The Way I see It # 17

"The world bursts at the seams
with people ready to tell you
you're not good enough. On
occasion, some may be correct.
But do not do their work for
them. Seek any job; ask anyone
out; pursue any goal. Don't
take it personally when they
say "no" - they may not be
smart enough to say "yes"."

Freedom Mix

I sit at Physician staff meetings often and constantly find myself immersed amongst new and yet familiar faces of my country each week. And without fail, each one of them have approached me on numerous occasions wanting to know who this young Indian girl is and why have we not seen her before. Whether it's food for gossip, community chitter chatter or simply keeping an eye out for prospective future proposals, something or the other always drives them to hunt me down in the crowd. Interestingly enough, I have noticed that all Indian adults have that same look of 'judgement' in their eye when they talk to you for the first time. Almost like they have a checklist spun out in their minds and are simply marking it with every question asked. You work here - yes! check. What is your name - Namita. check. What does your father do - CPA. check. What is your family name - Azad. !!#@&*^@#!!..and we have a breakdown. And in their minds: Azad? A muslim last name? Hmmm...and then the eyebrow rises and like survey style.. "If answer is Azad, skip to question 254"..they ask "So you are muslim?" Having perfected this with practice, I smile and say No, I am Hindu and from India. A sigh, and we are back on track.

So today, after many, many instances like that stated above, I will share with you the story of Azad.

Sitting under the skies of a heated saturday night of Summer,2007, with my grandparents who were visiting us from India, my dadaji took us back to the yester years of 1947 to explain the sweet tale of our uncanny last name. By degree he is a certified accountant, but by passion he is a poet who got caught in the age of freedom fighting. And just like a true poet, even the walls of the prison cell, where he was held captive for 18 months, were glorified by his words. It was during this time that he wrote a piece which till date, he holds very close to his heart. Upon gaining freedom from jail and India from the British, he very proudly went to his mentor and showed it to him. With the scent of freedom in the air, his mentor read through it and looked up and told him, "Madan, tum ajj Azad hogaye ho"...


"Eh abra, zara tham ke aa,
Woh aayen tau jaam ke aa,
Magar ase na baras ki woh aa na saken
Jab woh aayen, tau ase baras ke woh ja na saken"
- Madan Lal Azad

Is Old all Gold?

As public health practitioners, the health care system of the United States has constantly been under scrutiny in our eyes from the minute we stepped into that classroom. And it is from this that I now believe that it is one of the most complex systems of its kind and it is precisely for this reason why it has become increasingly difficult for it to navigate in the current climate of the United States.

Some of the issues arise with the health care industry being unique in the sense that its consumers, the patients, will interact so frequently with the providers and yet but gain much less in return. The technology is welcomed, but it is expensive to maintain and provide. Furthermore, the support structure is not sufficient to advance the technology; more qualified staffs, more machines, and better therapies are needed. As the health industry becomes more and more revolutionized, there are more major stakeholders in Health Care: the Public--collective and individual interest; Employers--constitute an influential group because they take on much more pro-active roles in determining cost of health care (large coalitions); and providers--professionals themselves; at the core--these are the people have the actual process of outcomes (they want to change it, but they cannot.) All of these facets have not yet addressed one of the most complex areas in health care: the aging population. By 2050, 30% of US population will be over age 65. Americans are living longer but are they living longer healthily?

An aging population results from the decline in fertility and increase in life expectancy. An increase in longevity raises the average age of the population by raising the number of years that each person is old relative to the number of years in which he is young. These two forces have in turn resulted in a large geriatric population. In fact, there are several reasons why health care providers are worried - First, sustaining their age and then prolonging it has become a huge economic strain. Second, although the quantity has increased, the quality of life decreases; more and more elderly are incapacitated or plagued by incurable diseases. Third, more Americans are waiting for a medical catastrophe by extending the natural lives of the elderly.

