KEMHRC Newsletter

The 7th Banoo Coyaji Oration,19th October, 2019 Medicine Past Present and Future

Dr Farokh E Udwadia, Padma Awardee, recipient of many academic, clinical and humanitarian honors, Professor Emeritus of Medicine, Grant Medical College and J.J. Hospital; Consultant Physician-Parsee General Hospital; Consultant Physician and ICU in charge Breach Candy Hospital

“Time present and time past Are both perhaps present in time future, And time future contained in time past.”

T. S. Eliot Poems

The Four Quartets

Delivered by men of eminence over the years, The Banoo Coyaji Oration is a platform of learning and rumination of the mysteries and miracle of life and death, medicine and humanity. The 7th Banoo Coyaji Oration was delivered by Dr Farokh Udwadia. It gives me immense pleasure to be rapporteur, capture and share one the finest oral narrations - Medicine –Past, Present and Future, reinforcing that the history of medicine is not linear but a romance, beset with twists and turns. It is as much a chronicle of change as the history of mankind. The oration took us through prehistory – to the present and a foreseeable future, where the roots of medicine lie hidden in the art of sympathetic magic, religion and healing, man and machines. From primitive man to the great Egyptian Civilization, Archaic Greece, Ancient India, Western Europe and the modern world the history unraveled, a history of Great ancestors of medicine, great discoveries, inventions in Science and Technology, the philosophical, political, social and cultural influences, which influenced medicine, which eventually affects humankind.

A virtual oral tour of the past, present and future of medicine through significant themes and milestones for a mixed audience of doctors, laymen and some of us who move back and forth between humanities and sciences was a tapestry of art, philosophy, literature, mythology, history of man, medicine and disease. Self-aware, engaging the audience, keeping them spellbound, the ability to tell a story filled with varying intonations powerful and gentle as the content demands, pauses and introspection, this was and is one of the finest orations, we shall always remember. A standing ovation is not enough.

The Oration

A mellow voice with the right modulation, pitch and inflection quoting Eliot was a perfect prologue for Dr Udwadia’s Medicine Past, Present and Future suggesting that the present is contained in the past and the future is contained in the present ‘blending and borrowing’ a little from each other. So, medicine was born with the awakening of a consciousness and awareness in primitive man and thereon the ‘trail saw many twists and turns, victories and defeats, blazing light and sombre darkness’. A trail over 4000 years of recorded history created an entity called medicine – the genesis of art, science, philosophy and profession which is making quantum leaps in the 21st century. The history of medicine is beautifully woven in Dr. Udwadia’s narration as a mix of both art and science bound by social and cultural anthropology a history of mankind. While the first is an art of healing the second is the science of cure and both are subtly different. The story of then and now slowly unfolded.

The Past

The World of Magic and Shamans

Speaking of the past, Dr. Udwadia took us to the roots of medicine which lie in magic- of demons and evil spirits entering our bodies from the orifices causing havoc, which we call disease today. Trying to understand a world filled with uncertainties and the unknown ushered in the ancient Shaman, healers or magic men connecting with benevolent and malevolent spirits practicing divination and healing or exorcising the demons. The perception of illness was a body, mind and soul possessed by evil spirits. Rudimentary cure lay in chanting, beating, wearing amulets, propitiating and exorcising rites.

The Priest Physicians of Sumer and Egypt and the Greek Philosophers

Speaking of civilizations Dr. Udwadia referred to the first documented and recordings of the Sumerian Egyptian priest physicians who combined religion and magic as ‘twins in their art and craft’ which led to empiricism. Scientists often scoff empiricism, but the ability to judge, determine and decide through observation have an important place in emergency medicine and led to great advances. ‘In the background of observation, slowly, gently tiptoed science, surreptitiously it embraced medicine and today took it over completely’. Memories are mythic and with every epoch and civilization they add to and transform it. Today, even with advanced science-based medicine there are parts of the world, especially developing countries where magic, religion, empiricism, medicine and science are mixed and coexist.

‘The history of medicine is a romance,’ not simply a linear chronology. It is embedded in great people – ‘the heroes and imposters, the caring and the uncaring’. He takes us to the late archaic Greek period – to the times of the pre-Socratic era, where western philosophy had emerged to raise philosophers who emphasized the rational unity of things – arguing and debating cosmos and mankind. Pythagoras, the Greek philosopher raised questions on, who is man? How did he come into being? What is life? What is death and what happens after death? The study of man, life and death began with philosophy and included the study of health, disease and lifecycles. Inquiries of the Socratic era continue with us even in the present. Medicine is not only linked to magic, medicine, empiricism and philosophy alone, ‘it is influenced by many aspects

like economies, art, geography, climate, wars and natural disasters, social and cultural milieu and the rise and fall of civilizations over the centuries. In the last 70’ years, it is influenced by natural sciences and sciences directly affecting mankind.’ Medicine therefore needs to be viewed with a larger perspective against the tapestry of human civilization.

Remembering Great Ancestors

Paying homage to some significant ancestors who gave and added to the character and content of medicine, significant contributions and personal qualities of these great men were unfolded.

The first distinctive individual in the history of medicine 2500BC who epitomized its core was the great priest physician Imhotep- the one who comes in peace. A multi skilled person, vizier, scribe, artist, architect and physician, who designed the oldest first step pyramid saqqara was better known as the greatest of physicians loved by all and deified as an Egyptian God some 3000 years later.

The Greek physician Hippocrates of Kos (c. 460 – c. 370 BC) called the father of medicine during the age of Pericles and Classical Greece revolutionized ancient Greek medicine as a distinct discipline and profession freeing it from liturgy (practice of magic and rituals) and philosophy. He brought in logic into his thinking. He described diseases as something from environment and lifestyle and not a punishment of Gods and demons. The character of a physician is also delineated. Wellkept, honest, calm, understanding, and serious are the qualities of a physician.

In Ancient India Dr Udwadia quoted Charaka and Sushruta as old as 100 BC - 200 BC when a holistic system of medicine and lifestyle - Ayurveda emerged. The muchvenerated medical treatise Charaka and Sushruta Samhita contributing in almost all areas of diseases, medicinal plants, metabolism and immunity and the twin concepts of diagnosis and prognosis was noted.

Skipping medieval medicine of Galen’s theory of Humors and the Renaissance, where scholasticism and rigorous scientific methods went hand in hand, he took examples of some great scientists, physicians, surgeons and anesthetists of the modern era. Beginning with Edward Jenner and the small pox vaccine – as the father of Immunology, and the then vaccine revolution upon which modern day immunizations and vaccines continues towards prevention and herd immunity.

Speaking of hygiene pioneered by Ignatius Semmelweis, the champion of hand washing and saviour of mothers, the relevance of a procedure of washing hands during delivery is highlighted. Simple handwashing brought down child birth puerperal fever and death. Was it ever realized something as simple and easy to practice procedure as ‘Handwashing’ would achieve a high place and become a mandate in medicine today and always?

Speaking of another pioneer Louis Pasteur, Dr. Udwadia highlighted this microbiologist’s origin of diseases, different micro-organisms and the germ

theory of diseases. Pasteur stipulated that each disease is caused by its own particular organism, and not one for all. Therefore, each disease requires its own vaccine. In the 1870s, he applied this immunization method cultivated bacteria from the blood of animals infected with anthrax which affected chicken and cattle. Pasteur is a revolutionary who also brought in intuition in medicine.

In the early 19th century the English surgeon Joseph Lister looked at antiseptic surgery. He revolutionized sterile surgery and asepsis, thereby preventing post-operative infections.

William Morton, in the same period founded Anesthesia a boon to surgeons and dentists.

Following closely behind was Sir Alexander Fleming, the true father of 20th century modern medicine and anti-biotic with the discovery of penicillin. While investigating the properties of staphylococci he accidently left a sample which was contaminated by fungus, which eventually led to the discovery of penicillin. The modern era of antibiotics was born.

Bringing lessons from medicine of the past Dr. Udwadia brought in a caveat‘there are limits to medicine in every age. Even today medicine falls short of expectations. There is no absolute truth and all truth is relative. So, what does this teach us? It teaches us humility, to respect others views.’ This on the premise that later day concepts may make today’s beliefs obsolete or false. The narrator said this indicates our need for humility and respect and that in a ‘structure with a strong foundation slowly rising up to the skyevery brick of that structure come from their contributions. We are standing on the shoulders of these giants’. Like all other histories, the history of medicine is also a chronicle of change. A few centuries from now we may not be able to recognize the medicine practiced then, it would be different not like the present or today.

From material contributions Dr. Udwadia shifted subtly to the non-material, which is the most sought value addition to medicine. He stated the one common thing these great ancestors possessed- Humanity and Humanism at the core of their being. In medicine it is these qualities which enable a physician to understand, and feel the suffering of the patient. This is empathy, an essential quality they possessed.

The Present

The Paradox in Medicine- Mechanization and the Hubris of Science and Technology

‘The mechanization of medicine and the hubris of science and technology has submerged the art of medicine and destroyed its raison d'être’.

The face of medicine is much changed from the late 20th century. Contemporary medicine is changed by Science and Technology. Medicine is capable of miracles today, impossible in the past and is making rapid strides today. Yet there is a paradox. There is a great antagonism about medicine and medical profession. This can be witnessed in the number of litigations, burning of nursing homes, assault on doctors and nurses. The double paradox is that when as a student years ago the ‘doctors and professors were Gods and the profession was at its acme, the reputation of the doctor was second to none’. Why has the reputation of the medical profession gone down in spite of the advances in medicine, inspite of the average life expectancy of

70 and plus, people living longer and there being cures? The answer lies with the fact that man with machine and man versus machine for this loss of humanity. This dehumanization loosens the bond between doctor and patient. Machines are slowly displacing this bond which is fundamental, central, heart and core of medicine. Doctors relate more to machines than patients and slowly patients too have more faith in machines than their doctors. The machine has become the interface between doctor and patient and vice versa. While technology is good it has sliced the human connect and contact, leaving the doctor patient relationship eroded.

The advances in medicine while greatly improving diagnosis with newer domains of specialty to super specialty and super super specialities with roadmaps to treatment, it has also left other co-lateral damages. The more over emphasis on superspeciality the more is medicine robbed of its holistic aspect. ‘You know more and more of less and less- you know almost next to nothing’. A doctor no longer ministers to a person a distinctive individual but he addresses compartmentalized sections of the body, ‘disordered functions of various organs of the system and simply anatomies. We no longer see the human being who houses these parts, these organs.’

Carrying the present-day trend of specializations and technologically advanced diagnostic tools Dr. Udwadia said we have to be reminded time and again that the disease is not a specialist. Even with a history of disease a patient comes with vague symptoms, attending to and listening to the patient will lead the way with a general investigation by a general practitioner. But we want no less than specialty and super specialty. This is directly the outcome of commercialization and consumerism making contemporary medicine crippling. So, it is not surprising to see the anger of a family who reposed their trust and their cash on the doctor and the institution. While the cost of an illness is partly inevitable, the doctor can act with discretion, he is ‘strict on his science, forgotten his art and relies more on his machine than his assessment. So, where has the art of history taking gone? Technology cannot substitute the art of a good and complete PE, observation, history taking, listening, empathy and assuaging the anxiety and sorrow of patients and caregivers.’ The art of PE and history taking, the body mind relationships are replaced with tests, numbers, reports etc., which the doctor relies more on. It is also the institutionalization of medicine and competing hospitals that are responsible for this transition in medicine. Every metropolis has within a radius of few kilometers’ diagnostics. There are 3, 4 and even 7 Tesla MRI’s today and how many can afford these? So, there is a need for more and more patients to undergo tests to recover the investment. ‘Patients become fodder to the machine’. This is the malaise of unethical practices, which naturally angers the people and so respect for the profession suffers.

The 3 Great Disadvantages of Medicine-and Iatrogenesis

The fall in the value system in medicine is a fall in the value system of all society. Dr. Udwadia says, ‘how can you be an island of virtue surrounded by a world of filth and corruption?’ Speaking of the pathogenesis in medicine, he reflected on the works of the sociologist Ivan Illich, who wrote on the contemporary practices of western medicine in his medical Nemesis – Limits to Medicine. Quoting Illich that modern medicine has done more harm than good he reflected on the 3 great disadvantages of medicine-what is termed as the clinical, social and cultural iatrogenesis. To be circumspect is important clinical iatrogenesis - where treatment can cause side effects and do more harm than good; social iatrogenesis - medicalization ‘where society is hopelessly dependent on medicine, bad for the patients but good for the doctors and cultural iatrogenesis where modern medicine has taken away the ability of a common man to understand that there is pain, disease and suffering., where the doctor will treat till death ends it all. He reiterates the age-old philosophy the business of a doctor is to ease suffering not prolong it’. This poses the ethical dilemma of how much is too much and personal guilt. ‘Some patients who wake up after all the suffering and some on the other hand die. This teaches that we can’t play God, neither should we take credit for the recovery of a patient nor blame oneself for a death.’

On a more philosophical note Dr. Udwadia looks at the scenario in developing countries with different conditions and different sets of problems compared to the west. He ponders,’ if there was a moratorium on big hospitals, if all the money was spent and we gave good education, nutrition, hygiene and sanitation, habits and habitats there would be far less mortality and morbidity, more than anything there is no need to

build super hospitals. We have infections like TB, multi drug resistant TB can spread like fire. It won’t improve, it won’t go unless life improves’.

The Future

‘The Future is written on the Wall for All to see.’

The future, Dr. Udwadia asserted belongs to Molecular Biology, Genetic Medicine, Biotechnology and advances in physiology of reproduction. Today Genetic Medicine is making strides in correcting, replacing or rewriting its functions. It has succeeded in some cases and not in some, like common diseases. While specific alteration in specific diseases make cure possible, common ailments are both influenced by exchange of information among many genes and also affected environmentally. He questions the cure of cancer by genetic science, with over 1000 cancers. He adds the cancer gene is stitched into the human genome and in the foreseeable near future one can unstitch or unstick these genes. The importance of Gene based therapy is an insight into the differences or variation of diseases. One disease does not present in the same manner as another so an individual’s response to a disease, its manifestation and response to treatment can be related to one’s genetic profile. It is the gene which is responsible. In the near future there will be personalized medicine based on your genetic profile. There are DNA manufactured vaccines being made today and both Bio Technology and Nano Technology are making tiny machines smaller than the atom. The Japanese are already making atom sized chips and inserting them into the blood stream to monitor, detect and signal and even to some degree correct any problem within the human body. There are smart watches, quick fixes and even smart toilets to detect an impending heart attack. The very intelligent human mind has used technologies to a vast extent.

Would a Computer Brain have the Imagination and Intuition of a Human Brain?

Something still more topical is Artificial Intelligence, machine intelligence of computers mimicking the human brain with billions and billions of neural networks. The question that Dr. Udwadia poses are would a computer brain have the imagination and intuition; would it negate judgment which is sound? Would a computer brain take the escape route when there is one on a battle field or stop to fight the battle till the end. Would this brain have the character of a General and be duty conscious, stay and fight till the end? These are humane ethical dilemmas that come with core principles. Yet take a scientific riddle of Einstein’s thought experiment chasing a ray of light, the notion of time and space and relativity, yes, the computer brain can solve such a riddle. Yet, would the computer brain do Quantum Physics of Max Planck? Can a computer brain have consciousness, self-awareness of Humans? Focusing a little more on consciousness, difficult to define and which scientists state that both consciousness and the mind are phenomena and the unit of this consciousness is provided by self-awareness, not by the neurons or the cerebral structures or the liaison of the two cerebral hemispheres. ‘Awareness consciousness is a self-subsistent entity, which integrates the neuronal activity or mechanism of the brain to give the human being a unit of consciousness moment to moment. Will the computer brain have this?’

The intelligent human brain today is filled with overreaching ambition and so came in Genetic Engineering- a short cut to the process of evolution, grown in the laboratory. Once again Dr. Udwadia introspects verbally on the natural selection of species. Through millions of years of a natural selection of species and survival of the fittest was propounded by Darwin, but today this is possible from a single laboratory bench. The 21st century man is ready to move from natural evolution to an engineered evolution by intelligent design. Human genetic material from outside the human can be today manipulated inside the sperm and we change the human race. So, comes in the ‘super intelligent genes- you can have your choice for height, weight color of eyes, brain, strength, adaptable thermoregulation etc.’ There will be a day when this new human species could colonize a planet of their choice. We have evolved from the Neanderthal man to the present smart human so very different in our transformation. So too it shall be in the future, when we may look someone totally different

from today’s human species. We would perhaps one day be at a cross road where we may have to make a choice - natural evolution or genetic fit. There may be a choice, Dr Udwadia voices potential justification of the Gene changers by saying,’ homo sapiens has had his day, his limits have been reached in everything. Now it will be a designed race-superior – we will have Superman and Superwomen. Imagine the political and social chaos-and there would be Superman, Supersupermen and Undermen.’ What happen to the human race, what is the ethics?’

Ethics

‘We forget in this race of various advances in science that each scientific advance should be accompanied by ethical principles that safeguard humankind.’

Pondering on ethical issues in medicine Dr. Udwadia says that the problem today is that the pace of scientific advance is so rapid that the ethics in relation to it is yet to be constructed and framed into ethical guidelines of do’s and don’ts. This can pose great problems in a country like India where science does more harm or good than reporting the cause of death. The pursuit of scientists to unravel the secrets of nature goes to extremes. Like a leitmotif or refrain, the thoughts and words that repeat themselves are life and death, what is man? Where is he going? What is death? What happens thereafter? Why are we not immortal? which began with Pythagoras and continued to be asked in different ways. It is prophetic when TS. Eliot one of , Dr.Udwadia’s favourite poet said, ‘We shall not cease from exploration, and the end of all our exploring will be to arrive where we started and know the place for the first time.’

These same questions were also asked by the father of Quantum Physics, the great genius Max Planck. Dr. Udwadia, shares an event in Planck’s life, a profound message to the world. When someone questioned Planck if he would unravel the secret of nature, Planck answered without a moment’s hesitation that he would not do so, because man is a part of nature and he himself cannot unravel a secret of which he is a part.

‘Will this philosophical statement be there 500 years from today, who knows?’

Quo Vadis Medicine

‘Which road is medicine going to take or follow, where is it going to lead us, what is its destination?’

With science advancing so fast will Genetic medicine and engineering, Bio technology etc. take along the core principles and values of medicine of human kindness, and caring to heal and lessen suffering OR? ‘It is also entirely possible that in the future a physician may never hold the hand of a dying man and tide with him to ease his passage into another world with compassion, empathy – teachings of the past not to be seen any more. So, the future of medicine rests with man. If he is bewitched or blinded by the great advances in science it is a woe for human kind, but however if he uses science, channels it to the well-being of human beings, perhaps Man and Medicine will usher in a brave new world, else what?’ Dr. Udwadia ended with a quote by Sir Winston Churchill, ‘man will once again be plunged into a new dark age made even more protracted by the sinister light of science.’

Dr Rama Sivaram, Consultant, KEMHRC

(Sources: Oration, Wikipedia and net for Pictures)

SCIENTIFIC ADvISORY COMMITTEE MEETING (SAC)

The Scientific Advisory Committee meeting was held on 14th -15th November 2019. The meeting was chaired by Dr. Usha Krishnan. The Director, KEMHRC welcomed the Members and gave an overview of the research being carried out in KEMHRC. It was noted that the major departments involved in research included Diabetes Unit, Pediatric unit and vadu Rural Health Program (vRHP). This year Psychiatry department presented their work being carried out in socio-behavioral research. The pediatric department continues their work in vaccine and surveillance with focus on pneumococcal disease. The research in Diabetes unit centres on Pune maternal nutrition study cohort along with research in type1 diabetes and clinical trials. vRHP continues its work in HDSS along with community based vaccine trials. Research in respiratory health is an upcoming feature in vRHP. The social behavioural research centres around the program for primary prevention against sexual violence, one of the first of its kind study to be undertaken in India to deal with child sexual abuse. Service projects mainly focused on developing tribal villages. This year for the first time 8 PhD students present their PhD work. A total of 21 research papers were published this year all in international journals.

The overview was followed by the diabetes unit presenting their ongoing research work with a focus on the life course evolution of diabesity which is a combination of diabetes and adiposity including work being done in the Pune Maternal Nutrition Study cohort. This study has been ongoing for last 25 years and data on diabesity at 18 years old was presented. A micronutrient intervention in adolescence in this cohort to improve the health of the next generation enabled to present intergenerational findings. The other upcoming research presented was in the field of sub-types of type 2 diabetes wherein comparison of Indian type 2 diabetic patients to Swedish patients, revealed that Indian are younger, thinner, more hyperglycemic, more beta-cell deficient and relatively less insulin resistant. Interesting data from studies ongoing where in the adiposity concept was being revisited and findings showed that in contrast to the conventional concept subcutaneous fat was related to all the known CvD risk factors compared to the visceral adipose tissue. Many studies presented revolved around vitamin B12 which is the main focus of diabetes unit. Research studies in gestational diabetes explained the concept of dual teratogenesis. Data from studies investigating the Maternal fetal communication through exosomes originating in the mother and going across the placenta to the baby were also presented. Data on long term follow up of gestational diabetic mothers threw light upon the future risk for the mother and the baby. Research data from Type 1 diabetes and clinical trials was also presented.

The pediatric department presented its research in the field of vaccine, surveillance studies to assess disease burden, study to understand the etiology of childhood Pneumonia, studies in micro-biome and implementation research. Surveillance of pertussis is an investigator sponsored study led by scientist from pediatric department. This is a multicentric study where 4 sites are involved. The data collected till date revealed a positivity rate of 5.2% amongst hospitalized infants with clinical suspicion of pertussis. Data was presented on the etiology of childhood pneumonia a multicentric study involving 5 sites. Surveillance study of Congenital Rubella syndrome investigated two components namely CRS surveillance in infants and serosurvey among pregnant women to see the sero-prevalence in them. Findings revealed 90% cases were from 1month to 11 month while 20% women were found to be susceptible hence vaccination is recommended. Findings from a Implementation research on management of possible serious bacterial infection in young infants was presented. One important lesson learned was that fast breathing pneumonia in 0-59 days infants can be effectively and safely treated with oral Amoxicillin. Data related to optimal dosing regimen of cholecalciferol supplementation in children with chronic kidney disease was also presented.

Department of Obstetrics and Gynecology presented data on supplementation of vitamin B12 to improve B12-folate ratio and its effect on birth outcome. Results from this study revealed that preterm birth earlier than 34 weeks and SGA fetus in third trimester was highest in the folic acid compared to vitamin B12 supplemented groups. This was followed by a presentation on respectful maternity care initiative which assessed the seven standards of respectful maternity care given in the hospital and engaged maternity caretakers to create awareness.

The Psychiatry unit presented their study investigating the cognitive abilities in patients with schizophrenia their first degree relatives and controls.

The first day proceeding concluded with presentation on oncology clinical trials being done by the oncology department.

The second day started with presentations by the vRHP team regarding the ongoing studies which included the data from HDSS which highlighted the increase in population density, marginal increase in fertility rates but showed decline in the neonatal, infant and under 5 mortality rate and increase in life expectancy. Other ongoing studies included an implementation research for improving outcomes of high risk pregnancy, typhoid surveillance, effect of nano encapsulated micronutrient fortified body oil for infant massage on developmental and nutritional outcomes, vaccine trials and research in respiratory health. Additionally the implementation research portfolio including the PSBI study, LPG related studies, high risk pregnancy care study, Rotavac rollout study and pulmonary rehabilitation to name a few. SAC members appreciated the initiative taken to form the community engagement committee but advised to rename it as community advisory board for a broader perspective. Members also suggested undertaking studies in the field of health demographics as well as shifting focus to non-communicable diseases while retaining focus on communicable disease was important.

This was followed by presentation on socio-behavioral and service projects whose overall aim is holistic development of underprivileged and vulnerable population by conducting socially relevant and need based activities in areas which include maternal and child health, tribal health and development, women and youth empowerment, HIv positive youth empowerment and women’s health with a focus on mensuration. The tribal empowerment project strives to achieve sustainability through training local health workers as Bare foot doctors supported by Grampanchyat to cater to the basic medical needs of the population. A mobile health unit holds camps in this tribal area with the support from BFD’s as well as looks at increased health awareness. The Happy menses program has helped in increasing awareness related to menstrual hygiene practices along with regulating use of sanitary pads distributed through the program. Jagruti project aims at giving holistic pregnancy care, increase awareness among young women on early stimulation of children and empower economically weak rural women and youth at grass root level.

Program for primary prevention of sexual violence focused on developing awareness in the public about pedophilia, its relation to child sexual Abuse (CSA) and prospects for treatment and prevention. The two arms of this program include treatment for pedophilia and development of an app called ‘NO app’ which is a mobile application which works as a social deterrent for prevention of sexual violence against women. All these efforts have led to people coming forward for treatment.

The Meeting concluded with presentation of PhD work by 8 students. valuable inputs regarding the design and formatting of a PhD proposal were given by the SAC members to all the students.

The general inputs of the SAC members were suggestions to change the structure of presentations, they should be divided into descriptive and analytical studies, the results should be presented first. Secondly that the various departments of the research should work together for the betterment of research and lastly that KEMHRC should aim at becoming self-sufficient and act as a leader in conducting future studies.

For the first time in SAC an award was constituted for the best research paper published in this year, which was awarded to Dr CS Yajnik and Dr Aditi Apte.

The scientific presentations were followed by a detailed discussion and guidance by our esteemed SAC members. This year’s SAC meeting concluded with a lecture by Dr. Sanjay Mehendale on health priorities in the next decade.

Vaduphoria 2020

vaduphoria, a week-long celebration of culture, art and talent is an initiative based on the principles and intentions of team building, community service, confidence building, enhancing team spirit, enhancing interaction between desk job teams and field teams. Celebration means of course entertainment and an enjoyable experience for each and every employee who work each day to make this institute what it is today with their hard work, loyalty and commitment. King Edward Memorial Hospital Research Centre (KEMHRC) hosted a cultural cum sports event between 18th Jan to 15th Feb this year. It was a time to celebrate and look forward to the journey ahead! vaduphoria 2020 was filled with some amazing events like the karaoke evening, various sports competitions, traditional day, food competition, debate, cultural dances, etc.

The vadu Rural Health Program (vRHP) is a department of KEMHRC and is conducting community-based research for over four decades. vRHP initiated cultural activities for its staff since 2010 which was later named as vaduphoria. The term vaduphoria is amalgamation of the work place “vadu” with the feeling of happiness “Euphoria”. This activity was later adapted by the entire KEMHRC and Dr. Laila Garda, Director KEMHRC encouraged participation from the entire KEMHRC fraternity.

Each event that has been curated for vaduphoria has been well thought of considering all these aspects. vaduphoria is a KEMHRC event that brings all departments of KEMHRC together. It brought together all the employees after an active participation was seen from all the departments. Some events were organized at vadu and some at KEMHRC, Pune. Employees of all the departments either gathered at KEMHRC or at vRHP to participate in their respective events and showed a great sense of willingness and active participation.

These events serve as a great opportunity for everyone to familiarize themselves with the faces they see each day but interact less as result of the different projects they work on. It gives an opportunity for people living in the urban areas of Pune to explore vadu and also for the people of vadu to visit Pune and get enlightened about the work done at these places and meet their colleagues with whom their interactions are limited. Employees who are camped in Pune get an opportunity to explore and discover the various research opportunities in vRHP and can help them direct their work to the appropriate people with the help of the interactions they have as a result of the groups they have been assigned.

The team building aspect is brought in action by dividing all members randomly in 4 houses. The names of these houses had to be associated to the beautiful village of vadu and hence were named Bhima, Bhama, Indrayani and velu, the four rivers that flow across the 22 villages where KEMHRC has implemented the longest ever public-private partnership for primary health care provision through its flagship department- the vRHP and currently implements its globally acclaimed health and demographic surveillance system that

come under the vRHP. Bhima, Bhama and Indrayani the three sacred rivers merge at Tulapur and continue their journey further as River Bhima. River velu joins them further at vitthalwadi. There is an immense sense of importance towards these rivers for all these villages and hence the houses were named in order to honour them. Below is the glimpse of some events celebrated during vaduphoria 2020.

Rangoli and Mehndi Competition

vaduphoria 2020 began with Rangoli (folk art using creative and auspicious designs in courtyards and other important places) and Mehndi (traditional art of painting hands and feet with henna) Competition in which all interested members participated and showcased their talent. Besides different traditional and modern designs some participants even managed to showcase a social message through their art.

Mismatch day, Twins Day and Treasure Hunt

vaduphoria 2020 was then followed by Mismatch day and Twins day. On mismatch day the participants were required to wear “mixed up” and “unmatched” clothes. All the members came dressed innovatively to celebrate Mismatch day. On twin’s day, participants dressed up matching up to their partner and some even performed some great twinning acts. It was a day filled with entertainment and laughter.

Another such activity that was filled with loads of laughter and fun was the treasure hunt! It was a time bound activity and the house that would gather all the clues and reach their goal was to be declared as a winner. There was a display of tremendous

team work and co-ordination among the house members. It was a treat to watch the winners find the treasure with huge smiles on their faces.

Traditional Day

Traditional day was celebrated with a great gusto and enthusiasm. Every house member came fully clad in their traditional dress. Their attires collectively displayed an array of colors that reflected the diversity of India. It was a moment of great joy and pride as everybody stood united to celebrate the spirit of various Indian traditions.

Karaoke Night, Food Competition & Food stall

Karaoke night is one of the most entertaining events of vaduphoria as it gives an opportunity to all the staff to come together and cook a delicious meal. A perfect example of team effort is seen here as each one picks a task and contributes in putting together a lovely meal on the terrace. The evening commenced with everyone singing their hearts out to their all-time favourite songs wherein some gave group performances while some went bold and solo.

The food competition this year was themed around preparing a food item that consisted of about 6070% of Jowar or Bajra. The competition got the best out of the participants who surprised the judges by preparing some innovative dishes that not only tasted good but had very high nutritious values. Jowar and Bajra which is a staple in the rural areas for preparing ‘Bhakris’ were given modern twists like a bhakri base pizza and some even created a dessert and a variety of snacks and wholesome meals using the same.

Another exciting food event that was organized was that of a food stall wherein participants were asked to set up their food stalls and the stall that sold the most of their food item was declared as the winner. The event turned out to be a fun fair wherein participants enthusiastically tried various forms of singing, dance and tag lines to attract people towards their stall.

Outing and trekking

A trip was organized to Lenyadri, Naneghat and Jivdangadh on 11th January 2020. The first stop of the trip was to the Ganesh temple at Lenyadri which is one of the eight revered Ganesha temples collectively known as ‘Ashtavinayaka’. It is situated at a height of about 200 mts above the plains. Once everyone was done with their temple visit, everyone climbed down and sat down for an authentic Maharashtrian lip smacking lunch that consisted of

some freshly made Bhakris, Maasvadi and Ambe mohar rice. Post lunch, the trip continued to Naneghat, which is a mountain pass in the Western Ghats range between the Konkan coast and the ancient town of Junnar. The name nane means "coin" and ghat means "pass".

The name is given because this path was used as a tollbooth to collect toll from traders crossing the hills. After enjoying the scenic beauty of Naneghat, everyone headed to start trekking to the Jivdhangadh fort, a hill fortress that is 3757 feet above sea level. The fort was looted and destroyed by the British upon siege between 1815-1818. It is a part of the ‘Famous 5’ trekking destinations among trekking enthusiasts. Many of our team members managed to trek to the top of the fort. The trek was concluded with another freshly prepared authentic Maharastrian cuisine for dinner.

Sports Events

The sports event were diligently organized with a lot of soul to it, a soul that was vibrant, contagious and exuberant. The sports day include some competitive games of cricket, volleyball, throwball, Tug-of-war and sack race. Mans’s cricket match had Indrayani and velu in the finals with velu winning the cup by scoring 98 runs with a loss of 3 wickets while Indryani lost 6 wickets at 59 runs chasing velu’s score. While the women’s cricket match had velu and Bhima competing for the cup. velu managed to chase the score of 26 perfectly without losing a single wicket defeating Bhima who managed to score their runs with a loss of 4 wickets. Fighting for the common goal with a group of players teaches us team spirit and helps to effectively communicate in order to solve problems. This experience is helpful when encountering problems at work and build a good rapport among team members. All the matches were thoroughly entertaining and developed a spirit of healthy competition and tested everyone’s skills and stamina.

Cultural Night and Prize Distribution

vaduphoria 2020 concluded with a day that was filled with some breath-taking performances and prize distributions. The event was inaugurated by our honorable chief guest, Dr. Mandeep Chadha. She has an MD in General Medicine and has been associated with National Institute of virology (NIv) since 1984. At NIv she was Influenza group leader at National Influenza Centre, India. This was followed by prize distribution ceremony wherein the office and field team were felicitated for their hard work throughout the year. Medals, cups and prizes were awarded to all those who achieved excellence and set high standards with their performances in their respective delegated responsibilities. This event highlighted the various hidden skills in our employees. All of them had a great opportunity to mingle with each other and to show case their talent.

All in all, this event was a huge success with special efforts from our staff members, the administrative and finance department of KEMHRC.

KEM Hospital Research Centre – Annual Day 2019-20

Like every year KEM Hospital Research Center, started celebrations for the annual day for 201920, 15 days in advance in the month of January 20 with various cultural and sports activities like Cricket, volleyball, Throw ball, Karaoke, Debate, Traditional day, Twins day, Mismatch day, Food competition, Rangoli, Antakshri etc at both KEMHRC Pune and vadu locations where in all the staff participated with full enthusiasm and flare. For the first time as a part of Annual Day activities on 2nd February 2020 there was the Bhima River Cross Country (BRCC) Marathon. This was a unique initiative taken up by vadu Rural Health Program in which runners ran parallel to sugar cane field, Bhima river and rural houses enjoying the scenic beauty of rural areas.

The main Annual day function was held on 15.02.2020 at Gauri Nandan Lawns in Sanaswadi, Pune between 4:30 PM to 8:30 PM.It was presided by the guest of honor, Dr Mandeep Chadha. Among the other dignitaries present were Dr Laila Garda (Director Research), Sanjay Juvekar (Officer in Charge vadu), Mr Naresh Singh (Legal Consultant) and other Senior officials of KEMHRC.

Ms. Diksha Singh & Ms. Dipali Patil

The program commenced with the traditional lezim dance performance by the employees of KEMHRC, vadu unit while escorting the chief guest and other dignitaries to their respective seats. It was followed by the Indian National anthem with feeling of inspiration and togetherness. The cultural evening was set rolling by evoking the blessings of lord Ganesh with the Ganesh vandana song and lighting of the Ceremonial lamp by the Hon’ble Chief Guest and other dignitaries. Mrs Rajalakshmi gave the welcome speech to greet the chief guest and to highlight the activities of the annual day. Dr Garda gave an introductory speech and felicitated the Chief Guest to extend a warm welcome to her.

The function continued with the giving away of the awards to the winners of BRCC Marathon, various cultural activities, sports events, outstanding achievers awards to staff and researchers by the Dignitaries with lot of cheer and claps in the background for all winners. Finally the Dr. Banoo Coyaji Trophy was given away to velu house for securing maximum points in all competitions.

The life time achievement award was given to Dr Yajnik for his outstanding contribution in the field of research (Diabetes). At this point of time Guest of honor also blessed the occasion with her kind words to applaud the Institute for its great work and wished for more success in future.

This was followed by an array of cultural events where employees across the organization gave impeccable performances through multiple dance forms, songs and comedy. The show enchanted all and also brought forth the latent talent of the staff which got unlocked in this attempt. The formal annual day came to an end with vote of thanks to all by Dr Anand Kawade. Before calling the day off the stage was set for all to shake a leg on famous Hindi and Marathi songs, wherein all the staff came together danced and enjoyed thoroughly. The day ended with delicious dinner served, for all staff and family to relish to the brim.

Annual Day every year is celebrated to mark the foundation day of KEMHRC, it is also used as an opportunity to celebrate and acknowledge the achievements of the organization which are possible only because of the combined efforts and hard work of all employees present.

Ms. Tanvi Kulkarni

International Women's Day

The KEM Hospital Research Centre emphasizes the importance of women and her many roles and responsibility at home, in the community and in her personal and professional capacity. The International Women’s Day is a celebration of respect, appreciation, love and care towards women in our life and society.

Empowering women is great responsibility and necessary for the gender equality. Our founder trustee Dr Mrs. Banoo Coyaji being a woman herself was well aware of this and aspired to empower housewives and school dropout girls in rural areas. This synchronised with the main objectives of KEMHRC wherein Pabal Centre was established. This Centre aims at empowering economically weak rural women and girls at the grass root level. The growth of Pabal over the decades has been so commendable that it is now being supported by another visionary which Dr.Mrs.Usha Krishna. Under her aegis the scope of the Centre’s vocational training courses like tailoring, and nursing, beauty Parlour, bedside assistance etc has increased, facilitating livelihood skills and employment to the rural women. This is in keeping with the main objective to make women in rural areas self-reliant and confident.

The tradition of the Great Dr. Mrs. Banoo Coyaji is reflected in the knowledge, experiences and skills acquired by the next generation members over the years. Today we feel proud to have Dr Mrs. Laila Garda as Director of KEMHRC who was mentored by Dr Mrs. Banoo Coyaji. We firmly believe she will hold up the great tradition and take the dreams of her mentor to greater heights.

To mark this important day, this year the best program we organized was appropriate and topical- awareness about COvID 19. To boost the morale of the women in KEMHRC Dr Sudipto Roy created awareness about the pandemic, do’s and don’ts and how to keep safe. While keeping the spirit of learning and enquiry open, there were stress busting fun activities for the women followed by refreshments.

While International Women’s Day is marked by a single date 8th March, the KEMHRC opines womanhood should be celebrated each day by giving them the due respect they owe.

Ms. Surekha Shinde

Diabetes Unit

MEETING

Meetings Attended by Dr. C. S. Yajnik

1. The 11th Developmental Origins of Health and Disease (DOHaD) World Congress, Melbourne, Australia, a talk on “Ethics in 30 years of DOHaD Research in Pune, India”. (20th Oct 2019).

2. Annual conference of AICC-RCOG South zone, Basics and beyond- Perinatal Health- Nature and Nurture, RCOG Trust, Bangalore, a talk on, “GDM: Is it Gestational? Is it Diabetes?” and “Diabesity- Intergenerational Programming” (16th &17th Nov 2019)

3. Scientific Advisory Committee Meeting, KEM Hospital Research Centre, Pune, a talk on Research in Diabetes Unit. (14th Nov 2019).

4. Understanding Public Health Nutrition: Towards Policy And Action, a PHN policy course, a talk on “Thin, fat Indian babies: A recipe for early onset of NCDs” at IIC, New Delhi (10th to 13th Dec 2019)

5. Award Ceremony for March of Dimes Agnes Higgins Award, London, (December 2019).

6. A workshop on “Clinical Research Ethical and Regulatory Requirements: An Indian and Global Scenario” at Dr. D. Y. Patil Institute of Pharmaceutical Sciences & Research Pimpri, Pune, a talk on “DOHaD theory” (10th Jan 2020)

7. A Guest lecture organized by Association of Microbiologists of India, Pune Unit at National Chemical Laboratory (NCL), Pune. (21st Feb 2020)

Attended by Dr. Rishikesh Behere

1. The 11th Developmental Origins of Health and Disease (DOHaD) World Congress,

a. Melbourne, Australia. Oral presentation: Developmental Origins of Neurocognitive Performance in Young Adults of the Pune Maternal Nutrition Study (PMNS) Cohort.

b. Poster presentation: Brain size and its relation to birth size in young adults of the Pune Maternal Nutrition Study and Maternal circulating micronutrients during pregnancy and its association with temperament and risk for common mental disorders in offspring during adulthood.

c. Co-chaired session on fetal origins of CNS disorders.

2. Invited seminar titled "Neurodevelopment over the life course: A Bio-Socio-Economic perspective" at Dept of Economics, University of North Dakota.

Attended by: Dr. Sanat Phatak

1. As a Faculty:

a. IRA Fellows’ retreat 2019, “Approach to Omics in Rheumatology”, at CMC vellore.(13th Oct 2019) CME: SLE in children at B.J.Medical College and General Hospital, Pune. (24th Nov 2019).

c. IRACON 2019, “CAR-T cells in autoimmune disease”, at JIPMER, Puducherry. (5th Dec 2019

d. National conference of Clinical Biochemists, “Interpretation of lab tests in AI disease”, at Deenanath Mangeshkar Hospital, Pune. (19th Jan 2020).

e. DERMAcon 2019, “Diagnostic interpretation of Ab tests”, at Pune. (30th Jan 2020).

2. Quizmaster: ‘Rheumawhiz’ quiz for fellows in rheumatology, at Mahabalipuram. (15th Oct 2019)

Attended by Ms. Rucha Wagh and Ms. Veena Kambale

1. The 11th Developmental Origins of Health and Disease (DOHaD) World Congress, Melbourne, Australia.

vISITS

1. Dr. Satyajeet Rath, IISER, Pune, Date: 28th Dec.2019

2. Ms. Erika Castano Moreno, Pontificia University, Chile, Dec.2019 to Mar.2020.

3. Dr. Bhushan Shukla,Pune, Date: 25th Jan.2020

4. Dr. Minal Wable, IISER,Pune, Date: 8th Feb.2020

5. Dr. Caroline Fall, Southampton, UK, Date: 22nd Feb.2020

CME / GUEST LECTURES

• Topic: Understanding libre pro & glucometer data

Speaker: Dr. Ritu Johri from Abbott, Date: 10 Oct 2019

• Topic: Impact of induced transient inflammation on testicular function and progeny characteristics

Speaker: Dr. Satyajeet Rath, IISER, Pune, Date: 28th Dec.2019

• Topic: Effective Parenting in T1D children

Speaker: Dr. Bhushan Shukla, Pune, Date: 25th Jan.2020

• Topic: Electrospun Nanofiber based Multi- stimuli Responsive Transdermal B12 delivery Patch

Speaker: Dr. Minal Wabale, IISER, Pune, Date: 8th Feb.2020

TRAINING SESSIONS

Conducted by:

Research:

• Dr. Sanat Phatak

Topic: Multiple Myeloma

Attended by: III MBBS (Part 2) students, B.J.Medical College, Pune, Date: 6th Mar.2020

OPD:

• Dr. Smita Dhadage

Topic: Diabetes in Pregnancy

Attended by: Staff members, Department of Gynaecology, KEM Hospital, Pune.

Dates: 7th October, 11th November, 2nd December 2018, 13th January, 17th February and 10th March 2019

Attended by:

• Dr. Rishikesh Behere

A Connectivity course at Marinos Center for biomedical imaging, Boston USA (October 2019).

• Ms. Rucha Wagh

One-month training for Body fat image analysis at University of Westminster, London, UK under the guidance of Prof. Jimmy Bell (November 2019).

• Dr. Krishna Kishore Sukla Rupanaguntla:

A two months training for Extraction and analysis exosomal miRNA in placental exosomes at National Childrens Hospital, Washington DC.

• Ms. Nilam Memane:

The NBM training programme – Good Clinical Laboratory Practice (GCLP), at Clinical Development Services Agency (CDSA), Translational Health Science and Technology Institute (THSTI), Faridabad.(30th – 31st January 2020).

PUBLICATIONS

1. Praveen P, Madhu S, viswanathan M, Das S, Kakati S, Shah N, Yajnik C et al. Demographic and clinical profile of youth onset diabetes patients in India—Results from the baseline data of a clinic based registry of people with diabetes in India with young age at onset—[YDR 02]. Pediatric Diabetes. 2020.286.

2. Ganpule-Rao A, Roy D, Karandikar B, Yajnik C, Rush E. Food Access and Nutritional Status of Rural Adolescents in India: Pune Maternal Nutrition Study. American Journal of Preventive Medicine. 2020;.287.

3. Yajnik C. vitamin B12: An Intergenerational Story. Global Landscape of Nutrition Challenges in Infants and Children. Nestlé Nutr Inst Workshop Ser. 2020, vol 93, pp 91–102288.

4. Krishnaveni G, veena S, Johnson M, Kumaran K, Jones A, Bhat D et al. Maternal B12, folate and homocysteine concentrations and offspring cortisol and cardiovascular responses to stress. The Journal of Clinical Endocrinology & Metabolism, dgz114, https://doi.org/10.1210/clinem/dgz114 ,March 2020

Highlights:

March Of Dimes Agnes Higgins Award, 2019:

Dr. Chittaranjan S. Yajnik and Dr. Caroline Fall Honored for Pioneering Research in Maternal-Fetal Nutrition and Its Short and Long-Term Impact on Child Health.

March of Dimes presented its 2019 Agnes Higgins Award to Drs. Chittaranjan S. Yajnik and Caroline Fall for their ground breaking research on the role of maternal nutrition on a child’s short- and long-term health. In particular, their independent and collaborative work contributed to the understanding of how a mom’s diet affects fetal development, which can impact a child’s health at birth and also increase the child’s risk of diabetes and cardiovascular disease in the future.

For nearly 20 years, the Agnes Higgins Award has recognized the distinguished achievements of leaders in the field of maternal-fetal nutrition focused on research, education or clinical services. This award is part of March of Dimes’ efforts to spearhead and promote achievements in actionable science that turn observations from the laboratory into interventions that can improve the health of moms and babies.

• Celebration of World Diabetes Day: on this occasion, Diabetes Unit, KEM, Pune has launched a mobile app, “Madhuraksha- A Pocket Diabuddy”

• The screening of film, “Sakhare peksha Goad” was organized on 25th Feb.2020 at KEM Hospital Research Centre Auditorium. This film is a joint effort between Diabetes Unit, Dr. Mohan Agashe and Mrs. Sumitra Bhave and is based on research at Diabetes Unit, KEMHRC, Pune.

vADU RURAL HEALTH PROGRAM

CONFERENCE / WORKSHOPS

Name

Anand Kawade

Dhiraj Agarwal

Sanjay Juvekar

Sudipto Roy

29th International congress of European Respiratory Society (ERS)

Priorities for Advancing Research on Health Effects of Air Pollution in India.

Sudipto Roy Presented an oral paper on ‘Implementation research on management of possible serious bacterial infection (PSBI) in young infants’ at the National conference, 2020, of the Indian Association of Preventive and Social Medicine

Sanjay Juvekar

Aditi Apte

Ankita Srivastava

Sudipto Roy

Rahul Srivastava

Dhiraj Agarwal

Harshpreet Kaur

Diksha Singh

Sanjay Juvekar

Himangi Lubree

Rutuja Patil

Aditi Apte

Shirish Raut

Sudipto Roy

Rutuja Patil

Dhiraj Agarwal

Harshpreet Kaur

Suyog Deshmukh

Pooja Khamkar

Diksha Singh

Health Economics by Dr. Narendra Javdekar

NIHR Global Health Research Unit on Respiratory Health (RESPIRE)

AIIMS

IAPSM

28.09.2019 to 02.10.2019

02.12.2019 to 01.12.2019

28.01.2020 to 30.01.2020

KEM Hospital Research Centre.

Madrid, Spain

Delhi, India

Mahabalipuram, India

24.01.2020

Pune, India

10th India Probiotic Symposium Cutting Edge Science and applications: Intestinal Microbiota and Probiotics

Research priorities in birth defects: Dr. Anita Kar.

Gut Microbiota and Probiotic Science Foundation (India)

29.02.202001.03.2020 New Delhi, India

Sanjay Juvekar Back to the future: Use of retrospective cohort data on health and wellbeing to map the future of services in Asia.

Dhiraj Agarwal “Continued Medical Education” on Coronavirus talk by Dr Sudipto Roy (MD Community Medicine, KEMHRC, Pune)

Sudipto Roy Invited to speak at a Plenary session on ‘Advancements in Air Pollution and Health Effects Research in India’ at the Annual National Conference of Indian Public Health Association in March 2020

MEETINGS

Asia Pacific Laboratory (APO).

KEM Hospital Research Centre, Pune.

IPHA

04.03.2020 to 05.03.2020

Kuala Lumpur, Malaysia

06.03.2020. Junnar, India

02.03.2020 Delhi, India

Anand Kawade Investigator meeting of Serum Hexa vaccine Trial Serum institute of India

Aditi Apte

Sudipto Roy

Rotavac Self Controlled Case Series Meeting

Sanjay Juvekar Meeting on Artificial Intelligence in health Intel

Sanjay Juvekar MINEr verbal Autopsy Technical Advisory Group meeting AIIMS

Sanjay Juvekar To attend meeting at BIRAC office BDT DBT

11.10.2019 to 13.10.2019 Amritsar, India

13.10.2019

India

21.10.2019 to 22.10.2019 Bengaluru, India

08.11.2019 to 09.11.2019

17.11.2019 to 18.11.2019

India

New Delhi, India

Sanjay Juvekar To attend Scientific Advisory Committee (SAC) meeting of ICMR-NIRT for the year 2019

ICMR 24.11.2019 to 26.11.2019

New Delhi, India

Anand Kawade Investigator meeting of Serum qHPv Serum institute of India 04.01.2020 to 05.01.2020 Mumbai, India

Aditi Apte ICMR meeting on research priorities in anaemia ICMR 13.01.2020 Delhi, India

Sanjay Juvekar

Dhiraj Agarwal

Sudipto Roy

Rutuja Patil

Harshpreet Kaur

Diksha Singh

Discuss and understand the site data management and sharing policy with regards to RESPIRE projects.

KEMHRC, vadu 20.01.2020 to 22.01.2020 Pune, India

Aditi Apte Embedding social science studies in CHIMS research THSTI 11.03.2020 Delhi, India (Online)

TRAININGS

Dhiraj Agarwal Spirometry Training Dhaka Shishu Hospital, Bangladesh and KEM Hospital Research Centre, Pune 04.12.2019 to 05.12.2019

PUBLICATIONS

Dhulikhel, Nepal

1. Diptaraj Chaudhari, Dhiraj Dhotre, Dhiraj Agarwal, Akshay Gaike, Devika Bhalerao, Parmeshwar Jadhav, Dattatray Mongad, Himangi Lubree, vilas Sinkar, Ulhas Patil, Sundeep Salvi, Ashish Bavdekar, Sanjay Juvekar, and Yogesh Shouche. Scientific Reports (In press). “Gut, oral and skin microbiome of Indian patrilineal families reveal perceptible association with age”. J Biosci (2019) 44:112 Indian Academy of Sciences DOI: 10.1007/s12038-019-9939-6

2. Rune Grønseth, Marta Erdal, Wan C. Tan, Daniel O. Obaseki, Andre F.S. Amaral, Thorarinn Gislason, Sanjay K. Juvekar, Parvaiz A. Koul, Michael Studnicka, Sundeep Salvi1, Peter Burney, A. Sonia Buist11, William M. vollmer and Ane Johannessen. Unemployment in chronic airflow obstruction around the world: results from the BOLD study. Eur Respir J 2017; 50: 1700499 [https://doi.org/10.1183/13993003.004992017].

3. Andrew Marsh, Siddhivinayak Hirve, Pallavi Lele, Uddhavi Chavan, Tathagata Bhattacharjee, Harish Nair, Sanjay Juvekar, Harry Campbell. Determinants and patterns of care-seeking for childhood illness in rural Pune District, India. Journal of global health; Vol. 10 No. 1 • 010601. doi: 10.7189/jogh.10.010601.

OTHER ACTIvITY

• Rutuja Patil gave an oral presentation on ‘Doctor to doctor Teleconsultation for management of chronic respiratory diseases a systematic review’ at Telemedicon 2019 on 1st December 2019 in New Delhi.

Bhima River Cross Country RUN FOR A CAUSE

vadu Rural Health Program (vRHP) of KEM Hospital Research Centre had organized a Bhima River Cross Country Run. This cross country was a first of its kind in Maharashtra as it gave the runners an opportunity to run near river Bhima through its picturesque landscapes, farms and experience of the rural air.

Cross country running is a sport that allows teams and individuals to run in open-air races on various surfaces of natural landscapes that could include grass, forest, hills, flat ground and gravel roads. Individual runners are judged on their individual timings while and the teams are judged by a points-scoring method.

The tagline for the event was “Run for Rural Health!”. The main purpose of the tagline was to increase awareness about rural health and hence the route that was finalised for this run was in a rural area itself.

The runners were given options to either independently run a complete 10 km cross country in which 38 participants actively participated and completed the entire run. The other option was to run in a group of 2 with each running 5kms each, 16 groups completed their runs in this category. The third category was that of participants running in a group of four wherein each participant had to complete 2.5 km each wherein 19 groups participated and completed their runs successfully. Even children participated in the run impromptu for which a separate category was created with the age group of these children at the last moment. They thoroughly enjoyed the run and also completed their respective runs with complete dedication. The women from the villages participated with great enthusiasm. It was immensely inspiring to watch them run in their traditional sarees.

Each winner was felicitated for their win with a medal and a trophy by the hands of honorary members of the village including their Sarpanch as well as the Officer in charge of vRHP, Dr. Sanjay Juvekar.

The team of vRHP decided to give their participants something authentic for refreshments. ‘Maas Wadi’, a Maharashtrian pudachi wadi which has chickpea flour or ‘besan’ casing stuffed with onion coriander filling with poppy seeds and grated coconut. It is a great source of protein. The participants were also given fresh sugarcane juice, a rich source of instant glucose post their run which proved to be a cherry on the icing of their overall rural experience.

The registrations were done online as well as in person. Local sponsorships played a huge role in making this event a success.

Ms. Diksha Singh

Social Interventions

PROGRAM FOR PRIMARY PREVENTION OF SEXUAL VIOLENCE (PPPSV)

WORKSHOPS

A series of two workshops on `prevention of Child Sexual Abuse Material offending was conducted on Oct. 6th, 2019 and Jan 23, 2020 by Dr. Ujjwal Nene and Prof. Dr. Dr. Kalus M. Beier, Director, Charite University Medical Clinic, Berlin, Dr. Hannes Giesler and Dr. vasudeo Paralikar

CONFERENCE

National Conference on ‘Online Interests, Offline Consequences: Navigating Complex Sexualities in Digital Contexts.’ :

The Program for Primary Prevention of Sexual violence (PPPSv) project undertaken by KEMHRC, Pune, organised a national conference on the topic ‘Online Interests, Offline Consequences: Navigating Complex Sexualities in Digital Contexts’ on 5th October 2019; in association with Charite university, Berlin and Bayer, India. The conference was supported by Bayer India through their Corporate Social Engagement activities. Several experts from different fields - Dr. T.S.S Rao, Dr. Mrugesh vaishnav, Dr. Harish Shetty, Dr. Nitin Anand, Rohit Srivastwa, N.S. Nappinai, Sonali Patankar, Dr. Sumit Narula, and Prof. Dr. Dr. Klaus M. Beier presented on different topics related to the themes of the conference.

Conference goals were-

• To identify different aspects that influence online dis-sexual behaviour

• To discuss prospective strategies to reduce online dis-sexual behaviour

• To discuss challenges and possible solutions in implementation of treatment strategies

130 participants had participated in the conference. Clinicians (including renowned psychiatrists in India), psychologists, lawyers, NGO professionals, social workers; crime branch representatives attended and appreciated it as a burning issue.

Appreciation by former Chief Minister- Mr. Devendra Fandanvis: Mr. Devendra Fadnavis, the honourable former Chief Minister of Maharashtra wrote in his letter to the project team, “I am glad to note that approaches such as PPPSv team of experts are working towards creating an acceptable solution to prevent sexual violence against children by highlighting prevention as an approach. This program undertaken by KEMHRC to provide psychological and medical treatment to people with pedophilia and help them refrain from acting out is very much needed.”

MEETING

Review meetings with funders Bayer India were conducted on Dec 17, 2019 and March 5th 2020.

AWARENESS ACTIvITIES

various strategies were used to spread pedophilia awareness and available treatment.

Group Sessions:

Awareness sessions have been conducted for various groups e.g. adolescent girls and boys, college students, medical and paramedical professionals, psychologists and counselors, NGO staff and beneficiaries, rickshaw drivers etc. The points covered during the session were paraphilias, pedophilia and pedophilic disorder, prevalence of child sexual abuse and CSA images, don’t offend- India Network, assessment for Pedophilia, treatment for Pedophilia, cultural challenges.

Following table illustrates sessions conducted during Oct 2019 to March 2020.

Total coverage so far is around 4976 people in group sessions.

Bus and Rickshaw Campaign:

To spread awareness about pedophilia and availability of confidential and free of cost treatment for the same at KEM Hospital Research Centre among lay people, an advertisement was made on public buses. Similarly, stickers were put in the rickshaws by obtaining permission from the authorities of rickshaw unions. Toll free number was provided on both the advertisements, which helped people to call anonymously.

Advertisements with reference to the topic were put on 152 buses and 1672 rickshaws. Feedback was obtained from the rickshaw drivers about passengers’ responses and reactions.

Screening Guide:

A screening guide was developed for private medical practitioners and hospitals, which would help them to screen suspected people. Those were kept with 50 such practitioners and hospitals.

Video spots screened in theaters: video spot related to the issues of pedophilia and CSAM (Child Sexual Abuse Material) were screened in multiplexes with message of `help available for those who feel sexually attracted towards children and for those who are tempted to consume child pornography. It was displayed at the 6 multiplex theatre screens for one month each prior to or during the popular films. This way, the message could reach up to an estimated number of 51,194 people per day approximately.

Awareness on Community Radio and Akashwani: Dr. Ujjwal Nene is interviewed in three episodes on `child sexual abuse and pedophilia’ and one episode on `NO app’ which was broadcasted on `vidyavani’; which is Community Radio Station run by Savitribai Phule Pune University at 107.4 frequency.

Dr. Nene was also interviewed on AIR Marathi (Akashwani Pune Kendra) on the occasion of `World Women’s Day’; and it was broadcasted on March 8, 2020 from All India Radio Air Marathi 558 MW. The interview consists of information on `No App’ and a brief talk on overall project activities as well.

Displaying posters in public toilets:

Solid Waste Management Department gave approval for putting posters in public toilets meant for men.

Hotline:

A 24*7 hotline with a toll-free number; was initiated by PPPSv project for people who need help. Sixtynine calls were received till 31st March 2020; from which 37 were directly project related calls i.e they had some sexuality related issues or queries regarding the project. Seven of them walked in for assessment and treatment and two of them have completed treatment. Remaining are undergoing assessment. Other calls were mostly to seek information about the project.

