives.

My Appeal

To everybody: This incident is the result of systemic failure. We are all responsible (I hope my responses to various claims establish that adequately). Therefore, please do not indulge in blaming others. For one, it will not solve any of the issues mentioned. Secondly, it will vitiate the atmosphere. What is needed is humility to accept our shortcomings and failings, and a willingness to cooperate and collaborate with others to bring about meaningful changes so that such an incident does not repeat itself.

To the medical fraternity: Please offer practical and actionable suggestions to address concerns, instead of only pointing out issues. Please do not disrupt medical services or training activities as doing so will be counter-productive. Please utilize the expertise available within the medical community to develop guidance documents, protocols, and other tools to deal with such instances (of substance use, violence, psychosis, withdrawal, etc.). Share these with policy makers and help with implementation at all levels. Be a part of the solution.

To the media: Please help spread awareness about substance use. Employ the tools available at your disposal to obtain statistics related to substance use, implementation of laws, etc. Serve as a watch-dog and speak truth to power, exposing lies and deficiencies. Please ensure that media coverage does not invade someone’s privacy or insult their dignity.

To leaders: Please use the inputs received and make meaningful changes to existing legislation. If necessary, enact new legislation. Please do whatever is necessary to provide a reasonably safe working environment to healthcare workers.

Featured post

What to do?

Disclaimer: This article is an outpouring of emotions following the untimely and unfortunate homicide of one of my students by a deranged patient while on duty at a Government hospital.

Today morning, I was woken by a phone call from a junior colleague (in-charge of house surgeons aka interns) informing me that one of our interns posted in a nearby government hospital had been stabbed multiple times by a patient. She was still alive, but barely so, and I immediately informed my superiors. By then she had already been shifted to a nearby private hospital, and I rushed there with another colleague.

The half hour drive was tense, and I was grateful that there wasn’t much traffic. By the time we reached, she had been intubated and the ambulance had begun its journey to a tertiary care hospital around 60 km away.

A few hours later I received the news I had dreaded the entire morning: she was no more.

By then the news had been picked up by media channels.

Throughout the day there was much milking of the incident by various agencies, institutions, and individuals for vested interests. Everything was converted into a media circus.

Her body was brought back to my institution in the evening. By then there were several media channels, a large police contingent, several political leaders, and representatives of various organizations who had nothing to do with the deceased. Reporters sought ‘bites’ from those present- one spoke to me as well. Her tragic death had by now become a morbid media spectacle.

Eventually, everyone left. I was left with my thoughts once again.

I had known her since the day she joined MBBS in 2016, and had taught her till she passed Final MBBS Part I. It was during her internship posting in my department that she was posted to the Government hospital, and I feel guilty for her death. She was my responsibility. I was supposed to ensure her well-being. Now, I have failed in my duty towards her.

I cannot hide behind excuses and pretend to have no role in her misfortune. After all, she was posted in another institution- a government hospital no less. So isn’t it the responsibility of the government to ensure her safety? Maybe, but she was first my student. I was like her local guardian- didn’t her parents entrust her to our collective care?

Having worked in resource-limited settings and a keen sense of social justice, I have encouraged my students to serve in areas of need. If she were in another state where law and order is nearly nonexistent, I would have cautioned her beforehand. She might also have been more vigilant. Unfortunately, this happened in a state that considers itself as ‘God’s own country’. A state that prides itself on rule of law and a vibrant democracy.

What will I tell my students now? What can I tell my students? Do I tell them that they must be willing to be the next medical martyr? Should I tell them to expect death whenever they are on duty (and prepare for it)? Should I tell them to ignore the hypocrisy and double-standards of society when it comes to doctors in particular and healthcare workers in general? Should I tell them not to expect the system to work for them, or for it to be there when they need its security and protection?

After some time, her demise will cease to be a talking point. The media and leaders will move on to other issues. But this incident will be a turning point in the lives of many young students and doctors. Life will not be the same for me.

I am torn between emotions. Anger, frustration, sorrow, and a sickening feeling of utter helplessness alternate. But what to do?

Featured post

A walk in the Park

This blog is dedicated to everyone who has struggled with Community Medicine. Through my posts I hope to simplify and demystify community medicine. The emphasis will be on clarifying concepts rather than providing ready-made answers to exam questions.

Feedback is crucial for the success of this endeavour, so you are encouraged to comment and criticize if you cannot understand something.

If you want a topic to be discussed sooner rather than later, please let me know via

Facebook: http://www.facebook.com/pages/Community-Medicine-for-ALL/429533760433198  

[Alternatively, you may join the group communitymedicine4ALL: 


Twitter: @DocRoopesh

A single example may not be able to explain 100% of a given topic, so multiple examples may be provided to explain different parts of a single concept.