The economy has become increasingly strained when it comes to providing healthcare, in this case, long-term healthcare, for the elderly. According to the federal Agency for Healthcare Research and Quality, “5% of Americans averaged $11,500/year and accounted for 49 percent of all health care spending in 2002… One in four of these people was between ages 65 and 79 and one in six was 80 or older.” Government organizations like Medicare established payment plans for home health facilities and visiting nurses associations. These systems are still in place, yet they changed this long-term care financing by diverting payments to and from providers. Since then, the financing system has been in turmoil, with federal and state legislative and regulating bodies hunting for solutions to a system that is fundamentally flawed. In focus group studies, elderly adults say that they consider health care an entitlement. Medicare can fund at levels the federal and state governments cannot afford, but the quality of care and quality of life that these programs provide do not suffice for the elderly. The system needs to allow for a shift in resources from the young to the old, yet due to the increase in longevity, this shift has not yet been possible. This redistribution needs to analyze what areas in medicine require the most funds and which can survive with lesser funds. Essentially, it is a stable economy that can insure a more financially stable health care system that caters to the elderly.
The aging population has been fortunate to receive better medical treatment than previous generations. Advancements in technology, medical awareness, and a sense of healthy living have increased the length of their lives. In fact, there are better facilities like rehab, better surgical procedures, and better treatments are adapting to their needs. However, as time goes on, the elderly lose function of basic activities and become frail. Management of their health over time becomes difficult as they endure strokes, diabetes, and multiple chronic illnesses. The system is not set up to treat long-term illnesses for so many people and can work successfully in fewer situations. The system is set up to merely diagnose, treat, and cure and unfortunately, the elderly need more long-term care around the clock.

The US health care system must learn quickly how to adapt itself to the aging population. Geriatric care is not easy, but if more and more elderly are living longer and more and more Americans would rather prolong their lives, it makes it essential that the system know accommodate for them. The US government must pay more attention to this national crisis and lobby for more funding into hospitals, clinics, home health services, nursing homes, rehab centers, and any other geriatric facilities. There need to be more programs put in place to hire CNAs, Physician Assistants, technicians, physical therapists, and nurses in order to support this essential expansion. Geriatric departments across the US must bring in the best doctors and find the best technologies to provide a comfortable setting.

To better adapt to the aging population, the health care industry must continue to provide the traditional excellent care and treatment, and expand it to focus more on the geriatric population. There should be an emphasis on healthy living in the elderly, prevention of disabilities, maintenance of current health state, encouragement to be independent, and above all amelioration of the quality of life. Additionally, I strongly believe that community organizations headed by public health departments should encourage programs that monitor the state of the elderly as well as the young in the community by shifting the focus to preventative medicine. Although it is a difficult task, this transition is one of the most essential phenomena in Medicine and affects all areas of society.

Timely Healing

On a terribly warm Tuesday afternoon in July, I sat in the first few rows from the back, attending my first Church service. As I glanced around admiring the interior my eyes fell upon the bodies who were slowly filling the rows with saddened faces, some already a little teary eyed and some simply with sullen expressions, but each reliving the memory of eight months ago. The sunshine singers ended their last performance and the tape of the commencement was put in and walked in our president, the executive committee, the Chintemaneni family and then finally the Archbishop and Father Kevin of St. Francis. We were all brought together that afternoon to celebrate and commemorate the works of Dr. Krishna Neni.

I remember driving back from Madison, having spent another fun weekend with my nearest and dearest, and was on the phone with my dad when he broke one of the most unfortunate accident stories to me. A man, who had just bought a new Mercedes Benz was leaving the showroom and driving back to his home, when a truck, traveling in the opposite lane, lost one of its spare tires, unknown to the truck driver himself. The tire spun across the busy roads of highway 894 and smashed right into the Mercedes Benz and killed Dr. Krishna Neni then and there. Not only was I shaken up to bits but wanted to erase this horrible memory for everytime I have been on the highway after that.

Much to my dismay, this memory was livened again when I started work at St. Francis and found out that Dr. Krishna Neni was our former Chief of Staff and the founder of our Intensive Care Unit. And eight months later, we were dedicating our ICU to his name and the legacy he left behind. I choose to say legacy not because I had met him or observed any of his work but because of the heroic stories that where jumping out at me as looked at his nurses crying, former patients sitting with their eyes closed praying to God, fellow physicians with their heads down in remembrance and as I listened to his wife so graciously talking about their journey together. They say that your closest are a reflection of you, and that held true that afternoon as I understood the magic of Dr. Neni sitting in that church.

Interestingly enough, as I lay in these deep thoughts for the rest of the day, when I went for the private dinner with the Chintemaneni family later that evening, I experienced a different rush of emotions. I sat there with observing the family, his children, his wife, his friends and his coworkers and everyone else merrily enjoying their cocktails and I felt a little aggravated trying very hard to understand why no one was sad, or a little less happy if you will. They were all enjoying their conversations, talking about the brewer's game score from last night, discussing meetings of the next day, relaying stories of their college experiences but no one was grieving. And then it hit me.. they have all been healed with the power of time. Life has a come a full circle for each of them. Dr. Krishna had left such a strong mark in each of their lives that his laughter was what was coming from within them. They all knew that if he was present, he would hated to see them not talking about their work and life. I sat back and enjoyed the view. Time had so beautifully healed the hearts of this family which may never be complete ever again but will always stay united only because they each shared their lives with Dr. Krishna Neni.