`NO App’:

A mobile application was developed through the project which aims to reduce the risk of violence to potential victims by increasing social control (‘NO’ App Community) over potential offenders. Awareness about `No’ App is also spread through multiple activities such as sessions in the colleges and among lay people, article in news-paper, participating in public events in the city, putting stickers in mobile shoppes etc. Approximately 5000 people are covered through awareness sessions and around 2000 have downloaded the App on their smart phones.

OTHER ACTIvITIES

• Social development department of Pune Municipal Corporation was approached for arranging sessions for Social Workers and Grass Root Level Workers since they have a component of women and child health. A no cost proposal for collaboration has been submitted.

• Commissioner of women and child development department was approached with a proposal for collaboration with women and child development department for advertisement of the issue under Government banner.

A news-paper articles published:

• `Tackling Pedophila: Psychologists open doors for those seeking help’; in Indian Express, Mumbai, Nov. 11th, 2019

• `Pedophilia Vikarapasun muktisathi’; in Maharashtra Times, Pune, Nov. 14th, 2019

• `Laingik atyachar pratibandhasathi NO app chi nirmiti’; in Loksatta, Pune, Dec 23rd, 2019.

Awareness on `No app’ and assisting in downloading the app

Awareness sessions with college students

Workshop with psychologists/ psychiatrists

Recording at Vidyvani community Radio

Awareness through posters in public toilets

MOBILE vAN PROJECT Funded by Light of life Trust

Our collaborative Mobile van Project with Light of Life Trust, Mumbai serves the health needs of our far to reach tribal population. Implemented in September, 2018 the main objective was to increase health care through primary health services in 36 villages in the 3 tribal blocks (Ambegaon, Junnar and Rajgurunagar) in Pune district. An equally important objective of the mobile medical unit is also to increase health awareness through barefoot doctors (BFD) and conduct periodic and scheduled medical camps. This is a point of care approach where health checkup and treatment facilities are made available at the door steps of the tribal homes and community. Medical officers routinely provide medical treatments to bridge the gaps. By gaps we mean poor access to a government Primary Health Centre or a rural hospital for various logistic issues. 85 mobile clinics were conducted and essential medicines provided free of cost from October 2019 to March 2020. 2851 patients of all age groups attended these clinics. 49% were female. Major complaints observed were ENT, Skin, General Weakness and Ortho related complaints.

Other Activities in Tribal Area:

Tribes are the most marginal groups facing various health problems. We found simply treating a fever, infection or topical health problem is not enough. The scope of our services is slowly expanding to other horizontal programmes which contribute to overall health and wellbeing. Services to these tribal groups in remote areas are:

1. Out Patient Services (OPD)

2. Regular Medical Officer visit

3. Health Camps

4. Health Education Program

5. Nutrition and Health Education

6. Medical Counseling

Medical officers and Medical Social Workers conduct awareness sessions about menstrual cycle and hygiene among adolescent girls and women. Awareness about physiological and psychological changes at puberty, cleanliness, personal and menstrual hygiene and use of sanitary pads, misconceptions regarding menstruation are addressed. These sessions got more popular among school children and this project will continue to create knowledge in the community regarding adolescent health, personal hygiene and menstruation. various types of health promotion and education activities in topics like Anemia, Nutrition, ANC Care, Child Health, Regular Exercise and Medical Counseling are also gaining ground in the community.

Ms. Trupti Ogale

Training and Monitoring Interventions

COMPREHENSIVE TRIBAL MODEL VILLAGE DEVELOPMENT PROGRAM

Funded by Bajaj (CSR)

TRAINING SESSIONS

• Bare Food Doctors Orientation training, Date: 28th Dec 2019

• Vocational Training Course: Tailoring, Date: 12th - 11th Dec 2019

• Vocational Training Course: Beauty Parlour, Date: 4th Dec - 4th Feb 2020

Bare Food Doctors Orientation training, 28th Dec 2019 Hands on session

Health Awareness Session at village Shendurli, 9th Dec 2019

OTHER ACTIvITIES:

• Liaising with Villagers

Total 30 liaising meetings have been conducted in the model villages by the field team during this period. As the first crucial step in intervention the meeting outcomes were good team building and coordination between field team and villages and extended support in various project activities.

• Meeting with Govt. Functionaries

It is always our practice to meet and keep the government functionaries informed about the project objectives and planned intervention. This is with a view to integrate and work in close co-ordination with the different department -especially Health, ICDS, Revenue Department and other local bodies working at the village level. Field staff provide regular project updates, current work updates and future plan of action to the government as well as the village committees. 12 meeting has been conducted with Govt. Fonctionnaires.

• Baseline Survey

Training in Baseline Data Collection tool is completed Pretests for the tool is completed and 250 Baseline data has been completed. Interviews were carried out and females between age group of 15 to 45 were selected.

• Health Awareness Sessions

Under the project, ANC would be mothers, PNC Mothers and adolescents were accessed for health education at different levels. Between Oct- Mar 2020, 71 ANCs, 106 PNCs and 114 Adolescents received orientation in different health subjects at the field level.

• Nutritional Education Sessions

Both ANC and PNC Mothers along with their family members like husband, mother in law, sister in law were provided nutrition education awareness with the of flip charts, mobile videos and nutrition-based recipes demonstration.

• Mobile Health Check Up Camps

22 camps have been conducted in 12 Model villages. Services were rendered for 999 beneficiaries. Simultaneously, we conducted another 25 camps in 14 other villages total and provided service to 1210 beneficiaries. Till date we have held 64 camps where 2867 beneficiaries received our services.

• Bare Foot Doctors Training

Orientation training session for Bare Foot Doctors from all model villages located in the tribal villages of program area has been completed. The training focused on the first aid kit and different medications based on presenting signs and symptoms. Nutrition awareness along with recipes were also included in the training so as to facilitate the BFDs, who will routinely and eventually deliver nutrition awareness to the ANC, PNC and adolescents, who need this for a safe and healthy mother and infant.

• Skill building: Vocational Training

Two batches of Beauty Parlour and Tailoring courses have been completed. 31 women have been trained under the women empowerment and skill building programme.

• Health Post Development

We have identified a suitable place to establish the Health Post in 11 model villages with prior willingness and permission from the village Gram Sabha. This Health Post aims to deliver first aid and treatment of common illness through the Bare Foot Doctors.

Health Awareness Session at village Shendurli, 9th Dec 2019

Mr. Arun Dhongade

WOMEN’S DEvELOPMENT TRAINING CENTRE, PABAL vocational courses - Current status (Oct. 2019 to Mar. 2020)

Follow up of batches from April 2019 to Mar. 2020

Public Health Program (OPD)

Jagruti – Women Empowerment in Pregnancy Programme

OTHER ACTIvITIES

Dr. Sarah Rao & Dr. v. N. Rao Education Fund and Certificate Distribution was held on 15.10.2019 at Pabal. Dr. Laila Garda Director Research, Mrs. Pallavi Dahale Sarpanch and Mrs. Archana Jadhav Deputy Sarpanch Pabal distributed certificates to trainees and education fund to poor and needy girls.

HPV Vaccination Camp was organized by KEMHRC on 20th and 25th Nov. 2019 at Pabal Centre for 86 girl beneficiaries.

Programme Visitors, Mr. Firoz and Mr. Yezdi Batliwala from Rotary Club of Poona Downtown visited Pabal Centre and interacted with trainees and instructors on 6th December, 2019.

Career Guidance Workshop was conducted on 28th Dec. 2019 and 4th Jan 2020 for students from Bhairavnath Vidya Mandir Pabal. 30 students participated in the workshop.

Haldi-Kumkum Program is celebrated at all the classroom and in Gynae OPD in January on the occasion of Makar Sankranti.

Students from University of Missouri with Dr. Carolyn visited Pabal center had interaction with trainee and staff. Dr. Carolyn distributed certificates to successful Home Nursing and Tailoring trainees on 11th Jan. 2020.

Field training, 4 trainees along with instructor attended the HPv vaccination program at Somantwadi Kanya Ashram Shala Junnar and assisted the staff on 23rd Jan. 2020.

Students from Padmashri School & Public Health Bangalore with Dr. Umashankar S. Principal visited Pabal center on 25.02.2020 and had interaction with staff.

World Women's Day function organized at Savindane, Shikrapur Tailoring class and Bedside assistant class at Alephata on 8th March 2020

Mr.vasant Pingale

Dr. Laila Garda Director Research, A3RMT team member Mr. Anand Halbe and Mr.& Mrs. Parekh inaugurated the A3RMT System on 11.2.2020 for MHC Telemedicine Pabal.