Breast is the best, or is it?

BREAST IS THE BEST, 

OR IS IT?

A relook at common wisdom

My blog for 

Population First

On BREASTFEEDING DAY

DR SHANTANU ABHYANKAR, WAI

Breast milk invigorates and nourishes the newborn like nothing else. It’s the baby’s first food, ensuring good health right into adulthood. Not surprisingly, almost every Bollywood hunk has sworn to the goodness of ‘Ma ka doodh’ on screen.

Successful breast feeding is the rich dividend following investment in the form of prenatal counselling, good   preparation, a positive attitude, institutional and government policies and time. 

‘Breast is the best’ and we need lactation friendly facilities even in public spaces. But there can be exceptions. The dictum, that all mothers should feed all babies, exclusively for six months, needs to be looked at again. Some special situations need to be factored in. 

Such blanket advice overlooks the physical, social and economic constraints of the mother. Ignorance or unwillingness to try hard enough aren’t the only reasons why a mother gives up breastfeeding. Many mothers need to get back to education/earning due to socioeconomic reasons. A six month sabbatical may not be affordable. If the cost of time invested, cost of giving up a job, refusing a promotion or a raise, is factored in, we will realize that breastfeeding isn’t cheap and certainly not free. 

Over glorification of breastfeeding can create guilt in the minds of women forced to give it up. Such mothers need positive support without guilt and judgment. Of course it is the mother's duty to feed the newborn but then it is the father's duty as well. It’s the responsibility of the family too. In fact just as not procreating is a personal choice, not breastfeeding can be a valid personal choice and needs to be respected. 

Low birth weight and preterm babies can accept only small aliquots of milk. They may not be able to cry aloud and are too weak to latch effectively and suckle vigorously. They need to be fed every hour or two, for the first three to four months. This leads to sleep deprivation and a lot of other physical and psychological challenges. In such situations, milk substitutes under medical supervision, may be given a thought. Insisting on exclusive breastfeeding can be counterproductive. The baby needs to be well fed and well-nourished; the source matters little in the face of such adverse conditions.

Babies larger than expected, especially those born to diabetic mothers, become too hungry, too soon. They may need supplement, till lactation is properly established.

Even normal babies often suffer hunger, for lactation is not well established in the first few days of life. The standard medical response to this is; ‘in the first few days of life, all that is secreted is all that the baby requires’.

However hunger in the early days of life can be life threatening. Emergency NICU admission with intravenous glucose may become necessary.  Long term neurological consequences of unrecognized low blood sugar can be disastrous. Hunger leads to excessive crying, lethargy, dehydration, convulsions, very low blood sugar and even sudden death.   

The mother is exhausted after labor and readily breaks into tears when she realizes that she is failing to feed the child. This inferiority complex and accompanying anxiety leads to reduced milk flow. Elderly mothers, comorbidities, cesarean section, a baby girl when a boy was expected; are stressful enough. A wailing toddler due to failed lactation is the last thing one would want. Lactation doesn't happen instantaneously. Suckling happens to be the strongest stimulus but suckling the child every two hours is easier said than done. Delayed onset of lactation is neither the mother’s fault nor the baby’s. 

Traditionally such problems have been tackled with wet nurses, cow’s milk etc.  Since milk powder is sterile and has known constituents in known proportion that closely match the composition of human milk, it’s preferred over animal milk.   Some cities now boast of milk banks, which is a good option too.

Breastfeeding is the obvious choice between sumptuous feeds and milk substitutes. However between reconstituted milk powder and emergency intravenous glucose; milk powder is obviously the better choice. Substitutes create problems because of improper reconstitution and unsafe water. We've made a lot of progress as far as safe drinking water is concerned. A properly constituted and safely prepared powdered milk is a good option. It is important to see that the baby is adequately and safely fed till the time lactation is well established. Once that happens, top feeds should be stopped forthwith.

Policies supporting milk substitute appeasing the market forces and abetting profiteering are bad but milk substitutes aren’t bad by themselves. Milk and milk substitute should be used judiciously according to their wishes needs and abilities off the mother and her family.

Let's take the beaten track

 

Let’s take the beaten track.

 

 

The Corona epidemic has flummoxed everyone, especially health care professionals.

 

It has also let loose a slew of Healers, Hakims, Homeopaths and Vaidyas, brandishing their materia medicas. Everyone claiming that traditional practices, potions, herbs, etc. will soon cast their magic to ward off Covid. Each swearing by the utility of his or her own unique ‘ancient wisdom’. Along with their high-flown ideas, they hold flags flying high. Flags with nationalist and cultural colors.

 

China leads the way. Chinese healers, with active support from their government, are going overboard claiming that their traditional medicines happen to be the best. The Chinese Journal of Integrative Medicine has published a list of half a dozen herbs and potions, of potential value. Of course none of their claims have strong enough evidence. Mostly it is wishful thinking and soft power positioning. 

 

The National institute of Health, USA, has warned against these and other such claims. It says that traditional Chinese medicine may contain pesticides, toxic chemicals and even modern pharmacological agents with no mention of them on the label. Efficacy and safety of these products is yet to be proved, the studies are incomplete. Figures provided by the Chinese are as doubtful as the Chinese numbers about the current epidemic.