Country roads take me home..

"I grew up in Botswana,"..."Oh! where do you like it better?".. the routine conversation starter. And after all this, I like to now say that home is where the heart is. Botswana is where I grew up, it is my home. The United States is where I found myself, it is also my home. But if someone were to ask me where my heart lies, I would smile and say that in my home, in my Madison.

Tucked away in the waves of lake mendota, this college town has so much to offer but to only he who seeks it. Lecture halls and auditoriums bombarded every 50 minutes with young blood inching closer and closer to their destiny. Small streets and city corners filled with scents from all over the world. The taste of beer and craze of college football drawing the old and young to Randall station. Strolls in the parks and zipping by water motorists. Scanner Dan, 24 library hours and toppers pizza cheese sticks. Kite runners on frozen Mendota and mosquito swarms on sticky summer evenings. The haunting stories of Science Hall and history written on each brick of the Red Gym. And this is only the beginning..

For me discovering Madison was like finding Narnia in my closet ..unknown and enchanted. I still vividly remember the weekend of my orientation, dad and I walking up and down the hilly routes in between lecture halls and dorms. Dad was reliving all his college memories in the two days that we spent there and availing every opportunity to narrate his student life stories as I tried to get my head around the magnanimous size of the campus.

And so began that unforgettable journey of the 'golden years'. I remember the first night I fell asleep to the patter of raindrops on my single bed, lying adjacent to another young heart, my room mate, in the only girls dormitory on campus. Strangely enough, that night, or any night following that for the next four years, I did not suffer from the home-sick bug but rather went to bed every night wanting to wake up and discover a little more of my world with each new day.

From crazy all nighters studying for biochemistry classes, to casual conversations by the terrace, to sledging down snow covered hills behind Liz waters, to canoeing on the lake, to India night 10 hour rehearsals and everything else one can possibly imagine under the sun, I did and had a gala time doing it! I made some of the most strongest friendships thus far, built beautiful memories with a few that I may never see again and understood that you cannot please everyone.

And so just like this, four years flew by right in front of my eyes. But even today, whenever I feel lonely, whenever I feel the need to breakdown, whenever I feel like there is nothing left to look forward to, whenever I feel the need to hold a friend's hand, whenever I want to fall back in love..I close my eyes and transport myself back to Madison and relive each and every memory harnessed there.

Thanks a Latte!

After finally settling into the new home, I was ready to jump on the wagon and start exploring all the coffee spots in the area. Having it being so close to home as well as I never been there either, Caribou Coffee it was! It may or may not be true otherwise, but we were always taught in marketing class the first impression invariably becomes the lasting impression and they weren't wrong..the image of an American family's river side log cabin 'up north', where the walls are decorated with stuffed animal heads, the couches are an army green shade, the lamp shades a dirty brown, and windows showcasing the surrounding green foliage will always stay with me. And so what better than settling into this with a warm cup of chai and your favorite novel.

As always, I am amazed at the incredible functions of the human mind and the extraordinary it finds in the ordinary.. Why I truly stepped out of the house was to make somewhat of an adventure our of this long boring weekend. Surrounded by the constant smell of cleaning detergents and indian food scents, I needed a change. I could only sit in my room so long with surfing anymore television channels, organizing my picture frames in every possible way or color coordinating my closet. So after having bickered with everyone I possibly could during the course of the day, I packed my backpack, put down my shades and was out. And even though this may only be 2 miles from home, with all my technology with me and with no money spent on gas, I did as much as I could of this weekend.

Blue (Da-Ba-Dee)

You will notice that every so often - more often than not - I keep editing and altering my blog templates. Today it is blue and white. Like the summer skies. Like the rain clouds. Like the new Starbucks coffee collection. Like the new New York & Company clothing line. Like the wallpaper of my office. Like the colors of flooded lakes and rivers of Wisconsin. Like Megha's summer skirts. Like the color of my Reynold's pen. Like the colors of my outlook mailbox. Like the colors of the ice mountain water bottle. Like the flag of Greece. Like Code Blue. Like the notepad that I scribble in. Like the feeling that lives within me - facing the waves head on!

Change is the essence of life they say. Change is the only way of life I say.