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Archive for August, 2017

 The importance of caste!

11 Aug, 17 | by jbanning

Dr Sagarika Kamath
Assistant Professor
Manipal University, India

As young doctors being trained in hospital and health administration, we had a class in Organisational behaviour where the professor began saying that caste was a very important factor in any organisation. It was important for the caste to be right, the professor pontificated. If attention wasn’t paid to caste, then no matter how good the organisation was, it wouldn’t last. Organisations that didn’t pay any attention to caste became uncompetitive. Caste was all important. Several of my classmates couldn’t believe their ears. We were in an educational institution that prided itself on its principles of equality, equity, social justice and welfare of the underprivileged. Casteism was anathema. This was among India’s foremost institutes of social sciences. Exactly half the class came from underprivileged backgrounds or from castes that had been classified by the government for, among other purposes, affirmative action, as historically disadvantaged. There was an air of disbelief at what was happening. How could someone say that the caste had to be right?

Healthcare was caste intensive, he continued. Maybe it wasn’t apparent now, but we only had to start working and we would realise the importance of caste. Top management is always concerned about caste. Your bosses will be concerned about caste. In no time, you will also become attuned to the all pervasive importance of caste! One of the students could take this no longer. Sir!, his hand shot up, I do not agree with you. How can you say these things about caste?! The professor seemed perplexed. If the caste is high, he continued, can the common man afford healthcare?

Afford? Caste? It then slowly dawned on us that what the professor with the Tamilian (Tamil Nadu is a state in southern India) accent meant was “Cost”, but his accent made it “Caste” to our non-Tamil ears. With this realisation came relieved laughter. The tension vanished. Caste didn’t matter, thankfully.

Competing interest statement : We declare that we have no competing interests.

Contributorship statement : Both the authors have conceptualised, drafted and proof – read the contribution.

A collection of thoughts from Colorado Springs to mind

8 Aug, 17 | by jbanning

Philip D Welsby
Retired Consultant in Infectious Diseases,
University Teaching Fellow, University of Edinburgh

Two events of medical interest occurred during a recent visit to the Rocky Mountains and Colorado Springs. I developed gout in my left little toe within one week of arrival in Denver, the “mile high” city (5,280 feet) above sea level. Denver is technically a semi desert, having only 15.8 inches of rain a year, and has the third lowest humidity of all American cities. I had had an exactly similar attack of gout when I had previously visited the Rocky Mountains. Almost certainly the gout was precipitated by unappreciated dehydration, with water loss via increased ventilation (related to relative hypoxaemia at altitude and increased sweating). Why the little toe? I had severely dislocated this during a judo related incident as a medical student.

My 12-year-old grandson, who lives in Illinois (583 feet above sea level), developed central cramping abdominal pain a few days after arrival, later localising to the right iliac fossa. There was tenderness, rebound tenderness, and a positive psoas stretch test. He was however afebrile and, although having marked discomfort, was not systemically unwell. His urine was dark but not cloudy. Appendicitis was obviously a possibility. I thought, correctly, that he ought to be seen by a proper doctor who, to my slight embarrassment, diagnosed constipation (although my grandson had never had constipation before), and this was supported by a predominantly right sided loaded colon on X-ray. Apparently doctors practicing locally at high altitude see more severe forms of constipation, again because of unappreciated dehydration.

The learning point from these two episodes is that altitude-related dehydration can be more significant than superficial assessment might suggest, can cause significant problem, and local “high-altitude doctors” see a different spectrum of dehydration in recently arrived visitors than do “sea-level” doctors.

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