 

China's political interests have fuelled support for Chinese medical practices. This is Chinese soft power trying to overpower alien culture by hard selling one’s language, culture, art, tradition, movies and medicine. Such soft power wars are constantly going on.  I am sure Zimbabwe awards its best movie makers but our eyes eye just the Oscars. This is an example of the American soft power. Worldwide reach of Yoga and Bollywood is an example of Indian soft power.  

 

All societies and cultures have traditional medicines; some useful, most doubtful and some useless.  Their claims need whetting and verification. There are subtle differences, for example if I have common cold, I ‘feel better’ with tea spiced with ginger but ginger doesn't ‘cure’ me. ‘Feeling better’ and ‘getting better’ are worlds apart.  In the current epidemic, they are literally worlds apart.

The Chinese president Xi Jinping has repeatedly stressed that this ancient Chinese wisdom, passed on through generations, needs to be nurtured, cared for, researched, respected and spread far ‘n wide. Does all this sound familiar? Well it does.

 

 

There is a competition. Across the world every ‘pathy’ is trying to hard sell its products. The ministry of Ayush has suggested Arsenic Album, a homeopathic preparation, as a prophylactic. There isn’t even a single study to back this claim.  Important it is, to note that in a Tweet on 26th of March, the health ministry of Maharashtra specifically states that, ‘there’s no medicine recommended to stop Corona.’ However Naturopaths, Reki healers, Aroma therapists Acupressure and Acupuncture specialists are hawking their ware. Acupuncture is supposed to ‘strengthen the kidney and lungs’! Since most such claims are hollow, they are useless, harmless and not taken very seriously. This is one reason why such claims continue to pop up all the time. But sometimes things go wrong.  In Iran, following a rumor that alcohol could protect from Corona, 44 people died due to methyl alcohol poisoning.

 

 

All this reminds me of the HIV-AIDS epidemic. It took a decade for an efficacious drug to be developed and all this time, quack shops mushroomed from Kerala to California.  Today we have several drugs and all these quacks have had to shut shop. But for a while they did encash the AIDS phobia. A looming disaster, fear stricken, helpless, populace and quacks making hay while ignorance shines, is an all too familiar pattern. This rise and fall of the quacks needs sociological analysis.

 

Amongst the most amusing is the claim to increase immunity, immune-boosters!

All traditional, complementary and alternative systems of medicine claim thus. ‘Immunity’ is an ill-defined concept. There's no single test to gauge immune power nor any unit to measure it. This makes it easy to claim an increase in immunity and at the same time, very difficult to disprove such claim. This is why such claims and claimants thrive. It’s like claiming to improve one's power of imagination. Even sugar can be sold as an immune-booster, and why not? One is prone to illness on empty stomach. Even water is an immune-booster! Dehydration erodes several bodily mechanisms, including immunity.

 

Balanced diet, enough rest, regular exercise and life free of addictions is what is important.  There's no quick fix, over the counter, universal immune booster pill. There can’t be one.  But there's no dearth of sellers who encash public panic.

 

These so called boosters are supposed to be taken along with the treatment offered by modern medicine. This is a ploy. While success is said to be sired by the booster, failure can always be blamed on modern medicine aka allopathy.

 

Another common argument is, ‘what’s the harm? What if people keep doing apparently useless but innocuous things?’ There are problems aplenty.  Using scares resources for unproductive and possibly counterproductive treatments is harmful, weaning people away from rational management is harmful, the false sense of security is harmful and the social Government and media sanction and attention, that these semi-sciences gain, is harmful as well.

 

Only men of modern medicine openly admit that there is no curative treatment in modern medicine. They are fighting the scourge with whatever resources they have. With masked faces and PPE kits; with experimental therapies and ventilators. Their gains and losses are for everyone to access and assess. Research goes on.  Ideas are exchanged, errors and omissions documented, guidelines formulated and revised. It is through such detailed studies and planning that smallpox was eradicated, polio driven away, Guinea worm non-existent, AIDS under control and Leprosy and Measles on way out.

 

This is the way to go, sans bias, sans bigotry, let's follow the beaten track.

 

 

Dr. Shantanu Abhyankar

Mobile Number 9822010349

 

Seniors, a necessary evil!

Seniors, a necessary evil!

Dr. Shantanu Abhyankar

I have been asked to share ideas on the topic, ‘Seniors, A Necessary Evil!’

Fortunately the request came through a telephonic conversation and I can take the liberty to add punctuation marks between the words, Seniors, Necessary and Evil. I toyed with Idea of adding a full stop, but then that is not what I want to convey. I don’t believe that seniors indeed are evil.  I also toyed with Idea of a question mark.  But that wouldn't do either, I firmly believe that the role of seniors should be beyond a question mark, beyond   doubt and certainly not evil; rather angelical. However since some might find my views rather surprising I have chosen an exclamation mark and titled my write up, Seniors, a necessary evil!

Seniors undertake what is called as ‘ragging’ and cause apprehension, shame, embarrassment and at times mild to severe physical and/or psychological harm. In   extreme cases the young student is driven to suicide. Everybody may not be driven to suicide but some are forced to leave the system, some suffer serious psychological trauma or post-traumatic stress disorder and all these are ultimately losses for the person, the family, the society and the nation.  The reported incidents are just the tip of the iceberg and a lot lies unseen and unreported.

Students often try to justify and even glorify this practice. It’s commonly argued that ragging prepares the newbie for more difficult situations in life. The fact remains that ragging makes the junior accept the situation weakly and meekly. This is achieved through the power of numbers and position. It encourages exploitation and nonresistant acceptance. Another popular myth is that ragging is supposed to help break ice between seniors and juniors.  I am sure there are more pleasant ways of interaction and camaraderie.

Juniors face many anxieties and seniors are expected to be understanding, sympathetic, helpful and tolerant. They are   expected to guide the junior in his initial unsteady, slippery, tentative, fledgling steps.  Instead what the juniors are presented with is arrogance and supremacy hooliganism.

Many see ragging as a chance to revenge what they have suffered as juniors and the vicious circle goes on. Many perpetrators associate manliness with inflicting such pain and many a victims associate macho ideas in bearing the pain with an unflinching grin.  Complaining is often seen as a sign of give way, defeat, shame, surrender and loss of face.

Fortunately, in India, ragging is now seen not just as a personal offence but as shameful for the institution as well. The Supreme Court and other authorities have proactively tried to tackle the menace and with good results. I firmly believe that evil behavior of a senior must come as a surprise rather than a matter of fact. Zero ragging incidents is a matter of pride for the institute and its students.

A SURE SOLUTION TO FIGHT SEX SELECTION

A SURE SOLUTION TO FIGHT SEX SELECTION

DR. SHANTANU ABHYANKAR, Wai,   Maharashtra. PIN 412 803

Mobile No: 98220 10 349

Female feticide, sex selection rather, is a complex problem and begets multipronged solutions. There are several important interventions.

Women’s empowerment is the final solution. Education, Sukanya Samruddhi Yojna, common civil code, special laws for women and an appropriate share for women in inheritance, are a few such efforts.

Laws like the PCPNDT provide only immediate but temporary respite.

The law just can’t nab the true culprits, with evidence strong enough to support conviction, without a lot of collateral damage.

It is readily possible to dodge the law by simply keeping your paperwork perfect, since that is all that the law checks. Pregnancies, abortions and births are such common occurrence, that it is humanly impossible to sniff out the offenders from the data currently generated, in keeping with this law. The frustration drives the NGOs and administration to ad hoc and arbitrary actions.

Is there a solution? Yes there is…

The law should mandate that every pregnancy be registered and should receive a unique identity number. The doctor will have to quote this number and register each ultrasound test online to a central server. All the outcomes of pregnancy, abortions (spontaneous or induced), births, stillbirths, etc: will be linked to this number. Thus outcome of every pregnancy will now be traceable. If the sex is declared, as suggested by Mrs. Maneka Gandhi, it will make the whole effort sharper. However this needs deeper consideration.

If abortions conducted after USG test in a particular centre are not being reported, we probably have nabbed the guilty.

If women deliver unusually high (statistically significant) number of boys after USG test at a particular center, we know who the wrongdoer is. The current law can’t nab families who choose not to abort a pregnancy since it is a male fetus! The whole focus is on female feticide. Knowingly continuing the pregnancy with a male fetus is sex selection too. It’s as criminal; it’s as harmful as female feticide but the law breakers can  never be apprehended. The present law thus allows half the culprits to go scot free. The new system will catch these parties, the implementation will become more focused, more effective more relevant.

It is easier to trace back each pregnancy from its outcome backwards. Playing ‘Help the Bunny reach Home’, it is easier to trace the route back to the Bunny, starting from the home; than trace all the roads beginning from the Bunny.

This may sound impossible but rest assured it is not. If ‘Idea’ can maintain records of each call, SMS etc of each of its customer, if the government can count each head for the census, this is too simple a task. Everyone has a smartphone; each Primary Health Center has an internet connection, so this is easy. The administration has all the skills to take care of wrong entries, double entries etc: what with the wide experience of Adhaar and Voter card schemes.

There are other positive benefits.

May be a woman has aborted, spontaneously or with medical help, maybe she has had a stillborn child, she has delivered at home, unsupervised by any birth attendant...and  none of this has been documented. However each of the above is an important bit of information and needs to be documented needs to be reported. Such an omission is a glaring gap in the health services reaching the woman. The suggested model helps to quantify this gap in service, helps to correct any lacunae. Routine investigations, iron supplementation, tetanus prophylaxis, all this and more can be added as a part of this model. This will lead to an overall improvement in antenatal services, a fall in sex selection will only be one of its many positive fallouts!

In short, the issue at stake is comprehensive and good women’s care, antenatal care. Sex selection is but a symptom of a deeper malady. One can’t treat it by singling it out. If you do, it’s like firing in a smoke screen, very little real effect but a lot of collateral damage.