FATHER OF SURGERY

It is a pleasant morning in Pune in the year 1793 and Cowasjee, a bullock cart driver, lies on a wooden bench in deep slumber. His face is partially covered by a muslin cloth. Around him several men and women are busy, assembling surgical instruments, preparing medicinal pastes and rolling cotton bandages. In attendance are two British surgeons who are about to witness the reconstruction of nose by a novel technique described by Sushruta, and practiced in India, but unknown to the Western world.

The surgeon enters – he belongs to the Kumbhar(potter) clan but is experienced in this surgery. Cowasjee has had his nose and arm amputated by Tipu Sultan’s army during the Third Anglo Mysore war as punishment for working for the British. Four others have received the same fate, however, after a year of imprisonment they have managed to escape and seek treatment.

The muslin cloth is removed revealing the ghastly hole where the nose used to be. The surgeon takes a thin plate of wax and fits it onto the stump of the nose, molding it to shape. Then he flattens the wax and places it over Cowasjee’s forehead. Cowasjee has been given some alcoholic potions and bhang and is totally oblivious. Swiftly, using the wax as template, the surgeon outlines and removes a piece of skin from the forehead, keeping an attachment between the eyes to preserve the blood supply and twists the flap over the nasal stump, the edges of which are freshened. The flap is attached with sutures made of cotton; warm compresses are placed to staunch excess blood. Two hollow reeds are placed in each nostril and the whole area is covered with cotton and pure sesame seed paste.

This successful technique of rhinoplasty had been described by Sushruta who used a cheek flap.  The observing British surgeons, thoroughly impressed, quickly reported this in the Madras Gazette and then published the procedure in the “Gentleman’s Magazine” in London in 1794 under the title “A Singular Operation”. This became widely known as the “Indian Method” in plastic

surgery. It differed from what was practiced in the West where a flap was made from arm skin, so the arm had to be attached to the face until healing occurred. This operation was commonly and successfully performed in India where removal of nose was a gruesome form of punishment, whereas in Europe loss of nose was usually secondary to disease such as leprosy or tertiary syphilis.

 The practice of surgery in India dates back to ancient times. Sushruta, who lived and practiced in modern day Varanasi is considered the Father of Surgery and wrote a comprehensive text in Sanskrit slokas, imparting knowledge of all aspects of surgery, called the Sushruta Samhita.

Sushruta lived around 600 BC – a period considered the golden age of Indian medicine He was a disciple of King Dievodasa who belonged to the Dhanvantari gurukul, Dhanvantari being the deity of medicine. There existed a thriving guru shishya parampara where knowledge was transferred verbally and Sushruta was a keen student. However, he revolutionized surgery as it was known then by advocating dissection of cadavers, which was against the tenets of Hindu ritual where a dead body was not to be touched by knife. To circumvent, Sushruta immersed the corpses for seven days under flowing water so the decomposed skin could be brushed off instead of cut and deeper layers could be studied.

He described various surgical techniques including excisions (Chedana), incisions, (Bhedana), scraping (Lekhana), puncturing (Vedhana), probing (Eshana), extraction (Aharana), drainage (Visravana) and suturing (Sivya), along with use of cauterization, by chemicals and heat, application of leeches and anesthesia drugs.

He designed instruments -101 blunt yantras and 20 sharp shastras and identified 700 medicinal herbs. He advocated that students spend six years studying and learn surgical techniques by practicing on vegetables and soft wood before touching a live patient. He described what an ideal surgeon should be – even tempered, fearless, knowledgeable, of steady hand, compassionate, clean with short hair and nails.

Aside from rhinoplasty he described in detail ear lobe repair, removal of cataracts by a process called couching where a sharp instrument is introduced into the eye to dislodge the opacified lens into the vitreous chamber and allow light. He

explained setting of bones and fractures by traction and manipulation and use of splints, removal of bladder stones by making an incision in the perineum, removal of a dead fetus from womb. He advised on after care and prevention of infection by cleanliness and medicinal herbs.

He was the first to connect malaria to mosquitoes, plague rats and identified diabetes by the honey taste of urine.

Sushruta Samhita along with Charaka Samhita forms the foundational text of Ayurveda. His genius remained unknown until translation into Arabic in the 8^th century as “Kitab e Susrud “. Further recognition came in the early 19^th century when Hessler translated into Latin and Max Muller into German. The English translation was edited and published by Kaviraj Kunja Lal Bhishagratne in Calcutta in 1907. The oldest surviving manuscript, written on palm leaves is displayed in the Kaiser Library in Nepal datable to 875 ce.

Udita Mukhuty Jahagirdar

India’s saris evolved out of manifold physical, historical, and cultural influences differing in regions and communities, managing to survive the onslaught of colonialism and industrialization, and have remained the quintessential Indian female garment.

Domestication of the cotton plant and ability to dye it was a significant legacy of the Indus Valley civilization and cotton seeds have been found at a Neolithic site in Mehrgarh, northern Baluchistanand dyed cotton cloth has been excavated at Mohenjo-daro- dated around 2000 BC.Sari-like drapescovering the entire bodyis seen in Indian terra cotta statues from as early as 200-50 BC. Garments in a body hugging kachcha style,is seen in temple stone carvings with pleats and folds carved in minute details.The murals of Ajanta show women in wrap around fabric.In ancient times it was customary in everyday lifeto tie a piece of cloth or antariya around the waist and a separate piece of cloth or uttariyoover the head or upper torso.These fused over time to form the sari.

In Bengal,a sari of shorter length was worn without a blouse or petticoat,many may remember their grandmothers clad in this. The end of the sari,flung over the shoulder was tied in aknot, from which various keys of household would hang – denotingthe supreme control of the “Grihini” over her domain.

Jnanadanandini Devi,sister in law of Rabindranath Tagore was the first amongBengali women to defy the purdah system and travel to Bombay to live with her husband who was posted as the first Indian member of the Civil Services. She developed a new manner of combining sari with ablouse and petticoat to enable women to move out of the ‘antarmahal’. She fused the Parsi style she saw in Bombay with the Bengali style of not using pleatsand wearing the pallu over left shoulder. Puff sleeved or long- sleeved blouses like jackets showed some British influence.This style was adopted by Brahmo Samaj women. The modern style is the Navistyle of Andhra Pradesh popularized by royal patronage from various princely states and ofcourse the cinema.

Traditional Bengali sarees prevalent in Eastern India and present Bangladesh are the Jamdani, Balucheri, Tant, Kantha, Garad, Korial, Tussar and Benarasiwith many variationsspecific to the weavers or regions.

Jamdani– the name is aPersian derivative meaning a flower vase.These areglorious works of artpreviously made for royalty.These were woven on fine cotton or muslin. Making a Jamdani is a time consuming,multi- weaver endeavor, perfected by Muslimweavers in Dhaka.The fabric of fine cotton is woven with zari or thicker thread with interrupted wefts–(transverse thread in aloom) having paisley motifs,butis (hazarbuti) or smallflowers, (panna hazar)

The diaphanous Dhaka muslin is the finest of muslins. Theyhave not been made since late 18^th century following decline of Mughal empire. The transparency is described in poetic terms as abrawn or running water, shabnam or dewdrop, bafta bana– cloud. In 16th centurymuslins,considered priceless, were part of diplomatic exchanges as well as royal clothing – so fine and weightless that the yardage would pass through alady’s finger ring.

Baluchari silk saris are a cherished possession, brought into West Bengal by Nawab Murshid Kuli Khanfrom Dhaka and started in the village of Baluchar on the banks of Bhagirathi river. Due to frequent floods this was moved to Bishnupur. The Baluchari sari depicts scenes from Ramayana, Mahabharata and at times a unique pictorial history of modern inventions such as the carriage and railroad.The embroidery is usuallydone in contrast color to the main body- or with colorful threads (meenakari) or with silver zariand goldresham( swarnakari). These are regarded as heirloom pieces- recurrent award winners in trade fairs.

Tant saris are crisp cotton lightweight saris with starch incorporated in the yarn during weaving. It is said that the water,soil, and moist weather of the region impart special qualities to the silk and cotton. Tant is very suitable for daily wear,an indispensable staple and never goes out of style.

Garad and Korial are similar-undyed traditional silk, usually with a deep red borderfor the young married woman-especially during the Durga puja. Korial is pure white with red border, Garaad silk being the version for the mature woman is off white with different color borders in resham thread, consideredthe ultimate in understated charm and sophistication.

Kanthasarees are madewith intricate threadwork embroideryfrom Shantiniketan and Bolpur regions.Kantha stich was used to recycle old material into quiltswhich wereimported by the Portuguese. Kantha saris areembroideredby rural womeninspired by nature and folkloreusually on cream colored tussarsilk.

Tussarsilk woven from silkworms in the wild have a raw texture but golden sheen.Ahimsa silk is name given to silk obtained after larvae have left the silkworm cocoons.Jute silkis vegan silkprocessed from jute fibre. Other silks are Murshidabad silk, lightweight, often batik printed with beautiful drape. Murshidabad was the seat of power of Nawabs of Bengal with fertile soil conducive to growth of mulberry trees.

Benarasi brocadeespecially the red sari with Zari borderbelongs to the trousseau of every Bengali bride- Benares being the center of silk industry today-made by a team of weavers on complex jacquard looms. This art was almost obsolete but revived by modern designers.Weavers from the Julekhaor Ansari community tracing their ancestry to 990AD, showMughal influence with intertwining botanical arabesque designs in subtle colors with or without zari.

Many places such as Donegal, Shantipur, Begumpur,Phulia, Bishnupur, Tangail (Bangladesh) make eponymous saris in their own unique style. These are in the border region where displaced Hindu weavers have migrated from Bangladesh.

Bengali saris are a part of our richtextile heritage; the weaving industry was decimated during the British rule by impositionof heavy taxes and forcing weavers to sell their goods at lesser prices, banning local cottonand silkand flooding the markets with their cheapimports.Partition had the effect of displacing the workers- and even post independence the focus was on industrialization and synthetic mass made mill saris.Designers like Sabyasachi have made a concerted effort to bring the handloom into vogue.There is a realization of the need to improve the condition of the weavers who are adying breed.Introduction of prestitched saris and interesting blouse patterns and novel ways of draping the sari make it appealing to the modern fashionista.We allhope that the craft survives and the Bengali sari is not relegated to dusty museum displays.

Udita Mukhuty Jahagirdar

We have three primary sources of ancient botanical information – the Indian, Chinese and Western.The first written record of medicinal plantswas created by Sumeriansof Mesopotamia on clay tablets. TheEbersPapyrus from ancient Egypt circa 1550 BCdescribe garlic, frankincense, aloe, henna.Sushruta Samhita written in 6^th century BC mentions 700 medicinal plants, including ashwagandha, turmeric,tulsi. Plants were also referenced in the earlier Charaka Samhitaand Atharva Veda.Chinese medicine lists astragulus, gingko,liqourice, dong quai. The Mayans, Polynesians, Arab, African civilizations were also aware of therapeutic properties – knowledge unfortunately lost with passage of time.

200 years ago, all botanists or “herbalists”, as they were called, were physicians. In early Renaissance all medical schools in Europe were required to have a medicinal garden, cultivation of these being part of the curriculum.Appropriate usage of herbs has been an integral part of Ayurvedic medicine and their action on various “doshas” are described in infinite detail.

Gardening as anendeavor has its benefits on mind and body; increasing physical activity, reducing the risks of strokes and heartattacks, decreasing childhood obesity, providing exposure to Vitamin D, improving mood,combating loneliness, not to mention the edible returns. Twentypercent of VAfacilities have therapeutic horticultural program for treatmentof PTSD.Dr. Benjamin Rush, a signer of Declaration of Independence, helped found theCollege of Physicians in Philadelphia urged College Fellows to maintain a medicinal garden – his advice finally taken in 1937 with the establishment of the Benjamin Rush Medicinal Garden. Even Kama Sutra describes the ideal wife and exhorts her to maintain a “Vatika,” an indoor garden of fruits, vegetables and herbs.

The compounds found in plants are of manykinds, but the common biochemical classes are alkaloids, glycosides, polyphenols and terpines. In the 19th century, with the advent of chemical analysis, the active substance could be extracted.Commercial extraction from plantsincluding morphine began in 1826 by Merck, Synthesis of substancesfirst isolated in a plant began withsalicylic acid in 1853.

A medicinal herb garden can be a relatively easy and fulfilling enterprise. It can be created on a balcony, terrace, patio, or even indoors in aterrarium. Most medicinal herbs grew in the wild, hence once planted in healthy soil, with a modicum of attention to sunlight,temperature and water, do not need the extraordinary care of say a vegetable garden, and often do surprising well with benign neglect.

Five easy medico- culinary plants would be the Aloe plant- asucculent- the fresh gel like sap from the leaf could be directly applied to cuts and burns and at times consumed as a nutritious drink. It can be grown indoors. A close second is the Tulsi, or the holy basil plant, considered sacred, its leaves and flowers can be simmeredwith tea as a stress reliever. The plant dies off in the winter, but usually self-propagates from seeds in summer.

The fragrant and robust Curry plant acts as a carminative and digestant and isused in almost all Indian cooking along with the universal Cilantroor Coriander a delicate and decorative herb that contains certain antimicrobial properties,therefore good as a raw food accompaniment, its seeds helping to lower blood sugar according to Ayurveda.

Ginger, and the spice that has taken the world by storm -Turmeric- easy rhizomes that can be grown in pots with roots harvested year after year, turmeric showing proven anti- inflammatory properties.

Mint- peppermint, spearmint -good for nausea, nasal congestion and a tasty herb to boot, is prolific in its growth.

An ambitious gardener may venture into creating the Medicinal Wheel of Native Americans. Other medicinal plants providing visual delight would be calendula blooms, the poor man’s saffron – used to make cosmetic and anti-spasmodicformulations, vincas – from whichvincristine and vinblastine were derived, poppy, its beauty belying the relief and ravagewrought by the species, foxglove of digitalis fame.

Neem, the king of medicinal plants, every part of it being usedcommercially like the coconut palm, would be beyond the scope of the casual gardener as would be the Pacific Yew (Taxol), Podophyllum species (Etoposide),Camphotheca- (Topotecan).

Forgive me if I have not mentioned your favorite medicinal plant- they are too numerous to enumerate. In this bruising year of Covid, gardening offers hope that nature will provide us the cure for the novel corona virus; paraphrasing the words of Voltaire in his famous novel Candide- “For now, I shall seek solacein cultivating my garden”.

Vaccines are an integral part of medicine today. Each vaccine contains a small amount of the disease germ or germ particle along with ingredients that provide stability, prevent contamination of multi- dose vials by bacteria or fungi and sometimes substances to boost the immune response. Vaccines are essentially prophylactic in that they prevent or ameliorate the effects of a future infection but can be therapeutic as well, to fight a disease that has already occurred, such as cancer. Upon receiving a vaccine the immune system in the body recognizes that specific disease causing germ in the vaccine as being foreign, responds by making antibodies to that germ for the future for a finite length of time, and remembers the germ so that the immune system is able to rapidly destroy it before sickness sets in.

Naturally acquired immunity that comes from the disease itself can be at the cost of serious and at times lethal complications. Vaccines imitate that infection in a less severe form and cause the immune system to produce T- lymphocytes and antibodies. As the minor side effects such as fever, malaise, aches go away the body is left with “memory” T- lymphocytes and B- lymphocytes that will remember how to fight the disease in the future. This process takes a few weeks and one may develop the disease before protection has occurred.

There are five main types of vaccine:

1. Live attenuated such as measles mumps rubella and chickenpox /TB vaccine.
2. Inactivated vaccines such as polio vaccine.
3. Toxoid vaccine to prevent diseases caused by bacteria producing toxins such as diphtheria and tetanus.
4. Subunit vaccine that includes only the essential antigenic part of the germ such as the pertussis component.
5. Conjugate vaccines to fight bacteria that have an outer coating of polysaccharides such as those against meningitis.

Vaccines may need multiple doses or a booster dose after so many years. Some viruses like the flu virus change every season so an annual dose is required. Severe allergy to any component of vaccine is a contraindication. Pregnancy and immunosuppression are contraindications to live vaccines. There are certain precautions for each individual vaccine as well, which must be taken into consideration prior to administration. The bogey of autism secondary to childhood vaccines or their preservatives has been raised in the past, but multiple studies have shown no link and original work that raised this concern was found to be flawed.

The evolution of vaccination is fascinating. There was a concept of immunity as early as 430 B.C when the Greek historian Thucydides noted in his account of the plague that killed a third of the population of Athens, that those who recovered were resistant to future attacks of the same disease. The history of vaccination is intricately connected to smallpox epidemics. The first efforts to vaccinate were in fact variolation which was the practice of using secretions from the pustules of someone with smallpox or variola to infect a healthy individual and create a mild form of the disease. The origin of inoculation is possibly from India where itinerant Brahmins inoculated by dipping a sharp iron needle into a smallpox pustule then puncturing the skin repeatedly in a small circle or perhaps in China where variolation was practiced by nasal insufflation of powdered smallpox scabs. In Africa mothers would tie a cloth around a child’s smallpox covered arm and then transfer the cloth to a healthy child.

In the 18^th and 19^th centuries the practice made its way to England thanks to Lady Montagu the wife of the British ambassador to Turkey who had observed variolation. New England and other American colonies saw smallpox arrive with cargo ships to Boston with devastating effects. Cotton Mather, an influential minister in Boston was told of the practice of variolation by his slave Onesimus who had experienced variolation in Africa and he took the bold step of introducing this concept despite much resistance.

Variolation did not prevent the disease, it just made it milder, and in some cases, people still developed severe symptoms and died. In late 1700, Edward Jenner noted that milkmaids got cow pox on their hands, but not smallpox. He took fluid from the cowpox and scratched it into his gardener’s son’s arm, a practice now called vaccination from vacca or cow. Two months later he inoculated the boy again, now with smallpox matter and no disease developed and the vaccine was a success. Louis Pasteur’s 1885 rabies vaccine came next followed by development of antitoxins and vaccines against diphtheria, tetanus, anthrax, cholera, plague typhoid, tuberculosis, yellow fever, herpes simplex. Middle of 20^th century was an active time for the development of vaccines.  Noteworthy is the development of the injectable killed virus Salk polio vaccine and the live attenuated oral Sabin polio vaccine amidst the intense rivalry between the two teams. Recombinant DNA technology and new delivery techniques addressed noninfectious conditions such as addiction and allergies. Among the fastest vaccines ever produced was the current mumps vaccine isolated by a scientist Dr. Hilleman who was working for Merck, obtained from the throat washings of his daughter JerylLynn in 1963 with the eponymous vaccine being licensed in 1967. In recent years, the Ebola vaccine though long in development was granted Breakthrough Therapy designation and FDA worked closely with the company and completed its evaluation for safety and effectiveness in six months.