If something doesn’t seem right:

a. Write to me about it (at commed4all@gmail.com), and

b. Cross check with another source (textbook, expert, etc.)

I hope that my exertions will make your experience with community medicine seem like a “Walk in the Park”

Note 1. Those who wish to contact me on facebook are requested to kindly send a personal message introducing themselves along with the request. This will help save time and effort of all concerned. Please do not expect me to visit your page to try and identify you/ your areas of work/ interest, etc. It is common courtesy to introduce oneself to another when interacting for the first time. I am merely requesting that the same civil courtesy be extended here, too. Henceforth, I may not accept any friend requests/ requests to join the group on facebook unless accompanied by a note of introduction (except when I already know the sender).  

Note 2. Please understand that this blog (and the corresponding facebook page/ group) is maintained in my spare time. I have a full time job, and am available to pursue these activities only after regular working hours (after 5 pm Indian Standard Time). However urgently you may wish to receive a response from me, I will be able to respond only upon returning home from work (I am offline the rest of the time).

Note 3. Please mind your language when interacting with me/ in the group linked to this blog. Rude/ offensive language will result in expulsion from both my friends list and the said group.

Enhanced by Zemanta

World Food Safety Day (7 June 2023): Food Standards Save Lives

Background Information:

The United Nations General Assembly established World Food Safety Day in 2018 to raise awareness on the importance of food safety. WHO and the Food and Agriculture Organization of the United Nations (FAO) jointly facilitate the observance of World Food Safety Day, in collaboration with Member States and other stakeholders.

Consumers should practice safe food handling at home and follow WHO’s Five Keys to Safer Food:

  1. keep clean,
  2. separate raw and cooked,
  3. cook thoroughly,
  4. keep food at safe temperatures and
  5. use safe water and raw materials.

Key Messages:

More than 600 million people fall ill and 420 000 die every year from eating contaminated food. Nobody should die from eating food. These are preventable deaths. 

One in ten people worldwide falls ill from contaminated food each year. It affects all countries.

Over 200 diseases are caused by eating food contaminated with bacteria, viruses, parasites or chemical substances such as heavy metals.

Children under 5 make up 9 percent of thepopulation, but carry 40 percent of the foodborne disease burden.

Food safety standards protect the lives of all, and the livelihoods of many. They establish the criteria which food should meet to protect consumers and establish confidence in the product.

The Codex Alimentarius Commission has been setting international food standards for 60 years. The Codex Alimentarius has 236 standards, 84 guidelines, 56 codes of practice, 126 maximum levels for contaminants in food, and over 10 000 quantitative standards covering maximum levels for food additives and maximum residue limits for pesticides and veterinary drugs in food. (As of February 2023).

Antimicrobial resistant microbes can be transmitted through the food chain, via direct contact between animals and humans or through the environment. Each year, an estimated 5 million people die around the globe because of infections with antimicrobial resistant microbes.

Microbial, chemical or physical contamination of food can be reduced or minimized through the implementation of food safety standards.

This year’s theme, “Food standards save lives”, highlights the role of established food safety practices and standards, which ensure food safety and quality.

There is no food security without food safety

Food safety is an essential part of food security. Only when food is safe can it meet nutritional needs and help adults to live an active and healthy life and children to grow and develop.

Food safety has a direct impact on health. Safe food allows for the uptake of nutrients, promotes long-term human development and achievement of several of the SDGs. Food safety is a shared responsibility, involving the whole supply chain, from producers to consumers. In this context, most foodborne disease is preventable with proper food handling and education at all levels.

Science underpins food standards. Food standards help to ensure food is safe. They are established following expert advice from food scientists, microbiologists, veterinarians, medical doctors and toxicologists, to name a few. They advise policymakers what food production, processing, handling and preparation practices are needed to make food safe.

Food standards protect consumers. When food safety standards are applied consumers will be protected by the efforts that have been undertaken in making sure that the food they consume is safer. Food safety standards provide the common basis for understanding and, at the same time, the common basis for joint action to ensure that all of us can benefit from safe food.

Food safety impacts positively on economies and livelihoods. By ensuring their commodities meet food standards, producers and food traders gain the confidence of their market and secure their income. Unsafe food in trade can lead to export bans and destroy businesses, but governments can help protect the livelihoods of food workers by establishing a robust food control system and rigorous export controls.

Useful Links:

Link to WHO fact sheet on food safety:


Link to World Food Safety Day site: