Wednesday, August 29

World's largest scandal

I am in a class about burden of mortality. The prof. Kirk Smith calls the total number of deaths in children < 5 years of age caused by vaccine preventable diseases as the "World's largest scandal".
I think this is probably a good description and a fantastic way to focus the world's attention on vaccine preventable diseases.

Good questions to ask:

1. Why doesn't India have cholera and typhoid vaccination programs or a Hib vaccination program?
I asked some simple questions - What do we need to know to justify the implementation of a vaccine program.

1. We need to have a vaccine that is successful in preventing the infection.
2. The disease must have high mortality/disability if people are infected. (NOTE: Pertussis,Diptheria don't have that right?)
3. We must be able to show that the cost of the vaccine is not greater than the cost of treatment or other prevention measures.
4. The vaccine must work irrespective of the load of the infectious agent
5. The agent must not have multiple strains/serotypes that making a vaccine difficult to prevent
6. How prevalent is the disease? what is the burden of disease and mortality rates?
7. Cynically, someone must have enough money to pay for the research.

Puerta

I suspect the best way to pay tribute to a sportperson is to highlight their acheivements. His goal in the UEFA cup.

Jokes

Why do we think something is funny enough for us to laugh or smile or feel something?
What is funniness?
The word "funny" is an American derivative of the word fun and probably means something strange or odd.
What is it in a joke that we find funny? the situation,tragedy,words used,imagery,irony or a complex interplay of all and more of this stuff that makes us think it to be funny.

Even more than that, what does funny mean to our brain? Interesting topic. I know there are courses which deal with humour in an academic way but if anybody has any idea what they think is funny,let me know.

Funnily enough, (pun unintended) the word "joke" is older than the word funny. It seems to be derived from Latin. See this for the exact etymology.

Tuesday, August 28

The bathroom - don't have to see this


Saranya 157
Originally uploaded by Saranya Sridhar
hmm..ignore the full laundry basket!

Apartment bathroom sink + mirror


Saranya 146
Originally uploaded by Saranya Sridhar
Not much else I can say about this.

Apartment Shower


Saranya 148
Originally uploaded by Saranya Sridhar
My shower!

Apartment 6


Saranya 156
Originally uploaded by Saranya Sridhar
This is a photo taken with my back to the futon and big bookshelf. It shows the small bookshelf at the foot of the bed and my in-wall closet. As you can see its terribly small which seems to suit my non-existent fashion sense. Another couple of chairs and the closet door is a full length mirror. Again something I don't use, although I know some people who when they visit might not be able to tear themselves away from it ;)

Apartment


Apartment
Originally uploaded by Saranya Sridhar
My prize possesion. A free futon mattress graces my floor. It is where I spend all my time when on the computer. The only problem is that its an old futon and doesn't provide the same comfort to my bottom as it should.

Apartment 4


Saranya 154
Originally uploaded by Saranya Sridhar
My table + chairs + window. The window almost always has the blind down because it looks into the buildings corridor. I know I am attractive, but somehow I really do not want people walking down the corridor to be able to watch everything I do.

Apartment 3


Saranya 153
Originally uploaded by Saranya Sridhar
My bed + quilt + small book stand which holds a radio(visible in photo) and my telephone (not visible). The bedside lamp is great for bedtime reading.

Apartment 2


Saranya 152
Originally uploaded by Saranya Sridhar
This is my kitchenette. Its a four place electric stove with an oven. You can see the small black fridge which presently has no food in it. Above the stove and sink are a few cupboards. The metallic door handle you can see leads to the bathroom.

Apartment


Apartment
Originally uploaded by Saranya Sridhar
This is the view of my room from the door. The photo is taken with my back to the door. To the left of the photo is my bathroom and opposite the table is the kitchentte. At the far end, to the left of the table and chest of drawers is my bed.
JM and I had an interesting conversation yesterday about responsibility. This was in response to an article we read in our International Health Policy class which I don't think I will take simply because it is too much work.
This article quoted an ADB representative as advising that HIV transmission may increase as a result of infrastructure projects and we must intergrate HIV prevention strategies in infrastructure projects in developing countries.

JM argues that the ADB, a bank should not just make such statements but also implement the policy involved, in this case they should make sure that all investments in infrastructure funded by ADB must include HIV prevention programs and more importantly ADB should invest some money in such activities themselves.

I disagreed with him and suggest that every institution has certain primary functions and secondary functions. ADB's primary function does not include funding, organising or implementing HIV prevention programs, although their secondary and moral responsibilities means they should ensure that if such a problem exists they integrate it as part of their funding projects.

So, whose responsibility is it to implement HIV prevention programs in infrastructre projects - ADB,World bank that fund such projects or governments that take this money to realise such projects or other private/public entreprise that work in the field of HIV?
My reaction would be that its up to the ADB to make sure that governments integrate health programs in infrastructure projects and the governments then employ whichever agency they believe is best able to implement the project.

First Day of School

I felt like I was in class 10 or something walking down the corridors of MSVV. Had to wake up early in the morning and head off to class to find myself among 100 odd people in a big lecture theater listening to someone drone about statistics. Did remind me a lot of school, not college because I did pay attention to lectures in college at least for my first six months.

My next class in the Life Sciences department made me feel like I was in an American teen movie. Corridors with 18 year old kids carrying backpacks, folders, cool cliques forming in corners and multitudes of eager first day college kids desperate to get into the first row of the Dean's lecture or whatever. Totally surreal!!

The whole day was an ordeal. I hate lectures, I learn very little from sitting in a class although I learn very little if I don't attend classes. I realise that I don't study much outside class and am able to absorb most things if I pay attention in class. But, most lectures are trying, mind-numbing and are given by poor presenters - so its very hard to keep listening. 250B - which is Epidemiological methods is totally scary. The prof. reminds me of Dr.Ghosh - intimidating, frightening and intense. This is going to be a really tough semester.

I am hoping to take about 18 units + a language. Should be fine although I might drop a few classes if the load gets too much. The language class is really intense, I am on the waiting list and haven't been able to attend a class yet but it looks terribly hard work.

Overall, I think its going to be a fun year, doing classes..doing some research on the side and meeting interesting people. Have made some friends from my summer session classes and we hang out a fair bit,although I doubt whether we will have much chance to do so later.

Anyway, shall post some pictures once I upload about 150 MB of photos onto flickr!

Miss Teen USA 2007 - South Carolina answers a question

Uhh..what is she saying? I did not quite understand,someone please explain. Does she believe South Africa and Iraq are part of the US???

Friday, August 24

You Want To Believe Davydenko Isn't Mr. Fix It -- Courant.com

This article - You Want To Believe Davydenko Isn't Mr. Fix It -- Courant.com
is an interesting point of view on the Davydenko betting scandal. I agree with the reporter who suggests that in situations like this, a truly innocent sportstar would be indignantly proclaiming his innocence at every press conference and opportunity he or she gets.
Unfortunately, the No.4 tennis player in the world does not think it necessary to rubbish such accussations. I do not think language is such a barrier, surely all you need is for someone to ask him the question in Russian.
I would be terribly hurt if this idiot did fix the match. Tennis so far, has not been party to any sporting scandal unlike almost every other major sport and it would be a pity if anyone associated with the sport scarred its reputation in any way.

On the other hand, I am sick of hearing about biking druggies, steroid sluggers and refereeing nepotism so a change is interesting.

blog colours

My absolute lack of any colour sense in combination with valued albeit polarised opinions from loyal readers has forced me to hand over the vital decision of blog colour design over to Google Blogger.
So, now everyday Blogger will shuffle my blog colour. I suspect this will be reasonably annoying initially but will allow me to sample different options.
Cheers to the kaleidoscope blog!

Thursday, August 23

reviewing my paper

I just met someone from Oxford! She is starting a PhD in public health and was in Oxford doing International Development at St.Antony. As it turns out we know a couple of people in common.
It was great, we had a long chat about Oxford, Berkeley and managing the change.

Of course, this did mean that my reviewing mind has gone off the boil and it is taking me some time to get back into focus. Surprisingly, I made lots of changes to my paper and realised how badly written it was initially. Terrible. Am doing the discussion right now and hopefully will send it off to ARS,AM over the weekend.

Also, need to come up with ideas for my master's paper - meta-analysis and systematic reviews have to be written. Any ideas - please let me know :)

right, back to work - a cup of tea and I shall be back.

To do list

As you can see, I spend my spare time changing the colouring of my blog. I didn't like the black because it strains my eyes and I didn't like the ochre colour scheme because it was too light, so have tried something in between. It is still being judged - comments welcome!

To do list: (update)
1. Send FP project idea + references - DONE
2. Mail AM,SB,SS - DONE mailed AM , not the others. Add Little One to list.
3. Revise paper - send to everyone for review - DONE ( need photoshop to polish figures)
4. Write and send abstract for conf. - DONE
5. Prepare figures for next two chapters.
6. groceries
7. Send BoA SSN - DONE
8. Call HSBC UK and transfer money
9. Cancel UK phone bill
10. Send Lovefilm CD's back.
NEW ADDITIONS:
11. Buy ERAS Token
12. Return Berkeley library books
13. Buy computer software

Tuesday, August 21

10 things I like about Berkeley

1. Restaurants and eateries
2. Sunshine
3. Wireless access
4. Apartment
5. Courses
6. Berkeley Hills
7. The Ocean
8. cheap food and large portions
9. coffee shops
10. San Francisco

20 things I miss about Oxford

1. the Lab
2. Blackwell's
3. Cycling
4. Cricket
5. Kebab Vans
6. G&D's
7. University Parks
8. Communal daily cuppa
9. (Dare I say it) - changing weather
10. bitching about Aramark
11. Magdalen tower
12. Wearing a suit - once in a while
13. Wellington square view from my room
14. FGF
15. High Table (especially the Merton one)
16. Sainsbury's brownies
17. Ben's Cookies
18. Free Alcohol - if you go to enough events
19. Covered market
20. Oxford after snowfall
I cannot sleep. Its 2.30 am and I have been awake for the last hour and a half trying to put myself to bed by reading an Oscar Wilde play, watching bits of DCH on youtube and now by surfing the net.

In terms of what this means for me tomorrow, I don't know. I can only hope that SR wakes me up tomorrow morning. I am having general thoughts about residency programs and wondering whether I should apply this year or the next with a more powerful application. I need some publications which I hope will happen this year and the next and also some 2nd author ones with ARS. The problem I have now is competition with other PhD applicants who have some publications. JC suggested I do so and I cannot but think thats not a bad idea. The point being whether I would actually be better off take an extra year to decide about residency at all or whether I could get into something else in the meantime. It does mean that I would have to find some work that leads to CV enhancement next year, but I am sure I can find something.

I suspect what I will do is apply this year and see what happens. I don't want to get into a community hospital program but rather somewhere I could continue to do some research work. So, I partake in a cup of early morning tea and mull what lies ahead.... the choices are many, but perhaps only one correct one.

Vik's chaat house-review

Went to Vik's chaat house on Saturday with Cousin K. It's the most famous chaat house in the Bay area and was established in 1989. In fact, the first thing I heard when I got to Berkeley was Vik's chaat. I must admit, I shy away from most chaat places abroad simply because they are rarely authentic or good. I have also found that most places with big reputations, especially Indian restaurants are the worst ones. Take Aziz in Oxford for example - I don't think I have ever tasted worse gajar ka halwa and sabji's in my life. Chutney's in Oxford is another example of a much hyped restaurant serving awful food. The only place in Oxford where I have had decent Indian khana is Cumin's, which on my last visit there also seemed to have lost its much appreciated authenticity.

So, I stayed away from Vik's till today. I walked in expecting mediocrity and prepared to be disappointed. The first thing that struck me was the absolute lack of decoration and attempt to manufacture an ambiance. I was pleasantly surprised that the place is a warehouse with tables scattered around. The ambiance is generated entirely by the constant murmur of conversation. There is no table service, you look around and wait for a table to get free and then sit down. Reminded me very much of chaat places back home,like Nathu's.

There is no pretensions to gourmet service or food. This is a chaat house, so don't expect anything fancy. The menu is meant to be fast food and simple. I was slightly disappointed that their chaat menu was very limited and they seemed to have more south indian dishes and things like biryani,fish fry and chicken tikka. It did seem that this was their submission to market forces and competitors.

I ordered a dahi papdi chaat and a masala dosa, just to taste both cuisines. I was very surprised by the quick service. The dahi papdi chaat was good. Nothing great and to rave about but definitely good. The green chutney was very good although I was not very happy about the number of puris per dish. The masala dosa was pretty standard and ok. The sambhar was much better than the one I had at the Udipi Palace although the chutney was a bit weird. I don't understand why they can't serve simple coconut chutney instead of trying to make it fancy. On the whole, I was satisfied with my food. Cousin K had a gobi paratha which he said was ok, while Mrs. K had chicken biryani which in my opinion did not look very appetising and fish fry which looked horrible. The prices are very reasonable - 10$ for a couple of dishes is a very good deal.
My only problem is that its a pain to get to if you do not have a car..but this is America, I forget.
Here are some more reviews of the place.
http://www.vikschaatcorner.com/press/sfchron_viks.htm
http://blogs.kqed.org/food/?p=36

I wasn't overly impressed,but also not disappointed. I suspect my expectations were so low, that I was bound to be impressed. It won't be the first place I go to for a dinner, but definitely worth a return trip some Saturday or Sunday afternoon for a taste of their dahi batata puri.I would definitely take someone on their first trip to the Bay area there. (Damn..now my mouth has begun to water thinking of imli chutney..I am getting chaat craving!!!). What impressed me the most was the complete lack of pandering to their own reputation. Mr. Chopra who runs it must be a shrewd businessman who recognises his market and its extent. It's like Swati in Bombay, we used to love going to it..stand outside, eat food while standing outside. Service through a window. Cheap food, good tasty, finger-licking stuff. Then they tried to expand their menu, become posh and increased prices concomitant with their reputation and I can't stand the place anymore. The food is not worth the money you pay.

As an aside, the best two places I have been to yet has been thanks to G and hubby.
Komala Vilas is brilliant. They have a lunch menu which is unlimited south indian food and its like eating home made food. Its great. I loved it and its very cheap. 10$ for unlimited lunch is good. It's like the Matunga restaurant, Appa loved.

The other place, I dont the name of is inside a grocery store in Sunnyvale or Fremont. Its a chaat place and is basically a corner of the shop and serves the best pani puri..like chowpatty pani puri. These two aunties make the stuff and its excellent.

Ok, enough food talk. My stomach is grumbling and I should be off to bed. Tomorrow is the first day of welcome week and their is free breakfast if I can wake up before 8am.

Monday, August 20

to do list

Haven't made one like this for ages, but considering that my weekend was spent walking, reading Louis Lamour and watching movies, this week must see me doing work.

1. Send FP project idea + references
2. Mail AM,SB,SS
3. Revise paper - send to everyone for review
4. Write and send abstract for conf.
5. Prepare figures for next two chapters.
6. groceries
7. Send BoA SSN
8. Call HSBC UK and transfer money
9. Cancel UK phone bill
10. Send Lovefilm CD's back.

Saturday, August 18

Berkeley vs Oxford

I changed my profile to show Berkeley, US instead of Oxford,UK for about an hour or so today and then changed it back. Somehow, I feel like I haven't closed out my Oxford chapter. I hope I never do because I think and hope I made some lifelong friends there but because I have to go back at some point I decided that until I submit and finish viva I shall not change either my profile address or my gmail signature.

Its a hard decision and hopefully will spur me onto finishing that *(($)### * thesis!

MotD

For the first time in two years, my saturday and sunday nights are not going to be taken up by Adrian Chiles, Gary Lineker, Alan Hansen, Mark Lawrenson and Alan Shearer. I am not going to be able to spend the evening having dinner (mostly chips and cheese with chilli sauce and mayo) and glued to the TV for an hour and a half or so watching MotD. For those philistines among you who do not know or scorn MotD, I pity you. For you are missing out on the the best part of being in the UK...the BBC and probably what is its best sports program. I loved MotD (sorry..Match of the Day) and would in fact break of all social engagements for the programme. I think its a combination of watching football combined with great presentation and insightful analysis that drew me to the program. After about a couple of programs, I was hooked. I used to have withdrawal syndromes if I couldn't hear Lineker's voice, Hansen's sarcasm and Lawrenson's accented opinion. I did not like Shearer that much because I suspected he was trying to be impartial and inoffensive unlike the other two who were quite opinionated.

Anyway, now I have to keep up with the BPL via internet and it is definitely not fun. I hated Adrian Chiles, very annoying nasal voice and slighltly obnoxious but loved MotD 2's "Two up Two Down" . Here,football is soccer and I don't watch but play. Still, I miss MotD. I cannot remember the number of times I have hurried a pleasant dinner with the Little One to be back home before 10:30pm. I think she began to get addicted as well. The worst time was when BPL finished and suddenly my weekend evenings were empty. Thats how they are now...and I have no intention of substituting MotD with Saturday night Live!!

Friday, August 17

PLAB vs USMLE

Now that I can write about my personal experiences without fear of having to take the exam again, I shall dispense my advice freely.

For the USMLE, I used a old edition of First Aid for CS and found it to be sufficient for my purpose. I also looked at NMS review for Step 2 which is quite a good book as well. I fear that I have become a First Aid convert and am proselytizing the world (or at least those that I come in contact with).

I think you need to read all the clinical scenarios and have some idea of the differential diagnosis and investigations you are going to order for each clinical scenario. After that, I suppose you should have a practiced and orderly examination protocol. This is what I did not have, in fact the reason for my first couple of scenarios being terrible was because in my head I did not have any idea of what I was doing. It took me some time to get questions I must not forget and some order to the general physical examination.

In hindsight, primitive medical training more than 5 years old came to my rescue. After a point I was on automatic mode. I was not conscious of what I was doing, it became automatic. I had to keep reminding myself of only the things that I should not forget to do which I had not done routinely as a medical intern, things like allergy history,sexual history and social history. My thought process started happening at the spinal level, never really reaching my cortex. It reminds me of how it was when we were immunising 60 odd subjects in the FGF. After a point, you have no clue as to what you are doing or why - your hands move automatically.

I suppose that was why I was really scared about the exam, because I had not prepared for it well enough and everything I did was reflex. It might have been correct or it might have not. Unlike for my PLAB exam, for which I did a course, spent almost one month practising physical examination scenarios, memorising procedural steps and learning by rote things to say and do in certain scenarios, I did NOTHING for the USMLE exam. I spent less than a total of 10 days studying for about a couple of hours a day reading through the clinical scenarios.

The big difference between the two exams is the marking system. PLAB has consultants sitting at each station who grade you on your physical examination technique, patient interaction and generally pass or fail you. However, the scary bit with the USMLE is that you have these Standardised Patients (actors who have been taught to act or say certain things) who mark you on everything. They have a sheet with questions you should have asked in history,whether the physcial examination was complete and on patient interaction and english speaking ability. This is much more difficult because you need to be able to second guess what exists on that marking sheet of theirs. From what I understand, they have a checklist and tick boxes. Unlike PLAB, where a medical consultant who knows what is important to ask or examine the SP has no medical knowledge. Therefore, you could have asked a very relevant question which does not exist on his checklist and therefore you do not get marks for it. On the other hand, if you don't ask something trivial that does exist on his marking list, you get marked down. The same principle holds true for physical examination. So, I would argue that the PLAB exam is in a way fairer, more valid and more likely to weed out poor physicians as judged by their own superiors.

The other difference exists in the time alloted per station. PLAB has five minutes per station, while USMLE has 10 minute of examination and another 10 minutes to write a patient note. PLAB does not require you to write anything. So the examiner who is a consultant sits in your station and marks you. Its as simple as that. Of course, because of the shorter time limit, you really must be proficient in your examination. Also, the tasks assigned to you in PLAB are far more specific. examples include - perform an examination of the Left knee for this 68 year old woman, counsel the lady about meningococcal vaccination, speak to your consultant on the telephone about a case of abdominal pain that has presented to you in the ER.

USMLE have clinic based scenarios, things you are supposed to handle when you become a first year resident. The idea behind this exam is that you weed out sociopathic or pyschopathic doctors who cannot interact with a patient in a normal way. US physicians and medical schools believe this is the most important exam for any medical student during their entire career.

Most important difference between the two exams - PLAB is only for Foreign medical students, whereas the USMLE is given by every single medic who wishes to practice in the US. Therefore the emphasis as you can understand is very different for the two exams.

Anyway, my last piece of advice for step 2CS - trust yourself as a doctor and you will be fine. As long as you are a normal human being and can hold a conversation in English with another human being you will pass this exam. At least, that seems to be my experience.

I passed - Whew!

So, I passed my Step 2 CS exam. This is the exam I gave within a couple of days of landing in the US. Recap - arrive SF 25th June, move to Stern Hall 26th June, leave for LA 27th June, exam on 28th June, return to SF 28th June, set up basic necessities of life 29th June (friday), spend weekend with G,trek up Mission Point(photos for proof), 2nd August - am attending classes!

Anyway, my exam was a disaster. Its a miracle I passed. In fact I had to check my results at three times before I was absolutely sure I passed. There were lots of reasons why I did badly. I did not study enough, I was totally jetlagged and had not been able to sleep at night for the previous couple of days. The day before the exam I arrived in LA at the hotel around 3pm and promptly went off to sleep. I don't know how long I slept,missed dinner and woke up around 10pm frantic,nervous and scared. I tried to study courtesy of four cups of coffee but my heart was not in it. I just could not get myself to concentrate hard enough or motivate myself to work. So, I spent about two hours getting ready and packing my stuff up and around 6am decided to head out to get some breakfast. The closest open place other than the rather expensive hotel breakfast was McDonald's! Hmm..early morning Big Mac did not sound good preparation for an 8 hour exam, so hung around till the building coffee shop opened around 7.30.

In the meantime, I had a long conversation with the security guard. Obviously, he was used to people like me coming in every morning to write exams and asked me the usual where, why,when questions.
Recgonising that my accent was not American and was not very Indian as well, we came around to the fact that the man has spent some time working in Liverpool. He asked what I did and I replied that I worked on malaria. What ensued was truly amazing. The man was a parasitologist from Nigeria as it turned out. His mother was a physician in Nigeria and he had worked on malaria and herbal remedies for some time after his bachelor's degree in parasitology! So, we discussed plasmodium falciparum in the hour leading upto my exam. I am grateful to him for distracting me and minimising my adrenaline surge. Of course, after a 16oz cup of English Breakfast ( this takes about half hour to drink) my adrenal glands were back to full speed.

The exam itself started only about 9.30 after induction blah blah. At this point I was ready for a quick nap but my first station was a lady who had been assaulted. After taking a detailed history and making sure that I got all the places she got hurt, I panicked during my examination and forgot to examine her jaw and face where she told me she felt the most pain! I got out and while writing up my medical notes, realised I had screwed up.
Forget it, next one I told myself. The next lady was an easy case of cough or something. Now, I was told and the books had this written. Must ask sexual history - partners, active/inactive, sexuality, contraception, H/o STI. Ok, so I went ahead and ascertained that she was sexually active with a single partner. So, I now began advising this young lady (22 yo) about safe sexual practices when in a surprised voice she mentioned that her partner was a female!! I spluttered and stammered pathetically and rapidly ended the interview.
I reckoned I was 0/2 there and had only 10 left to go. The general advice is you need to pass at least on 10 of your 12 stations to pass. So, it was all or nothing now. I calmed down and obviously was fine after that.

I suppose it was my fault for being so badly prepared. I remember studying so much harder for my PLAB 2 exam, which is a similar format except you have to do CPR on a dummy and you have procedures to complete on dummies as well. I really worked hard for the PLAB exam even attending a course in London (costing me 300GBP) over Xmas. Its pretty useless now, although I never know. I might just land up in the UK again.

Wednesday, August 15

Drinking

I have spent the whole day in front of a computer screen trying to find a research idea for my masters thesis. I have several ideas and today was working on HIV and malaria interaction. Phew..hard work especially trying to be creative. I wonder how people keep thinking of new stuff to come up with.

I noticed that I have not written anything about the US, berkeley and first impressions. I kept hoping that I would find time to do it and write a day by day account, but things have gone too quickly. So, I shall now bitch and whine about random stuff and daily experiences.

So, I spent my last day hanging out in an "American pub" called the Albatross which was actually quite nice with some friends from class. Its quite a comfy pub with lots of board games which 27 year olds like me decided to indulge in. Anyway, this is not the point.
I found one of my comrades was drinking Jack Daniels and DIET COKE! I did not quite get the rationale behind this. I would like to be fit and not die of strokes, CHD and the diet coke balances for the fact that I am having whisky which might kill my liver. Of course, this overlooks the fact that the man decided to pollute whisky (even blended stuff) with a carbonated drink!

As I understand it, this is a popular drink in the US. hmmmppfff.. I shall act as whisky snob.

On a personal note, I am drinking more beer than I ever have. There are only a couple of places in berkeley which have a beer garden and you can enjoy the sun and a leisurely drink. All the places are breweries and serve a good selection of beers but never a G&T or a nip of single malt. So, I have actually had more beer in these six weeks than I have ever had in 4 years in the UK. Just goes to show you what circumstance can do. I also am beginning to enjoy it and wish I was able to spend more time with MC at the Butcher's. I might have learnt something! oh..I do miss the Butchers, purely for sentimental reasons.

Avahan Interview HIV in India

Health Affairs Blog

This is a very interesting interview of perhaps India's best funded AIDS program. Ashok Alexander was a McKinsey consultant and now has become involved in NGO work. I was quite interested in reading his views about the epidemic and prevention.

The first question about prevalence estimates of HIV is very interesting because the Indian authorities have consistently argued that the WHO estimates have been inflated and wrong. I must admit that that I did not believe the Indian figures as I never trust the Indian government, but they seem to have come out on the right side of this argument and have found that the numbers are much reduced.
As an aside, there are some seriously weird people in the world. When this preliminary report based on the national Family Household survey was made public there were some civil society interest groups who believed this was a conspiracy between pharma companies and the Indian government to allow pharma companies to patent drugs and reduce the Indian government's spending on AIDS drugs. Here is their point of view and all I can say is considering what happened to Novartis quite recently I cannot see how these intelligent, educated people can make such absurd accusations.

I digress. Returning to this interview, the other interesting observation that Mr.Alexander makes regards the apparent North-South divide regarding HIV prevalence. The southern states have much higher HIV prevalence and he attributes this to greater economic development which leads to increased migration to these states, more slums, sex workers and human mobility. I think thats an interesting argument although I would also argue that your data from the Northern states are probably not very accurate and better education in the south would probably lead to better reporting and surveillance.

He also states "I would go so far as to say India has one of the most balanced and holistic national programs. Now one the biggest challenge is to implement it at scale and with quality. That remains to be done."
The greatest stumbling block in India's public health system is size and therefore I think we are looking at a difficult task in trying to scale up the problem. Take some basic health system indicators and you will realise the problem. USA has 730,000 physicians at a density of 2.65/1000 people while India has 645,000 at a density of 0.6/1000 while China has over 1 million physicians at a density of 1.06/1000. My point is that almost 90% of our doctors are concentrated in the urban areas so in essence you are probably only getting about 1 doctor per 10,000 people in the rural area and thats a conservative estimate. So, there is almost no way you are going to be able to reach the required people simply by using the already existing health set up. It is arguable that you do nor really require physicians for behavioural interventions. I agree and would be even more worried if you look at the numbers of health workers the government has recorded. It is close to 82 for every 10,000 people. This number is almost too small to be able to control, undertake surveillance,educate and implement a health program.

I would argue the way to manage our health system is in effect to break in down into local systems. Alexander alludes to this in the interview indicating the reason why Avahan's prevention program has been so successful. He gives two reasons - community participation and a "basic common policy" which is adapted at the local level. If we are to push our prevention programs forward and scale it up to the national level, perhaps we should try and break every metropolis into smaller sections each having its own unique millieu, issues and social dynamics that need to be understood, leveraged and encompassed for the success of the program. Similarly, the same needs to be done in towns and districts.

I wonder how it is going to happen. If I were the GOI I would look at two national programs to learn my lessons. The polio eradication program which was a massive success and the national malaria eradication program which was a failure before embarking on another and I would argue even more important national health program. The strategy should encourage community participation and build a bottom-up approach.

Tuesday, August 14

Tea issues again

I spent an inordinate amount of time in the past trying to get the right tea brewing procedure and I got lots of advice.
Now LA has sent me this BBC recipe for making masala chai. This Anjum Anand lady obviously has not made a cup of tea in the hostel has she? Issues I have with this procedure:

1. She uses a tea bag!! Eeks..sin committed, I don't know whether I should go on further.
2. Then, she uses 10 pods of cardomom for one cup of tea. Is she making tea or rasam?
3. She says adding salt is optional! Have you ever in your life heard of anyone who makes tea by adding salt? what was she thinking when she wrote this?
4. It takes her 15 minutes to cook the milk for tea? My god..can you imagine boiling ginger, fennel, cardamom, cinnamon for 15 minutes - there is a chance in hell that you will ever be able to taste the tea.You probably are having masala milk or masala water.

So, I hope you will not use this recipe to make tea or else at least make sure you call it "hot jal jeera"

Sporting news

I really miss being in England right now. I remember the last time India came to England, it was 2004 August and chatting with LA who was the only person in the group who followed cricket. Of course, now we have JF who also follows cricket and tries to convince people that a five day test is really interesting. When India played Pakistan I spent my day in the lab glued to the computer refreshing cricinfo every five minutes or attached speakers and listened to commentary. During that series people thought that I was some Indian weirdo with serious nationalistic issues and hating Pakistan but during the Ashes when I unashamedly had the commentary on in the lab rooting for england (as was everyone else in the world except the Aussies), I think people realised that I was mad! Of course, after the fateful smack on the eye I quickly acquired the label of "cricket representative" of the group.

Now, I get emails from LA saying the cricket is going badly. Oh if only I could have spent the day in the lab watching cricket once again,especially this series with India winning, my life would have been perfect.
Congratulations to Dravid and co. I woke up to watch the fourth days play and I remember thinking that I would have a bat and not enforced the follow-on for the same reasons that Dravid did. I agree with Andrew Miller's piece that endorses Dravid's decision to bat again and suggests that had he lost this test and in effect the series then the same fans who are pillorying him for his "cowardly" decision would be the ones that burnt effigies of him and called for his resignation.

In all likelihood we might have won the game if Dravid enforced the follow-on, but equally there was a risk considering India's last innings shenanigans we might have contrived to lose the game and I suspect memories of chasing 123 in Barbados in 1996 must have risen in Tendulkar's mind. In the long run nobody will remember this drawn test but will definitely remember the series win, just as few people today remember the exact sequence of Kapil's 1986 series win.

My only regret is that it isn't a five match series. We now have seven meaningless one-dayers which in my opinion are worthless compared to another couple of tests. For all I could care, we should eliminate one-dayers completely from the cricket schedule and have test series like these with sporting wickets like the ones prepared for this series. I am really looking forward to the Twenty-Twenty WC and see how that takes the Indian sub-continent's imagination as that will probably decide its fate on the international sporting calendar.

Other sporting news - Woods wins again and manages to avoid a major year drought, cycling needs to revamp their entire athlete list and rugby union had some great matches over the weekend. The All Blacks have still to have a warm up match while France,Wales, Ireland,England and Scotland have all had a couple already. No betting man would like to bet against the All Blacks reaching the finals of the WC and no betting man would like to bet on them winning it given their horrendous history in the WC. C'mon NZ for once, please win!

Over

The first quarter of my Berkeley experience is over. My summer session is over and now I have a two week break before the real thing starts. I must admit that the summer session wore me down after a point. I was spending close to 7 hours at a stretch in class either in front of a computer or listening to lectures and had homework and tests to study for over the weekends.
So, I spent the weekend reading Sackett and Hopalong Cassidy novels and doing nothing else. Its been a lazy weekend but the real work begins now. I need to finish my last two chapters of my thesis, write my CK exam and prepare a research project in the next two weeks. So, the plan is to go to office everyday and work from 8 - 8.

On the other hand I hope these two days of rest have given me enough time to recharge my batteries and get ready for the big battle. I shall know by the end of the week. Not much else going on with life really. Am cooking almost everyday unless I get chinese takeaway :) Made rajma the other day and since then have not made a big meal, generally omlette, pasta or upma.

Cook, eat, sleep, surf and write..thats my life!!

Friday, August 10

The Sydney Morning Herald Blogs: Entertainment

The Sydney Morning Herald Blogs: Entertainment

This is an incredible story. I love small book shops and small publishers. They give a chance to unknown authors and I love spending time in random small niche bookstores because you can often find the most interesting stuff in them.

I am glad someone is willing to stand up and take a stand against these big monopolising book stores. I must admit I miss Blackwells and have yet to find a bookstore in Berkeley where I can sit with a coffee and spend the day either people watching or my head deep in a fascinating book. I remember finishing (almost) "the Ayrton Senna Story" and getting hooked onto the Philip Pullman Lyra Trilogy in Blackwells. I also remember studying for my PLAB exam in Blackwells every Sunday while sipping a coffee,tea and polishing off some lovely chocolate cake. I cannot imagine the day when we no longer have bookstores and amazon or internet book buying takes over, I suspect my weekends will be spent shriveled up in front of a computer instead of enjoying a refreshing cup of tea in a bookshop.

Can you imagine Bombay without Fountain pavement book sellers? or Delhi without Daryaganj? or London without Charring Cross?
Thank you Mr. Rakusin

Wednesday, August 8

50 greatest sporting insults | Football - Times Online

50 greatest sporting insults | Football - Times Online

This is not a very good collection but still fun to read. I particularly like the one about Shaq in the comments. Basketball player Shaquille O'Neal on whether he had visited the Parthenon during his visit to Greece: "I can't really remember the names of the clubs that we went to."

Cannot wait for Aug 9th and the first test to begin. Should be interesting. I dont know whether India is going to be able to shrug off the win-lose curse. I sincerely hope they do considering that I have to wake up at 3am everyday to watch the match, the least they can do is draw. Anyway, I suspect a lot of it is going to have to do with winning the toss. Do not expect the Oval pitch to be dry and crumbly, rather a green top and crumbling on day 4 and 5.

Lets hope its a good match and that Sreesanth can stop acting like an idiot and instead bowl like he did in South Africa.