Researchers around the world are developing more than 165 vaccines, and 28 vaccines are in human trial for the novel corona virus. Work began in January 2020 with deciphering the Sars-Co V-2 genome. Phase 1- about 18 vaccines testing safety and dosage, Phase II -12 vaccines in expanded safety trials, Phase III – 6 vaccines in large scale efficacy tests and 1 vaccine has been approved for limited use. Vaccines typically take years of research and testing before reaching the clinics, but scientists all over the world are racing to provide a safe and effective vaccine by next year. Many governments including the US have bank rolled these efforts. Moderna along with NIH have launched a Phase III trial on July 27^th, 2020 on a Messenger RNA based vaccine. The final trial will enroll 30,000 healthy people at about 89 sites around US- Moderna has $1 billion in support from the US government. Operation Warp Speed is supporting a portfolio of similar vaccines so that they can meet FDA’s gold standards and reach the public without delay. University of Oxford and Jenner institute is also a front runner with U.K investing $6.5 million along with layers of private and international investors; India’s Bharat Biotech and Zydus Cadila have started Phase 1 and 2 clinical trials.  Germany, Russia and China are heavily funding their own trials. Serum Institute of India, Pune, under the chairmanship of Dr. Cyrus S. Poonawala is poised to be a big player in the manufacturing and distribution of the vaccine. It will also be a part of Phase 3 Novavax trials in India. One out of every two children in the world is vaccinated by a vaccine from the Serum Institute.

The successful companies will be runaway winners from both humanitarian and financial standpoints. Many ethical challenges regarding cost, prioritization of delivery, transparency of risk- benefit data remain. One thing is clear, there will be no resolution of the Covid-19 Crisis without the utmost harmonious and strategic cooperation of all global participants.

Udita Jahagirdar M.D., F.A. C. O. G.

The launch of a spaceship over at the coast of Central Florida is a site to behold. The anticipatory throng of humanity, the pulse quickening countdown growing into a chant, then the lift off –  a flash of fire on a bed of white cloud of smoke,  a rumble turning into a roar as the spacecraft hurtles skyward riding a plume of fire as the scaffolding tears away,  a thunderous applause with every eye straining to get a last glimpse of the fiery speck in the sky, and finally crowds dispersing with a universal murmur of obeisance to the marvels of science and human endeavor on their lips. As if this is not enough, one has the dazzling spectacle of a night launch and recent mind-boggling precision return to target landings of the reusable SpaceX booster rockets.

Commercial space travel or space tourism is now a certainty. NASA has now allowed private astronauts to go on the International Space Station with the use of Elon Musk’s Crew spacecraft and Boeing’s Starliner, priced at $ 35,000 per day. A Japanese businessman Yusaku Maezawa has paid a substantial deposit for a Moon loop flight on Space X. Virgin Galactic founder Sir Richard Branson has booked more than 600 tourists at $250,000 apiece on a 6 passenger SpaceShipTwo for a 3-4 hour sub orbital flight. There is a huge thrust to monetize space programs. Knowing AAPI members penchant for exotic travel we may well see our very own physicians in orbit soon.

With this growing realism, one may wonder about the effects of space on human body. Obviously, the impact depends on whether it is a brief space jaunt or a Mars mission. The risks are grouped into FIVE categories: Gravity Fields, Isolation/Confinement, Hostile/Closed Environment, Space Radiation and Distance from Earth. Space Medicine is a developing medical practice to discover how long people can survive extreme conditions in space and how fast they can readapt to the earth’s environment and the preventive and palliative measures to be undertaken.

The long term effects on the body were best studied by NASA’s trail blazing Twin study which compared retired astronaut Scott Kelly while he was in the International Space Station for 340 days to his identical twin brother Mark Kelly, also an astronaut, who remained back on earth. There were changes in his telomere length, gene expression, gut microbiome, body mass and vitamin levels, increased carotid artery thickening, ocular changes and cognitive functions. Overall, there was a return to preflight levels upon return to earth demonstrating the robustness and resilience of the human body.

As of now, there are no rules requiring space companies to set or meet any health criteria for accepting passengers- they just need to sign a statement that they understand the risks of such a flight and are able to pay the hefty amounts charged. Initial short duration flights will probably be a gentle low G- ride up, a few minutes of weightlessness at 100 km, an incredible view of earth, followed by a thrilling reentry and landing – perhaps only with some associated nausea and vomiting – far different from a long Mars mission.

A brief evaluation of the challenges and hazards of space travel is as follows:

Ascent and Reentry:  force or gravitational acceleration force – an untrained person can withstand 3G but may blackout at 4 to 6G because blood flows away from brain and eyes, especially with a vertical ascent and can cause loss of vision then loss of consciousness. This is mitigated by G- force training and a G- suit which constricts the body to keep more blood in the head. Most spacecrafts keep G- forces within comfortable limits.

Weightlessness has deleterious effects on muscle mass and bone density. Short term exposure causes Space Adaptation Syndrome, a self-limiting condition caused by derangement of the vestibular system and otoliths, resulting in motion sickness, lethargy, malaise, vertigo, and can reduce aerobic capacity and slow down the cardiovascular system. Without the pull of gravity, fluids distribute into upper half of body causing the round-faced puffiness, seen in astronauts, balance disorders, decreased performance, increased intracranial pressure on optic nerves, distorted vision and loss of taste and smell.  There is accelerated bone loss from normal 3% cortical bone loss every decade to 1% every month, an increased osteoclastic activity in the pelvic region with increased serum calcium levels and a potential to form kidney stones. In a weightless environment muscles atrophy rapidly and without regular exercise astronauts can lose 20% of muscle mass in 5 to 11 days The International Space Station has treadmills, stationary bikes and weight training equipment.

Isolation and Confinement cause behavioral, cognitive and psychiatric conditions with decline in mood, morale and interpersonal interaction. Loss of circadian rhythm causes sleep disorder, depression and may impact performance of a mission. Lack of fresh food may further contribute to nutritional deficiencies – morale and motivation may decrease three quarters of a way into a mission. NASA is developing LED technology to help align circadian rhythms and methods to assess performance fatigue.

Hostile/Closed environments: Microbes can change characteristics in space and microorganisms can be easily transferred from person to person. Illnesses like Epstein Barr may be reactivated as stress hormones are elevated and immune system is altered

Space Radiation: On the space station which sits just within earth’s magnetic field astronauts still receive over 10 times the radiation occurring on earth where we are protected by earth’s magnetic fields and atmosphere. There is lowered immunity from damage to lymphocytes experienced by astronauts and a higher incidence of cataracts. Cosmic rays may accelerate the onset of Alzheimer’s while solar flares may give a lethal dose of radiation in minutes.  A vehicle travelling to Mars would need significant yet undetermined shielding.

Distance from earth: The moon is 0.239 million miles away, while Mars is 140 million miles away. Imagine the challenges of communication, equipment failure and skills needed to endure.

As humans, we are poised to take this giant leap into the unknown. How far are we going to succeed? – only time will tell.

This is Dr. Udita Jahagirdar. I have started this Blog exclusively for my patients, peers and friends. It is my way of sharing my experiences and contributing to the society. I love to read and write and this blog on our website will definitely help me keep all my writing in one place and share them with you all.

I hope you all like my Blog and visit it often to check for updates.

Regards

Dr. Udita Jahagirdar

So here we were, a gaggle of bright eyed medical students doing our first day orientation at Seth G.S. Medical School, Bombay, all of us wannabe doctors strutting around, secretly convinced that making into medical school was half the battle.

I do not remember who was it that had the bright idea to take us to observe surgery on our first day. They probably did not quite know what to do with us, after the introductory tour and talk, so here we were being led up the narrow staircase, past the howling laboratory canines in the animal house, to the observation gallery overlooking the operating room of none other than Dr. P. K. Sen the stalwart of cardio vascular surgery who went on to perform the first heart transplant in India.

I remember the thrill and excitement of gazing down through the glass panes and seeing what we thought was the beating heart of the patient on the OR table. I recollect someone in the OR at the head of the table, probably the anesthesiologist, surveying the mass of young heads hovering overhead, gesturing to Dr. Sen who moved over slightly allowing us a better view. Before our rapturous young eyes the drama of surgery unfolded and we were instantaneous converts to this specialty.

Wide eyed with wonder we watched on and then we heard a crash and then some commotion within our ranks. A strapping young would-be doctor had fainted at the sight of blood and now there was a red stream spurting from his scalp where he had hit the edge of the bench. Someone rushed in and led him away. There was almost more heme on the floor next to us than in the OR below.

That was how our “vie en rose” started; with all the blood loss that we witnessed it was more like “la vie en rouge”. But after all these years, and in the midst of all our present medical travails, I often think of that first day and feel that shiver of excitement run down my spine as we watched that operation by Dr. Sen, and thereby reaffirm my faith in my chosen career.

Well versed in the hazards of altitude sickness, the dreaded “soroche” as it is called in Bolivia, we had taken the necessary precautions.  Coming from the sea level of Orlando Florida, we had acclimatized over a few days. Use of Diamox was a little controversial and though three of us took the medicine ahead of time, the fourth member of our party was somewhat reluctant since he was already on a diuretic for hypertension, We had fortified ourselves with quarts of the ubiquitous coca tea and faithfully avoided alcoholic beverages.

We were after all a group of four physicians, with more than 25 years of medical practice under our belts. What could possibly go wrong?

Traveling through the pristine, cobalt blue waters of Lake Titicaca, in the company of flying fish and soaring condors we arrived at the shores of Sun Island. We were met by an excited bunch of teenage locals who quickly grabbed our suitcases and proceeded along the steep Inca steps. Our route would be a three to four mile hike over a hilly ridge offering us majestic views of the lake and the towering snow clad Andes, to our hotel, the Posada del Incas. The terrain was moderately rough, at an altitude of about 13000 feet. We were met by a local guide with a mule that was to take one of the members of our party who had slightly sprained her ankle. Another person accompanying us was a small wizened person with an ageless weather lined Inca face, his barrel chest reflecting the compensatory lung capacity of the dwellers of this high altitude. He carried a flask of coca tea and much to our reassurance a small tank of oxygen in a satchel. .

So we set out at moderate pace. The mule trotted off and soon our friend became a small speck in the distance,

Halfway up the hill, our friend who had avoided Diamox, started feeling nauseous and complained of a headache. We slowed down our pace while he took several swigs of coca tea and we tried to admire the view. Few more paces and he complained of faintness and shortness of breath. His face had taken on a grayish hue.  Slightly alarmed but trying not to appear over concerned we nonchalantly felt his pulse.We tried to phone the hotel on our cell phones but there was no reception. The mule had disappeared into the horizon.

Suddenly our friend threw up. The little man began gesticulating towards his first aid bag. Of course, we had a portable oxygen canister! Why did we not think of it before? What a relief! He came over and attached a facemask to a clear tubing.  With infinite care he wiped the mask with an alcohol swab. Then with a flourish he attached it to the oxygen tank and with a practiced twist of his wrist opened the oxygen valve and carefully placed the mask over our friend’s face.  A minute passed and we waited with bated breath for our friend to respond. But what was this? Our friend tore off the mask, coughed and glared at the man, sputtering in rage. The oxygen tank was EMPTY. We four doctors with a combined 100 years of experience, veterans of travel into third world countries, had failed to do an elementary check of our equipment. Our guide was furious and roundly berated the attendant.

Somehow our friend got up and staggered the rest of the way, which wais now thankfully downhill and reached the hotel A tank of oxygen awaited him and after a half hour inhalation of the life sustaining gas he emerged as good as new.

Over dinner we rued the fact that we could never get too complacent or let our guard down. “Time out” pause whether in the operating room or in the realm of adventure remains of critical importance.

Rest of the trip passed without any untoward happening. The spirit of Viracocha smiled once again.

Living in Florida you are surrounded by water and you hear “diver yarns”everywhere.  People go diving in the coral reefsoffsouth Florida, they go diving and lobster fishing during season in the Keys; some go diving for sunken treasure hoping to find another“ Atocha” a la Mel Fisher; resorts offer weekend diving courses.In Central Florida, where I live, cave diving in the many natural springs that dot this region is very popular.

So Ravi and I signed up with a diving school in a nearby strip mall. The dive master sized us up. “You will do just fine” he proclaimed. I mentally gauged the pros and cons – the pros were that one had to be a competent swimmer not necessarily an excellent one. I had no medical contraindications, I did not have to travel far to train and I already had a buddy in Ravi who would be learning with me. The cons were that I was certainly no athlete and did tend to get muscle cramps in cold water. Ravi was more sanguine about his abilities- had he not represented his college in junior swimming some thirty years back?

The didactic portion of the diving lessons took us back to first year physiology. We were reminded that the air we breathe is 20.9% oxygen and 78% nitrogen; that air could be compressed in the scuba tanks, as air becomes denser it does not flow easily, the deeper you dive the greater is the resistance to this flow. Air at 80 degrees is “warm” but water at 80 degrees will cause you to grow chilled from loss of body heat as heat is conducted away by contact of the body with water at a rate 20 times greater than air. We were thoroughly coached on the effects of pressure while diving. At sea level we are under 1 atmosphere of air pressure, at a depth of 33 feet in the ocean we are under 2 atm of pressure at 66 feet under 3atm of pressure- this affects the airspace in our ears and lungs and sinuses. We learnt about buoyancy and need to use weights to the wet suits to sink and how to achieve neutral buoyancy to float.Most of all we were cautioned about effects of rapid ascent and the dreaded “bends”.

Then we were assisted in purchasing our gear- wet suits, masks fins, goggles, gloves,snorkel. Mastering the use of these would ensure survival in this foreign environment. After a few practice dives in a swimming pool we headed off to the Deleon Springs Park for our training sessions. Again we familiarized ourselves with the scuba tank, the gauges, the regulators, the timing devices. Safety routines in this potentially hazardous sport areparamount and the “buddy system” where you dive in twos looking out for each other is considered mandatory.

After weeks of training we passed our tests and received our NAUI diver’s certificate needed for independent diving.  Agog with excitement we headed off to try our diving skills. What better place than the Hol Chan Marine Reserve off the coast of Belize- second largest coral reef next to the Great Barrier Reef, teaming with fish, coral and marine animals- well known for its “Shark Alley” and to consummate divers for the challenge of the deep “Blue Hole.”

A short flight in a 6 sitter plane took us from Belize City to Ambergis Caye. Within few minutes of checking into our sea side cottage we were in the dive shop signing up for what would be our maiden dive in the open ocean. The first available slot was a night dive- something we had never done before. We did not want to wait for the next day and sales person lured us further with the promise of seeing phosphorescent fish at night.

So come night fall we made our way to the jetty. We were greeted by a weathered old salt who was to be our dive master. Given his age he certainly appeared experienced. But wait, who was this young lad barely twelve? – Hewas the “assistant” and would follow us from the rear we are told. I felt a wave of concern rising. This was our first dive, I informed our dive master- “Don’t worry- we will not feed you to the sharks” hereplied in heavily accented English.

The rest of the group joined us. They certainly seemed to be an experienced bunch – given their designer wet suits (yes, there is such athing) underwater photographic equipment, knives strapped to their pants and general confident chatter of past dives and fish citings. The boat sped away into the darkness and now it was the dive master‘s turn to outline the dive plan.

In twenty five minutes we would be reaching the dive site where the boat would be anchored. We were to flip backwards in pairs from either side of the boat then reunite with our buddy. One of us would be given a flash light. There would be a bit of acurrent against us and we would be swimming down the channel in between the reef where we would identify the various fish and photograph them if we pleased. The dive would go past an underwater rock mass and then turn back to head towards the boat. I looked at the ocean now glimmering with phosphorescent fish like moon beams come to life, and fear gripped at my throat. Was I really up to this? In any case, there was no turning back. Our turn came up and Ravi and I tumbled backwards into the water like the rest. My mask and snorkel went flying off my face upon impact with the water however I retrieved them as practiced. Atleast I could breathe now. The challenge now was to identify Ravi. He hadlost his flashlight when he hit water and was scrambling to get it back. In the general darkness all I saw was a mass of finned thrashing legs but which ones were Ravi’s? The group headed in the dive masters direction and I followed for dear life without my “buddy”. Clammy with fear I was still able to appreciate schools of fish as they darted past. Someone pointed to a large creature lying still at the bottom- it was a shark. No time to appreciate the fish, just follow the group and stay alive, I told myself. I was lagging behind as my endurance flagged and suddenly the group went passed a large boulder and then-vanished.

I was all by myself in the midst of the ocean. Try to stay calm I told myself,do not give in to the primordial desire to rip off everything and surface. Surely, they would find me missing. Then vaguely in the distance I saw aglimmer of flashlight. It was adifferent group of divers but there was hope. IfI managed to join them they would surely rescue me.

I started swimming towards them abandoning hopes of finding my own group,and then I felt a tug at my collar. It was the young diver assistant. My group had noticed my absence and he had come to find me. Holding me by the arm he turned me in the right direction. All fear vanished with my little savior by my side; I was beginning to appreciate fish anew. The dive master met us soon. One look at my gauge and he signed I was to surface and turn back to the boat. Fear had made me hyperventilate and I had lost all air in my tank.

The young assistant and I surfaced and we swam back to the boat holding on to each other in tandem. On the boat I checked my gauge. It was at zero. Few minutes later Ravi clambered on board. He had been the next one to run out of air. The rest of the gang now returned. They were thrilled with their dive; I was thrilled to be alive. Later on they were stunned to know that we had selected a night dive as our maiden attempt.

The following morning with renewed courage we dove to a ship wreck, petted nurse sharks on the way and resisted the impulse to touch a darting moray eelin the crevices of the wreck. The dive master held ablowfish which transformed itself into alittle balloon in alarm. Rays swam around us with lobsters and sea turtles crawling on the floor.

The third dive was near perfect. At 70 feet I could still see the warm rays of sunshine penetrating through the ocean surface. Colorful parrot and angel fish dancedand pirouetted some almost touching our masks. Swimming in the warm limpid sea water felt like being enveloped in amniotic fluid in one’s mother’s womb. Dainty sea weeds caressed us, with coral of all shape and color glittering in the background. The feeling of peace,tranquility and repose was unfathomable.

Soon it was time to surface. We headed into the interior jungles of Belize the next day for more adventures. But that is a story for another day……

Imagine a journey across an exotic far-flung land the size of Italy, which also happens to be the number one tourist destination in India. Imagine two busload full of family and friends, traveling together, bound in joyous camaraderie, sharing personal and professional information, exchanging ideas, interspersed with merry making, song and  “sher-o-shairi” deliveries and serious medical talks. Imagine stopping at a wayside truck stop on a foggy wintry morning and having sweet hot chai in earthenware cups, eating a myriad of local delicacies, staying in hotel palaces considered among the best in the world. Imagine waking to the song of the koyal, coming across a flock of peacocks majestically crossing the road, seeing fortresses rise in the horizon, resonating with tales of chivalry and martyrdom, vast sand dunes, rustic mandana decoration on the huts, elaborately decorated camels, little alleys filled with shops selling handicraft and bejeweled clothes, rubbing shoulders with old royalty and the new powers that be and above all basking in the warm local hospitality of courteous soft-spoken people with an underlying steely resolve and can-do spirit, culminating  in the unique Indo-US Healthcare conference presenting cutting edge medical know how for mutual benefit.

Such was the stuff of the recent 4^th Annual Indo-US Healthcare Summit preceded by a tour of Rajasthan over Jodhpur, Jaisalmer, Merta, Pushkar, Ajmer and Jaipur.

Journey stated in Jodhpur with shared tales of woe, of flight disruptions in the wintry weather, lost luggage, planes rerouted, none of which seemed to deter the general excitement and anticipation. Started with a quick transfer from the airport to the Taj Hari  Palace Hotel  where we met with our traveling companions . Late evening we were able to sneak a taxi ride to some local shops selling exquisite jewelry in some surprising modern and traditional styles, shrunken bandhej sarees and mojri shoes.